The United States faces a challenge that affects millions of people: the opioid epidemic, also referred to as the opioid crisis. In October 2017, the President of the United States declared the opioid epidemic a public health crisis.[1][1] The hope is that federal funding will be provided to address

Central nervous system (CNS) tumors are a rare but devastating malignancy, often robbing patients of the basic quality of life. Despite advances in our understanding of the CNS tumor disease processes, the prognosis for patients with CNS tumors remains poor. Better characterization and diagnostic and monitoring approaches are necessary to assist in diagnosis and treatment of CNS tumors. One important tool in the neuro-oncology armamentarium is the use of advanced imaging techniques. We searched PubMed using the keywords neuro-oncology imaging, pseudoprogression, molecular imaging, and biomarkers. We limited our search to full-text English articles and identified other relevant articles from the reference lists of previously identified articles. Advances in imaging techniques have allowed investigators to explore various imaging modalities, from tumor characterization to differentiating pseudoprogression from tumor progression. Better imaging can result in better diagnostic approaches, greater and safer resection techniques, and improved monitoring of tumor progression. This review highlights advances in neuro-oncology imaging techniques and their clinical utility in the treatment and management of primary brain tumors.

BACKGROUND: Diabetes disproportionately impacts the Hispanic community. Within the Advocate Lutheran General Hospital (ALGH) primary service area (PSA), ZIP code 60018 has twice the Hispanic population of other PSA ZIP codes. The 60018 initiative was developed to explore data on diabetes, partner with the 60018 Hispanic community, and improve the resident curriculum, thereby aligning our CHNA, population health, and GME goals. METHODS: We reviewed the CHNA, ALGH hospital data, and community survey data and conducted a literature review. We conducted a family medicine residency tour of the community and recommended curriculum revisions after performing a curriculum and literature review. We established a partnership with St. Stephen Protomartyr Catholic Church, offering free diabetes screenings and diabetes education. RESULTS: Through the partnership with St. Stephen Protomartyr Catholic Church, we obtained 23 completed surveys, conducted 3 focus groups with 20 participants, screened 23 patients, and held 4 education sessions with 12-15 attendees at each session. The screenings identified 8 individuals with an A1c of 5.7%-6.4% and 8 individuals with an A1c >6.5% (2 with an A1c >11%). The NI V work was incorporated into the new revision of ALGH’s CHNA. Grant money was secured to sustain the work, and family medicine residency curriculum changes were implemented. CONCLUSION: Our partnership with St. Stephen Protomartyr Catholic Church is a step toward preventing and reducing the impact of diabetes in the Hispanic community via culturally appropriate screening and diabetes prevention. However, cultural skepticism has a history, and trust takes time to build. ALGH has committed to long-term support of the work.

Patient perception of care is positively associated with better medical outcomes, clinician job satisfaction, and fewer malpractice claims and also has significant downstream economic impact for healthcare organizations. A sparse amount of data exists regarding provider and practice characteristics driving high levels of patient experience in the pediatric hematology-oncology (PHO) ambulatory setting. The aims of this study were to determine key drivers of high care provider ratings and of the likelihood of recommending our ambulatory PHO practice. Patient experience was measured using the Consumer Assessment of Healthcare Providers and Systems Clinician & Group Survey (CG-CAHPS). The study outcomes were to determine the survey items most associated with top-box scores for "Rate This Provider" and for "Likelihood of Your Recommending Our Practice to Others." The survey items Explanations the care provider gave you about your problem or condition and Concern the care provider showed for your questions or worries were most strongly correlated with high provider ratings. How well the staff worked together to care for you and Friendliness/courtesy of nurse/assistant were most strongly correlated with the likelihood of recommending the practice. High provider ratings were most associated with the physician's ability to explain problems and conditions to families. Staff teamwork and nursing attitude were most associated with patient recommendations of the PHO practice. By identifying key drivers of high provider and practice ratings by patients in the PHO ambulatory setting, a targeted approach with a focus on physician-specific communication attributes, teamwork, and nursing attitude can be deployed to improve the patient experience.

Dislocation of the hip is a well-described event that occurs in conjunction with high-energy trauma or postoperatively after total hip replacement. In this review, the types, causes, and treatment modalities of hip dislocation are discussed and illustrated, with particular emphasis on the assessment, treatment, and complications of dislocations following total hip replacement. Hip dislocations are commonly classified according to the direction of dislocation of the femoral head, either anterior or posterior, and are treated with specific techniques for reduction. Generally, closed reduction is the initial treatment method, usually occurring in the emergency room. Bigelow first described closed treatment of a dislocated hip in 1870, and since then many reduction techniques have been proposed. Each method has unique advantages and disadvantages. Anterior hip dislocation is commonly reduced by inline traction and external rotation, with an assistant pushing on the femoral head or pulling the femur laterally to assist reduction. Posterior hip dislocations are the most common type and are reduced by placing longitudinal traction with internal rotation on the hip. Patients with hip dislocations must receive careful diagnostic workup, and the treating physician must be well versed in the different ways to treat the injury and possible complications. Timely evaluation and treatment, including recognizing the potential complications, are necessary to offer the best outcome for the patient.

Children with sickle cell disease (SCD) face unique problems that attendance at a camp with their peers is well suited to address. However, because the staff members at ordinary summer camps are not accustomed to accommodating children with chronic diseases, the potential for significant health consequences exists. We searched the literature in PubMed and CINAHL using the keywords summer camp, camp, sickle, and anemia to identify the unique characteristics of camps for children with SCD and the recommendations for care and/or lessons learned. Published data are limited. Accommodations to avoid triggering sickle vaso-occlusive pain have been developed empirically and extrapolated from other settings. Camp experiences provide peer learning opportunities, positive role models, and a safe area to explore personal growth. The supportive atmosphere of the camp and escape from social stigma are welcome changes from the daily routine. Camp experiences can help with education on self-care and the transition from adolescent to adult healthcare. Camp offers unique opportunities for care coordination. Camps for children with SCD provide a setting for dissemination of best practices for the disease. Community-based organizations should partner in recruiting young adults with SCD as counselors. Educational material now available could be modified for use in the camp setting. All stakeholders in the care of children with SCD should work in unison to ensure these children enjoy the benefits of summer camp.

BACKGROUND: The CHNA for HonorHealth Osborn identified food insecurity as a significant health disparity within our community. The USDA defines food insecurity as “a state in which consistent access to adequate food is limited by a lack of money and other resources at times during the year.” Overall, 15.9% of all Maricopa County households are food insecure, including 25.4% of Maricopa County children. The Desert Mission (DM) program (established in 1927) began under the John C. Lincoln (JCL) Health Network to help underserved families meet their health and social needs. With the newly merged HonorHealth (Scottsdale Healthcare and JCL), DM expanded its services into a new geographic area. METHODS: We used a 2-question screening tool to identify those with food insecurity at Heuser Family Medicine Center. (1) Within the past 12 months, we worried whether our food would run out before we got money to buy more. This was true “often,” “sometimes,” “never.” (2) Within the past 12 months, the food we bought just didn’t last and we didn’t have money to get more. This was true “often,” “sometimes,” “never.” RESULTS: Overall, 1 in 3 patients screened positive for food insecurity. In November, 33.33% of patients screened positive; in December, 31.44% of patients screened positive; and in January, 35% of patients screened positive. Patients meeting criteria were offered services, including emergency food supplies, and were administered a risk assessment to better define their overall social needs. CONCLUSION: Implementation of a 2-question screening tool is a rapid, easily reproducible way to identify a previously unseen portion of our patient population that is food insecure. Partnering with community food banks and using their resources can help this vulnerable population address this health inequity. Future efforts targeting EHR integration will make it easier to follow these patients and improve screening efficiency.

Checkpoint inhibitors have transformed the treatment of cancer in adults. This class of drugs has demonstrated encouraging results in various malignancies such as metastatic melanoma, bladder cancer, renal cancer, and non-small cell lung carcinoma. However, researchers have only begun investigating the effectiveness and tolerability of checkpoint inhibitors in pediatric patients. We conducted a review of PubMed indexed literature and clinicaltrials.gov using combinations of the keywords checkpoint, inhibitor, pediatric, CTLA-4 (cytotoxic T lymphocyte antigen-4), PD-1 (programmed cell death-1), and PD-L1 (programmed cell death receptor-1 ligand) to find every recently completed and ongoing trial evaluating checkpoint inhibitors in patients younger than 21 years old. Pertinent articles and clinical trials discussing the role of immune checkpoint inhibitors in the pediatric population were selected for final analysis and manuscript citation. This review presents an overview of the cellular mechanisms involved in checkpoint inhibition and of studies evaluating checkpoint inhibitors in humans. The review also details results and side effects from studies conducted with pediatric patients, current pediatric clinical trials, and future implications. Immune checkpoint inhibitors have the potential to further therapeutic advances in pediatric oncology; however, we need more clinical trials and combination drug strategies targeted toward pediatric cancers.

Obesity is routinely cited as a negative predictive factor for outcomes after total knee arthroplasty (TKA), but the direct mechanism responsible for this relationship has not been described. One possible explanation is a propensity for component malalignment in obese patients that is attributable to difficulty with surgical exposure. This study evaluated the effect of obesity on TKA component alignment in 251 primary TKAs during a 12-month period at a single center in 2009. Postoperative component alignment was retrospectively measured and compared between patients defined as obese (body mass index [BMI] ≥30 kg/m2) and patients defined as nonobese (BMI <30 kg/m2). Alignment was determined by measuring the coronal tibiofemoral angle, coronal femoral component angle, coronal tibial component angle, sagittal femoral component angle, and sagittal tibial component angle in all of the study patients. Statistical analysis failed to demonstrate a statistically significant relationship between obesity and component alignment in any of the measured parameters. The results of this study support that obesity does not negatively affect TKA component alignment; another factor must be associated with the worse outcomes in obese patients undergoing TKA.

Ewing sarcoma, a rare cause of cord compression, is predominantly of osseous origin but can also originate in soft tissues. Soft-tissue manifestations account for <15% of all Ewing sarcoma tumors, and even fewer cases of Ewing sarcoma originating in the epidural space have been documented. A 19-year-old female presented to the emergency department for worsening low-back pain during the previous 6 months and numbness and weakness in her legs during the prior 2 weeks. Magnetic resonance imaging revealed an epidural mass at the L4-L5 level. Intravenous steroids were started for a presumed diagnosis of lymphoma. Orthopedic surgery consultants deferred computed tomography-guided biopsy of the mass out of concern for tumor seeding. Compression symptoms worsened to include foot drop and saddle anesthesia, prompting urgent radiation therapy. After the patient showed poor response to appropriate treatment for lymphoma, other malignant and infectious causes were considered. Biopsy was performed on day 3 of the patient's hospital stay, and by day 7, preliminary cytology results revealed Ewing sarcoma. Subsequent laminectomy and tumor resection produced immediate relief of pain, along with a gradual return of strength and sensation. The mass was found to be of soft-tissue origin and was classified as an extraosseous Ewing sarcoma. The patient was referred to a pediatric oncologist to complete the appropriate chemotherapy after diagnosis. This case demonstrates how an uncommon manifestation of a rare disease can mimic a classic presentation of cord compression. Our aim is to bring awareness to this disease and to emphasize the importance of timely biopsy of any mass.