Prehospital 12-lead electrocardiography (ECG) is critical to timely STEMI care although its use remains inconsistent. Previous studies identify reasons for failure obtain a prehospital ECG have generally only focused on individual emergency medical service (EMS) systems in urban areas. Our study objective was patient, geographic, and EMS agency-related factors associated with perform across statewide geography.We analyzed data from the Medical Information System (PreMIS) North Carolina...

Outpatient cardiac rehabilitation (CR) participation after myocardial infarction (MI) reduces all-cause mortality; however, less is known about effects of CR on post-MI hospitalization. The study objective was to investigate hospitalization following acute MI among older adults.Medicare beneficiaries aged 65 88 yr hospitalized in 2008 with MI, who survived at least 60 d post-discharge, had a revascularization procedure during index hospitalization, and did not have an previous year were...

Musculoskeletal pain is a common reason for emergency department (ED) visits. Following discharge from the ED, patients, particularly older often have difficulty controlling their and managing analgesic side effects. We conducted pilot study of an educational video about management with without follow-up telephone support adults presenting to ED musculoskeletal pain.ED patients aged 50 years were randomized to: (1) usual care, (2) brief only, or (3) plus protocol-guided call physician 48-72...

Abstract Purpose The objectives of this study were to investigate sensitivity and specificity myocardial infarction (MI) case definitions using multiple discharge code positions diagnosis codes when comparing administrative data hospital surveillance data. Methods Hospital for ARIC Study cohort participants with matching participant ID service dates Centers Medicare Medicaid Services (CMS) hospitalization records hospitalizations occurring between 2001 2013 included in study. Classification...

Unmet health-related social needs are common amongst older US adults and impact both quality of life health outcomes. One the ways that unmet is through malnutrition, an imbalance in a person's intake energy and/or nutrients. Lack reliable access to sufficient quantity nutritious food specific need can be assessed rapidly and, when unmet, direct risk factor for malnutrition may indicative broader range needs. We conducted cross-sectional study characterise insecurity receiving emergency...

Emergency departments (EDs) have been increasingly utilized over time for psychiatric care. While multiple studies assessed these trends in nationally representative data, few evaluated state-level data. This investigation seeks to understand the mental health-related ED burden North Carolina (NC) by describing visits associated with a health diagnosis (MHD) time.Using data from NC DETECT, this describes January 1, 2008 through December 31, 2014 presence of MHD code. A visit was classified...

Whether patients present to the emergency department (ED) with physical ailments and comorbid psychiatric needs or primary complaints, understanding differences in clinically relevant age sex patterns over time is crucial optimal care ED setting. We used population-level surveillance data provided by North Carolina Disease Event Tracking Epidemiologic Collection Tool (NC DETECT) from January 1, 2008, through December 31, 2014. Mental health-related (MHR) visits were identified International...

Professional health organizations recommend that outpatient cardiac rehabilitation programs include activities to optimize the physical, mental, and social well-being of patients. The study objectives were describe among (1) mental assessments performed; (2) psychosocial services offered; (3) leadership's perception barriers offerings.A cross-sectional survey North Carolina licensed on their 2018 was conducted. Descriptive statistics used summarize responses. Thematic analysis free text...

Background Residents from diverse specialties perform clinical rotations in the emergency department (ED). There is little research about value of ED rotation for them. Objectives We sought to determine learning objectives non-EM residents (NEMRs) ED, effectiveness rotation, and highest-yield components their experience. Methods From 2017-2019, we surveyed NEMR on pre-rotation comfort level with 15 common presentations/procedures before after rotation. assessed how well were met,...

Objective: Assess relationships between patient health literacy and formal education use of opioids during following an emergency department (ED) visit.Design: Prospective, cross-sectional study.Setting: Academic ED.Participants: Adults aged ≥ 60 years presenting to the ED with musculoskeletal pain.Main outcome measures: Opioid after visit.Results: In a sample 136 patients, patients low were more likely receive opioid in than high (70 percent vs 52 percent; 18 difference, 95% confidence...

Chronic musculoskeletal pain (MSP) affects more than 40% of adults aged 50 years and older is the leading cause disability in USA. Older with chronic MSP are at risk for analgesic-related side effects, long-term opioid use, functional decline. Recognizing burden MSP, reducing transition from acute to a public health priority. In this paper, we report protocol Brief EducaTional Tool Enhance Recovery (BETTER) trial. This trial compares two versions an intervention usual care preventing among...

Objectives: Around one million United States emergency department (ED) visits annually are due to acute decompensated heart failure (ADHF) symptoms.Characterizing ED symptom presentation of ADHF patients may improve clinical care, yet sex and age differences in chief complaints have not been thoroughly investigated.This paper aims describe comorbid conditions for with a diagnosis, stratified by age.Methods: Retrospective analysis adults presenting North Carolina EDs NC DETECT, statewide...

Abstract Objective To determine whether a Brief Negotiation Interview (BNI) performed in the emergency department (ED) can reduce future rates of alcohol use among older adults who are high‐risk drinkers. Methods Adults aged 65 years and single academic ED were screened for based on National Institute Alcohol Abuse Alcoholism definition >7 drinks per week or >3 occasion. Eligible individuals drinkers passed cognitive impairment screener consented to enrollment randomly assigned receive...

Background: Studies of the use health care after onset disease are important for assessing quality care, treatment disparities, and guideline compliance. Cohort definition analysis method considerations generalizability validity study results. We compared different approaches cohort (restriction by survival time vs. comorbidity score) [Kaplan-Meier (KM) competing risk] when patterns adoption in elderly patients. Methods: Medicare beneficiaries aged 65–95 years old who had an acute myocardial...

BACKGROUND Cardiac rehabilitation (CR) can improve quality of life and reduce subsequent hospitalizations for individuals with cardiovascular disease. Nevertheless, CR is underutilized, less known about the current content, patient population, workforce programs in North Carolina.OBJECTIVE To describe services, participation, Carolina order to characterize infrastructure identify opportunities use.METHODS We distributed an electronic survey all certified outpatient spring 2019. Descriptive...