Emergency Patient Voting Initiative in a Community Hospital During a Global Pandemic:: Lessons and a Call-to-Action for Expanded Voter Access.

The 2020 United States general election remained extremely polarized despite occurring during the midst of a global coronavirus pandemic. Acutely hospitalized persons in the days to weeks leading up to the general election are exceptionally vulnerable to voter disenfranchisement and not among the population typically discussed during election seasons. As residents in the Christiana Care Family Medicine Residency Program in Wilmington, Delaware, we organized an emergency ballot registration and absentee voting project for hospitalized patients in our community hospital during the days to weeks leading up to the 2020 general election. We experienced multiple challenges to registering and aiding patients with ballot applications, including but not limited to communication with an overworked New Castle County elections office and coordination of receiving and returning completed ballots. However, we did notice a positive trend in the number of patients acutely hospitalized in the days-weeks leading up to Election Day who had already cast their vote through the expanded mail-in voting campaign in the setting of the COVID19 pandemic. As physicians, we have a unique position and opportunity to not only educate patients and potential voters on voter registration, but also assist these members of our community in the registration process first-hand. In addition to these physician responsibilities, we feel strongly that the state of Delaware should continue the expansion of mail-in/absentee voting for all residents in addition to new initiatives such as extended voter registration period and early in-person voting.

Recognizing postoperative nutritional complications of bariatric surgery in the primary care patient: a narrative review.

Bariatric surgery is an effective treatment for patients with morbid obesity. However, as safe and common as bariatric procedures have become, multiple complications can still result. These complications vary depending on the type of procedure performed (malabsorptive or restrictive) and are often nutritional derangements from the altered malabsorptive surface of the gastrointestinal tract and decreased capacity of the stomach. Deficiencies in vitamin D after malabsorptive procedures such as the Roux-en-Y gastric bypass can result in subsequent hypocalcemia and bone demineralization, and anemias can also present after surgery from inadequate vitamin B12 and iron absorption. Because of the prevalence of these deficiencies, baseline micronutrient testing and postoperative screening are recommended in many cases. Additionally, supplemental treatment often requires higher doses than those recommended for healthy adults. The purpose of this narrative review is to outline the various nutrient deficiencies that can result from bariatric procedures and report previously-published recommendations for screening and medical treatment of patients with these deficiencies. This review is directed toward primary care practitioners because of their unique position in delivering continuity of care and the frequency with which they will encounter patients who have undergone bariatric surgery and are seeking counseling regarding weight loss modalities.