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October 2009 Briefing - Critical Care

Here are what the editors at HealthDay consider to be the most important developments in Critical Care for October 2009. 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.

Uninsured Children May Be More Likely to Die in the Hospital

FRIDAY, Oct. 30 (HealthDay News) -- In-hospital all-cause mortality is higher among uninsured children than among those who have insurance, according to a study published in the October issue of the Journal of Public Health.

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Toronto Acute Stroke Protocol Increases Timely Thrombolysis

FRIDAY, Oct. 30 (HealthDay News) -- An acute stroke treatment protocol in which patients were taken directly to a regional stroke center instead of the closest local hospital resulted in a six-fold increase in the number of patients receiving tissue plasminogen activator (tPA) within 2.5 hours of symptom onset over a four-month study period, according to a report published online Oct. 29 in Stroke.

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Additional Recommendations for Imaging on the Rise

THURSDAY, Oct. 29 (HealthDay News) -- Recommendations for additional imaging in radiology reports at one institution increased steeply in recent years, and from 1980 to 2006, radiologic and nuclear medicine procedures increased roughly 10-fold and 2.5 fold, respectively, according to two studies the November issue of Radiology.

Abstract - Sistrom
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Abstract - Mettler
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ACE Inhibitors May Negatively Impact CABG Outcomes

THURSDAY, Oct. 29 (HealthDay News) -- The preoperative use of angiotensin-converting enzyme (ACE) inhibitor therapy before coronary artery bypass grafting (CABG) may increase risk of mortality and other adverse outcomes, according to research published in the Nov. 3 Journal of the American College of Cardiology.

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Importance of ST-Segment Resolution Assessed

WEDNESDAY, Oct. 28 (HealthDay News) -- In patients with ST-segment elevation myocardial infarction (STEMI), ST-segment resolution at four hours after treatment may predict outcomes after fibrinolysis, but has limited prognostic value after primary percutaneous coronary intervention (pPCI), according to the DANish trial in Acute Myocardial Infarction-2 (DANAMI-2) substudy published in the Nov. 3 issue of the Journal of the American College of Cardiology.

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Majority of Americans Within Two Hours of a Burn Center

TUESDAY, Oct. 27 (HealthDay News) -- Seventy-nine percent of Americans are within two hours of an American Burn Association-verified care center, but access varies considerably by region and state, according to a study in the Oct. 28 issue of the Journal of the American Medical Association.

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Medical School Enrollment Continues to Expand

MONDAY, Oct. 26 (HealthDay News) -- Almost 18,400 students enrolled in medical school in the United States in 2009, a 2 percent increase over the previous year, but even more expansion is needed to meet future demand, according to an Oct. 20 report from the Association of American Medical Colleges (AAMC).

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Alteplase Effective for Stroke Even After Three-Hour Window

MONDAY, Oct. 26 (HealthDay News) -- The tissue plasminogen activator alteplase leads to better outcomes in stroke patients even when administered more than three hours after onset of symptoms, according to a study published online Oct. 21 in The Lancet Neurology.

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Far Fewer H1N1 Vaccine Doses Than Expected Are Available

MONDAY, Oct. 26 (HealthDay News) -- Because of production delays, far fewer than the goal of 40 million doses of H1N1 influenza vaccine will be available in the United States by the end of October, according to the U.S. Centers for Disease Control and Prevention. In addition, the U.S. Food and Drug Administration has issued an emergency use authorization for the investigational antiviral drug peramivir intravenous in certain patients with suspected or confirmed H1N1 infection.

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Some Hospital Staff Predicted to Be Infection Superspreaders

THURSDAY, Oct. 22 (HealthDay News) -- Hospital staff such as therapists and radiologists who are in contact with all patients have the potential to be superspreaders of infection if they fail to wash their hands regularly, according to a study published online Oct. 19 in the Proceedings of the National Academy of Sciences.

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Remote Patient Monitoring May Lower Heart Failure Risk

THURSDAY, Oct. 22 (HealthDay News) -- Heart failure patients whose status was checked regularly using remote patient monitoring (RPM), had reduced risk of death and hospitalization compared to patients who received usual standard of care, according to a study in the Oct. 27 issue of the Journal of the American College of Cardiology.

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Pulmonary Embolism Found to Be Often Unrelated to DVT

THURSDAY, Oct. 22 (HealthDay News) -- In patients with pulmonary embolism, only a few have deep venous thrombosis (DVT) of the pelvic or proximal lower extremity veins, suggesting that pulmonary embolism originates in the lungs, according to a study in the October issue of the Archives of Surgery.

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Causes of Heart Failure Patient Rehospitalizations Examined

THURSDAY, Oct. 22 (HealthDay News) -- Most of the hospitalizations of heart failure patients subsequent to their diagnosis are for non-cardiovascular conditions, according to a study in the Oct. 27 issue of the Journal of the American College of Cardiology.

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Higher Intensity Kidney Therapies Show Mixed Results

WEDNESDAY, Oct. 21 (HealthDay News) -- In critically ill adults with acute renal injury, higher-intensity renal-replacement therapy does not reduce mortality; however, in children with chronic kidney disease, higher-intensity blood-pressure control has beneficial effects on renal function, according to two studies in the Oct. 22 issue of the New England Journal of Medicine.

Abstract - Bellomo
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Abstract - Wühl
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Most H1N1 Hospitalizations Are in Young Patients

WEDNESDAY, Oct. 21 (HealthDay News) -- More than half of hospitalizations for H1N1 influenza are occurring in people younger than 25 years of age, and very few are occurring in the elderly, according to information presented at the Oct. 20 press briefing by the U.S. Centers for Disease Control and Prevention.

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Sources Find Different Numbers of Active Physicians

WEDNESDAY, Oct. 21 (HealthDay News) -- Estimates from U.S. Census Bureau surveys find fewer older physicians remaining active compared with the American Medical Association Physician Masterfile data, according to research published in the Oct. 21 issue of the Journal of the American Medical Association.

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Cardiovascular Disease Linked to Hip Fracture Risk

TUESDAY, Oct. 20 (HealthDay News) -- The risk of hip fracture is much higher for people who have a diagnosis of cardiovascular disease (CVD), according to a study among Swedish twins reported in the Oct. 21 issue of the Journal of the American Medical Association.

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CDC Says New Child Deaths Raise H1N1 Beyond Epidemic

MONDAY, Oct. 19 (HealthDay News) -- As of Oct.16, 11 more children in the United States had died of H1N1 influenza in the past week, elevating the disease above epidemic proportions, the U.S. Centers for Disease Control and Prevention announced at an Oct. 16 news conference.

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FDA Launches Drug Disposal Advice Web Page

FRIDAY, Oct. 16 (HealthDay News) -- The U.S. Food and Drug Administration has launched a new Web page for consumers to educate them on the safe disposal of certain medicines that can be dangerous or even fatal if they end up in the wrong hands.

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Action Urged to Reduce Global Diarrhea Deaths in Children

THURSDAY, Oct. 15 (HealthDay News) -- In an effort to reduce the worldwide diarrhea death toll among children, the United Nations Children's Fund and the World Health Organization have issued a series of prevention and treatment recommendations and an urgent call-to-action, published online Oct. 14 in The Lancet.

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More Very Preterm Births Is Raising Retinopathy Incidence

WEDNESDAY, Oct. 14 (HealthDay News) -- The increasing number of extremely preterm babies who are surviving is increasing the incidence of retinopathy of prematurity, according to a study published in the October issue of the Archives of Ophthalmology.

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Second-Line Diuretics in Hypertension Reviewed

WEDNESDAY, Oct. 14 (HealthDay News) -- The addition of diuretics as a second-line approach to another anti-hypertensive agent further lowers systolic and diastolic blood pressure, providing the same effect as when used as first-line monotherapy, according to a review published online Oct. 7 in the Cochrane Database of Systematic Reviews.

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Anesthesia Problems More Likely Early in Academic Year

WEDNESDAY, Oct. 14 (HealthDay News) -- Undesirable events are more common among anesthesia trainees at the beginning of the academic year, even in those with more clinical experience, according to research published Oct. 13 in BMJ.

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No Reduction Noted in Surgical Infection After High Oxygen

TUESDAY, Oct. 13 (HealthDay News) -- Administering high levels of oxygen during and after abdominal surgery does not reduce the rate of infection or other complications, according to a study in the Oct. 14 issue of the Journal of the American Medical Association.

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Triple Therapy Beneficial in Chronic Pulmonary Disease

TUESDAY, Oct. 13 (HealthDay News) -- In patients with chronic obstructive pulmonary disease (COPD), triple therapy with budesonide/formoterol added to tiotropium significantly improves lung function and reduces severe exacerbations compared to monotherapy with tiotropium, according to a study published in the Oct. 15 issue of the American Journal of Respiratory and Critical Care Medicine.

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Study Evaluates Hospital Quality and Mortality Rates

TUESDAY, Oct. 13 (HealthDay News) -- Hospital mortality rates in the United States have improved, although major differences in quality still exist between the best and worst hospitals, according to a report published Oct. 13 by HealthGrades.

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H1N1 Has Made Many Young Adult Patients Critically Ill

MONDAY, Oct. 12 (HealthDay News) -- The 2009 influenza A(H1N1) outbreak has put many young adult patients in intensive care with severe respiratory disease, leading to a high fatality rate, according to three studies published online Oct. 12 in the Journal of the American Medical Association.

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Atypical β-Blocker May Improve Endothelial Function

MONDAY, Oct. 12 (HealthDay News) -- Nebivolol, a third generation β-blocker that has recently become available in the United States, offers a treatment alternative for hypertension, coronary artery disease and heart failure that goes beyond simple adrenergic blocking with direct vasodilation and stimulatory effects to improve arterial endothelial function, according to a paper in the Oct. 13 Journal of the American College of Cardiology.

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Exhalation From Ventilation Masks May Pose Infection Risk

MONDAY, Oct. 12 (HealthDay News) -- Leakage of exhaled air from the face masks used for noninvasive positive-pressure ventilation (NPPV) in patients with pneumonia poses a risk of infection for health care workers, according to a study in the Oct. 1 issue of Chest.

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Evidence Scant on Effects of Exercise After Stroke

FRIDAY, Oct. 9 (HealthDay News) -- Aerobic exercise training that involves walking may improve walking ability in individuals following a stroke, but the effects of cardiorespiratory fitness training on death and disability remain unclear, according to research published online Oct. 7 in the Cochrane Database of Systematic Reviews.

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Health Care Disparities Among States Found to Be Widening

FRIDAY, Oct. 9 (HealthDay News) -- Increasing health care costs and growing disparities in coverage among U.S. states point to the urgent need for national health care reform, according to an Oct. 8 state-by-state report card from the Commonwealth Fund Commission, a private foundation supporting research on the health care system.

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Herpes Zoster Infection May Increase Risk of Stroke

FRIDAY, Oct. 9 (HealthDay News) -- The risk of stroke is higher in people who have had a herpes zoster infection than in those with no history of the disease, according to a study published online Oct. 8 in Stroke.

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Study Explores Thrombus Healing by Plaque Type

THURSDAY, Oct. 8 (HealthDay News) -- Thrombus healing in sudden cardiac death victims may depend on the presence of plaque ruptures or erosions, and, in some patients, call for different treatment approaches, according to research published online Oct. 7 in the Journal of the American College of Cardiology.

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Effect of H1N1 on Southern Hemisphere ICUs Assessed

THURSDAY, Oct. 8 (HealthDay News) -- During the winter of 2009 in Australia and New Zealand, the H1N1 flu virus had a significant effect on hospital intensive care units, according to a study published online Oct. 8 in the New England Journal of Medicine.

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ACS Education May Not Reduce Prehospital Delay

THURSDAY, Oct. 8 (HealthDay News) -- In patients at high risk for acute coronary syndrome (ACS), educational and counseling intervention may not lead to decreased hospital arrival times or increased emergency medical services (EMS) use after the onset of symptoms, according to a study published online Oct. 6 in Circulation: Cardiovascular Quality and Outcomes.

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Seasonal Flu Vaccine Protects Somewhat Against A/H1N1

THURSDAY, Oct. 8 (HealthDay News) -- There are early signs that the 2008/2009 trivalent inactivated seasonal flu vaccination offers some protection against influenza A/H1N1, particularly in its most severe forms, but this should not be taken to mean that vaccination against swine flu is superfluous, according to a study published online Oct. 6 in BMJ.

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COPD Combination Therapy Compared to Monotherapy

THURSDAY, Oct. 8 (HealthDay News) -- Treatment with an inhaled corticosteroid (ICS) in combination with long-acting β2-agonist (LABA) did not improve mortality and had more adverse effects than LABA alone in the treatment of severe chronic obstructive pulmonary disease (COPD), according to a meta-analysis in the October issue of Chest.

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Roundtable Discussion Tackles Health Care Reform

WEDNESDAY, Oct. 7 (HealthDay News) -- The health care payment system, the role of consumers in responsible health care spending, and the use of comparative-effectiveness research were topics covered in a roundtable discussion with several health economics experts published in the Oct. 8 issue of the New England Journal of Medicine.

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Perspective - Cutler

Study Reports Lacking Benefit of ICD Early After Heart Attack

WEDNESDAY, Oct. 7 (HealthDay News) -- An implantable cardioverter-defibrillator (ICD) does not reduce the risk of death when given to high-risk patients within a month after a heart attack, according to a study in the Oct. 8 issue of the New England Journal of Medicine.

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Medical Students Want More Practice of Medicine Training

WEDNESDAY, Oct. 7 (HealthDay News) -- Medical students in the United States perceive that they are not getting enough training in the practice of medicine, particularly in medical economics, according to a study in the September issue of Academic Medicine.

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Mother's Use of Antidepressant May Carry Risks for Newborn

WEDNESDAY, Oct. 7 (HealthDay News) -- Newborns who have been exposed in utero to selective serotonin reuptake inhibitors (SSRIs) taken by their mothers are at higher risk for shorter gestational age, preterm delivery and admission to a neonatal intensive care unit, according to a study in the October Archives of Pediatrics & Adolescent Medicine.

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Bovine Lactoferrin May Help Prevent Sepsis in Preemies

TUESDAY, Oct. 6 (HealthDay News) -- In very low birth weight infants, supplementation with bovine lactoferrin, either alone or in combination with the probiotic Lactobacillus rhamnosus GG, may significantly reduce the risk of a first episode of late-onset sepsis, according to a study in the Oct. 7 issue of the Journal of the American Medical Association.

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Effectiveness and Cost Help to Make Coverage Decisions

TUESDAY, Oct. 6 (HealthDay News) -- Countries using evidence-based cost-effectiveness and effectiveness to help make drug coverage decisions show how these factors can successfully support decision making and can also be adapted to the specific conditions of other countries, according to a study in the Oct. 7 issue of the Journal of the American Medical Association.

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Premature Death in China Linked to Hypertension

TUESDAY, Oct. 6 (HealthDay News) -- Elevated blood pressure is one of the leading preventable risk factors for premature death in China, according to a study published online Oct. 6 in The Lancet.

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Burns Often Send Children to the Emergency Room

MONDAY, Oct. 5 (HealthDay News) -- U.S. emergency rooms treat more than 120,000 pediatric burn injuries each year, and children under 6 years of age may be especially likely to sustain serious injuries, according to a study published online Oct. 5 in Pediatrics.

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Early Presentation Remains Uncommon in Stroke Patients

FRIDAY, Oct. 2 (HealthDay News) -- Between 2001 and 2004, there was no change in the proportion of stroke patients who arrived at academic medical centers within two hours of symptom onset. However, usage of intravenous tissue-type plasminogen activator (IV t-PA) in such patients increased, according to a study published online Oct. 1 in Stroke.

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Surgical Masks Found to Be Non-Inferior to Respirators

THURSDAY, Oct. 1 (HealthDay News) -- Surgical masks may be no less effective than N95 respirators in preventing influenza in health care workers, according to a study published online Oct. 1 in the Journal of the American Medical Association.

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CDC Says States Not Meeting Fruit and Veggie Objectives

THURSDAY, Oct. 1 (HealthDay News) -- In a Sept. 29 press release, the U.S. Centers for Disease Control and Prevention says no U.S. state is currently meeting the national Healthy People 2010 objectives for fruit and vegetable consumption.

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