April 2011 Briefing - Emergency Medicine

Here are what the editors at HealthDay consider to be the most important developments in Emergency Medicine for April 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.

Fractures Seen in Older Levothyroxine Users

FRIDAY, April 29 (HealthDay News) -- Older people who take levothyroxine may be at risk for fractures, particularly if their cumulative doses are medium or high, according to research published online April 28 in BMJ.

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Height and Obesity May Raise Venous Thromboembolism Risk

FRIDAY, April 29 (HealthDay News) -- Tall men may have an increased risk of venous thromboembolism (VTE); whereas tall stature and obesity are associated with an increased VTE risk in both men and women, according to a study published online April 28 in Arteriosclerosis, Thrombosis, and Vascular Biology.

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CDC: Injuries Cause More Missed Days in Older Workers

THURSDAY, April 28 (HealthDay News) -- While older workers, aged ≥55 years, represented just 17 percent of employer-reported nonfatal occupational injuries and illnesses in 2009, the median number of days older workers spent absent from work exceeded that of younger age groups, according to a report in the April 29 issue of the U.S. Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

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Infarct Size Varies According to Time of Day

THURSDAY, April 28 (HealthDay News) -- Significant variations in infarct size are associated with circadian oscillations at the time of ST-segment elevation myocardial infarction (STEMI) onset, with the largest infarcts occurring during the dark-to-light transition period (6:00 am to noon), according to a study published online April 27 in Heart.

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Low-Dose Aspirin Affects Post-Surgery Blood Drainage

WEDNESDAY, April 27 (HealthDay News) -- Patients taking low-dose aspirin have significantly increased blood drainage and are at increased risk of complications after spinal surgery, even if they stop taking aspirin seven days before surgery, according to a study published in the April issue of The Spine Journal.

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Lung Problems Common During and After Natural Disasters

WEDNESDAY, April 27 (HealthDay News) -- Pulmonary complications resulting from direct or indirect injury to the lung are a major cause of morbidity and mortality following natural disasters, according to a review published in the April issue of Respirology.

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Post-Vietnam-Era Vets Have Highest Substance Use Rate

WEDNESDAY, April 27 (HealthDay News) -- Substance use rates are highest in war veterans who served in the post-Vietnam era (VET), and in those who served in Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) in Iraq and Afghanistan and have comorbid diagnoses of bipolar disorder and schizophrenia, according to a study published in the May-June issue of the American Journal on Addictions.

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Specialist Transfer to Patients With MI Improves Outcome

WEDNESDAY, April 27 (HealthDay News) -- Transfer of qualified interventionalists to hospitals without interventionalists qualified for primary percutaneous coronary intervention (PPCI) may be more effective at improving care of patients with acute ST-segment elevation myocardial infarction (STEMI) than transferring patients to hospitals with qualified interventionalists, particularly where patient transfers could be delayed by congestion, according to a study published online April 26 in Circulation: Cardiovascular Quality and Outcomes.

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More MI Treatments Tied to Decreased Mortality in Sweden

TUESDAY, April 26 (HealthDay News) -- For patients with ST-elevation myocardial infarction (STEMI) in Sweden, an increase in evidence-based treatments is associated with a decrease in 30-day and one-year mortality, according to a study published in the April 27 issue of the Journal of the American Medical Association.

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ACC/AHA Issue Blood Pressure Control Guidelines for Elderly

TUESDAY, April 26 (HealthDay News) -- The American College of Cardiology (ACC) and the American Heart Association (AHA) have released a consensus document to help clinicians control and reduce the risks for high blood pressure in elderly adults; the document has been published online April 25 in the Journal of the American College of Cardiology.

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Inhaled Corticosteroids May Decrease Mortality in COPD

MONDAY, April 25 (HealthDay News) -- Prior use of inhaled corticosteroids (ICS) in patients with chronic obstructive pulmonary disease (COPD) is associated with a decreased risk of short-term mortality and use of mechanical ventilation following hospitalization for pneumonia, according to a study published online April 21 in the American Journal of Respiratory and Critical Care Medicine.

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Studies Add to Evidence on Clot Risk Tied to Contraceptives

FRIDAY, April 22 (HealthDay News) -- Oral contraceptives containing drospirenone appear to be associated with a higher risk of non-fatal venous thromboembolism than formulations containing levonorgestrel, according to two studies published online April 21 in BMJ.

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Depression After Traumatic Brain Injury Common

THURSDAY, April 21 (HealthDay News) -- About 30 percent of people who suffer traumatic brain injury (TBI) will experience depression, but there is a dearth of evidence to guide the care of the 1.2 million people in the United States who experience TBI each year, according to research published by the Agency for Healthcare Research and Quality.

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Researchers Review Risks Tied to Nuclear Accidents

THURSDAY, April 21 (HealthDay News) -- In a new article, researchers review the short- and long-term health risks associated with nuclear power plant accidents in light of the recent earthquake in Japan that caused substantial damage to a nuclear plant. The article has been published online April 20 in the New England Journal of Medicine.

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Uremic Patients Risk Spinal Surgery Complications

WEDNESDAY, April 20 (HealthDay News) -- Uremic patients undergoing posterior instrumented lumbar spinal surgery have similar solid fusion rates, but are at increased risk of complications compared to controls, according to a study published in the April 15 issue of Spine.

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More Than Five Million Youth Treated for Football Injuries

WEDNESDAY, April 20 (HealthDay News) -- An estimated 5.25 million children and adolescents in the age group 6 to 17 years were treated for football-related injury in U.S. emergency departments from 1990 to 2007, according to a study published in the March issue of Clinical Pediatrics.

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Arterial Obstruction Status Impacts IV Thrombolysis Benefit

WEDNESDAY, April 20 (HealthDay News) -- The infarct growth attenuating treatment effect of tissue plasminogen activator (tPA) is greater in ischemic stroke patients with arterial obstruction, according to a study published online April 7 in the Annals of Neurology.

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Low-Cost Thromboprophylaxis by Electronic Alerts Effective

WEDNESDAY, April 20 (HealthDay News) -- Electronic alert (e-alert) systems are cost-effective tools for reducing venous thromboembolism (VTE) in hospitalized patients, according to a study published online April 11 in the Journal of Thrombosis and Haemostasis.

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Perioperative MI Common and Usually Asymptomatic

WEDNESDAY, April 20 (HealthDay News) -- Perioperative myocardial infarction (MI) after noncardiac surgery is the most common major vascular complication, with most patients not experiencing ischemic symptoms, according to a study published in the April 19 issue of the Annals of Internal Medicine.

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New Test Effective for Detection of Tuberculosis

TUESDAY, April 19 (HealthDay News) -- Diagnosis of Mycobacterium tuberculosis (MTB) and rifampicin resistance (RIF), detected by the MTB/RIF test, is accurate and feasible in resource-poor countries, according to a study published online April 19 in The Lancet.

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Airway Exam Rare in Infants With Life-Threatening Events

TUESDAY, April 19 (HealthDay News) -- Well-appearing infants hospitalized with apparent life-threatening events (ALTEs) rarely undergo airway evaluation or require subsequent otolaryngologic surgical intervention, according to research published in the April issue of the Archives of Otolaryngology -- Head & Neck Surgery.

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Do-Not-Resuscitate Order Linked to Increased Surgical Mortality

MONDAY, April 18 (HealthDay News) -- Surgical patients with do-not-resuscitate (DNR) orders have more complications and a higher mortality rate than non-DNR patients, according to a study published online April 18 in the Archives of Surgery.

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Injecting Facility Reduces Illicit Drug Use Overdose Deaths

MONDAY, April 18 (HealthDay News) -- A supervised injecting facility (SIF), where drug users can inject pre-obtained illicit drugs, appears to reduce overdose mortality, according to a study published online April 18 in The Lancet.

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Insulin Resistance Linked to Increased Preeclampsia Risk

MONDAY, April 18 (HealthDay News) -- Mid-trimester maternal insulin resistance is associated with subsequent preeclampsia, according to a study published in the April issue of the American Journal of Obstetrics & Gynecology.

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Left Atrial Distensibility Predicts Heart Attack Outcomes

MONDAY, April 18 (HealthDay News) -- The distensibility of the heart's left atrium (LA) can identify patients with elevated left ventricular filling pressure (LVFP) after an acute myocardial infarction (AMI), and it is a predictor of in-hospital mortality, according to a study published in the April 15 issue of The American Journal of Cardiology.

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Stroke Outcomes Similar in Children and Young Adults

FRIDAY, April 15 (HealthDay News) -- Children and young adults who experience acute ischemic stroke tend to have similar stroke severity and clinical outcomes, even though they have different etiology and risk factors, according to a study published online March 21 in the Annals of Neurology.

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Geneva Score Prognostic in Patients Ruled Out for PE

FRIDAY, April 15 (HealthDay News) -- Assessment of clinical probability with a revised Geneva score (RGS) could help predict prognosis in patients for whom pulmonary embolism (PE) has been ruled out, according to research published in the April issue of the Journal of Internal Medicine.

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New Method May Quantify Response to Spinal Cord Injury

FRIDAY, April 15 (HealthDay News) -- Inflammation after a spinal cord injury (SCI) is nonresolving, and can be characterized by quantification of lymphocytes using resolution indexes (Ri) and resolution plateaus (Rp), according to an experimental study published online March 22 in Brain Pathology.

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Neighborhood Social Cohesion May Reduce Stroke Mortality

FRIDAY, April 15 (HealthDay News) -- Social cohesion at the neighborhood level is associated with a protective effect against stroke mortality, especially for whites, according to a study published online April 14 in Stroke.

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FDA: Penumbra Coil 400 System Recalled

THURSDAY, April 14 (HealthDay News) -- The U.S. Food and Drug Administration has notified health care providers of a class 1 recall of Penumbra Inc.'s Penumbra Coil 400 system, as a defect may cause premature detachment of the coil, which can lead to serious injury, including blood clots and stroke, due to the coil unintentionally migrating.

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Less Fast Food Eaten After Acute Myocardial Infarction

THURSDAY, April 14 (HealthDay News) -- Patients with acute myocardial infarction (AMI) significantly reduce the amount of fast food they consume six months after AMI, but certain populations still eat fast food on a weekly basis, according to a study published in the April 15 issue of The American Journal of Cardiology.

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Anesthesia Complications Twice As Likely in Obese

THURSDAY, April 14 (HealthDay News) -- Airway management is a basic anesthetic responsibility and skill, and strategies need to be implemented to appropriately manage difficult airways, according to the Fourth National Audit Project (NAP4) of the Royal College of Anaesthetists and the Difficult Airway Society, published online March 29 in the British Journal of Anaesthesia.

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Incidence of and Hospitalization for Dengue Fever Escalate

THURSDAY, April 14 (HealthDay News) -- The incidence of and hospitalization for dengue fever increased significantly from 2000 to 2007, according to a study published online April 13 in Emerging Infectious Diseases.

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New RX for Large Brain Aneurysm

WEDNESDAY, April 13 (HealthDay News) -- A new option to repair a large aneurysm in the brain has been approved by the U.S. Food and Drug Administration.

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Fixed-Dose Combos Equally Effective in TB Treatment

TUESDAY, April 12 (HealthDay News) -- Compared with separately administered drugs, a four-drug fixed-dose combination (FDC) regimen partially satisfies noninferiority criteria for tuberculosis treatment, according to a study published April 13 in an infectious disease and immunology themed issue of the Journal of the American Medical Association.

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Glucose Variability Has No Cardio Protective Role

TUESDAY, April 12 (HealthDay News) -- Reduction in intraday glucose variability (GV) in treatment of patients with type 2 diabetes does not affect subsequent secondary cardiovascular events, according to a study published in the April issue of Diabetes Care.

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FDA OKs Rapid Test to Spot C. difficile Infection

FRIDAY, April 8 (HealthDay News) -- A test designed to rapidly detect the genetic fingerprint of Clostridium difficile bacterial infection has been approved by the U.S. Food and Drug Administration.

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Virtual Reality Improves Stroke Patients' Motor Skills

FRIDAY, April 8 (HealthDay News) -- Virtual reality (VR) technology can assist in arm motor recovery after stroke, according to a meta-analysis published online April 7 in Stroke.

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'Global Trigger Tool' Identifies 10 Times More Errors

THURSDAY, April 7 (HealthDay News) -- Use of the new Global Trigger Tool, developed by the Institute for Healthcare Improvement, detects at least 10 times more adverse events than other methods currently in use, according to a study published in the April issue of Health Affairs.

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Partner Violence Victims Not Identified in Emergency Room

THURSDAY, April 7 (HealthDay News) -- Although most victims of intimate partner violence (IPV) present to the emergency department (ED), they are not usually identified and may not receive interventions, according to a study published online March 15 in the Journal of General Internal Medicine.

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Respiratory Distress Syndrome Tied to Long-Term Problems

WEDNESDAY, April 6 (HealthDay News) -- People who experience acute respiratory distress syndrome (ARDS) may feel the ramifications long after discharge in terms of physical limitations, psychological problems, and incurred costs, according to research published in the April 7 issue of the New England Journal of Medicine.

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Device Approved to Treat Brain Aneurysm

WEDNESDAY, April 6 (HealthDay News) -- A new device to treat brain aneurysm has been approved by the U.S. Food and Drug Administration.

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Reduced Mortality in Very Elderly Heart Failure Patients

WEDNESDAY, April 6 (HealthDay News) -- In the last decade, mortality for elderly heart failure patients has improved, but readmission to the hospital still occurs frequently, according to a study published online April 5 in Circulation: Heart Failure.

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Increase in Pediatric CT Scans in Emergency Departments

WEDNESDAY, April 6 (HealthDay News) -- The use of computed tomography (CT) scans in children presenting to U.S. emergency departments (EDs) has increased five-fold from 1995 to 2008, and mainly occurs in nonpediatric facilities, according to a study published online April 5 in Radiology.

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Non-Communicable Diseases Present a Global Health Crisis

WEDNESDAY, April 6 (HealthDay News) -- The global burden of non-communicable diseases (NCDs) is increasing, and a global movement is needed to tackle them, according to a report published online April 6 in The Lancet.

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Alteration in Health Outcomes Post Estrogen Therapy

TUESDAY, April 5 (HealthDay News) -- Among postmenopausal women with prior hysterectomy, cessation of conjugated equine estrogen (CEE) therapy reduces the risk of stroke, and the risk of breast cancer remains reduced, according to a study to be published on April 6 in the Journal of the American Medical Association.

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Sudden Death Among Athletes Higher Than Formerly Reported

TUESDAY, April 5 (HealthDay News) -- The incidence of sudden cardiac death (SCD) in National Collegiate Athletic Association (NCAA) student-athletes is higher than previous estimates suggest, with a rate of one in 43,770 athletes suffering SCD, according to a study published online April 4 in Circulation.

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High-Impact Activities Increase Fracture Risk in Girls

TUESDAY, April 5 (HealthDay News) -- Specific high-impact activities, including basketball, running, gymnastics, and cheerleading, significantly increase the risk of stress fractures among adolescent girls, according to a study published online April 4 in the Archives of Pediatrics & Adolescent Medicine.

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Autoimmune Diseases Number Two Cause of Chronic Illness

FRIDAY, April 1 (HealthDay News) -- Autoimmune diseases are the second leading cause of chronic illness in the United States and constitute a major direct and indirect economic burden to the U.S. health care system, according to a report released by the American Autoimmune Related Diseases Association (AARDA) on March 22 at a congressional briefing.

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