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Psychedelics, including ketamine, 3,4-Methyl enedioxy methamphetamine (MDMA), and psilocybin, have gained attention for their potential therapeutic role in mental health treatment. While recreational use is prohibited in Canada, medicinal exemptions can be granted. There are several psychedelic clinics in Ontario, Canada, promoting the use of psychedelics for a variety of medical indications. Our objective was to identify the indications for which psychedelics are being prescribed in Ontario clinics and assess the quality of evidence used to support these claims. Internet searches were conducted using Google and Bing to identify psychedelic clinics in Ontario. Inclusion criteria was as follow: clinics were physically located in Ontario, had a functioning website link, and demonstrated involvement of a licensed physician or nurse practitioner. Identified clinics were evaluated for their claims of effectiveness, the quality of evidence used to support these claims, and statements on psychedelic-related harms. The cited studies were appraised for quality using Oxford Centre for Evidence-Based Medicine Levels of Evidence, "level 5" being the lowest quality and "level 1" being the highest quality. Out of 200 search results, 10 psychedelic clinic websites met our inclusion criteria. These clinics advertised psychedelics for 47 medical conditions, most commonly for depression. Only 2 out of 10 clinics described potential risks associated with psychedelic use. There were 29 studies cited by these websites, majority coming from "level 4" evidence consisting of case-series and case-control studies. Overall, the cited evidence quality was low to moderate. Psychedelic clinics in Ontario promote a wide range of medical indications for psychedelics using primarily low to moderate "level 4" evidence. There is limited information shared on the potential adverse effects of psychedelics. Our study emphasizes the importance of using transparent and high-quality evidence by clinics and clinicians to ensure safe and effective use of psychedelics in mental health treatments. [ABSTRACT FROM AUTHOR]

Aim: The study aimed to evaluate the reliability and usability of the CARE‐Radiology checklist in assessing radiological case reports and provide a basis for its broader adoption and optimization. Methods: Ten randomly selected radiological case reports published in scientific journals in 2020 were evaluated using the CARE‐Radiology checklist. Twenty‐six experts from 10 countries were invited to independently assess all ten reports. The reliability of the checklist was measured using Fleiss' Kappa, and Cronbach's alpha coefficient. Usability was evaluated by recording the time taken to complete the assessments and requesting the evaluators to rate each item on a Likert scale for its easiness of use. Results: The median time for evaluating one radiological case report was 15 min. The overall agreement among evaluators showed moderate reliability with a Kappa value of 0.47 and a Cronbach's alpha of 0.51. The mean compliance rate for the items of CARE‐Radiology was 61.8%, with some items exceeding 90% compliance. Items related to abstracts and keywords had the lowest compliance rates. The evaluators found most items easy to understand, with a few exceptions. Conclusions: The CARE‐Radiology checklist is relatively easy for researchers to use and understand. Continuous feedback is necessary for future revisions and updates, to enhance the effectiveness of the checklist, and to improve user experience. [ABSTRACT FROM AUTHOR]

IntroductionXylitol (or 'birch sugar') is a naturally occurring sugar with antibacterial properties that has been used as a natural non-sugar sweetener in chewing gums, confectionery, toothpaste and medicines. In this preventative randomised trial, xylitol will be tested for the prevention of acute otitis media (AOM), a common and costly condition in young children. The primary outcome will be the incidence of AOM. Secondary outcomes will include upper respiratory tract infections (URTIs) and dental caries.Methods and analysisThis study will be a pragmatic, blinded (participant and parents, practitioners and analyst), two-armed superiority, placebo-controlled randomised trial with 1:1 allocation, stratified by clinical site. The trial will be conducted in the 11 primary care group practices participating in the TARGet Kids! research network in Canada. Eligible participants between the ages of 2-4 years will be randomly assigned to the intervention arm of regular xylitol syrup use or the control arm of regular sorbitol use for 6 months. We expect to recruit 236 participants, per treatment arm, to detect a 20% relative risk reduction in AOM episodes. AOM will be identified through chart review. The secondary outcomes of URTIs and dental caries will be identified through monthly phone calls with specified questions.Ethics and disseminationEthics approval from the Research Ethics Boards at the Hospital for Sick Children and St. Michael's Hospital has been obtained for this study and also for the TARGet Kids! research network. Results will be submitted for publication to a peer-reviewed journal and will be discussed with decision makers.Trial registration numberNCT03055091; Pre-results.

Objective To compare the medicines included in national essential medicines lists with the World Health Organization's (WHO's) Model list of essential medicines, and assess the extent to which countries' characteristics, such as WHO region, size and health care expenditure, account for the differences. Methods We searched the WHO's Essential Medicines and Health Products Information Portal for national essential medicines lists. We compared each national list of essential medicines with both the 2017 WHO model list and other national lists. We used linear regression to determine whether differences were dependent on WHO Region, population size, life expectancy, infant mortality, gross domestic product and health-care expenditure. Findings We identified 137 national lists of essential medicines that collectively included 2068 unique medicines. Each national list contained between 44 and 983 medicines (median 310: interquartile range, IQR: 269 to 422). The number of differences between each country's essential medicines list and WHO's model list ranged from 93 to 815 (median: 296; IQR: 265 to 381). Linear regression showed that only WHO region and health-care expenditure were significantly associated with the number of differences (adjusted [R.sup.2]: 0.33; P< 0.05). Most medicines (1248; 60%) were listed by no more than 10% (14) of countries. Conclusion The substantial differences between national lists of essential medicines are only partly explained by differences in country characteristics and thus may not be related to different priority needs. This information helps to identify opportunities to improve essential medicines lists. Objectif Comparer les medicaments inclus dans les listes nationales des medicaments essentiels avec la Liste modele de l'Organisation mondiale de la Sante (OMS) des medicaments essentiels, et determiner dans quelle mesure les caracteristiques des pays, comme la region OMS, la taille et les depenses de soins de sante, expliquent les differences. Methodes Nous avons recherche des listes nationales des medicaments essentiels sur le Portail d'information--Medicaments essentiels et produits de sante de l'OMS. Nous avons compare chaque liste nationale des medicaments essentiels avec la Liste modele de l'OMS de 2017 et d'autres listes nationales. Nous avons utilise une regression lineaire pour determiner si les differences dependaient de la region OMS, de la taille de la population, de l'esperance de vie, de la mortalite infantile, du produit interieur brut et des depenses de soins de sante. Resultats Nous avons selectionne 137 listes nationales des medicaments essentiels qui contenaient au total 2068 medicaments differents. Chaque liste national recensait entre 44 et 983 medicaments (mediane: 310; intervalle interquartile, IQR: de 269 a 422). Le nombre des differences entre la liste des medicaments essentiels de chaque pays et la Liste modele de l'OMS variait entre 93 et 815 (mediane: 296; IQR: de 265 a 381). La regression lineaire a montre que seules la region OMS et les depenses de soins de sante etaient clairement associees au nombre des differences ([R.sup.2] ajuste: 0,33; P< 0,05). La plupart des medicaments (1248; 60%) etaient listes par 10% (14) des pays, pas plus. Conclusion Les differences importantes entre les listes nationales des medicaments essentiels s'expliquent seulement en partie par des differences au niveau des caracteristiques des pays et ne sont donc pas forcement liees a differents besoins prioritaires. Ces informations aident a identifier des possibilites d'ameliorations des listes des medicaments essentiels. Objetivo Comparar los medicamentos incluidos en las listas nacionales de medicamentos esenciales con la Lista Modelo de Medicamentos Esenciales de la Organizacion Mundial de la Salud (OMS) y evaluar en que medida las diferencias se deben a las caracteristicas de los paises, como la region, el tamano y el gasto en atencion sanitaria de la OMS. Metodos Se realizaron busquedas en el Portal de Informacion de Medicamentos Esenciales y Productos de Salud de la OMS para obtener listas nacionales de medicamentos esenciales. Se comparo cada lista nacional de medicamentos esenciales con la Lista Modelo de la OMS de 2017 y con otras listas nacionales. Se utilizo la regresion lineal para determinar si las diferencias dependian de la region de la OMS, el tamano de la poblacion, la esperanza de vida, la mortalidad infantil, el producto interno bruto y el gasto en atencion sanitaria. Resultados Identificamos 137 listas nacionales de medicamentos esenciales que incluian colectivamente 2068 medicamentos unicos. Cada lista nacional contenia entre 44 y 983 medicamentos (mediana 310: rango intercuartil, IQR: 269 a 422). El numero de diferencias entre la lista de medicamentos esenciales de cada pais y la Lista Modelo de la OMS oscilo entre 93 y 815 (mediana: 296; IQR: 265 a 381). La regresion lineal mostro que solo la region de la OMS y el gasto en atencion sanitaria se asociaron significativamente con el numero de diferencias ([R.sup.2] ajustado: 0,33; P < 0,05). La mayoria de los medicamentos (1248; 60%) fueron listados por no mas del 10% (14) de los paises. Conclusion Las diferencias sustanciales entre las listas nacionales de medicamentos esenciales solo se explican en parte por las diferencias en las caracteristicas de los paises y, por lo tanto, pueden no estar relacionadas con las diferentes necesidades prioritarias. Esta informacion ayuda a identificar oportunidades para mejorar las listas de medicamentos esenciales., Introduction More than 5 billion people live in countries that use essential medicines lists. These lists typically contain hundreds of medicines intended to meet the priority health-care needs of a [...]

Background Adherence to medicines is low for a variety of reasons, including the cost borne by patients. Some jurisdictions publicly fund medicines for the general population, but many jurisdictions do not, and such policies are contentious. To our knowledge, no trials studying free access to a wide range of medicines have been conducted. Methods and findings We randomly assigned 786 primary care patients who reported not taking medicines due to cost between June 1, 2016 and April 28, 2017 to either free distribution of essential medicines (n = 395) or to usual medicine access (n = 391). The trial was conducted in Ontario, Canada, where hospital care and physician services are publicly funded for the general population but medicines are not. The trial population was mostly female (56%), younger than 65 years (83%), white (66%), and had a low income from wages as the primary source (56%). The primary outcome was medicine adherence after 2 years. Secondary outcomes included control of diabetes, blood pressure, and low-density lipoprotein (LDL) cholesterol in patients taking relevant treatments and healthcare costs over 2 years. Adherence to all appropriate prescribed medicines was 38.7% in the free distribution group and 28.6% in the usual access group after 2 years (absolute difference 10.1%; 95% confidence interval (CI) 3.3 to 16.9, p = 0.004). There were no statistically significant differences in control of diabetes (hemoglobin A1c 0.27; 95% CI -0.25 to 0.79, p = 0.302), systolic blood pressure (-3.9; 95% CI -9.9 to 2.2, p = 0.210), or LDL cholesterol (0.26; 95% CI -0.08 to 0.60, p = 0.130) based on available data. Total healthcare costs over 2 years were lower with free distribution (difference in median CAN$1,117; 95% CI CAN$445 to CAN$1,778, p = 0.006). In the free distribution group, 51 participants experienced a serious adverse event, while 68 participants in the usual access group experienced a serious adverse event (p = 0.091). Participants were not blinded, and some outcomes depended on participant reports. Conclusions In this study, we observed that free distribution of essential medicines to patients with cost-related nonadherence substantially increased adherence, did not affect surrogate health outcomes, and reduced total healthcare costs over 2 years. Trial registration ClinicalTrials.gov NCT02744963., Author(s): Nav Persaud 1,2,3,4,*, Michael Bedard 5, Andrew Boozary 6, Richard H. Glazier 1,2,3,7,8, Tara Gomes 1,2,9,10, Stephen W. Hwang 2,4,11, Peter Juni 4,11, Michael R. Law 12, Muhammad Mamdani [...]