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June 2010 Briefing - Critical Care

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

Biomarker Aids in Heart Attack Risk Stratification

WEDNESDAY, June 30 (HealthDay News) -- Mid-regional pro-adrenomedullin (sAM) levels can predict mortality or heart failure in non-ST-elevation myocardial infarction (NSTEMI) patients, complementing other risk stratification tools, according to a study published in the July 6 issue of the Journal of the American College of Cardiology.

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Lower CYP2C19 Function Plus Clopidogrel May Cause Harm

TUESDAY, June 29 (HealthDay News) -- Patients treated with clopidogrel who are carriers of the loss-of-function CYP2C19*2 allele may be at increased risk for cardiovascular events and death, according to research published in the July 6 issue of the Journal of the American College of Cardiology.

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Diagnostic Adverse Events Usually Due to Human Failure

TUESDAY, June 29 (HealthDay News) -- Diagnostic adverse events (DAEs) are most often caused by human error, and their consequences are more severe than those of other types of adverse events, according to research published in the June 28 issue of the Archives of Internal Medicine.

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End-of-Life Hospital Care Has Room for Improvement

TUESDAY, June 29 (HealthDay News) -- In U.S. hospitals, the care of patients at end of life nearly always includes close attention to pain management and efforts to ease breathing, but there are other areas of care that need improvement, according to research published in the June 28 issue of the Archives of Internal Medicine.

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Doctors Agree Malpractice Fears Drive Overuse of Tests

MONDAY, June 28 (HealthDay News) -- A large majority of physicians agree that the practice of defensive medicine -- stemming from malpractice concerns -- is responsible for an overuse of medical tests and procedures, according to a research letter in the June 28 issue of the Archives of Internal Medicine.

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Venous Thromboembolism Risk Factors Vary by Race

MONDAY, June 28 (HealthDay News) -- Black Americans with venous thromboembolism (VTE) are less likely to have commonly recognized transient risk factors for the condition, are more likely to have cardiovascular disease risk factors, and are more likely to progress to pulmonary embolism than are white Americans, according to research published in the July issue of the American Journal of Hematology.

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Moldy Homes Linked to Higher Risk of Severe Asthma Attacks

FRIDAY, June 25 (HealthDay News) -- High mold exposure in the home may lead to an increased risk of severe asthma attacks among children with variants in the chitinase gene CHIT1, according to research published online June 10 in the American Journal of Respiratory and Critical Care Medicine.

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Diabetes May Complicate COPD Hospital Admissions

THURSDAY, June 24 (HealthDay News) -- Patients admitted to the hospital with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) who have comorbid diabetes mellitus (DM) have trends toward longer hospital length of stay and an increased risk of death compared with those without DM, according to research published online June 4 in Respirology.

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Early Shunting Controls Bleeding in Cirrhotic Patients

WEDNESDAY, June 23 (HealthDay News) -- Typically reserved as a rescue therapy, the insertion of a transjugular intrahepatic portosystemic shunt (TIPS) soon after hospital admittance for acute variceal bleeding in cirrhosis patients may reduce the likelihood of treatment failure and death, according to research published in the June 24 issue of the New England Journal of Medicine.

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Racial Disparities in Sepsis Explained by Two Factors

TUESDAY, June 22 (HealthDay News) -- Racial differences in sepsis rates are due to higher infection rates as well as a higher risk of organ dysfunction among black patients compared with white patients, according to research published in the June 23/30 issue of the Journal of the American Medical Association.

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Brain Hemorrhage Diagnosis Delay Rare in Children

MONDAY, June 21 (HealthDay News) -- In children with uncomplicated minor head injuries, delayed diagnosis of intracranial hemorrhage is rare, according to research published online June 21 in Pediatrics.

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Rescue Antenatal Steroids Beneficial for Preterm Infants

MONDAY, June 21 (HealthDay News) -- If it has been at least 14 days since an initial dose of antenatal steroids, an additional course of rescue antenatal steroids administered to pregnant women at continued risk of premature delivery can improve their infants' postnatal respiratory function, according to research published in the June issue of the American Journal of Obstetrics & Gynecology.

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Hepatic Encephalopathy Linked to Chronic Cognitive Effects

FRIDAY, June 18 (HealthDay News) -- Among patients with cirrhosis, episodes of overt hepatic encephalopathy (OHE) may be associated with lingering and cumulative problems with learning, working memory, and response inhibition, according to research published in the June issue of Gastroenterology.

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10 Risk Factors Associated With Most of Stroke Risk

FRIDAY, June 18 (HealthDay News) -- Worldwide, 10 risk factors are associated with 90 percent of the risk for stroke, suggesting that interventions targeting these particular factors could greatly reduce the stroke burden, according to a study published online June 18 in The Lancet.

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Computed Tomography Angiography May Be Avoidable

WEDNESDAY, June 16 (HealthDay News) -- The risk of a computed tomography (CT) angiogram being positive for pulmonary embolism (PE) is unlikely among patients who do not present with thromboembolic risk factors, suggesting that CT angiography is unnecessary in many patients, according to research published online June 15 in Radiology.

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MRSA Linked to Higher Mortality in Cystic Fibrosis

TUESDAY, June 15 (HealthDay News) -- Cystic fibrosis (CF) patients with methicillin-resistant Staphylococcus aureus (MRSA) infection have worse survival rates than CF patients without the infection, according to a study in the June 16 issue of the Journal of the American Medical Association.

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In COPD, Oral, Intravenous Steroids Bring Same Outcomes

TUESDAY, June 15 (HealthDay News) -- Patients with chronic obstructive pulmonary disease (COPD) exacerbations treated with low-dose oral corticosteroids have outcomes similar to those treated with more costly and invasive high-dose intravenous corticosteroid therapy, according to research published in the June 16 issue of the Journal of the American Medical Association.

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Tranexamic Acid Reduces Mortality in Trauma Patients

TUESDAY, June 15 (HealthDay News) -- Tranexamic acid may be an effective option for reducing bleeding and mortality among trauma patients, without increasing the risk of serious complications such as myocardial infarction, stroke, or pulmonary embolism, according to a study published online June 15 in The Lancet.

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Incidental Findings Frequently Seen in Pediatric Brain Imaging

MONDAY, June 14 (HealthDay News) -- Nearly 7 percent of children involved in a magnetic resonance imaging (MRI) study had incidental intracranial findings, calling attention to issues related to counseling families when such findings arise in clinical situations, according to research published online June 14 in Pediatrics.

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Private Insurance Linked to Lower Hospital Mortality

FRIDAY, June 11 (HealthDay News) -- Patients with private insurance who are hospitalized for acute myocardial infarction (AMI), stroke or pneumonia have significantly lower in-hospital mortality than patients who are uninsured or have Medicaid, according to research published online June 10 in the Journal of Hospital Medicine.

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Hospira Expands Propofol and Lipsoyn Recall

FRIDAY, June 11 (HealthDay News) -- Hospira has alerted health care providers that it is expanding its March 31 recall of Propofol Injectable Emulsion 1 percent and Liposyn (Intravenous Fat Emulsion) products that include Liposyn II 10 percent, Liposyn II 20 percent, Liposyn III 10 percent, Liposyn III 20 percent, and Liposyn III 30 percent, as some of the containers may contain sub-visible inert stainless steel particles.

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Suppressed Anger in CAD Linked to Adverse Cardiac Events

THURSDAY, June 10 (HealthDay News) -- In patients with coronary artery disease (CAD), suppressing anger is associated with a higher risk of adverse cardiac events, according to research published in the June 1 issue of the American Journal of Cardiology.

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No Increased Mortality Seen With Ultrasound Contrast Agent

THURSDAY, June 10 (HealthDay News) -- There is no increased mortality risk for critically ill patients who undergo echocardiography with an ultrasound contrast agent (UCA), compared to those who do not have contrast during their echocardiogram, according to research published in the June issue of the Journal of the American College of Cardiology: Cardiovascular Imaging.

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FDA: Defibtech's DBP-2800 Battery Packs Recalled

THURSDAY, June 10 (HealthDay News) -- Defibtech has alerted customers of a voluntary recall of 5,418 DBP-2800 Battery Packs used in the Lifeline Automatic External Defibrillator (AED) and ReviveR AED, as these AEDs may incorrectly recognize an error condition during charging for a shock and discontinue the charge, not providing therapy when the defected battery packs are used.

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Long-Term Acute Care Hospital Utilization Increasing

TUESDAY, June 8 (HealthDay News) -- Hospitalizing patients in long-term acute care hospitals after critical illness is an expensive but increasingly utilized option, according to research published in the June 9 issue of the Journal of the American Medical Association.

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Fatal Medication Errors Rise in July at Teaching Hospitals

TUESDAY, June 8 (HealthDay News) -- In July there is a significant increase in fatal medication errors at medical institutions, and this spike is at least partly due to the arrival of new medical residents, according to a study published online May 29 in the Journal of General Internal Medicine.

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Many Adults With Pediatric Disorders Use Pediatric ERs

TUESDAY, June 8 (HealthDay News) -- Many adult patients with chronic pediatric disorders, known as transition patients, use pediatric emergency departments -- often for complaints unrelated to their pediatric disorders -- and these patients have high rates of intensive care unit and hospital admissions, according to a study in the June issue of the Archives of Pediatrics & Adolescent Medicine.

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Revised, Evidence-Based Brain Death Guideline Issued

MONDAY, June 7 (HealthDay News) -- A new guideline for determining brain death has been issued by the American Academy of Neurology, updating the 1995 version and including a checklist to provide doctors with clarity and direction. The guideline has been published in the June 8 issue of Neurology.

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Many Hospital Patients Readmitted Within Two Years

MONDAY, June 7 (HealthDay News) -- Approximately 25 percent of hospital patients were readmitted to the hospital within a two-year period for the same conditions that prompted their initial admission, according to a recent report from the Agency for Healthcare Research and Quality (AHRQ).

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Non-Married at Greater Risk of Hospitalization for Sepsis

FRIDAY, June 4 (HealthDay News) -- Single, separated, and widowed adults have a higher risk of hospitalization for sepsis than do their married peers, and some face higher mortality rates as well, according to research published in the June issue of Chest.

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Smoking History, Not Symptoms, Predictive of COPD

FRIDAY, June 4 (HealthDay News) -- Even though about half of all cases of chronic obstructive pulmonary disease (COPD) are undiagnosed, selecting symptomatic people for spirometric screening adds little to the strategy of screening older smokers, according to research published in the June issue of Chest.

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Many Ischemic Stroke Patients Arrive at ER Within Hour

FRIDAY, June 4 (HealthDay News) -- A substantial portion of ischemic stroke patients present to emergency departments within an hour of onset, and they are more likely to receive thrombolytic therapy than those who arrive later, but both factors present room for improvement, according to research published online June 3 in Stroke.

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Low HDL Predicts Development of Abdominal Aortic Aneurysm

FRIDAY, June 4 (HealthDay News) -- There appears to be a consistent association between low levels of high-density lipoprotein (HDL) and the presence of abdominal aortic aneurysms (AAAs) in men aged 65 years or older, according to research published in the May 15 issue of the American Journal of Cardiology.

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Early Heparin Beneficial in Pulmonary Embolism

THURSDAY, June 3 (HealthDay News) -- For patients with acute pulmonary embolism (PE), starting heparin early, while the patient is still in the emergency department, is associated with decreased mortality, according to research published in the June issue of Chest.

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Stroke Patients Benefit From Early Lipid-Lowering Therapy

THURSDAY, June 3 (HealthDay News) -- Early initiation of lipid-lowering therapy (LLT) during hospitalization for ischemic stroke or transient ischemic attack correlates with improved clinical outcomes, according to research published in the May 15 issue of the American Journal of Cardiology.

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Risk Score Predicts Bleeding in Acute Coronary Syndromes

WEDNESDAY, June 2 (HealthDay News) -- Researchers have developed and tested a practical risk score designed to predict the risk and implications of major bleeding in acute coronary syndromes (ACS), and have found it effective for identifying at-risk patients, according to research published in the June 8 issue of the Journal of the American College of Cardiology.

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Post-CPR Hyperoxia Linked to Higher Mortality Risk

TUESDAY, June 1 (HealthDay News) -- Both hyperoxia after cardiopulmonary resuscitation (CPR) and non-adherence to recommended timing of interventions after ST-elevation myocardial infarction (STEMI) result in significant increases in mortality, according to two studies published in the June 2 issue of the Journal of the American Medical Association.

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Abstract - Lambert
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In Heart Failure, Discharges Earlier, Readmission Rates Up

TUESDAY, June 1 (HealthDay News) -- Patients admitted to hospitals for heart failure in 2006 fared better in-hospital than did those in 1993, but were discharged more often to nursing homes, and readmitted more frequently, according to research published in the June 2 issue of the Journal of the American Medical Association.

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FDA: Claris IV Medications Recalled Due to Contamination

TUESDAY, June 1 (HealthDay News) -- The U.S. Food and Drug Administration has notified health care professionals not to use intravenous medications including metronidazole, ciprofloxacin and ondansetron manufactured by Claris Lifesciences, as the products may be contaminated.

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Ventilation Strategies Result in Similar Outcomes

TUESDAY, June 1 (HealthDay News) -- High-frequency oscillatory ventilation (HFOV), in which the lungs are continuously inflated and oscillate at a high rate through use of small volume changes, appears to be no better and no worse than conventional ventilation in preterm infants, according to research published online June 1 in The Lancet.

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Heart Fatty Acid-Binding Protein Levels May Indicate ACS Risk

TUESDAY, June 1 (HealthDay News) -- Obtaining the concentration of heart fatty acid-binding protein (H-FABP) in patients with suspected acute coronary syndrome (ACS) may help physicians identify high-risk patients who are troponin-negative, according to research published in the June 8 issue of the Journal of the American College of Cardiology.

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