The edition · Family Medicine
Ear pain without missing the dangerous cause, and the discharge letters that slip
A practical approach to otalgia and its red flags, a primary-care safety gap when discharge summaries are processed, plus lower reactogenicity with a protein COVID vaccine and sharper community carotid screening.
The edition in brief
Today's family medicine edition leads with a practical review of ear pain, separating primary causes (otitis media and externa, eustachian dysfunction) from referred secondary causes (dental, temporomandibular and cervical), and the red flags, persistent, severe or unilateral symptoms, that should prompt further assessment. A randomised comparison finds the protein-based Novavax COVID vaccine caused less day-1 reactogenicity than Pfizer-BioNTech (systemic events 62.1% vs 75.7%), useful for counselling hesitant patients, with most events mild and resolving by a week. An Annals of Family Medicine study shows AI-enhanced handheld ultrasound improved community carotid plaque detection (94.8% vs 87.6%) and stenosis grading, pointing to lower-cost stroke-prevention screening. A clinic pearl covers structured safety-netting. The edition closes on a UK primary-care record review showing that one in five requested actions from hospital discharge summaries went uncompleted, with harm in 4.4% and a 90-day readmission rate of 17.5%, disproportionately affecting people with dementia, a prompt to tighten how practices process discharge information.
Ear pain: a systematic approach that catches the serious causes
In ear pain, examine beyond the ear and treat persistent, severe or unilateral pain, especially with a normal ear, as a red flag rather than re-treating.
A protein COVID vaccine caused fewer early reactions than an mRNA one
For patients hesitant about mRNA vaccine side effects, offer the protein-based option as a better-tolerated alternative, noting effectiveness was not compared.
AI-assisted handheld ultrasound sharpened community carotid screening
Watch AI-enhanced handheld ultrasound as a way to extend community carotid screening, while noting it is validated against ultrasound, not stroke outcomes.
Safety-net every uncertain diagnosis, and write it down
Give a specific, time-bound, documented safety-net for every uncertain diagnosis.
One in five discharge-summary actions went undone in general practice
Audit and tighten how your practice processes hospital discharge summaries, with safeguards for patients who have dementia.
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