OBJECTIVES:Differences in COVID-19 outcomes may reflect variation in clinical expertise, institutional resources, and care coordination between academic teaching and non-teaching hospitals. We evaluated differences in patient characteristics, resource utilization, and mortality between hospital types during the early phase of the pandemic. METHODS:We conducted a retrospective cohort study of 2,767 adults (≥18 years) with COVID-19 presenting to five hospitals within the Johns Hopkins Health System between March 1 and 4 May 2020. Patient characteristics, clinical presentation, laboratory findings, and outcomes were compared between academic teaching and non-teaching hospitals. Group comparisons were performed using unpaired t-tests and chi-square tests. Multivariable logistic regression assessed the association between hospital teaching status and in-hospital mortality. A primary model included variables with minimal missing values, while a secondary model incorporated laboratory variables using complete-case analysis. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC) and the Hosmer-Lemeshow goodness-of-fit test. RESULTS:Of 2,767 patients, 801 (29%) were evaluated at academic teaching hospitals. Patients at academic centers had higher comorbidity burden and more severe clinical presentation, whereas patients at non-teaching hospitals had lower access to healthcare resources. Emergency department length of stay (430 vs 269 minutes, p < 0.001), hospital length of stay (12.2 vs 4.4 days), and hospitalization costs ($55,868 vs $5,543, p < 0.001) were higher in teaching hospitals. Mortality was higher in non-teaching hospitals across both adjusted models. In the primary (n = 2,605) model (OR 6.86; 95% CI 5.18-9.10; AUC 0.70) and the secondary (n = 372) model (OR 13.4; 95% CI 7.28-24.7; AUC 0.82). CONCLUSIONS:These findings suggest that structural differences, including resource availability and healthcare access, may contribute to disparities in COVID-19 outcomes. Non-teaching hospitals, while managing high volumes with limited resources, had markedly higher mortality despite lower comorbidity burden. Further investigation of system-level determinants of outcomes during public health emergencies is warranted.

Hyperglycemic chorea (HC), also known as diabetic striatopathy, is a rare, potentially reversible complication of poorly controlled diabetes mellitus. It manifests as involuntary, often unilateral, choreiform or ballistic movements. Despite its clinical significance, HC remains underrecognized, and its pathophysiology is not fully understood. We present a case of HC and a narrative review of the published case reports to characterize its epidemiology, clinical features, imaging findings, treatment, and outcomes. We conducted a narrative review of case reports and case series on HC using PubMed/MEDLINE from inception to 1 September 2024, following PRISMA guidelines. Inclusion criteria were English-language reports of adult patients (≥18 years) with chorea attributed to hyperglycemia. A total of 80 publications encompassing 100 patients were included. The mean age was 66.6 years, with a female predominance (67%). Hemichorea was more common (71%), with left-sided preponderance. Most patients (75%) had a prior diagnosis of diabetes, and the mean presenting blood glucose and HbA1c were 468 mg/dL and 13.7%, respectively. Imaging revealed basal ganglia hyperintensity on MRI in 80% of cases. Treatment primarily involved insulin therapy, with 69% receiving adjunctive anti-chorea medications. Symptom resolution occurred in 73.9% of patients, with a mean recovery time of 36.7 days. HC is an important differential diagnosis for acute-onset chorea in elderly patients with uncontrolled diabetes. Prompt recognition and glycemic control are key to symptom resolution. Neuroimaging, particularly MRI, plays a crucial role in diagnosis, and adjunctive pharmacotherapy may aid in symptom management.

ObjectiveTo determine the prevalence of nonadherence to breast cancer and colorectal cancer screening, associated risk factors, and screening preference among hospitalized women with and without diabetes aged 50-75 years who were cancer-free at baseline.MethodsA prospective study compared women with and without diabetes who were cancer-free (except for skin cancer) at baseline and between 50 and 75 years of age, admitted to the general medical service at an academic center were approached for study participation from December 1, 2014, to May 31, 2017. The study evaluated breast and colorectal cancer screening nonadherence prevalence, preference for screening locale, sociodemographic and clinical variables associated with nonadherence using multivariable logistic regression model.ResultsOf 510 women, 39% had a prior diagnosis of diabetes mellitus, and 36% were African American. Women with diabetes were more likely to have obesity, reliance on assistive devices for ambulation, inability to work (have a disability), and a greater average number of comorbidities compared to women without diabetes. Women with or without diabetes were equally nonadherent with BRC (28% vs 36%, p = 0.6) and CRC (25% vs 28%, p = 0.51) screening guidelines. After adjustment for sociodemographic and clinical risk factors, only high risk for CRC (OR = 3.20, 95%CI; 1.03-9.91) was an independent risk factor associated with nonadherence to BRC among hospitalized women with diabetes. Whereas after similar adjustment, age younger than 60 years (OR = 2.91, 95%CI; 1.15-7.35) and current or prior smoking (OR = 2.80, 95%CI; 1.14-6.86) were associated with nonadherence to CRC among women with diabetes. 46% of women with diabetes expressed a preference for in-hospital screening for BRC, while 45% expressed a similar preference for CRC.ConclusionHospitalizations may offer additional screening opportunities as almost half of the women with diabetes preferred undergoing breast and colorectal cancer screening during a hospital stay.

Background: Weekend presentation to the emergency department (ED) has been associated with increased morbidity and mortality in various clinical settings. However, the literature is scant whether such an effect exists for patients presenting with COVID-19 infection. Additionally, comparative analyses of mortality predictors in COVID-19 patients evaluated at the emergency department need further exploration. Methods: This retrospective cohort study examined factors associated with mortality among adult patients (aged ≥ 18 years) who presented with COVID-19 to the emergency departments of five hospitals within the Johns Hopkins Health System (combined capacity: 2513 beds) between March 1 and 4 May 2020. Data were extracted from electronic health records. Multivariable logistic regression was utilized to assess the relationship between mortality and a range of variables, including sociodemographic characteristics, clinical presentation, laboratory parameters, pre-existing comorbidities, and weekend versus weekday presentation. Results: Of the 2767 patients, 685 (25%) presented to the emergency department on weekends. Compared to weekday presenters, weekend patients were more likely to be hospitalized (64%), and these patients had a mean symptom duration of 5 days (SD ± 6). Weekend presenters also exhibited higher rates of clinical frailty, dehydration, hypoxia, and respiratory distress upon arrival. In multivariable logistic regression analysis adjusting for sociodemographic characteristics, clinical risk factors, and laboratory findings, independent predictors of increased mortality included absence of a primary care provider (OR 3.47; 95% CI: 2.37–5.07), peripheral oxygen saturation (SpO2) < 95% at presentation (OR 1.46; 95% CI: 1.001–2.12), and hyperglycemia (OR 2.13; 95% CI: 1.25–3.65). Notably, the presence of crackles on physical examination demonstrated a trend toward reduced mortality (OR 0.47; 95% CI: 0.24–0.92). Conclusions: While weekend presentation was associated with higher hospitalization rates among patients with COVID-19, it did not independently predict increased mortality. Absence of a primary care provider, hypoxia, and hyperglycemia at presentation emerged as strong, independent predictors of mortality in the ED setting. Race, gender, and obesity were not significantly associated with mortality in this cohort, warranting further investigation. These findings may support more effective triage and risk stratification strategies in current and future public health emergencies.

Background Oral cancer screenings are often on the back burner in the face of other cancer screenings. In high-risk individuals, early detection of oral cancer has a better prognosis and survival. Hospitalization may offer an opportunity to target high-risk populations. This study evaluates the prevalence of women at high risk for oral cancer among hospitalized women and their preference for oral cancer screening. Design and participants Five hundred and ten cancer-free women admitted to the hospital under the internal medicine service at an academic center were enrolled to participate in the study. Three hundred and seventy women were at high risk for developing oral cancer, defined by smoking status, alcohol use, or both. High-risk women received bedside smoking cessation counseling and oral cancer informational handouts and were offered oral screening examinations during hospitalization. Six months after discharge, study participants received a follow-up phone call to determine if these women discussed oral cancer screening with their primary care physicians at the follow-up visit. Results Seventy-three percent of the hospitalized women were at high risk for developing oral cancer. Fifty-seven percent of high-risk women reported having no primary dentist. High-risk women were more likely to be younger, reported a disability, and had a lower comorbidity burden than the average-risk group. Only 41% of high-risk hospitalized women received oral cancer screening examinations during the hospital stay. Post-hospitalization, 66% of high-risk patients discussed oral cancer screening with their primary care. Conclusion Almost three-fourths of hospitalized women are at high risk for developing oral cancer. Hospitalization provides an opportunity to educate and screen high-risk populations.

Pellagra, a rare disorder caused by niacin deficiency, manifests as 4Ds: dermatitis, diarrhea, dementia, and, if left untreated, death. Though it was thought to be eradicated from the United States after fortification with niacin, there have been concerns about its reemergence in specific high-risk populations such as chronic alcoholism, malabsorption, and anorexia nervosa. Here we present a patient with altered mental status who subsequently developed diarrhea during the course of hospitalization. After extensive workup, the final diagnosis was determined to be pellagra. The patient was administered niacin, resulting in subsequent improvement, and was discharged in stable condition from the hospital. Our case report highlights the importance of considering pellagra in the differential diagnosis for certain high-risk patients presenting with altered mental status as it has not been completely eradicated yet.

Amiodarone is an antiarrhythmic drug with a significant adverse effect profile, including neurotoxicity. While ataxia, neuropathy, and tremors are more commonly seen forms of amiodarone neurotoxicity, very few cases of nystagmus are reported. We report the case of an 86-year-old man who presented with abrupt-onset ataxia, dizziness, and inability to ambulate, 10 days after initiating amiodarone for atrial fibrillation. His examination revealed gaze-evoked nystagmus along with features of cerebellar dysfunction. After excluding other etiologies, amiodarone was stopped. His nystagmus resolved, and his ataxia improved within 48 h of stopping amiodarone. Due to the rarity of this drug-induced adverse effect, we performed a systematic review of available case reports in the literature (PubMed and Scopus) using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and presented our findings. Nystagmus is a rarely reported adverse effect of amiodarone, which can occur within days to months of starting the medication. Treatment includes stopping the drug and monitoring for resolution of nystagmus.

1050 Background: Breast cancer is the most commonly diagnosed cancer and second leading cause of death due to cancer in women in the United States. We aimed to determine site specific incidence of SPMs in post-menopausal women with primary BC using data from the US Surveillance, Epidemiology, and End Results (SEER-17) cancer registries. Methods: We retrospectively analyzed post-menopausal women aged 45 or older with a first primary breast cancer diagnosis between 2000 and 2019, excluding those aged 45 or younger or with non-breast cancers as their first malignancy. We defined SPMs as second malignancies occurring at least 6 months after the initial breast cancer diagnosis and calculated standardized incidence ratios (SIRs) and absolute excess risk (AER) using SEER*Stat. Statistical significance was determined using p-values <0.05 and a 95% CI assuming a Poisson distribution of SPM incidence. Results: Among 774,965 post-menopausal women ≥45 years old with primary breast cancer, 10.8% developed SPMs, with significantly increased risk compared to the general population (SIR=1.14, 95% CI=1.13-1.15, p<0.05), particularly for solid tumors (SIR=1.16, 95% CI=1.15-1.16, p<0.05) and certain malignancies including salivary gland (SIR=1.77), thyroid (SIR=1.56), endocrine system (SIR=1.56), and hematological malignancies such as ALL, ANLL, and AML (SIR>1.70). Women aged 45-59 and Black women had the highest risk for all malignancies. PR receptor-positive women had higher risk for thyroid SPMs, while PR-negative women had higher risk for SPMs in female genitalia, bones and joints, and hematological malignancies. HER-positive and triple-positive (HER ER PR) women had higher risk for thyroid and hematological SPMs, while triple-negative women had higher risk for ALL, ANLL, and AML. Conclusions: This study found that 11% of post-menopausal women with primary BC develop SPMs, with thyroid cancer being the most common. Black and older women (45-59 years) had a higher risk of developing SPMs. [Table: see text]

OBJECTIVES:This study explored the prevalence of nonadherence and preferences for breast cancer (BRC) and colorectal cancer (CRC) screening among hospitalized women with and without obesity who were cancer-free at baseline. In addition, the study evaluated risk factors associated with nonadherence among hospitalized women with obesity. METHODS:A prospective interventional study evaluated nonadherence prevalence and preference for cancer screening among hospitalized women aged 50 to 75 years. The intervention consisted of one-to-one bedside education via handouts about cancer screening. In addition, multivariable logistic regression models assessed associations between sociodemographic and clinical comorbidity variables believed to influence screening adherence among hospitalized women. Six months after discharge from the hospital, study participants received a follow-up telephone survey to determine adherence to BRC/CRC screening guidelines. RESULTS:Of 510 enrolled women, 61% were obese (body mass index ≥30 kg/m2). Women with and without obesity were equally nonadherent to BRC (34% vs 32%, P = 0.56) and CRC (26% vs 28%, P = 0.71) screening guidelines. Almost half of the study population preferred undergoing indicated BRC/CRC screening in the hospital regardless of obesity status. After adjustment for sociodemographic and clinical risk factors, not having a primary care physician (odds ratio [OR] 5.88, 95% confidence interval [CI] 2.20-15.7) and nonadherence to CRC screening (OR 3.65, 95% CI 1.94-6.54) were associated with nonadherence to BRC screening among women with obesity. After similar adjustment, having an education less than high school level (OR 2.55, 95% CI 1.21-5.39) and nonadherence to BRC screening (OR 3.64, 95% CI 1.97-6.75) were associated with nonadherence to CRC among women with obesity. CONCLUSIONS:Women with obesity are at risk of being underscreened for obesity-related malignancies, and hospitalizations may offer screening opportunities for BRC and CRC.

Guillain-Barre syndrome (GBS) is an autoimmune inflammatory polyneuropathy, which can be challenging to diagnose due to variability in the initial presenting features. Pain, flaccid paresis, motor sensory disturbance, hyporeflexia, and autonomic dysfunction are the typical manifestations, although atypical features, such as ataxia, neck stiffness, dysphagia, ophthalmoplegia, bulbar palsy, and isolated upper limb weakness, may be seen. It may also progress to fatal respiratory depression. As such, timely diagnosis and treatment are essential. We present the case of a 41-year-old man who presented with a four-day history of acute-onset bilateral lower extremity swelling, decreased motor strength, diffuse muscle pain, hyporeflexia, and absent vibratory sensation. After admission, symptoms worsened, and the patient developed new-onset swallowing difficulty and urinary retention. Neurological examination findings of hyporeflexia and flaccid paralysis, along with normal thyroid function, and the absence of cord compression on spinal MRI pointed toward the diagnosis of GBS. Nerve conduction studies (NCS) and concentric electromyography (EMG) confirmed the diagnosis. The patient was treated with intravenous immune globulin (IVIG) and eventually discharged to a rehabilitation facility after a 12-day hospital stay. Later, the patient developed contractures and chronic pain consistent with post-GBS syndrome, for which we referred him for pain management and physical therapy. A rapidly progressive weakness with autonomic dysfunction should prompt suspicion of GBS and should be treated with intravenous immunoglobulins or plasma exchange without further delay.

BACKGROUND:Lung cancer screening with low-dose computer tomography (CT) has been shown to reduce the lung cancer mortality in high-risk individuals by 20%. Despite the proven mortality benefit, the utilization of lung cancer screening among high-risk populations remains low. OBJECTIVE:This study explores the prevalence of high-risk population for developing lung cancer among hospitalized women and evaluates the screening behavior toward other common cancers during a hospital stay. METHODS:This is a cross-sectional study in which 248 cancer-free hospitalized women aged 50-75 years who reported current or prior smoking were enrolled during hospital admission at an academic center. A bedside survey was conducted to collect socio-demographic, cancer screening behavior, and medical comorbidities for the study patients. Unpaired t-test and Chi-square tests were used to compare characteristics and common cancer screening behavior by lung cancer risk stratification. RESULTS:Forty-three percent of the hospitalized women were at intermediate to high-risk for developing lung cancer risk. Intermediate to high-risk women were more likely to be older, Caucasian, retired, or with a disability, and had higher comorbidity burden as compared to the low-risk group. Women at low and intermediate to high risk were equally non-adherent with breast (35% vs 31%, p = 0.59) and colorectal (32% vs 24%, p = 0.20) cancers screening guidelines. Only 38% of women from the intermediate to the high-risk group had a CT chest within the last year. CONCLUSION:The study's findings suggest that almost half of the hospitalized women who report current or past smoking are at high-risk for developing lung cancer.

Osmotic demyelination syndrome (ODS) is seen due to an overt rise in serum osmolality, most often during rapid correction of chronic hyponatremia. We present the case of a 52-year-old patient who presented with polydipsia, polyuria, and elevated blood glucose with rapid correction of glucose levels under five hours and developed dysarthria, left-sided neglect, and unresponsiveness to light touch and pain in the left extremities on the second day of hospitalization. MRI revealed restricted diffusion in the central pons, extending into extrapontine areas suggestive of ODS. Our case highlights the importance of cautious correction of serum hyperglycemia and monitoring serum sodium levels in patients with a hyperosmolar hyperglycemic state (HHS).

Tissierella praeacuta is a rare gram-variable bacillus that naturally occurs in the environment and is pathogenic in humans with chronic infections. We report the case of a 45-year-old man with a history of chronic osteomyelitis of the left tibia and recurrent bacteremia secondary to intravenous drug use (IVDU). He had previously received multiple partially completed courses of antibiotics over the past one year. Blood cultures demonstrated polymicrobial infection, including T. praeacuta and methicillin-sensitive Staphylococcus aureus managed with parenteral beta-lactams, and the subsequent first surveillance cultures remained sterile. Medical literature on human infections with T. praeacuta is limited due to its rare occurrence. Most cases have reported sensitivity to beta-lactam antibiotics, making them an antibiotic of choice. T. praeacuta infections should prompt a search for additional underlying infectious foci and treatment of any additional co-infecting microbes.

OBJECTIVE:Life expectancy is an important tool for physicians and patients to determine when medical services for disease prevention should be rendered. Since patients' preference is an important predictor for cancer screening compliance, incorporating life expectancy with cancer screening preferences becomes essential. The purpose of the study is to explore the mean life expectancy duration that hospitalized women expect in order to undergo cancer screening tests. METHODS:A cross-sectional bedside survey including the contingent valuation method was used to assess the mean life expectancy among 475 cancer-free hospitalized women aged 50-75 years, which justified their willingness to undergo cancer screening tests. The probit and logistic regression models were used for the analysis in October 2021. RESULTS:A total of 74% of women were willing to undergo cancer screening if the mean life expectancy was 24.3 months (SE = 12.8, p = 0.058). After adjustment for sociodemographic and clinical covariates, hospitalized women were willing to undergo cancer screening if the mean life expectancy was 26.6 months (SE = 13.3, p = 0.045). Race (African American and others vs Caucasians, OR = 2.34, 95% CI: 1.43-3.81) and annual household income <$20,000 (OR = 1.71, 95% CI: 1.02-2.86) were associated with the willingness to undergo cancer screening among hospitalized women. CONCLUSION:The study's findings suggest that hospitalized women value the prospect of cancer screening tests, given the mean life expectancy of approximately 27 months. Therefore, offering screening tests to nonadherent hospitalized women with a mean life expectancy of 2¼ years, especially to those at high risk for developing cancer, with low income, or women of color, may improve adherence to cancer screening recommendations.

Background: Barriers to colorectal cancer screening persist despite screening campaigns, especially among women. This study explores the prevalence, preferences, and barriers associated with colorectal cancer screening and evaluates the effect of an inpatient intervention (one-on-one bedside education and handout about colorectal cancer) on screening adherence among hospitalized women. Methods: A prospective intervention study among 510 hospitalized women, who are cancer-free (except for skin cancer) at enrollment, aged between 50 and 75 years was conducted at an academic center. Socio-demographic, family history, and medical comorbidities data were collected for all patients. A post-hospitalization follow-up survey determined the effect of inpatient intervention on colorectal cancer screening adherence. Unpaired t-test and chi-square tests were used to compare characteristics, perspectives, and preferences for screening among adherent and non-adherent groups. Results: Mean age was 60.5 years, 45% reported an annual household income of <$20 000, 36% of women were African American, 27% of women were overdue for colorectal cancer screening, and 33% never had a screening colonoscopy. The most frequently reported barriers to colorectal cancer screening were “I have other problems more important than getting a colonoscopy,” “No transportation to get to the test,” and “Not counseled by primary care provider.” Sixty-six percent of the non-adherent women would agree to have an inpatient screening colonoscopy if offered. Conclusion: A significant number of hospitalized women are non-adherent to colorectal cancer screening, while the educational intervention was partially successful in enhancing colorectal cancer screening, most hospitalized women remained non-adherent after hospitalization. A majority of these women were amenable to inpatient screening colonoscopy if offered during a hospital stay.

ABSTRACT Objective To evaluate prevalence of nonadherence to breast cancer screening guidelines after bedside educational intervention and informed individualized risk assessment score during an inpatient stay. Methods A prospective intervention study was conducted among 507 cancer-free (except skin cancer) women aged 50–75 years hospitalized to a general medicine service. Study intervention included one-on-one bedside education via handout and videos about breast cancer screening and informed individualized risk assessment using the Gail risk model to predict 5-year risk for breast cancer development. Study outcomes were measured using posthospitalization follow-up survey to determine if intervention resulted in improved adherence to breast cancer screening. Chi-square and unpaired t-tests were utilized to compare population characteristics. Results The mean age for the study population was 60.5 years (SD = 6.9), the mean 5-year Gail risk score was 1.77 (SD = 1), and 36% of women were African American. One hundred sixty nine (33%) hospitalized women were nonadherent to breast cancer screening recommendations. Only 15% of the nonadherent women were reachable for follow-up survey, and 42% of these women self-reported adherence to screening mammography after a mean follow-up period of 27 months. Conclusion This study provides evidence that most women who are nonadherent to breast cancer screening remain nonadherent after hospital discharge despite educational interventions. Our study intervention was only partially successful in enhancing breast cancer screening among hospitalized women who were overdue and at high risk. Further studies need to evaluate strategies to overcome the barriers and improve adherence whenever patients encounter health care system regardless of clinical locale.

Hereditary Angioedema (HAE) is a rare disorder caused by C1 esterase inhibitor deficiency or dysfunction. Patients with HAE usually present without urticaria or pruritis affecting the skin, upper airway, or the gastrointestinal tract. They can also present with involvement of unusual sites making the diagnosis challenging and leading to unnecessary testing and complications. Prompt diagnosis and treatment is crucial to prevent mortality and morbidity associated with acute flare. Here we present, what is believed to be second case of isolated involvement of the jejunum from an attack of HAE.

Objectives Despite proven mortality benefit, disparities in colorectal cancer (CRC) screening utilization persist, especially among younger women, minorities, and low-income women, even those who are insured. The purpose of the present study is to evaluate and estimate the effects of sociodemographic and clinical variables associated with nonadherence to CRC screening among hospitalized women. Methods A cross-sectional bedside survey was conducted to collect sociodemographic and clinical comorbidity data believed to affect CRC screening adherence of hospitalized women aged 50 to 75 years who were cancer free (except skin cancer) at enrollment. Logistic regression models were used to assess the association between these factors and nonadherence CRC screening. Results In total, 510 women were enrolled for participation in the study. After adjustment for sociodemographic and clinical predictors, only two variables were found to be independently associated with nonadherence to CRC screening: age younger than 60 years (odds ratio [OR] 2.62, 95% confidence interval [CI] 1.58-4.33) and nonadherence to breast cancer screening (OR 3.72, 95% CI 2.29-6.04). By contrast, hospitalized women at high risk for CRC were more likely to be compliant with CRC screening (OR 0.14, 95% CI 0.04-0.50). Conclusions Both younger age and behavior toward screening remain barriers to CRC screening. Hospitalization creates an environment where patients are in close proximity to healthcare resources, and strategies could be used to capitalize on this opportunity to counsel, educate, and motivate patients toward this screening that is necessary for health maintenance. Seizing on this opportunity may help improve CRC screening adherence.

Background: Despite the proven mortality benefit of screening colonoscopy, similar to 27% of hospitalized women are nonadherent with colorectal cancer (CRC) screening guidelines. Colonoscopy is the most frequently used test for CRC screening in the United States. Although CRC is the second most common cause of cancer death in the United States, CRC screening has not been part of usual hospital care.Objective: This study explores how hospitalized women perceive value of inpatient screening colonoscopy by evaluating the mean amount of money that hospitalized women are willing to contribute toward the cost of a screening colonoscopy during a hospital stay.Methods: A cross-sectional bedside survey consisting of a contingent valuation questionnaire was used to assess the contribution these women considered to be justified for the convenience of an inpatient screening colonoscopy. The probit regression model was used for the analysis of contingent valuation data to predict mean willingness to pay toward inpatient screening colonoscopy.Results: Of the 312 enrolled patients, 48% were willing to pay a mean of $171.56 (95% confidence interval [CI] $37.59-$305.54, p = 0.012) in advance toward the cost of an inpatient screening colonoscopy. After adjustment of possible sociodemographic and clinical covariates that could impact willingness to contribute, hospitalized women were willing to pay a mean of $178.41 (95% CI $40.67-$316.16, p = 0.011).Conclusions: The findings of this study suggest that hospitalized women value the prospect of screening colonoscopy during hospitalization. Offering screening colonoscopy to nonadherent hospitalized women, especially those who are at high risk for developing CRC, may improve adherence among hospitalized women.This study is registered at www.clinicaltrials.gov (NCT04162925).

Background: Management of patients with syncope lacks standardization. We sought to assess regional variation in hospitalization rates and resource utilization of patients with syncope. Methods: We identified adults with syncope using the Nationwide Emergency Department Sample from years 2006 to 2014. Demographics and comorbidity characteristics were compared across geographic regions in the US. Multiple regression was conducted to compare outcomes. Results: 9,132,176 adults presented with syncope. Syncope in the Northeast (n = 1,831,889) accounted for 20.1% of visits; 22.6% in the Midwest (n = 2,060,940), 38.5% in the South (n = 3,527,814) and 18.7% in the West (n = 1,711,533). Mean age was 56 years with 57.7% being female. The Northeast had the highest risk-adjusted hospitalization rate (24.5%) followed by the South (18.6%, ORadj 0.58; 95% CI 0.52-0.65, p < 0.001), the Midwest (17.2%, ORadj 0.51; 95% CI 0.46-0.58, p < 0.001) and West (15.8%, ORadj 0.45; 95% CI 0.39-0.51, p < 0.001). Risk-adjusted rates of syncope hospitalizations significantly declined from 25.8% (95% CI 24.8%-26.7%) in 2006 to 11.7% (95% CI 11.0%-12.5%) in 2014 (P-trend < 0.001). The Northeast had the lowest risk-adjusted ED (Emergency Department) service charges per visit ($3320) followed by the Midwest ($4675, IRRadj 1.41; 95% CI 1.30-1.52, p < 0.001), the West ($4814, IRRadj 1.45; 95% CI 1.31-1.60, p < 0.001) and South ($4969, IRRadj 1.50; 95% CI 1.38-1.62, p < 0.001). Service charges increased from $3047/visit (95% CI $2912-$3182) in 2006 to $6267/visit (95% CI $5947-$6586) in 2014 (P-trend < 0.001). Conclusions: Significant regional variability in hospitalization rates and ED service charges exist among patients with syncope. Standardizing practices may be needed to reduce variability. (C) 2021 Elsevier Inc. All rights reserved.