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Category: Emergency Medicine | Monthly Briefing

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November 2011 Briefing - Emergency Medicine

Last Updated: December 01, 2011.

 

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

Pediatric Sports Concussion Alters Cerebral Blood Flow

WEDNESDAY, Nov. 30 (HealthDay News) -- Pediatric sports-related concussions (SRC) significantly alter cerebral blood flow (CBF) without measurable structural, metabolic, neuronal or axonal injury; and, about 40 percent of U.S. high schools that employ athletic trainers (ATs) manage SRCs using computerized neurocognitive tests, according to two studies published online Nov. 30 in Pediatrics.

Abstract - Maugans
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Abstract - Meehan
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Wrongly ID'd Ectopic Pregnancy + Methotrexate Catastrophic

WEDNESDAY, Nov. 30 (HealthDay News) -- Misdiagnosis of intrauterine pregnancies as ectopic, with subsequent first-trimester exposure to high-dose methotrexate, may result in severely malformed newborns or fetal deaths, according to a study published in the December issue of the American Journal of Obstetrics & Gynecology.

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Opioid Rx for Chronic Abdominal Pain Up Over Last Decade

TUESDAY, Nov. 29 (HealthDay News) -- The prevalence of opioid prescriptions for chronic abdominal pain more than doubled between 1997 and 2008 in the United States, with prescriptions most common for patients aged 25 to 40 years, according to a study published in the December issue of Clinical Gastroenterology and Hepatology.

Abstract
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Crash Injuries of Children in Restraints Not Tied to Weight

TUESDAY, Nov. 29 (HealthDay News) -- The risk of clinically significant crash-related injuries in motor vehicle crashes (MVCs) is not correlated with weight among children using forward-facing child restraints (FFCRs) or belt-positioning booster seats (BPBs), according to a study published online Nov. 28 in Pediatrics.

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Nearly One in 10 Patients With PCI Readmits Within 30 Days

MONDAY, Nov. 28 (HealthDay News) -- About one in 10 patients undergoing percutaneous coronary intervention (PCI) are readmitted within 30 days; and 30-day readmission is associated with an increased risk of one-year mortality, according to a study published online Nov. 28 in the Archives of Internal Medicine.

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Small Cell Carcinoma of Urinary Bladder Incidence Up

MONDAY, Nov. 28 (HealthDay News) -- The incidence of small cell carcinoma of the urinary bladder (SCCB) increased from 1991 to 2005, with elderly Caucasian men being the most commonly affected, according to a study published in the Dec. 1 issue of Cancer.

Abstract
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High-Performing Docs Learn Equally From Success, Failure

MONDAY, Nov. 28 (HealthDay News) -- Among physicians making decisions in a medically-framed learning task, high and low performers show distinct behavioral and neural patterns of learning, according to a study published online Nov. 23 in PLoS One.

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Home Birth Imposes Higher Risks for First-Time Mothers

MONDAY, Nov. 28 (HealthDay News) -- For healthy women with low-risk pregnancies, the incidence of adverse perinatal outcomes is low in all birth settings, giving these women more options when choosing where to have their baby, according to a study published online Nov. 24 in BMJ.

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Afternoon Shots Up Post-Immunization Sleep Duration

MONDAY, Nov. 28 (HealthDay News) -- Infants who have immunizations in the afternoon, or have an increased temperature in response to vaccines, have increased sleep duration after immunization, according to a study published online Nov. 28 in Pediatrics.

Abstract
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Autoimmune Disorders Tied to Pulmonary Embolism Risk

MONDAY, Nov. 28 (HealthDay News) -- Autoimmune disorders are associated with an increased risk of pulmonary embolism, particularly during the first year after hospitalization, according to a study published online Nov. 26 in The Lancet.

Abstract
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Many Pediatricians OK With Alternative Vaccine Schedules

MONDAY, Nov. 28 (HealthDay News) -- Pediatricians in Washington State are frequently asked to use alternative childhood immunization schedules (ACISs), and the majority are comfortable using them, according to a study published online Nov. 28 in Pediatrics.

Abstract
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Drugs ID'd in Most Older Adult Emergency Hospitalizations

WEDNESDAY, Nov. 23 (HealthDay News) -- Adverse drug events from commonly used medications, including warfarin, insulin, oral antiplatelet agents, and oral hypoglycemic agents, account for the majority of emergency hospitalizations in older adults in the United States, according to a study published in the Nov. 24 issue of the New England Journal of Medicine.

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Dabigatran Poses Challenge in Treating Injured Patients

WEDNESDAY, Nov. 23 (HealthDay News) -- Dabigatran etexilate, a new oral direct thrombin inhibitor, should be used with caution due to a lack of readily available methods to assess the degree of anticoagulation or reverse its effects, posing a threat of fatal bleeding complications for injured patients, according to a letter published in the Nov. 24 issue of the New England Journal of Medicine.

Letter

Similar Asthma Outcomes With Daily, Intermittent Budesonide

WEDNESDAY, Nov. 23 (HealthDay News) -- Daily low-dose budesonide therapy is not superior to intermittent high-dose therapy for reducing asthma exacerbations in children, according to a study published in the Nov. 24 issue of the New England Journal of Medicine.

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SAMHSA: Energy Drink-Related Emergency Visits Up in U.S.

WEDNESDAY, Nov. 23 (HealthDay News) -- Emergency department visits involving energy drinks increased approximately 10-fold between 2005 and 2009, according to a report published online Nov. 22 by the Substance Abuse and Mental Health Services Administration (SAMHSA).

Report

Staggered Acetaminophen Overdose Tied to Poor Outcome

WEDNESDAY, Nov. 23 (HealthDay News) -- Staggered acetaminophen overdose and delayed presentation after overdose are associated with adverse outcomes, according to a study published online Nov. 23 in the British Journal of Clinical Pharmacology.

Abstract
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Urinary Potassium, Sodium Excretion Tied to CV Events

TUESDAY, Nov. 22 (HealthDay News) -- Estimated urinary sodium and potassium excretion are associated with cardiovascular (CV) events, according to a study published in the Nov. 23/30 issue of the Journal of the American Medical Association.

Abstract
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BMI Predicts 30-Day Post-Surgery Mortality Risk

TUESDAY, Nov. 22 (HealthDay News) -- Body mass index (BMI) is a significant predictor of 30-day mortality after surgical procedures, irrespective of the type of surgery, according to a study published online Nov. 21 in the Archives of Surgery.

Abstract
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Radial Fracture Type Doesn't Impact Volar Plate Outcome

TUESDAY, Nov. 22 (HealthDay News) -- Open reduction and internal fixation of extra-articular and single sagittal intra-articular fractures of the distal radius using volar locking plates have similar outcomes, according to a study published in the Nov. 16 issue of The Journal of Bone & Joint Surgery.

Abstract
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Decision Aids Help Caregivers Discuss Terminal Illness

TUESDAY, Nov. 22 (HealthDay News) -- A decision aid, consisting of a video and an accompanying workbook, can help family caregivers discuss terminal disease status with a family member with cancer, according to a study published online Nov. 21 in the Journal of Clinical Oncology.

Abstract
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Black Patients Have Worse Diverticulitis Surgery Outcomes

TUESDAY, Nov. 22 (HealthDay News) -- Black patients who undergo surgery for diverticulitis have a higher risk of undergoing emergency procedures, and an increased mortality risk than white patients, according to a study published in the November issue of the Archives of Surgery.

Abstract
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Adverse Effects of Pediatric Acupuncture Usually Mild

MONDAY, Nov. 21 (HealthDay News) -- The majority of adverse effects (AEs) associated with pediatric acupuncture are mild in severity, according to a review published online Nov. 21 in Pediatrics.

Abstract
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Nonpunitive Method Improves Medical Error Reporting

MONDAY, Nov. 21 (HealthDay News) -- Medical error reporting in an academic pediatric ambulatory practice can be improved by a voluntary, nonpunitive, error-reporting system, according to a study published online Nov. 21 in Pediatrics.

Abstract
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Post-Bat Exposure Prophylaxis Up in New York

FRIDAY, Nov. 18 (HealthDay News) -- During a 10-year period of reporting concurrent with implementation of revised post-exposure prophylaxis (PEP) guidelines for bat rabies, there were increases in the number of bats submitted for testing, reports of exposure, and instances of human PEP, according to a letter published online Nov. 16 in the U.S. Centers for Disease Control and Prevention's Emerging Infectious Diseases.

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'Number of Criteria' Approach Best Defines Gout Flare

FRIDAY, Nov. 18 (HealthDay News) -- Gout flare is best defined using a "number of criteria" approach that includes the presence of four patient-reported features associated with flare, according to a study published online Nov. 14 in Arthritis & Rheumatism.

Abstract
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Factors Impacting Assignment to Triage Risk Level 2/3 ID'd

FRIDAY, Nov. 18 (HealthDay News) -- A triage nurse's decision to assign a patient to risk level 2 or 3 of the Emergency Severity Index (ESI) triage system is influenced by specific factors, according to a study published in the November issue of the Journal of Emergency Nursing.

Abstract
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Hyperglycemia, Mortality Linked in Pulmonary Embolism

THURSDAY, Nov. 17 (HealthDay News) -- Elevated glucose levels are common among patients with acute pulmonary embolism (PE), and are independently associated with increased 30-day mortality, according to a study published online Nov. 10 in Diabetes Care.

Abstract
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Drinking Age Law Impacts Adult Women's Suicide Risk

THURSDAY, Nov. 17 (HealthDay News) -- A minimum legal drinking age (MLDA) of less than 21 years is associated with a higher risk of adulthood suicides and homicides in women, according to a study published online Nov. 15 in Alcoholism: Clinical & Experimental Research.

Abstract
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Lower Floor Stiffness Reduces Peak Spine Forces in Falls

THURSDAY, Nov. 17 (HealthDay News) -- Peak spine force in backward falls is affected by the floor stiffness, according to a study published online Nov. 8 in Spine.

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Self-Harm Frequency Reduces From Adolescence to Adulthood

THURSDAY, Nov. 17 (HealthDay News) -- The frequency of self-harm reduces substantially from middle to late adolescence to young adulthood, according to a study published online Nov. 17 in The Lancet.

Abstract
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AHA Policy Statement on Cardiac Rehabilitation Issued

THURSDAY, Nov. 17 (HealthDay News) -- For patients with cardiovascular disease, participation in cardiac rehabilitation/secondary prevention programs (CR/SPPs) can be enhanced by overcoming patient and health care system-related barriers, and implementing new methods and policies for referral and enrollment, according to an American Heart Association policy statement published online Nov. 14 in Circulation.

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Patients Without Insurance Have Shorter Hospital Stays

TUESDAY, Nov. 15 (HealthDay News) -- Patients without Medicaid or any other insurance, with ambulatory care-sensitive conditions (ACSCs) or non-ACSCs, have shorter lengths of stay in hospitals than patients with insurance, according to a study published in the November/December issue of the Annals of Family Medicine.

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Delayed Acyclovir Ups Hospital Stay for Eczema Herpeticum

MONDAY, Nov. 14 (HealthDay News) -- For children hospitalized for eczema herpeticum, a delay in acyclovir initiation increases the length of stay (LOS), according to a study published online Nov. 14 in Pediatrics.

Abstract
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Community-Based Treatment Improves Pneumonia Outcomes

FRIDAY, Nov. 11 (HealthDay News) -- Implementation of community case management by lady health workers (LHWs) is associated with decreased treatment failure rates for children with severe pneumonia in Pakistan, according to a study published online Nov. 11 in The Lancet.

Abstract
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Transient Ischemic Attack Reduces Life Expectancy

FRIDAY, Nov. 11 (HealthDay News) -- Transient ischemic attack (TIA) reduces life expectancy, particularly in patients older than 65 years or with a previous history of stroke and heart problems, according to a study published online Nov. 10 in Stroke.

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Estimated Flu Incidence of 90 Million for 2008 in Under-5s

FRIDAY, Nov. 11 (HealthDay News) -- In 2008, there were an estimated 90 million new cases of influenza in children younger than 5 years of age, according to a review published online Nov. 11 in The Lancet.

Abstract
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Brain Hypoxia Tied to Poor Post-Traumatic Injury Outcome

FRIDAY, Nov. 11 (HealthDay News) -- Brain hypoxia (BH), or reduced brain oxygen (Pbto2), is independently associated with poor short-term outcomes in severe traumatic brain injury (TBI), according to a study published in the November issue of Neurosurgery.

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Recurrent Pelvic Inflammation Ups Infertility, Pelvic Pain

FRIDAY, Nov. 11 (HealthDay News) -- Recurrent pelvic inflammatory disease (PID) is associated with a nearly two-fold increase in infertility and more than four-fold increase in chronic pelvic pain (CPP), according to a study published in the September issue of Sexually Transmitted Diseases.

Abstract
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About 15,000 Intentional Poisoning ER Visits in 2009

FRIDAY, Nov. 11 (HealthDay News) -- In 2009, there were an estimated 14,720 emergency department visits due to intentional drug poisoning, with alcohol and drug combinations involved in 60 percent of these cases, according to a report published online Nov. 3 by the Substance Abuse and Mental Health Services Administration (SAMHSA).

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Child Abuse Underreported by Primary Health Care Providers

FRIDAY, Nov. 11 (HealthDay News) -- There is general agreement between child abuse experts and primary health care providers (PHCPs) concerning the assessment of suspected child abuse, but PHCPs report fewer cases of child abuse injuries to child protective services (CPS) than the experts, according to a report published online Oct. 13 in Academic Pediatrics.

Abstract
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Methamphetamine Linked to Increased Schizophrenia Risk

FRIDAY, Nov. 11 (HealthDay News) -- Individuals with methamphetamine-related conditions have an increased risk of developing schizophrenia compared to other drug use disorders, and a similar risk to those with cannabis-use disorders, according to a study published online Nov. 8 in The American Journal of Psychiatry.

Abstract
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Overactive Bladder Prevalent in Patients With Diabetes

THURSDAY, Nov. 10 (HealthDay News) -- Overactive bladder (OAB) is prevalent in patients with type 2 diabetes, with the prevalence higher in older patients and those with long-standing diabetes, according to a study published in the November issue of Urology.

Abstract
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FDA: Manufacturer Recalls Operating Room Tables

THURSDAY, Nov. 10 (HealthDay News) -- Mizuho OSI Modular Table Systems are the subject of a class I recall following reports of patient injury, according to a recall notice issued Nov. 9 by the U.S. Food and Drug Administration.

Mizuho OSI Modular Table Systems Recall Notice
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Glove Use Linked to Reduced Hand Hygiene Compliance

THURSDAY, Nov. 10 (HealthDay News) -- Glove usage among healthcare workers is often inappropriate, and hand hygiene compliance is worse when gloves are worn, according to a study published online Oct. 17 in Infection Control and Hospital Epidemiology.

Abstract
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Biolimus Stents Noninferior to Sirolimus Stents

WEDNESDAY, Nov. 9 (HealthDay News) -- Biodegradable biolimus-eluting stents (BES) are noninferior to durable polymer sirolimus-eluting stents (SES) in coronary artery disease (CAD), according to a study published online Nov. 9 in The Lancet to coincide with its presentation at the Transcatheter Cardiovascular Therapeutics meeting, held from Nov. 7 to 11 in San Francisco.

Abstract
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C-SSRS Useful for Assessing Suicidal Ideation and Behavior

WEDNESDAY, Nov. 9 (HealthDay News) -- The Columbia-Suicide Severity Rating Scale (C-SSRS) is a useful standardized measure for assessing suicidal behavior and ideation, according to a study published online Nov. 8 in The American Journal of Psychiatry.

Abstract
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Spinal Subdural Hemorrhage Linked to Abusive Head Trauma

WEDNESDAY, Nov. 9 (HealthDay News) -- The incidence of spinal subdural hemorrhage is high among children with abusive head trauma, and rare among those with accidental trauma, according to a study published online Nov. 8 in Radiology.

Abstract
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Hypertrophic Cardiomyopathy Guidelines Released

TUESDAY, Nov. 8 (HealthDay News) -- Hypertrophic cardiomyopathy (HCM) is a common cardiovascular disorder, and following diagnosis, patients should be managed at centers of clinical excellence, according to a scientific statement published online Nov. 8 in Circulation.

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Substance Use, Abuse Highest Among Native American Teens

TUESDAY, Nov. 8 (HealthDay News) -- Substance use varies according to race/ethnicity, with Native American adolescents having the highest prevalence of use and substance-related disorders, according to a study published in the November issue of the Archives of General Psychiatry.

Abstract
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Neuromuscular Warm-Up Cuts Lower Extremity Injury

TUESDAY, Nov. 8 (HealthDay News) -- Implementation of coach-led neuromuscular warm-up reduces the incidence of non-contact lower extremity (LE) injuries in female high school athletes, according to a study published in the November issue of the Archives of Pediatrics & Adolescent Medicine.

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Great Achievement at Young Age Function of Time, Not Field

MONDAY, Nov. 7 (HealthDay News) -- The frequency of great scientific achievements at young age is a function of time, and not related to the field, according to a study published online Nov. 7 in the Proceedings of the National Academy of Sciences.

Abstract
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K2 Linked to Cases of ST-Elevation Myocardial Infarction

MONDAY, Nov. 7 (HealthDay News) -- Use of K2, a synthetic cannabinoid, among adolescents is associated with ST-segment elevation-myocardial infarction (MI), according to a study published online Nov. 7 in Pediatrics.

Abstract
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Paternal Depression Tied to Child's Emotional Behavior

MONDAY, Nov. 7 (HealthDay News) -- Paternal mental health problems and depressive symptoms are independently associated with increased rates of emotional and behavioral problems in children, according to a study published online Nov. 7 in Pediatrics.

Abstract
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Causal Link Suggested Between Acetaminophen Use, Asthma

MONDAY, Nov. 7 (HealthDay News) -- The use of acetaminophen in children with asthma or at risk of asthma should be avoided until the drug's safety is established, as observations suggest a causative association between acetaminophen use and increased asthma prevalence in children, according to a report published online Nov. 7 in Pediatrics.

Abstract
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Factors Influencing Smoking Cessation Post-Stroke ID'd

FRIDAY, Nov. 4 (HealthDay News) -- For smokers who have a stroke, only 40 percent are nonsmokers at one year following stroke, with insular damage and prestroke intention to stop smoking strongly influencing smoking cessation, according to a study published online Nov. 3 in Stroke.

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AHA/ACCF Guidelines for Heart Disease Updated

FRIDAY, Nov. 4 (HealthDay News) -- For patients with coronary heart disease (CHD), and atherosclerotic vascular disease, health care practitioners should implement appropriate treatment based on evidence-based guidelines and assess their success, according to a scientific statement published online Nov. 3 in Circulation.

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Rooms of Patients With A. baumannii Often Contaminated

FRIDAY, Nov. 4 (HealthDay News) -- A considerable proportion of rooms of patients colonized or infected with multidrug-resistant Acinetobacter baumannii (A. baumannii) (MDR-AB) have surfaces which are positive for A. baumannii, even in patients with a remote history of infection, according to a study published in the November issue of the American Journal of Infection Control.

Abstract
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Carisoprodol-Related Emergency Visits Up in United States

THURSDAY, Nov. 3 (HealthDay News) -- Carisoprodol misuse- or abuse-related emergency department visits increased in the United States between 2004 and 2009, with the majority of visits involving other pharmaceuticals, according to a report published online Nov. 3 by the Substance Abuse and Mental Health Services Administration (SAMHSA).

Report

Children Not Vaccinated Against Pneumonia Remain Vulnerable

THURSDAY, Nov. 3 (HealthDay News) -- Some children are not receiving the current recommended 13-valent pneumococcal conjugate vaccine (PCV13), a replacement for the 7-valent vaccine (PCV7) in all children and a supplement for those aged 14 to 59 months, leaving them susceptible to invasive pneumococcal disease (IPD) and death, according to research published in the Nov. 4 issue of the U.S. Centers for Disease Control and Prevention's Morbidity & Mortality Weekly Report.

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No Medicare Savings From Disease-Management Hotline

THURSDAY, Nov. 3 (HealthDay News) -- Commercial disease-management companies using nurse-based call centers modestly improve quality-of-care measures in Medicare fee-for-service programs with no evident reduction in costs of care or acute care utilization, according to a study published in the Nov. 3 issue of the New England Journal of Medicine.

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Risks for C. difficile Infection, Colonization Identified

THURSDAY, Nov. 3 (HealthDay News) -- Health care-associated Clostridium difficile (C. difficile) infection and colonization are differentially associated with defined host and pathogen variables, according to a study published in the Nov. 3 issue of the New England Journal of Medicine.

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Prophylactic Therapy Reduces Bleeding in Hemophilia A

WEDNESDAY, Nov. 2 (HealthDay News) -- For patients with severe hemophilia A, anti-inhibitor coagulant complex (AICC) prophylaxis is safe and significantly reduces bleeding episodes compared with on-demand therapy, according to a study published in the Nov. 3 issue of the New England Journal of Medicine.

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CDC: Opioid Overdoses Have Reached Epidemic Proportions

WEDNESDAY, Nov. 2 (HealthDay News) -- Opioid pain relievers (OPR) are involved in most drug overdose deaths; and OPR-related deaths, sales, and treatment admissions have increased in the last decade, according to a report published in the Nov. 1 early-release issue of the U.S. Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

Report

Hand-Held Metal Detectors Safe With Implanted Devices

TUESDAY, Nov. 1 (HealthDay News) -- Exposure to hand-held metal detectors does not affect the function of pacemakers or implantable cardioverter defibrillators (ICDs), according to a study published in the Nov. 1 issue of Annals of Internal Medicine.

Abstract
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ADHD Drug Use Not Tied to Serious Cardiovascular Events

TUESDAY, Nov. 1 (HealthDay News) -- Current use of attention deficit-hyperactivity disorder (ADHD) drugs is not associated with a significantly increased risk of serious cardiovascular events, according to a study published online Nov. 1 in the New England Journal of Medicine.

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