P ediatric use of medical cannabis entered widespread public consciousness in 2013, when the CNN television network aired Weed, a documentary highlighting its therapeutic benefits in children with severe epilepsy. 1 Since then, pediatric medical cannabis has continued to gain societal and scientific attention. [2][3][4][5] Cannabis contains 2 main cannabinoids with proposed medicinal effects: cannabidiol (CBD) and delta-9-tetrahydrocannabinol (THC). 6 Cannabidiol reduces seizure frequency and duration in children with treatmentresistant epilepsy, 7 specifically Dravet syndrome; 8-10 THC is known to have antiemetic, appetite-stimulant and analgesic effects useful in cancer treatment. [11][12][13][14][15] We use the term medical cannabis for any combination of CBD and THC.In 2018, Canada became the second nation to legalize cannabis for both recreational and medical use. Products under pharmaceutical regulations (Controlled Drugs and Substances Act [S.C 1996, c. 19]) are available via prescription as semisynthetic drugs 16 or highly purified plant-derived drugs. 17 Nonpharmaceutical, standardized cannabis extracts are available with medical authorization from more than 150 licensed producers, (Cannabis Act [S.C. 2018, c. 16]). Additionally, adults may obtain cannabis intended for recreational use, without medical authorization, from retail stores, called dispensaries, or black market sources. 18,19 Provenance of cannabis from dispensaries is often unknown. Cannabis can also be grown at home.There is a lack of robust evidence to guide cannabis practices across pediatric medical disciplines. 2,20,21 The Canadian Paediatric Society does not support its use, except on a carefully considered, case-by-case basis, citing limited evidence and potential harms. 2 Thus, in Canada, use of medical cannabis is most known in children with severe conditions. Few
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Background: Developmental dysplasia of the hip (DDH) is a common condition affecting 5 in 1000 newborns. The standard first line of treatment is the use of an orthotic, which has generally high success rates, but can pose substantial difficulties and put undue burden on caregivers. The general experience of caregivers using these orthotics has not been well documented on an orthotic-specific basis. The purpose of this study was to investigate caregiver experience using prescribed DDH orthotics to identify challenges, differences between treatment options, and areas of improvement. Methods: A survey assessing treatment prescription, respondent demographics, and caregiver experience was distributed online to caregivers whose child/children were treated for DDH with an orthotic. Seven-point positively phrased Likert scale statements and open-ended questions were included to assess caregiver experience. The results were analyzed using summary statistics and orthotics with more than 30 responses were selected for more in-depth analysis. Results: A total of 530 survey responses were collected with 63% (334/530) of respondents using a Pavlik harness, 45% (236/530) a Rhino brace, and 13% (67/530) a Denis Browne Bar. The overall weighted average score across all Likert Scale statements was positive for the Pavlik harness, Rhino brace, and Denis Browne Bar at 4.19 (95% CI, 3.83 to 4.54), 4.63 (95% CI, 4.27 to 4.99) and 4.91 (95% CI, 4.58 to 5.24), respectively. In the open-ended responses, all 3 orthotics were perceived as easy to use and not hindering child-caregiver bonding, but raised concerns of discomfort and skin irritation, as well as preventing the ability to cuddle their child the way they desired. The Pavlik harness respondents consistently brought up concerns regarding cleanability. Conclusions: The results show that the DDH orthotics analyzed are generally easy to use and perceived positively by caregivers, but have orthotic-specific challenges that should be a focus of future improvement work. Clinical Relevance: This study evaluated opinions and attitudes of caregivers for children being treated with DDH orthotics, revealing experiences, concerns, and challenges associated with the use of commonly prescribed options.
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