The impact of music, play, and pet therapies in managing pain and anxiety in paediatric patients in hospital: a rapid systematic review.

Background: Hospitalized children face pain and anxiety associated with the environment and procedures. Objective: This review aimed to assess the impact of music, play, pet and art therapies on pain and anxiety in hospitalized paediatric patients. RCTs assessing the impact of music, play, pet, and/or art therapies on pain and/or anxiety in hospitalized paediatric patients were eligible. Methods: Database searching and citation screening was completed to identify studies. A narrative synthesis was used to summarize study findings and certainty of evidence was assessed using GRADE. Of the 761 documents identified, 29 were included spanning music (n = 15), play (n = 12), and pet (n = 3) therapies. Results: A high certainty of evidence supported play in reducing pain and moderate certainty for music and pet. A moderate certainty of evidence supported music and play in reducing anxiety. Conclusion: Complementary therapies utilized alongside conventional medical treatment may mitigate pain and anxiety in hospitalized paediatric patients.

Multifocal Epstein-Barr Virus-Positive Mucocutaneous Ulcers in a Patient With Crohn's Disease.

Epstein-Barr Virus-positive mucocutaneous ulcer (EBVMCU) is a rare and new category of mature B-cell neoplasms commonly linked to immunosuppression. It often has a benign course and regresses spontaneously after discontinuation or dose reduction of immunosuppressive agents. We report the case of a 48-year-old woman on long-term azathioprine therapy for rectosigmoid Crohn's disease. In contrast to the prevalent sites typically associated with EBVMCU, such as the oral mucosa and skin, this patient was found to have locations in the gastrointestinal tract and upper neck. These areas tested positive for histopathology consistent with EBVMCU and were excised due to bowel perforation and concern for malignancy.

Designing a Multidisciplinary Cardio-obstetrics Curriculum for General Cardiology and Obstetrics Residents: A National Survey of Educational Needs.

Background: The increasing and potentially preventable cardiac events in pregnant patients have led to calls to enhance multidisciplinary cardio-obstetrics education. To design a multidisciplinary cardio-obstetrics curriculum for general cardiology and obstetrics and gynecology (OBGYN) residents, we need to define educational needs from the perspectives of both cardiology and OBGYN residents. Our study characterizes the educational needs of Canadian cardiology and OBGYN residents. Methods: Canadian cardiology and OBGYN residents were surveyed on clinical exposures, perceived needs for topics, unperceived needs for topics (multiple-choice questions) and preferences for educational formats. High priorities were defined as ≥ 50% of responses indicating a perceived need or ≥ 50% indicating an unperceived need. Results: A total of 154 residents participated (cardiology n = 44, OBGYN n = 110). Residents reported insufficient clinical exposure to nearly all cardiac disorders, with 33% of exposures occurring in multidisciplinary contexts. All topics aside from gestational hypertension were rated as high priority on perceived needs by both specialties. High-priority unperceived needs were congenital heart disease (both specialties), pre-existing acquired heart disease (both specialties), medication safety (OBGYN), peripartum management (OBGYN), and pregnancy-related heart disease (OBGYN). Cardiology and OBGYN residents shared preferences for in-person simulation, virtual simulation, and online modules. Conclusions: Residents in both specialties reported low clinical exposure to most cardiac disorders during pregnancy, identified high-priority perceived needs in multiple topics, and shared 2 high-priority unperceived needs. OBGYN residents identified 3 additional high-priority unperceived needs. These data can inform design of multidisciplinary cardio-obstetrics curricula for general cardiology and OBGYN residents.

Contexte: L'augmentation du nombre d'événements cardiaques potentiellement évitables chez les patientes enceintes a conduit à des appels pour renforcer la formation multidisciplinaire en cardio-obstétrique. Afin de concevoir un programme d'études multidisciplinaires en cardio-obstétrique pour les résidents en cardiologie générale et en obstétrique et gynécologie (OBGYN), nous devons définir les besoins éducatifs du point de vue des résidents en cardiologie et en OBGYN. Notre étude caractérise les besoins éducatifs des résidents canadiens en cardiologie et en OBGYN. Méthodes: Les résidents canadiens en cardiologie et en OBGYN ont été interrogés sur leurs expositions cliniques, les besoins perçus et non perçus en matière de thématique à aborder (questions à choix multiples) et leurs préférences en matière de formats éducatifs. Les priorités élevées ont été définies comme représentant ≥ 50 % des réponses indiquant un besoin perçu ou ≥ 50 % indiquant un besoin non perçu. Résultats: Cent cinquante-quatre résidents ont participé (cardiologie n = 44, OBGYN n = 110). Les résidents ont signalé une exposition clinique insuffisante pour presque tous les troubles cardiaques, 33 % des expositions se produisant dans des contextes multidisciplinaires. Toutes les thématiques, à l'exception de l'hypertension gestationnelle, ont été jugées hautement prioritaires en ce qui concerne les besoins perçus par les deux spécialités. Les besoins non perçus comme hautement prioritaires comprenaient les cardiopathies congénitales (les deux spécialités), les cardiopathies acquises préexistantes (les deux spécialités), la sécurité des médicaments (OBGYN), la gestion du péripartum (OBGYN) et les cardiopathies liées à la grossesse (OBGYN). Les résidents en cardiologie et en OBGYN partageaient des préférences pour les simulations en personne, les simulations virtuelles et les modules de formation en ligne. Conclusions: Les résidents des deux spécialités ont rapporté une faible exposition clinique à la plupart des troubles cardiaques pendant la grossesse, ont identifié des besoins perçus comme hautement prioritaires dans plusieurs domaines, et ont partagé 2 besoins non perçus comme hautement prioritaires. Les résidents en OBGYN ont identifié 3 autres besoins non perçus comme hautement prioritaires. Ces données peuvent éclairer la conception de programmes d'études multidisciplinaires en cardio-obstétrique pour les résidents en cardiologie générale et en OBGYN.

Severe Ulcerative Colitis Complicated by Malakoplakia Resulting in Proctocolectomy.

We report a 45-year-old man with medically refractory ulcerative colitis with superimposed colonic malakoplakia, presumed related to chronic use of azathioprine and biologics. This is the first reported case of malakoplakia in a patient requiring high doses of combination therapy. Treatment of malakoplakia is not standardized, but can involve systemic antibiotics, or surgical resection, which in this case resulted in proctocolectomy.

Placebo Rates in Randomized Controlled Trials of Proctitis Therapy: A Systematic Review and Meta-Analysis Placebo Response in Proctitis.

BACKGROUND AND AIMS: Treatment options for proctitis are limited. To assist trial design for novel therapeutics, we conducted a systematic review and meta-analysis of proctitis randomized controlled trials [RCTs] to quantify placebo rates and identify factors influencing them. METHODS: We searched MEDLINE, EMBASE and CENTRAL from inception to June 2021. Placebo-controlled trials of pharmacological interventions for proctitis were eligible. Placebo clinical response and remission rates for induction and maintenance trials were extracted and pooled using a random-effects model. Mixed-effects meta-regression was used to evaluate the impact of patient and study-level characteristics. RESULTS: Twenty RCTs [17 induction and four maintenance phases] were included. The most common intervention was aminosalicylates and most studies investigated topical medications. The pooled placebo clinical response and remission rates for induction trials were 28% (95% confidence interval [CI] 22-35%; n = 17) and 20% [95% CI 12-32%; n = 9], respectively. Pooled placebo endoscopic response and remission rates were 32% [95% CI 26-39%, n = 12] and 18% [95% CI 9-33%, n = 6], respectively. For maintenance trials, the pooled placebo clinical remission rate was 29% [95% CI 16-46%, n = 17]. Trials published after 2005 and trials with a longer duration of follow-up were associated with significantly lower placebo response rates. Nineteen of 20 studies were assessed as having an unclear risk of bias, reflecting the historical nature of trials. CONCLUSIONS: Placebo response and remission rates in proctitis trials are influenced by trial phase and the endpoint being assessed. These contemporary rates will inform trial design for novel therapeutics for treatment of proctitis, which is a large unmet need.

Systematic review and meta-analysis of randomised controlled trials: Medical therapies for the treatment and prevention of pouchitis.

BACKGROUND AND AIMS: We conducted a systematic review to assess medical therapy for the treatment and prevention of pouchitis. METHODS: Randomised controlled trials (RCTs) of medical therapy in adults with or without pouchitis were searched to March 2022. Primary outcomes included clinical remission/response, maintenance of remission and prevention of pouchitis. RESULTS: Twenty RCTs (N = 830) were included. Acute pouchitis: One study compared ciprofloxacin with metronidazole. At 2 weeks, 100% (7/7) of ciprofloxacin participants achieved remission, compared with 67% (6/9) of metronidazole participants (RR: 1.44, 95% CI: 0.88-2.35, very low certainty evidence). One study compared budesonide enemas with oral metronidazole. Fifty percent (6/12) of budesonide participants achieved remission compared with 43% (6/14) of metronidazole participants (RR: 1.17, 95% CI: 0.51-2.67, low certainty evidence). Chronic pouchitis: Two studies (n = 76) assessed De Simone Formulation. Eighty-five percent (34/40) of De Simone Formulation participants maintained remission at 9-12 months compared with 3% (1/36) placebo participants (RR: 18.50, 95% CI: 3.86-88.56, moderate certainty evidence). One study assessed vedolizumab. Thirty-one percent (16/51) of vedolizumab participants achieved clinical remission at 14 weeks compared with 10% (5/51) of placebo participants (RR: 3.20, 95% CI: 1.27-8.08, moderate certainty evidence). PROPHYLAXIS: Two studies assessed De Simone Formulation. Ninety percent (18/20) of De Simone Formulation participants did not develop pouchitis compared with 60% (12/20) of placebo participants (RR: 1.50, 95% CI: 1.02-2.21, moderate certainty evidence). CONCLUSIONS: Apart from vedolizumab and the De Simone formulation, the effects of other medical interventions for pouchitis are uncertain.