COVID-19 Reflections: We Are Not OK: Safety Net Primary Care Access in a Non-Expansion State Amid COVID-19.

In North Carolina, rural health care-especially the primary care safety net-is a remarkable but under-resourced vital support system. COVID-19 stressed that already precarious system. While the acute COVID-19 crisis may be receding, we are concerned about the long-term effects of the pandemic on both individuals and the rural primary care safety net.

Supporting Community-Based Family Medicine Residency Training Programs in North Carolina and their Potential Impact on Healthy NC 2030.

North Carolina is a leader in family medicine, but a growing health care chasm exists between the state's urban centers and rural areas. Training family medicine residents in rural communities can address disparities in health care access and improve rural population health metrics for all subsets of the population, goals that align well with renewed state and national strategies.

"What's Love Got to Do with It?"

Traditional rural lifestyles are often identified as contributors to poor health and disparities. A diverse group of unique partners in Hertford County, North Carolina, are focusing on key components of strengths through the Farm to School to Healthcare initiative as a way to long-lasting positive, overall health and happiness.

Perioperative Outcomes and Management in Pediatric Complex Cranial Vault Reconstruction: A Multicenter Study from the Pediatric Craniofacial Collaborative Group.

BACKGROUND: The Pediatric Craniofacial Collaborative Group established the Pediatric Craniofacial Surgery Perioperative Registry to elucidate practices and outcomes in children with craniosynostosis undergoing complex cranial vault reconstruction and inform quality improvement efforts. The aim of this study is to determine perioperative management, outcomes, and complications in children undergoing complex cranial vault reconstruction across North America and to delineate salient features of current practices. METHODS: Thirty-one institutions contributed data from June 2012 to September 2015. Data extracted included demographics, perioperative management, length of stay, laboratory results, and blood management techniques employed. Complications and outlier events were described. Outcomes analyzed included total blood donor exposures, intraoperative and perioperative transfusion volumes, and length of stay outcomes. RESULTS: One thousand two hundred twenty-three cases were analyzed: 935 children aged less than or equal to 24 months and 288 children aged more than 24 months. Ninety-five percent of children aged less than or equal to 24 months and 79% of children aged more than 24 months received at least one transfusion. There were no deaths. Notable complications included cardiac arrest, postoperative seizures, unplanned postoperative mechanical ventilation, large-volume transfusion, and unplanned second surgeries. Utilization of blood conservation techniques was highly variable. CONCLUSIONS: The authors present a comprehensive description of perioperative management, outcomes, and complications from a large group of North American children undergoing complex cranial vault reconstruction. Transfusion remains the rule for the vast majority of patients. The occurrence of numerous significant complications together with large variability in perioperative management and outcomes suggest targets for improvement.

Stridor due to an innominate artery compression and posterior mediastinal mass in a pediatric patient.

There are many causes for stridor in a pediatric patient. We present an interesting case of a pediatric patient who had stridor due to an innominate artery compression and posterior mediastinal mass. We discuss the anesthetic complication and management of patients with stridor.

Use of telehealth to improve chronic disease management.

Remote patient monitoring that tracks vital signs of patients with chronic diseases is offering more-frequent contact between the patient and the primary care provider, providing earlier detection of potential problems, and allowing real-time alerts, resulting in a proactive, affordable option for best-practice health care.