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Introduction: ACC/AHA guidelines support use of clopidogrel, prasugrel, and ticagrelor for secondary prevention among patients with acute myocardial infarction (AMI). Little is known about patient and hospital characteristics associated with ticagrelor uptake in contemporary US practice. Methods: Patterns of clopidogrel, prasugrel, and ticagrelor use were assessed in the NCDR ACTION Registry® -GWTG™ among 362,354 AMI patients treated at 801 hospitals from the third quarter of 2013 to the first quarter of 2017. A multivariable hierarchical logistic regression identified patient and hospital characteristics associated with ticagrelor use at discharge. We then compared ticagrelor use between hospitals who were rapid and slow adopters of prasugrel. Results: The use of ticagrelor steadily increased over time, from 6.1% in the third quarter of 2013 to 33.7% in the first quarter of 2017, accompanied by corresponding reductions in clopidogrel and prasugrel use. In multivariable models, Caucasian patients, those with private insurance, and those with STEMI, as well as patients presenting to larger facilities, non-teaching hospitals, and hospitals in the Northeast were significantly more likely to receive ticagrelor (p<0.05 for all) (Figure, left panel). Hospitals with the slowest rate of prasugrel adoption, defined as <5% use during the first two years after its approval, had the slowest increase in ticagrelor use between July 2013 and June 2015 (correlation coefficient: 0.15, p =0.004) (Figure, right panel). Conclusions: After more than 7 years since FDA approval, about 1 in 3 AMI patients in the US receive ticagrelor. Patient characteristics as well as hospital and provider practices may significantly modify the rapidity of new drug uptake. Examining the characteristics associated with rapid adoption of new evidence may provide insights about improving health system performance. [ABSTRACT FROM AUTHOR]

As anyone who has suffered through a head cold knows, food eaten when the olfactory system is impaired tastes 'wrong', an experience that leads many to conclude that taste stimuli are processed normally only when the olfactory system is unimpaired. Evidence that the taste system influences olfactory perception, however, has been vanishingly rare. We found just such an influence; if taste cortex was inactivated when an odor was first presented, later presentations were properly appreciated only if taste cortex was again inactivated. [ABSTRACT FROM AUTHOR]

The precise role played by serotonin (5-HT) in taste--an issue of great interest given the involvement of serotonin in human sensory and eating disorders--is a matter of considerable debate, perhaps because of the variety of methodologies that have been brought to bear by different researchers. Here, we use multiple methods to reveal the motivational mechanism whereby 5-HT1A receptor activation modulates drinking behavior. Subcutaneous injections of the selective 5-HT1A agonist 8-hydroxy-2-di-npropylamino -tetralin (8-OH-DPAT), a drug that reduces 5-HT release by acting on presynaptic auto-receptors, dose-dependently increased consumption of 0.45M NaC1 in a one-bottle test. In a two-bottle test, however, 8-OH-DPAT-treated animals (30 µg/kg/ml) demonstrated decreased NaC1 preference --although our detection of this effect was obscured by adaptation to the drug across days. Rats' performance in a brief access test confirmed that 8-OH-DPAT decreased preference for saline by both increasing water consumption and decreasing NaC1 consumption. Finally, taste reactivity tests demonstrated that the latter result does not reflect decreased NaC1 palatability. Overall, the results suggest that 8-OH-DPAT-induced 5-HT hypofunction increases thirst without substantially affecting the palatability of NaC1. [ABSTRACT FROM AUTHOR]

Background: Alcohol withdrawal is a common reason for admission to acute care hospitals. Prescription of medications for alcohol-use disorder (AUD) and close outpatient follow-up are commonly recommended, but few studies report their effects on postdischarge outcomes., Objectives: The objective of this study is to evaluate the effects of medications for AUD and follow-up appointments on readmission and abstinence., Methods: This retrospective cohort study evaluated veterans admitted for alcohol withdrawal to medical services at 19 Veteran Health Administration hospitals between October 1, 2018 and September 30, 2019. Factors associated with all-cause 30-day readmission and 6-month abstinence were examined using logistic regression., Results: Of the 594 patients included in this study, 296 (50.7%) were prescribed medications for AUD at discharge and 459 (78.5%) were discharged with follow-up appointments, including 251 (42.8%) with a substance-use clinic appointment, 191 (32.9%) with a substance-use program appointment, and 73 (12.5%) discharged to a residential program. All-cause 30-day readmission occurred for 150 patients (25.5%) and 103 (17.8%) remained abstinent at 6 months. Medications for AUD and outpatient discharge appointments were not associated with readmission or abstinence. Discharge to residential treatment program was associated with reduced 30-day readmission (adjusted odds ratio [AOR]: 0.39, 95% confidence interval [95% CI]: 0.18-0.82) and improved abstinence (AOR: 2.50, 95% CI: 1.33-4.73)., Conclusions: Readmission and return to heavy drinking are common for patients discharged for alcohol withdrawal. Medications for AUD were not associated with improved outcomes. The only intervention at the time of discharge that improved outcomes was discharge to residential treatment program, which was associated with decreased readmission and improved abstinence., (Published 2024. This article is a US Government work and is in the public domain in the USA.)