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February 2010 Briefing - Emergency Medicine

Here are what the editors at HealthDay consider to be the most important developments in Emergency Medicine for February 2010. 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.

Arm Ischemia Reduces Damage After Heart Attack

FRIDAY, Feb. 26 (HealthDay News) -- Intermittently blocking blood flow in the arm, known as remote conditioning, during the ambulance ride to the hospital (before stenting) reduces damage to the heart after a heart attack, possibly by activating protective mechanisms in the heart, according to a study in the Feb. 27 issue of The Lancet.

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Score May Help Determine Death Risk in Heart Failure

FRIDAY, Feb. 26 (HealthDay News) -- A risk score that includes patient information available at discharge can identify the risk of mortality in individuals hospitalized with advanced decompensated heart failure, according to research published in the March 2 issue of the Journal of the American College of Cardiology.

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Awareness of Heart Disease Risk Still Lacking in Women

WEDNESDAY, Feb. 10 (HealthDay News) -- Despite some gains in public awareness, almost half of all American women are unaware that heart disease is the leading cause of death in women, according to research published online Feb. 10 in Circulation: Cardiovascular Quality and Outcomes.

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Resuscitation to Normalize Lactate Clearance Evaluated

TUESDAY, Feb. 23 (HealthDay News) -- Resuscitation to normalize lactate clearance in patients suffering from septic shock resulted in in-hospital mortality similar to that for patients resuscitated to normalize central venous oxygen saturation (ScvO2), according to a study in the Feb. 24 issue of the Journal of the American Medical Association.

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Physicians Working Fewer Hours for Lower Fees

TUESDAY, Feb. 23 (HealthDay News) -- Physicians in the United States have been working fewer hours for lower fees in the past decade, according to research published in the Feb. 24 issue of the Journal of the American Medical Association.

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United Effort Needed to Reduce Choking Risk in Young Children

MONDAY, Feb. 22 (HealthDay News) -- Regulatory agencies, pediatricians, parents and caregivers, toy manufacturers, and food companies should take concrete steps to reduce the risk of choking in young children, according to a policy statement from the American Academy of Pediatrics published online Feb. 22 in Pediatrics.

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Pediatric Obesity Affects Survival After In-Hospital CPR

MONDAY, Feb. 22 (HealthDay News) -- Obese children who undergo cardiopulmonary resuscitation (CPR) in the hospital are at greater risk of dying before hospital discharge than normal weight or underweight children, according to a study published online Feb. 22 in Pediatrics.

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Bevacizumab Reduces Nose Bleeds in Inherited Condition

MONDAY, Feb. 18 (HealthDay News) -- The vascular endothelial growth factor inhibitor bevacizumab administered by intranasal injection, or even by topical nasal spray, can effectively treat epistaxis from hereditary hemorrhagic telangiectasia (HHT), according to reports published in The Laryngoscope.

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Medical Checklists Needed to Improve Care and Outcomes

MONDAY, Feb. 22 (HealthDay News) -- The checklists so common in aviation and many professions are underused in medicine and, if more widely adopted, would provide powerful tools to standardize care and improve patient outcomes, according to an article published Dec. 31 in Critical Care.

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Enoxaparin and Unfractionated Heparin Compared

FRIDAY, Feb. 19 (HealthDay News) -- Enoxaparin used in percutaneous coronary intervention (PCI) reduces the risk of adverse cardiac outcomes compared to standard therapy with unfractionated heparin (UFH), according to a study in the February issue of the Journal of the American College of Cardiology: Cardiovascular Interventions.

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Intensive Statin Therapy Cuts Recurrent Cardiac Events

FRIDAY, Feb. 19 (HealthDay News) -- For patients who have had a cardiovascular event, intensive statin therapy reduces the risk of recurrent events better than less-intensive therapy, according to a study in the Feb. 1 issue of the American Journal of Cardiology.

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Many Adults in Utah Report Using Opioids Incorrectly

FRIDAY, Feb. 19 (HealthDay News) -- In 2008, one-fifth of adults in Utah had been prescribed an opioid pain medication in the past year, with some respondents reporting use of these medications despite no prescription for them, according to an article in the Feb. 19 issue of the U.S. Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

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Clinical Decision Rule Predicts High-Risk Syncope Patients

FRIDAY, Feb. 19 (HealthDay News) -- A clinical decision rule for use in patients with syncope has high sensitivity and negative predictive value, and, in combination with B-type natriuretic peptide (BNP) measurement, may help identify those at high risk of serious outcomes and death, according to a study in the Feb. 23 Journal of the American College of Cardiology.

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New System Aims to Improve Blood Transfusion Safety

FRIDAY, Feb. 19 (HealthDay News) -- The U.S. Centers for Disease Control and Prevention has started a national surveillance system to monitor adverse events in patients who receive blood transfusions, the agency has announced.

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Program Found to Increase Flu Vaccination Rates

THURSDAY, Feb. 18 (HealthDay News) -- Through methods such as multiple vaccination sites and online monitoring of vaccination status, a campaign to increase flu vaccination rates among employees and health care workers at Johns Hopkins has proven effective, according to a study in the February issue of Infection Control & Hospital Epidemiology.

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LABAs Can Harm Asthma Patients When Used Alone

THURSDAY, Feb. 18 (HealthDay News) -- The U.S. Food and Drug Administration has announced that long-acting beta agonists (LABAs) should never be used alone to treat asthma in children or adults.

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FDA Issues Maalox Total Relief Warning

THURSDAY, Feb. 18 (HealthDay News) -- The U.S. Food and Drug Administration is warning consumers not to mistake Maalox Total Relief, a gastrointestinal and anti-diarrhea medication, for Maalox antacids (Maalox Advanced Regular Strength and Maalox Advanced Maximum Strength), as this could result in serious side effects.

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Platelet Transfusion Dose Has No Effect on Bleeding

WEDNESDAY, Feb. 17 (HealthDay News) -- In patients with hypoproliferative thrombocytopenia, the platelet dose in prophylactic transfusions given after a trigger threshold of 10,000 platelets per cubic millimeter or lower is reached has no significant effect on the incidence of bleeding, according to a study in the Feb. 18 issue of the New England Journal of Medicine.

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Newborn Training Has Mixed Effect in Developing Countries

WEDNESDAY, Feb. 17 (HealthDay News) -- In developing countries, training birth attendants in the World Health Organization Essential Newborn Care course does not reduce neonatal mortality but does reduce rates of stillbirth, and further training in neonatal resuscitation does not have a significant effect on outcomes, according to a study in the Feb. 18 issue of the New England Journal of Medicine.

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Lumbar Fusion Linked to Improved Driver Reaction Time

TUESDAY, Feb. 16 (HealthDay News) -- The driver reaction time (DRT) in patients a week after lumbar fusion surgery is not significantly slower than their preoperative DRT, and after three months recovery their DRT may be faster than their preoperative DRT, according to a study in the Feb. 1 issue of Spine.

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Racial Disparities Seen in New York Surgical Patients

TUESDAY, Feb. 16 (HealthDay News) -- In New York City, minority patients are significantly less likely than Caucasians to use high-volume surgeons and hospitals when undergoing procedures with an established volume-mortality association, according to a study in the February issue of the Archives of Surgery.

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Risk Factors Often Present in Cases of SIDS

MONDAY, Feb. 15 (HealthDay News) -- Sudden infant death syndrome (SIDS) is often accompanied by multiple risk factors, many of which are modifiable, which call for more inclusive and comprehensive risk-reduction education, according to research published online Feb. 15 in Pediatrics.

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Poor Sleep Linked to More Car Accidents in Teenagers

TUESDAY, Feb. 16 (HealthDay News) -- Poor sleep habits are associated with a higher risk of car accidents among teenagers, according to a study in the Feb. 15 issue of the Journal of Clinical Sleep Medicine.

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H. Pylori Often Unrelated to Children's Gastrointestinal Pain

TUESDAY, Feb. 16 (HealthDay News) -- In pediatric patients with gastrointestinal symptoms, Helicobacter pylori infection is not likely associated with recurrent abdominal pain (RAP), but it may be associated with unspecified abdominal pain (UAP) and epigastric pain, according to a review published online Feb. 15 in Pediatrics.

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Superficial Venous Thrombosis May Herald Greater Risks

TUESDAY, Feb. 16 (HealthDay News) -- Given that many patients with superficial venous thrombosis (SVT) also have deep venous thrombosis (DVT) at presentation, and a considerable number develop thromboembolic complications in following months, SVT may be more of a concern than previously thought, according to research published in the Feb. 16 issue of the Annals of Internal Medicine.

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Outcomes Found to Be Poor in South Carolina Stroke Patients

TUESDAY, Feb. 16 (HealthDay News) -- In South Carolina, patients hospitalized for an initial stroke have an elevated short- and long-term risk of recurrent stroke, heart attack, vascular death, and all-cause death, according to a study in the Feb. 16 issue of Neurology.

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Cardiac Effects of Hormone Replacement Therapy Studied

TUESDAY, Feb. 16 (HealthDay News) -- Hormone replacement therapy that includes estrogen plus progestin may not reduce the risk for coronary heart disease (CHD) during the first several years of treatment in women who started hormone therapy near menopause, according to research published in the Feb. 16 issue of the Annals of Internal Medicine.

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Gender Differences Seen in CABG Operative Mortality

MONDAY, Feb. 15 (HealthDay News) -- Women who undergo coronary artery bypass graft (CABG) surgery have significantly higher operative mortality (OM) than men having the same surgery, according to a study in the Feb. 1 issue of the American Journal of Cardiology.

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Rapid H1N1 Flu Test Found to Be of Limited Value in Children

MONDAY, Feb. 15 (HealthDay News) -- In the diagnosis of pediatric H1N1 influenza A virus infection, the rapid influenza diagnostic test has poor sensitivity but excellent specificity, according to a study published online Feb. 15 in Pediatrics.

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2009 H1N1-Related Deaths and Hospitalizations Examined

MONDAY, Feb. 15 (HealthDay News) -- The U.S. Centers for Disease Control and Prevention has provided updated estimates of the 2009 H1N1 cases, related hospitalizations and deaths, with approximately 57 million cases occurring between April 2009 and January 2010.

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Shoulder Injuries Compared in High School Baseball, Softball

FRIDAY, Feb. 12 (HealthDay News) -- Although high school baseball and softball players tend to have similar rates of shoulder injuries, there are factors at play that may help improve preventive efforts, according to research published online Feb. 8 in Pediatrics.

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Stenosis Can Still Exist in Absence of Coronary Calcium

FRIDAY, Feb. 12 (HealthDay News) -- In contradiction of professional guidelines, the absence of coronary calcification in blood vessels does not rule out the potential existence of stenosis, and should not be used to decide if revascularization is needed, according to a study in the Feb. 16 issue of the Journal of the American College of Cardiology.

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Emotional Stress Can Trigger Acute Coronary Syndrome

FRIDAY, Feb. 12 (HealthDay News) -- Emotional stress, such as that experienced by a spectator at a major sporting event, can increase serum levels of inflammatory biochemicals that can trigger an acute coronary syndrome (ACS) event, according to a study in the Feb. 16 issue of the Journal of the American College of Cardiology.

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Mnemonic Device for Patient Decision-Making Assessed

FRIDAY, Feb. 12 (HealthDay News) -- Clinicians who must quickly assess a patient's capacity to make an emergency treatment decision can now fall back on a new mnemonic device, "CURVES," developed at Johns Hopkins University and reviewed in the February issue of Chest.

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Vesicoureteral Reflux Treatment in Children Studied

FRIDAY, Feb. 12 (HealthDay News) -- The treating hospital is the most important factor affecting treatment choice in children with vesicoureteral reflux (VUR), a condition characterized by an abnormal flow of urine from the bladder back into the ureter, according to research published online Feb. 8 in Pediatrics.

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Camp Mumps Outbreak Sickens Over 1,500 People

FRIDAY, Feb. 12 (HealthDay News) -- An outbreak of mumps that began at a summer camp in New York in June 2009 has since infected 1,521 people in New York and New Jersey as of the end of January 2010, according to an article published in the Feb. 12 issue of the U.S. Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

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Study Finds Speckle Tracking Aids in Patient Selection

THURSDAY, Feb. 11 (HealthDay News) -- Radial dyssynchrony by speckle tracking may be useful in predicting response to cardiac resynchronization therapy (CRT) in patients with borderline QRS and wide QRS durations, according to research published in the February Journal of the American College of Cardiology: Cardiovascular Imaging.

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FDA: Automated External Defibrillators Recalled

THURSDAY, Feb. 11 (HealthDay News) -- Cardiac Science Corporation has announced the worldwide voluntary recall of a number of their automated external defibrillators (AEDs) due to the inability of these devices to deliver therapy during resuscitation, which can result in serious complications and death, according to a Feb. 9 safety alert issued by the U.S. Food and Drug Administration.

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Myocarditis Linked to Pandemic H1N1 Flu in Children

THURSDAY, Feb. 11 (HealthDay News) -- Several cases of fulminant myocarditis, a rare complication of viral infection, have been identified among children infected with H1N1 pandemic influenza during a one month period, according to the results of a retrospective chart review published online Feb. 10 in the Journal of the American College of Cardiology.

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Laparoscopic Practice Takes Physical Toll on Surgeons

THURSDAY, Feb. 11 (HealthDay News) -- Many surgeons who perform laparoscopic surgery suffer pain, numbness, stiffness, fatigue and other physical symptoms, often as a result of high case load, according to a study published online Dec. 24 ahead of print in the Journal of the American College of Surgeons.

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Needleless Intravenous Valve Cause of Worldwide Recall

THURSDAY, Feb. 11 (HealthDay News) -- Becton, Dickinson and Company (BD) and Acacia, Inc. have announced the voluntary recall of any products containing the Q-Syte Luer Access Device, including BD's Nexiva Closed Intravenous (IV) Catheter System and Acacia's IV Extension Sets. The use of affected devices may cause an air embolism or fluid leakage, which can result in serious complications and death.

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Dietary Supplement Suspected of Causing Selenium Poisoning

THURSDAY, Feb. 11 (HealthDay News) -- A liquid dietary supplement that contained 200 times the labeled concentration of selenium caused a widespread outbreak of selenium poisoning affecting 201 people in 10 states, according to a study published in the Feb. 8 issue of the Archives of Internal Medicine.

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Youth Cardiovascular Risk Factors Linked to Early Death

WEDNESDAY, Feb. 10 (HealthDay News) -- Cardiovascular risk factors in childhood are associated with a higher rate of premature death from endogenous causes, according to research published in the Feb. 11 issue of the New England Journal of Medicine.

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Rural Diabetes Impact Calls for Variety of Outreach Solutions

WEDNESDAY, Feb. 10 (HealthDay News) -- The burden of diabetes in rural communities points to a need for strategies to improve diabetes care in these areas, according to an article published in the Jan. 1 issue of Clinical Diabetes.

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AHRQ: U.S. Adults Seeing Big Barriers to Specialty Care

WEDNESDAY, Feb. 10 (HealthDay News) -- In 2007, about one in 13 of U.S. adults reported that access to specialist care was a "big problem," according to a December report issued by the Agency for Healthcare Research and Quality (AHRQ).

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FDA Initiative Aims to Cut Medical Radiation Exposure

WEDNESDAY, Feb. 10 (HealthDay News) -- The U.S. Food and Drug Administration has launched a new initiative that aims to reduce exposure to radiation from computed tomography (CT), nuclear medicine studies and fluoroscopy, the three procedures that are the main sources of medically-related radiation exposure.

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Bedside Blood Test Found to Detect Anticoagulation Status

WEDNESDAY, Feb. 10 (HealthDay News) -- A new bedside blood test can be used to determine the sufficiency of anticoagulation in patients who are about to undergo catheterization or percutaneous coronary intervention (PCI), according to a study in the Feb. 16 issue of the Journal of the American College of Cardiology.

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Age-Related Treatment and Outcomes in Stroke Examined

TUESDAY, Feb. 9 (HealthDay News) -- Older people who suffer ischemic stroke are more likely to die in the hospital than younger stroke victims, though disparities in care by age group have been reduced or eliminated in recent years, according to a study published online Feb. 8 in Circulation.

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Outcomes Improving in Asymptomatic Carotid Stenosis

TUESDAY, Feb. 9 (HealthDay News) -- In patients with asymptomatic carotid stenosis (ACS), intensive medical therapy has significantly reduced microemboli on transcranial Doppler as well as cardiovascular events, according to a study in the February issue of the Archives of Neurology.

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AHA/ACC Offer Guidance for Dangerous Arrhythmia

MONDAY, Feb. 8 (HealthDay News) -- Hospitalized patients taking QT-prolonging drugs may be at risk for drug-induced long-QT syndrome (LQTS) and should be closely monitored by electrocardiogram (ECG) for the incidence of the serious arrhythmia known as torsade de pointes (TdP), according to a scientific statement from the American Heart Association and the American College of Cardiology Foundation published online Feb. 8 in Circulation.

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H1N1 Vaccination Still Highly Recommended

MONDAY, Feb. 8 (HealthDay News) -- Despite H1N1 virus levels stabilizing, transmission remains an issue and vaccination continues to be an effective option for prevention of this potentially serious condition, according to a Feb. 5 press briefing by the U.S. Centers for Disease Control.

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Many American Adults Do Not Get Recommended Vaccines

MONDAY, Feb. 8 (HealthDay News) -- Although most parents ensure their children are vaccinated, adults often do not receive recommended vaccinations themselves, according to a new report, Adult Immunization: Shots to Save Lives.

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Coalition Launches Campaign to Limit Residents' Hours

FRIDAY, Feb. 5 (HealthDay News) -- To prevent medical errors caused by doctor fatigue, a coalition of public interest and patient safety groups is urging the Accreditation Council for Graduate Medical Education (ACGME) to limit the amount of time residents must work without sleep to 16 hours and to increase resident supervision.

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Pediatric Amputations Cost $21.6 Million Annually

FRIDAY, Feb. 5 (HealthDay News) -- Traumatic amputations in children cost nearly $22 million in hospital-associated charges annually in the United States, according to a report in the January issue of the Journal of Trauma: Injury, Infection, and Critical Care.

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Health Care Spending Makes Record Leap in GDP Share

THURSDAY, Feb. 4 (HealthDay News) -- A growth in health spending in 2009, coupled with a sagging economy, created the largest one-year jump in health care's share of the nation's gross domestic product since 1960, according to an article published online Feb. 4 in Health Affairs.

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Diversity Growth Incremental in the Medical Professions

THURSDAY, Feb. 4 (HealthDay News) -- One hundred years after the Flexner Report recommended closing five of the seven African-American medical schools then extant, African-Americans and other minorities remain grossly underrepresented in the medical professions, according to an article in the February issue of Academic Medicine.

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Study Finds Antibiotics Benefit Buruli Ulcer Treatment

THURSDAY, Feb. 4 (HealthDay News) -- Early and limited Buruli ulcer, an infectious disease caused by Mycobacterium ulcerans, can be safely and effectively treated with antibiotics without surgery, according to a study published online on Feb. 4 in The Lancet.

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Communication Found Possible With Some Coma Patients

WEDNESDAY, Feb. 3 (HealthDay News) -- Basic communication can be established with some disorders-of-consciousness patients who are otherwise unresponsive, using functional magnetic resonance imaging (MRI) to measure neuroanatomically specific, blood-oxygenation-level-dependent responses to mental imagery tasks, according to a study published online Feb. 3 in the New England Journal of Medicine.

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Visual Impairment Linked to Increased Risk of Falls

WEDNESDAY, Feb. 3 (HealthDay News) -- In Latino adults, central visual impairment and peripheral visual impairment are independently associated with an increased risk of falls and fall-related injuries, according to a study in the February issue of Ophthalmology.

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The Lancet Retracts Study Linking MMR Vaccine, Autism

WEDNESDAY, Feb. 3 (HealthDay News) -- On Feb. 2, The Lancet retracted a controversial 1998 study that linked the measles, mumps and rubella (MMR) vaccine to autism and gastrointestinal problems.

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Red Flags for Serious Infection in Children Highlighted

WEDNESDAY, Feb. 3 (HealthDay News) -- Cyanosis, rapid breathing and poor peripheral circulation are all significant red flags for serious infection in children in developed country settings, while physicians' instinct and parental concern also play a role, according to a review published online Feb. 3 in The Lancet.

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Xiaflex Approved for Rare Hand Condition

WEDNESDAY, Feb. 3 (HealthDay News) -- Collagenase clostridium histolyticum (Xiaflex) has been approved by the U.S. Food and Drug Administration as the first drug to treat a disabling hand condition called Dupuytren's contracture.

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Computed Tomography Shows Advantage in Heart Disease

WEDNESDAY, Feb. 3 (HealthDay News) -- Computed tomography (CT) appears to hold an advantage over magnetic resonance imaging (MRI) for ruling out coronary artery disease, according to research published in the Feb. 2 issue of the Annals of Internal Medicine.

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Anticoagulation and Risk of VTE Studied in Suspected DVT

TUESDAY, Feb. 2 (HealthDay News) -- In patients with suspected lower extremity deep vein thrombosis (DVT), those with a negative whole-leg compression ultrasound (CUS) and no anticoagulation therapy are at low risk of venous thromboembolism, according to a meta-analysis reported in the Feb. 3 issue of the Journal of the American Medical Association.

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Lower Brain Serotonin Seen in Infants Who Died of SIDS

TUESDAY, Feb. 2 (HealthDay News) -- Lower levels of medullary serotonin in infants who died of sudden infant death syndrome (SIDS) suggest that a serotonin deficiency may play a role in the condition, according to research published in the Feb. 3 issue of the Journal of the American Medical Association.

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Antidepressant May Aid Post-Stroke Cognitive Recovery

TUESDAY, Feb. 2 (HealthDay News) -- Stroke patients who receive the antidepressant escitalopram within three months of their stroke show improvement in cognitive functioning as compared to those receiving either placebo or Problem Solving Therapy, according to a study in the February issue of the Archives of General Psychiatry.

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Medicine Errors More Common When Parents Use Dosing Cups

TUESDAY, Feb. 2 (HealthDay News) -- Using dosing cups to measure children's medications leads to more frequent dosing errors compared with using other methods, and parents with low levels of health literacy are at greater risk of making dosing mistakes, according to a study in the February issue of the Archives of Pediatrics & Adolescent Medicine.

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President Proposes $911 Billion Budget for HHS

TUESDAY, Feb. 2 (HealthDay News) -- As part of his 2011 budget proposal, President Barack Obama has proposed $911 billion for the U.S. Health and Human Services (HHS) Department, according to a Feb. 1 announcement by the secretary of HHS, Kathleen Sebelius.

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Algorithm Developed to Segment the Meniscus in MRIs

MONDAY, Feb. 1 (HealthDay News) -- Semi-automated segmentation of magnetic resonance images can accurately assess the lateral meniscus in patients with and without knee osteoarthritis, according to a study published in Osteoarthritis and Cartilage.

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