Sickle cell disease (SCD) presents unique challenges for youth transitioning from pediatric to adult health care systems. This study aimed to identify and address unmet needs in transition readiness for youth with SCD in Ontario through participatory design sessions involving patients, health care providers (HCPs), families, and caregivers. Thematic analysis of a participatory design session revealed significant barriers to successful transition: lack of education and awareness among adult HCPs, limitations in health care delivery, navigating multiple life transitions, and racial bias in health care. These barriers contribute to delayed or inadequate care, exacerbating the challenges faced by youth with SCD during the transition period. Building upon these findings, a low-fidelity prototype was developed, culminating in a digital educational module framework tailored for HCPs focusing on SCD transition care. This framework aims to equip providers with the knowledge and resources needed to effectively support transitioning youth with SCD. Successful transition is vital for the health and wellbeing of youth with SCD, and addressing the identified barriers through comprehensive interventions is essential for optimizing transition experiences and outcomes.

Gemcitabine is a chemotherapy agent that belongs to the class of pyrimidine analogues. It is used, alone or in combination, in a variety of neoplasms, including breast, lung, pancreatic, biliary, and ovarian cancers. One of its rare side effects is a form of cutaneous inflammation called “pseudocellulitis,” because it clinically manifests with local erythema, edema, and tenderness, as seen in cellulitis of infectious origin. We present the case of a 75-year-old woman with intrahepatic cholangiocarcinoma, who was hospitalized with an inflammatory reaction in her legs after the administration of gemcitabine. Based on clinical considerations and the results of the punch biopsy of the skin, our diagnostic conclusion was gemcitabine-induced pseudocellulitis. We review the literature reporting this rare form of dermatologic toxicity, and we describe its possible pathogenesis and management strategies.

Background: Glucagon-like peptide-1 receptor agonists have gained popularity in recent years because of their well-established benefits of increased glycemic control, weight loss, cardiovascular protection, and renal protection, with minimal adverse effects, and low risk for hypoglycemia in patients with type 2 diabetes. This study explored the effectiveness of the GLP-1 receptor agonist semaglutide and dulaglutide on body weight and hemoglobin A1c in patients with type 2 diabetes. Methods: In this retrospective cohort study, 244 patients diagnosed with type 2 diabetes and prescribed semaglutide or dulaglutide were identified through Lourdes Hospital electronic medical records. Over a 12-month period, in set intervals every 3 months, patients were assessed for changes in their hemoglobin A1c and body weight measured as a reduction in their body mass index (BMI). These primary outcomes were compared using linear mixed models from the lme4 package in R (v. 4.2.2). Results: Semaglutide and dulaglutide showed comparable effectiveness in reducing hemoglobin A1c compared with baseline. Both medications also led to a reduction in BMI. However, semaglutide showed statistically significant improvements in weight loss compared with dulaglutide at 3-6 months ( P = 0.01), 6-9 months ( P = 0.01), and 9-12 months ( P = 0.01). Conclusions: These findings suggest that in type 2 diabetes, semaglutide and dulaglutide show comparable effectiveness in reducing hemoglobin A1c. However, semaglutide was shown to be more effective in promoting weight loss. While these findings may be beneficial when treating patients with type 2 diabetes and obesity, treatment should be individualized to the patient, considering all factors before treatment choice.

Introduction: Total and hemi-shoulder arthroplasty have proved to be a safe and effective option for patients with symptomatic osteoarthritis. In some cases, glenoid implant failures or erosion can lead to acquired glenoid bone loss, complicating potential revision surgery. This paper presents a review of glenoid implant options for total shoulder arthroplasty and a case study which discusses a new augmented reverse baseplate for the revision of a failed hemi-shoulder arthroplasty. The patient was fully informed and gave written consent to submit the details of this case for publication in a peer-reviewed journal. Case Description: An 80-year-old retired professor with a prior history of right shoulder hemiarthroplasty presented with worsening right shoulder pain. She failed conservative care and wanted a conversion to a reverse total shoulder arthroplasty. The erosion on the patient's glenoid was severe enough for the surgeon to elect for the use of a metal augmented baseplate to fill the acquired defect and correct version and inclination. After an uneventful postoperative and recovery progression, at her one-year follow-up visit, she was pain-free and active, with significant improvements in her visual analogue scale (VAS) score, American Shoulder and Elbow Surgeons (ASES) score, and active range of motion (ROM). Discussion: The advent of metal augmentation with advanced glenoid preparation instruments allows shoulder specialists the ability to address implant-associated acquired glenoid bone loss and soft tissue deficiencies with ease and confidence and reduce additional clinical challenges.

Background: The opioid epidemic in the United States continues to accelerate, with opioid-related deaths increasing 30% from 2019 to 2021. Though medication assisted therapy (MAT) is an effective strategy for the treatment of opioid use disorder (OUD), utilization of this tool remains low, particularly in rural health settings. The aims of this study were (a) to examine perceived barriers to using MAT in a sample of rural health providers, (b) to examine the accuracy of medical providers’ perceptions of descriptive (eg, frequency) and injunctive (ie, approval of) norms related to the use of buprenorphine, and (c) to determine whether greater self-other differences predict greater likelihood of prescribing buprenorphine. Methods: An anonymous electronic survey was sent to 775 rural medical providers (response rate = 9.7%). Results: Results indicated that most providers do not prescribe buprenorphine or do so infrequently. Providers inaccurately believed that they were more accepting than their peers with regards to providing addiction care. Providers who assumed that peers were prescribing buprenorphine more often and were more accepting of it were more likely to engage in this practice themselves. Conclusions: These findings lay the groundwork for testing norms interventions that might enhance the uptake of the use of evidence-based substance use treatment by rural medical providers.

Introduction: Transportation of inpatients throughout hospitalization remains a critical aspect of patient care. Transport delays hinder the timely delivery of surgical procedures, radiology, and patient triage, consequently impacting the flow and receipt of treatment. This study reviews transport delays in a quaternary care hospital's inpatient orthopedic unit to the preoperative unit. The goal of the project was to reengineer processes for maximized efficiency and improve on-time starts for all surgical services. Methods: Manufacturing methods of an assembly-line–like model and contemporary process-improvement tools in Lean and Six Sigma were used to gauge, reengineer, and monitor processes to ameliorate patient flow. In addition to value streamlining the flow, evaluating communication triggers, eliminating redundant operations, and shifting roles and responsibilities, multiple data sources were used to assess flow for a redesign. Results: Changes in process operations led to a 40% decrease in delays. The grace period for 100 cases was decreased by 5 minutes, in addition to a savings of $110,000 in operating room costs in the first week and 3.5 full-time equivalents annually. Physician satisfaction with timely patient arrival increased in addition to a simplified workflow, which improved patient readiness on the inpatient surgical floor and increased safety. Discussion: Using data-driven approaches, overnight acuity level was removed as a barrier to the timely care of add-on cases. With a standardized process, prediction model, and simplified evidence-based communication strategies coupled with a “pull” manufacturing model, we implemented a structured, safe, and reliable method of efficient patient transport.

Background: Distribution of naloxone rescue kits has been found to be safe, reduce death rate from overdose, and be associated with a decrease in high-risk opioid use A rural emergency department (ED) developed an intervention to increase provision of naloxone rescue kits to patients at risk of opioid overdose. Methods: Naloxone rescue kits were stocked in the ED Omnicell. An order set was created in the electronic medical record (EMR) consolidating order for rescue kit and referral to substance abuse treatment center. ED providers were given an educational session to demonstrate the effectiveness of naloxone rescue kits and the new care plan. A retrospective review of 12-month periods pre- and post-intervention was completed. Patients at risk of opioid overdose were identified by diagnosis or provider judgement. Primary outcome was order for rescue kit provision at time of discharge. Secondary outcomes included buprenorphine order in ED, referral to substance abuse treatment center, and attendance of 7-day post-discharge follow-up encounter. Analysis performed with chi-square test and a p value of <0.05 was considered significant. Results: Rate of naloxone rescue kit order rose from 1.6% to 10.4% ( p = 0.0025). Rate of buprenorphine ordering rose from 14.2% to 31.3% ( p = 0.0007). Referrals to outpatient treatment did not differ (12.6% versus 19.6%; p = 0.1). Attendance of 7-day follow-up encounter decreased (24.5% versus 46.5%; p = 0.0001). Conclusions: This intervention modestly increased the provision of naloxone rescue kits in one ED. Future work should focus on care coordination with outpatient clinics to improve the follow-up rate.