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August 2014 Briefing - Critical Care

Here are what the editors at HealthDay consider to be the most important developments in Critical Care for August 2014. 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.

Report Highlights Progress, Challenges in Health IT

FRIDAY, Aug. 29, 2014 (HealthDay News) -- Progress has been made toward widespread adoption of electronic health records (EHRs), although there are still barriers to adoption of advanced use of EHRs, according to a report published by the Robert Wood Johnson Foundation.

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Worse Outcomes for Weekend Admission for Pediatric Leukemia

FRIDAY, Aug. 29, 2014 (HealthDay News) -- Children with newly diagnosed leukemia with an index admission on the weekend have an increased length of stay and risk for respiratory failure, according to a study published online Aug. 25 in JAMA Pediatrics.

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Factors ID'd for Late Hospice Admission for Cancer Patients

FRIDAY, Aug. 29, 2014 (HealthDay News) -- For patients with cancer, factors associated with late admission to hospice have been identified, according to a study published online Aug. 25 in the Journal of Clinical Oncology.

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AMGA: Physician Turnover Still High in 2013

THURSDAY, Aug. 28, 2014 (HealthDay News) -- For the second year running, physician turnover remains at the highest rate since 2005, according to a report published by the American Medical Group Association (AMGA).

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Ebola Outbreak Could Infect 20,000 People, U.N. Says

THURSDAY, Aug. 28, 2014 (HealthDay News) -- The deadly Ebola outbreak hitting four West African nations could eventually infect more than 20,000 people, the World Health Organization announced Thursday.

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Health Care Protective Gear Lacking in Ebola Outbreak

WEDNESDAY, Aug. 27, 2014 (HealthDay News) -- Health care workers in poor nations often do not have enough protective gear to keep them safe from being infected with blood-borne viruses such as Ebola and HIV, according to a study published online Aug. 8 in Tropical Medicine & International Health.

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CDC Director: Ebola has 'Upper Hand' in Outbreak

TUESDAY, Aug. 26, 2014 (HealthDay News) -- While officials and health experts have the means to prevent Ebola from spreading, the deadly virus currently has the "upper hand" in an outbreak that has killed more than 1,400 people in West Africa, according to the director of the U.S. Centers for Disease Control and Prevention.

Health Highlights: Aug. 26, 2014

Hospitals Should Follow CDC Recommendations for Ebola Care

TUESDAY, Aug. 26, 2014 (HealthDay News) -- Hospital and health care providers should follow the U.S. Centers for Disease Control and Prevention's recommendations for care of patients with Ebola, according to an ideas and opinions piece published online Aug. 21 in the Annals of Internal Medicine.

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Restrictive, Non-Solicitation Covenants Are Valid

MONDAY, Aug. 25, 2014 (HealthDay News) -- Restrictive and non-solicitation covenants are valid and can be enforced, according to an article published Aug. 5 in Medical Economics.

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Many Americans Harbor Unfounded Fears About Ebola

FRIDAY, Aug. 22, 2014 (HealthDay News) -- Many Americans know little about how Ebola is transmitted and harbor unfounded fears about the possibility of an outbreak in the United States, a new survey shows. About four in 10 adults said they are worried that there will be a major Ebola outbreak in the United States, and one-quarter are concerned that they or an immediate family member will get sick with the deadly virus in the next year, according to the latest Harvard School of Public Health poll.

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U.S. to Tighten Access to Certain Narcotic Painkillers

FRIDAY, Aug. 22, 2014 (HealthDay News) -- The U.S. Drug Enforcement Administration (DEA) is going ahead with tough new controls on painkillers containing hydrocodone, which has been tied to a surge in dangerous addictions across the United States.

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Futile Care Linked to Delays in Care for Other Patients

FRIDAY, Aug. 22, 2014 (HealthDay News) -- Futile care, which is used to prolong life without achieving a meaningful benefit for the patient, can cause delays in care for other patients waiting to be admitted to the intensive care unit (ICU), according to a study published in the September issue of Critical Care Medicine.

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U.S. Health Care Workers With Ebola Released From Hospital

THURSDAY, Aug. 21, 2014 (HealthDay News) -- The two American health care workers infected with the deadly Ebola virus while doing missionary medical work in West Africa have been released from the Atlanta hospital where they have been slowly recovering for several weeks, officials said Thursday.

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Organized Processes Help Practices Hire Well

WEDNESDAY, Aug. 20, 2014 (HealthDay News) -- A defined process is necessary to help physicians hire the right staff for their practice, according to an article published July 24 in Medical Economics.

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Fluid Restrictions May Cut Post-Op Complications

TUESDAY, Aug. 19, 2014 (HealthDay News) -- For patients undergoing pancreaticoduodenectomy (PD), fluid restrictions with 3 percent hypertonic saline can significantly cut complication rates, according to a study published in the September issue of the Annals of Surgery.

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Commentary Focuses on 2014 Ebola Outbreak in West Africa

TUESDAY, Aug. 19, 2014 (HealthDay News) -- The Ebola epidemic is spreading in West Africa, with little hope for treatment, and an experimental therapy is unlikely to be provided to African patients, according to two commentaries published online Aug. 19 in the Annals of Internal Medicine.

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Boxed Warnings Are Common in Novel Therapeutics

TUESDAY, Aug. 19, 2014 (HealthDay News) -- Boxed warnings are common on recent drug approvals, and many occur years after approval, according to a research letter published online Aug. 15 in JAMA Internal Medicine.

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Liberia Ebola Clinic Attack Could Harm Efforts to Control Outbreak

MONDAY, Aug. 18, 2014 (HealthDay News) -- An attack on an Ebola quarantine center in Liberia's capital and the possible disappearance of a number of patients could be a major setback in efforts to contain and halt the outbreak of the deadly disease.

Health Highlights: Aug. 18, 2014

WHO: Scope of Ebola Outbreak May Be 'Vastly Underestimated'

FRIDAY, Aug. 15, 2014 (HealthDay News) -- The magnitude of the Ebola outbreak in West Africa may be far greater than the current statistics indicate, officials from the World Health Organization said Friday.

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FDA Warns of Fake Ebola Treatments on the Internet

FRIDAY, Aug. 15, 2014 (HealthDay News) -- As the death toll in the West Africa Ebola outbreak passes 1,000, the U.S. Food and Drug Administration is warning against products sold online that claim to treat the deadly disease or prevent infection.

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Research Offers Clues to How Ebola Disarms Immune System

WEDNESDAY, Aug. 13, 2014 (HealthDay News) -- Researchers say they've discovered how the deadly Ebola virus disables the immune system. They hope the findings will prove valuable in efforts to find treatments for the disease taking hundreds of lives in Africa. The current Ebola outbreak in West Africa has killed more than 1,000 people, and the death rate among those infected with the virus is up to 90 percent, according to the World Health Organization.

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Extra Time Spent Counseling, Coordinating Care Billable

WEDNESDAY, Aug. 13, 2014 (HealthDay News) -- Extra time spent counseling patients and coordinating care can be billed using evaluation and management (E/M) and prolonged service codes, according to an article published July 24 in Medical Economics.

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Meta-Analysis Strategy Impacts Estimation of Tx Outcome

TUESDAY, Aug. 12, 2014 (HealthDay News) -- Estimation of treatment outcome varies with the meta-analysis strategy, according to a study published in the Aug. 13 issue of the Journal of the American Medical Association.

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WHO Experts Give Nod to Using Untested Ebola Drugs

TUESDAY, Aug. 12, 2014 (HealthDay News) -- A panel of ethicists specially appointed by the World Health Organization says it is ethical to give untested treatments to people battling Ebola in the current outbreak.

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Digoxin Ups Death Risk in Newly Diagnosed A-Fib Patients

TUESDAY, Aug. 12, 2014 (HealthDay News) -- Among patients with newly diagnosed atrial fibrillation (AF), the use of digoxin is associated with increased risk of death, according to research published in the Aug. 19 issue of the Journal of the American College of Cardiology.

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Hand Hygiene Plus Glove Use Cuts Preemie Infections

TUESDAY, Aug. 12, 2014 (HealthDay News) -- Nonsterile glove use after hand hygiene is associated with a reduction in gram-positive bloodstream infections and possible central line-associated bloodstream infections among preterm infants in the neonatal intensive care unit, according to a study published online Aug. 11 in JAMA Pediatrics.

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Ethicists Weigh Questions Over Early Release of Ebola Drugs

MONDAY, Aug. 11, 2014 (HealthDay News) -- As the number of dead in the West African Ebola outbreak nears 1,000, many people are calling for the wider production and release of untested medicines that might help patients.

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EHR Adoption Increasing, But Stage 2 Criteria Often Not Met

MONDAY, Aug. 11, 2014 (HealthDay News) -- Most U.S. hospitals and office-based physicians have adopted electronic health records (EHR), according to two studies published in the August issue of Health Affairs.

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Guidelines Updated for Contrast Agent Use in Clinical Echoes

MONDAY, Aug. 11, 2014 (HealthDay News) -- Initiatives have been developed to improve the appropriate use of contrast media in echocardiography. The guidelines were published in the August issue of the Journal of the American Society of Echocardiography.

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Intervention Cuts Catheter-Related Pediatric UTIs

MONDAY, Aug. 11, 2014 (HealthDay News) -- Enactment of a quality improvement prevention bundle at a tertiary care children's hospital significantly reduced the rate of catheter-associated urinary tract infections (CAUTIs), according to research published online Aug. 11 in Pediatrics.

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Neighborhood's Socioeconomic Status Tied to Readmissions

MONDAY, Aug. 11, 2014 (HealthDay News) -- Neighborhood socioeconomic status (SES) is linked to six-month, all-cause readmission among patients with heart failure, even after adjustment for patient-level factors, according to a study published online July 29 in Circulation: Cardiovascular Quality and Outcomes.

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Emergency Department Closures Up Inpatient Mortality Nearby

MONDAY, Aug. 11, 2014 (HealthDay News) -- Emergency department closures are associated with increased mortality for admissions that occur nearby, according to research published in the August issue of Health Affairs.

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Issues to Consider With Integration of Telemedicine

FRIDAY, Aug. 8, 2014 (HealthDay News) -- Integrating telemedicine raises various considerations, including operational and legal issues, according to an article published July 24 in Medical Economics.

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CDC Raises Ebola Outbreak Response to Highest Alert

FRIDAY, Aug. 8, 2014 (HealthDay News) -- The U.S. Centers for Disease Control and Prevention on Wednesday raised the level of its response to the West African Ebola outbreak to its highest alert status, and CDC is offering resources for clinicians on Ebola virus disease management.

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FAQ: Management of Patients With EVD in U.S. Hospitals

VA Health Care Reform Bill Signed Into Law

THURSDAY, Aug. 7, 2014 (HealthDay News) -- A bill signed into law Thursday by President Barack Obama is meant to provide veterans with easier access to government-paid health care.

Health Highlights: Aug. 7, 2014

Statins May Improve Wound Healing

THURSDAY, Aug. 7, 2014 (HealthDay News) -- Statin therapy can improve wound healing, according to a review published in the August issue of the Annals of Thoracic Surgery.

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Fears of U.S. Ebola Outbreak Unwarranted, Experts Say

WEDNESDAY, Aug. 6, 2014 (HealthDay News) -- The decision to bring two American aid workers infected with Ebola back to the United States has kicked up controversy, causing some to fear a local outbreak of the virus. But experts in infectious disease say there's close to no chance that this will cause an Ebola outbreak on these shores.

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Mortality Up With CKD in PCI Contrast-Induced Nephropathy

WEDNESDAY, Aug. 6, 2014 (HealthDay News) -- Contrast-induced nephropathy (CIN) is associated with long-term mortality in patients with, but not those without, chronic kidney disease (CKD), according to a study published in the Aug. 1 issue of The American Journal of Cardiology.

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Review: Earlier Alteplase Benefits Acute Ischemic Stroke More

WEDNESDAY, Aug. 6, 2014 (HealthDay News) -- Alteplase delivered within 4.5 hours of acute ischemic stroke onset is associated with increased odds of a good stroke outcome irrespective of age or stroke severity and despite an increased risk of fatal intracranial hemorrhage, with earlier treatment associated with bigger proportional benefits, according to a review published online Aug. 6 in The Lancet.

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No Benefit From Immune-Enhanced Enteral Nutrition

WEDNESDAY, Aug. 6, 2014 (HealthDay News) -- Use of high-protein enteral nutrition enriched with immune-modulating nutrients (IMHP) does not reduce the incidence of infectious complications among mechanically ventilated, critically ill patients compared to standard high-protein enteral nutrition (HP), according to a study published in the Aug. 6 issue of the Journal of the American Medical Association.

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Experimental Serum May Have Been Key to Ebola Recovery

TUESDAY, Aug. 5, 2014 (HealthDay News) -- An experimental serum never before tried in people may have been pivotal in helping treat two Americans stricken with Ebola, according to media reports.

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Influenza-Like Illness Carries High Pediatric Risk

TUESDAY, Aug. 5, 2014 (HealthDay News) -- More than one in three children presenting to the emergency department with influenza-like illness develop severe complications, according to a study published online Aug. 4 in Pediatrics.

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Many Physicians Have Secondary Income

MONDAY, Aug. 4, 2014 (HealthDay News) -- Many physicians report earning income from sources other than their primary practice/employer, according to an article published July 24 in Medical Economics.

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New Onset, Post-Op Atrial Fibrillation Ups Mortality

MONDAY, Aug. 4, 2014 (HealthDay News) -- New onset postoperative atrial fibrillation (POAF) is associated with worse patient outcomes, including increased risk-adjusted mortality, according to a study published in the August issue of The Annals of Thoracic Surgery.

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Review: Ketamine Does Not Adversely Affect Outcomes

MONDAY, Aug. 4, 2014 (HealthDay News) -- For intubated patients, ketamine is unlikely to adversely affect patient outcomes compared with other intravenous sedatives, according to a review published online July 22 in the Annals of Emergency Medicine.

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Interventions Avert Contrast-Induced Acute Kidney Injury

MONDAY, Aug. 4, 2014 (HealthDay News) -- A quality improvement program helps prevent contrast-induced acute kidney injury (CI-AKI) in patients undergoing percutaneous coronary intervention, according to research published online July 29 in Circulation: Cardiovascular Quality and Outcomes.

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CT Effective in Detection of Significant Cervical Spine Injury

MONDAY, Aug. 4, 2014 (HealthDay News) -- Computed tomography (CT) is effective in detecting clinically significant cervical spine (CS) injuries in patients with neurologic deficit or CS pain, according to a study published online July 30 in JAMA Surgery.

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Guidelines Issued for Cardiac Management of Noncardiac Sx

FRIDAY, Aug. 1, 2014 (HealthDay News) -- Recommendations have been developed for perioperative cardiovascular management of patients undergoing noncardiac surgery. These revised guidelines were published online Aug. 1 in the Journal of the American College of Cardiology.

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Off-Hour Arrival at Hospital Impacts Heart Attack Outcomes

FRIDAY, Aug. 1, 2014 (HealthDay News) -- Time of presentation to the hospital may influence treatment and mortality for patients with myocardial infarction, according to research published online July 29 in Circulation: Cardiovascular Quality and Outcomes.

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