Introduction: While cannabis has been medically legal in Vermont since 2004 and recreationally legal since 2018 there has been minimal published research regarding the use and practices in the adult population. This gap in understanding results in primary care providers having difficulty navigating conversations surrounding cannabinoid use. The purpose of this research was to identify current use and perceptions of cannabinoids, including Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD), in adult primary care patients in Vermont. Methods: An anonymous written survey was given to 1009 Vermont primary care patients aged 18 years and older. All measures were patient-reported and included use of CBD and THC products, perceived helpfulness for certain medical conditions, knowledge of CBD and THC, perceived knowledge of their provider, and concerns regarding cannabis legalization. Results: 45% of adult primary care patients reported using cannabinoids in the past year. Only 18% of patients reported their provider as being a good source of information regarding cannabis. Of the patients who used cannabis in the past year, a majority reported it helpful for conditions such as anxiety and depression, arthritis, pain, sleep, and nausea. Conclusions: Primary care providers need to be knowledgeable about cannabinoids to best support patient care. In addition, with a significant number of patients reporting cannabinoids helpful for medical conditions common in primary care, it is important that research continue to identify the potential benefits and harms of cannabis.
Objective This study's purpose was to investigate opioid prescribing practices after pediatric tonsillectomy in the year before and year after implementation of statewide policy interventions in Vermont. Methods We reviewed charts of consecutive patients less than 18 years old that underwent tonsillectomy or adenotonsillectomy at a single tertiary academic medical center 1 year before (July 2016–June 2017) and 1 year after (July 2017–June 2018) implementation of policy interventions targeted at opioid prescribing. Data collected included demographics, procedure performed, indication, complications, medical comorbidities, opioid prescribing practices (medication, dose, morphine milliequivalents, and postdischarge opioid prescriptions), and postoperative telephone calls and emergency department (ED) visits. Results Tonsillectomy or adenotonsillectomy was performed in 360 consecutive patients (185 in the pre‐policy year and 175 in the post‐policy year). Those receiving an opioid prescription in the pre‐ compared to post‐policy year was 49.7% versus 15.4% (p < .001). Of patients 6 years and older, 95.8% in the pre‐policy year compared to 25.2% in the post‐policy year received a postoperative opioid (p < .001). There was no difference in pain‐related office phone calls, postdischarge opioid prescriptions or ED visits between the two groups. There was no difference in morphine milligram equivalent prescribed in the pre‐ and post‐groups. Conclusion Implementation of statewide policy interventions can have a substantial impact on opioid prescribing practices in the pediatric tonsillectomy population without an increase in office phone calls, postdischarge opioid prescriptions, and ED visits. Level of Evidence 4
Cholesterol granulomas are a common benign pathology classically found in the mastoid antrum and air cells of the temporal bone and less commonly found in the paranasal sinuses. We present a unique case of bilateral cholesterol granulomas of the maxillary sinus that is the second case to our knowledge reported in the literature. In an effort to provide an update about cholesterol granulomas of the paranasal sinuses, we examined the literature from January 2011 through 2021 in conjunction with a previous systematic review of the literature from 1970 to December 2010. This report reinforces that upon presentation, cholesterol granulomas can resemble multiple pathologies and histology is needed for diagnosis. This report should serve as an updated resource for otolaryngologists regarding cholesterol granulomas of the paranasal sinuses.
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