November 2017 Briefing - Emergency Medicine

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

Severe Hypoglycemia a Potent Marker of Cardiovascular Risk

THURSDAY, Nov. 30, 2017 (HealthDay News) -- Among patients with diabetes, severe hypoglycemia is associated with high absolute risk of cardiovascular events and mortality, according to a study published online Nov. 10 in Diabetes Care.

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Wait Time Linked to Worse Outcomes in Hip Fracture Surgery

WEDNESDAY, Nov. 29, 2017 (HealthDay News) -- Increased wait time is associated with an increased risk of complications and 30-day mortality among adults undergoing hip fracture surgery, according to a study published in the Nov. 28 issue of the Journal of the American Medical Association.

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Education Program Builds GP's Knowledge of Radiation Therapy

WEDNESDAY, Nov. 29, 2017 (HealthDay News) -- Australia's national education program improves general practitioner (GP) knowledge about radiation therapy (RT) and may influence patient referrals for RT, according to a study published online Oct. 28 in the Journal of Medical Imaging and Radiation Oncology.

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Clinician Denial of Patient Requests Impacts Satisfaction

TUESDAY, Nov. 28, 2017 (HealthDay News) -- Clinician denial of some types of tests requested by patients is associated with worse patient satisfaction with the clinician, according to a study published online Nov. 27 in JAMA Internal Medicine.

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Similar Efficacy for Intranasal, Intramuscular Naloxone

TUESDAY, Nov. 28, 2017 (HealthDay News) -- For reversal of opioid overdose, higher-concentration intranasal naloxone has similar efficacy to that of intramuscular naloxone administered at the same dose, according to a review published online Nov. 27 in the Annals of Internal Medicine.

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Simple ECG May Help Distinguish MDD From Bipolar Depression

TUESDAY, Nov. 28, 2017 (HealthDay News) -- Heart rate variability (HRV) and specific inflammatory biomarkers can differentiate major depressive disorder (MDD) from depression in bipolar disorder (BD), according to a study published online Oct. 5 in The World Journal of Biological Psychiatry.

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Practice Variation in Treatment for Bronchiolitis in Infants

TUESDAY, Nov. 28, 2017 (HealthDay News) -- For infants with bronchiolitis, the use of evidence-based supportive therapies (EBSTs) varies by hospital site, according to a study published online Nov. 28 in Pediatrics.

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Ablation Cuts Risk of Recurrent Stroke in Patients With A-Fib

TUESDAY, Nov. 28, 2017 (HealthDay News) -- For patients with atrial fibrillation (AF) and prior cerebrovascular accident (CVA), ablation is associated with reduced risk of recurrent stroke, according to a study published online Nov. 13 in the Journal of Cardiovascular Electrophysiology.

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1998 to 2014 Saw Drop in CVD Hospitalization Rates in Diabetes

TUESDAY, Nov. 28, 2017 (HealthDay News) -- Cardiovascular disease (CVD) hospitalization rates have declined in recent years among individuals with and those without diabetes, according to a study published online Nov. 17 in Diabetes Care.

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Abdominal Obesity Linked to All-Cause Mortality in HFpEF

MONDAY, Nov. 27, 2017 (HealthDay News) -- For patients with heart failure with preserved ejection fraction (HFpEF), abdominal obesity is associated with increased risk of all-cause mortality, according to a study published in the Dec. 5 issue of the Journal of the American College of Cardiology.

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New Workflows Have Potential to Address Provider Burnout

MONDAY, Nov. 27, 2017 (HealthDay News) -- New solutions are needed to address burnout among health care team members, yet, in a catch-22 situation for health industry leaders, change fatigue contributes to burnout, according to a Vocera Communications report entitled In Pursuit of Resilience, Well-Being, and Joy in Healthcare.

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Essay Adds to Discourse on Impact of Suggestive Jokes

MONDAY, Nov. 27, 2017 (HealthDay News) -- Seemingly benign, recurring patterns of joking around a single theme (joke cycles) can contribute to humorizing and legitimizing sexual misconduct, according to an essay published online Nov. 12 in Communication and Critical/Cultural Studies.

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Clinician Suspicion Minimally Accurate for Lyme Disease

MONDAY, Nov. 27, 2017 (HealthDay News) -- Clinician suspicion has minimal accuracy for the diagnosis of Lyme disease, according to a study published online Nov. 24 in Pediatrics.

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NTproBNP Levels Are Significantly Lower in Blacks

WEDNESDAY, Nov. 22, 2017 (HealthDay News) -- Plasma N-terminal pro-B-type natriuretic peptide (NTproBNP) levels are significantly lower for black than white individuals, according to a study published online Nov. 22 in JAMA Cardiology.

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Raw Flour Can Be Source of Shiga Toxin-Producing E. coli

WEDNESDAY, Nov. 22, 2017 (HealthDay News) -- Raw flour can be a source of outbreak of Shiga toxin-producing Escherichia coli (STEC) infections, according to a study published in the Nov. 23 issue of the New England Journal of Medicine.

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Female Physicians' Spouses More Likely to Work

WEDNESDAY, Nov. 22, 2017 (HealthDay News) -- Spouses of female physicians are on average more educated and work more hours outside the home than spouses of male physicians, according to a research letter published online Nov. 21 in the Annals of Internal Medicine.

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CDC Issues Warning on Contaminated Raw Milk

WEDNESDAY, Nov. 22, 2017 (HealthDay News) -- Individuals who may have consumed contaminated raw milk and milk products from the Udder Milk company are urged to seek medical care, according to a report published by the U.S. Centers for Disease Control and Prevention.

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Immediate Access to Opioid Agonists Found Cost-Effective

WEDNESDAY, Nov. 22, 2017 (HealthDay News) -- Immediate access to opioid agonist treatment (OAT) for patients presenting with opioid use disorder may provide greater health benefits at less cost than observed standard of care, according to a study published online Nov. 21 in the Annals of Internal Medicine.

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High Costs Associated With Physician Burnout, Attrition

TUESDAY, Nov. 21, 2017 (HealthDay News) -- Physicians who are experiencing burnout are more than twice as likely to leave their organization within two years, and this is associated with significant economic costs, according to a report from the American Medical Association.

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NOACs Show Lower Risk of Adverse Renal Outcomes in A-Fib

TUESDAY, Nov. 21, 2017 (HealthDay News) -- For patients with atrial fibrillation (AF), non-vitamin K antagonist oral anticoagulants (NOACs) are associated with lower risks of adverse renal outcomes than warfarin, according to a study published in the Nov. 28 issue of the Journal of the American College of Cardiology.

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No Treatment or Imaging Follow-Up Most Effective for Tiny UIAs

TUESDAY, Nov. 21, 2017 (HealthDay News) -- For patients with unruptured intracranial aneurysms (UIAs) that are 3 mm or smaller, no preventive treatment or imaging follow-up is the most effective management strategy, according to a study published online Nov. 20 in JAMA Neurology.

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Best Practice Advice Issued for Hep B Vaccination, Screening

TUESDAY, Nov. 21, 2017 (HealthDay News) -- Best practice advice statements from the American College of Physicians and the U.S. Centers for Disease Control and Prevention, published online Nov. 21 in the Annals of Internal Medicine, encourage hepatitis B virus (HBV) screening in high-risk populations, vaccination of all unvaccinated at-risk adults, and linkage to care for HBV-positive patients.

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Increased Repolarization Dispersion Seen in SCD Survivors

TUESDAY, Nov. 21, 2017 (HealthDay News) -- Survivors of sudden cardiac death (SCD) with structurally normal hearts have increased dispersion of repolarization after exertion, and this is detectable on non-invasive electrocardiographic imaging (ECGi), according to a study published online Nov. 1 in the Journal of Cardiovascular Electrophysiology.

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Salivary miRNAs Can ID Duration of Concussion Symptoms

MONDAY, Nov. 20, 2017 (HealthDay News) -- For children with concussion, salivary microRNAs (miRNAs) can accurately identify the duration of symptoms, according to a study published online Nov. 20 in JAMA Pediatrics.

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Distinct Features for Drug Use-Related Endophthalmitis

MONDAY, Nov. 20, 2017 (HealthDay News) -- Patients with injection drug use (IDU) endogenous endophthalmitis (EE) are younger, with fewer comorbidities, and have more improvement in visual acuity after intervention compared with non-IDU EE patients, according to a research letter published online Nov. 16 in JAMA Ophthalmology.

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Dating Violence Victimization, Nonmedical Rx Med Use Linked

MONDAY, Nov. 20, 2017 (HealthDay News) -- For male and female high school students, nonmedical use of prescription drugs (NMUPD) is associated with experiences of dating violence victimization (DVV), according to a study published online Nov. 20 in Pediatrics.

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Many Health Care Providers Work While Sick

FRIDAY, Nov. 17, 2017 (HealthDay News) -- More than 40 percent of health care personnel (HCP) with influenza-like illness (ILI) work while ill, according to a study published in the November issue of the American Journal of Infection Control.

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Simple Checklist Can Identify Useful Clinical Practice Guidelines

FRIDAY, Nov. 17, 2017 (HealthDay News) -- A simple, easy-to-use checklist, the Guideline Trustworthiness, Relevance, and Utility Scoring Tool (G-TRUST), can identify useful clinical practice guidelines, according to a study published in the September/October issue of the Annals of Family Medicine.

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Erlotinib Overdose Tied to Conjunctivitis

FRIDAY, Nov. 17, 2017 (HealthDay News) -- Overdosing of erlotinib may be associated with rapid onset of conjunctivitis, according to a case report published online Oct. 25 in the Journal of Clinical Pharmacy and Therapeutics.

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Force Analysis May Help Distinguish Surgeon Skill Level

FRIDAY, Nov. 17, 2017 (HealthDay News) -- Force-sensing bipolar forceps and force analysis may help differentiate surgeon skill level, according to a study published online Nov. 15 in JAMA Surgery.

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FDA OKs Drug for Hemophilia A With Factor VIII Inhibitors

FRIDAY, Nov. 17, 2017 (HealthDay News) -- Hemlibra (emicizumab-kxwh) has been approved by the U.S. Food and Drug Administration to prevent or reduce the frequency of bleeding episodes among hemophilia A patients with Factor VIII inhibitors.

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High Levels of Burnout, Stress for U.S. Surgical Residents

THURSDAY, Nov. 16, 2017 (HealthDay News) -- Surgical residents have high levels of burnout, which is associated with high stress, depression, and suicidal ideation, according to a study published online in the Journal of the American College of Surgeons.

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Model Predicts Development of Chronic Kidney Disease

THURSDAY, Nov. 16, 2017 (HealthDay News) -- A multivariable model that uses routine laboratory data is able to predict advanced chronic kidney disease after hospitalization with acute kidney injury, according to a study published online Nov. 14 in the Journal of the American Medical Association.

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Accurate Diagnosis Seen With Photographs of Skin Conditions

THURSDAY, Nov. 16, 2017 (HealthDay News) -- Smartphone photographs of pediatric skin conditions taken by parents are of sufficient quality to allow accurate diagnosis, according to a study published online Nov. 15 in JAMA Dermatology.

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Simpler Tool Promising for Atherosclerosis Prediction

THURSDAY, Nov. 16, 2017 (HealthDay News) -- The ideal cardiovascular health score (ICHS) and the Fuster-BEWAT (blood pressure, exercise, weight, alimentation, and tobacco) score (FBS) are similar in their ability to predict subclinical atherosclerosis, according to a study published online Nov. 13 in the Journal of the American College of Cardiology.

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XR Naltrexone, Sublingual BUP-NX Deemed Equally Effective

WEDNESDAY, Nov. 15, 2017 (HealthDay News) -- Although initiation of extended-release naltrexone (XR-NTX) may be more difficult, XR-NTX and sublingual buprenorphine-naloxone (BUP-NX) are equally safe and effective once initiated for opioid relapse prevention, according to a study published online Nov. 14 in The Lancet.

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AHA: Noninvasive Testing Ups LOS in Patients With Chest Pain

WEDNESDAY, Nov. 15, 2017 (HealthDay News) -- Noninvasive cardiac testing leads to longer length of stay (LOS) for patients presenting to the emergency department with chest pain, according to a study published online Nov. 14 in JAMA Internal Medicine to coincide with the American Heart Association's Scientific Sessions, being held Nov. 11 to 15 in Anaheim, California.

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Perioperative Aspirin May Benefit Patients With Prior PCI

TUESDAY, Nov. 14, 2017 (HealthDay News) -- For patients with prior percutaneous coronary intervention (PCI), perioperative aspirin seems to be beneficial, according to a study published online Nov. 13 in the Annals of Internal Medicine.

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More Laboratory Tests Performed at Major Teaching Hospitals

TUESDAY, Nov. 14, 2017 (HealthDay News) -- For inpatients with a primary diagnosis of bacterial pneumonia or cellulitis, significantly more laboratory tests are performed per day at major teaching hospitals versus nonteaching hospitals, according to a study published online Nov. 13 in JAMA Internal Medicine.

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Outbreaks Linked to Drinking Water Mainly Due to Legionella

TUESDAY, Nov. 14, 2017 (HealthDay News) -- Most drinking water-associated waterborne disease outbreaks and waterborne disease outbreaks associated with environmental or undetermined exposure to water are due to Legionella, according to two studies published online Nov. 9 in Morbidity and Mortality Weekly Report.

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Inhaled Corticosteroids Not Linked to Fracture in Children

TUESDAY, Nov. 14, 2017 (HealthDay News) -- Inhaled corticosteroids are not associated with increased odds of fracture in the pediatric asthma population, according to a study published online Nov. 13 in JAMA Pediatrics.

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Soluble Interleukin 2 Receptor IDs Sarcoidosis in Uveitis

MONDAY, Nov. 13, 2017 (HealthDay News) -- Soluble interleukin 2 receptor (sIL-2R) has slightly better diagnostic value than angiotensin-converting enzyme (ACE) for sarcoidosis in patients with uveitis, according to a study published online Nov. 9 in JAMA Ophthalmology.

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Doctors Have Extra Two Weeks to Preview Performance Data

WEDNESDAY, Nov. 8, 2017 (HealthDay News) -- Physicians have two extra weeks to preview their 2016 performance information as a result of a mistake related to the Centers for Medicare & Medicaid Services' Physician Compare online resource, according to a report published by the American Academy of Family Physicians.

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Delay in Tranexamic Acid Administration Reduces Benefit

WEDNESDAY, Nov. 8, 2017 (HealthDay News) -- For patients with acute severe bleeding, any delay in treatment with tranexamic acid is associated with a reduction in the survival benefit, according to a meta-analysis published online Nov. 7 in The Lancet.

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Increases in U.S. Health Spending Tied to Health Service Price

WEDNESDAY, Nov. 8, 2017 (HealthDay News) -- Factors including increases in health care service price and intensity are associated with increases in U.S. health care spending from 1996 to 2013, according to a study published online Nov. 7 in the Journal of the American Medical Association.

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Evidence Scant for Treatment of Cough With the Common Cold

WEDNESDAY, Nov. 8, 2017 (HealthDay News) -- There has been little change in the treatment recommendations for cough due to the common cold since publication of guidelines in 2006, according to a review published online Nov. 7 in Chest.

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In ER, Combination of Ibuprofen, Acetaminophen Relieves Pain

WEDNESDAY, Nov. 8, 2017 (HealthDay News) -- For patients presenting to the emergency department with acute extremity pain, the combination of ibuprofen and acetaminophen does not differ in terms of pain reduction from three different opioid and acetaminophen combination analgesics, according to a study published online Nov. 7 in the Journal of the American Medical Association.

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Cannabidiol Concentration Varies Widely in Online Products

TUESDAY, Nov. 7, 2017 (HealthDay News) -- Among cannabidiol (CBD) products sold online, there is a wide range of CBD concentrations, and many products are under- or overlabeled, according to a research letter published online Nov. 7 in the Journal of the American Medical Association.

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Influenza Vaccines in Pediatric ERs Likely Cost-Effective

TUESDAY, Nov. 7, 2017 (HealthDay News) -- Influenza vaccination in the pediatric emergency department (PED) setting appears to be a cost-effective strategy, according to a study published online Nov. 6 in JAMA Pediatrics.

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'09 to '15 Saw Increase in Transradial Access for STEMI PCI

THURSDAY, Nov. 2, 2017 (HealthDay News) -- Use of transradial access (TRA) for ST-elevation myocardial infarction (STEMI) percutaneous coronary intervention (PCI) increased from 2009 to 2015, with considerable geographic, operator, and institutional variation, according to a study published online Nov. 1 in JACC: Cardiovascular Interventions.

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CYP2C19-Genotype Guided Antiplatelet Tx May Be Beneficial

FRIDAY, Nov. 3, 2017 (HealthDay News) -- Patients with a CYP2C19 loss-of-function allele have increased risk of major adverse cardiovascular events (MACE) with clopidogrel versus alternative antiplatelet therapy after percutaneous coronary intervention (PCI), according to a study published online Nov. 1 in JACC: Cardiovascular Interventions.

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Current Practice Not Cost-Effective for Air Medical Triage

FRIDAY, Nov. 3, 2017 (HealthDay News) -- Current practice is not cost-effective compared with the Air Medical Prehospital Triage (AMPT) score for trauma patients, and the field triage system undertriage rate for patients with severe injuries exceeds 20 percent, according to two studies published online Nov. 1 in JAMA Surgery.

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Favorable Prognosis for Syncope Patients Discharged From ER

THURSDAY, Nov. 2, 2017 (HealthDay News) -- Most patients presenting to the emergency department (ED) with a primary diagnosis of syncope are discharged and have a favorable prognosis, and though total costs to care for discharged syncope patients are high, cost per patient is lower compared with hospitalized patients, according to a study published online Nov. 1 in JACC: Clinical Electrophysiology.

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Prescription-Strength Steroids Sold Without Prescription

THURSDAY, Nov. 2, 2017 (HealthDay News) -- The ability to purchase a product containing a class 3 topical steroid online, without physician authorization, highlights the dangers of prescription-strength medications being acquired as over-the-counter products, according to a research letter published online Nov. 1 in JAMA Dermatology.

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Race a Factor in Intracranial Atherosclerotic Disease

THURSDAY, Nov. 2, 2017 (HealthDay News) -- Black men have increased prevalence and frequency of multiple intracranial atherosclerotic plaques, according to a study published online Nov. 1 in JAMA Cardiology.

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Driving Impairment Warnings Often Not Given With Rx Meds

THURSDAY, Nov. 2, 2017 (HealthDay News) -- Not all prescription drug users report receiving warnings about driving impairment, according to a study published online Nov. 1 in the Journal of Studies on Alcohol and Drugs.

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Promising Pneumonia Vaccine Under Development

WEDNESDAY, Nov. 1, 2017 (HealthDay News) -- A pneumonia vaccine under development provides the "most comprehensive coverage" to date and alleviates antimicrobial concerns, according to a study published online Oct. 18 in Science Advances.

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CMS Launches Initiative to Examine Impact of Regulations

WEDNESDAY, Nov. 1, 2017 (HealthDay News) -- The Centers for Medicare & Medicaid Services (CMS) has launched an initiative to examine which provider regulations should be discarded or revamped amid concerns that the regulations are reducing the amount of time that physicians spend with patients, according to an article published in Modern Healthcare.

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Updated Guidelines Released for Ventricular Arrhythmias

WEDNESDAY, Nov. 1, 2017 (HealthDay News) -- The American College of Cardiology, the American Heart Association, and the Heart Rhythm Society have released updated guidelines for the management of adults who have ventricular arrhythmias (VAs) or who are at risk for sudden cardiac death (SCD). The guidelines were published online Oct. 30 in the Journal of the American College of Cardiology.

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Dry Mouth Common Medication Reaction in Older Adults

WEDNESDAY, Nov. 1, 2017 (HealthDay News) -- In older adults, medication use is significantly associated with xerostomia and salivary gland dysfunction, according to a review published online Oct. 26 in the Journal of the American Geriatrics Society.

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