Treatment Alternatives in Charcot Arthropathy of the Foot

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Pediatric Brain Tumor Surgery Although pediatric neurosurgeons assess and treat a wider variety of conditions than their colleagues who treat adult patients, specialized centers for pediatric tumors and spine conditions offer specific programs for some patients. Eric Thompson, MD, a Duke pediatric neurosurgeon and tumor specialist, leads the Duke University Medical Center multidisciplinary pediatric brain tumor board composed of neurosurgeons, neuro-oncologists, radiation oncologists, neuroradiologists, neuropathologists, and trainees from those fields. The board discusses cases and reaches a consensus on treatment plans for the most challenging tumor cases. The most common types of tumors treated in children are those in the posterior fossa, including gliomas, medulloblastomas, and ependymomas. Metastases, although fairly rare, occur in up to 5% of children with solid tumors. Larger centers often offer the advantage of cutting-edge technology as well as clinical expertise. Intraoperative magnetic resonance imaging (MRI) is frequently used at Duke to facilitate the maximal safe removal of brain tumors. Another significant advantage is the ability to enroll children in clinical trials, especially patients whose cancer has progressed. Duke is a member of both the Pediatric Brain Tumor Consortium and the Children’s Oncology Group. When to Refer Parents most commonly ask pediatric neurosurgeons the following 2 questions: • Is the child’s head an abnormal shape? • Is the child’s head too large? The answers to these questions suggest when referral to specialists might be prudent. If a child’s head is flat in the back and the head is clearly not getting rounder after several months of prohibiting the child from laying on his or her back, then it is time to refer to a pediatric neurosurgeon. Regarding head size, there is usually not cause for alarm unless the head has begun to grow at an accelerated rate. “If a child’s skull size is crossing multiple percentiles, that would be a good time to refer,” Thompson says. Duke welcomes the opportunity to work closely with community physicians to treat pediatric patients with brain and spine tumors, craniosynostosis, vascular disease, epilepsy, spina bifida, hydrocephalus, and spasticity. To learn more or to refer, call 844-790-2013. (T2-weighted MRI reveals a medulloblastoma.) 6 Clinical Practice Today from Duke Medicine
Four Strategies for Managing Patients Who Refuse Vaccinations By Meredith Lidard Kleeman Thanks to immunizations, the United States has very low rates of vaccine-preventable diseases such as measles, mumps, and polio, according to the Centers for Disease Control and Prevention (CDC). Yet, despite the success rates of immunizations, some patients refuse to vaccinate themselves and their children. Understanding your patients’ objections is the first step in trying to encourage them to get vaccinated, says Robert Wergin, MD, board chair of the American Academy of Family Physicians. Wergin shares his strategies for responding to common patient concerns. 1 Emphasize safety. Many of the patients in his practice are concerned about vaccine safety, Wergin says. They may have heard about the infamous article linking autism to the measles, mumps, and rubella (MMR) vaccine. Physicians can address this concern by informing patients that there is clear proof that the MMR vaccine does not cause autism and letting them know that the antivaccine study has since been discredited. Wergin also advises physicians to explain that, although vaccines are associated with some risks, they are extremely low. He tells his patients that the risks are about the same as being struck by lightning. Explain herd immunity. Most people, 2 including many medical professionals, have never experienced polio, measles, or mumps firsthand. This lack of first-hand knowledge can make patients believe that these diseases are no longer a threat. Remind patients that because of herd immunity, as long as everyone around them continues to get vaccinated, the threat of contracting those diseases remains low; however, if enough members of a community do not get immunized, those diseases could reemerge. 3 Practice “cheerful persistence.” Wergin talks to his patients about vaccines at every visit and begins the conversation about immunizations as early as possible, starting with prenatal and well-baby checkups. “I have a group of patients who have a lot of concerns, but sometimes with my ‘cheerful persistence’ technique, their kids will get immunized, but it may be a little late,” he says. 4 Define your practice’s policies. Some pediatric practices strictly adhere to the CDC-recommended immunization schedule to motivate patients to get vaccinated, whereas other practices are willing to alter the schedule for patients with concerns. As the only doctor in his rural community, Wergin wants to remain a trusted resource for his patients. “I try to adhere to the CDC guidelines, but, personally, I choose to keep fostering the [doctor-patient] relationship…and keep prodding gently toward getting the vaccines,” he says. “But each practice has to decide how they’ll handle those issues.” December 2015 ClinicalPracticeToday.com 7
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Treatment Alternatives in Charcot Arthropathy of the Foot

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