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February 2013 Briefing - Critical Care

February 2013 Briefing - Critical Care

Here are what the editors at HealthDay consider to be the most important developments in Critical Care for February 2013. 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.

CMS Issues Final Rule on Physician Sunshine Act

THURSDAY, Feb. 28 (HealthDay News) -- The Centers for Medicare and Medicaid Services (CMS) have issued a final rule requiring drug and device manufacturers and group purchasing organizations (GPOs) to report payment or gifts of more than $10 to physicians, hospitals, and other providers, and necessitating manufacturers and GPOs to report ownership or investment interests held by physicians or their family members.

More Information (http://www.gpo.gov/fdsys/pkg/FR-2013-02-08/pdf/2013-02572.pdf )

Intern Performance No Better With Simulation-Based Training

TUESDAY, Feb. 26 (HealthDay News) -- A single simulation-based medical education (SBME) training session is not sufficient to improve interns' clinical procedural performance in infant lumbar puncture (ILP) and child intravenous line placement (CIV), according to a study published online Feb. 25 in Pediatrics.

Abstract (http://pediatrics.aappublications.org/content/early/2013/02/20/peds.2012-0607.abstract )Full Text (subscription or payment may be required) (http://pediatrics.aappublications.org/content/early/2013/02/20/peds.2012-0607.full.pdf+html )

Aldosterone Blockade Ups Left Ventricular Diastolic Function

TUESDAY, Feb. 26 (HealthDay News) -- For patients with heart failure with preserved ejection fraction, aldosterone blockade with spironolactone improves left ventricular diastolic function, but has no impact on maximal exercise capacity, quality of life, or patient symptoms, according to a study published in the Feb. 27 issue of the Journal of the American Medical Association.

Abstract (http://jama.jamanetwork.com/article.aspx?articleid=1656252#Abstract )Full Text (subscription or payment may be required) (http://jama.jamanetwork.com/article.aspx?articleid=1656252 )Editorial (subscription or payment may be required) (http://jama.jamanetwork.com/article.aspx?articleid=1656233 )

FDA: Omontys Injection Pulled From Market

TUESDAY, Feb. 26 (HealthDay News) -- Affymax Inc. of Palo Alto, Calif., and Takeda Pharmaceuticals Company Limited of Deerfield, Ill., have voluntarily recalled all lots of Omontys Injection, used to treat anemia in adult dialysis patients, following reports of serious and fatal hypersensitivity reactions, according to a safety recall issued by the U.S. Food and Drug Administration.

More Information (http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm340899.htm )

List of Five Unnecessary Vascular Tests Released

TUESDAY, Feb. 26 (HealthDay News) -- The Society for Vascular Medicine (SVM) has published "Five Things Physicians and Patients Should Question" in vascular medicine, a list of five tests and procedures that are commonly used but can be unnecessary or even harmful.

More Information (http://www.vascularmed.org/choosing/SVMCWList.pdf )

Preparation Underway for Implementation of ACA in 2014

TUESDAY, Feb. 26 (HealthDay News) -- As the implementation of the Affordable Care Act (ACA) nears, states are preparing for some of its provisions, including expanded access to Medicaid and the Children's Health Insurance Program (CHIP) and the use of information technology, according to a report issued by the Kaiser Family Foundation.

More Information (http://www.kff.org/medicaid/2013medicaid50statesurvey.cfm )

Families Prefer ICU Doctors in Traditional White Coats, Scrubs

TUESDAY, Feb. 26 (HealthDay News) -- Intensive care unit (ICU) physician attire may influence patient family perceptions, according to a research letter published online Feb. 18 in JAMA Internal Medicine.

Abstract (http://archinte.jamanetwork.com/article.aspx?articleid=1653992 )Full Text (subscription or payment may be required) (http://archinte.jamanetwork.com/article.aspx?articleid=1653992 )

Mental Health and Substance Use Disorder Benefits Expanded

FRIDAY, Feb. 22 (HealthDay News) -- In a final rule, which will make purchasing health coverage easier for consumers, mental health and substance use benefits will be expanded to 62 million Americans, according to a report published Feb. 20 by the U.S. Department of Health and Human Services.

More Information (http://www.hhs.gov/news/press/2013pres/02/20130220a.html )

CMS Proposes Payment and Policy Updates for 2014

THURSDAY, Feb. 21 (HealthDay News) -- Payment and policy updates have been proposed for 2014, according to the Centers for Medicare and Medicaid Services (CMS) Advanced Notice and draft Call Letter published Feb. 15.

More Information (http://www.cms.gov/apps/media/press/release.asp?Counter=4540&intNumPerPage=10&checkDa%20te=&checkKey=&srchType=1&numDays=3500&sr )

Air Pollution Ups Mortality Rate Post-ACS Hospitalization

THURSDAY, Feb. 21 (HealthDay News) -- For individuals hospitalized with acute coronary syndrome (ACS), exposure to higher levels of air pollution, specifically particulate matter with a diameter of ≤2.5 µm (PM2.5), correlates with increased all-cause mortality, according to a study published online Feb. 19 in the European Heart Journal.

Abstract (http://eurheartj.oxfordjournals.org/content/early/2013/02/18/eurheartj.ehs480.abstract )Full Text (http://eurheartj.oxfordjournals.org/content/early/2013/02/18/eurheartj.ehs480.full )Editorial (subscription or payment may be required) (http://eurheartj.oxfordjournals.org/content/early/2013/02/18/eurheartj.eht045.extract )

IV Hydroxyethyl Starch Not OK in Critically Ill Patients

THURSDAY, Feb. 21 (HealthDay News) -- Due to significant safety concerns, hydroxyethyl starch should not be used for acute volume resuscitation in critically ill patients, according to research published in the Feb. 20 issue of the Journal of the American Medical Association.

Abstract (http://jama.jamanetwork.com/article.aspx?articleid=1653505#Abstract )Full Text (subscription or payment may be required) (http://jama.jamanetwork.com/article.aspx?articleid=1653505 )Editorial (subscription or payment may be required) (http://jama.jamanetwork.com/article.aspx?articleid=1653508 )

Report Discusses Impact of ACGME 2011 Requirements

THURSDAY, Feb. 21 (HealthDay News) -- Although many residency program directors approve of individual components within the Accreditation Council for Graduate Medical Education (ACGME) Common Program Requirements introduced in 2011, less than half express overall approval, according to a perspective piece published in the Feb. 21 issue of the New England Journal of Medicine.

Full Text (http://www.nejm.org/doi/full/10.1056/NEJMp1214483 )

Faster Adoption of Electronic Health Records Needed

WEDNESDAY, Feb. 20 (HealthDay News) -- The adoption of electronic health records (EHRs) by health providers for Medicare is increasing, but not quickly enough to avoid penalties in 2015, according to a letter published in the Feb. 21 issue of the New England Journal of Medicine.

Full Text (subscription or payment may be required) (http://www.nejm.org/doi/full/10.1056/NEJMc1213481 )

Synthetic Marijuana Linked to Acute Kidney Injury

WEDNESDAY, Feb. 20 (HealthDay News) -- Synthetic cannabinoids, sold under labels such as "synthetic marijuana," "herbal incense," "potpourri," and "spice" have been tied to hospitalizations for unexplained acute kidney injury (AKI) in the United States, according to research published in the Feb. 15 issue of the U.S. Centers for Disease Control and Prevention's Morbidity & Mortality Weekly Report.

Full Text (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6206a1.htm?s_cid=mm6206a1_w )

Women's Awareness of Heart Disease Improving

WEDNESDAY, Feb. 20 (HealthDay News) -- Over the past 15 years there has been an improvement in women's awareness of cardiovascular disease (CVD), but racial disparity still exists, according to a study published online Feb. 19 in Circulation.

Abstract (http://circ.ahajournals.org/content/early/2013/02/19/CIR.0b013e318287cf2f.abstract )Full Text (http://circ.ahajournals.org/content/early/2013/02/19/CIR.0b013e318287cf2f.full )

Opioids Involved in Most Medical Overdose Deaths

WEDNESDAY, Feb. 20 (HealthDay News) -- Opioid analgesics are involved in the majority of pharmaceutical-related overdose deaths, frequently involving drugs prescribed for mental health conditions, according to a research letter published in the Feb. 20 issue of the Journal of the American Medical Association.

Full Text (subscription or payment may be required) (http://jama.jamanetwork.com/article.aspx?articleid=1653518 )

Multimodality Approach Needed to Reengineer Health Care

TUESDAY, Feb. 19 (HealthDay News) -- A multimodality approach focusing on reengineering the U.S. health care system may provide a way to improve quality and reduce costs, according to a viewpoint published in the Feb. 20 issue of the Journal of the American Medical Association.

Full Text (subscription or payment may be required) (http://jama.jamanetwork.com/article.aspx?articleid=1653532 )

CMS: Unnecessary Medicare Regulations to Be Reformed

TUESDAY, Feb. 19 (HealthDay News) -- Medicare regulations which are unnecessary, obsolete, or excessively burdensome on hospital or health care providers will be reformed, according to a rule proposed by the Centers for Medicare & Medicaid Services (CMS) in response to the President's instructions in Executive Order 13563.

Proposed Rule (http://www.gpo.gov/fdsys/pkg/FR-2013-02-07/html/2013-02421.htm )Press Release (http://www.hhs.gov/news/press/2013pres/02/20130204d.html )

Artificial Intelligence Can Improve Patient Care

TUESDAY, Feb. 19 (HealthDay News) -- Use of an artificial intelligence (AI) framework can improve patient outcomes at one-third of the costs of the current standard of care, according to a study published online Jan. 2 in Artificial Intelligence in Medicine.

Abstract (http://www.aiimjournal.com/article/S0933-3657(12)00151-0/abstract )Full Text (subscription or payment may be required) (http://www.aiimjournal.com/article/S0933-3657(12)00151-0/fulltext )

Neonatal Bisphenol A Levels Linked to Medical Device Use

MONDAY, Feb. 18 (HealthDay News) -- The levels of bisphenol A (BPA) in the urine of premature infants in the neonatal intensive care unit is associated with greater exposure to medical devices, but not with nutritional intake, according to a study published online Feb. 18 in Pediatrics.

Abstract (http://pediatrics.aappublications.org/content/early/2013/02/13/peds.2012-1380.abstract )Full Text (subscription or payment may be required) (http://pediatrics.aappublications.org/content/early/2013/02/13/peds.2012-1380.full.pdf+html )

AMA Issues Code for Safe Care Transitions After Hospital Stay

MONDAY, Feb. 18 (HealthDay News) -- A series of five responsibilities and five principles should guide ambulatory practices to achieve safe and effective care transitions for patients after hospital stays, according to a report issued by the American Medical Association (AMA).

More Information (http://www.ama-assn.org/resources/doc/patient-safety/ambulatory-practices.pdf )

Health Care-Associated Infections Decreased in 2011

FRIDAY, Feb. 15 (HealthDay News) -- In 2011, decreases were noted for some health care-associated infections (HAIs), according to a report prepared by the U.S. Centers for Disease Control and Prevention.

More Information (http://www.cdc.gov/hai/pdfs/SIR/SIR-Report_02_07_2013.pdf )

Income Inequality Ups Risk for 30-Day Hospital Readmission

FRIDAY, Feb. 15 (HealthDay News) -- For Medicare beneficiaries, income inequality correlates with 30-day readmission following hospitalization for myocardial infarction, heart failure, or pneumonia, according a study published online Feb. 14 in BMJ.

Full Text (http://www.bmj.com/content/346/bmj.f521 )

Psychological, Sexual Impact of Female Breadwinners Explored

THURSDAY, Feb. 14 (HealthDay News) -- For couples in which the wife earns more than the husband, there may be psychological and sexual implications, according to a study published in the March issue of the Personality and Social Psychology Bulletin.

Abstract (http://psp.sagepub.com/content/39/3/359.abstract )Full Text (subscription or payment may be required) (http://psp.sagepub.com/content/39/3/359.full )

IOM Urges International Action to Eradicate Fake Drugs

THURSDAY, Feb. 14 (HealthDay News) -- Falsified and substandard medications pose public health problems around the world, and international action should be taken to combat the phenomenon, according to a report published Feb. 13 by the Institute of Medicine (IOM).

More Information (http://www.iom.edu/Reports/2013/Countering-the-Problem-of-Falsified-and-Substandard-Drugs.aspx )

Oregon Experiment Will Provide Insight Into ACO-Based Reform

WEDNESDAY, Feb. 13 (HealthDay News) -- The outcome of the Oregon experiment, an ambitious program centered on a model of an accountable care organization (ACO), will offer important lessons for the wider implementation of ACOs as cost-saving mechanisms, according to a perspective piece published online Feb. 13 in the New England Journal of Medicine.

Full Text (http://www.nejm.org/doi/full/10.1056/NEJMp1214141?query=featured_home )

Health Insurance Exchanges Are Top Priority on U.S. Agenda

WEDNESDAY, Feb. 13 (HealthDay News) -- The public's health care agenda places creation of a health insurance exchange or marketplace as a top priority, according to a report published by the Kaiser Family Foundation/Robert Wood Johnson Foundation/Harvard School of Public Health.

More Information (http://www.kff.org/kaiserpolls/8405.cfm )

No Link Between Mortality, Readmission Quality Measures

TUESDAY, Feb. 12 (HealthDay News) -- As measures of hospital quality, there is no association between risk-standardized mortality rates and readmission rates for elderly individuals hospitalized for acute myocardial infarction or pneumonia and a weak association for patients with heart failure, according to a study published in the Feb. 13 issue of the Journal of the American Medical Association.

Abstract (http://jama.jamanetwork.com/article.aspx?articleid=1570282#Abstract )Full Text (subscription or payment may be required) (http://jama.jamanetwork.com/article.aspx?articleid=1570282 )

Use of Evidence-Based Meds Increasing for STEMI, NSTEMI

TUESDAY, Feb. 12 (HealthDay News) -- Evidence-based therapies are increasingly being used to treat patients with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI), according to research published in the Feb. 1 issue of The American Journal of Cardiology.

Abstract (http://www.ajconline.org/article/S0002-9149(12)02281-3/abstract )Full Text (subscription or payment may be required) (http://www.ajconline.org/article/S0002-9149(12)02281-3/fulltext )

Report Emphasizes Physicians' Role in Gun Policy Discussions

MONDAY, Feb. 11 (HealthDay News) -- Physicians can play important roles in discussions of gun policy and prevention of gun violence, according to a report published online Feb. 12 in the Annals of Internal Medicine.

Full Text (subscription or payment may be required) (http://annals.org/article.aspx?articleid=1569946 )

Increasing Patient Activation Tied to Lower Health Care Costs

MONDAY, Feb. 11 (HealthDay News) -- Patient activation is associated with improved outcomes and lower health care costs, according to a review published in the February issue of Health Affairs.

Abstract (http://content.healthaffairs.org/content/32/2/207.abstract )Full Text (subscription or payment may be required) (http://content.healthaffairs.org/content/32/2/207.full )

Final HIPAA Omnibus Rule Goes Into Effect March 26

FRIDAY, Feb. 8 (HealthDay News) -- The final omnibus rule, which makes changes to the Health Insurance Portability and Accountability Act (HIPAA) of 1996, goes into effect March 26, and physicians must be in compliance by Sept. 23.

More Information (https://west.exch021.serverdata.net/owa/redir.aspx?C=2BpJN5QLtEmB-5Woq0l-bNrw6TmX2c8I7hgPmbx20P3Mfgjo9nB4RSWE9wgEPgrSDXzoR0FnkQ4.&URL=http%3a%2f%2fwww.gpo.gov%2ffdsys%2fpkg%2fFR-2013-01-25%2fpdf%2f2013-01073.pdf )

Seizures in ~Half Peds Patients With Intracranial Hemorrhage

FRIDAY, Feb. 8 (HealthDay News) -- Acute symptomatic seizures occur in about half of pediatric patients with intracerebral hemorrhage (ICH) and are often a presenting symptom, according to a study published online Feb. 7 in JAMA Neurology.

Abstract (http://archneur.jamanetwork.com/article.aspx?articleid=1566835#Abstract )Full Text (subscription or payment may be required) (http://archneur.jamanetwork.com/article.aspx?articleid=1566835 )Editorial (subscription or payment may be required) (http://archneur.jamanetwork.com/article.aspx?articleid=1566836 )

Antimicrobial Washcloths Reduce Hospital Infections

THURSDAY, Feb. 7 (HealthDay News) -- Bathing hospitalized patients with antimicrobial washcloths reduces the risk of acquiring multidrug-resistant organisms and the risk of developing hospital-acquired bloodstream infections, according to a study published in the Feb. 7 issue of The New England Journal of Medicine.

Full Text (subscription or payment may be required) (http://www.nejm.org/doi/full/10.1056/NEJMoa1113849 )

Albumin Improves Bacterial Peritonitis Outcomes

THURSDAY, Feb. 7 (HealthDay News) -- For patients with spontaneous bacterial peritonitis (SBP), albumin infusion is associated with reduced renal impairment and decreased mortality, according to research published in the February issue of Clinical Gastroenterology and Hepatology.

Abstract (http://www.cghjournal.org/article/S1542-3565(12)01404-8/abstract )Full Text (subscription or payment may be required) (http://www.cghjournal.org/article/S1542-3565(12)01404-8/fulltext )

Rivaroxaban Found Noninferior to Enoxaparin in Acutely Ill

WEDNESDAY, Feb. 6 (HealthDay News) -- In acutely ill hospitalized patients, standard-duration rivaroxaban has similar efficacy as enoxaparin in reducing the risk of venous thromboembolism, while extended-duration rivaroxaban has superior efficacy, according to a study published in the Feb. 7 issue of the New England Journal of Medicine.

Full Text (subscription or payment may be required) (http://www.nejm.org/doi/full/10.1056/NEJMoa1111096?query=featured_home )

Pertactin-Negative Bordetella pertussis Identified in U.S.

WEDNESDAY, Feb. 6 (HealthDay News) -- Pertactin-negative variants of Bordetella pertussis have been identified in the United States; and children who receive diphtheria-tetanus-whole-cell pertussis (DTwP) priming have lower reported rates of pertussis, according to correspondence published in the Feb. 7 issue of the New England Journal of Medicine.

Full Text - Queenan (http://www.nejm.org/doi/full/10.1056/NEJMc1209369 ) Full Text - Liko (http://www.nejm.org/doi/full/10.1056/NEJMc1212006 )

Fewer Medicare Patients Dying in Hospital Setting

TUESDAY, Feb. 5 (HealthDay News) -- Fewer Medicare beneficiaries are dying in the setting of acute care hospitals, but health care transitions and intensive care unit (ICU) utilization are increasing in the last month of life, according to a study published in the Feb. 6 issue of the Journal of the American Medical Association.

Abstract (http://jama.jamanetwork.com/article.aspx?articleid=1568250#Abstract )Full Text (http://jama.jamanetwork.com/article.aspx?articleid=1568250 )Editorial (subscription or payment may be required) (http://jama.jamanetwork.com/article.aspx?articleid=1568231 )

Physicians' Pay for Existing Patients Dropped in 2012

TUESDAY, Feb. 5 (HealthDay News) -- Physicians' pay for existing patients dropped considerably in 2012, according to the results of the Fee Schedule Survey published Jan. 31 in Physicians Practice.

More Information (http://www.physicianspractice.com/fee-schedule-survey/2012-fee-schedule-survey-data )

Stopping Aspirin Therapy After GI Bleed Ups Cardiovascular Risk

MONDAY, Feb. 4 (HealthDay News) -- Patients with cardiovascular disease who discontinue low-dose aspirin therapy after peptic ulcer bleeding have a seven-fold higher risk of death or acute cardiovascular event, according to research published in the January issue of Clinical Gastroenterology and Hepatology.

Abstract (http://www.cghjournal.org/article/S1542-3565(12)01038-5/abstract )Full Text (http://www.cghjournal.org/article/S1542-3565(12)01038-5/fulltext )

FSMB: Approaches Explored for Expediting Multi-State Licenses

MONDAY, Feb. 4 (HealthDay News) -- New approaches are being explored for streamlining physician multi-state licensure to accommodate the use of telemedicine in the delivery of health care, according to a report from a meeting held from Jan. 16 to 17 by the Federation of State Medical Boards (FSMB).

More Information (http://www.fsmb.org/pdf/nr-licensure-meeting.pdf )

CDC: Flu Activity Still Up in U.S. in Fourth Week of 2013

MONDAY, Feb. 4 (HealthDay News) -- In the fourth week of 2013, influenza activity remained elevated in the United States, with the proportion of pneumonia and influenza-linked deaths above the epidemic threshold, according to FluView, a weekly influenza surveillance report prepared by the Influenza Division of the U.S. Centers for Disease Control and Prevention.

FluView (http://www.cdc.gov/flu/weekly/ )

Prediction Rule Can Obviate Abdominal CT Scans in Children

MONDAY, Feb. 4 (HealthDay News) -- Seven factors can accurately predict whether a child with blunt torso trauma is at very low risk of intra-abdominal injuries and can avoid undergoing computed tomography (CT), according to a study published online Feb. 4 in the Annals of Emergency Medicine.

Abstract (http://www.annemergmed.com/article/S0196-0644(12)01743-X/abstract )Full Text (subscription or payment may be required) (http://www.annemergmed.com/article/S0196-0644(12)01743-X/fulltext )

Knowing Cost of Imaging Tests Doesn't Cut Utilization

FRIDAY, Feb. 1 (HealthDay News) -- Physicians do not order fewer imaging tests if they are aware of the costs, according to a study published online Jan. 2 in the Journal of the American College of Radiology.

Abstract (http://www.jacr.org/article/S1546-1440(12)00347-X/abstract )Full Text (subscription or payment may be required) (http://www.jacr.org/article/S1546-1440(12)00347-X/fulltext )