Firelands Regional Medical Center

Chronic pain is a pervasive health issue in the United States, affecting up to 50 million adults and contributing to a substantial economic burden. The worsening opioid crisis has increased the need for nonopiate, nonaddictive alternatives to pain management. Cannabidiol (CBD) has recently garnered attention for its potential analgesic and anti-inflammatory properties without addictive or dependence potential. However, there is limited research regarding the efficacy and safety of CBD in the treatment of chronic pain. This study aimed to explore the use of CBD isolate in adults suffering from chronic pain. We decided to investigate its perceived effectiveness, dosage, frequency of use, and reported side effects through a publicly available, completely anonymous Qualtrics survey. This survey was posted online and in multiple medical clinics. The key findings of our anonymous online survey are that the use of cannabinoids is positively associated with decreased chronic pain, even at low dosages (<100 mg). In addition, though some mild side effects are noted, the majority of patients self-report no side effects, and there are no noted severe side effects. These findings suggest that CBD may serve as a promising alternative to conventional pain management strategies. However, the results warrant further investigation and research into the efficacy and safety of CBD for chronic pain. We believe these data point the way for new and continued avenues of research that can better optimize treatment regimens and help patients with chronic pain.

The Accreditation Council for Graduate Medical Education and the American Board of Psychiatry and Neurology first developed milestones for the clinical neurophysiology (CNP) fellowship in 2015. The milestones provide a comprehensive evaluation of the fellow's development based on six domains of competency. Here, we describe the development of a new set of milestones for CNP fellowship with level 1 as the incoming level, level 4 as the goal for graduation, and level 5 as the aspirational level that may not be achieved. Committee members were nominated or volunteered to participate in the milestones update. Milestone development began with the creation of a shared mental model of the ideal skills and knowledge a graduating CNP fellow should attain. The CNP committee met virtually 7 times for a total of 14 meeting hours. Nine Patient Care and five Medical Knowledge milestones evolved from the seven Patient Care and six Medical Knowledge milestones that were in the first iteration. The committee incorporated 11 "Harmonized Milestones" into the revision and a supplemental guide was created. The revised Accreditation Council for Graduate Medical Education milestones for CNP fellowship contain important updates that program directors should review against their curricula to identify any gaps in learning. Program leadership should take note of two new Patient Care milestones for telemedicine and intraoperative monitoring. Clinical neurophysiology fellowships are not designed to provide level 4 competency across all milestones. The revised milestones should be viewed within the context of an individual program's goals.

Thrush is an opportunistic infection of the buccal cavity by the organism Candida albicans. It is most commonly seen in infants and becomes relatively uncommon between 6 to 9 months of age implying the infection is possibly dictated by risk factors present at or around the time of birth. The objective of this study is to determine if there is an association between the development of thrush and cesarean delivery, as we hypothesize. Neonatal records were obtained through retrospective chart review of the past 10 years from an outpatient clinic and hospital records in Sandusky Ohio. ICD 9 and 10 codes for thrush and well child visit were used to identify patients. Statistical analysis performed on the data included: multivariable logistic regression, χ2 test of association, and nonparametric χ2 test of goodness-of-fit. A total of 636 patient records were reviewed, with 127 having a diagnosis of thrush and 509 without the diagnosis. A multivariable logistic regression indicated that during the first year of life, children born by cesarean section were no more likely to develop thrush compared with those born by vaginal delivery, controlling for age and sex of the neonate as well as parity and group B streptococcus status of the mother. This study demonstrated that there is no significant correlation between the mode of delivery and the development of thrush. It is reasonable to conclude that of the many factors associated with neonatal thrush development, mode of delivery is likely not one of them.