Removing barriers to accessing medical cannabis for paediatric patients.

Medical cannabis (MC) may offer therapeutic benefits for children with complex neurological conditions and chronic diseases. In Canada, parents, and caregivers frequently report encountering barriers when accessing MC for their children. These include negative preconceived notions about risks and benefits, challenges connecting with a knowledgeable healthcare provider (HCP), the high cost of MC products, and navigating MC product shortages. In this manuscript, we explore several of these barriers and provide recommendations to decision-makers to enable a family-centered and evidence-based approach to MC medicine and research for children.

Addressing Proficiency Gaps in Future Skills Between Employers and Learners Through Data Visualization.

The pandemic has principally changed the way the construction industry operates. It has caused a profound shift in how we conduct our work, with a large-scale take-up of remote working and changes in our digital approach. The way we work is changing. All these impacts challenge the traditional supply chain and working practices of the construction industry negatively, resulting in price escalations, additional costs, loss of revenue, payment delays and increase in disputes and claims. This study aimed to assess the skill proficiency of learners and narrow the employers' and young engineers' perspectives on what are the future skills requirements in the construction industry in the world of digitalization. This study, which comprised two surveys entitled "Future Skills-What does the future look like for young engineers?" (for employers) and "WLA Survey in "Future Skills"-The Proficiency Analyses of Young Engineers-to-be" (for learners), was a part of the Workplace Learning and Assessment (WLA) Engagement Series for students. This research attempts to map skill proficiency of learners (or young engineers-to-be) with the future skill requirements of the employers and to make recommendations on the construction-related institutional arrangements. A quantitative approach by using online surveys as the main data collection tool was adopted. A sample of 20 WLA-participating employers and 23 WLA-participating students in construction companies was generated. In December 2021, the project team initiated two surveys to explore the expectation for the future workforce in the construction industry. Interview results covering various construction-related disciplines, including civil engineering, building studies, surveying and building technology, were analysed and illustrated using Microsoft Power BI. Content analysis with data visualizations was used to identify major themes. This study has shown that employers and students have different perceptions of skills and attributes as critical competencies for a successful workforce. On a positive note, there was a high level of satisfaction for both employers and learners in "Training Structure" and "Training and Development". This study highlighted that students did not have the appropriate level of knowledge as expected by their employers in key subject areas of the construction industry. Employers expressed a clear expectation for the roles and responsibilities of young engineers in their organizations. Areas of practice such as building information modelling (BIM), "Problem Solving", and "Presentation Skills" were highlighted as critical for the future. The competency of youngsters in achieving targeted vision and goals as well as the competency in striving for continual improvement was identified as highly relevant for the future. There was potential for young engineers to play a more active role in their organizations and to repackage their technical skill and interpersonal skill sets for anticipated future roles. The choice of the quantitative research design approach was guided by the need to capture numerical data in the construction industry of Hong Kong for the purpose of illuminating differences in perspectives among participants about future skills for WLA implementation in vocational and professional education and training (VPET). This study can help to investigate the skill proficiency gaps that employers will be looking for and how WLA can bring maximized benefits to students and companies. Based on the results, the students can be better informed about the workplace settings and be prepared for the upcoming industrial attachment or apprenticeship programme with WLA. Feedback provided by the companies can help support students' transition into the world of work. On the other hand, by understanding learners' self-perception, this adaptation made by the companies could result in what looks to be part of a longer-term change in how we work, particularly with a move to increased use of hybrid working. The statistical models with data visualization based on Power BI can also lead to the experimentation and inference that inform the institution's strategy.

Retrospective Review of Fluvoxamine-Clomipramine Combination Therapy in Obsessive-Compulsive Disorder in Children and Adolescents.

OBJECTIVES: To inform dosing and describe the pharmacokinetic interaction, efficacy and safety of fluvoxamine-clomipramine combination therapy for treatment-resistant pediatric obsessive-compulsive disorder (OCD). METHODS: A retrospective chart review of OCD-affected patients at a tertiary care children's hospital between January 2010 and August 2017 was conducted. Those included were 18 years of age or younger at initiation of fluvoxamine-clomipramine combination therapy and had at least one set of serum concentration values capturing clomipramine and desmethylclomipramine levels. RESULTS: Six adolescents met study inclusion criteria. Fluvoxamine adequately inhibited clomipramine metabolism to desmethylclomipramine in a dose-dependent manner. Fluvoxamine-clomipramine combination therapy was generally well tolerated with no serious or life-threatening adverse effects reported. CONCLUSION: Fluvoxamine-clomipramine combination therapy permits use of lower clomipramine doses than typically used as clomipramine monotherapy and appears to be a safe alternative for pediatric OCD patients failing sequential selective serotonin reuptake inhibitor monotherapy trials. Inter-patient variability and saturable kinetics support therapeutic drug monitoring of serum clomipramine and desmethylclomipramine concentrations to optimize therapy. A proposed algorithm that aligns with current OCD treatment guidelines is described. Further study is needed to evaluate efficacy of this approach.

OBJECTIFS: Préciser la posologie et décrire l'interaction pharmacocinétique, l'efficacité et l'innocuité de la thérapie combinée fluvoxamine-clomipramine pour le trouble obsessionnel-compulsif (TOC) pédiatrique réfractaire au traitement. MÉTHODES: Une revue de dossiers rétrospective de patients souffrant du TOC à un hôpital pour enfants de soins tertiaires entre janvier 2010 et août 2017 a été menée. Les patients inclus avaient 18 ans ou moins lors de l'initiation de la thérapie combinée fluvoxamine-clomipramine et avaient au moins une série de valeurs de concentration sérique pour le captage des taux de clomipramine et de desméthylclomipramine. RÉSULTATS: Six adolescents satisfaisaient aux critères d'inclusion de l'étude. La fluvoxamine inhibait adéquatement le métabolisme de la clomipramine pour la desméthylclomipramine de manière dose-dépendante. La thérapie combinée fluvoxamine-clomipramine était généralement bien tolérée sans effets indésirables sérieux ou dangereux déclarés. CONCLUSION: La thérapie combinée fluvoxamine-clomipramine permet d'utiliser des doses plus faibles de clomipramine que celles habituellement utilisées en monothérapie de clomipramine et semble être une solution de rechange sûre pour les patients du TOC pédiatrique qui ne répondent pas aux essais de monothérapie d'inhibiteurs sélectifs séquentiels de recaptage de la sérotonine. La variabilité inter-patients et la cinétique saturable soutiennent le contrôle des médicaments thérapeutiques et des concentrations sériques de clomipramine et de desméthylclomipramine afin d'optimiser la thérapie. Un algorithme proposé qui correspond aux lignes directrices du traitement du TOC est décrit. Il faut d'autres études pour évaluer l'efficacité de cette approche.

Proportion and risk indicators of nonadherence to statin therapy: a meta-analysis.

BACKGROUND: Nonadherence to chronic disease medications is important. A growing body of literature suggests that better delivery of established therapies would save more lives than would discovery of innovations. Our first objective was to quantify the proportion of adherence to statin medications. The second objective was to provide estimates of risk indicators associated with nonadherence to statin medications. METHODS: We performed a systematic literature review and meta-analysis of all studies published between database inception and June of 2011 that reviewed adherence, and risk indicators associated with nonadherence, to statin medications. RESULTS: In the end, 67 studies met our inclusion and exclusion criteria and passed our methodological-quality evaluation. Among observational studies, 49.0% (95% confidence interval [CI], 48.9%-49.2%) of patients were adherent to statin medications at 1 year of follow-up. Among randomized trials, 90.3% (95% CI, 89.8%-90.8%) of patients were adherent to statin medications at 1 year of follow-up. The association between 147 variables and adherence to statin medications was determined. After meta-analysis, only 6 variables were associated with nonadherence to statin medications: primary prevention (rate ratio = 1.52; 95% CI, 1.50-1.53); new statin users (rate ratio = 1.46; 95% CI, 1.33-1.61); copayment (rate ratio = 1.28; 95% CI, 1.09-1.50; lower income status (rate ratio = 1.26; 95% CI, 1.16-1.37); fewer than 2 lipid tests performed (rate ratio = 1.38; 95% CI, 1.16-1.64), and not having hypertension (rate ratio = 1.16; 95% CI, 1.12-1.21). CONCLUSIONS: This study provides some insight into the extent of nonadherence by study type along with 6 risk indicators associated with nonadherence to statin medications.