Medical cannabis in schools: The experiences of caregivers.

Objectives: Implementing medical cannabis (MC) into a child's daily routine can be challenging and there is a lack of guidance for its therapeutic use in schools in Canada. Our objective was to learn about the experiences of caregivers of school-aged children who require MC. Methods: Qualitative description was used and caregivers were interviewed about MC in schools and in general. The transcripts were entered into Dedoose software for qualitative analysis and content analysis was performed. Sentences and statements were ascribed line by line into meaning units and labelled with codes, and organized according to categories and subcategories. Results: Twelve caregivers of school-aged children who take MC participated. The most common reasons for treatment were drug-resistant epilepsy (DRE), autism, or other developmental disorders. Approximately half of the participants' children (n = 6) took MC during the school day and most (5/6) perceived their experiences to be positive or neutral but reported a lack of knowledge about MC. While data saturation was not reached regarding MC in schools, rich dialogues were garnered about MC in general and three categories were identified: challenges (subcategories stigma, finding an authorizer, cost, dosing, and supply); parents as advocates (subcategories required knowledge, attitudes, skills, and sources of information); and caregiver relief for positive outcomes. Conclusions: Caregivers demonstrate remarkable tenacity despite the many challenges associated with MC use. Education and practice change are needed to ensure that children using MC can benefit from or continue to experience its positive outcomes within the school environment and beyond.

Medical Cannabis in Canadian Schools: A Scoping Review of Existing Policies.

Objective: An increasing number of children and youth in Canada are taking medical cannabis for complex medical conditions. While they deserve safe and consistent access to pharmacotherapy throughout the day, administrative policies on cannabis use in schools are inconsistent. A scoping review identified policies and publications associated with medical cannabis in Canadian schools. Methods: Five databases (Scopus, PubMed, CINAHL, EMBASE, and Web of Science) were searched to identify scientific literature. Legislation in each province and territory and Ministry of Education webpages were reviewed for pertinent laws and policies regarding cannabis use in schools. Results: The scientific search resulted in 1289 articles. The five included articles pertain to implications for school nurses in the United States, which are not relevant to the Canadian context. A search of Ministry of Education websites identified only one policy with information regarding medical cannabis in schools (from Ontario). Federal legislation (the Cannabis Act) does not specifically address medical cannabis in schools, and there is a lack of consistency in terminology and clarity within provincial and territorial laws. All provinces and territories prohibit smoking and vaping of cannabis on school property and some provinces prohibit any method of cannabis consumption. Conclusions: In Canada, there is a lack of guidance for medical cannabis administration, storage, and disposal in schools, with some policies explicitly prohibiting this type of treatment. This shifts the burden to families to individually create plans school by school. A federally harmonized approach to supporting children who take cannabis for medical purposes ought to be explored.

Development of the REACH (Real Education About Cannabis and Health) Program for Canadian Youth.

BACKGROUND: Because cannabis use in children can have negative consequences, the recent legalization of recreational cannabis for adults in Canada creates an urgent need for youth education. METHOD: A multidisciplinary clinical rotation was developed wherein nursing and pharmacy students collaborated with youth (grades 7 through 10) to construct an educational program about cannabis. Four schools participated, representing a variety of socioeconomic demographics. Feedback was solicited from students and stakeholders. The purpose of this project was to create REACH (Real Education About Cannabis and Health), a toolkit and curriculum resource that includes lesson plans for teachers covering the science of cannabis, social science implications, peer pressure, decision making and harm reduction, videos featuring youth testimonials, and supplemental resources. RESULTS: Preliminary feedback suggests the materials are engaging and informative. CONCLUSION: A collaboration of health science students with youth in schools resulted in an authentic and relatable educational program about cannabis. Future studies will evaluate REACH's effectiveness in seventh- and ninth-grade students. [J Nurs Educ. 2020;59(8):465-469.].

Physical therapist recognition of signs and symptoms of infection after shoulder reconstruction: a patient case report.

STUDY DESIGN: Patient case report. BACKGROUND: Clinical reasoning associated with patient evaluation leads physical therapists to one of three choices: 1) treat; 2) treat and refer; or 3) refer. Patients seen postoperatively require screening for potential complications, including infection. Inconsistent or unusual signs and symptoms following orthopedic surgery should lead to consultation and referral, and modifications to the physical therapy plan of care. CASE DESCRIPTION: A 35-year-old female with Type II glenohumeral instability was referred to physical therapy 5 weeks after a capsular shift surgical procedure of the right shoulder. During the initial physical therapy examination, unexpected complaints were noted including bilateral diffuse multi-joint arthralgia as well as fatigue that significantly limited the patient's abilities and functions. These and other atypical signs were recognized by the physical therapist as indicative of a possible infection or other type of medical complication. Recognition of the atypical findings led the therapist to immediately contact the referring physician, an action which influenced the timely addition of antibiotic therapy. After antibiotic therapy was added to the medical care of the patient, she was able to fully participate in postoperative rehabilitation and successfully completed postoperative rehabilitation within the expected time frame. DISCUSSION: This case illustrates the importance of physical therapists recognizing and reporting atypical signs and symptoms during postoperative care. Prompt communication between the physical therapist and the referring physician in this case led to appropriate medical management in the addition of antibiotic therapy that facilitated patient recovery.