October 2017 Briefing - Pulmonology

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Here are what the editors at HealthDay consider to be the most important developments in Pulmonology for October 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.

Systemic Lupus Erythematosus Mortality Down Since 1968

TUESDAY, Oct. 31, 2017 (HealthDay News) -- Rates of systemic lupus erythematosus (SLE) mortality have decreased since 1968 but are still higher than non-SLE mortality, according to a study published online Oct. 30 in the Annals of Internal Medicine.

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Depressive Symptoms Increase During Internship Year

TUESDAY, Oct. 31, 2017 (HealthDay News) -- Depressive symptoms increase during the internship year for training physicians, with a greater increase among women, according to a study published online Oct. 30 in JAMA Internal Medicine.

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PFA-100-Measured Aspirin Resistance Linked to CV Events

TUESDAY, Oct. 31, 2017 (HealthDay News) -- Aspirin resistance, measured using the Platelet Function Analyzer (PFA)-100 system, is associated with cardiovascular events in aspirin-treated patients, according to a study published online Oct. 21 in the Journal of Clinical Pharmacy and Therapeutics.

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More Than One in Five U.S. Working Adults Uses Tobacco

MONDAY, Oct. 30, 2017 (HealthDay News) -- Overall, 22.1 percent of working U.S. adults currently use any form of tobacco, according to a study published online Oct. 26 in Morbidity and Mortality Weekly Report.

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E-Cigarettes Alter Defense Proteins in Airway Secretions

MONDAY, Oct. 30, 2017 (HealthDay News) -- E-cigarette use changes the profile of innate defense proteins in airway secretions, according to a study published online Oct. 20 in the American Journal of Respiratory and Critical Care Medicine.

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Treatment for Stage I NSCLC Patients Up From 2000 to 2010

FRIDAY, Oct. 27, 2017 (HealthDay News) -- For patients with stage I non-small-cell lung cancer (NSCLC), the odds of receiving radiation therapy (RT) or surgery increased from 2000 to 2010, with improved survival during the same period, according to a study published online Oct. 26 in the Annals of Thoracic Surgery.

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Incretin Tied to Better Outcomes in NOCS-Diabetes

FRIDAY, Oct. 27, 2017 (HealthDay News) -- Incretin treatment appears to improve non-ST-elevation myocardial infarction (NSTEMI) outcomes in patients with type 2 diabetes and non-obstructive coronary artery stenosis (NOCS), according to a study published online Sept. 26 in Diabetes, Obesity and Metabolism.

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Afternoon Heart Surgery Linked to Better Patient Outcomes

FRIDAY, Oct. 27, 2017 (HealthDay News) -- For patients undergoing aortic valve replacement, perioperative myocardial injury occurs more with morning surgery than with afternoon surgery, according to a study published online Oct. 26 in The Lancet.

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Cataract Surgery Associated With Reduced Mortality in Women

THURSDAY, Oct. 26, 2017 (HealthDay News) -- For older women with cataract, cataract surgery is associated with lower all-cause and cause-specific mortality, according to a study published online Oct. 26 in JAMA Ophthalmology.

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Gifts From Pharma Companies Influence Prescribing Behavior

THURSDAY, Oct. 26, 2017 (HealthDay News) -- Receipt of gifts from pharmaceutical companies is associated with more prescriptions per patient and more costly prescriptions, according to a study published online Oct. 25 in PLOS One.

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Borderline Pulmonary HTN Linked to Increased Mortality Risk

THURSDAY, Oct. 26, 2017 (HealthDay News) -- For patients undergoing right heart catheterization (RHC), borderline pulmonary hypertension (PH) is associated with increased risk of mortality, according to a study published online Oct. 25 in JAMA Cardiology.

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Most Patients Satisfied With Relationship With Physician

WEDNESDAY, Oct. 25, 2017 (HealthDay News) -- Results of the Physicians Foundation 2017 Patient Survey show that most patients are satisfied with their overall relationship with their physician, according to an article published by the American Academy of Family Physicians.

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Alterations in Gut Microbiome Noted Within 72 Hours of Injury

WEDNESDAY, Oct. 25, 2017 (HealthDay News) -- Critically injured patients develop changes in the composition of the gut microbiome within 72 hours, according to a study published online Oct. 23 in Trauma Surgery & Acute Care Open.

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Mechanism ID'd for Chemo-Related Peripheral Neuropathy

WEDNESDAY, Oct. 25, 2017 (HealthDay News) -- Researchers may have uncovered the mechanism for chemotherapy-induced peripheral neuropathy (CIPN) related to paclitaxel, according to a study published online Oct. 11 in Neuron.

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Diabetes Tied to Worse Outcomes in Heart Failure Patients

WEDNESDAY, Oct. 25, 2017 (HealthDay News) -- Among patients with acute heart failure (HF), long-term prognosis is worse in those who have diabetes than in those who do not, though prognosis has improved in both groups, according to a study published online Oct. 5 in Diabetes Care.

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DEA Taking Back Unwanted Prescription Drugs on Oct. 28

TUESDAY, Oct. 24, 2017 (HealthDay News) -- The public is being given its 14th opportunity to safely dispose of pills and patches at collection points operated by the U.S. Drug Enforcement Agency (DEA) and its partners.

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Smoking Alters Genetic Relationship with Parkinson's

MONDAY, Oct. 23, 2017 (HealthDay News) -- Smoking may modify a previously reported genetic association with Parkinson's disease (PD), according to an analysis published online Oct. 5 in the Annals of Neurology.

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Sudden Death Most Common CV Death in T2DM/ASCVD

MONDAY, Oct. 23, 2017 (HealthDay News) -- Among patients with type 2 diabetes and atherosclerotic cardiovascular disease (ASCVD), sudden death is the most common category of cardiovascular (CV) mortality, according to a study published online Oct. 6 in Diabetes Care.

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Design Thinking Enables Med Students to Solve Challenges

MONDAY, Oct. 23, 2017 (HealthDay News) -- A joint effort between students at Warren Alpert Medical School of Brown University and Rhode Island School of Design (RISD) is training future physicians in design thinking to help identify and repair health system issues that contribute to physician burnout, according to an article by the American Medical Association.

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Psychosocial Intervention May Boost Hospitalization Satisfaction

MONDAY, Oct. 23, 2017 (HealthDay News) -- A brief psychosocial intervention in which physicians ask inpatients about their current situation and respond empathetically appears to improve the hospitalization experience, according to a study published in the October issue of Family Medicine.

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Clinician Job Satisfaction Linked to Improved Burnout Scores

FRIDAY, Oct. 20, 2017 (HealthDay News) -- Clinicians' job satisfaction is associated with improved burnout scores and reduced intention to leave their practices, according to a study published in the October issue of Health Affairs.

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H7N9 Avian Influenza May Be Capable of Pandemic

FRIDAY, Oct. 20, 2017 (HealthDay News) -- A highly pathogenic H7N9 avian influenza variant has evolved and now has the potential to cause a pandemic, according to a study published online Oct. 19 in Cell Host & Microbe.

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In Norway, Risk of SCC After Organ Transplant Has Fallen

FRIDAY, Oct. 20, 2017 (HealthDay News) -- For organ recipients in Norway, the risk of skin cancer, particularly squamous cell carcinoma (SCC), has decreased since the mid-1980s, according to a study published online Oct. 18 in JAMA Dermatology.

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Conditions Tied to Clinician Dissatisfaction Are Modifiable

THURSDAY, Oct. 19, 2017 (HealthDay News) -- Modifiable conditions, like chaos, incohesiveness, and lack of communication, contribute to unsatisfying workplaces for clinicians, according to a study published in the October issue of Health Affairs.

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Uninsurance Down by One-Third for Cancer Diagnoses in 2014

THURSDAY, Oct. 19, 2017 (HealthDay News) -- In the first year of the Affordable Care Act (ACA), there was a relative decrease of one-third in uninsurance among adults with new cancer diagnoses, according to a research letter published online Oct. 19 in JAMA Oncology.

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More Penalties With Hospital-Wide Readmission Measure

THURSDAY, Oct. 19, 2017 (HealthDay News) -- Transition from a condition-specific to a hospital-wide readmission measure would result in a modest increase in the number of hospitals eligible for readmission penalties and would substantially increase penalties for safety-net hospitals, according to a study published online Oct. 18 in the New England Journal of Medicine.

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MRI Findings Prognostic for Long-Term Recovery in Cardiac Arrest

THURSDAY, Oct. 19, 2017 (HealthDay News) -- Measures of cerebral functional network connectivity measured within four weeks of cardiac arrest (CA) are associated with a favorable outcome (FO) at one year, according to a study published online Oct. 18 in Radiology.

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Key Stakeholders Discuss How to Make EHRs More Usable

THURSDAY, Oct. 19, 2017 (HealthDay News) -- Key stakeholders and physicians discussed electronic health record (EHR) usability and optimization in the American Medical Association Running Your Practice Community.

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New Expert Consensus Pathway for Mitral Regurgitation

WEDNESDAY, Oct. 18, 2017 (HealthDay News) -- Identification of mitral regurgitation (MR) should prompt evaluation of its etiology, mechanism, severity, and indications for treatment, according to an expert consensus decision pathway published online Oct. 18 in the Journal of the American College of Cardiology.

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Sharing Passwords Is Widespread Among Medical Staff

WEDNESDAY, Oct. 18, 2017 (HealthDay News) -- Sharing of passwords to access electronic medical records is common among medical staff members, according to a study published in the July issue of Healthcare Informatics Research.

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Men Now Comprise ~10 Percent of RN Workforce

WEDNESDAY, Oct. 18, 2017 (HealthDay News) -- The increasing participation of men in registered nursing can be attributed to multiple factors, including increasing educational attainment, rising labor demand in health care, and liberalizing gender role attitudes, according to a working paper published by the Washington Center for Equitable Growth.

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No Increased Risks for DOAC Use Versus Warfarin in VTE

WEDNESDAY, Oct. 18, 2017 (HealthDay News) -- For patients with venous thromboembolism, direct oral anticoagulant (DOAC) use is not associated with increased risk of major bleeding or mortality within the first 90 days compared with warfarin use, according to a study published online Oct. 17 in the BMJ.

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Appropriate Use Criteria Developed for Aortic Stenosis Tx

WEDNESDAY, Oct. 18, 2017 (HealthDay News) -- Appropriate use criteria (AUC) have been developed for the treatment of patients with severe aortic stenosis (AS), according to a report published online Oct. 17 in the Journal of the American College of Cardiology.

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Potentially Preventable Spending Concentrated in Frail Elderly

TUESDAY, Oct. 17, 2017 (HealthDay News) -- Much of the total potentially preventable spending for Medicare beneficiaries is concentrated among frail elderly individuals, according to a study published online Oct. 16 in the Annals of Internal Medicine.

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Female Physicians May Be Especially at Risk of Burnout

TUESDAY, Oct. 17, 2017 (HealthDay News) -- Female physicians are more burned out than their male colleagues, but there are steps they can take to reduce the stress associated with burnout, according to a blog post published in Medical Economics.

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Screening Tools Identify Potentially Inappropriate Meds

TUESDAY, Oct. 17, 2017 (HealthDay News) -- Internal medicine patients are frequently prescribed potentially inappropriate medications (PIMs), but screening tools can detect clinically relevant PIMs, according to a study published online Oct. 8 in the Journal of Clinical Pharmacy and Therapeutics.

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Kneeling Posture Impacts Chest Compressions' Effectiveness

MONDAY, Oct. 16, 2017 (HealthDay News) -- During cardiopulmonary resuscitation (CPR) performed by males, self-adjusted and nearest kneeling postures are more effective for chest compression, with lower perceived exertion, according to a study published online Oct. 5 in the Journal of Clinical Nursing.

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Online Ratings Not Aligned With Objective Quality Measures

MONDAY, Oct. 16, 2017 (HealthDay News) -- Online consumer ratings of specialist physicians do not predict objective measures of quality of care or peer assessment of clinical performance, according to a study published online Sept. 8 in the Journal of the American Medical Informatics Association.

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Most Female Physicians Have Faced Sexist Patient Comments

MONDAY, Oct. 16, 2017 (HealthDay News) -- Most female physicians have been sexually harassed by patients at some point in their careers, according to a blog post published in Medical Economics.

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Moderate Alcohol Consumption Tied to Lower Heart Failure Risk

MONDAY, Oct. 16, 2017 (HealthDay News) -- Moderate alcohol consumption is associated with reduced risk of heart failure but not atrial fibrillation (AF), according to a study published online Oct. 11 in JACC: Heart Failure.

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Serious Suffering Affects Almost Half of Those Who Die Yearly

FRIDAY, Oct. 13, 2017 (HealthDay News) -- In 2015, more than 25.5 million people who died worldwide experienced serious health-related suffering (SHS), and the vast majority lacked access to palliative care and pain relief, according to a report published online Oct. 12 in The Lancet.

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Pre-Retirement Morbidity Higher in Later Birth Cohorts

FRIDAY, Oct. 13, 2017 (HealthDay News) -- Americans who must work longer to reach Social Security retirement age have worse measures of health in the years leading up to retirement, according to a study published in the October issue of Health Affairs.

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Quality Issues for Both Paper-, Electronic-Based Health Records

FRIDAY, Oct. 13, 2017 (HealthDay News) -- Both paper-based and electronic health records (EHRs) have shortcomings in terms of quality of content, process, and structure, with poor quality of nursing documentation seen for both methods, according to a study published online Oct. 5 in the Journal of Clinical Nursing.

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Guidelines Needed for 6MWT in Idiopathic Pulmonary Fibrosis

FRIDAY, Oct. 13, 2017 (HealthDay News) -- The six-minute walk test (6MWT) is increasingly being used for patients with idiopathic pulmonary fibrosis (IPF), and guidelines are needed for its implementation in this population, according to a report published online Sept. 21 in the Annals of the American Thoracic Society.

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Court Considering Fate of Noneconomic Damages Cap

THURSDAY, Oct. 12, 2017 (HealthDay News) -- The Wisconsin Supreme Court is considering whether it will hear a case that will determine the fate of the state's $750,000 cap on noneconomic damages, according to an article published by the American Medical Association (AMA).

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New System Streamlines CME Credit Approval Process

THURSDAY, Oct. 12, 2017 (HealthDay News) -- The American Academy of Family Physicians (AAFP) and the American Board of Family Medicine (ABFM) have launched a new performance improvement activity credit reporting process called the AAFP Credit System, according to an article published by the AAFP.

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Six-Month Tai Chi Program Improves Physical Activity in CHD

THURSDAY, Oct. 12, 2017 (HealthDay News) -- A six-month tai chi program is safe and improves physical activity (PA), weight, and quality of life for patients with coronary heart disease who decline to enroll in cardiac rehabilitation, according to a study published online Oct. 11 in the Journal of the American Heart Association.

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Risk Conferred by T2D Modified by HbA1c in Heart Failure

THURSDAY, Oct. 12, 2017 (HealthDay News) -- For patients with heart failure, the risks conferred by type 2 diabetes (T2D) can be stratified by glycemic control and drug treatments, according to a study published online Oct. 11 in JACC: Heart Failure.

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Low-Cost Services a Major Player in Unnecessary Health Spending

THURSDAY, Oct. 12, 2017 (HealthDay News) -- The costs associated with low-cost, low-value health services are nearly twice as high as those of high-cost, low-value services, according to a study published in the October issue of Health Affairs.

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2004 to 2014 Saw Increases in Risk Factors in Ischemic Stroke

THURSDAY, Oct. 12, 2017 (HealthDay News) -- From 2004 to 2014 there were increases in the prevalence of hypertension, diabetes, dyslipidemia, smoking, and drug abuse in acute ischemic stroke (AIS), according to a study published online Oct. 11 in Neurology.

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Primary, Pulmonary Providers Endorse Lung CA Screening

THURSDAY, Oct. 12, 2017 (HealthDay News) -- Primary care clinicians and pulmonologists endorse lung cancer screening (LCS), but there are limitations in their knowledge of screening components, according to a study published online Sept. 21 in the Annals of the American Thoracic Society.

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Physician Salaries Appear to Be Flat or Declining

WEDNESDAY, Oct. 11, 2017 (HealthDay News) -- Anecdotally, physician career coaches report that physician salaries are flat at best, according to an article published in Medical Economics.

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Medical License Questions Sway Doctors' Mental Health Help

WEDNESDAY, Oct. 11, 2017 (HealthDay News) -- Medical licensure application questions (MLAQs) regarding mental health contribute to physicians' reluctance to seek help for mental health, according to a study published in the October issue of Mayo Clinic Proceedings.

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Guide Offers Doctors Tips for Choosing a Health System

TUESDAY, Oct. 10, 2017 (HealthDay News) -- A guide has been developed to assist physicians considering joining a physician-led integrated health system, according to a report published by the American Medical Association (AMA).

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Pediatric Physicians Should Revisit Approaches to Marijuana

TUESDAY, Oct. 10, 2017 (HealthDay News) -- In light of the changing legal status of marijuana, physicians should provide counseling on its effects to adolescents, according to an opinion article published online Oct. 9 in JAMA Pediatrics.

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Novel Metrics Suggested for Assessing EHR Use

TUESDAY, Oct. 10, 2017 (HealthDay News) -- Novel metrics have been developed to assess electronic health record (EHR) use and are described in an opinion article published online Oct. 9 in the Annals of Internal Medicine.

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Adding Albumin to Risk Score Improves Mortality Prediction

MONDAY, Oct. 9, 2017 (HealthDay News) -- Serum albumin, as a marker of frailty, can significantly improve the ability of the Society of Thoracic Surgeons (STS) and European System for Cardiac Operative Risk Evaluation (EuroSCORE-2) scores to predict transcatheter aortic valve replacement (TAVR)-related mortality, according to a study published online Sept. 23 in the Journal of the American Geriatrics Society.

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Remede System Approved for Central Sleep Apnea

MONDAY, Oct. 9, 2017 (HealthDay News) -- The Remede sleep system, an implanted device that treats central sleep apnea, has been approved by the U.S. Food and Drug Administration.

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2016 Physician Quality Reporting System Reports Available

MONDAY, Oct. 9, 2017 (HealthDay News) -- The 2016 Physician Quality Reporting System (PQRS) and the 2016 annual Quality and Resource Use reports have been released for individuals and group practices, according to a report published by the American Academy of Family Physicians.

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Injured Patients Want More Info on Safety Improvement Efforts

MONDAY, Oct. 9, 2017 (HealthDay News) -- Communication-and-resolution program (CRP) experiences are positive overall for a small majority of patients and families, but they report that hospitals rarely share information about preventing recurrences, according to a study published online Oct. 9 in JAMA Internal Medicine.

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Short-Lived Benefits for Abusive Supervisory Behavior

FRIDAY, Oct. 6, 2017 (HealthDay News) -- Engaging in abusive supervisory behavior may be associated with short-term beneficial effects, but over longer periods of time, abusive supervisory behavior is negatively related to supervisors' recovery level and engagement, according to a study published online Sept. 11 in the Academy of Management Journal.

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Stronger Nocebo Effect When Inert Rx Labeled As Expensive

FRIDAY, Oct. 6, 2017 (HealthDay News) -- Nocebo hyperalgesia is stronger when an inert treatment is labeled as being an expensive medication rather than a cheap one, according to a study published online Oct. 5 in Science.

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Most Cancer Drugs Approved in Europe Show No Survival Benefit

FRIDAY, Oct. 6, 2017 (HealthDay News) -- Most cancer drugs that enter the market in Europe have no evidence of benefit for survival or quality of life, according to a study published online Oct. 4 in BMJ.

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21 Percent of Americans Report Experiencing a Medical Error

THURSDAY, Oct. 5, 2017 (HealthDay News) -- More than one in five patients report having experienced a medical error, according to a survey released Sept. 28 by the Institute for Healthcare Improvement (IHI)/National Patient Safety Foundation Lucian Leape Institute and NORC at the University of Chicago.

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Medicare Paid $1.5 Billion to Replace Faulty Heart Devices

THURSDAY, Oct. 5, 2017 (HealthDay News) -- Medicare paid at least $1.5 billion over a decade to replace seven types of defective heart devices that apparently failed for thousands of patients, according to an article published Oct. 2 in The New York Times.

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Reasons Physicians Are Delaying Retirement Vary

THURSDAY, Oct. 5, 2017 (HealthDay News) -- Physicians are delaying retirement, often because they feel they are providing a useful service to patients or because of concerns about social interaction in retirement, according to an article published online Sept. 25 in Medical Economics.

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Pay Inequality, Work-Life Balance Top Concerns for Female Docs

WEDNESDAY, Oct. 4, 2017 (HealthDay News) -- Many female physicians report feeling disadvantaged when negotiating contracts and feel that they are assessed for promotion using different criteria than those used for men, according to a report published by the American Medical Association (AMA).

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LAMA Plus LABA Tied to Fewer Exacerbations in Stable COPD

WEDNESDAY, Oct. 4, 2017 (HealthDay News) -- Treatment with long-acting muscarinic antagonists (LAMA) plus long-acting β-agonists (LABA) is associated with fewer exacerbation events in patients with chronic obstructive pulmonary disease (COPD), according to a clinical evidence synopsis published online Oct. 3 in the Journal of the American Medical Association.

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Anticoagulants With Other Drugs Raise Bleeding Risk in AF

WEDNESDAY, Oct. 4, 2017 (HealthDay News) -- Nonvalvular atrial fibrillation (AF) patients who take non-vitamin K oral anticoagulants (NOACs) along with certain other medications are at increased risk for major bleeding, and antithrombotic medications are significantly associated with increased rates of hematuria-related complications in older adults, according to two studies published online Oct. 3 in the Journal of the American Medical Association.

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Rate of Obesity-, Overweight-Related Cancers High in the U.S.

WEDNESDAY, Oct. 4, 2017 (HealthDay News) -- The burden of overweight- and obesity-related cancer is high in the United States, and incidence has increased in some states and age groups, according to a study published online Oct. 3 in Morbidity and Mortality Weekly Report.

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Smoking Cessation Support Less Likely for Cancer Patients

WEDNESDAY, Oct. 4, 2017 (HealthDay News) -- General practitioners are less likely to support cessation of smoking in patients with cancer than in those with coronary heart disease (CHD), according to a study published online Sept. 11 in the Annals of Family Medicine.

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ER Risk Score Predicts 30-Day Mortality in Acute Heart Failure

WEDNESDAY, Oct. 4, 2017 (HealthDay News) -- For patients with acute heart failure (AHF) admitted to the emergency department (ED), a risk score based on 13 independent risk factors can predict 30-day mortality, according to a study published online Oct. 2 in the Annals of Internal Medicine.

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Scientists Support Genome Editing to Prevent Disease

WEDNESDAY, Oct. 4, 2017 (HealthDay News) -- Many basic scientists and clinical researchers support somatic genome editing in adults for prevention of serious disease but not for human enhancement; they also believe the public should be consulted before any clinical application of germline gene editing proceeds, according to survey results published online Oct. 3 in Circulation: Cardiovascular Genetics.

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Commercialization of Generics Impacts Adverse Event Rates

WEDNESDAY, Oct. 4, 2017 (HealthDay News) -- Immediate or delayed differences in adverse event rates were seen after generic commercialization of three antihypertensive drugs, according to a study published online Oct. 3 in Circulation: Cardiovascular Quality and Outcomes.

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Communication Program Doesn't Raise Hospital Liability Costs

TUESDAY, Oct. 3, 2017 (HealthDay News) -- A communication-and-resolution program, in which hospitals and liability insurers communicate with patients when adverse events occur, does not lead to higher liability costs, according to a study published online Oct. 2 in Health Affairs.

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Fewer Deaths Projected With Switch to Electronic Cigarettes

TUESDAY, Oct. 3, 2017 (HealthDay News) -- Replacement of cigarettes with electronic cigarettes (e-cigarettes) is projected to result in fewer premature deaths, even under a pessimistic scenario, according to a study published online Oct. 2 in Tobacco Control.

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MI Incidence Down With CT Angiography in Suspected CAD

TUESDAY, Oct. 3, 2017 (HealthDay News) -- For patients with suspected coronary artery disease (CAD), coronary computed tomography angiography (CCTA) is associated with reduced incidence of myocardial infarction but no reduction in death or cardiac hospitalization versus functional stress testing, according to a review published online Oct. 2 in JAMA Internal Medicine.

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Skipping Breakfast Tied to Increased Odds of Atherosclerosis

MONDAY, Oct. 2, 2017 (HealthDay News) -- Habitual skipping of breakfast is associated with increased likelihood of atherosclerosis independent of traditional and dietary cardiovascular (CV) risk factors, according to a study published online Oct. 2 in the Journal of the American College of Cardiology.

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Tdap Given in Pregnancy Protects Infants From Pertussis

MONDAY, Oct. 2, 2017 (HealthDay News) -- Tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccination during the third trimester of pregnancy is effective for preventing pertussis in infants in the first months of life, according to a study published online Sept. 28 in Clinical Infectious Diseases.

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