Category Archives: MLP-research

Who should we be offering pharmacological Thrombo-prophylaxis to following below knee lower limb immobilisation?

Author: Dr Matthew Reay
Type: MLP-research
Date: June 2022
Abstract:
Lower limb immobilisation increases the risk of Venous Thrombo-Embolism (VTE). The aim of this medical literature project is to firstly examine the risk factors most associated with an increased risk of VTE and the accuracy of risk stratification scores in predicting who will benefit from thrombo-prophylaxis. There are a number of risk stratifications scores available, all with varying accuracy. The TRiP (cast score) shows the most promise with 2 prospective trials (CASTING and TILLIRI) currently running, with results yet to be published.
The ideal risk stratification score, will have low rates of both under (sensitivity) and over treatment (specificity).

Diverticulitis: the role of antibiotics in urgent care

Author: Dr Eleri Clissold
Type: MLP-research
Date: April 2022
Abstract:
Our understanding of this common and painful disease is evolving. What was thought to be a predominantly infective process is postulated to be inflammatory and self-limiting in the majority of cases. Over several decades multiple high quality studies have emerged questioning the role of antibiotics in the management of acute diverticulitis without perforation, sepsis or other complications. No study has demonstrated the superiority of any antibiotic strategy in any one of multiple outcomes assessed. This literature search seeks to examine the evidence in-depth and place it in context for urgent care practitioners.

Building Bridges for DVT Diagnosis: Rivaroxaban versus Enoxaparin Guideline Review and Discussion

Author: Dr Gary Mitchell
Type: MLP-research
Date: December 2021
Abstract:
Rivaroxaban is well established as a treatment for deep vein thrombosis and pulmonary embolism, but there has been hesitation in using it as a bridging agent in clinical situations where DVT is suspected but not yet confirmed by definitive ultrasound scan. The evidence for the safety and efficacy of this approach is explored. During this time of research, the use of rivaroxaban began to gain acceptance and usage in New Zealand, leading to a brief analysis of factors involved in trying to introduce up to date guidelines into a small health organisation in New Zealand prior to widespread acceptance and definitive guidelines at District Health Board level.

Cannabinoid Hyperemesis Syndrome

Author: Dr Sandy Crofts
Type: MLP-research
Date: December 2021
Abstract:
Cannabinoid Hyperemesis Syndrome (CHS) is a syndrome of intractable vomiting with severe abdominal pain that is associated with chronic marijuana use. Classically, symptoms are relieved by hot showers and are often unresponsive to traditional acute interventions such as antiemetics.
Patients commonly undergo multiple investigations without diagnosis.  Complete resolution of symptoms occurs with abstinence from cannabis. The following Medical Literature Project gives an overview of Cannabinoid Hyperemesis Syndrome and review of current management.

Is Adenosine safe for conversion of SVT in Urgent Care settings?

Author: Dr Imran Zia
Type: MLP-research
Date: December 2021
Abstract: A literature review was carried out to assess the safety of Adenosine in Urgent Care (UC) setting for the termination of Paroxysmal Supraventricular tachycardia (PSVT). Thorough literature evaluation advocates the use of adenosine for the acute termination of PSVT in Urgent care settings, especially in rural and remote practices. It has the potential to improve patient management and satisfaction along with a reduction in cost, ED load, and associated hospitalization.

Treatment of Base of the Fifth Metatarsal Fractures in Urgent Care

Author: Dr Olu De Rozario
Type: MLP-research
Date:November 2020
Abstract: This retrospective audit was aimed at determining the best treatment modality for
proximal (zone one) fifth metatarsal fractures in an urgent care setting. The analysis was
not able to show a statistically significant advantage between treatment groups (weight
bearing moon boot/non weight bearing moonboot/non weight bearing below knee cast) in
fracture healing at six weeks post injury.

Management of dog bite wounds in the Urgent Care clinic

Author: Dr Lize Upton
Type: MLP-research
Date: 10 November 2020
Abstract:
Injuries sustained from dog bites are often seen in Urgent Care. This review looks at relevant studies and the current management guidelines for these injuries in relation to wound closure and the use of prophylactic antibiotics.