Interrupted time series analysis of cannabis coding in Colorado during the ICD-10-CM transition

Pulmonologists provide quality care, however, their number is not adequate to take care of all the chronic obstructive pulmonary disease (COPD) needs of the population and their services come with a cost. Their optimal role should be defined, ideally based on evidence, to ensure that their abilities are applied most efficiently where needed. To determine if concomitant pulmonologist and primary care physician care after COPD hospital or emergency department discharge was associated with better health outcomes than primary care services alone. A population cohort study was conducted in Ontario, Canada from 2004 to 2011. All individuals with a COPD hospital or emergency department discharge were included. Patients who visited both a pulmonologist and a primary care physician within 30 days of the index discharge were matched to patients who had visited a primary care physician alone using propensity scores. The composite outcome of death, COPD hospitalization or COPD emergency department visit was compared using proportional hazards regression. In the propensity score matched sample, 39.7% of patients who received concomitant care and 38.9% who received primary care only died or visited the emergency department visit or hospital for COPD within 1 year (adjusted hazard ratio 1.08, 95% confidence interval 1.00-1.17). The former, however, were more likely to receive diagnostic testing and medications. Patients who received concomitant care after COPD emergency department or hospital discharge did not have better outcomes than those who received primary care alone, however, they did receive more testing and medical management.

Identification of ICD codes suggestive of child maltreatment

OBJECTIVES/GOALS: Cannabis laws may impact cannabis and tobacco use, given high prevalence of co-use of these products among young adults (YAs). The objective of this study was to examine trends in YA any cannabis, blunt, cigarette, and cigar use from 2002-2018 in states that passed adult and medical use (AMU) or medical use only (MUO) cannabis laws during that time (N=16). METHODS/STUDY POPULATION: Using data from the National Survey on Drug Use and Health, we conducted a segmented regression analysis to calculate absolute percent change (APC) in past 30-day cannabis and tobacco use between time points. The National Cancer Institute’s Joinpoint software was used to also estimate points of inflection (Joinpoints) when the slope of a trend significantly (p<0.05) changes. Separate models were estimated for each state, with time as the independent variable measured in years. Up to three Joinpoints per model were allowed. The model with optimal Joinpoints was determined using a model selection criterion via a permutation test. Joinpoints and APCs were compared with key legalization dates to describe patterns within and across states with varying cannabis policies. RESULTS/ANTICIPATED RESULTS: Generally, the 16 states showed a steady decline in YA cigarette smoking over time, a slight decline in cigar smoking, and increases in cannabis and blunt use. AMU states had lower average 2018 prevalence of cigarette smoking than MUO states (18.3% vs. 21.5%) and higher cannabis use (32.3% vs. 21.3%). Cannabis use consistently increased following opening of MUO retail outlets. Generally, there appears to be a slight delay in cannabis use increases following AMU laws, and in some states temporary declines. For example, Washington experienced an initial decrease (-20.3%) following AMU passage (2012) then increase (+16.3%) after retail dispensaries opened in 2014. In AMU states, blunt use has surpassed cigar smoking, while in MUO states, the prevalence of blunt and cigar use is similar. DISCUSSION/SIGNIFICANCE: Introduction of cannabis laws are correlated with increases in YA cannabis and blunt use, with higher cannabis use in AMU states. Trends may also correlate other state political, economic, or social factors. Joinpoint regression can assess changes in a policy’s target behavior with no a priori assumptions regarding timing of policy effects.

Opioids are common substances involved in poisonings with increasing rates in fentanyl-related mortality since 2014. The COVID-19 pandemic compromised school attendance and supervision, which may have increased the risk of opioid ingestions in children. Our objective was to evaluate pediatric opioid poisonings in Connecticut before and during the COVID-19 pandemic. This cross-sectional retrospective study used emergency department (ED) discharges involving children aged 0-17 years captured in the Connecticut Injury Surveillance System. International Classification of Diseases, 10th Revision, Clinical Modification codes were used to identify discharges involving opioids (T40.0-T40.4, T40.60, T40.69, F11). The χ 2 test was used to identify differences by pre-COVID (2017-2019) and COVID (2020-2022) periods. Rates were examined by age, sex, race/ethnicity, insurance, and discharge status. There were 1,386,796 ED discharges during the study period. Less than 1% involved opioid (N = 257) or fentanyl (N = 31) poisonings; no discharges were coded for both. The rate of opioid poisonings decreased 28.6%, from 2.1 to 1.5 per 10,000 ED visits. Subanalysis showed that the rate of fentanyl poisonings remained the same (0.2 per 10,000 ED visits). The rate of opioid poisonings was highest among non-Hispanic White children during both periods. However, there was a 57.7% increase in the rate of opioid poisonings in non-Hispanic Black children. The rate decreased for all other race/ethnic groups. Results of our study showed a rise in opioid poisonings among non-Hispanic Black and elementary school-aged children during the COVID-19 pandemic. Future prevention efforts may choose to further investigate and understand the trends in the more vulnerable groups.

IntroductionAlthough emergency department (ED) discharge presents patient-safety challenges and opportunities, the ways in which EDs address discharge risk in the general ED population remains disparate and largely uncharacterized. In this study our goal was to conduct a review of how EDs identify and target patients at increased risk at time of discharge.MethodsWe conducted a literature search to explore how EDs assess patient risk upon discharge, including a review of PubMed and gray literature. After independently screening articles for inclusion, we recorded study characteristics including outcome measures, patient risk factors, and tool descriptions. Based on this review and discussion among collaborators, major themes were identified.ResultsPubMed search yielded 384 potentially eligible articles. After title and abstract review, we screened 235 for potential inclusion. After full text and reference review, supplemented by Google Scholar and gray literature reviews, we included 30 articles for full review. Three major themes were elucidated: 1) Multiple studies include retrospective risk assessment, whereas the use of point-of-care risk assessment tools appears limited; 2) of the point-of-care tools that exist, inputs and outcome measures varied, and few were applicable to the general ED population; and 3) while many studies describe initiatives to improve the discharge process, few describe assessment of post-discharge resource needs.ConclusionNumerous studies describe factors associated with an increased risk of readmission and adverse events after ED discharge, but few describe point-of-care tools used by physicians for the general ED population. Future work is needed to investigate standardized tools that assess ED discharge risk and patients’ needs upon ED discharge.

The U.S. population is aging and increasing numbers of older adults are using cannabis. Cognitive decline is common in older age and subjective memory complaints (SMC) have been associated with increased risk for dementia. While residual cognitive effects of cannabis use at younger ages are well understood, the links between cannabis use and cognition in older adults is less clear. The present study represents the first population-level analysis of cannabis use and SMC in older adults in the U.S. We used the National Survey of Drug Use and Health (NSDUH) dataset to evaluate SMC in respondents over age 50 (N = 26,399) according to past-year cannabis use. Results revealed that 13.2% (95%CI: 11.5%-15.0%) of those who reported cannabis use also reported SMC, compared to 6.4% (95%CI: 6.1%-6.8%) among individuals with no cannabis use. Logistic regression revealed a two-fold increase (OR = 2.21, 95%CI: 1.88-2.60) of reporting SMC in respondents who had used cannabis in the past year, which was attenuated (OR = 1.38, 95%CI: 1.10-1.72) when controlling for additional factors. Other covariates, including physical health conditions, misuse of other substances, and mental illness also significantly contributed to SMC outcomes. Cannabis use represents a modifiable lifestyle factor that has potential for both risk and protective properties that may impact the trajectory of cognitive decline in older age. These hypothesis generating results are important for characterizing and contextualizing population-level trends related to cannabis use and SMC in older adults.

Background: Managing shock, a life-threatening emergency, is challenging. The influence of the initial misclassification of undifferentiated hypotension (UH) in the emergency department (ED) on patients' outcomes remains uninvestigated. The aim of this study was to investigate whether the initial misclassification of UH in the ED affects patients' clinical outcomes. Materials and Methods: This prospective observational study enrolled 270 non-traumatic adult patients with UH who had visited the ED of National Taiwan University Hospital between July 2020 and January 2022. The patients were divided into same-diagnosis and different-diagnosis groups, depending on the consistency between the initial and final classifications of shock. The outcome was survival to discharge. The clinical variables, management, and outcomes were compared between the groups. Results: A total of 39 of 270 patients (14.4%) were in the different-diagnosis group. Most misclassified patients were initially diagnosed as having hypovolemic shock (HS, n = 29) but finally diagnosed as having distributive shock (DS, n = 28) or cardiogenic shock (n = 1). When compared with the same-diagnosis group, the different-diagnosis group had higher hospitalization (94.9% vs. 81.4%, p = 0.023) but lower ED discharge (5.1% vs. 16.5%, p = 0.046) rates. Logistic regression analysis showed that the HS initially diagnosed was associated with an increased risk of misclassification (odds ratio [OR] = 14.731, 95% confidence interval [CI] = 3.572-60.749, p < 0.001). However, the survival to discharge did not differ between the two groups. DS, when finally diagnosed instead of the initial misclassification, was associated with in-hospital mortality (OR = 0.317, 95%CI = 0.124-0.810, p = 0.016). Conclusions: The misclassification of UH in the ED is not rare, particularly in patients with DS, who are likely to be initially misdiagnosed with HS. Although misclassification may increase hospitalization and decrease ED discharge, it does not affect survival to discharge.

Sexual diversity, adolescent mental health, and adult cannabis use: Longitudinal associations through cannabis use motives.

IntroductionIn March 2020, UK epistaxis guidelines were issued incorporating major shifts in standard practice, namely the recommended use of dissolvable products and discharge of patients with non-dissolvable packs.The aim of this audit was to assess patient outcomes following epistaxis care during the initial COVID-19 peak, exploring factors relating to unscheduled re-presentations.MethodsA UK-wide prospective multicentre national audit was performed over 12-weeks from 6th April 2020 at ENT departments treating adults with epistaxis. The primary outcome was re-presentation within 10-days. Univariable binary logistic regression analysis was used to identify significant determinants of the primary outcome measure.Results83 centres from all four UK nations submitted 2,631 cases, the majority of which were Emergency Department (ED) referrals (89.7%). ENT clinicians used a dissolvable intranasal product in 34.7% of patients overall (n = 816/2,351), and in 61.1% of those receiving an intranasal product (n = 816/1,336). 54.6% were discharged from the ED following ENT review. The overall re-presentation rate was 19.5% for ED discharges (n = 245/1,259) and 9.9% for ED admissions (n = 104/1,046). 6.8% of ED discharges and 5.7% of ED admissions were admitted following their re-presentations (n = 86 and 60 respectively). Not being packed by ED clinicians, antiplatelet medications, failed cautery and recent epistaxis treatment were predictors of re-presentation within 10-days.DiscussionRe-presentation data were similar to the 2016 UK Epistaxis Audit, however, there was a notable shift towards alternative packing techniques and reduced admission. This highlights that many patients who would previously have necessitated admission may be safely discharged from ED.

Limited research has evaluated the impact of cannabis policies on young adult cannabis use, after full implementation (retail outlets opened), nor on cannabis product type. This study examined the relationship between adult-use cannabis retail sales in New Jersey (United States) and young adult cannabis use by type. Data on New Jersey young adults (18-23years) were from the Policy Communication and Evaluation (PACE) New Jersey Study. Generalized estimating equations models estimated differences in prevalence of ever and past 30-day use of cannabis and sub-types before (Waves 1-3 [March-November 2021], n=1439) and after (Wave 4 [June-July 2022], n=1127) adult-use retail sales began. Ever cannabis use among New Jersey young adults was higher in the post-retail sales period than pre-sales (58.1% vs. 48.9%, p<0.01). The odds of ever cannabis use were 42% higher (95% CI=32%-54%) in the post-retail period. Ever use of dried herb (post vs. pre: 44.4% vs. 38.5%, p<0.01), drinks (7.0% vs. 4.8%, p<0.01), edibles (45.9% vs. 35.6%, p<0.01), and topicals (6.4% vs. 4.6%, p<0.05), and past 30-day edible use (11.8% vs. 9.0%, p=0.01) were higher post-retail; use of other product types did not differ. Cannabis use overall and among certain subtypes (e.g., edibles) increased among New Jersey young adults in the three months after adult-use cannabis retail sales began, demonstrating that increased access to legal cannabis for sale may encourage use. Continued monitoring is needed over longer follow-up periods in New Jersey and other states legalizing cannabis.

URL: http://www.clinicaltrials.gov. Unique identifier: NCT02519283.

PurposeThe efficacy of cannabis (THC, CBD) for pain management remains uncertain with limited evidence in patients undergoing arthroscopic surgery. The aim of this study was to quantify prevalence of self-reported cannabis use within the population of adults undergoing hip arthroscopy and investigate the potential association of cannabis use and immediate post-operative pain in this patient population.MethodsFollowing IRB approval, adult patients undergoing hip arthroscopy between January 1, 2023, and December 31, 2023.were identified at a high-volume orthopedic specialty hospital in a state where adult cannabis use has been legalized. Demographic variables (age, sex, race/ethnicity), any drug-use reported by the patient pre-operatively, procedures undergone, and NRS pain scores (0-10, 10 is worst) in the post-anesthesia care unit (PACU) were extracted. Paired t-tests were performed for continuous variables to assess differences in patients reporting vs not reporting cannabis use. Chi Square tests were utilized for categorical variables.ResultsAmong 668 patients identified, 19.3% reported cannabis use pre-operatively. The mean age of the cohort was 36.17 years (SD 15.21) and 53.1% (n = 355) male. A significantly higher proportion of cannabis users were male (p < 0.001). Patients self-reporting cannabis use were also significantly older compared to non-users (45.16 years v. 34.04 years, p < 0.0001). Across both groups, most patients underwent labral repair as their primary procedure (90.1%, n = 602). There was no significant difference in anesthetic method between groups (regional anesthesia, neuraxial block) (p = 0.219). PACU pain scores were significantly higher among cannabis users (6.44) compared to non-users (5.86) (p = 0.018).DiscussionThere is a relatively high prevalence of THC use in our study population. Patients using THC are significantly older and more likely to be male compared to those who do not report cannabis use. Additionally, patients using THC pre-operatively demonstrated significantly increased perioperative pain scores. Further investigation is warranted to determine clinical relevance of cannabis use on pain outcomes in sports medicine and hip preservation. THC screening may be useful for identifying patients with heightened postoperative pain control needs.

BackgroundPatient education on pharmacological therapy may increase medication adherence and decrease hospitalizations. Our aim is to evaluate the effectiveness of pharmaceutical care at emergency department discharge in patients with hypertension and/or diabetes.Methods/designThis is a randomized controlled trial. Participants will be recruited from a public emergency department at Restinga district in Porto Alegre, southern Brazil. A total of 380 patients will be randomly assigned into 2 groups at the moment of emergency department discharge after receiving medical orientations: an intervention group, consisting of a structured individual counseling session by a pharmacist in addition to written orientations, or a control group, consisting only of written information about the disease. Outcomes will be assessed in an ambulatory visit 2 months after the randomization. The primary outcome is the proportion of patients with high medication adherence assessed using the Morisky-Green Test and the Brief Medication Questionnaire. The secondary outcomes are reduction of blood pressure, glycated hemoglobin, fasting plasma glucose, quality of life and number of visits to the emergency department.DiscussionPharmaceutical care interventions have shown to be feasible and effective in increasing medication adherence in both hospital outpatient and community pharmacy settings. However, there have been no previous assessments of the effectiveness of pharmacy care interventions initiated in patients discharged from emergency departments. Our hypothesis is that pharmaceutical counseling is also effective in this population.Trial registrationClinicalTrials.gov registration number: NCT01978925 (11 November 2013) and Brazilian Registry of Clinical Trials U1111-1149-8922 (5 November 2013).Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-015-0579-3) contains supplementary material, which is available to authorized users.

To estimate the association between the inpatient admissions and Emergency Department (ED) visits before age of 18 years and adulthood-onset first-episode psychosis (FEP). We conducted a FEP incidence and case-control study and calculated the odds ratios (ORs) for incident FEP associated with inpatient admissions and ED visits prior to age of 18 years, adjusting our results for cannabis use, parental socio-economic class and childhood trauma. In multivariate logistic regression analysis, odds of FEP increased significantly if the participant had a history of at least one inpatient admission (OR = 3.52; 95% confidence interval [95%CI] 1.07-11.54; P = .04) or at least one ED visit (OR = 8.93; 95%CI 2.41-33.14; P = .001) before age of 18. The associations remained significant adjusting for cannabis use, education, parental socio-economic class and childhood trauma. Consistently with the socio-neurodevelopmental model, we found a significant association between a positive history of hospital care in childhood and adulthood-onset psychosis.

Current literature on the effect of cannabis use on sleep quality is mixed, and few studies have used objectively-measured sleep measures or real-time sampling of cannabis use to examine this relationship. The prevalence of cannabis use among older adults and persons living with HIV has increased in recent years, and poor sleep quality is elevated in these populations as well. However, research examining cannabis-sleep relationships in these populations is lacking. Thus, we aimed to examine the relationship between daily cannabis use and subsequent objectively-measured sleep quality in middle-aged and older adults with and without HIV. In this pilot study, seventeen (11 HIV+, 6 HIV-) adults aged 50-70 who consumed cannabis completed four daily smartphone-based surveys for 14 days, in which they reported their cannabis use (yes/no) since the last survey. Participants also wore actigraphy watches during the 14-day period to objectively assess sleep quality (i.e., efficiency, total sleep time, and sleep fragmentation). In linear mixed-effects models, cannabis use was significantly associated with greater subsequent total sleep time (β=0.56; p=0.046). Cannabis use was not related to a change in sleep efficiency (β=1.50; p=0.46) nor sleep fragmentation (β=0.846, p=0.756) on days with cannabis use versus days without cannabis use. These preliminary results indicate cannabis use may have a positive effect on sleep duration in middle-aged and older adults. However, future studies with larger sample sizes that assess cannabis use in more detail (e.g., route of administration, dose, reason for use) are needed to further understand this relationship.