Background and aims Recreational cannabis was legalized in Canada in October 2018. Initially, the Government of Ontario (Canada’s largest province) placed strict limits on the number of cannabis retail stores before later removing these limits. This study measured changes in cannabis‐attributable emergency department (ED) visits over time, corresponding to different regulatory periods. Design Interrupted time–series design using population‐level data. Two policy periods were considered; recreational cannabis legalization with strict store restrictions (RCL, 17 months) and legalization with no store restrictions [recreational cannabis commercialization (RCC), 15 months] which coincided with the COVID‐19 pandemic. Segmented Poisson regression models were used to examine immediate and gradual effects in each policy period. Setting Ontario, Canada. Participants All individuals aged 15–105 years (n = 13.8 million) between January 2016 and May 2021. Measurements Monthly counts of cannabis‐attributable ED visits per capita and per all‐cause ED visits in individuals aged 15+ (adults) and 15–24 (young adults) years. Findings We observed a significant trend of increasing cannabis‐attributable ED visits pre‐legalization. RCL was associated with a significant immediate increase of 12% [incident rate ratio (IRR) = 1.12, 95% confidence interval (CI) = 1.02–1.23] in rates of cannabis‐attributable ED visits followed by significant attenuation of the pre‐legalization slope (monthly slope change IRR = 0.98, 95% CI = 0.97–0.99). RCC and COVID‐19 were associated with immediate significant increases of 22% (IRR = 1.22, 95% CI = 1.09–1.37) and 17% (IRR = 1.17, 95% CI = 1.00–1.37) in rates of cannabis‐attributable visits and the proportion of all‐cause ED visits attributable to cannabis, respectively, with insignificant increases in monthly slopes. Similar patterns were observed in young adults. Conclusions In Ontario, Canada, cannabis‐attributable emergency department visits stopped increasing over time following recreational cannabis legalization with strict retail controls but then increased during a period coinciding with cannabis commercialization and the COVID‐19 pandemic.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.Disclaimer: Parts of this material are based on data and information compiled and provided by the Canadian Institute for Health Information and the Ontario Ministry of Health. The analyses, conclusions, opinions, and statements expressed herein are solely those of the authors and do not reflect those of the funding or data sources; no endorsement is intended or should be inferred.

Background and purposeStroke survivors are often left with deficits requiring rehabilitation to recover function and yet, many are unable to access rehabilitative therapies. Mobile tablet-based therapies (MTBTs) may be a resource-efficient means of improving access to timely rehabilitation. It is unclear what MTBTs have been attempted following stroke, how they were administered, and how patients experienced the therapies. The review summarizes studies of MTBTs following stroke in terms of administrative methods and patient experiences to inform treatment feasibility.MethodsArticles were eligible if they reported the results of an MTBT attempted with stroke participants. Six research databases were searched along with grey literature sources, trial registries, and article references. Intervention administration details and patient experiences were summarized.ResultsThe search returned 903 articles of which 23 were eligible for inclusion. Most studies were small, observational, and enrolled chronic stroke patients. Interventions commonly targeted communication, cognition, or fine-motor skills. Therapies tended to be personalized based on patient deficits using commercially available applications. The complexity of therapy instructions, fine-motor requirements, and unreliability of internet or cellular connections were identified as common barriers to tablet-based care.ConclusionsStroke patients responded positively to MTBTs in both the inpatient and home settings. However, some support from therapists or caregivers may be required for patients to overcome barriers to care. Feasibility studies should continue to identify the administrative methods that minimize barriers to care and maximize patient adherence to prescribed therapy regiments.

IMPORTANCE Physicians self-report high levels of symptoms of anxiety and depression, and surveys suggest these symptoms have been exacerbated by the COVID-19 pandemic. However, it is not known whether pandemic-related stressors have led to increases in health care visits related to mental health or substance use among physicians.OBJECTIVE To evaluate the association between the COVID-19 pandemic and changes in outpatient health care visits by physicians related to mental health and substance use and explore differences across physician subgroups of interest. DESIGN, SETTING, AND PARTICIPANTSA population-based cohort study was conducted using health administrative data collected from the universal health system (Ontario Health Insurance

IntroductionStroke survivors frequently experience a range of post-stroke deficits. Specialized stroke rehabilitation improves recovery, especially if it is started early post-stroke. However, resource limitations often preclude early rehabilitation. Mobile technologies may provide a platform for stroke survivors to begin recovery when they might not be able to otherwise. The study objective was to demonstrate the feasibility of RecoverNow, a tablet-based stroke recovery platform aimed at delivering speech and cognitive therapy.MethodsWe recruited a convenience sample of 30 acute stroke patients to use RecoverNow for up to 3 months. Allied health professionals assigned specific applications based on standard of care assessments. Participants were encouraged to take home the RecoverNow tablets upon discharge from acute care. The study team contacted participants to return for a follow-up interview 3 months after enrollment. The primary outcome of interest was feasibility, defined using 5 facets: recruitment rate, adherence rate, retention rate, the proportion of successful follow-up interventions, and protocol deviations. We tracked barriers to tablet-based care as a secondary outcome.ResultsWe successfully recruited 30 of 62 eligible patients in 15 weeks (48% recruitment rate). Participants were non-adherent to tablet-based therapy inside and outside of acute care, using RecoverNow for a median of 12 minutes a day. Retention was high with 23 of 30 patients participating in follow-up interviews (77% retention rate) and all but 3 of the 23 interviews (87%) were successfully completed. Only 2 major protocol deviations occurred: one enrollment failure and one therapy protocol violation. Barriers to tablet-based care were frequently encountered by study participants with many expressing the assigned applications were either too easy or too difficult.ConclusionsAcute stroke patients are interested in attempting tablet-based stroke rehabilitation and are easily recruited early post-stroke. However, tablet-based therapy may be challenging due to patient, device and system-related barriers. Reducing the frequency of common barriers will be essential to keeping patients engaged in tablet-based therapy.