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March 2014 Briefing - Emergency Medicine

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

Post-Discharge Deaths Drop in Young Acute MI Patients

MONDAY, March 31, 2014 (HealthDay News) -- In the most recent decade, compared with earlier decades, post-discharge death rates have dropped for young adults hospitalized for acute myocardial infarction (AMI), according to research published in the April 1 issue of The American Journal of Cardiology.

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One in 12,000 Hospital Deliveries Result in Cardiac Arrest

FRIDAY, March 28, 2014 (HealthDay News) -- Cardiac arrest occurs in approximately one of every 12,000 hospitalizations for delivery, according to a study published in the April issue of Anesthesiology.

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NCHS Estimates Health Insurance Coverage for 2013

THURSDAY, March 27, 2014 (HealthDay News) -- In the first nine months of 2013, 6.7 percent of children and 20.5 percent of adults were uninsured, according to a study published online March 27 by the National Center for Health Statistics (NCHS).

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White House Extends Affordable Care Act Enrollment Deadline

WEDNESDAY, March 26, 2014 (HealthDay News) -- Americans who've started applying for health insurance under the Affordable Care Act but can't complete the process by the March 31 enrollment deadline will be given an extension.

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Nitroglycerin Shortage Has Medical Community Worried

WEDNESDAY, March 26, 2014 (HealthDay News) -- An ongoing shortage of the drug nitroglycerin is causing problems and concerns for doctors and hospitals in the United States. The drug is often the first therapy used by emergency room doctors when treating a heart attack patient.

Health Highlights: March 26, 2014

AMA Introduces Medical Education Initiative

WEDNESDAY, March 26, 2014 (HealthDay News) -- The American Medical Association's (AMA) Accelerating Change in Education initiative is being introduced in 11 medical schools in an effort to shift the focus of education toward real-world practice and competency assessment, according to an AMA report.

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Americans Seem Unprepared for Health Insurance Exchanges

WEDNESDAY, March 26, 2014 (HealthDay News) -- Individuals in the United States seem not to be sufficiently informed about the health insurance exchanges established by the Affordable Care Act (ACA), according to a study published online March 24 in the Proceedings of the National Academy of Sciences.

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Opioid Prescriptions in the Emergency Room Rising

TUESDAY, March 25, 2014 (HealthDay News) -- Prescriptions for opioid analgesics in the emergency department have risen dramatically over the last decade, according to a study published in the March issue of Academic Emergency Medicine.

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Nicotine 'E-Liquids' Pose Serious Health Threat

MONDAY, March 24, 2014 (HealthDay News) -- A potent, liquid form of nicotine poses a serious and potentially deadly threat, but is sold legally in stores across the United States and online. The so-called "e-liquids" -- the key ingredients in e-cigarettes -- are extracted from tobacco and enhanced with flavorings, colorings, and various chemicals, The New York Times reported.

Health Highlights: March 24, 2014

Mortality Up for PCI After Cardiac Arrest

MONDAY, March 24, 2014 (HealthDay News) -- Patients who undergo percutaneous coronary intervention (PCI) after cardiac arrest are more likely to have more complex lesions, cardiogenic shock, and higher mortality, according to research published in the April 1 issue of The American Journal of Cardiology.

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Patient Request Impacts Doc Prescribing Behavior

MONDAY, March 24, 2014 (HealthDay News) -- Patients requesting specific medications are more likely to be prescribed those medications, according to research published in the April issue of Medical Care.

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Cervical Spine Clearance Protocols Vary Considerably

MONDAY, March 24, 2014 (HealthDay News) -- Cervical spine clearance protocols for level-1 trauma centers are highly variable, according to a study published in the March 1 issue of Spine.

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Practices Can Take Steps to Improve Care Transitions

FRIDAY, March 21, 2014 (HealthDay News) -- Implementation of a rigorous process can improve transitions of care, according to an article published March 10 in Medical Economics.

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Older Drivers More Susceptible to the Effects of Alcohol

FRIDAY, March 21, 2014 (HealthDay News) -- Older adults' driving performance may be more susceptible to the effects of alcohol, according to a study published in the February issue of Psychopharmacology.

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Age-Adjusted D-Dimer Levels Aid Pulmonary Embolism Dx

FRIDAY, March 21, 2014 (HealthDay News) -- Age-adjusted levels of D-dimer safely exclude pulmonary embolism (PE) in older patients, according to a study published in the March 19 issue of the Journal of the American Medical Association.

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Continuity of Care Improves Outcomes in Chronic Disease

WEDNESDAY, March 19, 2014 (HealthDay News) -- For Medicare beneficiaries with congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), and type 2 diabetes mellitus (T2DM), continuity of care is associated with differences in costs, emergency department use, and complications, according to a study published online March 17 in JAMA Internal Medicine.

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Gender Differences Identified in Access to Care in ACS

WEDNESDAY, March 19, 2014 (HealthDay News) -- Gender differences exist in access to care among younger adults with acute coronary syndrome, according to a study published online March 17 in CMAJ, the journal of the Canadian Medical Association.

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Neuroimaging Ordered for >12 Percent of Headaches

WEDNESDAY, March 19, 2014 (HealthDay News) -- Neuroimaging is frequently ordered for patients with headache, according to a research letter published online March 17 in JAMA Internal Medicine.

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Same Meningitis Strain Behind Drexel, Princeton Outbreaks: CDC

TUESDAY, March 18, 2014 (HealthDay News) -- The strain of bacterial meningitis that killed a Drexel University student earlier this month is the same strain behind a Princeton University outbreak last year, federal health officials said Tuesday. This suggests that the outbreak strain might still be present in the Princeton community and that the situation requires close monitoring, according to the U.S. Centers for Disease Control and Prevention.

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Insurers Must Offer Same-Sex Couples Spousal Benefits

MONDAY, March 17, 2014 (HealthDay News) -- Health plans that offer benefits for heterosexual couples must do the same for same-sex married couples, the Obama administration says.

Other Health Highlights: March 17, 2014

Rx Expenditures Expected to Rise in 2014

MONDAY, March 17, 2014 (HealthDay News) -- Drug costs are projected to rise 3 to 5 percent across all care settings in 2014, according to a study published in the March 15 issue of the American Journal of Health-System Pharmacy.

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Better Ruptured Abdominal Aortic Aneurysm Outcomes in U.S.

MONDAY, March 17, 2014 (HealthDay News) -- Outcomes for patients with ruptured abdominal aortic aneurysm (rAAA) are better in the United States than in England, with common factors suggesting strategies for outcome improvement, according to a study published in the March 15 issue of The Lancet.

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NATA: Recommendations Issued for Sport Concussion Management

MONDAY, March 17, 2014 (HealthDay News) -- Recommendations have been developed for management of sport-related concussion. The recommendations have been published online March 7 in the Journal of Athletic Training as a National Athletic Trainers' Association Position Statement.

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Most Influenza Infections Seem to Be Asymptomatic

MONDAY, March 17, 2014 (HealthDay News) -- For individuals infected with influenza, most cases are asymptomatic, and a minority of those with confirmed disease have medically attended illness, according to a study published online March 17 in The Lancet Respiratory Medicine.

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Ischemic Stroke Outcomes Worse for Mexican-Americans

FRIDAY, March 14, 2014 (HealthDay News) -- Mexican-Americans (MAs) experience worse stroke outcomes than non-Hispanic whites, according to a study published online March 13 in Stroke.

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Chronic Hyperglycemia Tied to Worse Surgical Outcomes

FRIDAY, March 14, 2014 (HealthDay News) -- Chronic hyperglycemia (A1C >8 percent) is associated with poor surgical outcomes, as measured by an increased hospital length of stay (LOS), according to a study published in the March issue of Diabetes Care.

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Improving EHR Interoperability Is a National Priority: HHS

FRIDAY, March 14, 2014 (HealthDay News) -- Interoperability of electronic health record (EHR) systems is a national priority of the Office of the National Coordinator for Health Information Technology, according to an article published March 4 in Medical Economics.

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Benefits of Faster Thrombolysis Time Quantified

FRIDAY, March 14, 2014 (HealthDay News) -- Faster thrombolysis treatment is associated with improved stroke outcome, with each minute of onset-to-treatment time saved correlating with an additional 1.8 days of healthy life, according to a study published online March 13 in Stroke.

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CDC: Most Alcohol-Linked Deaths Occur Among Working-Age Adults

FRIDAY, March 14, 2014 (HealthDay News) -- Americans' excessive alcohol use contributes to thousands of deaths each year, and the majority who die are working-age adults, according to a report published in the March 14 issue of the U.S. Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

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Repeat Spine Imaging Frequent With Injured Patient Transfers

THURSDAY, March 13, 2014 (HealthDay News) -- There is a substantially high rate of repeat spine imaging when patients with known spinal injuries are transferred from an outside hospital (OSH) to a tertiary receiving institution (RI), according to a study published in the Feb. 15 issue of Spine.

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Oldest Old at High Risk for Insulin-Related Hypoglycemia

THURSDAY, March 13, 2014 (HealthDay News) -- Among insulin-treated patients, those 80 years of age and older have the highest rate of emergency department visits and subsequent hospitalizations for insulin-related hypoglycemia and errors (IHEs), according to research published online March 10 in JAMA Internal Medicine.

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Prehospital Stroke Alerts Speed Door-to-CT Times

WEDNESDAY, March 12, 2014 (HealthDay News) -- Emergency medical services (EMS) prenotification regarding the arrival of patients who have had a stroke allows patients to bypass the emergency department and undergo computed tomography (CT) in a timely manner, according to a study published in the March issue of Neurosurgery.

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Resistant Strain of Head Lice Prevalent in North America

WEDNESDAY, March 12, 2014 (HealthDay News) -- Widespread use of pyrethrins- or pyrethroid-based products appears to have resulted in selection pressure for a highly-resistant strain of human head lice in North America, according to research published in the March issue of the Journal of Medical Entomology.

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White House: More Than Four Million Have Signed Up for ACA

TUESDAY, March 11, 2014 (HealthDay News) -- More than four million Americans have signed up for health coverage through state and federal insurance marketplaces established by the Affordable Care Act, the Obama administration announced Tuesday.

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Medicare Drug Plan Changes Withdrawn by White House

TUESDAY, March 11, 2014 (HealthDay News) -- Proposed changes to the Medicare prescription drug program have been withdrawn by the Obama administration after strong opposition from patient groups.

Other Health Highlights: March 11, 2014

Discrepancies ID'd in Studies on ClinicalTrials.gov, Journals

TUESDAY, March 11, 2014 (HealthDay News) -- Nearly all clinical trials reported on ClinicalTrials.gov and published in high-impact journals report at least one discrepancy in cohort, intervention, or results, according to a research letter published in the March 12 issue of the Journal of the American Medical Association.

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Marijuana Use Up, Cocaine Use Down, U.S. Report Finds

MONDAY, March 10, 2014 (HealthDay News) -- Americans' use of cocaine fell by half from 2006 to 2010, but marijuana use increased by more than 30 percent during that time, according to a new report. The spike in pot use may be due to an increase in the number of people who said they use the drug on a daily or near-daily basis, said the researchers, whose study covered drug trends from 2000 to 2010. Heroin use remained fairly stable during the decade, while methamphetamine use rose sharply during the first half of the decade and then fell.

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For Children, Asthma Exacerbations Peak in September

MONDAY, March 10, 2014 (HealthDay News) -- For children aged 2 to 15 years, asthma exacerbations and asthma medication prescriptions peak in September, correlating with the start of the school year, according to a study published online March 10 in Pediatrics.

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Keeping Salaries Secret Harms Worker Performance

MONDAY, March 10, 2014 (HealthDay News) -- Keeping salaries secret hurts worker performance and increases turnover of top talent, according to a study published online Jan. 13 in the Academy of Management Journal.

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Higher Cardiovascular Events Risk After Outbursts of Anger

FRIDAY, March 7, 2014 (HealthDay News) -- There is a heightened risk of cardiovascular events in the hours following an angry outburst, according to research published online March 3 in the European Heart Journal.

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Outpatient Abx Culprit in Most Childhood C. Difficile Cases

FRIDAY, March 7, 2014 (HealthDay News) -- Antibiotics prescribed in doctors' offices are linked with a majority of Clostridium difficile (C. difficile) infection cases in children, according to a new study published online March 3 in the Pediatrics.

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FDA: Pfizer Voluntarily Recalls Certain Lots of Antidepressant

FRIDAY, March 7, 2014 (HealthDay News) -- Two lots of Pfizer's Effexor XR (venlafaxine HCl) are being recalled because they may contain capsules of another drug, Tikosyn (dofetilide), used to treat heart rhythm disorders.

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Indoor Air Pollution Tied to Asthma, Asthma-Related Symptoms

FRIDAY, March 7, 2014 (HealthDay News) -- Indoor air pollution, specifically mold and environmental tobacco smoke, is associated with asthma and asthma-related respiratory symptoms in middle-aged adults, according to a study published online Feb. 12 in Respirology.

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Chest Complaints More Costly in Obese Patients

FRIDAY, March 7, 2014 (HealthDay News) -- Higher body mass index (BMI) is associated with increased cost of care and longer hospital stays for patients who present to the emergency department with chest pain and dyspnea, according to research published online March 4 in Circulation: Cardiovascular Quality and Outcomes.

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In STEMI, Hyperglycemia Tied to Larger Myocardial Area-at-Risk

FRIDAY, March 7, 2014 (HealthDay News) -- For patients with ST-segment elevation myocardial infarction (STEMI), hyperglycemia is associated with larger area-at-risk and infarct size, and the effect of exenatide treatment is independent of glucose levels, according to a study published online Feb. 28 in Diabetes.

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AMA Grants Curriculum Efforts to Address Health Disparities

FRIDAY, March 7, 2014 (HealthDay News) -- Medical schools are beginning to change their curriculum to address ways to eliminate health disparities, according to the American Medical Association (AMA).

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Gender Gap Exists in Domestic Duties of Working Physicians

FRIDAY, March 7, 2014 (HealthDay News) -- Gender differences exist in domestic activities among career-oriented academic physicians with children, according to a study published online March 3 in the Annals of Internal Medicine.

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MRI IDs Vulnerable Carotid Plaque Characteristics

FRIDAY, March 7, 2014 (HealthDay News) -- Magnetic resonance imaging (MRI) aids in cardiovascular disease prediction by identifying vulnerable carotid plaque characteristics, according to a study published online March 4 in Radiology.

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Physicians Better Able to Recall Narratives About Rx Guidelines

FRIDAY, March 7, 2014 (HealthDay News) -- Physicians show better recall after reading evidence-based narratives, rather than summaries, of opioid prescribing guidelines, according to a study published online Feb. 20 in Academic Emergency Medicine.

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Relative Value Units Useful In Evaluating Practice Finances

THURSDAY, March 6, 2014 (HealthDay News) -- The Relative Value Unit (RVU) is a useful tool for managing practice finances, according to an article published Feb. 25 in Medical Economics.

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New Guidelines Issued for Valvular Heart Disease in Adults

THURSDAY, March 6, 2014 (HealthDay News) -- New recommendations have been issued for the diagnosis and management of valvular heart disease (VHD) in adults, according to the American Heart Association/American College of Cardiology guidelines published online March 4 in the Journal of the American College of Cardiology.

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Drop in Compensation Gap for Primary Care Docs, Specialists

THURSDAY, March 6, 2014 (HealthDay News) -- From 2012 to 2013, there was a 5.7 percent increase in the median total cash compensation for primary care physicians, with a smaller gap seen for medical and surgical specialists, according to the results of a recent survey from SullivanCotter.

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Value-Based Insurance Plans Can Up Rx Adherence

WEDNESDAY, March 5, 2014 (HealthDay News) -- Value-based insurance design (VBID) plans with certain features aside from solely lowering cost sharing can increase medication adherence, according to a study published in the March issue of Health Affairs.

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CDC: Antibiotics Often Prescribed During Hospitalization

WEDNESDAY, March 5, 2014 (HealthDay News) -- Inpatients frequently receive antibiotics, and in many cases antibiotic prescribing could be improved, according to a report published in the March 4 early-release issue of the U.S. Centers for Disease Control and Prevention's Morbidity and Mortality Weekly.

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Gap in Regulatory Coverage Affects 5 to 16 Percent of Trials

WEDNESDAY, March 5, 2014 (HealthDay News) -- Human subjects protections (HSP) policies do not provide regulatory coverage for all clinical trials, while up to about a quarter of trials are considered overlap trials, according to a research letter published in the March 5 issue of the Journal of the American Medical Association.

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WHO Program Improves U.S. Medical Facility Hand Hygiene

WEDNESDAY, March 5, 2014 (HealthDay News) -- For U.S. health care facilities, participation in the World Health Organization (WHO) global campaign to improve hand hygiene practices is associated with improved hand hygiene, according to a study published in the March issue of the American Journal of Infection Control.

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Women-Specific Research Is Still Inadequate

MONDAY, March 3, 2014 (HealthDay News) -- Women are still underrepresented in medical science and research, and sex differences are often ignored, according to a report published March 3 by the Brigham and Women's Hospital.

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High Rates of Violence for Mentally Ill Adults

MONDAY, March 3, 2014 (HealthDay News) -- Adults with mental illnesses experience violence in the community at high rates, according to a study published online Feb. 13 in the American Journal of Public Health.

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CMS: No More Delays to ICD-10 Implementation Deadline

MONDAY, March 3, 2014 (HealthDay News) -- There will be no more delays to the Oct. 1, 2014, deadline for implementation of the International Classification of Diseases, 10th Revision (ICD-10), according to an article published Feb. 27 in Medical Economics.

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DASH Diet May Lower Risk of Recurrent Kidney Stones

MONDAY, March 3, 2014 (HealthDay News) -- The Dietary Approaches to Stop Hypertension (DASH) diet might be an effective alternative to the low-oxalate diet for reducing risk of kidney stone recurrence, according to research published in the March issue of the American Journal of Kidney Diseases.

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