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March 2011 Briefing - Critical Care

Here are what the editors at HealthDay consider to be the most important developments in Critical Care for March 2011. 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.

Areas With More Surgeons Have Fewer Car Crash Deaths

THURSDAY, March 31 (HealthDay News) -- Areas with more surgeons available have fewer deaths from motor vehicle crashes (MVCs), according to a study published online March 29 in the Journal of the American College of Surgeons.

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Accurate Cerebral Aneurysm Diagnosis by CT Angiography

WEDNESDAY, March 30 (HealthDay News) -- Computed tomographic (CT) angiography, especially by modern multidetector CT, is a highly accurate tool for diagnosing cerebral aneurysms, according to a meta-analysis published online March 9 in the Annals of Neurology.

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Online Health Records Less Used by Minorities, Poor

WEDNESDAY, March 30 (HealthDay News) -- Online personal health records (PHRs) are less frequently used by racial or ethnic minorities and patients with low annual income, according to a study published in the March 28 issue of the Archives of Internal Medicine.

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Discharge to Skilled Nursing Facilities Linked to Death

WEDNESDAY, March 30 (HealthDay News) -- Patients with heart failure discharged to skilled nursing facilities (SNFs) have an increased risk for rehospitalization and death, according to a study published online March 29 in Circulation: Heart Failure.

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Air Pollution May Compromise Lung Transplant Patients

TUESDAY, March 29 (HealthDay News) -- Lung transplant patients who have high exposure to traffic-related air pollution may be at increased risk for bronchiolitis obliterans syndrome (BOS) and death, according to research published online March 23 in Thorax.

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Decline Seen in Global Youth Mortality Over Last 50 Years

TUESDAY, March 29 (HealthDay News) -- Overall mortality declined substantially between 1955 and 2004 in children aged 14 years or younger and in females aged 15 to 24, but a smaller decline was evident for males aged 15 to 24 years, according to a study published online March 29 in The Lancet.

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Room Cleaning Linked to Lower Drug-Resistant Infections

TUESDAY, March 29 (HealthDay News) -- Enhanced intensive care unit (ICU) cleaning may reduce methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) transmission, according to a study published in the March 28 issue of the Archives of Internal Medicine.

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Guidelines Provided for Deep Vein Thrombosis Management

MONDAY, March 28 (HealthDay News) -- Blood thinners should not be the only therapy considered for patients with deep vein thrombosis (DVT), according to a scientific statement published online March 21 in Circulation.

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ISICEM: Decompressive Craniectomy May Be Harmful

FRIDAY, March 25 (HealthDay News) -- The use of decompressive craniectomy in patients with severe diffuse traumatic brain injury and refractory intracranial hypertension appears to lower intracranial pressure and shorten intensive care unit (ICU) stays but is associated with more unfavorable outcomes, according to a study published online March 25 in the New England Journal of Medicine to coincide with research presented at the 31st International Symposium on Intensive Care and Emergency Medicine, held from March 22 to 25 in Brussels, Belgium.

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Early Tranexamic Acid Reduces Bleeding-Related Death

THURSDAY, March 24 (HealthDay News) -- Early administration of tranexamic acid reduces mortality due to bleeding in trauma patients; given more than three hours after injury, however, the agent could raise the risk of death, according to research published online March 24 in The Lancet.

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Reduced Hours for Trainees Has Had Little Effect in U.S.

THURSDAY, March 24 (HealthDay News) -- Reducing work hours for doctors in training to less than 80 per week has had little impact on patient outcomes or postgraduate training in the United States, according to a literature review published online March 22 in BMJ.

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Tiotropium Shows Edge Over Salmeterol for COPD

WEDNESDAY, March 23 (HealthDay News) -- Tiotropium, an anticholinergic drug, appears to be more effective than salmeterol in preventing exacerbations in patients with moderate or worse chronic obstructive pulmonary disease (COPD), according to research published in the March 24 issue of the New England Journal of Medicine.

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Hydrocortisone Lowers Risk of Hospital-Acquired Pneumonia

TUESDAY, March 22 (HealthDay News) -- Intravenous hydrocortisone decreases the risk of developing hospital-acquired pneumonia in intubated trauma patients, according to a study published in the March 23/30 issue of the Journal of the American Medical Association.

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Dalteparin Not Superior to Unfractionated Heparin

TUESDAY, March 22 (HealthDay News) -- Dalteparin, a low-molecular-weight heparin, does not appear any more effective in lowering the incidence of proximal deep-vein thrombosis than unfractionated heparin, according to research published online March 22 in The New England Journal of Medicine.

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Antibiotics Reduce Risk of ICU-Acquired Infection

MONDAY, March 21 (HealthDay News) -- Critically ill patients given prophylactic antibiotics may be significantly less likely to be infected by intensive care unit (ICU)-acquired, highly resistant microorganisms, according to research published online March 21 in The Lancet Infectious Diseases.

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Multifaceted Approach Reduces Pneumonia in ICU

MONDAY, March 21 (HealthDay News) -- Rates of ventilator-associated pneumonia (VAP) can be significantly reduced with the implementation of multifaceted intervention aimed at increasing the use of evidence-based therapies in the intensive care unit (ICU), according to a study published in the April issue of Infection Control and Hospital Epidemiology.

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Group B Strep Still Main Cause of Neonatal Meningitis

MONDAY, March 21 (HealthDay News) -- Group B streptococci (GBS) is still the dominant cause of neonatal bacterial meningitis, whereas Escherichia coli (E. coli) is the most common cause among preterm infants, according to a study published in the March issue of The Pediatric Infectious Disease Journal.

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Stem Cells Linked to Functional Recovery of Heart Post MI

FRIDAY, March 18 (HealthDay News) -- In patients with left ventricular (LV) dysfunction due to remote myocardial infarction, injections of autologous bone marrow progenitor cells reduce heart size and scar tissue size, and improve regional contractility, according to a study published online March 17 in Circulation Research.

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Professional Values of U.S. and U.K. Doctors Examined

THURSDAY, March 17 (HealthDay News) -- A core of professional values exists among doctors in the United States and the United Kingdom, though significant differences exist in how these values are expressed and prioritized, according to a study published online March 7 in BMJ Quality & Safety.

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Sirolimus Shows Promise for Treating Lung Disease

WEDNESDAY, March 16 (HealthDay News) -- Sirolimus, a mammalian target of rapamycin inhibitor, appears to be an effective therapy for stabilizing lung function and improving symptoms and quality of life in patients with lymphangioleiomyomatosis (LAM), according to research published online March 16 in the New England Journal of Medicine.

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Short Nurse Staffing Linked to Higher Patient Mortality

WEDNESDAY, March 16 (HealthDay News) -- Patient mortality appears to be higher when nurse staffing falls eight or more hours below target level and during nursing shifts when patient turnover is high, according to research published in the March 17 issue of the New England Journal of Medicine.

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U.S. Death Rate Reaches All-Time Low

WEDNESDAY, March 16 (HealthDay News) -- The age-adjusted death rate for the United States has fallen for 10 straight years and has reached an all-time low of 741 per 100,000, or 2,436,682 deaths, in 2009, down 2.3 percent from 2008, according to a new report issued by the U.S. Centers for Disease Control and Prevention's National Center for Health Statistics.

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Smokers Advised to Stop Even Just Before Surgery

WEDNESDAY, March 16 (HealthDay News) -- There is no evidence to suggest that quitting smoking within eight weeks prior to surgery increases postoperative complications, according to a meta-analysis published online March 14 in the Archives of Internal Medicine.

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Retinal Vein Occlusion Tied to Cerebrovascular Event Risk

WEDNESDAY, March 16 (HealthDay News) -- Patients with retinal vein occlusion (RVO) have an almost two-fold higher event risk rate for cerebrovascular accident (CVA) compared to controls, but similar rates of myocardial infarction (MI) events, according to a study published in the March issue of the Archives of Ophthalmology.

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More Cholera Cases and Deaths Expected in Haiti

WEDNESDAY, March 16 (HealthDay News) -- Mathematical modeling estimates that more cases of cholera than expected will occur in the coming months in Haiti, but many could be averted by the provision of clean water, vaccinations, and increased antibiotic distribution, according to a study published online March 16 in The Lancet.

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Drug-Related Poisonings Highest in Young Children

MONDAY, March 14 (HealthDay News) -- Emergency department visits for unintentional drug-related poisonings in the United States are highest among children age 0 to 5 and more prominent in rural areas, and young women have the highest rate of drug-related poisonings with suicidal intent, according to research published online March 3 in the American Journal of Emergency Medicine.

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Device OK'd to Continue Blood Flow During Brain Surgery

FRIDAY, March 11 (HealthDay News) -- A device that permits the rerouting of blood flow during surgery to treat a brain aneurysm or tumor in people at greater risk of stroke has been approved by the U.S. Food and Drug Administration.

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Heart Rate Turbulence Risk Factor for Cardiac Mortality

FRIDAY, March 11 (HealthDay News) -- Abnormal heart rate turbulence (HRT) is independently associated with increased cardiac mortality risk for low-, intermediate-, and high-risk individuals, while C-reactive protein (CRP) is associated with an increased cardiac mortality risk only in those who are low risk, according to a study published in the February issue of the Journal of Cardiovascular Electrophysiology.

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Coffee Consumption Linked to Lower Stroke Risk in Women

FRIDAY, March 11 (HealthDay News) -- Women who consume one or more cups of coffee daily have a lower risk of stroke than those who consume less than one cup of coffee a day, according to a study published online March 10 in Stroke.

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Non-Infectious Problems Lower Dialysis Catheter Survival

THURSDAY, March 10 (HealthDay News) -- The failure of peritoneal dialysis (PD) catheters is associated with catheter-related non-infectious problems, and other risk factors need not hinder the selection of patients for PD catheter initiation, according to a study published in the October-December 2010 issue of The Journal of Vascular Access.

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Nitrous Oxide May Up Risk of Myocardial Infarction

THURSDAY, March 10 (HealthDay News) -- The administration of nitrous oxide in surgeries longer than two hours is linked to an increased long-term risk of myocardial infarction (MI), but not death or stroke, according to a report in the February issue of Anesthesia & Analgesia.

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Depression Care in Hospital May Improve Cardiac Outcomes

THURSDAY, March 10 (HealthDay News) -- Among patients with depression and cardiac illness, managing depression during hospitalization improves mental health outcomes and may also improve medical outcomes after intervention, according to a study published online March 8 in Circulation: Cardiovascular Quality and Outcomes.

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Irbesartan Does Not Prevent Cardiovascular Events in A-Fib

WEDNESDAY, March 9 (HealthDay News) -- The angiotensin-receptor blocker irbesartan fails to lower the rate of cardiovascular events in patients with atrial fibrillation, according to research published in the March 10 issue of the New England Journal of Medicine.

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HealthGrades Finds Rates of Patient Safety Events Vary

WEDNESDAY, March 9 (HealthDay News) -- Patients treated at hospitals rated with a HealthGrades Patient Safety Excellence Award have, on average, a 46 percent lower risk of experiencing a patient safety incident compared to those treated at the lowest-ranked hospitals, according to the eighth annual HealthGrades Patient Safety in American Hospitals Study published online March 9.

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Ethnic Differences Seen in Academic Measures for U.K. Docs

WEDNESDAY, March 9 (HealthDay News) -- United Kingdom-trained physicians and medical students with ethnic minority backgrounds tend to underperform academically compared to their white peers, according to a meta-analysis published online March 8 in BMJ.

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Pharmacological Meta-Analyses Rarely Report Disclosures

TUESDAY, March 8 (HealthDay News) -- Meta-analyses of pharmacological treatments rarely include information addressing primary study funding and conflicts of interest (COIs) of the authors for the included randomized control trials (RCTs), according to a study published in the March 9 issue of the Journal of the American Medical Association.

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Post-Hospitalization Mortality High in Trauma Patients

TUESDAY, March 8 (HealthDay News) -- The three-year cumulative mortality rate for trauma patients after being discharged from Washington state hospitals is relatively high, particularly in those discharged to skilled nursing facilities, according to research published in the March 9 issue of the Journal of the American Medical Association.

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FDA: Adverse Events Tied to Kaletra in Preterm Infants

TUESDAY, March 8 (HealthDay News) -- The U.S. Food and Drug Administration has notified health care providers of a revision to the label of lopinavir/ritonavir (Kaletra) oral solution to include a new warning, as administration of the oral solution may result in serious health problems among premature babies.

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Majority of Pediatric Burn Admissions Due to Scalding

TUESDAY, March 8 (HealthDay News) -- Although admission rates for burn injury declined from 1983 to 2008, more than half of burn-injury hospital admissions for children younger than 5 years of age in Western Australia are due to scalding, according to a study published online March 7 in Pediatrics.

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Atrial Fibrillation Tied to Higher Incidence of Dementia

TUESDAY, March 8 (HealthDay News) -- Atrial fibrillation (AF) is associated with an increased incidence of dementia, and this association is strongest in patients with stroke, according to a meta-analysis published in the March 8 issue of Neurology.

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Cerebral Palsy Incidence Down in Preterm Survivors

MONDAY, March 7 (HealthDay News) -- The incidence and severity of cerebral palsy (CP) among preterm survivors decreased significantly from 1990 to 1993 onward, possibly because of a reduction in severe cystic periventricular leukomalacia (c-PVL), according to a study published online March 3 in The Journal of Pediatrics.

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Abuser's Gender Affects Head Trauma Outcome in Youth

MONDAY, March 7 (HealthDay News) -- Male perpetrators of abusive head trauma in children are more likely to confess and be convicted, and their victims are more likely to have more serious presentations and worse outcomes, according to a study published online March 7 in Pediatrics.

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Risk Factors Identified for Catheter-Related Thrombosis

MONDAY, March 7 (HealthDay News) -- The risk of catheter-related thrombosis (CRT) is decreased by use of implanted ports and increased by previous history of deep vein thrombosis, insertion into the subclavian vein, and improper catheter tip position, according to a review published in the February issue of the Journal of Thrombosis and Haemostasis.

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Majority Identify Need for an Ambulance in an Emergency

FRIDAY, March 4 (HealthDay News) -- The majority of people are able to identify emergency situations that require an ambulance to be called, but there is a high level of inappropriate response in nonemergency situations, according to a study published online Feb. 22 in the Emergency Medicine Journal.

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Rule Predicts Ability to Walk After Spinal Cord Injury

FRIDAY, March 4 (HealthDay News) -- A new clinical prediction rule, which accounts for age and four neurological variables, can predict independent walking one year following traumatic spinal cord injury, according to a study published online March 4 in The Lancet.

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Depression Tied to Lower Priority of Care in Heart Attack

THURSDAY, March 3 (HealthDay News) -- Heart attack patients with a documented history of depression in their charts may be triaged to lower priority of care than patients with no documented history of depression, and they are more likely to have worse associated performance on quality indicators, according to research published online Feb. 28 in CMAJ, the journal of the Canadian Medical Association.

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Diuretic Has Similar Effect Regardless of Method or Dose

THURSDAY, March 3 (HealthDay News) -- The responses of patients with acute decompensated heart failure to loop diuretics don't appear to differ between groups administered the agent by bolus or continuous infusion, or at a high or low dose, according to research published in the March 3 issue of the New England Journal of Medicine.

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Increased Dietary Potassium Tied to Lower Stroke Risk

WEDNESDAY, March 2 (HealthDay News) -- Higher dietary potassium intake is correlated with reduced rates of stroke and may also lower the risk of coronary heart disease (CHD) and total cardiovascular disease (CVD), according to a meta-analysis published in the March 8 issue of the Journal of the American College of Cardiology.

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Higher Spending Does Not Improve Sepsis Outcomes

WEDNESDAY, March 2 (HealthDay News) -- There is substantial variation in both hospital spending and mortality rates for patients with sepsis among hospitals, but higher levels of spending are not associated with improved survival, according to a study published in the Feb. 28 issue of the Archives of Internal Medicine.

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Inhaled Nitric Oxide Does Not Shorten Sickle Cell Crisis

WEDNESDAY, March 2 (HealthDay News) -- Among patients with sickle cell disease (SCD), the use of inhaled nitric oxide does not reduce the time to resolution of a vaso-occlusive pain crisis (VOC) compared to placebo, according to a study published in the March 2 issue of the Journal of the American Medical Association.

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Type of Health Care-Associated Infections Is Falling

TUESDAY, March 1 (HealthDay News) -- The incidence of central line-associated blood stream infections (CLABSIs) in intensive care units (ICUs) has decreased by more than half since 2001, but the infections continue to occur in substantial numbers in inpatient wards and outpatient hemodialysis centers, according to research published in the March 1 early-release issue of the U.S. Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

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Risk of Death From Heart Attacks Not Linked to Gender

TUESDAY, March 1 (HealthDay News) -- The association between female gender and increased mortality among patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) does not persist after adjusting for age and comorbidities, according to a study published in the January issue of the American Heart Journal.

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Helmets Protect Motorcyclists From Cervical Spine Injury

TUESDAY, March 1 (HealthDay News) -- Motorcyclists who wear helmets are less likely to suffer a cervical spine injury after a collision, according to a study published in the March issue of the Journal of the American College of Surgeons.

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Physician's Briefing