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WASHINGTON (Reuters) Jan 03 - U.S. officials on Thursday gave four states currently governed by Republicans the green light to set up their own health insurance exchanges under President Barack Obama's healthcare reform law, an initiative largely opposed by Republicans. The U.S. Department of Health and Human Services said Idaho, Nevada, New Mexico and Utah joined a list totaling 17 states and the District of Columbia that have all won conditional approval to establish their own state exchanges, with operations set to begin on January 1, 2014. A fifth Republican-governed state, Mississippi, applied to operate a state exchange, but has not received approval because of a dispute about how much authority state officials should exercise over the operations of its prospective online marketplace, officials said. The U.S. administration also cleared an exchange that Arkansas plans to run in partnership with the federal government. Delaware received approval for a similar partners

By Genevra Pittman NEW YORK (Reuters Health) Jan 03 - One-third of people getting a CT scan didn't know the test exposed their body to radiation, in a new study from a single U.S. medical center. The majority of patients also underestimated the amount of radiation delivered by a CT scan, and just one in 20 believed the scan would increase their chance of ever getting cancer. The study's lead researcher, Janet Busey, said doctors need to do a better job of talking to patients about the risks and benefits of the tests, including about radiation exposure. One challenge is that there is still debate within the medical community about just how much long term cancer risk the scans carry, she said. That risk also depends on how many scans a patient gets and which organs are exposed to radiation. "There's no doubt, CT saves lives," Busey, from the University of Washington in Seattle, told Reuters Health. And their benefits usually outweigh their risks, she ad

Withholding transfusions until hemoglobin levels are lower than 7%, rather than 9%, improves overall survival by 45% in patients with acute upper gastrointestinal (GI) bleeding, according to a  study published  in the January 3 issue of the New England Journal of Medicine . "[This study] provides long-awaited evidence to guide practice and justify current recommendations for the management of upper gastrointestinal bleeding," asserts Loren Laine, MD, from the Yale University School of Medicine in New Haven and the VA Connecticut Healthcare System in West Haven, in an accompanying editorial . Although prior meta-analyses have largely excluded the potential for benefit with a liberal transfusion strategy, only 1% or less of included patients had acute GI bleeds, Dr. Laine writes. To examine the potential benefit of a more narrow approach, Càndid Villanueva, MD, from the Gastrointestinal Bleeding Unit, Department of Gastroenterology, Hospital de Sant Pau, Autonomous Uni