Nicotine Patch Prescription Fulfillment Rates for Emergency Department Patients.

INTRODUCTION: Smoking cessation has significant health benefits, and the emergency department (ED) can be an important venue for smoking cessation counseling. Nicotine replacement therapy with transdermal patches has been shown to be associated with smoking cessation in a variety of studies. This study evaluated fulfillment rates for prescriptions for nicotine replacement transdermal patches (NRT-P) from the ED. METHODS: We conducted a retrospective review of all patients receiving a prescription for a NRT-P product from January 2018-October 2019. Charts were reviewed to gather data including age, gender, presence of chronic heart or lung problems, and health insurance. We assessed the fulfillment rate of prescriptions using the Surescripts system, which is a functionality within our electronic health record system that queries participating pharmacies. Statistical analysis was conducted to determine associations between fill rates and the other variables collected from charts. RESULTS: We had follow-up on 500 patients prescribed nicotine patches. Of those patients, 44% filled their prescriptions. Those who filled their prescriptions were more likely to be female and have a history of chronic lung disease. Self-pay patients were least likely to fill their prescriptions. Overall, we had evidence of smoking cessation in 13% of patients. CONCLUSION: This study found that a substantial proportion of patients fail to fill their NRT-P prescriptions. Further work on means of enhancing fulfillment rates is warranted.

Past extreme warming events linked to massive carbon release from thawing permafrost.

Between about 55.5 and 52 million years ago, Earth experienced a series of sudden and extreme global warming events (hyperthermals) superimposed on a long-term warming trend. The first and largest of these events, the Palaeocene-Eocene Thermal Maximum (PETM), is characterized by a massive input of carbon, ocean acidification and an increase in global temperature of about 5 °C within a few thousand years. Although various explanations for the PETM have been proposed, a satisfactory model that accounts for the source, magnitude and timing of carbon release at the PETM and successive hyperthermals remains elusive. Here we use a new astronomically calibrated cyclostratigraphic record from central Italy to show that the Early Eocene hyperthermals occurred during orbits with a combination of high eccentricity and high obliquity. Corresponding climate-ecosystem-soil simulations accounting for rising concentrations of background greenhouse gases and orbital forcing show that the magnitude and timing of the PETM and subsequent hyperthermals can be explained by the orbitally triggered decomposition of soil organic carbon in circum-Arctic and Antarctic terrestrial permafrost. This massive carbon reservoir had the potential to repeatedly release thousands of petagrams (10(15) grams) of carbon to the atmosphere-ocean system, once a long-term warming threshold had been reached just before the PETM. Replenishment of permafrost soil carbon stocks following peak warming probably contributed to the rapid recovery from each event, while providing a sensitive carbon reservoir for the next hyperthermal. As background temperatures continued to rise following the PETM, the areal extent of permafrost steadily declined, resulting in an incrementally smaller available carbon pool and smaller hyperthermals at each successive orbital forcing maximum. A mechanism linking Earth's orbital properties with release of soil carbon from permafrost provides a unifying model accounting for the salient features of the hyperthermals.