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21-01-2013 | Article

Global medical news in review: January 13-19, 2013

medwireNews: A roundup of select stories of interest to US physicians from the MerckMedicus Medical News wire.

Long after the bell was rung

From youth sport leagues to professional hockey, concussions garner a lot of attention these days as brain science and famous athletes have both shown the extent and repercussions this form of head trauma can have.

In the USA, American football has produced the highest incidence of concussions in boys while girls have higher rates of sports-related concussions overall.

The symptoms of these concussions vary from cognitive difficulties to mood changes, which can ultimately interfere with school, interpersonal relationships, and future participation in sports. Appropriate management is a must if future harm is to be avoided - especially when reaction times are slowed long after an injury, as one University of Oregon study has found.

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It's a graft off

Saphenous vein grafts are a commonly used medium for surgical revascularization of coronary arteries due to the vein's ease of use, relatively large diameter, and wall characteristics being plentiful, long, and easily harvested.

Yet, saphenous vein grafts lack durability and longevity with reported failure rates of 10% to 20% within a year of coronary surgery. Another 5% to 10% of grafts fail after 1 to 5 years, and there is an extra 20% to 25% failure rate from 6 to 10 years. Altogether, only approximately half of all saphenous vein grafts are patent.

To see whether another graft option performs better, a study in Heart compared arterial grafts and saphenous grafts in revascularization of the right coronary system and found that there was no overall reduction in graft failure.

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The old fashioned way

Fundamental to the practice of emergency medicine is airway management for patients who are critically ill or injured. Rapid sequence intubation is a common and successful means of intubating the trachea, with 82% of those with cardiac arrest receiving such airway management.

Yet, it has increasingly come to light that advanced airway management, such as endotracheal intubation or supraglottic airway device use, in the prehospital context does not necessarily lead to better outcomes than bag-valve-mask ventilation after out-of-hospital cardiac arrest (OHCA).

To clarify this issue, researchers looked at how OHCA patients fared after advanced airway management by conducting a prospective, nationwide Japanese study, which found that any type of technique decreased the odds of neurologically favorable survival compared with the more standard bag-valve-mask ventilation.

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False expectations

One of the biggest reasons a patient visits the outpatient primary care setting is on account of acute cough illness (ACI), which accounts for 2% to 3% of all trips. While ACI most often is a self-limiting condition elicited by viruses, patients are just as likely to wrongly request antibiotics as not.

To see whether this mistaken request is due in part to a difference between expectations that patients have about the duration of ACI and the actual course that the condition takes, researchers looked at both factors in otherwise healthy adults.

The Annals of Family Medicine study indeed found a large mismatch between patients' expectations and the natural history of ACI, reflecting a need for education and physician emphasis on checking expectations.

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Artificial diagnosis

Our trust in technology has always been a point of contention - especially in the realm of health and medicine. While health apps are meant to increase patient engagement, garner data, and empower patients to better manage their health, they are nowhere close to replacing the extensive education and experience inherent in a doctor's insights.

Yet that might be changing as exemplified by apps being used to diagnose whether skin lesions are benign or malignant. A JAMA Dermatology study that compared apps that refer to board-certified dermatologists to assess an image of a skin lesion to apps that solely use algorithms found that the latter was drastically less accurate.

While the study authors support apps that make it easier for patients to initiate timely detection of melanomas, they warn that inaccurate diagnosis that apps may be prone to provide can be harmful.

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By Peter Sergo, medwireNews Reporter