Here are what the editors at HealthDay consider to be the most important developments in Critical Care for September 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.
Advanced Directive Discussions Do Not Appear to Affect Survival
FRIDAY, Sept. 30 (HealthDay News) -- Having advanced directive (AD) discussions or the presence of an AD in the medical records does not appear to result in increased mortality of patients at low or medium risk of death within one year, according to a study published online Sept. 29 in the Journal of Hospital Medicine.
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Doctors, Patients Identify Tacit Clues in Their Interactions
FRIDAY, Sept. 30 (HealthDay News) -- Both doctors and patients identify tacit clues as well as judgments based on these clues during video elicitation interviews of health maintenance examinations, according to a study published in the October issue of the Journal of Evaluation in Clinical Practice.
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Surfactants Feasible for Self-Breathing Preterm Infants
FRIDAY, Sept. 30 (HealthDay News) -- Application of surfactant to spontaneously breathing preterm infants stabilized with continuous positive airway pressure (CPAP) is feasible, and reduces the need for mechanical ventilation, according to a study published online Sept. 30 in The Lancet.
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Prehypertension Tied to Higher Risk of Incident Stroke
THURSDAY, Sept. 29 (HealthDay News) -- Individuals with prehypertension are at significant risk of incident stroke, with the risk increasing substantially among those with higher prehypertensive values, according to a meta-analysis published online Sept. 28 in Neurology.
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Burdensome Transitions Impact End-of-Life Care Quality
WEDNESDAY, Sept. 28 (HealthDay News) -- Burdensome health care transitions in the last months of life are common and are associated with poor quality end-of-life care, according to a study published in the Sept. 29 issue of the New England Journal of Medicine.
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Immune Globulin Therapy Has No Benefit for Neonatal Sepsis
WEDNESDAY, Sept. 28 (HealthDay News) -- Infants with suspected or proven sepsis treated with intravenous immune globulin have no significant difference in outcomes compared to those receiving a placebo, according to a study published in the Sept. 29 issue of the New England Journal of Medicine.
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Child Face Mask Approved to Help Prevent Spread of Germs
WEDNESDAY, Sept. 28 (HealthDay News) -- A child-size, single-use face mask to help prevent the spread of germs in hospitals and other health care settings has been approved by the U.S. Food and Drug Administration.
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Calcineurin-Inhibitor-Sparing Regimens Improve Outcomes
WEDNESDAY, Sept. 28 (HealthDay News) -- Use of calciuneurin-inhibitor-sparing regimens immediately after kidney transplantation is associated with improved outcomes, including less delayed graft function, improved graft function, and less new-onset diabetes, according to a meta-analysis published online Sept. 23 in the Journal of the American Society of Nephrology.
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Cognition Similar for Standard, Intensive Glycemic Control
WEDNESDAY, Sept. 28 (HealthDay News) -- Intensive glycemic lowering is not better than standard glycemic control for preventing cognitive decline in patients with type 2 diabetes, despite a higher total brain volume, according to a study published online Sept. 28 in The Lancet Neurology.
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Operator Experience Tied to Carotid Stenting Mortality Risk
TUESDAY, Sept. 27 (HealthDay News) -- Carotid stenting in older patients performed by operators with low annual volume or less experience is associated with higher 30-day mortality risk, according to a study published in the Sept. 28 issue of the Journal of the American Medical Association.
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U.S. Docs Feel They Give More Patient Care Than Required
TUESDAY, Sept. 27 (HealthDay News) -- Many primary care physicians in the United States believe that their patients are receiving too much medical care, and that the pressure to do more than is necessary could be reduced by malpractice reform, adjusting financial incentives, and spending more time with patients, according to a study published in the Sept. 26 issue of the Archives of Internal Medicine.
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Generic Tacrolimus Safe for Liver, Kidney Recipients
MONDAY, Sept. 26 (HealthDay News) -- Patients who have undergone liver or kidney transplants may safely switch from brand-name to generic tacrolimus with no change in the indices of liver or kidney function or rejection, according to a study published in the September issue of the American Journal of Transplantation.
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Soliris Approval Expanded to Include Rare Blood Disorder
FRIDAY, Sept. 23 (HealthDay News) -- Soliris (eculizumab) has been approved by the U.S. Food and Drug Administration as the first drug to treat atypical hemolytic uremic syndrome (aHUS), a rare blood disease that may trigger kidney failure, stroke or death.
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Risk Up for Patients During Long Interdialytic Interval
WEDNESDAY, Sept. 21 (HealthDay News) -- For patients receiving hemodialysis, mortality and adverse cardiovascular-related events occur mainly on the day after the long interdialytic interval, rather than on other days, according to a study published in the Sept. 22 issue of the New England Journal of Medicine.
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Exposure to Air Pollution Found to Up Transient Risk of MI
WEDNESDAY, Sept. 21 (HealthDay News) -- Short-term exposure to particles with a diameter <10 µm (PM10) and nitrogen dioxide (NO2) in the air is associated with a short-term increased risk of myocardial infarction (MI) one to six hours later, according to a study published online Sept. 20 in BMJ.
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Depression Significantly Ups Stroke Morbidity, Mortality
WEDNESDAY, Sept. 21 (HealthDay News) -- Depression is linked to a significantly increased risk of stroke morbidity and mortality, according to a review published in the Sept. 21 issue of the Journal of the American Medical Association.
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Soft Tissue Sarcoma Therapy Limb Salvage Rate 81 Percent
WEDNESDAY, Sept. 21 (HealthDay News) -- Tumor necrosis factor-α (TNF) and melphalan-based isolated limb perfusion (TM-ILP) therapy has a limb salvage rate of 81 percent in patients with locally advanced extremity soft tissue sarcomas (STSs) who would have otherwise undergone amputation, according to a study published online Sept. 19 in the Journal of Clinical Oncology.
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Preterm Birth Ups Mortality Risk in Young Adulthood
WEDNESDAY, Sept. 21 (HealthDay News) -- Low gestational age at birth is associated with increased mortality in young adulthood, according to a study published in the Sept. 21 issue of the Journal of the American Medical Association.
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Mortality Up in Hospitals With More Minority Trauma Patients
WEDNESDAY, Sept. 21 (HealthDay News) -- The odds of in-hospital mortality for trauma patients are associated with the proportion of minority patients in the hospital, according to a study published online Sept. 19 in the Archives of Surgery.
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Platelet Reactivity Status Predicts Ischemic Event Risk
TUESDAY, Sept. 20 (HealthDay News) -- High residual platelet reactivity (HRPR) after clopidogrel loading is significantly associated with an increased risk of short- and long-term ischemic events in patients receiving platelet reactivity-guided antithrombotic medication after percutaneous coronary intervention (PCI), according to a study published in the Sept. 21 issue of the Journal of the American Medical Association.
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Chronic Total Occlusion PCI Improves Outcomes in Diabetes
TUESDAY, Sept. 20 (HealthDay News) -- Percutaneous coronary intervention (PCI) of chronic total occlusions (CTOs) is associated with reduced mortality and reduced need for coronary artery bypass grafting in patients with diabetes mellitus (DM), according to a study published in the Oct. 1 issue of The American Journal of Cardiology.
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Payer Status Affects Health Care Quality and Outcomes
TUESDAY, Sept. 20 (HealthDay News) -- Patients with heart failure who have no insurance, or have Medicaid or Medicare, have lower quality of care and worse outcomes than those with private/health maintenance organization (HMO) insurance, according to a study published in the Sept. 27 issue of the Journal of the American College of Cardiology.
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Treatment Delays Identified in Regional STEMI Systems
TUESDAY, Sept. 20 (HealthDay News) -- Treatment delays occur in standardized regional systems for transfer of patients with ST-segment-elevation myocardial infarction (STEMI) to receive primary percutaneous coronary intervention (PCI), with delays most frequently occurring at the referral hospital, PCI center, and during the transport process, according to a study published online Sept. 19 in Circulation.
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Lower Sudden Death Risk With Add-On Antiepileptic Therapy
TUESDAY, Sept. 20 (HealthDay News) -- Patients with refractory epilepsy who are treated with adjunctive antiepileptic drugs (AEDs) at efficacious doses may have lower incidence of sudden unexpected death in epilepsy (SUDEP) compared with those receiving a placebo, according to a meta-analysis published online Sept. 20 in The Lancet Neurology.
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Work Intensity Similar Across Physician Specialties
MONDAY, Sept. 19 (HealthDay News) -- The level of physician work intensity appears to be similar among specialties, with variations in the specific dimensions of stress, physical demands, performance, and temporal demand, according to a study published online Sept. 3 in Medical Care.
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MS-Related Disorders ID'd by Proteomic Pattern Analysis
MONDAY, Sept. 19 (HealthDay News) -- Proteomic pattern analysis of cerebrospinal fluid (CSF) analysis using matrix-assisted laser desorption/ionization time-of-flight (MALDI) mass spectrometry distinguishes between similar multiple sclerosis (MS)-related disorders, according to a study published online Sept. 12 in the Annals of Neurology.
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Enoxaparin Bests Unfractionated Heparin in Occlusive PAD
MONDAY, Sept. 19 (HealthDay News) -- Intravenous enoxaparin is safe and more effective than unfractionated heparin (UFH) for treating peripheral arterial occlusive disease (PAOD), according to a study published online Sept. 12 in the Journal of Thrombosis and Haemostasis.
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Child Abuse Head Trauma Rates Increase During Recession
MONDAY, Sept. 19 (HealthDay News) -- The rate of abusive head trauma (AHT) in children increased significantly in three U.S. geographic regions during the recent economic recession, according to a study published online Sept. 19 in Pediatrics.
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Treatable Disorders Often Misdiagnosed As Creutzfeldt-Jakob
FRIDAY, Sept. 16 (HealthDay News) -- Patients with potentially treatable disorders may be misdiagnosed with Creutzfeldt-Jakob disease (CJD), according to a study published in the September issue of the Annals of Neurology.
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Thrombomodulin Gene Variants Up Post-CABG Mortality Risk
FRIDAY, Sept. 16 (HealthDay News) -- Genetic variants in the thrombomodulin gene (THBD) are independently associated with an increased risk of long-term all-cause mortality after coronary artery bypass graft (CABG) surgery, according to a study published in the Sept. 13 issue of Circulation.
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Statins After Ischemic Stroke Not Tied to Brain Hemorrhage
FRIDAY, Sept. 16 (HealthDay News) -- Exposure to statins after acute ischemic stroke is not associated with intracerebral hemorrhage (ICH), according to a study published online Sept. 12 in the Archives of Neurology.
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Pre-Liver Transplant Serum Ferritin Level Predicts Mortality
FRIDAY, Sept. 16 (HealthDay News) -- Elevated serum ferritin (SF) concentration in combination with low transferrin saturation (TFS) prior to liver transplantation (LT) is an independent predictor of mortality following transplantation, according to a study published online Sept. 2 in Hepatology.
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Hospital Births More Than Halve Neonatal Deaths in China
FRIDAY, Sept. 16 (HealthDay News) -- The implementation of a large-scale, facility-based strategy of intrapartum care and hospital births significantly reduced neonatal mortality in China between 1996 and 2008, according to a study published online Sept. 16 in The Lancet.
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CDC: MRSA USA300 Strain Resistant to Topical Antibiotics
FRIDAY, Sept. 16 (HealthDay News) -- Most methicillin-resistant Staphylococcus aureus (MRSA) isolates are susceptible to bacitracin, but MRSA USA300 isolates show resistance to bacitracin and neomycin, according to a study published online Sept. 14 in the U.S. Centers for Disease Control and Prevention's Emerging Infectious Diseases.
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Anti-Nausea Drug May Lead to Dangerous Heart Rhythms
THURSDAY, Sept. 15 (HealthDay News) -- Zofran (ondansetron), used to prevent nausea in patients receiving cancer treatment, is undergoing an ongoing safety review and labeling change by the U.S. Food and Drug Administration because it may cause potentially fatal changes in heart rhythm, according to a Sept. 15 FDA safety alert.
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CDC: Risk Factors ID'd in Most C. difficile Diarrhea Cases
THURSDAY, Sept. 15 (HealthDay News) -- The majority of patients with diarrhea caused by Clostridium difficile (C. difficile) infection (CDI) have recognized risk factors or a co-infection with another pathogen, according to a study published online Sept. 14 in the U.S. Centers for Disease Control and Prevention's Emerging Infectious Diseases.
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Congenital Heart Disease Ups Endotoxemia Risk in Children
WEDNESDAY, Sept. 14 (HealthDay News) -- Children undergoing surgery for congenital heart disease are at an increased risk of intestinal mucosal injury, endotoxemia, and activation of endotoxin signaling pathways that are associated with adverse outcome, according to a study published online Aug. 25 in the American Journal of Respiratory and Critical Care Medicine.
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Sorafenib Plus DEB-TACE Safe, Tolerated in Unresectable HCC
WEDNESDAY, Sept. 14 (HealthDay News) -- In patients with unresectable hepatocellular carcinoma (HCC), combined treatment with transarterial chemoembolization (TACE) with doxorubicin-eluting beads (DEB) and sorafenib is well tolerated and safe, according to a study published online Sept. 12 in the Journal of Clinical Oncology.
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Mortality Gap Widening for Schizophrenia, Bipolar Disorder
WEDNESDAY, Sept. 14 (HealthDay News) -- By 2006, the standardized mortality ratios for individuals with schizophrenia or bipolar disorder was approximately double the population average, with the mortality gap increasing over time, according to a study published online Sept. 13 in BMJ.
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Number of Lymph Nodes Tested for Colon CA Up 1988 to 2008
TUESDAY, Sept. 13 (HealthDay News) -- For patients treated surgically for colon cancer, the number of lymph nodes evaluated increased from 1988 to 2008; however, there was no significant increase in lymph node positivity during the same period, according to a study published in the Sept. 14 issue of the Journal of the American Medical Association.
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Aortic Dissection Incidence Higher in Individuals With BAV
TUESDAY, Sept. 13 (HealthDay News) -- Aortic dissection incidence is higher in individuals with bicuspid aortic valves (BAVs) than in the general population, according to a study published in the Sept. 14 issue of the Journal of the American Medical Association.
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Febrile Seizures Tied to Systemic Respiratory Alkalosis
TUESDAY, Sept. 13 (HealthDay News) -- Febrile seizures (FS) in children are associated with systemic respiratory alkalosis, and the lack of FS in children with gastroenteritis (GE) may be attributable to the low pH in GE, according to a study published online Sept. 13 in Epilepsia.
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Metabolic Syndrome Beats Obesity for Heart Failure Risk
TUESDAY, Sept. 13 (HealthDay News) -- Obese individuals who are metabolically healthy have a lower risk of heart failure than those with metabolic syndrome (MetS) who are normal weight, according to a study published in the Sept. 20 issue of the Journal of the American College of Cardiology.
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Current Smoking Tied to Higher Risk of Hodgkin's Lymphoma
TUESDAY, Sept. 13 (HealthDay News) -- Current cigarette smoking is associated with an increased risk of developing Hodgkin's lymphoma (HL), with an elevated risk for men and older individuals, which increases with intensity and duration of smoking, according to a meta-analysis published online Sept. 12 in the Journal of Clinical Oncology.
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Ureteral Access Sheaths Safe in Urothelial Carcinoma
MONDAY, Sept. 12 (HealthDay News) -- Ureteral access sheaths (UASs) are safe for use in the diagnosis and treatment of upper tract urothelial carcinoma (UTUC), facilitate acquisition of multiple biopsy specimens adequate for histopathologic evaluation, and minimize the need for repeat diagnostic procedures, according to a study published in the September issue of Urology.
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Clopidogrel Adherence Tied to Daily Pre-PCI Med Adherence
MONDAY, Sept. 12 (HealthDay News) -- Low patient adherence to daily medication regimens before percutaneous coronary intervention (PCI) is a good predictor of low clopidogrel adherence after PCI, according to a study published in the Sept. 15 issue of The American Journal of Cardiology.
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~13 Percent of Trauma Patients Re-Present Post Discharge
FRIDAY, Sept. 9 (HealthDay News) -- A substantial percentage of trauma patients, particularly those who are uninsured, publicly insured, or who belong to low-income neighborhoods, re-present to the emergency department within 30 days of discharge from the hospital, but only a small percentage of these need readmission, according to a study published online June 20 in the Annals of Emergency Medicine.
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64-MDCT Improves Radiologic Workflow in Mass Casualties
FRIDAY, Sept. 9 (HealthDay News) -- The implementation of an emergency radiology protocol using a modern 64-multidetector computed tomography (MDCT) scanner coupled with volume image reading during a mass casualty incident improves radiologic workflow, according to a study published in the September issue of the American Journal of Roentgenology.
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Child's Death Ups Mortality Risk in Bereaved Parents
FRIDAY, Sept. 9 (HealthDay News) -- Parents experiencing stillbirth or death of an infant during the first year of life (bereaved parents) have a significantly increased risk of mortality up to an average of 25 years compared with non-bereaved parents, according to a study published online Sept. 1 in BMJ: Supportive & Palliative Care.
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MRSA Colonization Ups Future Infection Risk in Children
THURSDAY, Sept. 8 (HealthDay News) -- Children with colonizations of methicillin-resistant Staphylococcus aureus (MRSA) on admission to hospital have an increased risk of subsequent MRSA infection, according to a study published online Aug. 29 in Clinical Infectious Diseases.
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Stenting Inferior to Aggressive Medical Management in Stroke
WEDNESDAY, Sept. 7 (HealthDay News) -- Medical management alone is better at preventing recurrent stroke for patients with intracranial arterial stenosis than in combination with percutaneous transluminal angioplasty and stenting (PTAS), according to a study published online Sept. 7 in the New England Journal of Medicine.
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Medical Students Show Racial, Cultural Patient Preference
WEDNESDAY, Sept. 7 (HealthDay News) -- Medical students may have a preferential bias toward whites and wealthier patients, but this does not appear to influence their clinical decision making or physician-patient interactions, according to a study published in the Sept. 7 medical education-themed issue of the Journal of the American Medical Association.
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Odds of Board Certification Vary in New Doctors
WEDNESDAY, Sept. 7 (HealthDay News) -- Certification of recent U.S. medical school graduates by the American Board of Medical Specialties (ABMS) varies across specialties by educational and demographic factors, according to a study published in the Sept. 7 medical education-themed issue of the Journal of the American Medical Association.
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Many Hospital Staff Uniforms Contaminated With Bacteria
WEDNESDAY, Sept. 7 (HealthDay News) -- More than 60 percent of hospital staff uniforms are contaminated with potentially pathogenic bacteria, including drug-resistant species, according to a study published in the September issue of the American Journal of Infection Control.
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Training Protocols Do Not Affect Ventilation Knowledge
TUESDAY, Sept. 6 (HealthDay News) -- For first-time examinees of the American Board of Internal Medicine (ABIM), training in a high-intensity ventilator protocol environment does not correlate with worse knowledge about mechanical ventilation management compared to training in a low-intensity environment, according to a study published in the Sept. 7 medical education-themed issue of the Journal of the American Medical Association.
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Cases of Transfusion-Linked Babesiosis in U.S. Described
TUESDAY, Sept. 6 (HealthDay News) -- From 1979 to 2009, 159 Babesia microti (B. microti) transfusion-associated cases of Babesiosis were identified in the United States, and occurrence was not limited by season or region, according to a study published online Sept. 5 in the Annals of Internal Medicine.
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Immunoadsorption Therapy Effective in E. coli-Induced HUS
TUESDAY, Sept. 6 (HealthDay News) -- Immunoadsorption of immunoglobulin G (IgG) antibodies can safely be used to treat neurological complications in patients with Escherichia coli (E. coli) O104:H4-induced hemolytic uremic syndrome (HUS), according to a study published online Sept. 5 in The Lancet.
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More Than 50 Air, Paintball Gun Injuries Present Daily to ER
TUESDAY, Sept. 6 (HealthDay News) -- In 2008, an average of 56 emergency department visits per day were due to air and paintball gun injuries, with more visits for males, children, and adolescents, according to an August statistical brief based on Healthcare Cost and Utilization Project data published by the Agency for Healthcare Research and Quality (AHRQ).
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Palliative Coronary Stenting Safe and Feasible in Infants
TUESDAY, Sept. 6 (HealthDay News) -- Coronary artery stent implantation is a feasible and safe palliative option in infants and young children with coronary artery stenosis, according to a study published online Aug. 30 in Catheterization and Cardiovascular Interventions.
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Increase in Child/Young Adult Stroke Hospitalization Rate
TUESDAY, Sept. 6 (HealthDay News) -- The rates of hospitalization due to acute ischemic stroke increased in children and young adults of all age and gender groups from 1995 to 2008, except females aged 5 to 14 years, according to a study published online Sept. 2 in the Annals of Neurology.
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Increase in Infection Incidence With Cardiac Device Implants
THURSDAY, Sept. 1 (HealthDay News) -- The incidence of infection in patients with cardiac implantable electrophysiological devices (CIEDs) remained constant from 1993 to 2004, and increased from 2004 to 2008, according to a study published in the Aug. 30 issue of the Journal of American College of Cardiology.
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Traumatic Brain Injury Deaths Tied to Life Support Removal
THURSDAY, Sept. 1 (HealthDay News) -- For patients with traumatic brain injury, most deaths are associated with withdrawal of life-sustaining therapy, according to a study published online Aug. 29 in CMAJ, the journal of the Canadian Medical Association.
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