CHA Family Medicine Residency

Tufts family medicine residents have "the best of both worlds"


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Referrals to Malden Family Medicine Sports Medicine Clinic

What to do prior to Sports Medicine referral

  1. Work up patient as appropriate with comfort level (labs, imaging etc)
  2. Include previous work up/history (imaging, past providers seen, studies, etc.) in your note
  3. Include chronic pain/medication history
  4. Formulate question you want me to answer

Appropriate referral
Young athlete low back pain
MSK/Sports injury
Injections
Fracture care and casting
Concussion management
Female Athlete issues (disordered eating, pregnancy and exercise, etc)
Exercise Induced Bronchospasm
Athlete with heart issues or risk factors
Exercise Prescription and counseling on Exercise is Medicine
Clearance of Athlete with history of MSK injuries after initial Sports Physical with PCP

Do not refer for
Epidurals
Back pain/Neck pain
Chronic pain
Fibromyalgia
Pain that is not related to joint or muscle
Sciatica
First evaluation after car accident 

Please feel free to curbside Dr Jess Knapp for opinion or help in clinic

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Number Needed to Treat in Severe Sepsis and Septic Shock to Save a Life = 4.

"7 out of 10" graphic

~3 of 10 people in the ICU are “non-survivors” of severe sepsis and septic shock. What can we do to maximize their chances?

Teaching Pearl: In severe sepsis and septic shock, only 7 out of 10 survive.  the NNT for antibiotics (in general is 4.)  There is good evidence to consider broadening coverage if: there are risk factors of surgery or prior antibiotic use.

The prevalence-adjusted pathogen-specific number needed to treat (PNNT) with appropriate antimicrobial therapy to prevent one patient death was lowest for MDR bacteria (multidrug-resistant bacteria) (PNNT = 20) followed by Candida species (PNNT = 34), methicillin-resistant Staphylococcus aureus (PNNT = 38), Pseudomonas aeruginosa (PNNT = 38), Escherichia coli (PNNT = 40), and methicillin-susceptible S. aureus (PNNT = 47).

Conclusions: Our results support the importance of appropriate antimicrobial treatment as a determinant of outcome in patients with severe sepsis and septic shock. Our analyses suggest that improved targeting of empiric antimicrobials for multidrug-resistant bacteria, Candida species, methicillin-resistant S. aureus, and P. aeruginosa would have the greatest impact in reducing mortality from inappropriate antimicrobial treatment in patients with severe sepsis and septic shock.

They note a few other risk factors identifies by multivariate logistic regression analysis as: resistance to cefepime, resistance to meropenem, and presence of multidrug resistance, but these are less useful clinically since they can only be determined post-hoc.