Emergency medicine

Online CBT eases anxiety after low-risk chest pain in ED trial; telehealth counseling cuts risky firearm behavior; CDC drills find isolation gaps

• Research Sept 28, 2026
  PACER trial: peer-supported online CBT improves anxiety more than primary care referral after low-risk chest pain
  The PACER trial enrolled 375 adults discharged from EDs at six university health systems after low-risk chest pain who had at least moderate anxiety and compared primary care follow-up, peer-supported internet-based CBT and therapist-delivered CBT by telehealth, according to results published Sept. 28 in JAMA Internal Medicine. Over 12 months, the peer-supported program improved Generalized Anxiety Disorder-7 scores 1.22 points more than primary care referral (95% CI 0.01 to 2.43), with the strongest effect, 2.8 points, in severe anxiety. Odds of patient-reported global improvement were three times higher in both CBT groups than with primary care referral.
  Sources: JAMA Internal Medicine, PubMed
• Research Sept 28, 2026
  Trial at two Michigan EDs: telehealth counseling cuts risky firearm behaviors 57.4% versus 25.4% in young carriers
  Researchers at two U.S. trauma center EDs in Michigan randomized 373 people aged 16 to 30 who reported carrying a firearm in the previous three months to three telehealth counseling sessions using motivational interviewing plus a smartphone app or to a control group that received an assessment-only app for 30 days. At six months, self-reported risky firearm behaviors fell 57.4% in the intervention group versus 25.4% in the control group (rate ratio 0.51; 95% CI 0.33 to 0.79), according to the trial published Sept. 28 in JAMA Pediatrics.
  Sources: JAMA Pediatrics, PubMed
• Public health Oct 1, 2026
  CDC: patient actors simulating H5 avian influenza were masked and isolated in 44 of 73 unannounced facility drills
  In unannounced drills from January to June 2026, patient actors presenting with a simulated avian influenza A(H5) scenario to EDs, outpatient clinics and urgent care centers in New Jersey, New York and the U.S. Virgin Islands were masked and isolated in 44 of 73 drills (60%), the Centers for Disease Control and Prevention reported Oct. 1. Isolation occurred in 52 drills (71.2%), a median of 11.0 minutes after entry. Clinicians wore all required personal protective equipment in 25.0% of drills, and internal infection prevention staff were notified or scheduled to be notified in 40 of 73 (54.8%).
  Source: CDC MMWR
• Public health Oct 1, 2026
  CDC's violent death reporting system counts 72,093 deaths in 2023, with firearms used in 58.6%
  The National Violent Death Reporting System collected information on 70,133 fatal incidents involving 72,093 deaths in 2023 from the District of Columbia, 47 states with statewide data and counties covering part of California, Florida and Texas, the Centers for Disease Control and Prevention reported Oct. 1. Of those deaths, suicides made up 62.4% and homicides 28.5%; firearms were used in 58.6% of all deaths, 54.5% of suicides and 77.8% of homicides. People aged 24 or younger accounted for about 55% of unintentional firearm injury deaths. Puerto Rico data covered another 730 deaths.
  Source: CDC MMWR Surveillance Summaries
• Public health Oct 1, 2026
  CDC reports fatal pneumonic plague in Arizona man who died less than eight hours after admission
  A young adult man was evaluated in a Coconino County, Arizona, emergency department in July 2025 after two days of abdominal pain, chest pain and dry cough and died less than eight hours after admission, the Centers for Disease Control and Prevention reported Oct. 1. He had occupational exposure to two sick cats four and five days before illness onset; Yersinia pestis was detected six days after his death, and 46 potentially exposed people began ciprofloxacin prophylaxis. The authors said clinicians where plague is endemic should consider it in patients with severe respiratory and systemic disease exposed to ill animals.
  Source: CDC MMWR