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Increasing enrollment of students who are underrepresented in medicine has been a priority of United States (US) medical schools. The authors sought to compare how increasing minority student representation factors into mission statements, statements of values, and strategic action plans at top research-oriented US medical schools and US medical schools with a social mission. A Web search was performed to locate three documents for each medical school: the mission statement; a statement of values; and a strategic plan. Data were retrieved on the number of underrepresented minority graduates and total graduates from each school in the graduating classes of 2015–2019. The number and percentage of graduates during this period were compared according to schools’ mission statements using rank-sum tests. Other quantitative study data were compared by school mission using Fisher’s exact tests. Five of the schools with a social mission (25%) and none of the schools with a research mission had a mission statement that addressed increasing representation of underrepresented minority students in the medical school (p = 0.047). Schools with a mission statement that addressed this group had a higher proportion of those graduates during 2015–2019 (median 66%; IQR 28%, 68%) compared to schools that did not address this in their mission statement (median 10%; IQR 6%, 13%; p = 0.003). More research is needed to explore the association between US medical school mission statements and the representation of underrepresented students in medical education, especially at research-oriented medical schools.

[...]accurately describing how volatile anesthetics are associated with delirium requires balancing methods used to remove statistical bias (e.g., prevent distortion of odds ratios [ORs] due to confounding) with methods that are used to preserve statistical efficiency (i.e., prevent the 95% confidence intervals [CIs] from becoming so wide as to be meaningless). [...]a simpler model can be fit to the cases within each “leaf.” [...]the findings supply valuable information for trial design, including a plausible effect size for volatile anesthetics, and information about the patient population in which randomized trials of anesthetic type for delirium prevention might be most relevant.

Background Social determinants of health (SDH) influence emergency department (ED) use among children with asthma. We aimed to examine if SDH were more strongly associated with ED use among children with moderate/severe compared to mild asthma. Methods This study utilized the 2016–2019 data from the National Survey of Children’s Health. Children with asthma ages 0–17 years ( N  = 9937) were included in the analysis. Asthma severity and all-cause ED use in the past year were reported by caregivers. The association between patient factors and ED visits was evaluated using ordinal logistic regression. Results Based on the study sample, 29% of children with asthma had moderate/severe asthma. In the mild group, 30% visited the ED at least once in the past 12 months, compared to 49% in the moderate/severe group. SDH associated with ED visits included race/ethnicity, insurance coverage, and parental educational attainment, but the strength of these associations did not vary according to asthma severity. Conclusions In a nationally representative data set, SDH were equally predictive of ED use regardless of children’s asthma severity. Interventions to reduce ED use among children with asthma should be considered for children with any severity of asthma, especially children in socially disadvantaged groups at higher risk of ED utilization.

We document patterns of intermarriage between immigrants and natives during a period of unprecedented growth in the size and diversity of America's foreignborn population. Roughly one in six U.S. marriages today involve immigrants and a large share includes U.S.-born partners. Ethno-racial background clearly shapes trajectories of immigrant social integration. White immigrants are far more likely than other groups to marry U.S.-born natives, mostly other whites. Black immigrants are much less likely to marry black natives or out-marry with other groups. Intermarriage is also linked with other well-known proxies of social integration—educational attainment, length of time in the country, and naturalization status. Classifying America's largest immigrant groups (e.g., Chinese and Mexican) into broad panethnic groups (e.g., Asians and Hispanics) hides substantial diversity in the processes of marital assimilation and social integration across national origin groups.

Objectives: Barriers to healthcare in rural areas can delay treatment in pediatric patients who have experienced poisoning. We compared emergency medical services (EMS) response times and EMS-reported delays in responding to pediatric poisoning incidents between rural and urban settings using the 2021 National Emergency Medical Services Information System (NEMSIS). Methods: The NEMESIS defines rural areas as locations with a population of <50,000, not part of metropolitan areas, while all other locations are classified as urban (metropolitan) areas. In this study we included 11,911 patients (12% rural) <18 years of age who were transported by EMS with a first-responder primary impression of poisoning. We compared study variables using rank-sum tests and chi-square tests. Multivariable analysis of outcomes included quantile regression and logistic regression for continuous data and categorical data, respectively. Results: The median total prehospital time by EMS was 40 minutes (interquartile range 29-57), and the most common type of delay was scene delay (6%). On multivariable quantile regression, patients transported by rural EMS agencies experienced 6.6 minutes (95% confidence interval 5-8, P<0.001) longer prehospital time than those transported by urban agencies. There were no differences between rural and urban EMS agencies in the occurrence of dispatch, response, scene, and transportation delays. Conclusion: These results elucidate the need for equitable allocation of resources and training to enhance rural EMS responders. The additional nearly seven minutes translates into greater risk for the human body to remain physiologically unstable and not be optimally treated. Therefore, by integrating targeted interventions to rural pediatric populations, better care can be achieved across all geographic regions. Further research must be conducted to ascertain the specific factors, aside from delays, that result in the disparity between rural and urban prehospital response time.

INTRODUCTION:Colonoscopy is highly sensitive for the detection of precancerous polyps and for the visualization of the entire colon during colorectal screening. Inpatient colonoscopies pose a special risk of poor preparation. We reviewed bowel preparation methods and patient factors to identify predictors of inadequate bowel preparation for inpatient colonoscopy at our institution.METHODS:All patients ages older than 18 years of age undergoing inpatient colonoscopy in 2017–2018 were reviewed. The primary outcome was inadequate bowel preparation and secondary outcomes were successful cecal intubation, duration of colonoscopy, and hospital LOS. Outcomes were compared according to demographic characteristics, comorbidities, abdominal surgery, and medications using multivariable regression with stepwise covariate selection. Statistical significance was set at P < 0.05.RESULTS:The analysis included 315 patients (median age = 67 years; 45% female, Table 1). The majority of colonoscopies were performed for anemia (78%). Visualization was deemed adequate in 56%, fair in 27%, and poor in 17% of cases. Cecal intubation was successful in 84% of cases. The median duration of colonoscopy was 25 min and LOS was 2 days. Unsuccessful cecal intubation was most likely with poor visualization (36% vs 11%, P = 0.014). There was no increased colonoscopy duration with poor visualization (P = 0.075). There was no significant LOS with worse visualization quality (P = 0.185). Factors predicting worse visualization quality included older age, history of CHF, cirrhosis, and motility disorders (Table 2). Older age, COPD, and colonoscopy performed for other indications were associated with unsuccessful cecal intubation. Factors predicting prolonged LOS included several comorbidities and usage of iron or neuromodulators (Table 3).CONCLUSION:At our institution, patients who were older or had significant co-morbid conditions (CAD, CHF, COPD, motility disorders, or cirrhosis) were more likely to have inadequate inpatient bowel preparation. Other studies found similar findings in patients with diabetes, cirrhosis, history of stroke or TCA use. Bowel preparation type did not affect the duration, quality of visualization, or the success of cecal intubation. Further work is needed to optimize inpatient bowel preparation protocols in older patients with multiple co-morbidities. Future studies should evaluate the success of bowel preparation in inpatient setting with a standardized bowel preparation score like the Boston Bowel Prep score.

To date, research on opioid overdose during the COVID-19 pandemic has focused on rates of Emergency Department (ED) visits related to opioids but has not considered how interaction with concurrent COVID-19 infection may have influenced clinical outcomes. We hypothesized that COVID-19 infection increased the need for respiratory support, prolonged hospital stays, and increased mortality among ED patients admitted to the hospital after presenting with opioid overdose. The 2020 National Emergency Department Sample (NEDS) was used to identify patients admitted to the hospital after presenting to the ED with opioid overdose, and whose COVID-19 infection status could be determined. The primary outcome was the use of respiratory support, and secondary outcomes were hospital length of stay (LOS) and mortality. Among the 5913 eligible patients, 3 % had a COVID-19 infection diagnosis. Among all included patients, 28 % received respiratory support, in-hospital mortality was 4 %, and the mean hospital length of stay was 3.9 days. After multivariable adjustment, COVID-19 was not associated with the use of respiratory support (odds ratio [OR]: 0.98; 95 % confidence interval [CI]: 0.67, 1.44; p = 0.938). COVID-19 was associated with higher odds of in-hospital mortality (OR: 2.22; 95 % CI: 1.20, 4.11; p = 0.011) and longer hospital stay (incidence rate ratio: 1.57, 95 % CI: 1.22, 2.01; p < 0.001). This data suggests that COVID-19 infection in patients admitted to the hospital with opioid overdose results in higher morbidity and longer hospital stay, but had no association with the use of respiratory support. The physiologic cause deserves future study.