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July 2013 Briefing - Emergency Medicine

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

Severe Hypoglycemia Common in Type 2 Diabetes

WEDNESDAY, July 31 (HealthDay News) -- Severe hypoglycemia is common among patients with type 2 diabetes, with the highest risk among those with near-normal or very poor glycemic control, according to a study published online July 30 in Diabetes Care.

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Health 'Mutual Accountability' Pilot Program Launching

WEDNESDAY, July 31 (HealthDay News) -- The State of Oklahoma Office of Management and Enterprise Services has chosen MedEncentive to conduct a three-year heath improvement program pilot among HealthChoice beneficiaries.

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Diagnosis of Bell's Palsy in ER Is Usually Accurate

WEDNESDAY, July 31 (HealthDay News) -- The incidence of incorrect diagnoses of Bell's palsy in the emergency department with subsequent alternative diagnosis is low, according to a study published online July 29 in the Annals of Emergency Medicine.

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Reversal of Medical Practices Common Over Past Decade

TUESDAY, July 30 (HealthDay News) -- Over 100 contemporary medical practices have subsequently been reversed over the last 10 years, according to a review published online July 22 in Mayo Clinical Proceedings.

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About One in Five Children Outgrow Asthma

TUESDAY, July 30 (HealthDay News) -- About 20 percent of children experience remission of their childhood asthma, which is less likely for females, children sensitized to furred animals, and children with severe asthma, according to a study published online July 29 in Pediatrics.

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Back Pain Management Relying on Guideline Discordant Care

TUESDAY, July 30 (HealthDay News) -- Management of back pain is increasingly relying on guideline discordant care, including narcotic use, advanced imaging, and referrals to physicians, according to research published online July 29 in JAMA Internal Medicine.

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USPSTF: Low-Dose CT Screening Benefits Smokers

MONDAY, July 29 (HealthDay News) -- The U.S. Preventive Services Task Force (USPSTF) finds that low-dose computed tomography (LDCT) screening is associated with reductions in lung cancer and all-cause mortality for high-risk smokers. This Recommendation Statement is based on an evidence review published online July 30 in the Annals of Internal Medicine.

Draft Recommendation Statement
Comment on Recommendations
Background Review

Nonfatal Food-Linked Choking Occurs in 12,435 Children/Year

MONDAY, July 29 (HealthDay News) -- The rate of nonfatal food-related choking is 20.4 emergency department visits per 100,000 children, and more than one-third of cases occur in infants aged 1 year or younger, according to research published online July 29 in Pediatrics.

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FDA Updates Oral Nizoral Label to Reflect Safety Concerns

MONDAY, July 29 (HealthDay News) -- The U.S. Food and Drug Administration has approved label changes for Nizoral (ketoconazole) oral tablets and added a Medication Guide detailing various associated safety concerns.

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For Ischemic Stroke, Fewer Women Receive Thrombolytics

FRIDAY, July 26 (HealthDay News) -- Women with acute ischemic stroke are less likely than men to arrive at the hospital within four hours and are less likely to receive thrombolytic treatment, according to research published online July 25 in Stroke.

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Flow Restrictors Protect Children From Liquid Medicine

FRIDAY, July 26 (HealthDay News) -- Adding flow restrictors to bottles limits the ability of young children to access liquid medicine, according to a study published online July 25 in the The Journal of Pediatrics.

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IOM Confirms Geographic Variation in Health Spending

THURSDAY, July 25 (HealthDay News) -- Considerable geographic variation exists in health care spending and utilization, but a geographically-based value index is unlikely to promote value improvement, according to a report published July 24 by the Institute of Medicine.

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Docs Need to Follow Patients' Lead, Embrace Social Media

WEDNESDAY, July 24 (HealthDay News) -- As more patients discuss and manage their health care online, doctors need to keep up and use social media, according to a report published by the American Medical Association (AMA).

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Dizziness Visits Account for About 4 Percent of ER Costs

WEDNESDAY, July 24 (HealthDay News) -- Emergency department costs for patients presenting with dizziness or vertigo are considerable, accounting for about 4 percent of total costs, according to a study published in the July issue of Academic Emergency Medicine.

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U.S. Physicians Not Supportive of Changes in Payment Models

TUESDAY, July 23 (HealthDay News) -- U.S. physicians accept some responsibility for reducing health care costs in their practice, but most do not want to change payment models, according to research published in the July 24/31 issue of the Journal of the American Medical Association.

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Low Rate of Change in Care With Transthoracic Echocardiography

TUESDAY, July 23 (HealthDay News) -- Although more than 90 percent of transthoracic echocardiograms (TTEs) are considered appropriately used, only about 30 percent result in active change in care, according to a study published online July 22 in JAMA Internal Medicine.

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About One in Four Families With Pediatrician Use Retail Clinics

TUESDAY, July 23 (HealthDay News) -- About one-quarter of parents whose children have a pediatrician also use retail clinics (RCs) for pediatric care, according to a study published online July 22 in JAMA Pediatrics.

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Consensus Statement Describes Role of Team Physicians

TUESDAY, July 23 (HealthDay News) -- Team physicians have medical and administrative duties and responsibilities to athletes, according to a consensus statement published in the August issue of Medicine & Science in Sports & Exercise.

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Automated ECG Directs Patients With Acute MI to Cath Lab

TUESDAY, July 23 (HealthDay News) -- Use of an automated electrocardiogram (ECG) to diagnose acute ST-segment elevation myocardial infarction (STEMI) activates the protocol for referral to the cardiac catheterization laboratory (CCL) and achieves timely intervention with balloon angioplasty, according to a study published in the July 15 issue of The American Journal of Cardiology.

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No Benefit of Echo Screening for Heart Dx in General Population

TUESDAY, July 23 (HealthDay News) -- Echocardiographic screening for heart disease in a general population of middle-aged asymptomatic individuals does not reduce the risk of death or the incidence of heart attacks and stroke, according to a study published online July 22 in JAMA Internal Medicine.

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Pros and Cons of Electronic Cigarette Regulation Discussed

TUESDAY, July 23 (HealthDay News) -- The pros and cons of electronic cigarette (EC) regulation are discussed in to two editorials published online July 23 in The Lancet Respiratory Medicine.

Editorial 1 (subscription or payment may be required)
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Premiums Expected to Be About 20 Percent Lower in 2014

MONDAY, July 22 (HealthDay News) -- Premiums in the Health Insurance Marketplace are likely to be about 20 percent lower than anticipated in 2014, according to a report published by the U.S. Department of Health and Human Services (HHS).

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Tablets Help Physicians Keep Up With Medical Research

MONDAY, July 22 (HealthDay News) -- Most physicians find keeping up with the latest research to be challenging, but the use of tablets and smartphones may help, according to a report published by Wolters Kluwer Health.

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Cough in Adolescent Boys May Signal Aspirated Blowgun Dart

MONDAY, July 22 (HealthDay News) -- Twenty websites have been identified that give instructions on how to make blowgun darts, but few offer safety warnings, and cases of adolescent boys who have accidentally aspirated the darts have been reported, according to a case report published online July 22 in Pediatrics.

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Use of Radiographs Increasing for Children With Asthma

MONDAY, July 22 (HealthDay News) -- Emergency department use of radiographs is increasing for children with asthma; and there is considerable variation between hospitals in the use of diagnostic testing for children with community-acquired pneumonia (CAP), according to two studies published online July 22 in Pediatrics.

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Child Injuries From Falling TVs Are Increasing in the U.S.

MONDAY, July 22 (HealthDay News) -- The rate of pediatric injuries caused by falling televisions (TVs) is increasing in the United States, according to research published online July 22 in Pediatrics.

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Newer Anticoagulants Linked to Gastrointestinal Bleeding

FRIDAY, July 19 (HealthDay News) -- Patients taking the new generation of oral anticoagulants appear to have a higher risk of gastrointestinal bleeding compared with standard care, particularly when treated for venous thrombosis or acute coronary syndrome, according to a review published in the July issue of Gastroenterology.

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Top Challenges for Docs Include Financial Management

FRIDAY, July 19 (HealthDay News) -- The top issues and challenges facing physicians include managing changing reimbursement models with payors and financial management, according to a report published by Wolters Kluwer Health.

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Missed Diagnoses, Med Errors Most Common Malpractice Claims

FRIDAY, July 19 (HealthDay News) -- The most common medical misadventures resulting in malpractice claims in primary care are missed or delayed diagnoses and medication errors, according to a review published online July 18 in BMJ Open.

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~2 Percent of Opioid Rx Bought by 0.7 Percent of Patients

THURSDAY, July 18 (HealthDay News) -- A small proportion of opioid prescription purchasers (0.7 percent) obtain an average of 32 prescriptions from 10 different prescribers, accounting for 1.9 percent of all opioid prescriptions, according to a study published online July 17 in PLOS ONE.

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Multiple Strategies Being Used to Address Distracted Driving

THURSDAY, July 18 (HealthDay News) -- More states are implementing multiple strategies to address the threats posed by distracted driving, according to a report published by the Governors Highway Safety Association (GHSA).

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Men Forgo Care With Switch to High-Deductible Health Plan

THURSDAY, July 18 (HealthDay News) -- Men may forgo needed care following the transition to high-deductible health plans (HDHP), according to a study published in the August issue of Medical Care.

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Music Beneficial for Children Undergoing IV Placement

THURSDAY, July 18 (HealthDay News) -- For children undergoing intravenous placement, music seems to have a favorable effect, with benefits also reported by parents and health care providers, according to a study published online July 15 in JAMA Pediatrics.

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Women in ER for Non-Urgent Care Can Be Screened for Health Needs

THURSDAY, July 18 (HealthDay News) -- Survey instruments may be used to screen for information about abuse experiences, substance use, and sexual health in women seeking non-urgent care at an emergency department, according to research published in the July issue of the Journal of Emergency Nursing.

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Changes Necessary to Help Homeless Quit Smoking

WEDNESDAY, July 17 (HealthDay News) -- Many homeless are interested in quitting smoking, and specific interventions are necessary for this population, according to a perspective piece published in the July 18 issue of the New England Journal of Medicine.

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Ways to Lower Readmission Rates for Heart Failure Identified

WEDNESDAY, July 17 (HealthDay News) -- Several strategies associated with a lower risk of readmission have been identified for patients with heart failure, according to research published in the July issue of Circulation: Cardiovascular Quality and Outcomes.

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Financial Incentives Can Drive Health IT Adoption

WEDNESDAY, July 17 (HealthDay News) -- Financial incentives can drive providers' adoption of health information technology, including e-prescribing, according to a study published in the July issue of Health Affairs.

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Combination Treatment Beneficial for Cardiac Arrest

TUESDAY, July 16 (HealthDay News) -- Among patients with cardiac arrest requiring vasopressors, treatment with epinephrine, vasopressin, and methylprednisolone during cardiopulmonary resuscitation (CPR) leads to improved survival to hospital discharge and improved neurological status, according to a study published in the July 17 issue of the Journal of the American Medical Association.

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Repeat Hospitalization Factors for Nursing Home Residents Studied

TUESDAY, July 16 (HealthDay News) -- Nursing home residents with advanced cognitive impairment have significantly lower survival if they are repeatedly hospitalized for dehydration or infection, according to a research letter published in the July 17 issue of the Journal of the American Medical Association.

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CMS Medicare Physician Fee Schedule Could Benefit Docs

TUESDAY, July 16 (HealthDay News) -- The Centers for Medicare and Medicaid Services has released the 2014 proposed Medicare physician fee schedule, which could help create a more equitable payment system by adjusting misvalued codes and proposing new complex management codes, according to a report published by American Academy of Family Physicians.

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Redesign of Medical Education Needed for Chronic Disease Era

TUESDAY, July 16 (HealthDay News) -- Medical education programs should be redesigned to address the current complex chronic disease era, with emphasis on appropriate basic sciences and clinical skills, according to a special communication published online July 15 in JAMA Internal Medicine.

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Improvements Made to CMS Online Directory of Physicians

TUESDAY, July 16 (HealthDay News) -- The Centers for Medicare and Medicaid Services (CMS) has reworked and redesigned their online directory of physicians (Physicians Compare) after errors were discovered throughout the site.

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CDC Reports 30-Year Low in Rate of Youth Homicides

TUESDAY, July 16 (HealthDay News) -- For the period from 1981 to 2010, homicide rates in persons in the United States aged 10 to 24 years fluctuated, but a downward trend starting in 1994 led to the lowest rate recorded for the 30-year period in 2010, according to research published in the July 12 issue of the U.S. Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

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Liver Failure Via Acetaminophen OD Tied to Worse Outcomes

MONDAY, July 15 (HealthDay News) -- Long-term survivors of acute liver failure report lower quality of life compared with the general population, while survivors of acetaminophen overdose report the lowest quality of life, possibly due to psychiatric and substance abuse disorders, according to a study published online June 18 in Liver Transplantation.

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EHRs May Slow Growth in Ambulatory Health Care Costs

MONDAY, July 15 (HealthDay News) -- Adoption of electronic health records (EHRs) modestly slows growth in ambulatory health care costs, according to research published in the July 16 issue of the Annals of Internal Medicine.

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Tool Helps Emergency Providers ID Drug-Seeking Behavior

MONDAY, July 15 (HealthDay News) -- Emergency providers are fairly accurate at identifying drug-seeking behavior, demonstrating fair agreement with prescription drug monitoring program criteria, according to a study published online July 11 in the Annals of Emergency Medicine.

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More Job Opportunities Available for Physicians

MONDAY, July 15 (HealthDay News) -- More than half of physicians are receiving up to three employment solicitations per week, according to a report published by American Medical Association (AMA).

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CMS Proposes New Rule for Outpatient Payment Policies

MONDAY, July 15 (HealthDay News) -- A new rule proposes updating Medicare payment policies and rates for the hospital outpatient prospective payment system (OPPS) and ambulatory surgical center (ASC) services, according to a report issued by the Centers for Medicare and Medicaid Services.

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Physicians Frustrated by Third-Party Interference

FRIDAY, July 12 (HealthDay News) -- Third-party interference is the most commonly cited key frustration for physicians, according to the results of a survey published in Physicians Practice.

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AMA Offers Guidance for Improving EHR Effectiveness

FRIDAY, July 12 (HealthDay News) -- The American Medical Association (AMA) House of Delegates has voted for policies to help physicians navigate patient interaction while using electronic devices and to improve the interoperability of electronic health records (EHRs).

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Length of ER Visit Will Increase With Aging Population

FRIDAY, July 12 (HealthDay News) -- The aging population will not cause emergency department visits to increase in frequency, but their duration will increase, according to research published in the July issue of Health Affairs.

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U.S. Adults Value Health Care Provider Skill Evaluation

THURSDAY, July 11 (HealthDay News) -- Most adults feel that health care providers who treat them should adhere to a recertification program, including passing examinations, attending educational programs, and undergoing certification, regardless of time in practice, according to a report published by the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA) and the Citizen Advocacy Center.

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Grants of $150 Million for Community Health Centers

THURSDAY, July 11 (HealthDay News) -- Grants totaling $150 million are to be shared by 1,100 community health centers to help enroll patients in insurance programs, according to the U.S. Department of Health and Human Services (HHS).

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Health Searches May Be Leaked to Third Parties

THURSDAY, July 11 (HealthDay News) -- Free health-related websites often have third-party tracking elements and leak search terms to third-party tracking entities, unlike U.S. government or physician-oriented websites, according to a research letter published online July 8 in JAMA Internal Medicine.

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Low-Income Patients Prefer Hospital to Outpatient Care

THURSDAY, July 11 (HealthDay News) -- Patients in low socioeconomic groups who live in urban settings report that they prefer hospital care to ambulatory care because it is less expensive, more accessible, and superior in quality, according to research published in the July issue of Health Affairs.

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One in Five U.S. Adults Will Have Trouble Paying Medical Bills

THURSDAY, July 11 (HealthDay News) -- About one in five U.S. adults will have problems paying health care bills in 2013, including about 10 million adults with year-round insurance coverage, according to a report published by the American Medical Association (AMA).

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Quality Metrics Play Small Role in Physician Compensation

THURSDAY, July 11 (HealthDay News) -- Quality measures play a small but emerging role in physician compensation, according to a report published by the Medical Group Management Association (MGMA).

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In 2010, Blood Transfusion Most Frequent Hospital Procedure

THURSDAY, July 11 (HealthDay News) -- The most frequent procedure performed during hospitalization in 2010 was blood transfusion, which was common among all age groups except for infants, according to the Agency for Healthcare Research and Quality (AHRQ).

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Red Cross Issues Emergency Call for Blood Donors

THURSDAY, July 11 (HealthDay News) -- The American Red Cross has issued an emergency request for blood and platelet donors of all blood types, according to report posted July 9.

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Docs Don't Often Talk to Patients About Dietary Supplements

THURSDAY, July 11 (HealthDay News) -- Although primary care physicians are discussing dietary supplements with patients during outpatient visits, these exchanges happen infrequently, according to research published in the June issue of Patient Education and Counseling.

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Improvement Needed in Drug Post-Marketing Studies

WEDNESDAY, July 10 (HealthDay News) -- Since the requirement in 2007 that drug makers conduct post-marketing studies, the number of studies not yet started has declined while the number of studies fulfilling obligations has nearly doubled, according to a report published in the July 10 issue of the Journal of the American Medical Association. However, more than 40 percent of studies had not yet been started in 2011, and the number of studies with delays doubled as of 2011.

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Tablets More Useful Than Smartphones for Docs Using EHRs

WEDNESDAY, July 10 (HealthDay News) -- Although tablets are less often used by physicians than smartphones, they are more frequently used for accessing electronic health records (EHRs), and time spent on tablets is much higher, according to two reports published by AmericanEHR Partners.

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Health Insurance Marketplaces Not Required to Verify Claims

WEDNESDAY, July 10 (HealthDay News) -- Health insurance marketplaces will not be required to verify consumers' income and health insurance status and can rely on self-reported information, the Obama administration announced Friday.

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Digital Divide Plagues Underserved Areas

TUESDAY, July 9 (HealthDay News) -- Electronic health record (EHR) adoption is uneven, with traditionally underserved areas having lower adoption rates across the United States, according to a study published online June 26 in Health Services Research.

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Physicians Urged to Consider Gun-Related Violence in Elderly

TUESDAY, July 9 (HealthDay News) -- Physicians must consider their role in restricting gun-related violence among the elderly and those with mental illness, according to two ideas and opinions pieces published in the July 9 issue of the Annals of Internal Medicine.

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Adoption of Electronic Health Records Is Progressing

TUESDAY, July 9 (HealthDay News) -- In 2012, 44 percent of hospitals reported having at least a basic electronic health record (EHR), according to an annual report published by the Robert Wood Johnson Foundation.

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Awareness of Risks Reduces Parents' Desire for CT Scans

MONDAY, July 8 (HealthDay News) -- Willingness to subject children with a head injury to computed tomography (CT) scans decreases once parents are informed of lifetime malignancy risks associated with the scans, but most are still willing to proceed with head CT, according to a study published online July 8 in Pediatrics.

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Practices Are Not Ready for Implementation of ICD-10

MONDAY, July 8 (HealthDay News) -- Most practices are not ready for implementation of the International Classification of Diseases, Tenth Revision (ICD-10), according to a report published by the Medical Group Management Association (MGMA).

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About One-Quarter of Assault-Injured Youth Own a Gun

MONDAY, July 8 (HealthDay News) -- Nearly one-quarter of youth presenting to the emergency department for assault-related injuries report possessing a firearm, most of which are obtained illegally, according to a study published online July 8 in Pediatrics.

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Early Predictors of Disability After Spine Trauma Identified

MONDAY, July 8 (HealthDay News) -- The presence of hypotension, hyperglycemia, and moderate or severe traumatic brain injury early after spine trauma are independent predictors of functional disability at one year, according to a review published in the May 20 issue of Spine.

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Adding 'Organ Donor' to Facebook Ups Registration

FRIDAY, July 5 (HealthDay News) -- Initiation of the Facebook organ donor initiative has dramatically increased organ donor registration, according to a study published online June 18 in the American Journal of Transplantation.

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Decrease in Beach Closing/Advisory Days in 2012

THURSDAY, July 4 (HealthDay News) -- There was a 14 percent decrease from 2011 to 2012 in the number of beach closing and advisory days, according to a report from Natural Resources Defense Council (NRDC).

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More Than 40 Percent of Docs Report Work Dissatisfaction

WEDNESDAY, July 3 (HealthDay News) -- Many physicians are dissatisfied and are unlikely to recommend the medical profession to young people, according to a report published by Jackson Healthcare.

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CT Pulmonary Angiography Linked to Overdiagnosis of PE

WEDNESDAY, July 3 (HealthDay News) -- The increased use of computed tomography (CT) pulmonary angiography is associated with increased incidence of pulmonary embolism among U.S. adults, but with minimal decrease in mortality from pulmonary embolism, according to an analysis published online July 2 in BMJ.

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Drug Overdose Deaths, ER Visits Up for Women Since 1999

WEDNESDAY, July 3 (HealthDay News) -- Drug-related deaths and emergency department visits have increased among women since 1999, according to research published in the July 2 early-release issue of the U.S. Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

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Obama Administration: ACA's Employer Mandate Delayed

WEDNESDAY, July 3 (HealthDay News) -- The Obama Administration is postponing a major Affordable Care Act (ACA) provision, the employer mandate, according to an announcement made Tuesday via the U.S. Department of the Treasury website.

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Docs Impact Comparative Effectiveness Research Opinion

TUESDAY, July 2 (HealthDay News) -- Doctors' support of comparative effectiveness research (CER) influences public opinion and has a greater impact on public opinion than cues from political players, according to research to be published this fall in the Journal of Health Politics, Policy and Law.

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Long-Term Night Shift Work Ups Likelihood of Breast Cancer

TUESDAY, July 2 (HealthDay News) -- Prolonged night shift work (for 30 years or more) is associated with a significantly increased likelihood of breast cancer, according to a study published online July 1 in Occupational & Environmental Medicine.

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Prehospital Triage Policy for Suspected Stroke Ups tPA Use

MONDAY, July 1 (HealthDay News) -- Implementation of a prehospital triage policy for patients with suspected stroke is associated with increased use of intravenous (IV) tissue plasminogen activator (tPA), according to a study published online July 1 in JAMA Neurology.

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Injuries in Young Due to All-Terrain Vehicles Declining

MONDAY, July 1 (HealthDay News) -- Nonfatal injuries among children and adolescents due to all-terrain vehicles (ATVs) have declined since the mid-2000s, although boys have twice the injury rate as girls, according to research published online July 1 in Pediatrics.

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Collapsible Laundry Hampers Can Cause Severe Eye Injuries

MONDAY, July 1 (HealthDay News) -- Exposed wire in collapsible cloth laundry hampers can cause penetrating eye injuries in children, according to research published online July 1 in Pediatrics.

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