Medical Marijuana Policy Reform Reaches Florida: A Scoping Review

Background: Florida became the first state in the U.S. South to legalize the use of medical marijuana to treat a variety of health conditions including chronic pain, epilepsy, and spasticity symptoms from multiple sclerosis. While there are over 200,000 medical marijuana patients in Florida, there remain financial, psychological, and insurance coverage barriers which reduce access for many patients. Purpose: This scoping review, with a focus on state health policy, first describes some clinical studies examining the therapeutic benefits of medical marijuana. Next, there is a discussion of the Florida regulatory environment and major legislation. Also, the review describes how the current Florida policy landscape presents challenges for physicians and patients. Methods: A scoping review of the literature was conducted in PubMed and Google Scholar using the search terms, “medical marijuana” and “medical cannabis” to identify research articles, newspaper reports, and government documents. The purpose of the review was to identify research investigating the therapeutic efficacy of medical marijuana and state policies affecting physician practice. Results: The review concluded there was general scientific consensus of therapeutic benefits for patients, especially for chronic pain, from the use of medical marijuana. The review also identified several barriers for physicians and patients around cost, stigma, and lack of insurance coverage which constrains use and access. Discussion: The review discusses several directions for future medical marijuana policy and research with the aim to improve therapeutic benefits for Florida patients

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Interior of Old Lodge, Alexandria, Virginia, circa 1907-1908

The interior of the Old Lodge in Alexandria, Virginia, circa 1907-1908. Caption reads: "Interior view of Old Lodge. East view of "Old" Alexandria Washington Lodge, No. 22, A. F. & A. M., of Alexandria, Va., of which General George Washington was first Worshipful Master in 1788-89, showing Master's chair occupied by Washington when Master, also original desks, benches, etc. The Lesser Lights were used at the laying of the Cornerstone of the National Capitol and at Washington's Funeral. On the wall to the left of Master's Chair is the Williams Painting of Washington, made in 1794 for the Lodge

Alexandria-Washington Lodge, Alexandria, Virginia, circa 1907-1914

The interior of the Alexandria-Washington Lodge in Alexandria, Virginia, circa 1907-1914. Reverse caption reads: "East view of Alexandria-Washington Lodge, No. 22, A. F. & A. M. of Alexandria, Va. as it stands today. This Lodge was first instituted by the Grand Lodge of Pennsylvania, at Philadelphia in 1783, and wrought under the Pa. Charter for five years when upon its surrender General Washington headed a petition to the Grand Lodge of Virginia for a new Charter, which was granted by Edmund Randolph G.M., in 1788. Washington became first Master under the Virginia jurisdiction and served two terms.

On and after Monday, the 21st inst. The trains on this road, until further notice, will run regularly at the following hours ... December 21st, 1857. [Washington, 1857].

Transportation.; On verso: 3

Constitution of the Washington Society. Instituted the 28th of January, 1800 ....

Imprint 2

A Qualitative Analysis of Information Sharing in Hospice Interdisciplinary Group Meetings

Background:In the United States, hospice agencies are required to convene interdisciplinary group (IDG) meetings no less frequently than every 15 days to review patients? care plans. Challenges associated with information sharing during these meetings can impede efficiency and frustrate attendees.Objectives:We sought to examine information sharing in the context of hospice IDG meetings as a first step toward developing an informatics tool to support interdisciplinary collaboration in this setting. Specifically, we wanted to better understand the purpose of information sharing in IDG meetings and determine the type(s) of information required to fulfill that purpose.Methods, Setting, and Participants:In this qualitative descriptive study, we analyzed video recordings of care plan discussions (n = 57) in hospice IDG meetings and individual interviews of hospice providers (n = 24).Results:Data indicated that sharing physical, psychosocial, and spiritual information is intended to optimize hospice teams? ability to deliver whole-person care that is aligned with patient and family goals and that satisfies regulatory requirements.Conclusion:Information sharing is a key function of hospice teams in IDG meetings. Informatics tools may optimize IDG meeting efficiency by succinctly presenting well-organized and required information that is relevant to all team members. Such tools should highlight patient and family goals and ensure that teams are able to satisfy regulatory requirements