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March 2011 Briefing - Emergency Medicine

Here are what the editors at HealthDay consider to be the most important developments in Emergency Medicine for March 2011. This roundup includes the latest research news from journal articles, as well as the FDA approvals and regulatory changes that are the most likely to affect clinical practice.

Areas With More Surgeons Have Fewer Car Crash Deaths

THURSDAY, March 31 (HealthDay News) -- Areas with more surgeons available have fewer deaths from motor vehicle crashes (MVCs), according to a study published online March 29 in the Journal of the American College of Surgeons.

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Accurate Cerebral Aneurysm Diagnosis by CT Angiography

WEDNESDAY, March 30 (HealthDay News) -- Computed tomographic (CT) angiography, especially by modern multidetector CT, is a highly accurate tool for diagnosing cerebral aneurysms, according to a meta-analysis published online March 9 in the Annals of Neurology.

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Online Health Records Less Used by Minorities, Poor

WEDNESDAY, March 30 (HealthDay News) -- Online personal health records (PHRs) are less frequently used by racial or ethnic minorities and patients with low annual income, according to a study published in the March 28 issue of the Archives of Internal Medicine.

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Discharge to Skilled Nursing Facilities Linked to Death

WEDNESDAY, March 30 (HealthDay News) -- Patients with heart failure discharged to skilled nursing facilities (SNFs) have an increased risk for rehospitalization and death, according to a study published online March 29 in Circulation: Heart Failure.

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Four-Dose Rabies Prevention Vaccine Schedule Endorsed

TUESDAY, March 29 (HealthDay News) -- A U.S. Centers for Disease Control and Prevention committee has proposed a reduced schedule for prophylactic rabies vaccine, and the recommendations have been endorsed by the American Academy of Pediatrics Committee on Infectious Diseases, according to a policy statement published online March 28 in Pediatrics.

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Decline Seen in Global Youth Mortality Over Last 50 Years

TUESDAY, March 29 (HealthDay News) -- Overall mortality declined substantially between 1955 and 2004 in children aged 14 years or younger and in females aged 15 to 24, but a smaller decline was evident for males aged 15 to 24 years, according to a study published online March 29 in The Lancet.

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Guidelines Provided for Deep Vein Thrombosis Management

MONDAY, March 28 (HealthDay News) -- Blood thinners should not be the only therapy considered for patients with deep vein thrombosis (DVT), according to a scientific statement published online March 21 in Circulation.

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ISICEM: Decompressive Craniectomy May Be Harmful

FRIDAY, March 25 (HealthDay News) -- The use of decompressive craniectomy in patients with severe diffuse traumatic brain injury and refractory intracranial hypertension appears to lower intracranial pressure and shorten intensive care unit (ICU) stays but is associated with more unfavorable outcomes, according to a study published online March 25 in the New England Journal of Medicine to coincide with research presented at the 31st International Symposium on Intensive Care and Emergency Medicine, held from March 22 to 25 in Brussels, Belgium.

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Fracture Rates Slightly Higher in HIV Patients

FRIDAY, March 25 (HealthDay News) -- People with HIV infection have a higher bone fracture rate compared to the general U.S. population, according to a study published online March 10 in Clinical Infectious Diseases.

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Tuberculosis Rates in United States at All-Time Low

THURSDAY, March 24 (HealthDay News) -- The rate of tuberculosis (TB) infection in the United States continues to decline, but the goal of elimination has not been met, and the infection disproportionately affects foreign-born individuals and ethnic minorities, according to a report published in the March 25 issue of the U.S. Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

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Early Tranexamic Acid Reduces Bleeding-Related Death

THURSDAY, March 24 (HealthDay News) -- Early administration of tranexamic acid reduces mortality due to bleeding in trauma patients; given more than three hours after injury, however, the agent could raise the risk of death, according to research published online March 24 in The Lancet.

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Reduced Hours for Trainees Has Had Little Effect in U.S.

THURSDAY, March 24 (HealthDay News) -- Reducing work hours for doctors in training to less than 80 per week has had little impact on patient outcomes or postgraduate training in the United States, according to a literature review published online March 22 in BMJ.

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Tiotropium Shows Edge Over Salmeterol for COPD

WEDNESDAY, March 23 (HealthDay News) -- Tiotropium, an anticholinergic drug, appears to be more effective than salmeterol in preventing exacerbations in patients with moderate or worse chronic obstructive pulmonary disease (COPD), according to research published in the March 24 issue of the New England Journal of Medicine.

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Rapid Assessment Identifies Low-Risk Chest Pain Patients

WEDNESDAY, March 23 (HealthDay News) -- A novel two-hour accelerated diagnosis protocol (ADP) appears quite accurate in identifying patients with chest pains who are at low risk for a major adverse cardiac event and could probably be discharged early, according to research published online March 23 in The Lancet.

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Lower Troponin Assay Threshold Aids MI Diagnosis

WEDNESDAY, March 23 (HealthDay News) -- Lowering the diagnostic threshold of plasma troponin in patients with suspected acute coronary syndrome (ACS) is associated with lower risk of death and recurrent myocardial infarction (MI), according to a study published in the March 23/30 issue of the Journal of the American Medical Association.

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Hydrocortisone Lowers Risk of Hospital-Acquired Pneumonia

TUESDAY, March 22 (HealthDay News) -- Intravenous hydrocortisone decreases the risk of developing hospital-acquired pneumonia in intubated trauma patients, according to a study published in the March 23/30 issue of the Journal of the American Medical Association.

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Combination Therapy Given to Elderly Without Indications

MONDAY, March 21 (HealthDay News) -- Combination therapy of angiotensin-converting-enzyme (ACE) inhibitors and angiotensin-receptor blockers is often prescribed without established indications, and is associated with an elevated risk of adverse renal outcomes compared to monotherapy, according to a study published online March 21 in CMAJ, the journal of the Canadian Medical Association.

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Group B Strep Still Main Cause of Neonatal Meningitis

MONDAY, March 21 (HealthDay News) -- Group B streptococci (GBS) is still the dominant cause of neonatal bacterial meningitis, whereas Escherichia coli (E. coli) is the most common cause among preterm infants, according to a study published in the March issue of The Pediatric Infectious Disease Journal.

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AAP Updates Recommendations on Car Seat Use

MONDAY, March 21 (HealthDay News) -- In a policy statement and technical report published online March 21 in Pediatrics, the American Association of Pediatrics (AAP) has updated their recommendations on best practices for the use of car seats and seat belts for children from birth through adolescence.

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Up to a Fifth of ER Patients Leave Without Being Seen

FRIDAY, March 18 (HealthDay News) -- The percentage of patients in emergency departments who leave without being seen (LWBS) varies greatly across hospitals and is higher for emergency departments with more low-income and poorly insured patients, according to a study published online Feb. 21 in the Annals of Emergency Medicine.

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Professional Values of U.S. and U.K. Doctors Examined

THURSDAY, March 17 (HealthDay News) -- A core of professional values exists among doctors in the United States and the United Kingdom, though significant differences exist in how these values are expressed and prioritized, according to a study published online March 7 in BMJ Quality & Safety.

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Short Nurse Staffing Linked to Higher Patient Mortality

WEDNESDAY, March 16 (HealthDay News) -- Patient mortality appears to be higher when nurse staffing falls eight or more hours below target level and during nursing shifts when patient turnover is high, according to research published in the March 17 issue of the New England Journal of Medicine.

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Adding Omalizumab Improves Asthma Control in Youth

WEDNESDAY, March 16 (HealthDay News) -- The addition of omalizumab to a regimen of guidelines-based therapy among youth with persistent asthma appears to improve asthma control and reduce the need for other medications to control the condition, according to a study published in the March 17 issue of the New England Journal of Medicine.

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Fever Not Tied to Influenza Virus Shedding Duration

WEDNESDAY, March 16 (HealthDay News) -- Health care personnel (HCP) infected with influenza (H1N1) 2009 virus who return to work 24 hours after defervescence may still be shedding virus, according to a study published online March 16 in Emerging Infectious Diseases.

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U.S. Death Rate Reaches All-Time Low

WEDNESDAY, March 16 (HealthDay News) -- The age-adjusted death rate for the United States has fallen for 10 straight years and has reached an all-time low of 741 per 100,000, or 2,436,682 deaths, in 2009, down 2.3 percent from 2008, according to a new report issued by the U.S. Centers for Disease Control and Prevention's National Center for Health Statistics.

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Worse Outcomes in Patients With Low Socioeconomic Status

WEDNESDAY, March 14 (HealthDay News) -- Among patients with epilepsy who receive regular care, those with a low socioeconomic status (SES) make greater use of health care facilities but have worse outcomes than their higher SES peers, according to a study published online Feb. 14 in Epilepsia.

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More Cholera Cases and Deaths Expected in Haiti

WEDNESDAY, March 16 (HealthDay News) -- Mathematical modeling estimates that more cases of cholera than expected will occur in the coming months in Haiti, but many could be averted by the provision of clean water, vaccinations, and increased antibiotic distribution, according to a study published online March 16 in The Lancet.

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Heavy Smoking Prevalence Decline Greatest in California

TUESDAY, March 15 (HealthDay News) -- Between 1965 and 2007, the prevalence of high-intensity smoking declined in California and in the remaining states, according to a study published in the March 16 issue of the Journal of the American Medical Association.

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Drug-Related Poisonings Highest in Young Children

MONDAY, March 14 (HealthDay News) -- Emergency department visits for unintentional drug-related poisonings in the United States are highest among children age 0 to 5 and more prominent in rural areas, and young women have the highest rate of drug-related poisonings with suicidal intent, according to research published online March 3 in the American Journal of Emergency Medicine.

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Colonic Stenting No Better Than Emergency Surgery

MONDAY, March 14 (HealthDay News) -- Colonic stenting does not offer a decisive advantage over emergency surgery in patients with acute obstructive left-sided colorectal cancer, and may pose safety concerns, according to a study published online March 12 in The Lancet Oncology.

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Long-Term Increase in Death Rates After Head Injury

FRIDAY, March 11 (HealthDay News) -- Head injury is associated with increased susceptibility to death for at least 13 years after hospital admission, according to a study published online Jan. 31 in the Journal of Neurology, Neurosurgery & Psychiatry.

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Device OK'd to Continue Blood Flow During Brain Surgery

FRIDAY, March 11 (HealthDay News) -- A device that permits the rerouting of blood flow during surgery to treat a brain aneurysm or tumor in people at greater risk of stroke has been approved by the U.S. Food and Drug Administration.

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Heart Rate Turbulence Risk Factor for Cardiac Mortality

FRIDAY, March 11 (HealthDay News) -- Abnormal heart rate turbulence (HRT) is independently associated with increased cardiac mortality risk for low-, intermediate-, and high-risk individuals, while C-reactive protein (CRP) is associated with an increased cardiac mortality risk only in those who are low risk, according to a study published in the February issue of the Journal of Cardiovascular Electrophysiology.

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Coffee Consumption Linked to Lower Stroke Risk in Women

FRIDAY, March 11 (HealthDay News) -- Women who consume one or more cups of coffee daily have a lower risk of stroke than those who consume less than one cup of coffee a day, according to a study published online March 10 in Stroke.

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Irbesartan Does Not Prevent Cardiovascular Events in A-Fib

WEDNESDAY, March 9 (HealthDay News) -- The angiotensin-receptor blocker irbesartan fails to lower the rate of cardiovascular events in patients with atrial fibrillation, according to research published in the March 10 issue of the New England Journal of Medicine.

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HealthGrades Finds Rates of Patient Safety Events Vary

WEDNESDAY, March 9 (HealthDay News) -- Patients treated at hospitals rated with a HealthGrades Patient Safety Excellence Award have, on average, a 46 percent lower risk of experiencing a patient safety incident compared to those treated at the lowest-ranked hospitals, according to the eighth annual HealthGrades Patient Safety in American Hospitals Study published online March 9.

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Ethnic Differences Seen in Academic Measures for U.K. Docs

WEDNESDAY, March 9 (HealthDay News) -- United Kingdom-trained physicians and medical students with ethnic minority backgrounds tend to underperform academically compared to their white peers, according to a meta-analysis published online March 8 in BMJ.

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Brief CPR Education of Laypersons Proves Beneficial

WEDNESDAY, March 9 (HealthDay News) -- Laypersons who have been exposed to short American Heart Association (AHA) Hands-Only cardiopulmonary resuscitation (CPR) videos are more likely to attempt CPR, and demonstrate better CPR technique than untrained individuals, according to a study published in the March issue of Circulation: Cardiovascular Quality and Outcomes.

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Pharmacological Meta-Analyses Rarely Report Disclosures

TUESDAY, March 8 (HealthDay News) -- Meta-analyses of pharmacological treatments rarely include information addressing primary study funding and conflicts of interest (COIs) of the authors for the included randomized control trials (RCTs), according to a study published in the March 9 issue of the Journal of the American Medical Association.

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Post-Hospitalization Mortality High in Trauma Patients

TUESDAY, March 8 (HealthDay News) -- The three-year cumulative mortality rate for trauma patients after being discharged from Washington state hospitals is relatively high, particularly in those discharged to skilled nursing facilities, according to research published in the March 9 issue of the Journal of the American Medical Association.

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FDA: Adverse Events Tied to Kaletra in Preterm Infants

TUESDAY, March 8 (HealthDay News) -- The U.S. Food and Drug Administration has notified health care providers of a revision to the label of lopinavir/ritonavir (Kaletra) oral solution to include a new warning, as administration of the oral solution may result in serious health problems among premature babies.

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Majority of Pediatric Burn Admissions Due to Scalding

TUESDAY, March 8 (HealthDay News) -- Although admission rates for burn injury declined from 1983 to 2008, more than half of burn-injury hospital admissions for children younger than 5 years of age in Western Australia are due to scalding, according to a study published online March 7 in Pediatrics.

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Atrial Fibrillation Tied to Higher Incidence of Dementia

TUESDAY, March 8 (HealthDay News) -- Atrial fibrillation (AF) is associated with an increased incidence of dementia, and this association is strongest in patients with stroke, according to a meta-analysis published in the March 8 issue of Neurology.

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Abuser's Gender Affects Head Trauma Outcome in Youth

MONDAY, March 7 (HealthDay News) -- Male perpetrators of abusive head trauma in children are more likely to confess and be convicted, and their victims are more likely to have more serious presentations and worse outcomes, according to a study published online March 7 in Pediatrics.

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Inhaled Epinephrine Gives Temporary Relief From Croup

MONDAY, March 7 (HealthDay News) -- Inhaled epinephrine improves moderate to severe croup symptoms in children from 30 minutes to two hours after treatment, according to a literature review published in the Cochrane Database of Systematic Reviews.

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Nonmilitary Personnel Have More Non-War-Related Injuries

FRIDAY, March 4 (HealthDay News) -- Nonmilitary personnel are more likely than military personnel to be medically evacuated for non-war-related injuries, but they are also more likely to return to duty after recovering from non-war-related injuries, according to research published online Feb. 14 in CMAJ, the journal of the Canadian Medical Association.

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Majority Identify Need for an Ambulance in an Emergency

FRIDAY, March 4 (HealthDay News) -- The majority of people are able to identify emergency situations that require an ambulance to be called, but there is a high level of inappropriate response in nonemergency situations, according to a study published online Feb. 22 in the Emergency Medicine Journal.

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Rule Predicts Ability to Walk After Spinal Cord Injury

FRIDAY, March 4 (HealthDay News) -- A new clinical prediction rule, which accounts for age and four neurological variables, can predict independent walking one year following traumatic spinal cord injury, according to a study published online March 4 in The Lancet.

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Depression Tied to Lower Priority of Care in Heart Attack

THURSDAY, March 3 (HealthDay News) -- Heart attack patients with a documented history of depression in their charts may be triaged to lower priority of care than patients with no documented history of depression, and they are more likely to have worse associated performance on quality indicators, according to research published online Feb. 28 in CMAJ, the journal of the Canadian Medical Association.

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Diuretic Has Similar Effect Regardless of Method or Dose

THURSDAY, March 3 (HealthDay News) -- The responses of patients with acute decompensated heart failure to loop diuretics don't appear to differ between groups administered the agent by bolus or continuous infusion, or at a high or low dose, according to research published in the March 3 issue of the New England Journal of Medicine.

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FDA: Proton Pump Inhibitors Tied to Hypomagnesemia

WEDNESDAY, March 2 (HealthDay News) -- The U.S. Food and Drug Administration has notified health care providers and consumers that taking prescription proton pump inhibitor (PPI) drugs for prolonged periods of time, particularly for longer than one year, may be associated with low serum magnesium levels (hypomagnesemia).

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Inhaled Nitric Oxide Does Not Shorten Sickle Cell Crisis

WEDNESDAY, March 2 (HealthDay News) -- Among patients with sickle cell disease (SCD), the use of inhaled nitric oxide does not reduce the time to resolution of a vaso-occlusive pain crisis (VOC) compared to placebo, according to a study published in the March 2 issue of the Journal of the American Medical Association.

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Risk of Death From Heart Attacks Not Linked to Gender

TUESDAY, March 1 (HealthDay News) -- The association between female gender and increased mortality among patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) does not persist after adjusting for age and comorbidities, according to a study published in the January issue of the American Heart Journal.

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Helmets Protect Motorcyclists From Cervical Spine Injury

TUESDAY, March 1 (HealthDay News) -- Motorcyclists who wear helmets are less likely to suffer a cervical spine injury after a collision, according to a study published in the March issue of the Journal of the American College of Surgeons.

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Physician's Briefing