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February 2010 Briefing - Critical Care

Here are what the editors at HealthDay consider to be the most important developments in Critical Care for February 2010. 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.

Score May Help Determine Death Risk in Heart Failure

FRIDAY, Feb. 26 (HealthDay News) -- A risk score that includes patient information available at discharge can identify the risk of mortality in individuals hospitalized with advanced decompensated heart failure, according to research published in the March 2 issue of the Journal of the American College of Cardiology.

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Awareness of Heart Disease Risk Still Lacking in Women

WEDNESDAY, Feb. 10 (HealthDay News) -- Despite some gains in public awareness, almost half of all American women are unaware that heart disease is the leading cause of death in women, according to research published online Feb. 10 in Circulation: Cardiovascular Quality and Outcomes.

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Critical Illness Linked to Decline in Cognitive Function in Elderly

TUESDAY, Feb. 23 (HealthDay News) -- Elderly adults who are hospitalized for an acute or critical illness are more likely to experience cognitive decline, and the risk of developing dementia is significantly higher after hospitalization for a non-critical illness, according to research published in the Feb. 24 issue of the Journal of the American Medical Association.

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Resuscitation to Normalize Lactate Clearance Evaluated

TUESDAY, Feb. 23 (HealthDay News) -- Resuscitation to normalize lactate clearance in patients suffering from septic shock resulted in in-hospital mortality similar to that for patients resuscitated to normalize central venous oxygen saturation (ScvO2), according to a study in the Feb. 24 issue of the Journal of the American Medical Association.

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Physicians Working Fewer Hours for Lower Fees

TUESDAY, Feb. 23 (HealthDay News) -- Physicians in the United States have been working fewer hours for lower fees in the past decade, according to research published in the Feb. 24 issue of the Journal of the American Medical Association.

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Multi-Disciplinary Teams Cut Intensive Care Mortality

TUESDAY, Feb. 23 (HealthDay News) -- Multi-disciplinary teams conducting daily rounds may lower the risk of mortality among medical patients in intensive care units, according to a study in the Feb. 22 issue of the Archives of Internal Medicine, while another study found that there is a growing need for internal medicine education to include training in the medical management of surgical patients, in line with the growing trend of comanagement of hospitalized patients.

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Hospital-Acquired Infections Impose Heavy Burden

TUESDAY, Feb. 23 (HealthDay News) -- Hospital-acquired sepsis and pneumonia impose a significant financial and clinical burden, according to a study published in the Feb. 22 issue of the Archives of Internal Medicine, while another study found that hospitals that keep costs down do not necessarily have poorer quality of care or higher readmission rates.

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Pediatric Obesity Affects Survival After In-Hospital CPR

MONDAY, Feb. 22 (HealthDay News) -- Obese children who undergo cardiopulmonary resuscitation (CPR) in the hospital are at greater risk of dying before hospital discharge than normal weight or underweight children, according to a study published online Feb. 22 in Pediatrics.

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Medical Checklists Needed to Improve Care and Outcomes

MONDAY, Feb. 22 (HealthDay News) -- The checklists so common in aviation and many professions are underused in medicine and, if more widely adopted, would provide powerful tools to standardize care and improve patient outcomes, according to an article published Dec. 31 in Critical Care.

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Intensive Statin Therapy Cuts Recurrent Cardiac Events

FRIDAY, Feb. 19 (HealthDay News) -- For patients who have had a cardiovascular event, intensive statin therapy reduces the risk of recurrent events better than less-intensive therapy, according to a study in the Feb. 1 issue of the American Journal of Cardiology.

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New System Aims to Improve Blood Transfusion Safety

FRIDAY, Feb. 19 (HealthDay News) -- The U.S. Centers for Disease Control and Prevention has started a national surveillance system to monitor adverse events in patients who receive blood transfusions, the agency has announced.

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Platelet Transfusion Dose Has No Effect on Bleeding

WEDNESDAY, Feb. 17 (HealthDay News) -- In patients with hypoproliferative thrombocytopenia, the platelet dose in prophylactic transfusions given after a trigger threshold of 10,000 platelets per cubic millimeter or lower is reached has no significant effect on the incidence of bleeding, according to a study in the Feb. 18 issue of the New England Journal of Medicine.

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Predictors of 'Never-Event' Complications Identified

WEDNESDAY, Feb. 17 (HealthDay News) -- After major surgery, the occurrence of complications designated as "never events" by the Centers for Medicare and Medicaid Services is affected by patient and disease characteristics and by the type of operation performed, according to a study in the February issue of the Archives of Surgery.

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Erythropoiesis-Stimulating Agents Safety Plan Approved

WEDNESDAY, Feb. 17 (HealthDay News) -- Under a new safety plan approved Feb. 16 by the U.S. Food and Drug Administration, physicians will be required to provide all patients prescribed Erythropoiesis-Stimulating Agents (ESAs) with a Medication Guide, and to receive specific training and certification for the proper use of these agents in cancer patients receiving chemotherapy.

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Lumbar Fusion Linked to Improved Driver Reaction Time

TUESDAY, Feb. 16 (HealthDay News) -- The driver reaction time (DRT) in patients a week after lumbar fusion surgery is not significantly slower than their preoperative DRT, and after three months recovery their DRT may be faster than their preoperative DRT, according to a study in the Feb. 1 issue of Spine.

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Risk Factors Often Present in Cases of SIDS

MONDAY, Feb. 15 (HealthDay News) -- Sudden infant death syndrome (SIDS) is often accompanied by multiple risk factors, many of which are modifiable, which call for more inclusive and comprehensive risk-reduction education, according to research published online Feb. 15 in Pediatrics.

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Poor Sleep Linked to More Car Accidents in Teenagers

TUESDAY, Feb. 16 (HealthDay News) -- Poor sleep habits are associated with a higher risk of car accidents among teenagers, according to a study in the Feb. 15 issue of the Journal of Clinical Sleep Medicine.

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Superficial Venous Thrombosis May Herald Greater Risks

TUESDAY, Feb. 16 (HealthDay News) -- Given that many patients with superficial venous thrombosis (SVT) also have deep venous thrombosis (DVT) at presentation, and a considerable number develop thromboembolic complications in following months, SVT may be more of a concern than previously thought, according to research published in the Feb. 16 issue of the Annals of Internal Medicine.

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Outcomes Found to Be Poor in South Carolina Stroke Patients

TUESDAY, Feb. 16 (HealthDay News) -- In South Carolina, patients hospitalized for an initial stroke have an elevated short- and long-term risk of recurrent stroke, heart attack, vascular death, and all-cause death, according to a study in the Feb. 16 issue of Neurology.

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Cardiac Effects of Hormone Replacement Therapy Studied

TUESDAY, Feb. 16 (HealthDay News) -- Hormone replacement therapy that includes estrogen plus progestin may not reduce the risk for coronary heart disease (CHD) during the first several years of treatment in women who started hormone therapy near menopause, according to research published in the Feb. 16 issue of the Annals of Internal Medicine.

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Gender Differences Seen in CABG Operative Mortality

MONDAY, Feb. 15 (HealthDay News) -- Women who undergo coronary artery bypass graft (CABG) surgery have significantly higher operative mortality (OM) than men having the same surgery, according to a study in the Feb. 1 issue of the American Journal of Cardiology.

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Rapid H1N1 Flu Test Found to Be of Limited Value in Children

MONDAY, Feb. 15 (HealthDay News) -- In the diagnosis of pediatric H1N1 influenza A virus infection, the rapid influenza diagnostic test has poor sensitivity but excellent specificity, according to a study published online Feb. 15 in Pediatrics.

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Lifestyle Changes Found to Improve Endothelial Function

MONDAY, Feb. 15 (HealthDay News) -- Lifestyle changes such as a low-fat diet and regular exercise improve endothelial function and inflammatory markers of atherosclerosis in patients with coronary artery disease (CAD), according to a study published in the Feb. 1 issue of the American Journal of Cardiology.

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2009 H1N1-Related Deaths and Hospitalizations Examined

MONDAY, Feb. 15 (HealthDay News) -- The U.S. Centers for Disease Control and Prevention has provided updated estimates of the 2009 H1N1 cases, related hospitalizations and deaths, with approximately 57 million cases occurring between April 2009 and January 2010.

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Study Suggests Treatment Target for Enlarged Tonsils

FRIDAY, Feb. 12 (HealthDay News) -- Phosphoserine phosphatase (PSPH) may play a role in tonsil enlargement in children with obstructive sleep apnea (OSA), and may serve as a target for treating this enlargement, according to research published online Jan. 21 in the American Journal of Respiratory and Critical Care Medicine.

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Stenosis Can Still Exist in Absence of Coronary Calcium

FRIDAY, Feb. 12 (HealthDay News) -- In contradiction of professional guidelines, the absence of coronary calcification in blood vessels does not rule out the potential existence of stenosis, and should not be used to decide if revascularization is needed, according to a study in the Feb. 16 issue of the Journal of the American College of Cardiology.

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MRI Benefit in Breast Cancer Risk Assessment Questioned

FRIDAY, Feb. 12 (HealthDay News) -- Using magnetic resonance imaging (MRI) in addition to the usual triple assessment for breast cancer diagnosis does not reduce the risk of repeat operation and is not a good use of resources, according to a study published in the Feb. 13 issue of The Lancet.

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Mnemonic Device for Patient Decision-Making Assessed

FRIDAY, Feb. 12 (HealthDay News) -- Clinicians who must quickly assess a patient's capacity to make an emergency treatment decision can now fall back on a new mnemonic device, "CURVES," developed at Johns Hopkins University and reviewed in the February issue of Chest.

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Gout Associated With Higher Heart Attack Risk in Women

THURSDAY, Feb. 11 (HealthDay News) -- Gout is associated with an increased risk of heart attack in women, as previously observed in men, although the risk is higher in women, according to a study published online Feb. 2 in the Annals of the Rheumatic Diseases.

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Study Finds Speckle Tracking Aids in Patient Selection

THURSDAY, Feb. 11 (HealthDay News) -- Radial dyssynchrony by speckle tracking may be useful in predicting response to cardiac resynchronization therapy (CRT) in patients with borderline QRS and wide QRS durations, according to research published in the February Journal of the American College of Cardiology: Cardiovascular Imaging.

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Protein May Block Letrozole Therapy in Breast Cancer

THURSDAY, Feb. 11 (HealthDay News) -- The overexpression of low-molecular-weight cyclin E (LMW-E) in the tumors of many menopausal women with estrogen-receptor-positive (ER+) breast cancers nullifies the effects of letrozole, an aromatase inhibitor. However, letrozole's effect can be restored by adding the cyclin-dependent kinase 2 (CDK2) inhibitor roscovitine to treatment, according to a study published online Feb. 9 in Clinical Cancer Research.

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FDA: Automated External Defibrillators Recalled

THURSDAY, Feb. 11 (HealthDay News) -- Cardiac Science Corporation has announced the worldwide voluntary recall of a number of their automated external defibrillators (AEDs) due to the inability of these devices to deliver therapy during resuscitation, which can result in serious complications and death, according to a Feb. 9 safety alert issued by the U.S. Food and Drug Administration.

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Myocarditis Linked to Pandemic H1N1 Flu in Children

THURSDAY, Feb. 11 (HealthDay News) -- Several cases of fulminant myocarditis, a rare complication of viral infection, have been identified among children infected with H1N1 pandemic influenza during a one month period, according to the results of a retrospective chart review published online Feb. 10 in the Journal of the American College of Cardiology.

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Needleless Intravenous Valve Cause of Worldwide Recall

THURSDAY, Feb. 11 (HealthDay News) -- Becton, Dickinson and Company (BD) and Acacia, Inc. have announced the voluntary recall of any products containing the Q-Syte Luer Access Device, including BD's Nexiva Closed Intravenous (IV) Catheter System and Acacia's IV Extension Sets. The use of affected devices may cause an air embolism or fluid leakage, which can result in serious complications and death.

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Dietary Supplement Suspected of Causing Selenium Poisoning

THURSDAY, Feb. 11 (HealthDay News) -- A liquid dietary supplement that contained 200 times the labeled concentration of selenium caused a widespread outbreak of selenium poisoning affecting 201 people in 10 states, according to a study published in the Feb. 8 issue of the Archives of Internal Medicine.

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Youth Cardiovascular Risk Factors Linked to Early Death

WEDNESDAY, Feb. 10 (HealthDay News) -- Cardiovascular risk factors in childhood are associated with a higher rate of premature death from endogenous causes, according to research published in the Feb. 11 issue of the New England Journal of Medicine.

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Reducing Skin Toxicity During Cancer Treatment Studied

WEDNESDAY, Feb. 10 (HealthDay News) -- Preemptive treatment reduces the development of high-grade skin toxicity (the most common adverse event observed with inhibitors of the epidermal growth factor receptor) by more than half in patients with colorectal cancer receiving panitumumab-containing therapy, according to a study published online Feb. 8 in the Journal of Clinical Oncology.

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AHRQ: U.S. Adults Seeing Big Barriers to Specialty Care

WEDNESDAY, Feb. 10 (HealthDay News) -- In 2007, about one in 13 of U.S. adults reported that access to specialist care was a "big problem," according to a December report issued by the Agency for Healthcare Research and Quality (AHRQ).

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FDA Initiative Aims to Cut Medical Radiation Exposure

WEDNESDAY, Feb. 10 (HealthDay News) -- The U.S. Food and Drug Administration has launched a new initiative that aims to reduce exposure to radiation from computed tomography (CT), nuclear medicine studies and fluoroscopy, the three procedures that are the main sources of medically-related radiation exposure.

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Active Bowel Disease May Increase Blood Clot Risk

WEDNESDAY, Feb. 10 (HealthDay News) -- Patients with inflammatory bowel disease (IBD) have a much greater risk of suffering a venous thromboembolism than people in the general population without the bowel condition, particularly during periods of active disease, according to a study published online Feb. 9 in The Lancet.

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Bedside Blood Test Found to Detect Anticoagulation Status

WEDNESDAY, Feb. 10 (HealthDay News) -- A new bedside blood test can be used to determine the sufficiency of anticoagulation in patients who are about to undergo catheterization or percutaneous coronary intervention (PCI), according to a study in the Feb. 16 issue of the Journal of the American College of Cardiology.

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Use of Feeding Tubes in Adults With Dementia Varies Widely

TUESDAY, Feb. 9 (HealthDay News) -- Feeding tube insertions in older individuals with advanced cognitive impairment -- a practice that has drawn scrutiny in the literature -- varied widely in U.S. hospitals during a recent period, according to research published in the Feb. 10 issue of the Journal of the American Medical Association.

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Paroxetine May Compromise the Efficacy of Tamoxifen

TUESDAY, Feb. 9 (HealthDay News) -- Women with breast cancer who take tamoxifen and the antidepressant paroxetine (Paxil), which has been hypothesized to reduce the effectiveness of tamoxifen, may be at higher risk of dying of breast cancer, according to research published online Feb. 8 in BMJ.

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Age-Related Treatment and Outcomes in Stroke Examined

TUESDAY, Feb. 9 (HealthDay News) -- Older people who suffer ischemic stroke are more likely to die in the hospital than younger stroke victims, though disparities in care by age group have been reduced or eliminated in recent years, according to a study published online Feb. 8 in Circulation.

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Outcomes Improving in Asymptomatic Carotid Stenosis

TUESDAY, Feb. 9 (HealthDay News) -- In patients with asymptomatic carotid stenosis (ACS), intensive medical therapy has significantly reduced microemboli on transcranial Doppler as well as cardiovascular events, according to a study in the February issue of the Archives of Neurology.

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Coronary Risk Information May Benefit High Risk Patients

MONDAY, Feb. 8 (HealthDay News) -- Adults at moderate to high risk of coronary heart disease (CHD) may be more likely to seek treatment if they are given a quantitative estimate of their risk odds in the form of CHD risk information, but the population-wide effect of disseminating such information remains unclear, according to a review published in the Feb. 8 issue of the Archives of Internal Medicine.

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AHA/ACC Offer Guidance for Dangerous Arrhythmia

MONDAY, Feb. 8 (HealthDay News) -- Hospitalized patients taking QT-prolonging drugs may be at risk for drug-induced long-QT syndrome (LQTS) and should be closely monitored by electrocardiogram (ECG) for the incidence of the serious arrhythmia known as torsade de pointes (TdP), according to a scientific statement from the American Heart Association and the American College of Cardiology Foundation published online Feb. 8 in Circulation.

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H1N1 Vaccination Still Highly Recommended

MONDAY, Feb. 8 (HealthDay News) -- Despite H1N1 virus levels stabilizing, transmission remains an issue and vaccination continues to be an effective option for prevention of this potentially serious condition, according to a Feb. 5 press briefing by the U.S. Centers for Disease Control.

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Many American Adults Do Not Get Recommended Vaccines

MONDAY, Feb. 8 (HealthDay News) -- Although most parents ensure their children are vaccinated, adults often do not receive recommended vaccinations themselves, according to a new report, Adult Immunization: Shots to Save Lives.

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FDA Warns of Link Between Natalizumab, Brain Infection

FRIDAY, Feb. 5 (HealthDay News) -- On Feb. 5, the U.S. Food and Drug Administration notified health care professionals and patients that the risk of developing a rare but serious brain infection increases as the number of natalizumab (Tysabri) infusions received increases.

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Coalition Launches Campaign to Limit Residents' Hours

FRIDAY, Feb. 5 (HealthDay News) -- To prevent medical errors caused by doctor fatigue, a coalition of public interest and patient safety groups is urging the Accreditation Council for Graduate Medical Education (ACGME) to limit the amount of time residents must work without sleep to 16 hours and to increase resident supervision.

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Thomas Medical Announces Recall of Safesheath Product

FRIDAY, Feb. 5 (HealthDay News) -- The U.S. Food and Drug Administration and Thomas Medical Products Inc. have notified health care professionals of a recall of certain lots of the Safesheath Coronary Sinus Guide Hemostatic Introducer System with Infusion Sideport.

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Pediatric Amputations Cost $21.6 Million Annually

FRIDAY, Feb. 5 (HealthDay News) -- Traumatic amputations in children cost nearly $22 million in hospital-associated charges annually in the United States, according to a report in the January issue of the Journal of Trauma: Injury, Infection, and Critical Care.

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Health Care Spending Makes Record Leap in GDP Share

THURSDAY, Feb. 4 (HealthDay News) -- A growth in health spending in 2009, coupled with a sagging economy, created the largest one-year jump in health care's share of the nation's gross domestic product since 1960, according to an article published online Feb. 4 in Health Affairs.

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No Rebound Seen in Platelet Aggregation After Clopidogrel

THURSDAY, Feb. 4 (HealthDay News) -- There was no rebound in platelet aggregation (PA) observed in cardiovascular patients who stopped taking clopidogrel abruptly or tapered off the medication gradually after the prescribed course of treatment, according to a study in the Feb. 9 issue of the Journal of the American College of Cardiology.

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Diversity Growth Incremental in the Medical Professions

THURSDAY, Feb. 4 (HealthDay News) -- One hundred years after the Flexner Report recommended closing five of the seven African-American medical schools then extant, African-Americans and other minorities remain grossly underrepresented in the medical professions, according to an article in the February issue of Academic Medicine.

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Study Finds Antibiotics Benefit Buruli Ulcer Treatment

THURSDAY, Feb. 4 (HealthDay News) -- Early and limited Buruli ulcer, an infectious disease caused by Mycobacterium ulcerans, can be safely and effectively treated with antibiotics without surgery, according to a study published online on Feb. 4 in The Lancet.

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Communication Found Possible With Some Coma Patients

WEDNESDAY, Feb. 3 (HealthDay News) -- Basic communication can be established with some disorders-of-consciousness patients who are otherwise unresponsive, using functional magnetic resonance imaging (MRI) to measure neuroanatomically specific, blood-oxygenation-level-dependent responses to mental imagery tasks, according to a study published online Feb. 3 in the New England Journal of Medicine.

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Lower Serum Vitamin D Levels Linked to Asthma Severity

WEDNESDAY, Feb. 3 (HealthDay News) -- Lung function tends to be worse and glucocorticoid response poorer in asthma patients who have lower serum levels of vitamin D, according to a study published online Jan. 14 in the American Journal of Respiratory and Critical Care Medicine.

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Not All Terminally Ill Receive Desired End-of-Life Care

WEDNESDAY, Feb. 3 (HealthDay News) -- Most terminally ill patients receive end-of-life care consistent with their stated preferences, and are more likely to receive the care they prefer if they have discussed their preferences with a physician, according to a study published online Feb. 1 in the Journal of Clinical Oncology.

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The Lancet Retracts Study Linking MMR Vaccine, Autism

WEDNESDAY, Feb. 3 (HealthDay News) -- On Feb. 2, The Lancet retracted a controversial 1998 study that linked the measles, mumps and rubella (MMR) vaccine to autism and gastrointestinal problems.

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Red Flags for Serious Infection in Children Highlighted

WEDNESDAY, Feb. 3 (HealthDay News) -- Cyanosis, rapid breathing and poor peripheral circulation are all significant red flags for serious infection in children in developed country settings, while physicians' instinct and parental concern also play a role, according to a review published online Feb. 3 in The Lancet.

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Computed Tomography Shows Advantage in Heart Disease

WEDNESDAY, Feb. 3 (HealthDay News) -- Computed tomography (CT) appears to hold an advantage over magnetic resonance imaging (MRI) for ruling out coronary artery disease, according to research published in the Feb. 2 issue of the Annals of Internal Medicine.

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Anticoagulation and Risk of VTE Studied in Suspected DVT

TUESDAY, Feb. 2 (HealthDay News) -- In patients with suspected lower extremity deep vein thrombosis (DVT), those with a negative whole-leg compression ultrasound (CUS) and no anticoagulation therapy are at low risk of venous thromboembolism, according to a meta-analysis reported in the Feb. 3 issue of the Journal of the American Medical Association.

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Study Doesn't Support Drug for Pericardial Effusion

TUESDAY, Feb. 2 (HealthDay News) -- In patients with pericardial effusion following heart surgery, the use of the nonsteroidal anti-inflammatory drug diclofenac doesn't reduce the size of the effusions or lower the risk of late cardiac tamponade, according to research published in the Feb. 2 issue of the Annals of Internal Medicine.

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President Proposes $911 Billion Budget for HHS

TUESDAY, Feb. 2 (HealthDay News) -- As part of his 2011 budget proposal, President Barack Obama has proposed $911 billion for the U.S. Health and Human Services (HHS) Department, according to a Feb. 1 announcement by the secretary of HHS, Kathleen Sebelius.

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FDA Revises Label for the HIV Drug Didanosine

MONDAY, Feb. 1 (HealthDay News) -- In patients with HIV, use of Videx or Videx EC (didanosine) may increase the risk of non-cirrhotic portal hypertension, according to a Safety Announcement released Jan. 29 by the U.S. Food and Drug Administration, which has revised the Warning and Precautions section of the didanosine drug label to assure safe use of the medication.

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