ED patients with LEP experienced both increased rates of diagnostic testing and of hospital admission. Research is needed to examine why these differences occurred and if they represent inefficiencies in care.

This cohort study analyzes the trends in filled naloxone prescriptions during the COVID-19 pandemic in the United States and compare these to opioid prescriptions and overall prescriptions.

As many as 1 in 10 patients experience dyspnea at hospital admission but the relationship between dyspnea and patient outcomes is unknown. We sought to determine whether dyspnea on admission predicts outcomes.We conducted a retrospective cohort study in a single, academic medical center. We analysed 67 362 consecutive hospital admissions with available data on dyspnea, pain, and outcomes. As part of the Initial Patient Assessment by nurses, patients rated “breathing discomfort” using a 0 to 10 scale, (10=“unbearable”). Patients reported dyspnea at the time of admission and recalled dyspnea experienced in the 24 h prior to admission. Outcomes included in-hospital mortality, 2-year mortality, length of stay, need for rapid response system activation, transfer to the intensive care unit, discharge to extended care, and 7- and 30-day all cause readmission to the same institution.Patients who reported any dyspnea were at an increased risk of death during that hospital stay; the greater the dyspnea, the greater the risk of death (dyspnea=0, 0.8% in-hospital mortality; dyspnea=1–3, 2.5% mortality; dyspnea ≥4, 3.7% mortality, p<0.001). After adjustment for patient comorbidities, demographics, and severity of illness, increasing dyspnea remained associated with inpatient mortality (dyspnea 1–3, aOR 2.1, 95% CI 1.7–2.6; dyspnea ≥4, aOR 3.1, 95% CI 2.4–3.9). Pain did not predict increased mortality. Patients reporting dyspnea also used more hospital resources, were more likely to be readmitted, and were at increased risk of death within 2 years (dyspnea=1–3 adjusted HR 1.5, 95% CI 1.3–1.6; dyspnea ≥4 adjusted HR 1.7, 95% CI 1.5–1.8).We found that dyspnea of any rating was associated with an increased risk of death. Dyspnea can be rapidly collected by nursing staff, which may allow for better monitoring or interventions that could reduce mortality and morbidity.

Dyspnea is a common symptom among all hospitalized patients. Routine documentation of dyspnea is feasible in a large tertiary care center.

BackgroundResearch has shown that tobacco smoke contains substances of microbiological origin such as ergosterol (a fungal membrane lipid) and lipopolysaccharide (LPS) (in the outer membrane of Gram-negative bacteria). The aim of the present study was to compare the amounts of ergosterol and LPS in the tobacco and mainstream (MS) and sidestream (SS) smoke of some popular US cigarettes.MethodsWe measured LPS 3-hydroxy fatty acids and fungal biomass biomarker ergosterol in the tobacco and smoke from cigarettes of 11 popular brands purchased in the US. University of Kentucky reference cigarettes were also included for comparison.ResultsThe cigarette tobacco of the different brands contained 6.88-16.17 (mean 10.64) pmol LPS and 8.27-21.00 (mean 14.05) ng ergosterol/mg. There was a direct correlation between the amounts of ergosterol and LPS in cigarette tobacco and in MS smoke collected using continuous suction; the MS smoke contained 3.65-8.23% (ergosterol) and 10.02-20.13% (LPS) of the amounts in the tobacco. Corresponding percentages were 0.30-0.82% (ergosterol) and 0.42-1.10% (LPS) for SS smoke collected without any ongoing suction, and 2.18% and 2.56% for MS smoke collected from eight two-second puffs.ConclusionsTobacco smoke is a bioaerosol likely to contain a wide range of potentially harmful bacterial and fungal components.