Consider this tool to reduce antibiotic-associated adverse events in patients with sepsis

For patients hospitalized with sepsis, consider procalcitonin (PCT)-guided early discontinuation of antibiotic therapy for fewer infection-associated adverse events (AEs).Timothy Mott, MD, FAAFP; Zachary Orme, DO, (South Baldwin Regional Medical Center Family, Medicine Residency Program)Includes bibliographical reference

Introduction to Clinical Inquiries : new series by the Family Physicians Inquiries Network

"Commentary"Introduction to Clinical Inquiries and FPIN. The Clinical Inquiries were included in Canadian Family Physician beginning March 2020.Timothy Mott, MD; Richard Guthmann, MD, MPHDr Mott is Executive Editor and Vice President of Publications and Dr Guthmann is Editor-in-Chief for Clinical Inquiries, both for the Family Physicians Inquiries Network in Columbia, Mo

What is the best approach to a solitary pulmonary nodule identified by chest x-ray?

Your initial risk assessment should include the patient's smoking history, advancing age, cancer history, and chest radiography features (strength of recommendation [SOR]: A, based on a validated clinical decision rule). You'll also need to review old chest radiographs (SOR: C, based on expert opinion). A solitary pulmonary nodule unchanged for >2 years on chest radiograph or containing benign central calcifi cations requires no further work-up (SOR: B, based on historical cohort studies)

Is methylphenidate useful for treating adolescents with ADHD?

Methylphenidate (Ritalin) is effective in the shortterm treatment of attention deficit/hyperactivity disorder (ADHD) (strength of recommendation [SOR]: A, multiple randomized control trials). Though the immediate-release preparation is the best studied of methylphenidate formulations, extended-release methylphenidate (Concerta) has similar benefits, with a dosing regimen that may better suit an adolescent lifestyle (SOR: B, based on extrapolation of 1 randomized controlled trial and expert opinion)

“Is Bay Area Regional Planner fun?” an analysis of game design in the face of urban planning

Master of Regional and Community PlanningDepartment of Landscape Architecture/Regional and Community PlanningLaBarbara J. WigfallPlay is an integral part of learning. Games address the human need to play, but with a structure of underlying mechanics designers can use them to create much more. Detailed simulations, abstract stories, and compelling drama are only the tip of what designers can create within games. Most importantly, games can use their rules to create dynamic experiences that respond to their player’s mistakes and successes in ways that other media cannot. This point is particularly compelling when considering how viable they are as a teaching tool. The Urban Planning field is constantly seeking new and creative ways to engage with community stakeholders and to solicit feedback, share information, and create lasting relationships. Games naturally fill these roles in childhood development, and continue into our adult lives, so we are left asking, “why shouldn’t we try using games to engage with stakeholders?” Because it’s hard. The ways in which games are used in community outreach must be as carefully designed as the games we play and communities we live in. We look to games that boldly dive into community outreach . Bay Area Regional Planner is a game that does so, being designed for a local community workshop in San Francisco. In order to understand the ways we can use games in the planning process, we must study Bay Area Regional Planner for both its successes and its failings. We pose the research question, “is Bay Area Regional Planner fun?” As I study the way the game unfolds, and unravel the workings of the designer’s intent, I ask not just if the game is fun but why and how. Ultimately, the answers both surprise and inspire us to see what could come next – and how the result could prove valuable to the Urban Planning field

A "no-biopsy" approach to diagnosing celiac disease

Deputy Editor: Katherine Hale, PharmD, BCPS (Kadlec Regional Medical Center)This noninvasive alternative to the diagnostic gold standard may cut risk and expense for adult patients.Timothy Mott, MD; Carrie Gray, DO; Jon Storey, MD (South Baldwin Regional Medical Center Family Medicine Residency Program). Deputy Editor: Katherine Hale, PharmD, BCPS (Kadlec Regional Medical Center)Includes bibliographical reference

Which interventions can increase breastfeeding duration?

Q: Which interventions can increase breastfeeding duration? Evidence-based answer: Breastfeeding support, beyond standard care, from lay people or professionals increases both short- and long-term breastfeeding duration (strength of recommendation: B, meta-analyses of randomized controlled trials [RCTs] with demonstrated heterogeneity)

Brachial Artery Pseudoaneurysm Secondary to a Sessile Osteochondroma in an Avid Teenage Basketball Player

PURPOSE: Osteochondromas (OCE) are typically characterized as benign cartilaginous neoplasms occurring as either solitary lesions or as part of multiple hereditary exostosis (MHE). In some instances, they may cause pain due to irritation of nearby musculoskeletal structures such as ligaments, tendons, nerves and vessels. Growth of these lesions is often slow and mimics skeletal growth. Rapid change in the size of an OCE warrants investigation due to concern for malignant transformation. Presented here is the case of a 17 year old male who noted rapid ongoing growth in a humeral osteochondroma secondary to development of a brachial artery pseudoaneurysm. METHODS: 17 year old male avid basketball player presents with history of MHE who is status post resection of OCE lesions about his knee. He reported a one year history of significant and progressive growth of a lesion in his right medial upper arm associated with mechanical pain (especially during basketball), night pain and occasional numbness. Physical exam revealed a large, firm and relatively immobile non-pulsatile mass just distal to the axilla without adjacent adenopathy. CT scan revealed a 10 cm mass with subjacent cortical irregularity concerning for a mass/sarcoma with hemorrhage versus pseudoaneurysm. MRI was most suggestive of a pseudoaneurysm with displacement of the neurovascular structures. MRA and CT angiogram confirmed the suspected pseudoaneurysm. He subsequently underwent successful resection and repair of the pseudoaneurysm in addition to resection of the offending exostosis by Orthopaedic oncology. His recovery to date has been unremarkable. DISCUSSION: Vascular complications associated with OCE are rare, with around 100 reported in the literature. The most common location for vascular findings is typically the popliteal artery, likely secondary to the knee being a common location for OCE’s, frequent trauma to the area and the relative tethering of this artery about the knee. The humerus is decidedly an uncommon location despite the shoulder’s large range of motion. Conclusion: Rapid or ongoing enlarging OCE’s require prompt medical attention and work up. Whereas sarcomatous degeneration needs to always be considered, other etiologies such as pseudoaneurysms need to be included in the differential diagnosis. Presented is a case report of the rare complication of an OCE leading to a brachial artery pseudo-aneurysm in the upper extremity. Recognition of this potential diagnosis aided in appropriate imaging without disastrous open or needle biopsy and an ultimate successful outcome.https://scholarlycommons.henryford.com/merf2019caserpt/1067/thumbnail.jp

Confidently rule out CAP in the outpatient setting

Confidently rule out CAP in the outpatient setting. A focus on specific signs and symptoms -- without imaging -- may rule out community-acquired pneumonia in outpatients. PRACTICE CHANGER: You can safely rule out community-acquired pneumonia (CAP) -- without requiring a chest x-ray -- in an otherwise healthy adult outpatient who has an acute cough, a normal pulmonary exam, and normal vital signs using this simple clinical decision rule (CDR). STRENGTH OF RECOMMENDATION: A: Based on a systematic review of prospective case-control studies and randomized controlled trials in the outpatient setting.Timothy Mott, MD; David Echeverri, MD; Luke Fondren, DO; Ashley Hunter, MD (South Baldwin Regional Medical Center Family Medicine Residency, Foley, AL)Includes bibliographical reference