Mullenaagesen6248

patient-centered care. Future studies should validate PRISM in different clinical settings.

The demographics of heart failure are changing. The rate of growth of the "older" heart failure population, specifically those ≥ 75, has outpaced that of any other age group. These older patients were underrepresented in the early beta-blocker trials. There are several reasons, including a decreased potential for mortality benefit and increased risk of side effects, why the risk/benefit tradeoff may be different in this population.

We aimed to determine the association between receipt of a beta-blocker after heart failure discharge and early mortality and readmission rates among patients with heart failure and reduced ejection fraction (HFrEF), specifically patients aged 75+.

We used 100% Medicare Parts A and B and a random 40% sample of Part D to create a cohort of beneficiaries with ≥ 1 hospitalization for HFrEF between 2008 and 2016 to run an instrumental variable analysis.

The primary measure was 90-day, all-cause mortality; the secondary measure was 90-day, all-cause readmission.

Using the two-0-day mortality and readmission rates. The magnitude of benefit does not appear to wane with age. Absent a strong contraindication, all patients with HFrEF should attempt beta-blocker therapy at/after hospital discharge, regardless of age.

The clinical course of COVID-19 includes multiple disease phases. Data describing post-hospital discharge outcomes may provide insight into disease course. Studies describing post-hospitalization outcomes of adults following COVID-19 infection are limited to electronic medical record review, which may underestimate theincidence of outcomes.

To determine 30-day post-hospitalization outcomes following COVID-19 infection.

Retrospective cohort study SETTING Quaternary referral hospital and community hospital in New York City.

COVID-19 infected patients discharged alive from the emergency department (ED) or hospital between March 3 and May 15, 2020.

Outcomes included return to an ED, re-hospitalization, and mortality within 30 days of hospital discharge.

Thirty-day follow-up data were successfully collected on 94.6% of eligible patients. Among 1344 patients, 16.5% returned to an ED, 9.8% were re-hospitalized, and 2.4% died. Among patients who returned to the ED, 50.0% (108/216) went to a different hospital from the hospital of the index presentation, and 61.1% (132/216) of those who returned were re-hospitalized. JAK Inhibitor I In Cox models adjusted for variables selected using the lasso method, age (HR 1.01 per year [95% CI 1.00-1.02]), diabetes (1.54 [1.06-2.23]), and the need for inpatient dialysis (3.78 [2.23-6.43]) during the index presentation were independently associated with a higher re-hospitalization rate. Older age (HR 1.08 [1.05-1.11]) and Asian race (2.89 [1.27-6.61]) were significantly associated with mortality.

Among patients discharged alive following their index presentation for COVID-19, risk for returning to a hospital within 30 days of discharge was substantial. These patients merit close post-discharge follow-up to optimize outcomes.

Among patients discharged alive following their index presentation for COVID-19, risk for returning to a hospital within 30 days of discharge was substantial. These patients merit close post-discharge follow-up to optimize outcomes.

Cigarette smoking is a risk factor for severe COVID-19 disease. Understanding smokers' responses to the pandemic will help assess its public health impact and inform future public health and provider messages to smokers.

To assess risk perceptions and change in tobacco use among current and former smokers during the COVID-19 pandemic.

Cross-sectional survey conducted in May-July 2020 (55% response rate) PARTICIPANTS 694 current and former daily smokers (mean age 53, 40% male, 78% white) who had been hospitalized pre-COVID-19 and enrolled into a smoking cessation clinical trial at hospitals in Massachusetts, Pennsylvania, and Tennessee.

Perceived risk of COVID-19 due to tobacco use; changes in tobacco consumption and interest in quitting tobacco use; self-reported quitting and relapse since January 2020.

68% (95% CI, 65-72%) of respondents believed that smoking increases the risk of contracting COVID-19 or having a more severe case. In adjusted analyses, perceived risk was higher in Massachusetts whenerability.

Most smokers believed that smoking increased COVID-19 risk. Smokers' responses to the pandemic varied, with increased smoking related to stress and increased quitting associated with perceived COVID-19 vulnerability.

While substance use disorder remains a leading cause of morbidity and mortality for young adults, low rates of treatment engagement and retention persist. One explanation is that substance use disorder treatment approaches do not match young adults' expectations for recovery. While the concept of recovery has been explored among adult populations, less is known about how young adults think about recovery.

To describe perspectives of recovery among young adults with substance use disorder.

Qualitative, in-depth interviews exploring young adults' definitions of recovery.

Twenty English-speaking young adults (7 women; 21-29 years old) diagnosed with substance use disorder recruited from an urban safety net hospital in Massachusetts.

Interviews were recorded and transcribed verbatim. An iterative categorization analytic approach was used to identify and interpret themes.

Four themes related to recovery were identified. First, young adults described recovery as a way to grow up and live a normal life nd recovery as a complex and individually motivated process that includes multiple components such as mental health treatment and re-engagement in regular daily activities. Models of care for young adults should consider incorporating these treatment elements to improve engagement and retention.

Longitudinal clerkships provide students with meaningful clinical care roles that promote learning and professional development. It remains unclear how longitudinal primary care clerkships inform students' perceptions of primary care.

To explore perceptions of primary care among medical students enrolled in longitudinal primary care clerkships.

Qualitative, semi-structured interviews with medical students over 4 years.

Thirty-eight medical students participated at baseline; 35 participated in a 2-year follow-up interview; 24 participated at 4 years. Each student was enrolled in one of two longitudinal primary care clerkships a team-based Education-Centered Medical Home (ECMH) or a one-on-one individual preceptorship (IP).

De-identified interview transcripts were analyzed using a process of open and axial coding, followed by elaborative coding for longitudinal analysis. Codes were compiled into a set of themes and compared across time periods and between clerkships.

Students reported that primary care serves as a first point of contact, emphasizing longitudinal care with a wide scope of practice and approaching patient care with a biopsychosocial perspective.