Area deprivation and respiratory morbidities in children with bronchopulmonary dysplasia.

INTRODUCTION: Infants and children diagnosed with bronchopulmonary dysplasia (BPD) have a higher likelihood of recurrent hospitalizations and asthma-like symptoms. Socio-environmental factors that influence the frequency and severity of pulmonary symptoms in these children during the preschool age are poorly understood. In this study, we used the Area Deprivation Index (ADI) to evaluate the relationship between the socio-environmental exposures in children with BPD and respiratory outcomes during the first few years of life. METHODS: A registry of subjects recruited from outpatient BPD clinics at Johns Hopkins University (n = 909) and the Children's Hospital of Philadelphia (n = 125) between January 2008 and October 2021 was used. Subjects were separated into tertiles by ADI scores aggregated to ZIP codes. Caregiver questionnaires were used to assess the frequency of respiratory morbidities and acute care usage for respiratory symptoms. RESULTS: The mean gestational age of subjects was 26.8 ± 2.6 weeks with a mean birthweight of 909 ± 404 g. The highest tertile (most deprived) of ADI was significantly associated with emergency department visits (aOR 1.72; p = 0.009), hospital readmissions (aOR 1.66; p = 0.030), and activity limitations (aOR 1.55; p = 0.048) compared to the lowest tertile. No association was seen with steroid, antibiotic or rescue medication use, trouble breathing, or nighttime symptoms. CONCLUSION: In this study, children with BPD who lived in areas of higher deprivation were more likely to be rehospitalized and have ED visits for respiratory reasons. Identifying socio-environmental factors that contribute to adverse pulmonary outcomes in children with BPD may provide opportunities for earlier interventions to improve long-term pulmonary outcomes.

Diagnostic accuracy of the PLASMIC score in patients with suspected thrombotic thrombocytopenic purpura: A systematic review and meta-analysis.

BACKGROUND: The PLASMIC score was developed to identify patients with thrombotic microangiopathy who are most likely to have immune thrombotic thrombocytopenic purpura (TTP) and benefit from therapeutic plasma exchange (TPE). PLASMIC scores of 0-4, 5, and 6-7 are said to correspond to low, intermediate, and high probability of TTP, respectively. STUDY DESIGN AND METHODS: We conducted a systematic review and meta-analysis on the diagnostic accuracy of the PLASMIC score in adults with suspected TTP. We evaluated the sensitivity, specificity, positive predictive value, and negative predictive value (NPV) of PLASMIC score thresholds of ≥5 and ≥6. Study quality was appraised using the QUADAS-2 tool. RESULTS: We identified 13 eligible studies, which collectively enrolled 970 patients. The median prevalence of TTP among eligible studies was 35%. The sensitivity and specificity of a PLASMIC score ≥5 was 0.99 (95% confidence interval [CI], 0.91-1.00) and 0.57 (95% CI, 0.41-0.72), respectively. At a prevalence of 35%, the NPV of a PLASMIC score ≥5 was 0.99 (95% CI, 0.92-1.00). A PLASMIC score ≥6 was associated with a sensitivity and specificity of 0.85 (95% CI, 0.67-0.94) and 0.89 (95% CI, 0.81-0.94), respectively. The NPV of a PLASMIC score ≥6 at a prevalence of 35% was 0.92 (95% CI, 0.82-0.97). CONCLUSION: A PLASMIC score threshold of ≥5 is associated with high sensitivity and NPV and may be a useful screening tool for identifying patients who are unlikely to have TTP and do not require TPE, though prospective assessment is required. A PLASMIC score <6 appears to have insufficient sensitivity to rule out TTP and the need for TPE.

Canadian residents' perceptions of cross-cultural care training in graduate medical school.

BACKGROUND: The Royal College of Physicians and Surgeons of Canada specifies both respect for diversity as a requirement of professionalism and culturally sensitive provision of medical care. The purpose of the present study was to evaluate the perception of preparedness and attitudes of medical residents to deliver cross-cultural care. METHODS: The Cross Cultural Care Survey was sent via e-mail to all Faculty of Medicine residents (approx. 450) in an academic health sciences centre. Comparisons were made between psychiatry residents, family medicine residents, and other residency groups with respect to training, preparedness, and skillfulness in delivering cross-cultural care. RESULTS: Seventy-three (16%) residents responded to the survey. Residents in psychiatry and family medicine reported significantly more training and formal evaluation regarding cross-cultural care than residents in other programs. However, there were no significant differences in self-reported preparedness and skillfulness. Residents in family medicine were more likely to report needing more practical experience working with diverse groups. Psychiatry residents were less likely to report inadequate cross-cultural training. CONCLUSION: While most residents reported feeling skillful and prepared to work with culturally diverse groups, they report receiving little additional instruction or formal evaluation on this topic, particularly in programs other than psychiatry and family medicine.

Attitudes to cannabis and patterns of use among Canadians with multiple sclerosis.

BACKGROUND: Canada has the highest incidence of MS worldwide. Anecdotal evidence reveals that people with MS smoke, ingest or vaporize cannabis for a multiplicity of reasons. With the legal situation in relation to use currently in flux, we undertook a study investigating patterns of use amongst people with MS and their attitudes towards the drug. METHODS: A consecutive sample of people with MS (n=246) attending a neurology (n=118) and a neuropsychiatry (n=107) clinic was enrolled and asked to complete a questionnaire containing demographic, disease and cannabis related variables. RESULTS: Of the 246 people approached, 225 (91.8%) agreed to participant. Attitude towards cannabis revealed that 122 (54.3%) participants approved of the drug while 75 (33.2%) were neutral. Legalization was endorsed by 98 (43.7%) participants, while 98 (43.7%) were in favour of legalization for medical use only. Current use was endorsed by 44 (19.5%) people with 125 (56.1%) reporting lifetime use. If cannabis were legal, 113 (50.2%) participants would use it. The most common symptoms for which cannabis was being used were: sleep (86%), pain (75%), anxiety (73%) and spasticity (68%). Participants attending the neuropsychiatry clinic were more likely to use cannabis for managing depression (χ2=4.99; p=0.03) and pain (χ2=3.85; p=0.05). CONCLUSION: There is a wide acceptance of cannabis within the MS patient community. One in five people currently use the drug for reasons that differ between neuropsychiatry and neurology clinics. Use could potentially more than double if the drug were legalized.

What to make of cannabis and cognition in MS: In search of clarity amidst the haze.

Given data showing that cannabis (herbal drug from the Cannabis sativa plant) can impair cognition in healthy subjects, the possibility that it may also do so in people with multiple sclerosis (MS) should be cause for concern. Approximately 20% of people with MS inhale or ingest cannabis for a variety of symptoms, or as a lifestyle choice. In addition, pharmaceutically manufactured cannabis (in capsules or spray) is prescribed most often for pain and spasticity; however, there is a dearth of literature on the cognitive effects of cannabis. Furthermore, methodological limitations introduce a cautionary note when interpreting the data. The evidence, which must therefore be considered preliminary, suggests that smoked cannabis may further compromise information processing speed and memory, with magnetic resonance imaging (fMRI) demonstrating more inefficient patterns of cerebral activation during task performance. The findings related to pharmaceutically manufactured cannabis are equivocal. There is a pressing need for further research to inform clinical opinion, which at present reflects a combination of uncertainty and dogma.