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.

Safety and Outcomes of Intravenous Thrombolytic Therapy in Ischemic Stroke Patients with COVID-19: CASCADE Initiative.

BACKGROUND: There is little information regarding the safety of intravenous tissue plasminogen activator (IV-tPA) in patients with stroke and COVID-19. METHODS: This multicenter study included consecutive stroke patients with and without COVID-19 treated with IV-tPA between February 18, 2019, to December 31, 2020, at 9 centers participating in the CASCADE initiative. Clinical outcomes included modified Rankin Scale (mRS) at hospital discharge, in-hospital mortality, the rate of hemorrhagic transformation. Using Bayesian multiple regression and after adjusting for variables with significant value in univariable analysis, we reported the posterior adjusted odds ratio (OR, with 95% Credible Intervals [CrI]) of the main outcomes. RESULTS: A total of 545 stroke patients, including 101 patients with COVID-19 were evaluated. Patients with COVID-19 had a more severe stroke at admission. In the study cohort, 85 (15.9%) patients had a hemorrhagic transformation, and 72 (13.1%) died in the hospital. After adjustment for confounding variables, discharge mRS score ≥2 (OR: 0.73, 95% CrI: 0.16, 3.05), in-hospital mortality (OR: 2.06, 95% CrI: 0.76, 5.53), and hemorrhagic transformation (OR: 1.514, 95% CrI: 0.66, 3.31) were similar in COVID-19 and non COVID-19 patients. High-sensitivity C reactive protein level was a predictor of hemorrhagic transformation in all cases (OR:1.01, 95%CI: 1.0026, 1.018), including those with COVID-19 (OR:1.024, 95%CI:1.002, 1.054). CONCLUSION: IV-tPA treatment in patients with acute ischemic stroke and COVID-19 was not associated with an increased risk of disability, mortality, and hemorrhagic transformation compared to those without COVID-19. IV-tPA should continue to be considered as the standard of care in patients with hyper acute stroke and COVID-19.

Introducing medical students to deep learning through image labelling: a new approach to meet calls for greater artificial intelligence fluency among medical trainees.

Our approach addresses the urgent need for AI experience for the doctors of tomorrow. Through a medical education-focused approach to data labelling, we have fostered medical student competence in medical imaging and AI. We envision our framework being applied at other institutions and academic groups to develop robust labelling programs for research endeavours. Application of our approach to core visual modalities within medicine (e.g. interpretation of ECGs, diagnostic imaging, dermatologic findings) can lead to valuable student experience and competence in domains that feature prominently in clinical practice, while generating much needed data in fields that are ripe for AI integration.

Notre approche répond au besoin urgent de familiariser les médecins de demain avec l'IA. Nous avons cherché à développer leurs compétences en imagerie médicale et en IA par une approche à l'étiquetage de données axée sur la formation médicale. D'autres établissements et groupes universitaires souhaitant mettre sur pied des programmes d'étiquetage solides pour leurs projets de recherche pourraient adopter notre modèle. L'application de notre approche aux principales modalités visuelles en médecine (par exemple, l'interprétation des ECG, l'imagerie diagnostique, le diagnostic des lésions dermatologiques) peut permettre aux étudiants d'acquérir une expérience et des compétences précieuses dans des domaines importants de la pratique clinique, tout en procurant des données indispensables dans des secteurs qui sont mûrs pour une intégration de l'IA.

The impact of socioeconomic status on the burden of atherosclerosis, and the effect of intensive preventive therapy on its progression: A retrospective cohort study.

BACKGROUND AND AIMS: Socioeconomic status (SES) is associated with cardiovascular disease. However, the relationship between SES and atherosclerosis is not well documented. This study aims to explore this relationship. METHODS: This is a retrospective cohort study in London, Ontario Canada. It includes 6,907 subjects from a vascular prevention centre at baseline, with long term follow up from 1989 to 2021 (total ultrasound examinations 27,103). Using carotid ultrasound, the burden of atherosclerosis was measured as total plaque area (TPA). The Ontario Marginalization Index (OMI) was used to identify SES of participants' neighborhoods. We used a Bayesian hierarchical regression and mixed effects model to identify associations between SES, baseline TPA and plaque progression. In 2003, we implemented more intensive therapy of vascular risk factors after 2003 (called "Treating arteries instead of risk treating factors"); therefore, we compared our findings before and after 2003. RESULTS: SES was found to have a significant association with TPA, with lower SES associated with higher TPA (adjusted odds ratio [OR] = 2.22, 95% Credible interval [CrI]: 1.37, 3.66). While we observed a higher rate of plaque progression with lower SES in those treated before 2003 (OR = 1.46, 95% CrI:1.04, 2.06), there was no significant association between plaque progression and SES after implementation more intensive therapy (OR = 0.99, 95% CrI: 0.78, 1.27). CONCLUSIONS: SES has a strong association with atherosclerosis and should be considered an important risk factor in clinical practice and vascular disease research. Intensive preventive therapy can prevent plaque progression irrespective of baseline SES.