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October 2009 Briefing - Emergency Medicine

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

Uninsured Children May Be More Likely to Die in the Hospital

FRIDAY, Oct. 30 (HealthDay News) -- In-hospital all-cause mortality is higher among uninsured children than among those who have insurance, according to a study published in the October issue of the Journal of Public Health.

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Toronto Acute Stroke Protocol Increases Timely Thrombolysis

FRIDAY, Oct. 30 (HealthDay News) -- An acute stroke treatment protocol in which patients were taken directly to a regional stroke center instead of the closest local hospital resulted in a six-fold increase in the number of patients receiving tissue plasminogen activator (tPA) within 2.5 hours of symptom onset over a four-month study period, according to a report published online Oct. 29 in Stroke.

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Additional Recommendations for Imaging on the Rise

THURSDAY, Oct. 29 (HealthDay News) -- Recommendations for additional imaging in radiology reports at one institution increased steeply in recent years, and from 1980 to 2006, radiologic and nuclear medicine procedures increased roughly 10-fold and 2.5 fold, respectively, according to two studies the November issue of Radiology.

Abstract - Sistrom
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Abstract - Mettler
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ACE Inhibitors May Negatively Impact CABG Outcomes

THURSDAY, Oct. 29 (HealthDay News) -- The preoperative use of angiotensin-converting enzyme (ACE) inhibitor therapy before coronary artery bypass grafting (CABG) may increase risk of mortality and other adverse outcomes, according to research published in the Nov. 3 Journal of the American College of Cardiology.

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Post-Exposure Prophylaxis of HIV Transmission Spotlighted

WEDNESDAY, Oct. 28 (HealthDay News) -- Patients who have a one-time sexual encounter with a person who is highly likely to be HIV-positive should initiate post-exposure prophylaxis as soon as possible, according to a feature article published in the Oct. 29 issue of the New England Journal of Medicine.

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Importance of ST-Segment Resolution Assessed

WEDNESDAY, Oct. 28 (HealthDay News) -- In patients with ST-segment elevation myocardial infarction (STEMI), ST-segment resolution at four hours after treatment may predict outcomes after fibrinolysis, but has limited prognostic value after primary percutaneous coronary intervention (pPCI), according to the DANish trial in Acute Myocardial Infarction-2 (DANAMI-2) substudy published in the Nov. 3 issue of the Journal of the American College of Cardiology.

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Majority of Americans Within Two Hours of a Burn Center

TUESDAY, Oct. 27 (HealthDay News) -- Seventy-nine percent of Americans are within two hours of an American Burn Association-verified care center, but access varies considerably by region and state, according to a study in the Oct. 28 issue of the Journal of the American Medical Association.

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Venous Thromboembolism Risk Varies With Body Type

TUESDAY, Oct. 27 (HealthDay News) -- There is a positive, dose-dependent association between risk of venous thromboembolism and all the measurements of obesity, such as waist and hip circumference, according to a study published online Oct. 26 in Circulation.

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Medical School Enrollment Continues to Expand

MONDAY, Oct. 26 (HealthDay News) -- Almost 18,400 students enrolled in medical school in the United States in 2009, a 2 percent increase over the previous year, but even more expansion is needed to meet future demand, according to an Oct. 20 report from the Association of American Medical Colleges (AAMC).

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Alteplase Effective for Stroke Even After Three-Hour Window

MONDAY, Oct. 26 (HealthDay News) -- The tissue plasminogen activator alteplase leads to better outcomes in stroke patients even when administered more than three hours after onset of symptoms, according to a study published online Oct. 21 in The Lancet Neurology.

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Far Fewer H1N1 Vaccine Doses Than Expected Are Available

MONDAY, Oct. 26 (HealthDay News) -- Because of production delays, far fewer than the goal of 40 million doses of H1N1 influenza vaccine will be available in the United States by the end of October, according to the U.S. Centers for Disease Control and Prevention. In addition, the U.S. Food and Drug Administration has issued an emergency use authorization for the investigational antiviral drug peramivir intravenous in certain patients with suspected or confirmed H1N1 infection.

More Information - CDC
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Broad Asthma Screening May Offer Minimal Health Gains

FRIDAY, Oct. 23 (HealthDay News) -- The potential health benefits from asthma screenings in children seem to be smaller than previously expected, according to research published online Oct. 19 in Pediatrics.

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Review Evaluates Systems of Care for STEMI Patients

THURSDAY, Oct. 22 (HealthDay News) -- In Europe and North America, improvements in systems of care may improve outcomes in patients with ST-segment elevation myocardial infarction (STEMI), according to a state-of-the-art paper published in the October issue of the Journal of the American College of Cardiology: Cardiovascular Interventions.

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Some Hospital Staff Predicted to Be Infection Superspreaders

THURSDAY, Oct. 22 (HealthDay News) -- Hospital staff such as therapists and radiologists who are in contact with all patients have the potential to be superspreaders of infection if they fail to wash their hands regularly, according to a study published online Oct. 19 in the Proceedings of the National Academy of Sciences.

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Remote Patient Monitoring May Lower Heart Failure Risk

THURSDAY, Oct. 22 (HealthDay News) -- Heart failure patients whose status was checked regularly using remote patient monitoring (RPM), had reduced risk of death and hospitalization compared to patients who received usual standard of care, according to a study in the Oct. 27 issue of the Journal of the American College of Cardiology.

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Pulmonary Embolism Found to Be Often Unrelated to DVT

THURSDAY, Oct. 22 (HealthDay News) -- In patients with pulmonary embolism, only a few have deep venous thrombosis (DVT) of the pelvic or proximal lower extremity veins, suggesting that pulmonary embolism originates in the lungs, according to a study in the October issue of the Archives of Surgery.

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Obstetric Health Workers May Discourage Flu Vaccine

THURSDAY, Oct. 22 (HealthDay News) -- Many obstetric health care workers may have negative attitudes toward flu vaccinations during pregnancy, and the prophylactic use of influenza antivirals in pregnant women after exposure to an infected individual appears cost-effective during a pandemic, according to two studies in the November Obstetrics & Gynecology.

Abstract - Broughton
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Full Text - Lee

Novel H1N1 Vaccine Found Effective for Most Age Groups

WEDNESDAY, Oct. 21 (HealthDay News) -- A new influenza A (H1N1) vaccine developed in China successfully generated a protective immune response in subjects ranging in age from 12 to 60 years, according to a study published online Oct. 21 in the New England Journal of Medicine.

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Most H1N1 Hospitalizations Are in Young Patients

WEDNESDAY, Oct. 21 (HealthDay News) -- More than half of hospitalizations for H1N1 influenza are occurring in people younger than 25 years of age, and very few are occurring in the elderly, according to information presented at the Oct. 20 press briefing by the U.S. Centers for Disease Control and Prevention.

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Sources Find Different Numbers of Active Physicians

WEDNESDAY, Oct. 21 (HealthDay News) -- Estimates from U.S. Census Bureau surveys find fewer older physicians remaining active compared with the American Medical Association Physician Masterfile data, according to research published in the Oct. 21 issue of the Journal of the American Medical Association.

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Cardiovascular Disease Linked to Hip Fracture Risk

TUESDAY, Oct. 20 (HealthDay News) -- The risk of hip fracture is much higher for people who have a diagnosis of cardiovascular disease (CVD), according to a study among Swedish twins reported in the Oct. 21 issue of the Journal of the American Medical Association.

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Study Confirms Benefits of Belt-Positioning Booster Seats

MONDAY, Oct. 19 (HealthDay News) -- The use of belt-positioning booster seats in children reduces the risk of injury during a crash as compared to the use of standard seat belts, according to a study published online Oct. 19 in Pediatrics.

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CDC Says New Child Deaths Raise H1N1 Beyond Epidemic

MONDAY, Oct. 19 (HealthDay News) -- As of Oct.16, 11 more children in the United States had died of H1N1 influenza in the past week, elevating the disease above epidemic proportions, the U.S. Centers for Disease Control and Prevention announced at an Oct. 16 news conference.

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Fish Oil Deemed Safe for Antiplatelet Therapy Patients

FRIDAY, Oct. 16 (HealthDay News) -- In patients with cardiovascular disease, the bleeding risk is not increased when high-dose fish oil is combined with aspirin and clopidogrel, according to a study in the Oct. 15 issue of the American Journal of Cardiology.

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FDA Launches Drug Disposal Advice Web Page

FRIDAY, Oct. 16 (HealthDay News) -- The U.S. Food and Drug Administration has launched a new Web page for consumers to educate them on the safe disposal of certain medicines that can be dangerous or even fatal if they end up in the wrong hands.

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Intervention May Benefit Trial-Ineligible Heart Patients

THURSDAY, Oct. 15 (HealthDay News) -- In patients with ST-elevation myocardial infarction who are usually excluded from randomized controlled trials, primary percutaneous coronary intervention is associated with a lower rate of in-hospital death than thrombolytic therapy, according to a study in the Oct. 15 issue of the American Journal of Cardiology.

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Action Urged to Reduce Global Diarrhea Deaths in Children

THURSDAY, Oct. 15 (HealthDay News) -- In an effort to reduce the worldwide diarrhea death toll among children, the United Nations Children's Fund and the World Health Organization have issued a series of prevention and treatment recommendations and an urgent call-to-action, published online Oct. 14 in The Lancet.

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Second-Line Diuretics in Hypertension Reviewed

WEDNESDAY, Oct. 14 (HealthDay News) -- The addition of diuretics as a second-line approach to another anti-hypertensive agent further lowers systolic and diastolic blood pressure, providing the same effect as when used as first-line monotherapy, according to a review published online Oct. 7 in the Cochrane Database of Systematic Reviews.

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Pronation and Supination Compared for Pulled Elbow

WEDNESDAY, Oct. 14 (HealthDay News) -- In the treatment of children with pulled elbow, limited evidence suggests that pronation may be a more effective and less painful manipulative intervention than the standard supination method, according to an review published online Oct. 7 in the Cochrane Database of Systematic Reviews.

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Study Evaluates Hospital Quality and Mortality Rates

TUESDAY, Oct. 13 (HealthDay News) -- Hospital mortality rates in the United States have improved, although major differences in quality still exist between the best and worst hospitals, according to a report published Oct. 13 by HealthGrades.

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H1N1 Has Made Many Young Adult Patients Critically Ill

MONDAY, Oct. 12 (HealthDay News) -- The 2009 influenza A(H1N1) outbreak has put many young adult patients in intensive care with severe respiratory disease, leading to a high fatality rate, according to three studies published online Oct. 12 in the Journal of the American Medical Association.

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Exhalation From Ventilation Masks May Pose Infection Risk

MONDAY, Oct. 12 (HealthDay News) -- Leakage of exhaled air from the face masks used for noninvasive positive-pressure ventilation (NPPV) in patients with pneumonia poses a risk of infection for health care workers, according to a study in the Oct. 1 issue of Chest.

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Evidence Scant on Effects of Exercise After Stroke

FRIDAY, Oct. 9 (HealthDay News) -- Aerobic exercise training that involves walking may improve walking ability in individuals following a stroke, but the effects of cardiorespiratory fitness training on death and disability remain unclear, according to research published online Oct. 7 in the Cochrane Database of Systematic Reviews.

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Health Care Disparities Among States Found to Be Widening

FRIDAY, Oct. 9 (HealthDay News) -- Increasing health care costs and growing disparities in coverage among U.S. states point to the urgent need for national health care reform, according to an Oct. 8 state-by-state report card from the Commonwealth Fund Commission, a private foundation supporting research on the health care system.

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Herpes Zoster Infection May Increase Risk of Stroke

FRIDAY, Oct. 9 (HealthDay News) -- The risk of stroke is higher in people who have had a herpes zoster infection than in those with no history of the disease, according to a study published online Oct. 8 in Stroke.

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Study Explores Thrombus Healing by Plaque Type

THURSDAY, Oct. 8 (HealthDay News) -- Thrombus healing in sudden cardiac death victims may depend on the presence of plaque ruptures or erosions, and, in some patients, call for different treatment approaches, according to research published online Oct. 7 in the Journal of the American College of Cardiology.

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Effect of H1N1 on Southern Hemisphere ICUs Assessed

THURSDAY, Oct. 8 (HealthDay News) -- During the winter of 2009 in Australia and New Zealand, the H1N1 flu virus had a significant effect on hospital intensive care units, according to a study published online Oct. 8 in the New England Journal of Medicine.

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ACS Education May Not Reduce Prehospital Delay

THURSDAY, Oct. 8 (HealthDay News) -- In patients at high risk for acute coronary syndrome (ACS), educational and counseling intervention may not lead to decreased hospital arrival times or increased emergency medical services (EMS) use after the onset of symptoms, according to a study published online Oct. 6 in Circulation: Cardiovascular Quality and Outcomes.

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Seasonal Flu Vaccine Protects Somewhat Against A/H1N1

THURSDAY, Oct. 8 (HealthDay News) -- There are early signs that the 2008/2009 trivalent inactivated seasonal flu vaccination offers some protection against influenza A/H1N1, particularly in its most severe forms, but this should not be taken to mean that vaccination against swine flu is superfluous, according to a study published online Oct. 6 in BMJ.

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Doctor Attitude Affects Counsel on Emergency Contraception

THURSDAY, Oct. 8 (HealthDay News) -- Pediatricians who have less favorable attitudes toward abortion and teen sex are less likely to counsel their patients on emergency contraception and prescribe it in accordance with pediatric practice guidelines, according to a study in the October issue of the Archives of Pediatrics & Adolescent Medicine.

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Roundtable Discussion Tackles Health Care Reform

WEDNESDAY, Oct. 7 (HealthDay News) -- The health care payment system, the role of consumers in responsible health care spending, and the use of comparative-effectiveness research were topics covered in a roundtable discussion with several health economics experts published in the Oct. 8 issue of the New England Journal of Medicine.

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Perspective - Cutler

Study Reports Lacking Benefit of ICD Early After Heart Attack

WEDNESDAY, Oct. 7 (HealthDay News) -- An implantable cardioverter-defibrillator (ICD) does not reduce the risk of death when given to high-risk patients within a month after a heart attack, according to a study in the Oct. 8 issue of the New England Journal of Medicine.

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Medical Students Want More Practice of Medicine Training

WEDNESDAY, Oct. 7 (HealthDay News) -- Medical students in the United States perceive that they are not getting enough training in the practice of medicine, particularly in medical economics, according to a study in the September issue of Academic Medicine.

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Effectiveness and Cost Help to Make Coverage Decisions

TUESDAY, Oct. 6 (HealthDay News) -- Countries using evidence-based cost-effectiveness and effectiveness to help make drug coverage decisions show how these factors can successfully support decision making and can also be adapted to the specific conditions of other countries, according to a study in the Oct. 7 issue of the Journal of the American Medical Association.

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Premature Death in China Linked to Hypertension

TUESDAY, Oct. 6 (HealthDay News) -- Elevated blood pressure is one of the leading preventable risk factors for premature death in China, according to a study published online Oct. 6 in The Lancet.

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Studies Examine Strategies Against Flu Pandemics

TUESDAY, Oct. 6 (HealthDay News) -- Vaccinating against H1N1 earlier this fall may save more money and avert more deaths than vaccinating later in the season, and expanded adjuvanted vaccination and antiviral prophylaxis could be beneficial in an influenza A (H5N1) pandemic, according to two studies published online Oct. 6 in the Annals of Internal Medicine.

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Low-Contrast Visibility May Be Issue for Parkinson's Drivers

TUESDAY, Oct. 6 (HealthDay News) -- Drivers with Parkinson's disease may be more prone to poor vehicle control and crashes while driving in low-contrast visibility conditions due to issues with perception, cognition and motor dysfunction, according to a study in the Oct. 6 issue of Neurology.

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Report Finds Invasive MRSA Infections on the Rise in Iowa

MONDAY, Oct. 5 (HealthDay News) -- Invasive community-associated methicillin resistant Staphylococcus aureus (MRSA) infection is an increasing public health threat in Iowa, according to a study in the October issue of Emerging Infectious Diseases.

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Burns Often Send Children to the Emergency Room

MONDAY, Oct. 5 (HealthDay News) -- U.S. emergency rooms treat more than 120,000 pediatric burn injuries each year, and children under 6 years of age may be especially likely to sustain serious injuries, according to a study published online Oct. 5 in Pediatrics.

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Resynchronization Can Slow Heart Failure Progression

FRIDAY, Oct. 2 (HealthDay News) -- Cardiac resynchronization therapy (CRT) improves clinical outcomes, as well as left ventricular function and size, in patients with asymptomatic or mildly symptomatic left ventricular dysfunction, according to a study published online Sept. 30 in the Journal of the American College of Cardiology.

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Early Presentation Remains Uncommon in Stroke Patients

FRIDAY, Oct. 2 (HealthDay News) -- Between 2001 and 2004, there was no change in the proportion of stroke patients who arrived at academic medical centers within two hours of symptom onset. However, usage of intravenous tissue-type plasminogen activator (IV t-PA) in such patients increased, according to a study published online Oct. 1 in Stroke.

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Surgical Masks Found to Be Non-Inferior to Respirators

THURSDAY, Oct. 1 (HealthDay News) -- Surgical masks may be no less effective than N95 respirators in preventing influenza in health care workers, according to a study published online Oct. 1 in the Journal of the American Medical Association.

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CDC Says States Not Meeting Fruit and Veggie Objectives

THURSDAY, Oct. 1 (HealthDay News) -- In a Sept. 29 press release, the U.S. Centers for Disease Control and Prevention says no U.S. state is currently meeting the national Healthy People 2010 objectives for fruit and vegetable consumption.

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Physicians May Fail to Act on Electronic Alerts Quickly

THURSDAY, Oct. 1 (HealthDay News) -- Physicians using a system with electronic medical records and computerized alerts may not acknowledge or act upon critical imaging results in a timely manner, according to research published in the Sept. 28 Archives of Internal Medicine.

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