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BACKGROUND: Cannabinoids are a diverse group of compounds under investigation for various medical purposes, including analgesia. Given the evolving landscape of cannabinoid use, we aimed to analyze their prevalence and effect in pain management among urban orthopedic hand patients. METHODS: An electronic survey was administered to 122 new patients presenting to the orthopedic hand clinic of a major urban academic hospital. Demographic data, numerical rating scale pain scores, cannabinoid usage, and other concomitant pain regimens were recorded. RESULTS: Approximately half of the new patients were dissatisfied with current pain management for their hand pathology. Prescription (Rx) and over-the-counter (OTC) pain medications were used by 58% (71/122) of patients, while cannabinoids were used by 15% (18/122) of patients. Compared with pre-usage pain scores, both cannabinoids and Rx/OTC medications induced significant reductions in pain associated with patients' hand pathologies (Cannabinoid: Δ4.4, P = .002; Rx/OTC: Δ3.0, P < .001). Cannabinoids induced a larger analgesic effect, but this difference was not statistically or clinically significant (P = .06). Subjectively, cannabinoid users either preferred their cannabinoid over Rx/OTC medications or liked both equally. Opioid use was higher among cannabinoid users (22.2% vs 12.5%), although this was not statistically significant (P = .28). CONCLUSION: Approximately 15% of new urban hand patients use cannabinoids for pain control, and these compounds have similar analgesic efficacy in hand pathologies as Rx/OTC medications. Cannabinoids are equally liked or preferred relative to traditional medications in this cohort, and they may play an important role in pain management for hand patients.
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INTRODUCTION: Advanced practice providers (APPs), such as nurse practitioners and physician assistants, are a growing part of urology practices. However, the impact of APPs on improving new patient access in urology is unknown. We examined the impact of APPs on new patient wait times in a real-world sample of urology offices. METHODS: Research assistants posing as caretakers called urology offices in the Chicago metropolitan area and attempted to schedule a new patient appointment for an elderly grandparent with gross hematuria. Appointments were requested with any available provider: physician or APP. Descriptive measurements of clinic characteristics were reported and differences in appointment wait times were determined using negative binomial regressions. RESULTS: Of the 86 offices with which we scheduled appointments, 55 (64%) employed at least 1 APP but only 18 (21%) allowed for new patient appointments with APPs. When requested for the earliest appointment regardless of provider type, offices with APPs could offer shorter wait times compared to physician-only offices (10 vs 18 days; p=0.09). Initial appointments with an APP were available with a significantly shorter wait than those with a physician (5 days vs 15 days; p=0.04). CONCLUSIONS: Urology offices are commonly employing APPs but giving them a limited role in new patient visits. This suggests that offices with APPs may have an unrealized opportunity to improve new patient access. Further work is needed to better elucidate the role of APPs in these offices and how they might best be deployed.
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Importance: While current evidence supports UV exposure as an important risk factor for cutaneous melanoma in fair-skinned populations, the evidence for this association in skin of color is less certain. Objective: To critically assess and synthesize the published data regarding the association between UV exposure and the risk of cutaneous melanoma in skin of color. Evidence Review: A search was conducted including PubMed, Cochrane, and Web of Science databases from database origin to June 3, 2020. Only peer-reviewed original studies were screened in full text. Eligible studies analyzed UV exposure as a risk factor for cutaneous melanoma in people with skin of color, which was defined broadly as any race/ethnicity other than non-Hispanic White, Fitzpatrick skin types IV through VI, or tanning ability of rarely or never burns. Measures of UV exposure included UV index, irradiance, latitude, history of phototherapy, and history of sunburn. Evidence quality was assessed using criteria from the Oxford Centre for Evidence-Based Medicine. Findings: After duplicate removal, 11â¯059 database records were screened, 548 full-text articles were assessed, and 13 met inclusion criteria. Study types included 7 ecological studies, 5 cohort studies, and 1 case-control study. All studies used race and/or ethnicity to categorize the participants, and more than 7700 melanomas in skin of color were included. Of the 13 studies that met inclusion criteria, 11 found no association between UV exposure and melanoma in skin of color, 1 study showed a small positive relationship in Black males, and 1 showed a weak association in Hispanic males. All studies were of moderate to low quality (Oxford Centre ratings 2b to 4). Conclusions and Relevance: In this systematic review, the evidence suggests that UV exposure may not be an important risk factor for melanoma development in people with skin of color. Current recommendations promoting UV protection for melanoma prevention in skin of color are not supported by most current studies. However, evidence is of moderate to low quality, and further research is required to fully elucidate this association.