The study found an unexpectedly high prevalence of domestic violence in the three internal medicine clinics. Physicians should ask their patients routinely about domestic violence and, when domestic violence is present, should offer emotional support, information about social service agencies, and psychological care.

Key Points Question What are the associations of home-based vs center-based cardiac rehabilitation (CR) with hospitalizations, medication adherence, and cardiovascular risk factor control among diverse patients with cardiovascular disease and high risk? Findings In this cohort study of 2556 demographically diverse patients with high risk in a large integrated health system, there were fewer hospitalizations at 12 months among participants in home-based CR compared with participants in center-based CR programs. Meaning This cohort study found that participation in home-based CR was associated with fewer hospitalizations at 12 months compared with participation in center-based CR.

Background COVID-19 mRNA vaccination-associated acute-onset hypersensitivity reactions have caused anxiety and may be contributing to vaccine hesitancy. Objective Determine the incidence, severity, and risk factors for treated acute-onset COVID-19 mRNA vaccination-associated hypersensitivity reactions in a well-characterized population. Methods All Kaiser Permanente Southern California (KPSC) members who received COVID-19 mRNA vaccinations between 12-15-2020 and 3-11-2021 at a KPSC facility were identified and characterized, along with all treated acute-onset vaccination-associated hypersensitivity events. Results We identified 391,123 unique vaccine recipients, 59.18% female, age 64.19±17.86 years; 215,156 received 2 doses (53.54% Moderna), 157,615 only a first dose (50.13% Moderna) [1,961 (1.46%) >2 weeks late getting a second dose], and 18,352 (74.43% Moderna) only a second dose. Only 104 (0.028%), 85.58% female, age 53.18±15.96 years, had treated first dose events, 68 (0.030%) Moderna. Only 32 (0.014%), 93.75% female, age 57.28±17.09 years, had treated second dose events, 21 (0.016%) Moderna. Only 2 (0.00033%) vaccinations resulted in anaphylaxis. Only 27 (20.77%) of those with treated first dose reactions failed to get a second dose. Only 6/77 (7.8%) with first dose reactions also had second dose reactions. Individuals with treated events were more likely to be female (p < .0001), younger (p < .0001), and had more preexisting drug “allergies” (2.11 ± 2.12 versus 1.02 ± 1.41 (p <.0001) for average recipients). Conclusions Treated acute-onset hypersensitivity events were mostly benign, more common with first COVID-19 mRNA vaccine doses, more likely to occur in younger females with typical risk factors associated with multiple drug intolerance syndrome, and very unlikely to be primarily immunologically mediated.

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This retrospective, observational cohort study of mechanically ventilated patients at 21 community and 2 academic hospitals demonstrated that in 28,758 derivation cohort admissions, every 10% increase in SpO2/ FiO2 time at risk (SF-TAR) was associated with a 24% increase in adjusted odds of hospital mortality. The SF-TAR can identify ventilated patients at increased risk of death, offering modest improvements compared with single SpO2/FiO2 and P/F ratios. This longitudinal, noninvasive, and broadly generalizable tool may have particular utility for early phenotyping and risk stratification.