Pets Cause Many ER Visits For Owners Due to Accidental Falls

From Cleveland Clinic YouTube channel: Accidental falls are the leading cause of non fatal injuries in the United States according to the American Association of Neurological Surgeons, and a new study finds more than 86,000 of those falls are caused by cats and dogs.

Antibiotics prescribed during 21% of pediatric ambulatory visits; 50% were broad-spectrum

Antibiotics are commonly prescribed for children with conditions for which they provide no benefit, including viral respiratory infections.

The researchers used the National Ambulatory and National Hospital Ambulatory Medical Care surveys from 2006 to 2008, which are representative of ambulatory care visits in the United States.

Antibiotics were prescribed during 21% of pediatric ambulatory visits; 50% were broad-spectrum, most commonly macrolides. Respiratory conditions accounted for >70% of visits in which antibiotics were prescribed.

The authors concluded that broad-spectrum antibiotic prescribing in ambulatory pediatrics is extremely common and frequently inappropriate.

Cough is one of the common reasons for unnecessary antibiotic prescription. As you can see from the diagram below, the differential diagnosis of chronic cough is broad and includes asthma and other conditions in which antibiotics are ineffective:



Differential diagnosis of cough, a simple mnemonic is GREAT BAD CAT TOM. Click here to enlarge the image: (GERD (reflux), Laryngopharyngeal Reflux (LPR), Rhinitis (both allergic and non-allergic) with post-nasal drip (upper airway cough syndrome), Embolism, e.g. PE in adults, Asthma, TB (tuberculosis), Bronchitis, pneumonia, pertussis, Aspiration, e.g foreign body in children, Drugs, e.g. ACE inhibitor, CF in children, Cardiogenic, e.g. mitral stenosis in adults, Achalasia in adults, Thyroid enlargement, e.g. goiter, "Thoughts" (psychogenic), Other causes, Malignancy, e.g. lung cancer in adults).

References:

Antibiotic Prescribing in Ambulatory Pediatrics in the United States. Adam L. Hersh, MD, PhDa, Daniel J. Shapiro, BAb, Andrew T. Pavia, MDa, Samir S. Shah, MD, MSCE. Pediatrics Vol. 128 No. 6 December 1, 2011, pp. 1053 -1061, (doi: 10.1542/peds.2011-1337).

Image source: Wikipedia, GNU Free Documentation License.

Are doctors ready for virtual visits? Telemedicine may not be accurate enough

Are Doctors Ready for Virtual Visits? Many fear telemedicine will jeopardize the doctor-patient bond. NYT http://bit.ly/7c2RA8

Telemedicine has a place for second opinion when initiated by a physician but primary assessment is more problematic. One successful example of telemedicine is Cleveland Clinic's second opinion service for physicians abroad. For reference, please see our blog post from a few years ago: Cleveland Clinic Offers a Second Opinion Online for $565 http://bit.ly/4NQyer

The accuracy of teledermatology was inferior to real-life clinic dermatology for melanoma diagnosis http://bit.ly/8A4oiu.



CNN Video: Doctor will see you now -- on Webcam. Telemedicine takes a new turn. Now you can see the doctor while you shop, as CNN's Elizabeth Cohen reports.

Related:

Melanoma - JAMA Patient Page illustrates the ABCDE of diagnosis, 2011.
Skin cancer in the USA - follow Australia's successful "Slip Slop Slap Seek Slide" campaign - The Lancet, 2011.
Telemedicine boosting dermatology care: improved outcomes, with better diagnosis and disease management. AMA News, 2012.