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Unintentional pediatric ingestions of substances can lead to serious and even fatal consequences in children1 and raises concern for supervisory neglect. Supervisory neglect occurs when a caregiver's supervisory decisions or behaviors place a child in their care at significant risk for physical, emotional or psychological harm.2 A caregiver who is taking prescription medication or who uses recreational or therapeutic substances, such as cannabis, must protect children in their care from accessing these potentially harmful drugs. Studies have demonstrated that unintentional cannabis ingestions by children has increased in states that have legalized medical and recreational cannabis.3 Given the changing laws surrounding cannabis in Rhode Island, this study aims to provide a conceptual framework to diagnose, manage and understand supervisory neglect when children present to care with a cannabis ingestion. Additionally, this paper provides guidance for providers to help prevent unintentional cannabis ingestions.

In recent years, there has been a surge in the number of global health programs directed by academic institutions. Global health programs take many forms, focusing on different curricular goals such as knowledge attainment of endemic diseases, community service projects, and improved foreign-language skills. This is an expository paper describing the origins and evolution of the medical exchange program between Rhode Island Hospital and Hospital Regional Universitario José María Cabral y Báez. The exchange program is unique because it is trainee-driven and has strived to maintain a bilateral educational exchange over the past 15 years. Future goals for the program include further developing a research curriculum for both institutions and creating a longitudinal relationship with a community-based state-funded clinic in Santiago, Dominican Republic.

The Brown Human Rights Asylum Clinic (BHRAC) is a medical student-led organization affiliated with Physicians for Human Rights that collaborates with medical and mental health clinicians, lawyers, and community organizations to provide pro bono medical affidavits to undocumented individuals seeking legal status in the United States. Affidavits can document and corroborate the physical and psychological evidence of trauma alleged by asylum seekers, leading to better legal outcomes. This article describes our innovative program, partnerships, and workflow, as well as demographics and statistics from our past seven years of operation. Since its founding in 2013, BHRAC has conducted 55 medical evaluations, the majority involving Spanish-speaking female-identifying individuals from Guatemala, El Salvador, and the Dominican Republic. Thirteen individuals have been granted legal status, one individual was denied status, and the rest of the cases are pending. BHRAC has experienced a marked increase in affidavit requests. This paper serves as a call to action for medical professionals to become involved in this work.

This paper describes a unique collaboration between consumer health care advocates, experts in geriatrics, a state, and a health plan to improve care for adults with both Medicare and Medicaid. Ineffective care coordination between the Medicare and Medicaid programs has led to poor care and high costs. As part of the Affordable Care Act (ACA), CMS initiated state demonstrations to align financing and care delivery. In 2016, Rhode Island launched an integrated care model. Geriatrics experts teamed up with an aging services advocate to work on the Rhode Island project. The team's objective was to bring a geriatrics lens to policy development and clinical care. The team made critical recommendations to the state and CMS during the planning stage, and geriatrics experts presented trainings to health plan care providers. The project demonstrated the potential for geriatrics experts partnering with consumer advocates to influence policy development and implementation.

As the United States embarks on health care reform through the Affordable Care Act (ACA), the knowledge, skills and attitudes necessary to practice medicine will change. Education centered on health disparities and social determinants of health will become increasingly more important as 32 million Americans receive coverage through the ACA. In this paper, we describe future initiatives at the Warren Alpert Medical School of Brown University in training medical students on health disparities and social determinants of health through mechanisms such as the Primary Care-Population Medicine Program, the Rhode Island Area Health Education Center, the Scholarly Concentration program and other mechanisms.

Health care transitions are often dangerous for older patients. Interviews with older adults about their health care moves in Rhode Island (RI) were conducted to develop an Internal Medicine (IM) curriculum designed to provide IM interns with insights about the impact of transitions on patients. This paper describes some ways patients talk about their transitional experiences. Following pilot interviews, 10 nursing home residents were interviewed about their care transitions, conversations with physicians, and advice to doctors beginning their careers. The interviews were analyzed to identify themes. Patients described multiple moves, often did not know what to expect, appreciated help from a family member and desired effective communications with physicians. Learning about patient experiences may help new physicians appreciate the experiences of transitions on patients.

The Hospital Association of Rhode Island, in conjunction with the Rhode Island Cancer Registry, received funding for a special project to improve the validity and reliability of race and ethnicity data in hospital inpatient records. In the past year, five hospitals participated in a pilot to improve race/ethnicity data collection. This paper provides an overview of the design and initial implementation of the pilot, and reports on early feedback. Given that the Affordable Care Act strengthens federal data collection efforts, with a new standard issued which adds granularity, these policies can renew efforts to record more accurate and detailed race and ethnicity data. Improved race and ethnicity data will increase our understanding of the health needs of different racial and ethnic groups and health disparities between groups. Better data improves understanding, increases the likelihood of effective actions to address and monitor disparities, and ensure that every American has the opportunity to live the healthiest life possible.