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May 2009 Briefing - Emergency Medicine

Here are what the editors at HealthDay consider to be the most important developments in Emergency Medicine for May 2009. 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.

Links Between Bleeding, PCI, Mortality Explored

FRIDAY, May 29 (HealthDay News) -- Major bleeding may play a causal role in mortality in patients undergoing percutaneous coronary intervention (PCI), according to a paper published in the June 2 Journal of the American College of Cardiology.

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Window for Stroke Treatment Opened to 4.5 Hours

FRIDAY, May 29 (HealthDay News) -- The clot-busting drug recombinant tissue plasminogen activator (rtPA) can be given to eligible stroke victims as long as 4.5 hours after onset of symptoms, according to a new scientific advisory published online May 28 in Stroke: Journal of the American Heart Association, but the American Heart Association (AHA)/American Stroke Association (ASA) still urge further analyses.

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Stimulant Gum Can Cause Caffeine Overdose

FRIDAY, May 29 (HealthDay News) -- Excessive consumption of stimulant chewing gum resulted in the hospitalization of a 13-year-old boy due to caffeine overdose, highlighting the hidden risk to children of such easily available products, according to a case report published in the May 30 issue of The Lancet.

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Vascular Disease Prevention Benefits of Aspirin Uncertain

FRIDAY, May 29 (HealthDay News) -- The benefits of using aspirin in the primary prevention of vascular disease are uncertain because it reduces the risk of heart attack but increases the risk of internal bleeding, according to a study published in the May 30 issue of The Lancet.

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Physician, Patient Traits Affect Back Pain Imaging in Elderly

FRIDAY, May 29 (HealthDay News) -- Quality metrics that focus on overuse as well as underuse of services may be helpful in improving the quality of diagnostic services for elderly patients presenting with acute low back pain (LBP), according to a study in the May 25 Archives of Internal Medicine.

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Medical School Faculty, Students Conflict Over Priorities

FRIDAY, May 29 (HealthDay News) -- Medical school faculty and new physicians who have completed internship training hold differing views about the procedures that are essential to learn during internship, according to a study published in the April issue of Medical Teacher.

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Decision Makers Can't Delay Until H1N1's Scale Is Clear

THURSDAY, May 28 (HealthDay News) -- Officials must decide what actions to take before the severity and scale of the H1N1 virus are certain, and geography plays an important role in the incidence of the virus, according to perspectives published online May 27 in the New England Journal of Medicine.

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Computerized Prescription Order Errors a Risk for Patients

THURSDAY, May 28 (HealthDay News) -- Computerized provider order entry systems are prone to input errors that may put patients at risk, according to a study published in the May 25 issue of the Archives of Internal Medicine.

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Focus on Meaningful Work Protects Doctors From Burnout

THURSDAY, May 27 (HealthDay News) -- Academic faculty physicians who focus on what they find most meaningful are less likely to experience burnout, according to a study published in the May 25 issue of the Archives of Internal Medicine.

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Dispatching Software Misses More Than Half of Strokes

TUESDAY, May 26 (HealthDay News) -- The telephone-based software used to prioritize emergency ambulance response failed to identify more than half the incidents of stroke over a six-month period, according to a study in the June Emergency Medicine Journal.

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Intensive Glucose Lowering Reduces Diabetics' Heart Risks

FRIDAY, May 22 (HealthDay News) -- In patients with type 2 diabetes, an intensive glucose-lowering regimen significantly reduces coronary events without increasing the risk of death, according to a study published in the May 23 issue of The Lancet.

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Drug-Resistant Pneumonia Emerging in Healthy People

FRIDAY, May 22 (HealthDay News) -- Community-acquired meticillin-resistant Staphylococcus aureus (MRSA) is an emerging cause of pneumonia in otherwise healthy individuals, according to a case report and review in the June issue of The Lancet Infectious Diseases.

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Echocardiography in CRT Patient Selection Controversial

FRIDAY, May 22 (HealthDay News) -- Research should continue into the use of echocardiography as a means to select candidates for implant of cardiac resynchronization therapy (CRT) devices, but QRS prolongation remains the recommended criterion in making that decision. That was the apparent consensus of a trio of papers arguing the question in the May 26 issue of the Journal of the American College of Cardiology.

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Exercise Echocardiography Can Predict Cardiac Events, Death

THURSDAY, May 21 (HealthDay News) -- Exercise echocardiography (EE) can help predict major cardiac events and mortality in patients who appear normal on electrocardiogram (ECG) tests, according to a study in the May 26 Journal of the American College of Cardiology.

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Democrats Set Ambitious Goal for Health Care Reform

THURSDAY, May 21 (HealthDay News) -- Congressional Democrats face formidable challenges in their efforts to pass health care reform legislation by July 31, but physicians can take the lead to ensure changes are enacted, according to two perspectives published online May 20 in the New England Journal of Medicine.

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Sticking to Work Hours Limits Very Costly

WEDNESDAY, May 20 (HealthDay News) -- Adherence to the 2003 Accreditation Council for Graduate Medical Education (ACGME) limits on work hours, and other measures aimed at reducing fatigue among residents, would be costly with no proven benefits, according to an article published in the May 21 issue of the New England Journal of Medicine.

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Early Angiography Benefits High-Risk Coronary Patients

WEDNESDAY, May 20 (HealthDay News) -- For high-risk patients with acute coronary syndrome, coronary angiography within hours after presentation can reduce the chance of subsequent death, heart attack and stroke, according to a study in the May 21 issue of the New England Journal of Medicine.

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Antihypertensive Drugs Also Benefit Non-Hypertensives

WEDNESDAY, May 20 (HealthDay News) -- In everyone at risk for heart attack or stroke -- including those with normal blood pressure -- antihypertensive treatment significantly reduces the risk of coronary heart disease events and stroke, according to a study published online May 19 in BMJ.

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Door-to-Balloon Delays Increase Risk of Death

WEDNESDAY, May 20 (HealthDay News) -- In patients admitted with ST elevation myocardial infarction, any delay in primary percutaneous coronary intervention is associated with an increased risk of death, according to a study published online May 19 in BMJ.

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Findings Support Clopidogrel Guideline Recommendations

WEDNESDAY, May 20 (HealthDay News) -- The use of clopidogrel in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) is associated with suitable ischemic reduction and bleeding outcomes to support its use before cardiac catheterization, even if patients should need coronary artery bypass grafting (CABG), according to research published in the May 26 issue of the Journal of the American College of Cardiology.

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'Obesity Paradox' Makes Heart Disease Outlook Puzzling

TUESDAY, May 19 (HealthDay News) -- Although obesity is associated with poor cardiovascular health, an "obesity paradox" shows that obese individuals with certain cardiovascular diseases or risk factors may have a better prognosis than people with a healthy weight, according to a review published in the May 26 issue of the Journal of the American College of Cardiology.

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Facial Fractures in Car Accidents Decreasing

TUESDAY, May 19 (HealthDay News) -- Improvements in car design with a view to minimizing the effects of crashes may help explain the decrease in facial fractures as a result of car accidents, while use of seat belts and other restraints continues to be an important aspect of injury prevention, according to a study published in the May/June issue of the Archives of Facial Plastic Surgery.

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Higher Bleed Risk in Women With Acute Coronary Syndrome

MONDAY, May 18 (HealthDay News) -- Women with acute coronary syndrome (ACS) gained similar protection against ischemic events with bivalirudin compared to heparin plus a glycoprotein IIb/IIIa inhibitor (GPI), with less bleeding, according to research published in the May 1 issue of the American Journal of Cardiology.

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Swine Flu Has Higher Fatality Rate Than Seasonal Flu

MONDAY, May 18 (HealthDay News) -- The fatality rate from H1N1 swine flu is slightly higher than the fatality rate from seasonal flu, according to United States' health officials, but they say most cases of swine flu are no worse than seasonal flu.

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Iron Not Linked to Survival in Primary Myelofibrosis

MONDAY, May 18 (HealthDay News) -- Higher serum ferritin levels weren't associated with decreased survival in patients with primary myelofibrosis, which could be a finding that's relevant to ongoing discussions in hematology regarding the use of iron chelation, according to research published in the May issue of the American Journal of Hematology.

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CDC: Thousands Sickened by Pool Chemical Exposures

MONDAY, May 18 (HealthDay News) -- Thousands of people have sought treatment at hospital emergency departments or poison centers in recent years as a result of exposure to swimming pool chemicals, according to a study published in the May 15 issue of the U.S. Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

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Imaging Technology Assesses Graft During Off-Pump CABG

FRIDAY, May 15 (HealthDay News) -- Intraoperative fluorescence imaging (IFI) can evaluate graft patency during off-pump coronary artery bypass graft (CABG) surgery, making possible immediate graft revision, if needed, and potentially better clinical outcomes, according to a study in the May issue of the Journal of the American College of Cardiology: Cardiovascular Imaging.

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Combined Treatment May Offer Bronchiolitis Benefit

WEDNESDAY, May 13 (HealthDay News) -- The use of nebulized epinephrine and oral dexamethasone in infants presenting to emergency departments with bronchiolitis might reduce later hospital admission, according to research published in the May 14 issue of the New England Journal of Medicine.

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Fatal Encephalitis in New York Man Linked to Deer Tick Virus

WEDNESDAY, May 13 (HealthDay News) -- A report of a fatal case of encephalitis related to deer tick virus illustrates that the incidence of infection in humans may be underappreciated, according to research published in the May 14 issue of the New England Journal of Medicine.

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Telemedicine Can Help Improve Stroke Care

TUESDAY, May 12 (HealthDay News) -- Telemedicine can be implemented within stroke-care systems to help fill the gaps in coverage, according to two articles published online on May 7 in Stroke. A third article published in the same online edition revisits the definition and evaluation of transient ischemic attack.

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Number of Swine Flu Cases in U.S. Exceeds 2,500

MONDAY, May 11 (HealthDay News) -- The United States has surpassed Mexico to become the nation with the most confirmed cases of H1N1 swine flu, according to figures released May 11 by the World Health Organization (WHO).

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Better Treatment of Brain Hemorrhage Needed

FRIDAY, May 8 (HealthDay News) -- Given that death rates for patients with non-traumatic cerebral hemorrhage have not improved in the last decade, better clinical management is needed to reduce death and increase functional survival, according to a study in the May 9 issue of The Lancet.

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Triple-Reassortant Swine Virus Seen Since 2005 in US

THURSDAY, May 7 (HealthDay News) -- Eleven cases of infection similar to the swine flu outbreak currently under way -- triple-reassortant swine influenza A (H1) viruses -- have been documented since 2005 in the United States, according to a study led by researchers at the U.S. Centers for Disease Control and Prevention in Atlanta and released May 7 by the New England Journal of Medicine. This study was accompanied by another study, two editorials, and three perspectives focused on the swine flu outbreak.

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Correct Diagnosis of Syncope Important for Treatment

THURSDAY, May 7 (HealthDay News) -- Although difficult, correctly diagnosing the cause of syncope, a transient lack of consciousness followed by a quick recovery, is important in initiating effective treatment, according to a review in the May 12 issue of the Journal of the American College of Cardiology.

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Little Evidence to Support Some H1N1 Flu Measures

WEDNESDAY, May 6 (HealthDay News) -- Some of the interventions that have been introduced in the wake of the outbreak of H1N1 flu have little or no evidence to support them, according to an editorial published online May 5 in The Lancet, while a report in the same journal asks whether or not the international response to the outbreak was fast enough.

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CDC Confirms Over 400 H1N1 Flu Cases

WEDNESDAY, May 6 (HealthDay News) -- As of May 5, the U.S. Centers for Disease Control and Prevention (CDC) has confirmed 403 cases of H1N1 flu nationally in 38 states, with over 700 additional probable cases which, if confirmed, will mean the disease has spread across 44 states. The CDC continues to urge the public to rigorously observe preventive measures.

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Minimum Interval Vaccination Schedule Effective in Arizona

WEDNESDAY, May 6 (HealthDay News) -- Positive results were seen with minimum interval vaccine scheduling during an outbreak of pertussis in Arizona, while recall systems appear to benefit influenza vaccination rates among high-risk children despite vaccine shortage in Colorado. These two studies are published in the May issue of the Archives of Pediatrics & Adolescent Medicine.

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Post-Hospital Housing Helps Chronically Ill Homeless

TUESDAY, May 5 (HealthDay News) -- Post-hospitalization housing assistance for homeless people with chronic illnesses results in fewer subsequent emergency department visits and hospitalizations, according to a study published in the May 6 issue of the Journal of the American Medical Association.

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High Urine Albumin Linked to Venous Thromboembolism

TUESDAY, May 5 (HealthDay News) -- Already a recognized risk factor for arterial thromboembolism, microalbuminuria also is a risk factor for venous thromboembolism (VTE), according to a study published in the May 6 issue of the Journal of the American Medical Association.

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Heart Arrhythmias Increase Mortality in Catheterizations

TUESDAY, May 5 (HealthDay News) -- The incidence of ventricular tachycardia or fibrillation (VT/VF) during and after percutaneous coronary intervention (PCI) is associated with higher death rates within 90 days, according to a study published in the May 6 issue of the Journal of the American Medical Association.

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Medical Center Press Releases Often Lacking Key Details

TUESDAY, May 5 (HealthDay News) -- Press releases from academic medical centers may often overstate the importance of research findings while failing to acknowledge relevant limitations of the studies, according to research published in the May 5 Annals of Internal Medicine.

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Modified Protocol Improves Cardiac Arrest Survival

TUESDAY, May 5 (HealthDay News) -- Modified guidelines on the out-of-hospital management of cardiac arrest patients that optimizes compressions and reduces disruption improves survival rates, according to a study published online on May 4 in Circulation.

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Falling Furniture Is an Increasing Hazard for Children

MONDAY, May 4 (HealthDay News) -- Because tipped-over furniture accounts for an increasing number of injuries among children, pediatricians and caregivers need to be aware of such hazards and acquaint themselves with prevention strategies, according to a study published online May 3 in Clinical Pediatrics.

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Number of US Swine Flu Cases Climbs to 286 in 36 states

MONDAY, May 4 (HealthDay News) -- The confirmed number of swine flu cases in the United States swelled to 245 in 35 states by May 3, but federal health officials are expressing cautious optimism that the disease may be leveling off and may not be as dangerous as initially feared. The U.S. Centers for Disease Control and Prevention (CDC) has updated the number of confirmed national cases to 286 in 36 states as of late this morning.

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Erythropoietin May Worsen Mortality in Cancer Patients

FRIDAY, May 1 (HealthDay News) -- The use of erythropoiesis-stimulating agents to treat anemia in cancer patients worsens mortality, according to two separate reviews of past clinical studies.

Abstract - Bohlius (The Lancet)
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H1N1 Flu Poses Major Surveillance Challenge

FRIDAY, May 1 (HealthDay News) -- Containment of the influenza A strain H1N1, or swine flu, outbreak is probably impossible because cases are already geographically widespread and countries with fragile health systems lack the ability to properly conduct surveillance and containment activities, according to an editorial published online April 30 in BMJ.

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More Americans Reporting Disability

FRIDAY, May 1 (HealthDay News) -- The number of Americans reporting disabilities rose by 7.7 percent from 44.1 million in 1999 to 47.5 million in 2005, according to a report in the May 1 issue of the U.S. Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

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CDC: More Than 100 H1N1 Flu Infections in US

FRIDAY, May 1 (HealthDay News) -- As of Thursday, April 30, the U.S. Centers for Disease Control and Prevention (CDC) has confirmed 109 cases of influenza A strain H1N1, or swine flu, in the United States, with 50 cases in New York, 26 in Texas, 14 in California, 10 in South Carolina, and the rest in seven other states. So far, only one death has been recorded.

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Physician's Briefing