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April 2008 Briefing - Critical Care

Here are what the editors at HealthDay consider to be the most important developments in Critical Care for April 2008. This roundup includes the latest research news from journal articles, as well as the FDA approvals and regulatory changes that are the most likely to affect clinical practice.

FDA Clears Coronary Plaque Imaging Device

TUESDAY, April 29 (HealthDay News) -- The U.S. Food and Drug Administration announced Tuesday that it has cleared for marketing a device that physicians can use during cardiac angiography to assess the fat content of atherosclerotic plaques on coronary arteries.

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Blood Substitutes May Raise Risk of Heart Attack, Death

TUESDAY, April 29 (HealthDay News) -- Using hemoglobin-based blood substitutes increases the risk of death by 30 percent and the risk of myocardial infarction by 2.7 times, according to a report published online April 28 in the Journal of the American Medical Association.

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Physicians Lack Feedback on Accuracy of Diagnoses

TUESDAY, April 29 (HealthDay News) -- Clinical diagnosis is a largely open-loop system in which there is no systematic way for clinicians to obtain feedback on the outcome of their diagnoses, according to an article published in a supplement to the May issue of The American Journal of Medicine.

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Palliative Care Can Improve Patient Care Most, Poll Finds

MONDAY, April 28 (HealthDay News) -- In an international poll conducted by BMJ to determine which area of health care would enable doctors to make the greatest difference to patients, palliative care for non-malignant disease received the most votes, the BMJ Group announced at the International Forum on Quality and Safety in Health Care in Paris this week.

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FDA Approves Drug for Opioid-Induced Constipation

FRIDAY, April 25 (HealthDay News) -- The U.S. Food & Drug Administration (FDA) announced this week that it has approved Relistor (methylnaltrexone bromide) to help restore bowel function in patients with late-stage, advanced illness requiring chronic opioids for pain control.

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Heparin Contaminant Activates Contact System

THURSDAY, April 24 (HealthDay News) -- The serious allergic-type reactions recently reported in patients receiving intravenous heparin appear to be due to the presence of a contaminant, oversulfated chondroitin sulfate (OSCS), which leads to activation of the contact system and release of vasoactive mediators, according to an article first published online April 23 in the New England Journal of Medicine.

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Health Care Workers Affected By Staph Infections

WEDNESDAY, April 16 (HealthDay News) -- While only 5 percent of health care workers become colonized with methicillin-resistant Staphylococcus aureus infection, they are more frequently vectors of the disease, according to a review published in the May issue of The Lancet Infectious Diseases.

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Number of Surgeons Decreases 26 Percent in 25 Years

MONDAY, April 21 (HealthDay News) -- From 1981 to 2005 there was a 25.91 percent drop in the number of surgeons in the United States, according to a study published in the April issue of the Archives of Surgery.

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Heart Bypass Surgery Getting Safer Despite Drop in Cases

MONDAY, April 21 (HealthDay News) -- The number of coronary artery bypass grafting (CABG) surgeries being performed is declining, but mortality rates from the procedure continue to improve, particularly in hospitals with lower procedural volume, according to an article published in Archives of Surgery in April.

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Mouse Model Sheds Light on Scleroderma Lung Damage

MONDAY, April 21 (HealthDay News) -- Transforming growth factor Β may play a key role in determining fibrosis after epithelial lung injury, and lung fibroblasts may regulate the response of alveolar epithelial cells (AECs) to injury, offering insight into factors underlying scleroderma-associated pulmonary fibrosis (SSc-PF), according to research in the April Arthritis & Rheumatism.

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Cesarean is Independent Risk Factor for Postpartum Stroke

MONDAY, April 21 (HealthDay News) -- Women who undergo cesarean delivery have a higher risk of postpartum stroke than those who deliver vaginally, according to research published in the April issue of the American Journal of Obstetrics & Gynecology.

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Elderly on Antipsychotics Face Higher Pneumonia Risk

MONDAY, April 21 (HealthDay News) -- The use of antipsychotic medications is associated with an increased risk of pneumonia in elderly patients, particularly shortly after they begin treatment, according to research published in the April Journal of the American Geriatrics Society.

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Palliative Care and Legal Euthanasia Can Coexist

MONDAY, April 21 (HealthDay News) -- Although palliative care and legal euthanasia are usually perceived as antagonistic camps, this need not be the case, and euthanasia can be linked to the development of palliative care, according to an article published in the April 19 issue of BMJ.

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Treatment Regimen Benefits Colorectal Cancer Patients

FRIDAY, April 18 (HealthDay News) -- Oxaliplatin-based chemotherapy combined with bevacizumab significantly improves progression-free survival in patients with metastatic colorectal cancer, according to two studies published in the April 20 issue of the Journal of Clinical Oncology.

Abstract - Saltz
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Abstract - Cassidy
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Two Methods Equal for Pulmonary Embolism Exclusion

FRIDAY, April 18 (HealthDay News) -- In patients with suspected pulmonary embolism, D-dimer measurement and multislice computed tomography (MSCT) is as effective as D-dimer measurement, venous compression ultrasonography of the leg and MSCT for exclusion of pulmonary embolism, researchers report in the April 19 issue of The Lancet.

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Road Transport Pollution Linked to Excess Deaths

WEDNESDAY, April 16 (HealthDay News) -- High levels of air pollution caused by road transport are associated with increased rates of death from cancer and other diseases, particularly pneumonia, according to study findings published in the May issue of the Journal of Epidemiology and Community Health.

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Suicide Leading Cause of Violent Deaths

TUESDAY, April 15 (HealthDay News) -- More than half of all violent deaths in the United States are caused by suicide, with higher rates among males than females, according to a report published in the April 11 issue of the U.S. Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

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Gene Linked to Ethanol-Induced Liver Damage

FRIDAY, April 11 (HealthDay News) -- Deleting a gene involved in protecting cells against xenobiotic and oxidative stress leads to liver damage and death in mice fed an ethanol diet, researchers report in the April issue of Gastroenterology.

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Individualized Health Care Budgets Improve Care

FRIDAY, April 11 (HealthDay News) -- The U.K.'s National Health Service (NHS) should allow patients individual control of their health care budgets, an approach that has been shown in pilot studies to improve outcomes and patient satisfaction in a cost-effective manner, according to an analysis published April 12 in BMJ.

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Survey Examines Spine Surgery Complication in Japan

FRIDAY, April 11 (HealthDay News) -- In Japan, the incidence of vertebral artery injury during cervical spine surgery is similar to or slightly less than that reported in the literature. In many cases, this potentially catastrophic complication can be successfully managed with tamponade, according to a report published in the April issue of Spine.

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Cardiac Rehabilitation Referral Does Not Boost Enrollment

FRIDAY, April 11 (HealthDay News) -- Use of the American Heart Association's Get With The Guidelines-based clinical pathway at one medical center resulted in a significantly higher referral rate to cardiac rehabilitation after acute myocardial infarction than has been previously reported. But only about one in three referred patients enrolled in a rehabilitation program, and minority patients were especially unlikely to enroll, according to a report published in the April 15 issue of the American Journal of Cardiology.

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Consider Health Literacy Level When Writing for Patients

THURSDAY, April 10 (HealthDay News) -- Giving patients clearly written educational materials that convey key messages without resorting to jargon is an important part of engaging patient compliance with treatment and can contribute to health literacy, according to an article published in the April issue of Chest.

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Doctors Vote on the Ways to Make Biggest Difference

WEDNESDAY, April 9 (HealthDay News) -- The BMJ has begun accepting votes on which areas of health care allow doctors to make the biggest difference to patient care, with a shortlist of six areas each being championed by eminent doctors and researchers. The winning topic will gain special coverage in the BMJ and the BMJ Group's 24 other specialist journals and online education products.

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Possible Person-to-Person Transmission of Bird Flu

WEDNESDAY, April 9 (HealthDay News) -- Person-to-person transmission of bird flu may have taken place between a father and son in China in late 2007, according to a study published online April 8 in The Lancet.

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Factors Affecting Respiratory Distress Risk Identified

TUESDAY, April 8 (HealthDay News) -- A number of factors increase the risk of acute respiratory distress syndrome (ARDS) in patients on mechanical ventilation, including high airway pressures, positive fluid balance, plasma transfusion, sepsis and tidal volume, according to research published in the April issue of the journal Chest.

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Blood Pressure Lowering in Hemorrhagic Stroke Studied

TUESDAY, April 8 (HealthDay News) -- Early intensive blood pressure-lowering therapy in patients with acute intracerebral hemorrhage appears safe and may decrease hematoma size, but more research is needed to see if this strategy improves outcomes, according to research published online April 7 in The Lancet Neurology.

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Kidney Function Predicts Risk of Cardiac Arrest in Women

TUESDAY, April 8 (HealthDay News) -- Impaired kidney function is an independent predictor of sudden cardiac death among women with heart disease, according to research published online April 7 in Hypertension.

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Model Predicts Survival Factors in Gallbladder Cancer

MONDAY, April 7 (HealthDay News) -- A model based on patient and tumor characteristics can predict the value of adjuvant radiotherapy for overall survival in patients with gallbladder cancer, according to a report released online March 31 in advance of publication in the May issue of the Journal of Clinical Oncology.

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Symptoms of Unexplained Dyspnea Identified

MONDAY, April 7 (HealthDay News) -- Symptoms that can be used to discriminate between patients with medically unexplained dyspnea and patients with cardiopulmonary diseases have been identified, researchers report in the April issue of the journal Chest.

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Over 90,000 U.S. Infants Non-Fatally Mistreated Annually

MONDAY, April 7 (HealthDay News) -- From October 2005 through September 2006, approximately 905,000 U.S. children, nearly 20 percent of whom were younger than 1 year of age, were victims of maltreatment, according to a report published in the April 4 issue of the U.S. Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

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Some Increased Cancer Survival Due to Cure Rate

MONDAY, April 7 (HealthDay News) -- Treatment advances have increased the life expectancy of late-stage colorectal and testicular cancer patients mostly by increasing the percentage cured, while the increase in life expectancy for ovarian cancer patients is primarily due to longer survival of uncured patients, according to study findings published online April 7 in Cancer.

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Cytokine Facilitates Breast Cancer Metastasis to Lung

MONDAY, April 7 (HealthDay News) -- Breast cancer metastasis to the lung is dependent on the induction of a cytokine that increases the permeability of lung capillaries and facilitates the passage of tumor cells, researchers report in the April 4 issue of Cell.

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The Lancet Launches Two New Global Partnerships

FRIDAY, April 4 (HealthDay News) -- The Lancet has entered into two new partnerships that will address issues of global health and global warming, according to two commentaries published in the April 5 issue of The Lancet.

Full Text (subscription or payment may be required) - Horton
Full Text (subscription or payment may be required) - Costello

Allopurinol Does Not Halt Procedure-Related Pancreatitis

FRIDAY, April 4 (HealthDay News) -- Pre-procedure treatment with allopurinol does not appear to reduce the risk of pancreatitis caused by endoscopic retrograde cholangiopancreatography (ERCP) but may be of benefit in patients at highest risk of the complication, according to research published in Clinical Gastroenterology and Hepatology in April.

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Provider Input Affects Post-Mastectomy Reconstruction

FRIDAY, April 4 (HealthDay News) -- Disparities in rates of breast reconstruction following mastectomy for breast cancer may in part depend on whether physicians discussed breast reconstruction with their patients, according to an article published in the April issue of the Journal of the American College of Surgeons.

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Controversy Highlights Need for Funding Disclosure

THURSDAY, April 3 (HealthDay News) -- An editorial published April 2 in the New England Journal of Medicine disclosed that a previously published study reporting a favorable prognosis among individuals with stage I lung cancers detected by screening had received a large amount of funding from a foundation with links to the cigarette industry, highlighting the necessity of full disclosure of funding sources of biomedical research.

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Adding Clopidogrel to Aspirin Reduces Cardiac Risk

WEDNESDAY, April 2 (HealthDay News) -- Treatment with aspirin plus clopidogrel reduces the risk of major cardiovascular events in high-risk patients but has no effect on mortality compared with aspirin alone, although the risk of major bleeding is much higher with combination treatment, according to the results of a study published in the April 1 issue of the American Journal of Cardiology.

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Assay Helps Diagnose Multidrug-Resistant Tuberculosis

WEDNESDAY, April 2 (HealthDay News) -- New diagnostic methods are effective for more quickly diagnosing multidrug-resistant tuberculosis and for distinguishing Mycobacterium avium-complex pulmonary disease (MAC-PD) from pulmonary tuberculosis, according to two studies in the April 1 issue of the American Journal of Respiratory and Critical Care Medicine.

Abstract - Barnard
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Abstract - Kitada
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CDC: Atlas Shows Geographic Variation in U.S. Strokes

TUESDAY, April 1 (HealthDay News) -- Among Medicare beneficiaries, blacks and individuals residing in certain parts of the southeastern United States are those most likely to be hospitalized for stroke, according to a report released March 28 by the U.S. Centers for Disease Control and Prevention in collaboration with the Centers for Medicare and Medicaid Services.

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Physician's Briefing