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Category: Critical Care | Monthly Briefing

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April 2009 Briefing - Critical Care

Last Updated: May 01, 2009.

 

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Here are what the editors at HealthDay consider to be the most important developments in Critical Care for April 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.

New Web-based Information Source to Support UK Clinicians

THURSDAY, April 30 (HealthDay News) -- The United Kingdom's National Institute for Health and Clinical Excellence (NICE) has announced the launch of NHS Evidence, a Web-based evidence resource for clinicians, public health professionals of the National Health Service, and others involved in making patient care decisions. The announcement came in the April 30 issue of The Lancet.

NICE home page
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NEJM Commends New Conflict of Interest Proposal

THURSDAY, April 30 (HealthDay News) -- A new proposal to control conflict of interest is notable for its breadth and variety of recommended solutions, according to a Perspective article published online April 29 in the New England Journal of Medicine.

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WHO Rasies Influenza Epidemic Alert Level From 4 to 5

THURSDAY, April 30 (HealthDay News) -- The U.S. Centers for Disease Control and Prevention (CDC) has confirmed that the United States has had its first fatality as a result of swine flu. The case was a 23-month-old Mexican boy who was in Houston for medical treatment. Also, on April 29, the World Health Organization raised the influenza epidemic alert level from 4 to 5, meaning a pandemic is imminent.

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Critically Ill Patients May Often Be Vitamin D Deficient

WEDNESDAY, April 29 (HealthDay News) -- High percentages of critically ill patients in intensive care may be vitamin D deficient, potentially worsening outcomes, according to an article published in the April 30 issue of the New England Journal of Medicine.

Abstract
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Telaprevir-Based Drugs Show Promise to Treat Hepatitis C

WEDNESDAY, April 29 (HealthDay News) -- Phase 2 clinical trials of treatment regimens based on telaprevir in combination with peginterferon alfa-2a and ribavirin show significantly improved virologic responses in chronic hepatitis C virus patients, according to two studies published in the April 30 issue of the New England Journal of Medicine.

Abstract - McHutchison
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Abstract - Hezode
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Poisoning Deaths Prompt Methadone Outreach

WEDNESDAY, April 29 (HealthDay News) -- A more than threefold increase in the number of deaths linked to methadone poisoning in recent years is prompting a new public information campaign on the safe use of the prescription drug in both addiction treatment and as a pain reliever, according to a statement released April 28 by the U.S. Food and Drug Administration (FDA).

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FDA Requires OTC Pain Relievers to Display Warnings

WEDNESDAY, April 29 (HealthDay News) -- Popular over-the-counter (OTC) pain relievers and fever medications containing acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) will be required to display prominent warnings about the risks of liver damage and internal bleeding, under a new rule announced April 28 by the U.S. Food and Drug Administration (FDA).

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Specialist Centers Key to Treating Cystic Fibrosis

WEDNESDAY, April 29 (HealthDay News) -- Earlier diagnosis and more aggressive treatment at specialized centers has improved the outlook for cystic fibrosis patients, and the disease's underlying molecular-biological origins are now well understood, according to an article published online on April 28 in The Lancet.

Abstract
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CDC Confirms 64 Swine Flu Cases in United States

WEDNESDAY, April 29 (HealthDay News) -- The U.S. Centers for Disease Control and Prevention has confirmed 64 cases of swine-origin influenza A (H1N1) virus in the United States as of April 28, including five cases requiring hospitalization. The cases have occurred across five states, including 45 in New York, 10 in California, six in Texas, two in Kansas and one in Ohio, according to a dispatch on April 28 in the Morbidity and Mortality Weekly Report.

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H1N1 Swine Flu Susceptible to Oseltamivir and Zanamivir

WEDNESDAY, April 29 (HealthDay News) -- The swine-origin influenza A virus H1N1 is susceptible to both neuraminidase inhibitors oseltamivir and zanamivir, but is resistant to the M2 ion channel blockers amantadine and rimantadine, according to a dispatch on April 28 from the U.S. Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

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Pharmacist Involvement May Decrease Medication Errors

TUESDAY, April 28 (HealthDay News) -- Adding a pharmacist to health care teams may significantly decrease patients' risk of adverse drug events and medication errors, according to a report published in the April 27 issue of the Archives of Internal Medicine. A second study indicates that an interdisciplinary medication reconciliation intervention can also reduce unintentional medication discrepancies with potential for harm.

Abstract - Murray
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Abstract - Schnipper
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Editorial

Women Found to Have Less Access to Cardiologists

TUESDAY, April 28 (HealthDay News) -- Women with coronary artery disease or congestive heart failure have less access to consultations with cardiologists compared with men, according to study findings published online April 27 in Circulation: Journal of the American Heart Association.

Abstract
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Glucose Control During Surgery Linked to Better Outcomes

TUESDAY, April 28 (HealthDay News) -- Aggressive glycemic control during surgery reduces the risk of major cardiovascular events, researchers report in the May issue of Anesthesiology.

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Gene Variant Linked to Worse Outcomes in Pneumonia

TUESDAY, April 28 (HealthDay News) -- Patients hospitalized with severe pneumonia have a higher risk of death and spend a longer time on mechanical ventilation if they have a variant of the plasminogen activator inhibitor-1 (PAI-1) gene, according to a study in the May issue of Anesthesiology.

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Computed Tomography May Help Early Chest Pain Triage

TUESDAY, April 28 (HealthDay News) -- Early use of coronary computed tomography angiography in the early triage of patients presenting with acute chest pain can play an important role in improving emergency department patient management, according to a study published in the May 5 issue of the Journal of the American College of Cardiology.

Abstract
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Steep Copayments Increase Risk of Non-Adherence

TUESDAY, April 28 (HealthDay News) -- In patients who are newly diagnosed with a chronic disease, higher out-of-pocket costs for medications are associated with an increased likelihood of non-treatment, according to a study published in the April 27 issue of the Archives of Internal Medicine.

Abstract
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Editorial

Number of US Swine Flu Cases Rises, CDC Reports

TUESDAY, April 28 (HealthDay News) -- At least 40 cases of swine flu have been confirmed in the United States, prompting a wide range of governmental actions to counter what could become a worldwide pandemic, according to Richard Besser, M.D., acting director of the U.S. Centers for Disease Control and Prevention.

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Swine Flu Declared Public Health Emergency in US

MONDAY, April 27 (HealthDay News) -- Two recent cases of swine influenza A (H1N1) virus infection in Southern California raised the possibility that the virus can be transmitted by human-to-human contact, according to a report published in the April 24 issue of the U.S. Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report. Subsequently, the number of U.S. cases continues to rise and U.S. officials have declared it a public health emergency.

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Having Health Insurance May Not Improve Mortality Risk

THURSDAY, April 23 (HealthDay News) -- People without health insurance have about the same mortality rate as people with health insurance, according to an observational study published online April 21 in Health Services Research.

Abstract
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Stretches Without Health Insurance More Common

WEDNESDAY, April 22 (HealthDay News) -- Periods of uninsurance have become more common in recent decades, particularly among those with less education, according to research published in the April 23 issue of the New England Journal of Medicine.

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Gene Defect Found in Patients with Small-Vessel Disease

WEDNESDAY, April 22 (HealthDay News) -- A gene defect has been identified in patients with a hereditary cerebral small-vessel disease, according to a study in the April 23 issue of the New England Journal of Medicine.

Abstract
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Organ Donation Consent Depends on Diverse Factors

WEDNESDAY, April 22 (HealthDay News) -- The number of organs available for transplantation could be significantly increased by improving the rate of consent for organ donation by relatives of people who have died, according to a study published in the April 21 issue of BMJ.

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Continuity of Care Declining for Medicare Beneficiaries

TUESDAY, April 21 (HealthDay News) -- Medicare beneficiaries in the hospital in 2006 were much less likely to be seen there by a familiar physician than those in the hospital a decade earlier, according to a study reported in the April 22/29 issue of the Journal of the American Medical Association.

Abstract
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Transplant Center Distance No Factor in Kidney Transplant

TUESDAY, April 21 (HealthDay News) -- Living in a rural area or far from a kidney transplant center does not significantly affect a patient's chances of getting a transplant, according to a study in the April 22/29 issue of the Journal of the American Medical Association.

Abstract
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Defibrillator Implant Success Varies by Specialty

TUESDAY, April 21 (HealthDay News) -- Patients who receive an implantable cardioverter-defibrillator (ICD) are more apt to get the most appropriate device and are less likely to suffer complications if an electrophysiologist performs the procedure, according to a study reported in the April 22/29 issue of the Journal of the American Medical Association.

Abstract
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Revascularization Not Linked to Long-Term Benefit

FRIDAY, April 17 (HealthDay News) -- In patients with high cardiac risk undergoing major vascular surgery, preoperative coronary revascularization was not associated with better long-term outcomes, according to research published April 1 in the American Journal of Cardiology.

Abstract
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Secondary Stroke Prevention Lower in Elderly Patients

FRIDAY, April 17 (HealthDay News) -- In stroke survivors, secondary prevention is essential regardless of age, according to a study published online April 16 in BMJ.

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Statins May Prevent Stroke, Another Drug Improves Outcome

FRIDAY, April 17 (HealthDay News) -- Statins may help prevent stroke among high-risk patients, but when stroke occurs, controlling the patient's post-stroke body temperature may help improve the outcome, according to separate studies reported in the May issue of The Lancet Neurology.

Abstract - Amarenco
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Abstract - Hertog
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Elderly May Be Shortchanged in Stroke Care

FRIDAY, April 17 (HealthDay News) -- Current stroke care practices shortchange the elderly, who undergo fewer diagnostic investigations than their younger counterparts, and who also receive less advice on how to modify their lifestyles in order to prevent stroke recurrence, according to a study published in the March issue of the Postgraduate Medical Journal.

Abstract
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Drug-Resistant TB Remains a Worldwide Threat

THURSDAY, April 16 (HealthDay News) -- Drug-resistant tuberculosis (TB) remains a serious worldwide problem with the median prevalence of multidrug-resistant strains of TB as high as one in five new cases in some hot spots, according to the results of a survey by the World Health Organization reported in the April 16 online edition of The Lancet.

Abstract
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Valsartan Not Linked to Fewer Atrial Fibrillation Recurrences

WEDNESDAY, April 15 (HealthDay News) -- The use of valsartan was not associated with a decrease in recurrences of atrial fibrillation in patients with underlying cardiovascular disease, diabetes, or left atrial enlargement, according to research published in the April 16 issue of the New England Journal of Medicine.

Abstract
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Genetic Link Seen in Ischemic, Atherothrombotic Strokes

WEDNESDAY, April 15 (HealthDay News) -- A locus on chromosome 12p13 may be linked to an increased risk of stroke, according to research published online April 15 in the New England Journal of Medicine.

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Hypoglycemic Events Increase Dementia Risk with Diabetes

TUESDAY, April 14 (HealthDay News) -- Incidents of hypoglycemia in older patients with type 2 diabetes increase the risk of their eventually developing dementia, according to a study in the April 15 issue of the Journal of the American Medical Association.

Abstract
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Heart Screening of Diabetics May Not Improve Outcomes

TUESDAY, April 14 (HealthDay News) -- Screening type 2 diabetes patients for asymptomatic coronary artery disease does not significantly reduce the number of heart attacks or improve outcomes compared to unscreened patients, according to a study in the April 15 issue of the Journal of the American Medical Association.

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Researchers Describe Epidemiology of Heart Failure

TUESDAY, April 14 (HealthDay News) -- Among older Americans, heart failure is a common condition that disproportionately affects blacks. But many cases could be prevented if risk factors were modified, according to a study published in the April 13 issue of the Archives of Internal Medicine.

Abstract
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Cigarette Smoke Alters Lungs' Inflammatory Response

MONDAY, April 13 (HealthDay News) -- Exposure to cigarette smoke exacerbates and skews the respiratory system's inflammatory response to bacteria in mice, which may shed light on smoking's role in the development of inflammation in chronic obstructive pulmonary disease (COPD) in humans, researchers report in the April 15 issue of the American Journal of Respiratory and Critical Care Medicine.

Abstract
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Pain Requires Meticulous Attention in Intensive Care Units

MONDAY, April 13 (HealthDay News) -- In intensive care units, the evaluation and management of pain is a significant clinical challenge, according to two Contemporary Reviews in Critical Care Medicine published in the April issue of the journal Chest.

Abstract - Puntillo
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Abstract - Erstad
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Injecting-Drug Users Still Put Themselves at Risk for HIV

FRIDAY, April 10 (HealthDay News) -- Injecting-drug users accounted for 6,600 (12 percent) of the new cases of HIV detected in the United States in 2006, and many report engaging in HIV-associated behaviors, according to a report published in the April 10 issue of the U.S. Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

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Financial Rewards for Healthy Behavior Can Be Effective

FRIDAY, April 10 (HealthDay News) -- Although paying people to engage in healthy behaviors or successfully tackle unhealthy ones can be effective, it may carry unintended consequences, according to an editorial published online April 9 in BMJ.

Editorial

New Vaccine Successfully Tested in Latent TB Infection

FRIDAY, April 10 (HealthDay News) -- A new vaccine for tuberculosis produced immunogenic response without immunopathology in patients with latent tuberculosis infection, according to the results of a study published in the April 15 issue of the American Journal of Respiratory and Critical Care Medicine.

Abstract
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Cardiac Outcomes of Sleep Apnea Studied in Rats

THURSDAY, April 9 (HealthDay News) -- The endothelin system, a potent vasoconstrictor and promoter of vascular growth, plays a major role in the cardiovascular consequences of obstructive sleep apnea in a rat model of the condition, researchers report in the April 14 issue of the Journal of the American College of Cardiology.

Abstract
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Accelerated Care Cost-Effective After Joint Replacement

THURSDAY, April 9 (HealthDay News) -- In patients who receive total hip and knee arthroplasty, an accelerated perioperative care and rehabilitation protocol is more cost-effective than a more standard protocol, according to a study published in the April issue of the Journal of Bone & Joint Surgery.

Abstract
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Reduced Tube Voltage Linked to Less Radiation Exposure

THURSDAY, April 9 (HealthDay News) -- Lower tube voltage was linked to reduced radiation exposure in patients undergoing coronary dual-source computed tomography (CT) angiography, according to research published in the April issue of the American Journal of Roentgenology.

Abstract
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Gastric Drug Does Not Improve Asthma Control

WEDNESDAY, April 8 (HealthDay News) -- Treating asymptomatic gastroesophageal reflux disease with a proton-pump inhibitor in patients with poorly controlled asthma does not improve asthma control, researchers report in the April 9 issue of the New England Journal of Medicine.

Abstract
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Editorial

Socioeconomic Status a Risk Factor in Child Heart Transplant

WEDNESDAY, April 8 (HealthDay News) -- Children from lower socioeconomic groups are at greater risk for graft failure following a heart transplant than children from higher socioeconomic groups, according to a study published online April 7 in Circulation: Heart Failure.

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Exercise Modestly Benefits Patients With Heart Failure

TUESDAY, April 7 (HealthDay News) -- Patients with heart failure have modest reductions in mortality and hospitalization, as well as improvements in self-reported health status, after implementation of an aerobic exercise program, according to two studies published in the April 8 issue of the Journal of the American Medical Association.

Abstract - O'Connor
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Abstract - Flynn
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New Cerebrovascular Intervention Statement Issued

TUESDAY, April 7 (HealthDay News) -- In response to the rapid pace of technological development in the field of intracranial endovascular cerebrovascular interventions, the American Heart Association has released guidelines on performance of such procedures to treat a range of cerebrovascular disorders. The indications were laid out in a statement published online April 6 in Circulation: Journal of the American Heart Association.

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Erythropoietin Improves Functioning in Kidney Disease

MONDAY, April 6 (HealthDay News) -- Treatment to increase hemoglobin levels in kidney disease patients with severe anemia can improve cardiac function and quality of life, according to two studies reported in the April 1 issue of the Clinical Journal of the American Society of Nephrology.

Abstract - Parfrey
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Abstract - Foley
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Bleeding Linked to Cardiovascular Events After PCI

MONDAY, April 6 (HealthDay News) -- Bleeding complications associated with percutaneous coronary intervention (PCI) may raise the risk of adverse outcomes in patients, according to research published in the April 1 issue of the American Journal of Cardiology.

Abstract
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Intensive Dialysis Restores Renal Function in Myeloma

FRIDAY, April 3 (HealthDay News) -- An intensive dialysis regimen can restore renal function in patients with multiple myeloma-induced cast nephropathy, but only when there is effective concurrent chemotherapy, according to research published in the April 1 issue of the Clinical Journal of the American Society of Nephrology.

Abstract
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Catheter-Based Therapies May Benefit Stroke Patients

FRIDAY, April 3 (HealthDay News) -- In some patients who aren't candidates for intravenous thrombolysis, catheter-based therapy (CBT) provides an optional treatment for acute ischemic stroke, according to research published in the April 1 issue of Catheterization and Cardiovascular Interventions.

Abstract
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Moxifloxacin May Accelerate Tuberculosis Cure by Months

FRIDAY, April 3 (HealthDay News) -- The standard first-line tuberculosis treatment regimen enhanced with the fluoroquinolone moxifloxacin can cure the disease three times faster than standard treatment alone, researchers report in the April 4 issue of The Lancet.

Abstract
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New Guidelines Published for Managing Hypoglycemia

THURSDAY, April 2 (HealthDay News) -- Hypoglycemia should only be evaluated and managed in patients with documented hypoglycemia, and hypoglycemia in the absence of diabetes should be investigated for the root causes, according to guidelines published in the March issue of the Journal of Clinical Endocrinology & Metabolism.

Abstract
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Electronic Prescribing Online-Learning Tools Launched

THURSDAY, April 2 (HealthDay News) -- U.S. physicians will be able to better evaluate electronic prescribing systems thanks to a new online learning center on ePrescribing launched April 1 by the American Medical Association.

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Changes Needed in New-Drug Evaluation Process

WEDNESDAY, April 1 (HealthDay News) -- The evaluation process for new drugs is overdue for an overhaul, which could provide benefits for the public and the pharmaceutical industry, according to a point-counterpoint commentary published online March 31 in BMJ.

Abstract - Garattini
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Abstract - Tremblay
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Adult Spinal Stem Cells Reverse Paralysis in Rats

WEDNESDAY, April 1 (HealthDay News) -- Spinal stem cells taken from adult rats with an injured spinal cord are effective at differentiating into oligodendrocytes and motor neurons and can reverse paralysis when transplanted into rats with a spinal cord injury, according to a study published in the March issue of Stem Cells.

Abstract
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New Health Program Leads to Questions in the UK

WEDNESDAY, April 1 (HealthDay News) -- A new British program to improve patient choices and competition in the health care marketplace may lead to excess capacity in some areas and instability in others, according to a commentary published online March 31 in BMJ.

Abstract
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