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Introduction: Pain is a major driver of visits to the emergency department (ED). Clinicians must consider not only the efficacy of treatment options but also subsequent healthcare utilization and patient-centered outcomes such as side effects from prescribed medications. Our goal in this study was to determine whether there was an association between acute pain treatment regimen (opioids, intranasal non-steroidal anti-inflammatory drugs [NSAIDs], or both) and unscheduled healthcare visits following ED discharge.Methods: This study was a secondary analysis of the Acute Management of Pain from the Emergency Department (AMPED) prospective, observational cohort study. We used Cox proportional hazards analysis to assess the relationship between treatment regimen and time to first unscheduled healthcare visit. Repeated measures logistic regression analyses were used to determine the relationship between treatment regimen and any unscheduled visits, and to evaluate whether this relationship was mediated by pain severity and/or medication side effects.Results: Of 831 total enrolled participants, 141 (16.9%) experienced an unplanned healthcare visit within five days of ED discharge. A majority of these visits happened one day after the ED visit. Those who were treated with intranasal NSAIDs only were less likely to have an unscheduled healthcare visit compared to those who received opioids only, with an adjusted odds ratio (AOR) of 0.63. The higher odds of unscheduled healthcare visits with opioids were mediated by both the presence of side effects and higher pain levels, with AORs of 2.24 and 1.33, respectively.Conclusion: Opioid treatment for acute pain is associated with increased unscheduled healthcare visits compared to those treated with intranasal ketorolac. This difference can be explained by higher levels of ongoing pain and greater medication side effects.

Introduction: Triage functions to quickly prioritize care and sort patients by anticipated resource needs. Despite widespread use of the Emergency Severity Index (ESI), there is still no universal standard for emergency department (ED) triage. Thus, it can be difficult to objectively assess national trends in ED acuity and resource requirements. We sought to derive an ESI from National Hospital Ambulatory Medical Care Survey (NHAMCS) survey items (NHAMCS-ESI) and to assess the performance of this index with respect to stratifying outcomes, including hospital admission, waiting times, and ED length of stay (LOS).Methods: We used data from the 2010-2015 NHAMCS, to create a measure of ED visit complexity based on variables within NHAMCS. We used NHAMCS data on chief complaint, vitals, resources used, interventions, and pain level to group ED visits into five levels of acuity using a stepwise algorithm that mirrored ESI. In addition, we examined associations of NHAMCS-ESI with typical indicators of acuity such as waiting time, LOS, and disposition. The NHAMCS-ESI categorization was also compared against the “immediacy” variable across all of these outcomes. Visit counts used weighted scores to estimate national levels of ED visits.Results: The NHAMCS ED visits represent an estimated 805,726,000 ED visits over this time period. NHAMCS-ESI categorized visits somewhat evenly, with most visits (42.5%) categorized as a level 3. The categorization pattern is distinct from that of the “immediacy” variable within NHAMCS. Of admitted patients, 89% were categorized as NHAMCS-ESI level 2-3. Median ED waiting times increased as NHAMCS-ESI levels decreased in acuity (from approximately 14 minutes to 25 minutes). Median LOS decreased as NHAMCS-ESI decreased from almost 200 minutes for level 1 patients to nearly 80 minutes for level 5 patients.Conclusion: We derived an objective tool to measure an ED visit’s complexity and resource use. This tool can be validated and used to compare complexity of ED visits across hospitals and regions, and over time.

Background: The COVID-19 pandemic led to widespread college campus closures in the months of March to June 2020, endangering students' access to on-campus health resources, including reproductive health services. Objective: To assess contraceptive access and use among undergraduate and graduate students in North Carolina during the COVID-19 pandemic. Methods: We conducted a cross-sectional web-based survey of undergraduate and graduate students enrolled at degree-granting institutions in North Carolina. Participants were recruited using targeted Instagram advertisements. The survey queried several aspects of participants' sexual behavior, including sex drive, level of sexual experience, number of sexual partners, digital sexual experience, dating patterns, and types of contraception used. Participants were asked to compare many of these behaviors before and after the pandemic. The survey also assessed several sociodemographic factors that we hypothesized would be associated with contraceptive use based on prior data, including educational background, sexual orientation and gender minority status (ie, lesbian, gay, bisexual, transgender, queer), health insurance status, race, ethnicity, degree of sensation seeking, religiosity, and desire to become pregnant. Results: Over 10 days, 2035 Instagram users began our survey, of whom 1002 met eligibility criteria. Of these 1002 eligible participants, 934 completed the survey, for a 93% completion rate. Our respondents were mostly female (665/934, 71%), cisgender (877/934, 94%), heterosexual (592/934, 64%), white (695/934 75%), not Hispanic (835/934, 89%), and enrolled at a 4-year college (618/934, 66%). Over 95% (895/934) of respondents reported that they maintained access to their preferred contraception during the COVID-19 pandemic. In a multivariable analysis, participants who were enrolled in a 4-year college or graduate program were less likely to lose contraceptive access when compared to participants enrolled in a 2-year college (risk ratio [RR] 0.34, 95% CI 0.16-0.71); in addition, when compared to cisgender participants, nonbinary and transgender participants were more likely to lose contraceptive access (RR 2.43, 95% CI 1.01-5.87). Respondents reported that they were more interested in using telehealth to access contraception during the pandemic. The contraceptive methods most commonly used by our participants were, in order, condoms (331/934, 35.4%), oral contraception (303/934, 32.4%), and long-acting reversible contraception (LARC; 221/934, 23.7%). The rate of LARC use among our participants was higher than the national average for this age group (14%). Emergency contraception was uncommonly used (25/934, 2.7%). Conclusions: Undergraduate and graduate students in North Carolina overwhelmingly reported that they maintained access to their preferred contraceptive methods during the COVID-19 pandemic and through changing patterns of health care access, including telehealth. Gender nonbinary and transgender students and 2-year college students may have been at greater risk of losing access to contraception during the first year of the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Objectives. This study examined prevalence of psychiatric disorders, social and family risk factors for disorders, and met and unmet needs for mental health care among Appalachian youth. Methods. All 9-, 11-, and 13-year-old American Indian children in an 11-county area of the southern Appalachians were recruited, together with a representative sample of the surrounding population of White children. Results. Three-month prevalences of psychiatric disorders were similar (American Indian, 16.7%; White, 19.2%). Substance use was more common in American Indian children (9.0% vs 3.8% in White children), as was comorbidity of substance use and psychiatric disorder (2.5% vs 0.9%). American Indian poverty, family adversity (e.g., parental unemployment, welfare dependency), and family deviance (parental violence, substance abuse, and crime) rates were higher, but the rate of family mental illness, excluding substance abuse, was lower. Child psychiatric disorder and mental health service use were associated with family mental illness in both ethnic groups but were associated with poverty and family deviance only in White children. Despite lower financial barriers, American Indian children used fewer mental health services. Conclusions. This study suggests that poverty and crime play different roles in different communities in the etiology of child psychiatric disorder. (Am J Public Health. 1997;87:827-832)

Objectives: Outpatient parenteral antimicrobial therapy (OPAT) is associated with high hospital readmission rates. A 30 day unplanned readmission risk prediction model for OPAT patients has been developed in the UK. Given significant differences in patient mix and methods of OPAT delivery, we explored the model for its utility in Duke University Health System (DUHS) patients receiving OPAT., Methods: We analysed OPAT episodes of adult patients from two hospitals between 1 July 2019 and 1 February 2020. The discriminative ability of the model to predict 30 day unplanned all-cause and OPAT-related admission was examined. An updated model was created by logistic regression with the UK risk factors and additional risk factors, OPAT delivery in a skilled nursing facility, vancomycin use and IV drug abuse., Results: Compared with patients of the UK cohort, our study patients were of higher acuity, treated for more invasive infections, and received OPAT through different modes. The 30 day unplanned readmission rate in our cohort was 20% (94/470), with 59.5% (56/94) of those being OPAT-related. The original model was unable to discriminate for all-cause readmission with a C-statistic of 0.52 (95% CI 0.46-0.59) and for OPAT-related readmission with a C-statistic of 0.55 (95% CI 0.47-0.64). The updated model with additional risk factors did not have improved performance, with a C-statistic of 0.55 (95% CI 0.49-0.62)., Conclusions: The UK 30 day unplanned hospital readmission model performed poorly in predicting readmission for the OPAT population at a US academic medical centre., (© The Author(s) 2023. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy.)

Background: The diagnosis of pulmonary hypertension (PH) remains challenging. Pre- and post-capillary PH have different signatures on noninvasive 129 Xe gas-exchange magnetic resonance imaging (MRI) and dynamic MR spectroscopy (MRS). We tested the accuracy of 129 Xe MRI/MRS to diagnose PH status compared to right heart catheterisation (RHC)., Methods: 129 Xe MRI/MRS from 93 subjects was used to develop a diagnostic algorithm, which was tested in 32 patients undergoing RHC on the same day (n=20) or within 5 months (42±40 days) (n=12). Three expert readers, blinded to RHC, used 129 Xe MRI/MRS to classify subjects as pre-capillary PH, post-capillary PH, no PH and no interstitial lung disease (ILD), or ILD., Results: For pre-capillary PH, 129 Xe MRI/MRS diagnostic accuracy was 75% (95% CI 66-84) with a sensitivity of 67% (95% CI 54-79) and a specificity of 86% (95% CI 75-96); for post-capillary PH accuracy was 69% (95% CI 59-78) with sensitivity of 54% (95% CI 34-74) and specificity of 74% (95% CI 63-84). The model performed well in straightforward cases of pre-capillary PH but was less accurate in its diagnosis in the presence of mixed disease, particularly in the presence of ILD or combined post- and pre-capillary PH., Conclusion: This study demonstrates the potential to develop 129 Xe MRI/MRS into a modality with good accuracy in detecting pre- and post-capillary PH. Furthermore, the combination of 129 Xe dynamic MRS and gas-exchange MRI uniquely provide concurrent, noninvasive assessment of both haemodynamics and gas-exchange impairment that may aid in the detection of PH., Competing Interests: Conflict of interest: E.A. Bier. reports a provisional patent for “Dynamic 129Xe Gas Exchange Spectroscopy.” Conflict of interest: F. Alenezi. has nothing to disclose. Conflict of interest: J. Lu. has nothing to disclose. Conflict of interest: Z. Wang. reports a provisional patent for “Dynamic 129Xe Gas Exchange Spectroscopy.” Conflict of interest: J.G. Mammarappallil reports consulting fees from Coreline Imaging and Bard Peripheral, and payments from Boehringer Ingelheim for lectures or presentations, outside the submitted work. Conflict of interest: B. O'Sullivan-Murphy has nothing to disclose. Conflict of interest: A. Erkanli has nothing to disclose. Conflict of interest: B. Driehuys reports grants from the National Institutes of Health during the conduct of the study and a provisional patent for “Dynamic 129Xe Gas Exchange Spectroscopy”; and reports personal fees from and is founder and chief technology officer for Polarean Imaging, a company which produces 129Xe hyperpolarisation equipment, outside the submitted work. Conflict of interest: S. Rajagopal reports grants from the National Institutes of Health and a provisional patent for “Dynamic 129Xe Gas Exchange Spectroscopy”; and reports consulting fees from APIE Therapeutics, Altavant, Gossamer Bio, Insmed, Janssen Pharmaceuticals, Liquidia Technologies, Polarean, United Therapeutics Corp. and Visterra, and payments from TotalCME and AcademicCME for lectures or presentations, outside the submitted work., (Copyright ©The authors 2022.)