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April 2014 Briefing - Emergency Medicine

Here are what the editors at HealthDay consider to be the most important developments in Emergency Medicine for April 2014. 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.

Nongroup Insurance Market Lacked Stability Before ACA

WEDNESDAY, April 30, 2014 (HealthDay News) -- The nongroup insurance market has been characterized by frequent disruptions in coverage before implementation of the Affordable Care Act (ACA), according to research published online April 23 in Health Affairs.

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Established Modifiable Factors Account for Half of Strokes

WEDNESDAY, April 30, 2014 (HealthDay News) -- Established causal and modifiable factors, including hypertension and smoking, account for about half of all strokes, according to a study published online April 29 in PLOS Medicine.

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U.S. Children Experiencing Less Violence

TUESDAY, April 29, 2014 (HealthDay News) -- Fewer American children have been exposed to violent acts such as assault, bullying, sexual victimization, and emotional abuse since 2003, according to a study published online April 28 in JAMA Pediatrics.

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Winter's Polar Vortex Ushers in Spring's 'Pollen Vortex'

TUESDAY, April 29, 2014 (HealthDay News) -- Allergy experts say that the long, cold winter kept trees dormant for longer than usual, which means tree pollen season will overlap with grass pollen and mold seasons this year.

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AAP Issues Guidance for Freestanding Urgent Care Facilities

MONDAY, April 28, 2014 (HealthDay News) -- Guidance is provided for freestanding urgent care facilities serving children in an American Association of Pediatrics (AAP) Policy Statement published online April 28 in Pediatrics.

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AAP Cautions Against High-Deductible Health Plans for Kids

MONDAY, April 28, 2014 (HealthDay News) -- High-deductible health plans (HDHPs) are an increasingly popular way to reduce health care expenditures, but may be particularly inappropriate for children, according to an American Association of Pediatrics (AAP) Policy Statement published online April 28 in Pediatrics.

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SLIP-2 Tops Original SLIP Model for ID'ing Post-Op ARDS

FRIDAY, April 25, 2014 (HealthDay News) -- The updated surgical lung injury prediction 2 (SLIP-2) model outperforms the original SLIP model for identifying patients at risk for postoperative acute respiratory distress syndrome (ARDS), according to a study published in the May issue of Anesthesiology.

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Benzodiazepines May Worsen Respiratory Outcomes in COPD

FRIDAY, April 25, 2014 (HealthDay News) -- New use of benzodiazepines may increase the risk of adverse respiratory outcomes in older adults with chronic obstructive pulmonary disease (COPD), according to research published online April 17 in the European Respiratory Journal.

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CDC: Workplace Ladder Falls a Major Cause of Deaths, Injuries

FRIDAY, April 25, 2014 (HealthDay News) -- Workplace tumbles off of ladders are a major cause of injury and death among American employees, according to a study published in the April 25 issue of the U.S. Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

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Cannabis May Cause Heart Problems in Young Adults

FRIDAY, April 25, 2014 (HealthDay News) -- Young adults who use cannabis may experience serious, sometimes fatal, cardiovascular complications, according to research published online April 23 in the Journal of the American Heart Association.

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CDC: Measles on Upswing Despite Vaccines' Effectiveness

FRIDAY, April 25, 2014 (HealthDay News) -- Vaccinations have prevented an estimated 732,000 deaths, 21 million hospitalizations, and 322 million illnesses among U.S. children born in the last 20 years, according to a government report published in the April 25 issue of the U.S. Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

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Impact of Rising Incidence of Measles Discussed

THURSDAY, April 24, 2014 (HealthDay News) -- With the rising incidence of measles, the importance of vaccination should be emphasized and precautions must be exercised in cases of suspected measles, according to a commentary piece published online April 24 in the Annals of Internal Medicine.

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Physician Groups Find Fault With Medicare Payment Data Release

THURSDAY, April 24, 2014 (HealthDay News) -- Physician groups cite major problems associated with the release of Medicare payment data, according to an article published April 16 in Medical Economics.

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Educational Changes Suggested for Patient-Centered Medicine

THURSDAY, April 24, 2014 (HealthDay News) -- Changes in medical education and training are suggested to help new physicians address the needs of patients and their families, according to an ideas and opinions piece published in the April 22 issue of the Annals of Internal Medicine.

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Research Initiatives Demonstrate Ways to Speed Stroke Care

WEDNESDAY, April 23, 2014 (HealthDay News) -- New efforts to hasten treatment in both ambulances and emergency rooms appear to have significantly improved patients' chances of survival and limited their long-term disability, according to a pair of studies published in the April 23/30 issue of the Journal of the American Medical Association.

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FDA Proposes Accelerated Medical Device Approval Plan

WEDNESDAY, April 23, 2014 (HealthDay News) -- The U.S. Food and Drug Administration has proposed a new program that would provide expedited access to high-risk medical devices intended for patients with serious conditions whose medical needs are not met by current technology.

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Lorazepam No Better Than Diazepam for Epilepsy in Kids

TUESDAY, April 22, 2014 (HealthDay News) -- Lorazepam should not be preferentially used over diazepam in pediatric patients with convulsive status epilepticus, according to a study published in the April 23/30 issue of the Journal of the American Medical Association.

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Considerable Sudden Death in Hypertrophic Cardiomyopathy

TUESDAY, April 22, 2014 (HealthDay News) -- Patients with hypertrophic cardiomyopathy (HC) without traditional risk factors and with no or mild symptoms have a considerable rate of sudden cardiac death, according to a study published in the May 1 issue of The American Journal of Cardiology.

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Some Docs Still Prescribe Codeine for Peds Cough/URI

TUESDAY, April 22, 2014 (HealthDay News) -- Despite national guidelines recommending against its use in children, some physicians continue to prescribe codeine for pediatric cough or upper respiratory infection (URI), according to research published online April 21 in Pediatrics.

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Task Force Recommends Ways to Improve Price Transparency

MONDAY, April 21, 2014 (HealthDay News) -- Price transparency frameworks, which provide price information presented in the context of other relevant information, should be developed to meet patients' needs, according to recommendations presented in a report from the Healthcare Financial Management Association (HFMA).

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AMA Examines Economic Impact of Physicians

FRIDAY, April 18, 2014 (HealthDay News) -- Physicians who mainly engage in patient care contribute a total of $1.6 trillion in economic output, according to the American Medical Association (AMA)'s Economic Impact Study.

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Int'l Medical Education Standards Not Equivalent to U.K. Standards

FRIDAY, April 18, 2014 (HealthDay News) -- International medical graduates passing the Professional and Linguistic Assessments Board (PLAB) of the General Medical Council (GMC) have lower performance on MRCP(UK) (Membership of the Royal Colleges of Physicians) and MRCGP (Membership of the Royal College of General Practitioners) and on annual review of competence progression (ARCP) examinations, according to two studies published online April 17 in BMJ.

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White House: 8 Million People Signed Up for Health Insurance

FRIDAY, April 18, 2014 (HealthDay News) -- Eight million Americans signed up for private health insurance during the just-concluded first enrollment period under the Affordable Care Act, the White House announced Thursday afternoon.

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Salmonella Cases Dip but Food Poisoning Rates Remain High

FRIDAY, April 18, 2014 (HealthDay News) -- While the United States has seen a decline in the number of Salmonella illnesses in recent years, there's been little progress overall in reducing food poisoning outbreaks, according to a report published in the April 18 issue of the U.S. Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

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One in 20 U.S. Adults a Victim of Diagnostic Errors

THURSDAY, April 17, 2014 (HealthDay News) -- Diagnostic errors affect at least one in 20 U.S. adults, according to research published online April 17 in BMJ Quality & Safety.

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Educator Discusses Key Issues for Future Doctors to Consider

THURSDAY, April 17, 2014 (HealthDay News) -- The key issues for future physicians are discussed in an article published by the American Medical Association (AMA).

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Patient-Clinician Relationship Impacts Health Care Outcomes

THURSDAY, April 17, 2014 (HealthDay News) -- The patient-clinician relationship has a small but significant effect on health care outcomes, according to a study published online April 9 in PLOS ONE.

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Risk for Nonelective Thoracic Aortic Sx Up for Uninsured

WEDNESDAY, April 16, 2014 (HealthDay News) -- Uninsured patients have an increased risk of nonelective thoracic aortic operations, and have increased risks of major morbidity or mortality, according to a study published online April 8 in Circulation: Cardiovascular Quality and Outcomes.

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MRI Connects Vestibulopathy and Damage From Brain Injury

WEDNESDAY, April 16, 2014 (HealthDay News) -- Damage to specific brain regions may be linked to the prognosis of concussion patients with vestibulopathy, according to a study published online April 14 in Radiology.

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Continued Reliance on Windows XP May Threaten Data Security

WEDNESDAY, April 16, 2014 (HealthDay News) -- Physicians who use Windows XP in their practices may be affected by Microsoft's recent discontinuation of support for the program, according to an article published April 8 in Medical Economics.

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Patients Paying Much More for Specialty Drugs

TUESDAY, April 15, 2014 (HealthDay News) -- Many Americans are paying less for prescription drugs, but some are having to deal with sharp rises in the cost of specialty medicines for rare or serious diseases, according to a new report.

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CDC: Drowning Deaths Down Overall, but Still a Problem

TUESDAY, April 15, 2014 (HealthDay News) -- Drowning deaths are still a problem in the United States, even though overall deaths from drowning are down, according to a report published in the U.S. Centers for Disease Control and Prevention's April edition of the National Center for Health Statistics Data Brief.

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Younger Adults Hit Hardest This Flu Season

TUESDAY, April 15, 2014 (HealthDay News) -- The H1N1 flu was the predominant influenza strain in the United States this year, but it packed a lot less punch than in 2009 when it caused a worldwide pandemic, health officials report.

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NSAIDs With Anticoagulant Tx Ups Major Bleeding in VTE

TUESDAY, April 15, 2014 (HealthDay News) -- Concomitant use of a nonsteroidal anti-inflammatory drug (NSAID) or aspirin in patients with venous thromboembolism receiving anticoagulant therapy is tied to increased risk of bleeding, according to a study published online April 14 in JAMA Internal Medicine.

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Internists Favor Public Policy to Reduce Gun Violence

TUESDAY, April 15, 2014 (HealthDay News) -- Most internists believe that firearm-related violence is a public health issue and favor policy initiatives aimed at reducing it, according to research published online April 10 in the Annals of Internal Medicine.

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Alcohol May Hinder Immune Response in Wound Healing

MONDAY, April 14, 2014 (HealthDay News) -- Binge alcohol exposure impairs key components of the immune system involved in wound repair, which may account for the delayed wound healing seen in people who are injured while intoxicated, according to an animal study published online April 1 in Alcoholism: Clinical & Experimental Research.

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Serum Potassium Levels Linked to Long-Term Mortality Post-MI

MONDAY, April 14, 2014 (HealthDay News) -- For patients with acute myocardial infarction (AMI), serum potassium levels are associated with long-term mortality risk, according to a study published in the April 15 issue of The American Journal of Cardiology.

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New Health Secretary to Confront Health Care Reform Hurdles

MONDAY, April 14, 2014 (HealthDay News) -- With the resignation of U.S. Health and Human Services Secretary Kathleen Sebelius on Friday, the Affordable Care Act will get a fresh face. But turning around public perception of the controversial health care reform law in a politically charged mid-term election year poses an enormous challenge for the department's next leader, policy experts said.

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AAFP Provides Tips to Address Patients' Vaccine Concerns

MONDAY, April 14, 2014 (HealthDay News) -- Physicians remain the biggest influence on whether patients get vaccinated, and must be prepared to address patients' reservations, according to an article published in the March/April issue of Family Practice Management.

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Sebelius Stepping Down As HHS Secretary

FRIDAY, April 11, 2014 (HealthDay News) -- U.S. Health and Human Services Secretary Kathleen Sebelius is stepping down from her position, after overseeing the troubled rollout of the Affordable Care Act that remains unpopular with some Americans and virtually all Republican lawmakers.

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CDC: Measles Cases Linked to U.S. Adoptions From China

FRIDAY, April 11, 2014 (HealthDay News) -- A series of measles cases in the United States involving children adopted from China highlights the importance of vaccinations for any adopted child from overseas, according to a report published in the April 11 issue of the U.S. Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

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Benefits/Risks for Fibrinolytic Therapy in Intermediate-Risk PE

FRIDAY, April 11, 2014 (HealthDay News) -- A single intravenous bolus of tenecteplase reduces early death and hemodynamic decompensation in normotensive patients with intermediate-risk pulmonary embolism, but increases the risk of major hemorrhage and stroke, according to a study published in the April 10 issue of the New England Journal of Medicine.

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Medicaid Expansion Hasn't Eroded Perceived Care Access

THURSDAY, April 10, 2014 (HealthDay News) -- Previous Medicaid expansions did not diminish perceived access to care, according to a study published online April 7 in JAMA Internal Medicine.

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Updated Reviews Issued for Oseltamivir, Zanamivir Use in Flu

THURSDAY, April 10, 2014 (HealthDay News) -- Oseltamivir and zanamivir reduce the time to symptomatic improvement in influenza by about half a day, but evidence to support claims of reduced admissions to hospital or complications of influenza is lacking, according to two systematic reviews of regulatory information published online April 10 in BMJ.

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Cortisol Response Associated With Crash Risk in Teen Drivers

THURSDAY, April 10, 2014 (HealthDay News) -- Cortisol level in response to stress is associated with crash risk in teenaged drivers, according to research published online April 7 in JAMA Pediatrics.

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Fewer Americans Overwhelmed by Medical Bills

WEDNESDAY, April 9, 2014 (HealthDay News) -- While millions of Americans still feel hamstrung by medical expenses, a new government report shows that some people are getting relief.

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More Justification Needed for Choosing Wisely Selections

WEDNESDAY, April 9, 2014 (HealthDay News) -- Most services included in specialty medical societies' Top 5 lists for the Choosing Wisely campaign are based on evidence demonstrating equivalent but not superior benefit, with higher risk or higher costs compared to other options, according to a research letter published in the April 9 issue of the Journal of the American Medical Association.

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Advice, Exercise Equally Effective for Chronic Whiplash

WEDNESDAY, April 9, 2014 (HealthDay News) -- Simple advice is as effective as a comprehensive exercise program for reducing pain in patients with chronic whiplash, according to research published online April 4 in The Lancet.

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Some Doctors Paid at Least $3 Million Each by Medicare

WEDNESDAY, April 9, 2014 (HealthDay News) -- A small number of doctors received at least $3 million each in Medicare payments in 2012, for a total of nearly $1.5 billion, according to an analysis of Medicare claims data released Wednesday by the White House. In total, Medicare paid individual physicians nearly $64 billion in 2012. The median payment was just over $30,000, the Associated Press reported.

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Most PCPs Accepting New Patients, Insurance Still a Factor

TUESDAY, April 8, 2014 (HealthDay News) -- Although most primary care physicians are accepting new patients, access for new patients varies across states and with insurance status, according to a study published online April 7 in JAMA Internal Medicine.

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Road Design Affects Motor Vehicle-Pedestrian Collisions

MONDAY, April 7, 2014 (HealthDay News) -- For school children, the correlation between walking to school and pedestrian collisions is not significant after adjustment for road design variables, according to a study published online April 7 in Pediatrics.

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Newly Eligible for Expanded Medicaid Are Healthier

MONDAY, April 7, 2014 (HealthDay News) -- Persons newly eligible for expanded Medicaid coverage under the Affordable Care Act (ACA) are not sicker than pre-ACA enrollees, according to research published online March 26 in Health Affairs.

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CDC: U.S. Traveler Returning From Africa Has Lassa Fever

MONDAY, April 7, 2014 (HealthDay News) -- A person returning to the United States after visiting West Africa has been confirmed as having Lassa fever and is recovering after being treated at a Minnesota hospital, the U.S. Centers for Disease Control and Prevention announced Friday.

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Patients Select Fewer New Docs at Bottom of Tiered Ranking

MONDAY, April 7, 2014 (HealthDay News) -- Patients are less likely to select a new physician ranked in the bottom of a tiered network, but often don't switch if their current physician is ranked at the bottom, according to research published online March 11 in Health Services Research.

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AMA Provides Resources to Aid Physicians' Collections

FRIDAY, April 4, 2014 (HealthDay News) -- The American Medical Association (AMA) has released resources to help doctors confront policy jumpers who may pose a financial risk to physicians during the Affordable Care Act's 90-day premium grace period, according to an article published March 25 in Medical Economics.

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Breath-Actuated, Handheld Nebulizers Yield Similar Results

FRIDAY, April 4, 2014 (HealthDay News) -- There are no significant clinical differences between the use of a breath-actuated nebulizer (BAN) and a handheld nebulizer (HHN) for the treatment of wheezing or dyspnea among adults seen in the emergency department, according to a study published in the March issue of the Journal of Emergency Nursing.

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Patient Safety Not Affected by Resident Hour Reforms

THURSDAY, April 3, 2014 (HealthDay News) -- In the year following 2011 work-hour reforms for residents there were no changes in patient safety outcomes when comparing patients treated by residents to those treated by hospitalists, according to a study published online Feb. 22 in the Journal of Hospital Medicine.

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CDC: Calls to Poison Centers for E-Cigarette Exposure Up

THURSDAY, April 3, 2014 (HealthDay News) -- There has been a recent increase in the number of calls to poison centers regarding electronic cigarette (e-cigarette) exposure, according to research published in the April 4 issue of the U.S. Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

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Hands-Free Cellphones Don't Make Driving Safer

THURSDAY, April 3, 2014 (HealthDay News) -- Hands-free cellphone use while driving is not risk-free driving, new research shows.

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FDA Approves Sublingual Tablet for Grass Allergies

WEDNESDAY, April 2, 2014 (HealthDay News) -- Oralair has been approved by the U.S. Food and Drug Administration as the first sublingual treatment for certain grass allergies.

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ER Use Up With Health Care Reform in Massachusetts

WEDNESDAY, April 2, 2014 (HealthDay News) -- Implementation of health care reform in Massachusetts was associated with an increase in emergency department use, according to a study published online March 24 in the Annals of Emergency Medicine.

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Half of Uninsured Don't Intend to Sign Up for Health Coverage

WEDNESDAY, April 2, 2014 (HealthDay News) -- About 50 percent of uninsured adults do not intend to sign up for coverage through the Affordable Care Act's health care exchanges, according to an article published March 26 in Medical Economics.

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