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December 2017 Briefing - Emergency Medicine

Tue, Jan 2, 2018

Here are what the editors at HealthDay consider to be the most important developments in Emergency Medicine for December 2017. 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.

Tips Offered for Patient-Provider Opioid Tapering Talks

THURSDAY, Dec. 28, 2017 (HealthDay News) -- Helping patients understand individualized reasons for opioid tapering and encouraging them to provide input into the process are key for patient-provider communications, according to a study published in the November issue of the Journal of Pain.

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Survival Down With Ventricular Arrhythmia Early Post CF-LVAD

TUESDAY, Dec. 26, 2017 (HealthDay News) -- For patients post contemporary continuous flow left ventricular assist device (CF-LVAD) implantation, early ventricular arrhythmias (VAs) are associated with significantly reduced survival, according to a study published online Dec. 20 in JACC: Clinical Electrophysiology.

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FDA Removes Boxed Warning From Certain Asthma Medications

TUESDAY, Dec. 26, 2017 (HealthDay News) -- New evidence regarding safety is spurring the U.S. Food and Drug Administration to remove a Boxed Warning from certain inhaled medications used to treat asthma and chronic obstructive pulmonary disease.

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Gender Differences Seen in Mental Stress-Induced Ischemia

THURSDAY, Dec. 21, 2017 (HealthDay News) -- Men and women have different cardiovascular reactivity mechanisms for mental stress-induced myocardial ischemia (MSIMI), according to a study published online Dec. 21 in Arteriosclerosis, Thrombosis, and Vascular Biology.

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Swelling, Infection Most Common Side Effects of Injectable Fillers

THURSDAY, Dec. 21, 2017 (HealthDay News) -- The most common adverse events associated with injectable fillers are swelling and infection, according to a study published online Dec. 21 in JAMA Facial Plastic Surgery.

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Obesity Tied to Greater Asthma Impairment in Preschoolers

THURSDAY, Dec. 21, 2017 (HealthDay News) -- For preschool children, overweight/obesity is associated with more asthma symptom days and exacerbations among those not treated with a daily controller, and inhaled corticosteroids (ICS) are associated with significant improvements among overweight/obese preschoolers, according to research published online Dec. 19 in the Journal of Allergy and Clinical Immunology.

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CDC: 2015 to 2016 Saw Drop in Life Expectancy in United States

THURSDAY, Dec. 21, 2017 (HealthDay News) -- From 2015 to 2016, life expectancy decreased by one-tenth of a year, and there was an increase in the rate of age-adjusted drug overdose deaths, according to two December data briefs published by the U.S. Centers for Disease Control and Prevention's National Center for Health Statistics.

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Interruption of Apixaban Doesn't Impact Bleeding in A-Fib

THURSDAY, Dec. 21, 2017 (HealthDay News) -- For patients undergoing catheter ablation for nonvalvular atrial fibrillation (AF), both uninterrupted and minimally interrupted apixaban are associated with a very low rate of thromboembolic events, according to a study published online Dec. 20 in JACC: Clinical Electrophysiology.

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Medicare Costs Associated With Mortality Rates in AMI Patients

WEDNESDAY, Dec. 20, 2017 (HealthDay News) -- For patients hospitalized with acute myocardial infarction, Medicare expenditure growth is associated with reduced 180-day case fatality, according to a study published online Dec. 20 in JAMA Cardiology.

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Self-Reported Symptoms in Elderly Predict Readmission

WEDNESDAY, Dec. 20, 2017 (HealthDay News) -- Post-discharge symptoms self-reported by frail, elderly adults may predict 30-day hospital readmission and emergency department visits, according to a study published online Dec. 12 in the Journal of the American Geriatrics Society.

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Two Cases of Progressive Cutaneous Anthrax Described

TUESDAY, Dec. 19, 2017 (HealthDay News) -- Two cases of cutaneous anthrax which started on the right forearm and progressed are described in a case report published online Dec. 12 in the International Journal of Dermatology.

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Narrow-Spectrum Antibiotics Best for Children With Acute RTIs

TUESDAY, Dec. 19, 2017 (HealthDay News) -- For children with acute respiratory tract infections, broad-spectrum antibiotics are not associated with better clinical or patient-centered outcomes compared with narrow-spectrum antibiotics, according to a study published in the Dec. 19 issue of the Journal of the American Medical Association.

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Special Precautions Not Advised for Flu Vaccine in Egg Allergic

TUESDAY, Dec. 19, 2017 (HealthDay News) -- Inactivated influenza vaccine (IIV) and live attenuated influenza vaccine (LAIV) are safe for individuals with egg allergy of any severity, according to a practice parameter update published online Dec. 19 in the Annals of Asthma, Allergy & and Immunology.

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Gingko Biloba Extract Found Effective in Acute Ischemic Stroke

TUESDAY, Dec. 19, 2017 (HealthDay News) -- For acute ischemic stroke, Ginkgo biloba extract (GBE) in combination with aspirin alleviates cognitive and neurological deficits, according to a study published online Dec. 18 in Stroke and Vascular Neurology.

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STEMI Patient Perceptions Impact Emergency Medical Services Use

TUESDAY, Dec. 19, 2017 (HealthDay News) -- ST-elevation myocardial infarction (STEMI) patient perceptions, including those involving the speed of transport and concerns about resource misuse, are an important factor in determining emergency medical services (EMS) use, according to a study published online Dec. 13 in the Journal of Evaluation in Clinical Practice.

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Rx Discrepancies Common in Hospital Discharge Summaries

TUESDAY, Dec. 19, 2017 (HealthDay News) -- For older patients discharged from a regional hospital, there are frequently discrepancies between the electronic discharge summaries and the National Inpatient Medication Chart (NIMC) or discharge prescription, according to a study published online Dec. 13 in the Journal of Pharmacy Practice and Research.

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Intensive BP Goals Reduce Risk of Cardiovascular Events

TUESDAY, Dec. 19, 2017 (HealthDay News) -- Intensive blood pressure lowering may similarly decrease cardiovascular events in both patients with and patients without type 2 diabetes mellitus, according to a study published online Dec. 6 in Diabetes Care.

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Equation Predicts Risk of End-Stage Renal Disease in Children

MONDAY, Dec. 18, 2017 (HealthDay News) -- The kidney failure risk equation (KFRE) is a simple tool that provides excellent discrimination of the risk of end-stage renal disease (ESRD) in children with chronic kidney disease (CKD), according to a study published online Dec. 18 in JAMA Pediatrics.

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Emergency-Only Hemodialysis Linked to Worse Outcomes

MONDAY, Dec. 18, 2017 (HealthDay News) -- Emergency-only hemodialysis treatment is associated with increased mortality compared with standard hemodialysis for undocumented immigrants with end-stage renal disease, according to a study published online Dec. 18 in JAMA Internal Medicine.

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Male U.S. Doctors Receive Higher Values of Industry Payments

MONDAY, Dec. 18, 2017 (HealthDay News) -- Male physicians in the United States received higher values of general payments from industry than females in 2015, according to a research letter published online Dec. 18 in JAMA Internal Medicine.

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Probiotics, Chewing Gum Found Ineffective for Pharyngitis

MONDAY, Dec. 18, 2017 (HealthDay News) -- Neither probiotics nor xylitol-based chewing gum cuts the severity of symptoms associated with pharyngitis, according to a study published in the Dec. 18 issue of CMAJ, the journal of the Canadian Medical Association.

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PCPs Perform Ultrasound for DVT Similarly to Vascular Experts

MONDAY, Dec. 18, 2017 (HealthDay News) -- Compared to vascular experts, general practitioners perform compression ultrasonography for diagnosis of deep vein thrombosis (DVT) of the leg similarly well, according to a study published in the November/December issue of the Annals of Family Medicine.

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Year One Results Out for Value-Based Payment Modifier Program

MONDAY, Dec. 18, 2017 (HealthDay News) -- Almost 30 percent of eligible practices failed to register and report data in the first year of the Physician Value-Based Payment Modifier program, according to a report published in the December issue of Health Affairs.

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Anaphylaxis Is Rare Complication of Pregnancy

MONDAY, Dec. 18, 2017 (HealthDay News) -- Anaphylaxis is a rare complication of pregnancy, with an estimated incidence of 1.6 per 100,000 maternities, according to a study published online Nov. 29 in BJOG: An International Journal of Obstetrics and Gynaecology.

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Doctors Must Report on at Least 1 Patient, 1 Measure for MACRA

FRIDAY, Dec. 15, 2017 (HealthDay News) -- In order to meet the 2017 Medicare and CHIP Reauthorization Act (MACRA) participation reporting deadline and avoid a Medicare payment penalty in 2019, physicians must report on at least one patient and one measure by Dec. 31, and submit to Medicare no later than Feb. 28, 2018, according to a report from the American Medical Association (AMA).

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Flu Vaccine Expected to Protect Against Most U.S. H3N2 Viruses

FRIDAY, Dec. 15, 2017 (HealthDay News) -- A novel bioinformatics approach can predict vaccine effectiveness for the influenza season, and indicates that the current vaccines are likely to be effective against H3N2 flu viruses in the U.S. 2017/2018 flu season, according to research published online Nov. 29 in F1000 Research.

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Making Insurers Participate in Marketplace Could Cut Volatility

THURSDAY, Dec. 14, 2017 (HealthDay News) -- Requiring insurers that participate in Medicare or Medicaid to also participate in Marketplaces in the same geographic area could improve access to insurance, according to a study published in the December issue of Health Affairs.

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Serial hsTnT Level IDs Risk of 30-Day Adverse Cardiac Event

WEDNESDAY, Dec. 13, 2017 (HealthDay News) -- High-sensitivity troponin (hsTnT) assay can identify patients presenting with suspected acute coronary syndrome at very low risk for 30-day adverse cardiac events (ACE), according to a study published online Dec. 13 in JAMA Cardiology.

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Observation Care Cost Saving in Commercially-Insured Patients

WEDNESDAY, Dec. 13, 2017 (HealthDay News) -- Among commercially-insured patients, the cost of observation care has increased, but it is still lower than spending for short-stay hospitalizations, according to a report published in the December issue of Health Affairs.

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Paramedic-PCP Protocol Can Cut ER Visits for Assisted Living Falls

WEDNESDAY, Dec. 13, 2017 (HealthDay News) -- A protocol involving collaboration between paramedics and primary care physicians could help prevent transport to the emergency department for residents of assisted living facilities who have fallen, according to a study published online Dec. 12 in the Annals of Internal Medicine.

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Amount of Opioids Prescribed After Hospital Discharge Varies

WEDNESDAY, Dec. 13, 2017 (HealthDay News) -- For postoperative patients there is considerable variation in the amount of opioids prescribed at hospital discharge, according to research published online Dec. 13 in JAMA Surgery.

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C. Difficile + Kidney Injury Admissions Are Up

WEDNESDAY, Dec. 13, 2017 (HealthDay News) -- Hospital admissions of patients with Clostridium difficile infection (CDI) and accompanying acute kidney injury (AKI) are increasing, according to a study published online Dec. 4 in the Journal of Gastroenterology and Hepatology.

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Allopurinol Rx More Likely With Eligibility at Diagnosis

TUESDAY, Dec. 12, 2017 (HealthDay News) -- Allopurinol prescribing is more likely if patients meet eligibility criteria at diagnosis, according to a research brief published in the November/December issue of the Annals of Family Medicine.

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CABG May Be Best Method to Revascularize in Diabetes

TUESDAY, Dec. 12, 2017 (HealthDay News) -- In patients with diabetes and multivessel coronary artery disease (MV-CAD), coronary artery bypass grafting (CABG) may be the preferred method of revascularization, with lower rates of major adverse cardiac or cerebrovascular events (MACCE), according to a study published in the Dec. 19 issue of the Journal of the American College of Cardiology.

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In-Hospital Deaths in A-Fib Patients Higher in Rural Areas

MONDAY, Dec. 11, 2017 (HealthDay News) -- In-hospital mortality among patients with atrial fibrillation (AF) is higher in rural hospitals than in urban hospitals, according to a study published online Dec. 11 in Heart Rhythm.

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Window Blinds Continue to Pose Injury Risk for Young Children

MONDAY, Dec. 11, 2017 (HealthDay News) -- The rate of window blind-related injuries among children younger than 6 years of age treated in U.S. emergency departments is 2.7 per 100,000 children, according to a study published online Dec. 11 in Pediatrics.

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Deceleration in Health Care Spending Growth in 2016

MONDAY, Dec. 11, 2017 (HealthDay News) -- Health care spending growth slowed in 2016 following faster growth in 2014 and 2015, according to research published online Dec. 6 in Health Affairs.

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Novel Subcutaneous Furosemide May Be Option in Heart Failure

FRIDAY, Dec. 8, 2017 (HealthDay News) -- A novel, pH-neutral furosemide formulation administered subcutaneously (SC) in outpatients with worsening heart failure appears to be safe and effective, according to a study published online Dec. 6 in JACC: Heart Failure.

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ORBIT Bleeding Risk Score Performs Best in A-Fib

FRIDAY, Dec. 8, 2017 (HealthDay News) -- Four contemporary clinical bleeding risk scores are able to identify atrial fibrillation (AF) patients at risk for major bleeding and life-threatening bleeding, according to a study published online Nov. 7 in the Journal of Internal Medicine.

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Influenza Picking Up in U.S., Predominantly A(H3N2)

FRIDAY, Dec. 8, 2017 (HealthDay News) -- Influenza activity was low during October 2017 but started increasing in November, with influenza A, predominantly A(H3N2), most commonly identified, according to research published in the Dec. 8 issue of the U.S. Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

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Alternative Diagnosis for Many Referred for Optic Neuritis

FRIDAY, Dec. 8, 2017 (HealthDay News) -- Almost 60 percent of patients referred for acute optic neuritis have an alternative diagnosis, according to a study published online Dec. 7 in JAMA Ophthalmology.

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Pharmacomechanical Thrombolysis No Benefit in DVT

THURSDAY, Dec. 7, 2017 (HealthDay News) -- The addition of pharmacomechanical thrombolysis does not reduce the risk of post-thrombotic syndrome among patients with acute proximal deep vein thrombosis, according to a study published in the Dec. 7 issue of the New England Journal of Medicine.

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Evidence-Based Guidelines Cut Postoperative Opioid Use

WEDNESDAY, Dec. 6, 2017 (HealthDay News) -- Implementation of evidence-based guidelines can reduce opioid prescribing after laparoscopic cholecystectomy, according to a research letter published online Dec. 6 in JAMA Surgery.

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Guideline-Adherent Assessment of Nonaccidental Trauma Up

WEDNESDAY, Dec. 6, 2017 (HealthDay News) -- An improvement methodology can increase guideline-adherent evaluation for patients with provider concern for nonaccidental trauma (NAT) in the pediatric emergency department, according to research published online Dec. 6 in Pediatrics.

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In CAD With GI Bleeding, Higher Mortality With Triple Therapy

WEDNESDAY, Dec. 6, 2017 (HealthDay News) -- For patients with lower gastrointestinal bleeding (LGIB) and coronary artery disease (CAD), triple therapy is associated with increased risk of mortality at 90 days after adjustment for confounding variables, according to a study published online Nov. 20 in the Journal of Gastroenterology and Hepatology.

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CRP Levels Potentially Useful in Chronic Spontaneous Urticaria

WEDNESDAY, Dec. 6, 2017 (HealthDay News) -- C-reactive protein (CRP) levels are frequently elevated in patients with chronic spontaneous urticaria (CSU), and these elevations are relevant and potentially useful in management of the condition, according to a study published online Nov. 12 in Allergy.

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Acute Intermittent Porphyria Described in Teen Girl

TUESDAY, Dec. 5, 2017 (HealthDay News) -- A case of a 16-year-old presenting to the emergency department with acute intermittent porphyria (AIP) is described in a case report published online Dec. 5 in Pediatrics.

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About One in Six Readmitted Post-Revascularization for PAD

TUESDAY, Dec. 5, 2017 (HealthDay News) -- For patients with peripheral arterial disease who are discharged following peripheral arterial revascularization, 17.6 percent have 30-day nonelective readmission, according to a study published online Dec. 5 in the Annals of Internal Medicine.

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CVS-Aetna Merger Has Implications for Doctors' Offices

TUESDAY, Dec. 5, 2017 (HealthDay News) -- CVS Health's planned purchase of insurance giant Aetna, a $69 billion deal, was announced Sunday.

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Specialty Care Tied to Reduced Mortality in New-Onset A-Fib

MONDAY, Dec. 4, 2017 (HealthDay News) -- Cardiologist care is associated with a lower rate of death in patients with new-onset atrial fibrillation (AF), according to a study published in the December issue of the Canadian Journal of Cardiology.

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Odds for Carotid Artery Stenting in Seniors Up Post-CREST Era

MONDAY, Dec. 4, 2017 (HealthDay News) -- The odds of carotid artery stenting (CAS) have increased in the post-Carotid Revascularization Endarterectomy vs Stenting Trial (CREST) era, despite safety concerns for patients older than 70 years, according to a study published online Dec. 4 in JAMA Neurology.

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ACC Guides Treatment of Bleeding With Oral Anticoagulation

FRIDAY, Dec. 1, 2017 (HealthDay News) -- A decision pathway has been developed to guide management of acute bleeding in patients treated with oral anticoagulants (OACs); the decision pathway was published online Dec. 1 in the Journal of the American College of Cardiology.

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FDA Approves Once-Monthly Injection for Opioid Addiction

FRIDAY, Dec. 1, 2017 (HealthDay News) -- Sublocade, a once-monthly injection of buprenorphine to treat opioid use disorder, has been approved by the U.S. Food and Drug Administration.

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