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April 2013 Briefing - Emergency Medicine

Here are what the editors at HealthDay consider to be the most important developments in Emergency Medicine for April 2013. 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.

More Than One-Third of Stroke Patients Don't Utilize EMS

TUESDAY, April 30 (HealthDay News) -- More than one-third of stroke patients still do not use emergency medical services (EMS), despite the fact that EMS use is linked to significantly more rapid evaluation and treatment, according to a study published online April 29 in Circulation: Cardiovascular Quality and Outcomes.

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FDA Approves Kcentra to Reverse Anticoagulation

TUESDAY, April 30 (HealthDay News) -- Kcentra (prothrombin complex concentrate, human) has been approved by the U.S. Food and Drug Administration to treat severe acute bleeding in adults after administration of warfarin and similar products.

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FDA Concerned Caffeinated Foods Could Harm Children

TUESDAY, April 30 (HealthDay News) -- On the heels of the introduction of a new chewing gum containing as much caffeine as half a cup of coffee, the U.S. Food and Drug Administration is taking a closer look at the impact of caffeinated products on children's health.

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Multicenter Study Links Peri-Op SSRI Use to Adverse Outcomes

TUESDAY, April 30 (HealthDay News) -- Perioperative use of selective serotonin reuptake inhibitors (SSRIs) is associated with adverse outcomes, including in-hospital mortality, bleeding, and 30-day readmission, according to a multicenter study published online April 29 in JAMA Internal Medicine.

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Renewed Efforts From AAFP to Repeal OTC Provision in ACA

TUESDAY, April 30 (HealthDay News) -- Members of the American Academy of Family Physicians (AAFP) and other medical associations are urging further consideration of Section 9003 of the Patient Protection and Affordable Care Act (ACA) that requires holders of tax-preferred health care accounts to obtain a physician's prescription to use funds from those accounts to pay for over-the-counter (OTC) medications. The concerns have been laid out in a letter to the chair and the ranking member of the House Committee on Ways and Means.

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FDA Announces New Network to Focus Exclusively on Patients

MONDAY, April 29 (HealthDay News) -- The U.S. Food and Drug Administration has announced the launch of a new interactive tool for educating patients, their advocates, and consumers about the processes involved in medication development.

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Standardized Debriefing Ups Outcomes on CPR Simulation

MONDAY, April 29 (HealthDay News) -- Use of a standardized debriefing script during resuscitation training programs conducted by novice instructors is associated with improved acquisition of knowledge and team leader behavioral performance in subsequent simulated cardiopulmonary arrests, according to a study published online April 22 in JAMA Pediatrics.

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Medical Interns Spending Less Time With Patients

FRIDAY, April 26 (HealthDay News) -- Medical interns are spending less time with patients and more time at a computer since new rules limiting total work hours were instituted in 2011, according to a study published online April 18 in the Journal of General Internal Medicine.

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Saturday Marks Sixth Annual Rx Drug Take-Back Day

FRIDAY, April 26 (HealthDay News) -- United States residents across the nation will have an opportunity to safely and anonymously unload expired, unwanted prescription medications on Saturday, April 27, during the sixth annual National Prescription Drug Take-Back Day.

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Review: All Approved Drugs Similarly Prevent Migraines

THURSDAY, April 25 (HealthDay News) -- There is no significant difference in effectiveness in approved drugs for preventing episodic migraine frequency by 50 percent or more, according to a review published in the April issue of the Journal of General Internal Medicine.

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Insurance Prior Authorization Doesn't Up Psych ER Stay

THURSDAY, April 25 (HealthDay News) -- For psychiatric patients, the requirement to obtain authorization from insurance companies prior to admission does not seem to add to the total time spent in emergency departments, according to a study published in the May issue of the Annals of Emergency Medicine.

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Analgesics in Endurance Events Can Have Serious Adverse Effects

THURSDAY, April 25 (HealthDay News) -- Analgesic use before endurance sports can cause serious medical events, according to a study published online April 19 in BMJ Open.

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Air Pollution Linked to Marker of Atherosclerosis

THURSDAY, April 25 (HealthDay News) -- Greater exposure to air pollution is associated with greater progression of carotid artery thickness, a marker of atherosclerosis, according to a study published online April 23 in PLOS Medicine.

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Prevalence, Costs of Heart Failure Estimated for 2030

THURSDAY, April 25 (HealthDay News) -- The impact of heart failure is likely to increase, with more than eight million U.S. adults anticipated to have heart failure by 2030, at an estimated total cost of $70 billion, according to a study published online April 24 in Circulation: Heart Failure.

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Physicians Less Empathetic in Talking to Heavy Patients

THURSDAY, April 25 (HealthDay News) -- Primary care physicians (PCPs) are less likely to bond with overweight and obese patients, according to research published online March 20 in Obesity.

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Most With Confirmed H7N9 Avian Flu Are Critically Ill

THURSDAY, April 25 (HealthDay News) -- Most Chinese patients with confirmed avian influenza A (H7N9) are critically ill and 21 percent have died, according to a preliminary report published online April 24 in the New England Journal of Medicine.

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Breast CA Tx Delays Still More Common for Poor, Uninsured

WEDNESDAY, April 24 (HealthDay News) -- For young women with breast cancer, a longer treatment delay time (TDT) is associated with decreased survival, especially for African-American women, those with public or no insurance, and those with low socioeconomic status; and women with early-stage breast cancer with Medicaid are more likely to undergo mastectomy than those with private insurance, according to two studies published online April 24 in JAMA Surgery.

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Doc Describes Medical Tent Experience of Boston Marathon

WEDNESDAY, April 24 (HealthDay News) -- The experience of a physician in the medical tent at the Boston marathon provides insight into the impact of the bombings on medical professionals at the scene; the perspective piece was published online April 23 in the New England Journal of Medicine.

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Asthma Health Care Access Worse for Young Adults

WEDNESDAY, April 24 (HealthDay News) -- Young adults with asthma have worse health care access and utilization compared with adolescents with asthma, according to a study published online April 22 in Pediatrics.

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Review Looks at Best Modality for Diagnosing Ectopic Pregnancy

WEDNESDAY, April 24 (HealthDay News) -- For pregnant women with abdominal pain or vaginal bleeding, transvaginal sonography is the best modality for diagnosing ectopic pregnancy, according to research published in the April 24 issue of the Journal of the American Medical Association.

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Diagnostic Errors Are the Leading Type of Malpractice Claim

WEDNESDAY, April 24 (HealthDay News) -- In the past 25 years, diagnostic errors have been the leading type of malpractice claim and account for the highest proportion of total payments, according to a study published online April 22 in BMJ Quality & Safety.

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Peri-Noncardiac Op Exposure to β-Blockers Improves Outcome

TUESDAY, April 23 (HealthDay News) -- For patients undergoing major noncardiac surgery with two or more Revised Cardiac Risk Index factors, early exposure to β-blockers is associated with improved 30-day postoperative outcome, according to research published in the April 24 issue of the Journal of the American Medical Association.

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>40 Percent of Parents Give Cough Meds to Young Children

TUESDAY, April 23 (HealthDay News) -- More than 40 percent of parents with children younger than 4 years of age give them cough medicine or multi-symptom cough and cold medicine, despite warning labels that products should not be used for young children, according to a report published by the C.S. Mott Children's Hospital.

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Patient Characteristics Impact CABG-PCI Treatment Effect

TUESDAY, April 23 (HealthDay News) -- In the community setting, coronary artery bypass graft (CABG) surgery is associated with reduced mortality versus percutaneous coronary intervention (PCI), with the association affected by patient-level characteristics, according to a study published in the April 23 issue of the Annals of Internal Medicine.

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Firearms Account for About 2 Percent of Child Injuries

TUESDAY, April 23 (HealthDay News) -- In level 1 trauma centers in Denver and Aurora, Colo., about 2 percent of pediatric injuries result from firearms, according to a research letter published in the April 24 issue of the Journal of the American Medical Association.

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U.S. Shortfall in Neurologists Expected to Get Worse

TUESDAY, April 23 (HealthDay News) -- The current national shortfall in neurologists is about 11 percent, and is likely to increase to 19 percent by 2025, according to research published online April 17 in Neurology.

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Severe Cutaneous Adverse Rxns Up in Allopurinol Initiators

TUESDAY, April 23 (HealthDay News) -- Allopurinol initiators have an almost 10-fold increased risk of severe cutaneous adverse reactions (SCARs) compared with nonusers, according to a study published in the April issue of Arthritis Care & Research.

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Interdisciplinary Model Ups Care of Hospitalized Elderly

TUESDAY, April 23 (HealthDay News) -- For elderly patients, admission to the Mobile Acute Care of the Elderly (MACE) service, a novel model of care delivered by an interdisciplinary team, correlates with lower rates of adverse events and shorter hospital stays, compared with usual care, according to a study published online April 22 in JAMA Internal Medicine.

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Parental Permissiveness Linked to Rx Drug Abuse, Misuse

TUESDAY, April 23 (HealthDay News) -- Nearly one-quarter of teenagers misuse or abuse a prescription drug at least once in their lifetime, with perceived parental permissiveness linked to misuse and abuse of prescription drugs as well as use of alcohol and marijuana, according to a report published online April 23 by The Partnership at Drugfree.org.

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USPSTF: Primary Care Screening Can Help ID Suicide Risk

MONDAY, April 22 (HealthDay News) -- The U.S. Preventive Services Task Force finds that primary care screening tools could probably identify adults at increased risk of suicide, although they have limited efficacy in adolescents. This Recommendation Statement is based on an evidence review published in the April 23 issue of the Annals of Internal Medicine.

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Outcomes No Worse With Home Call for Surgical Interns

MONDAY, April 22 (HealthDay News) -- For surgical interns, being on call from home is not associated with increased rates of postoperative morbidity or mortality, according to a study published in the April issue of JAMA Surgery.

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Docs' Role in Gauging Fitness for Concealed Weapons Queried

MONDAY, April 22 (HealthDay News) -- Given the ethical, legal, and policy issues relating to the role of physicians in assessing competency for concealed-weapons permits, standards should be issued, according to a perspective piece published online April 17 in the New England Journal of Medicine.

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Dangers of the 'Cinnamon Challenge' Need Emphasis

MONDAY, April 22 (HealthDay News) -- With the increasing popularity of the "Cinnamon Challenge," especially among adolescents, the potential dangers need to be emphasized, according to a perspective piece published online April 22 in Pediatrics.

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CDC: About 20,000 Cases of Foodborne Infection in 2012

FRIDAY, April 19 (HealthDay News) -- There were about 20,000 cases of foodborne infection in 2012, with the highest incidence among young children and the greatest proportion of hospitalizations and deaths among the elderly, according to research published in the April 19 issue of the U.S. Centers for Disease Control and Prevention's Morbidity & Mortality Weekly Report.

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CDC: Traffic-Related Pedestrian Deaths Increasing With Age

FRIDAY, April 19 (HealthDay News) -- Traffic-related pedestrian death rates over the last decade were highest among the elderly, males, and racial and ethnic minorities, according to research published in the April 19 issue of the U.S. Centers for Disease Control and Prevention's Morbidity & Mortality Weekly Report.

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Lupus Ups Risk of Spontaneous Subarachnoid Hemorrhage

FRIDAY, April 19 (HealthDay News) -- Patients with systemic lupus erythematosus (SLE) have an increased risk of spontaneous subarachnoid hemorrhage (SAH) and increased mortality after SAH, according to a study published in the April issue of Arthritis Care & Research.

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Patient-Centered Decision Making Ups Health Outcomes

FRIDAY, April 19 (HealthDay News) -- Patient-centered decision making (PCDM) is associated with improved health care outcomes, according to a study published in the April 16 issue of the Annals of Internal Medicine.

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Guidelines Issued Relating to Online Medical Professionalism

THURSDAY, April 18 (HealthDay News) -- Physicians should be aware of the benefits on online media and should recognize the implications for patient confidentiality and public perception, according to a position paper published in the April 16 issue of the Annals of Internal Medicine.

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Family-Centered Teaching Rounds Good for Patients, Students

THURSDAY, April 18 (HealthDay News) -- Teaching and conducting rounds in the presence of patients and their families can be beneficial for patients and learners, according to research published online April 15 in Pediatrics.

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Relative Proportion of MRSA Increasing in S. aureus Isolates

THURSDAY, April 18 (HealthDay News) -- The relative proportion of methicillin-resistant Staphylococcus aureus (MRSA) is increasing in S. aureus isolates, and methicillin-sensitive S. aureus (MSSA) is becoming increasingly resistant to antibiotics, according to a study published in the April issue of JAMA Dermatology.

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Community Benefit Spending Varies for Tax-Exempt Hospitals

WEDNESDAY, April 17 (HealthDay News) -- There is considerable variation in the level of community benefit expenditure by tax-exempt hospitals, according to a study published in the April 18 issue of the New England Journal of Medicine.

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Glutamine, Antioxidants No Benefit to Critically Ill Patients

WEDNESDAY, April 17 (HealthDay News) -- For critically ill patients with multiorgan failure, early supplementation with glutamine or antioxidants does not improve clinical outcomes, according to a study published in the April 18 issue of the New England Journal of Medicine.

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Presenting Fee Data to Docs Cuts Number of Tests Ordered

WEDNESDAY, April 17 (HealthDay News) -- Presenting fee data to providers at the time of laboratory test orders is associated with a small reduction in the number of tests ordered, according to a study published online April 15 in JAMA Internal Medicine.

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Left Anterior Fascicular Block May Not Be a Benign Finding

WEDNESDAY, April 17 (HealthDay News) -- Left anterior fascicular block (LAFB) is associated with an increased risk of atrial fibrillation (AF), congestive heart failure (CHF), and death in older adults without apparent cardiovascular disease, according to research published in the April 17 issue of the Journal of the American Medical Association.

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Some Triggered Fainting May Be Inherited

TUESDAY, April 16 (HealthDay News) -- Some inherited cases of vasovagal syncope, or fainting caused by particular triggers, are linked to a particular region of chromosome 15q26, according to a study in the April 16 issue of Neurology.

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Family Doc Counseling Fails to Lift QoL for Abused Women

TUESDAY, April 16 (HealthDay News) -- For women identified as positive for fear of partner, counseling from trained family doctors is not associated with improved quality of life, but may reduce depression, according to a study published online April 16 in The Lancet.

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Quality Improvement Methods Up Appropriate Antibiotic Rx

MONDAY, April 15 (HealthDay News) -- Quality improvement (QI) methods can be used to rapidly implement national guidelines relating to appropriate first-line antibiotic therapy for children aged 3 months or older with community-acquired pneumonia (CAP), according to a study published online April 15 in Pediatrics.

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Transgastric Appendicectomy Is Feasible for Select Patients

FRIDAY, April 12 (HealthDay News) -- A minimally invasive surgical technique for acute appendicitis that uses one transumbilical 5-mm incision seems feasible for select patients with acute appendicitis, according to a study published online April 11 in the British Journal of Surgery.

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Most ED Docs, Nurses Doubtful About Suicide Preventability

FRIDAY, April 12 (HealthDay News) -- Less than half of emergency department (ED) physicians and nurses believe that most or all suicides are preventable, and most do not assess suicidal patients for firearm access unless the patient has a suicide plan involving a firearm, according to a study published online March 14 in Depression and Anxiety.

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Speech Details Practices to Improve U.S. Health Systems

THURSDAY, April 11 (HealthDay News) -- There are specific steps health care providers and policymakers should take to create high-quality, patient-centered care at lower costs, according to remarks made in an April 9 speech to the National Press Club.

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Patients Using Different Rx Strategies to Save Money

TUESDAY, April 9 (HealthDay News) -- Adults in the U.S. who are poor or uninsured are more likely to ask for lower-cost alternatives or not to take their prescribed medications, according to research published in the April NCHS Data Brief.

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NYC Health Department, ER Docs Clash Over Opioid Guidelines

TUESDAY, April 9 (HealthDay News) -- There is uncertainty as to whether the New York City Emergency Department Discharge Opioid Prescribing Guidelines will aid emergency physicians as they weigh the complex decisions of relieving patient pain while working to ensure patient safety, according to opposing viewpoints published online April 8 in the Annals of Internal Medicine.

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Delayed Allergy Reactions Seen With Pediatric Meat Consumption

MONDAY, April 8 (HealthDay News) -- Immunoglobulin E (IgE) antibody specific for galactose-α1,3-galactose (α-Gal), which is associated with delayed anaphylaxis and urticaria that occurs several hours after eating beef, pork, or lamb, has been identified in children reporting idiopathic anaphylaxis or urticaria, according to a study published online April 8 in Pediatrics.

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Novel Digital Stethoscope Detects Coronary Artery Disease

FRIDAY, April 5 (HealthDay News) -- An advanced digital electronic stethoscope that detects coronary artery microbruits showed high sensitivity and specificity in detecting coronary artery disease (CAD) when compared to computed tomographic (CT) angiography, according to research published in March 15 issue in The American Journal of Cardiology.

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EEG Proves Useful in Detection of Causes of In-Hospital Spells

FRIDAY, April 5 (HealthDay News) -- Seizures are common among hospitalized patients who undergo electroencephalography (EEG) due to spells or altered mental status, according to a study in the April issue of Mayo Clinic Proceedings.

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All Hospital Emergency Rooms Should Be Prepared for Children

THURSDAY, April 4 (HealthDay News) -- All hospital emergency departments (EDs), including community hospital EDs, should have the appropriate medications, equipment, policies, and staff to provide effective emergency care for children, according to a policy statement published in the March issue of the Journal of Emergency Nursing.

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Prevalence of Self-Reported Hypertension Rises in U.S.

THURSDAY, April 4 (HealthDay News) -- The prevalence of self-reported hypertension among U.S. adults increased slightly, but significantly from 2005 to 2009, and the proportion of adults using anti-hypertensive medications also increased, according to research published April 4 in Morbidity and Mortality Weekly.

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Low Risk With Normal Coronary Arteries, Nonobstructive CAD

THURSDAY, April 4 (HealthDay News) -- Patients who experience acute chest pain, and have nonobstructive coronary artery disease (CAD), as determined by coronary computed tomographic angiography, have similarly benign outcomes as those with normal coronary arteries, according to a study published in the April 1 issue of The American Journal of Cardiology.

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Glucocorticoids Are Tied to Increased Risk of Clots

THURSDAY, April 4 (HealthDay News) -- Glucocorticoid users face an increased risk of venous thromboembolism (VTE), according to a study published online April 1 in JAMA Internal Medicine.

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After Chest Pain, Outcomes Are Better With Cardiologist's Care

TUESDAY, April 2 (HealthDay News) -- Patients with high cardiovascular risk seen for chest pain have better outcomes if they receive follow-up from a cardiologist rather than a primary care physician or no physician follow-up, according to a study published online April 1 issue of Circulation.

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Most Partners of U.S. Docs Satisfied in Their Relationships

MONDAY, April 1 (HealthDay News) -- Most spouses/partners of U.S. physicians report being satisfied with their relationships, with satisfaction linked to time spent together each day, according to research published in the March issue of the Mayo Clinic Proceedings.

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Physician's Briefing