Longwoods Healthcare Blog

CPAC Program Helps Newcomers Re-enter Healthcare Field

2010-04-22T18:32:00.005-04:00

Celebrates Graduates from RBC Sponsored Program

TORONTO – April 22^nd, 2010. Immigrants with a background in healthcare were awarded Certificates of Graduation for completing a mentorship program that helped them become licensed to work as healthcare professionals in Ontario.

With funding support from the Royal Bank of Canada (RBC), the Chinese Professionals Association of Canada (CPAC) launched a unique Mentoring for Healthcare Professionals program. This is the first bridging program in the community that is focused specifically on helping immigrants obtain registration/licensure and work in the healthcare profession.

“As a frontline service provider, we know too well the frustrations and the barriers immigrants can face,” said Howard Shen, President of CPAC. “With encouragement from RBC, we took on the task of adding a healthcare program to our portfolio and we are very glad that we did,” continued Mr. Shen. “Not only is this an important occasion for these proud graduates, but it is also an important day for their families, their employers and of course for CPAC and our partner, RBC,” said Mr. Shen.

The occupations of the graduates at today’s ceremony include pharmacist, registered nurse, and registered practical nurse.

“I am very thankful for the help of my mentor who guided me every step of the way,” said Yanni He, a registered nurse. “I had been a nurse for several years in China before I immigrated to Canada in 2007. However, the language barrier and complicated accreditation process made my dream of working as a nurse again look impossible.” Ms. He then learned about the CPAC program. Under the guidance of her mentor, Ping Xiao, a Registered Nurse working at Toronto Public Health, Ms. He passed the required exams in four months and is now a registered nurse in Canada.

Ms. Jennifer Tory, RBC Regional Vice President, Greater Toronto Region, also spoke at the event in support of CPAC and the program.

CPAC began the Healthcare Mentoring Program in 2007 and has served 20 immigrants including the seven graduates at today’s graduation. Intensive one-on-one mentoring not only helps participants improve professional and language skills, but also guides them through the registration/licensure process and eventually leads them to healthcare jobs. Over the years, CPAC has built a strong mentor team, representing physicians, surgeons, pharmacists, registered nurses, registered practical nurse, dental hygienists, and medical laboratory technologists.

Despite the services available to help immigrants become licensed to practice in Canada, barriers still exist for internationally trained professionals. For example, Mr. Qiupeng Zhan, a foreign trained MD with a PhD in cardiovascular research and a graduate of the CPAC program, continues to wait for a medical resident opportunity long after passing the required exams. Mr. Zhan’s story is common among immigrant professionals and CPAC encourages all healthcare stakeholders to work together to provide open access to training and jobs in the healthcare field.

About CPAC

The Chinese Professionals Association of Canada (CPAC) is a federally registered not-for-profit organization with over 25,000 members across the country. It is one of the most active organizations providing career development and training services for immigrant professionals. CPAC has been serving immigrant professionals since its inception in 1992. With growing needs from the increasing immigrant healthcare professionals looking for re-entry in their original field in Canada, CPAC is committed to expanding its healthcare mentoring service to help Canada’s newcomers.

For more information, please contact

Mr. Jason Yi

Tel: 416-298-7885 ext. 106

Email: msc@chineseprofessionals.ca.

Performance Measurement and Pay-At-Risk || Alberta Health || 15 Apr 2010

2010-04-22T09:04:00.000-04:00

EDMONTON – The executive contracts tabled by the Liberal Party of Alberta in the legislature this week are more than a year out of date and reflect past practices long since overhauled by the Alberta Health Services Board of Directors and the AHS Executive Team. They do not represent AHS practice today.
The contracts included both agreements signed under the authority of the former Health Regions and the interim AHS Board. The provisions for senior executives in the former regions varied by region and, where provisions existed, often varied by individual contract. These “legacy” agreements were contractual obligations that AHS inherited. AHS was legally bound to comply with these agreements until new rules were put in place.

The AHS Board recognized the need to overhaul the process of executive contract negotiation and took decisive steps last year to address concerns held by the Board and the public. The Board implemented a standardized contract for all executives, effective January 2010, which ensures clarity, consistency and best-practice governance on human resources management. In January 2010, the AHS Board established a standardized contract for all executives. Highlights of the contract template include the following:

o Severance terms standardized at up to 12 months base pay (excluding "pay at risk") and a fixed 15% of base pay (excluding "pay at risk") in lieu of benefits;
o A duty to mitigate damages by diligently seeking alternate employment – whereby severance payments cease and an amount equal to 50% of the outstanding severance is paid out;
o "Pay at risk" standardized as part of base salary but withheld until completion of annual individual performance review and receipt of an unqualified opinion of the Auditor General confirming organizational performance;
o Benefits standardized including any professional / personal allowances;
o Relocation allowances standardized including need to repay if voluntary termination occurs within first 12 months of employment;
o Standardized confidentiality and contract enforceability.

Pay-at-risk is just that: Performance measures are established at the beginning of the budget year. Pay is withheld throughout the year subject to completion of the agreed-upon objectives and measures. Payment is not made if performance measures are not met.

This follows a series of measures implemented to ensure best practice:
o In April 2009, AHS established benchmark executive salary ranges and has been using these consistently for job offers made to Vice Presidents and above;
o In September 2009, job evaluation protocols were completed for all positions of Vice President and above;
o In October 2009, based on performance measures consistent with AHS' strategic direction, the CEO established "pay at risk" for its Senior Management team (Vice President and above) at percentages consistent with the April 2009 market data;
o In November 2009, AHS responded to the Auditor General report by ensuring the SVP Human Resources reviewed all job offers at Vice President and above until a standardized contract was approved by the Board.

The Globe & Mail’s André Picard Files for 2010 (to date)

2010-04-13T13:19:00.004-04:00

(. . . to April 13)

Warning issued about mixing blood thinners and some antibiotics ...

André Picard. Public Health Reporter — From Tuesday's Globe and Mail Published on Tuesday, Apr. 13, 2010 10:49AM EDT. Certain antibiotics used to treat ...

http://www.theglobeandmail.com/life/warning-issued-about-mixing-blood-thinners-and-some-antibiotics/article1532800/?cmpid=rss1

André Picard

Apr 1, 2010 ... André Picard is the public health reporter at The Globe and Mail, and the author ... Mr. Picard has received much acclaim for his writing, ...

http://www.theglobeandmail.com/life/health/andre-picard/

We're not short of MDs, we need NPs

Nurse practitioners can take on much of the routine health care load.

http://www.theglobeandmail.com/life/health/andre-picard/were-not-short-of-mds-we-need-nps/article1519842/

Toronto smoking ban leads to decline in hospitalizations - The ...

André Picard Public Health Reporter. From Tuesday's Globe and Mail Published on Monday, Apr. 12, 2010 8:58PM EDT Last updated on Tuesday, Apr. 13, ...

http://www.theglobeandmail.com/news/national/toronto/toronto-smoking-ban-leads-to-decline-in-hospitalizations/article1532219/

Medical user fees? They're so 1980

André Picard's Second Opinion. Medical user fees? ... André Picard. Published on Thursday, Apr. 08, 2010 10:37AM EDT Last updated on Thursday, Apr. 08, ...

http://www.theglobeandmail.com/life/health/andre-picard/medical-user-fees-theyre-so-1980/article1527565/

André Picard

The latest health news stories , including articles on nutrition and public policy.

http://www.theglobeandmail.com/life/health/andre-picard/?page=5

Is Obama's law a health-care revolution? Meh

André Picard. Published on Thursday, Mar. 25, 2010 8:50AM EDT Last updated on Thursday, Mar. 25, 2010 9:44AM EDT .... More recent pieces from André Picard ...

http://www.theglobeandmail.com/life/health/is-obamas-law-a-health-care-revolution-meh/article1511586/

Time to end pelvic exams done without consent

Jan 28, 2010 ... André Picard's Second Opinion. Time to end pelvic exams done without consent .... More recent pieces from André Picard ...

http://www.theglobeandmail.com/life/health/time-to-end-pelvic-exams-done-without-consent/article1447337/

Williams's heart surgery choice was based on ignorance

Feb 25, 2010 ... André Picard's Second Opinion. Williams's heart surgery choice was based on ignorance .... More recent pieces from André Picard ...

http://www.theglobeandmail.com/life/health/williamss-heart-surgery-choice-was-based-on-ignorance/article1480937/

The fright before Christmas, by André Picard

Dec 23, 2009 ... A holiday classic is reimagined in the time of the swine flu panic.

http://www.theglobeandmail.com/life/health/h1n1-swine-flu/the-fright-before-christmas-by-andr-picard/article1410888/

André Picard: Why H1N1 panic is not the answer

The fear is real but the flu's risk is small, public health reporter André Picard writes. So what should anxious parents do? Get their kids vaccinated and ...

http://www.theglobeandmail.com/life/health/h1n1-swine-flu/andr-picard-why-h1n1-panic-is-not-the-answer/article1341226/

FW: Medical user fees? They're so 1980

Home; › Life; › Health & Fitness; › André Picard; › FW: Medical user fees? They' re so 1980. Back to top. News; Quote; Web; Local; People. News Search ...

http://www.theglobeandmail.com/life/health/andre-picard/article1527894.ece

HIFU prostate cancer treatment stirs debate

Apr 5, 2010 ... André Picard's Second Opinion: Working with cancer: For many Canadians, it's not always a choice Wednesday, Feb. 10, 2010 07:46PM EST ...

http://www.theglobeandmail.com/life/health/hifu-prostate-cancer-treatment-stirs-debate/article1524081/?cmpid=rss1

Working with cancer: For many Canadians, it's not always a choice ...

Feb 10, 2010 ... André Picard's Second Opinion. Working with cancer: For many Canadians, it's not always a choice .... More recent pieces from André Picard ...

http://www.theglobeandmail.com/life/health/working-with-cancer-for-many-canadians-its-not-always-a-choice/article1463609/

How will the global response to the pandemic H1N1 be reviewed?

2010-04-13T08:58:00.000-04:00

printable version

12 April 2010

The assessment of the global response to the pandemic H1N1 will be conducted by the International Health Regulations Review Committee, a committee of experts with a broad mix of scientific expertise and practical experience in public health. The members are some of the leading experts in the world in their respective fields.

The International Health Regulations (IHR) is an international legal agreement that is binding on 194 States Parties across the globe, including all of the Member States of WHO. The basic purpose of the IHR is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide.

In January 2010, the WHO Executive Board requested a proposal from the Director-General on how to assess the international response to the pandemic influenza, and then approved her suggestion to convene the IHR Review Committee to review both the pandemic response and the functioning of the IHR.

The pandemic H1N1 is the first public health emergency of international concern to occur since the revised IHR came into force. The IHR played a central role in the global response to the pandemic and so review of the IHR and review of the global handling of the pandemic influenza are closely related.

The IHR facilitate coordinated international action by requiring countries to report certain disease outbreaks and public health events to WHO so that global reporting of important public health events is timely and open.
The IHR were first implemented (i.e., "entered into force") worldwide in 2007 and the Health Assembly determined that a first review of its functioning is to take place by the 63rd World Health Assembly in May 2010.

Objectives

The review has three key objectives:

Assess the functioning of the International Health Regulations (2005);
Assess the ongoing global response to the pandemic H1N1 (including the role of WHO); and
Identify lessons learned important for strengthening preparedness and response for future pandemics and public health emergencies.

The committee

The IHR Review Committee is made up of approximately 29 members who have been selected from the roster of experts under the IHR structure or other WHO expert committees. The committee members represent a broad mix of expertise, practical experience and backgrounds, and includes experts from developed and developing countries.

The members are some of the leading experts in the world in their respective fields. They are not WHO staff, nor do they receive funding from WHO for their contributions to the review process. Names of the committee members were made public prior to the first meeting: List of members of the review committee

At the first meeting, Professor Harvey V. Fineberg was elected as chair; Professor Babatunde Osotimehin was elected as vice chair.

The IHR Review Committee is considered a WHO expert committee and so its operations and structure follows regulations for WHO expert advisory panels and committees, and provisions of the IHR.

Proceedings

The committee will determine its methods and schedule of work.

The first meeting is scheduled for 12-14 April 2010 at WHO headquarters in Geneva.
Observers invited to the first meeting include representatives of all States Parties to the IHR (194 countries), United Nations organizations and relevant intergovernmental organizations, and nongovernmental organizations in official relations with WHO.

The committee will advise the Director-General of its views and findings. Based on the committee's advice, the Director-General will provide an interim report to the World Health Assembly (WHA) in May 2010, and an expected second, final report to the WHA in May 2011.

Participation by countries (IHR States Parties)

Countries will have the opportunity to make brief statements to the committee at first meeting, and may also submit comments to the Review Committee on key issues, concerns and lessons learned related to the pandemic response and functioning of the IHR.

More about the IHR

In the globalized world, diseases can rapidly spread far and wide via international travel and trade. A health crisis in one country can impact livelihoods and economies in many parts of the world. Emerging infections such as an influenza pandemic are an important cause of such events. However, other public health emergencies such as chemical spills, leaks and dumping, or nuclear melt-downs may similarly have global effects.

The IHR are not specific for any one disease or group of diseases but generally aim to limit interference with international traffic and trade while ensuring public health through the prevention of disease spread. The IHR define the rights and obligations of countries to report public health events, and establish a number of procedures that WHO must follow in its work to uphold global public health security. The IHR also require countries to strengthen their existing capacities for public health surveillance and response.
(updated from 1 April 2010 version)

Preparing Professionals for a Nationwide Health Care Transformation

2010-04-07T17:34:00.001-04:00

A Message from Dr. David Blumenthal, National Coordinator for Health Information Technology

April 7, 2010

I know that health care providers are concerned about implementing new health information technology and finding professionals who can operate and maintain such systems. I know many clinicians are unsure how they will develop or strengthen their skill set to incorporate using health IT efficiently and effectively without jeopardizing their communication with patients during a clinical visit. It seems like a daunting transformation to clinicians themselves and, indeed, for our health care system overall. The HITECH Act recognized that the success of this health IT journey depends on people: people who are passionate about improving patient care, and who are supported in making those improvements.

To this end, the Department of Health and Human Services awarded $84 million to 16 institutions of higher education to fund the Health IT Workforce Development Program, which focuses on several key resources required to rapidly expand the availability of health IT professionals who will support broad adoption and use of health IT in the provider community. Those resources include:

A community college training program to create a workforce that can facilitate the implementation and support of an electronic health care system
Quality educational materials that institutions of higher education can use to construct core instructional programs
A competency examination program to evaluate trainee knowledge and skills acquired through non-degree training programs
Additional university programs to support certificate and advanced degree training

The Workforce Development Program is one of the best examples of the depth of thought behind the HITECH Act. We could spend many billions of dollars developing, incentivizing, and implementing health IT solutions, but without an effectively trained workforce, our efforts would fall short of their ultimate goal of improving patient care. These efforts, designed in collaboration with the National Science Foundation, Department of Education, and the Department of Labor, are estimated to reduce the shortfall of qualified health IT professionals by 85 percent.

I congratulate the Workforce Development Program awardees and look forward to working with them on this important initiative. Those who take advantage of professional training in health IT provided through award recipients will find opportunities for interesting, challenging, and important work. Not only do these opportunities represent new jobs, they represent promising careers in a growing sector of our economy.

Sincerely,

David Blumenthal, M.D., M.P.P.
National Coordinator for Health Information Technology
U.S. Department of Health & Human Services

$45 Million to Support Better Patient Care in British Columbia

2010-04-05T13:04:00.001-04:00

April 1, 2010

Ministry of Health Services | BC Medical Association

VICTORIA – Starting today, specialist physicians in B.C. are eligible for new fees and support that will improve access and service for patients while increasing efficiency and capacity for physicians.

The new supports are initiatives of the Specialist Services Committee (SSC), a joint committee of the Province and the BC Medical Association (BCMA) that works closely with health authorities on the delivery of specialist physician services to British Columbians. With the mandate of supporting and improving the specialist care system, the committee will receive a total of $45 million in funding by 2011-12 to support its policies and programs.

“The SSC initiatives are one more example of the work we are doing in partnership with the BCMA to improve patient care across the province,” said Health Services Minister Kevin Falcon. “Since 2004, we have invested around $100 million annually through the General Practice Services Committee to support health services provided by family physicians, and evaluations have shown that our investment has paid off with increased satisfaction for patients and doctors. We look forward to similar positive results for B.C.’s specialist care system, including more collaboration between specialist physicians and general practitioners.”

Created to increase specialist capacity and improve patient access to specialist physicians, the Specialist Services Committee introduces a number of new billing options that were not available under the previous billing system. It is anticipated that the changes will result in overall cost avoidance for the health system and provide benefits for both patients and physicians through a reduction in ER visits, and unnecessary or inappropriate referrals. Other expected benefits are increased job satisfaction for specialists and reduced stress for their medical office assistants (MOAs).

“The doctors of B.C. look forward to the long-term success of the SSC initiatives,” said Dr. Brian Brodie, president of the BC Medical Association. “These new initiatives will help support the much-needed communication between specialists and GPs as they co-ordinate the care of their patients. This is about finding ways to improve access to specialty care, as well as improving the overall quality of the services being delivered.”

From Open Medicine

2010-04-01T13:04:00.000-04:00

Calgary researchers show that ~64 percent of Canadians have access to PCI, a life-saving heart attack procedure. http://tinyurl.com/yhqop3h
about 2 months ago from web
What should Canadian policymakers take away from a new study on access to a life-saving heart attack treatment? http://tinyurl.com/yzbr2vn
about 2 months ago from web
Congrats to the 3 members of Open Med's editorial family who are finalists for the BMJ Group Award for Lifetime Achievement! Vote at bmj.com
about 2 months ago from web
Open Med's editors weigh in on ghost writing in med journals with a new ghost and guest authorship policy: http://tinyurl.com/yd8bpoc
about 2 months ago from web
Congrats to the 3 members of Open Medicine's Ed Team and Ed Board who are finalists for the BMJ Lifetime Achievement Award! Vote at bmj.com
about 3 months ago from web
New research: How effective are evidence-based medicine short courses, and what teaching strategies work best? http://tinyurl.com/yhysh7j
about 3 months ago from web

Court Decides that Human Genes Cannot Be Patented

2010-03-31T12:38:00.000-04:00

Center for Genetics and Society Calls Ruling a Victory for Patients, Consumers and Responsible Research

Contact:
Jesse Reynolds, 1-510-625-0819 x308, jreynolds [AT]geneticsandsociety[DOT]org
Marcy Darnovsky, 1-510-625-0819 x305, mdarnovsky [AT]geneticsandsociety[DOT]org

The Center for Genetics and Society, a policy research and advocacy group, welcomed yesterday’s District Court decision invalidating patents on genes associated with breast and ovarian cancer, which ruled that human genes cannot be patented because they are products of nature. This and related arguments were central to the lawsuit filed in May 2009 by the American Civil Liberties Union and the Public Patent Foundation. In support of the suit, the Center for Genetics and Society filed a “friend of the court” brief, together with the Pro-Choice Alliance for Responsible Research, Generations Ahead, the National Women’s Health Network, and Asian Communities for Reproductive Justice.

“Overturning these patents will help patients get better health care at lower costs. It removes an unnecessary and illegitimate obstacle to both medical treatment and medical research,” said Center for Genetics and Society policy analyst Jesse Reynolds.

In the lawsuit, Breast Cancer Action, Our Bodies Ourselves, individual women and breast cancer patients, genetic counselors, four scientific organizations representing more than 150,000 researchers and laboratory professionals, and individual researchers challenge patents held by Myriad Genetics and the University of Utah Research Foundation that give the biotech company exclusive control of two genes associated with an increased risk of breast and ovarian cancer, all variations of these genes, and a monopoly over tests to detect them. It represents the first time US courts have ruled on a case on human gene patents.
Myriad Genetics is expected to appeal yesterday’s decision, and many observers believe it will end up in the Supreme Court. If upheld, its implications could be far-reaching. About twenty percent of human genes have already been patented.

“Genetic research is becoming more important to the practice of medicine, and we urgently need public policies to ensure that it is responsibly conducted and that its benefits are widely accessible,” said Marcy Darnovsky, Center for Genetics and Society Associate Executive Director.

For more information:
• The amicus brief of the Center for Genetics and Society et al [PDF]
• “The Battle to Patent Your Genes: The Meaning of the Myriad Case” by Marcy Darnovsky & Jesse Reynolds, The American Interest, Sept-Oct 2009
The Center for Genetics and Society is a non-profit public affairs and policy advocacy organization working to encourage responsible uses and effective societal governance of human genetic and reproductive biotechnologies.

Agfa HealthCare contributes to innovation in diagnosis of Alzheimer Disease

2010-03-16T18:06:00.000-04:00

Agfa HealthCare Institute partners with the Centre de recherche Université Laval Robert-Giffard to develop new technology for diagnosis of Alzheimer’s – a Canadian first

Quebec, QC – March 16, 2010 - Agfa HealthCare, a leading provider of diagnostic imaging and healthcare IT solutions, announces today that it has launched a new initiative to help improve the diagnosis of Alzheimer’s disease, in partnership with the Canadian Minister of Economic Development, Innovation and Export Trade, the Centre de recherche Université Laval Robert-Giffard and the Société de valorisation des applications de la recherche (SOVAR). Agfa HealthCare will contribute to the development of a prototype IT solution under the Agfa HealthCare Institute – a new initiative leveraging collaborative partnerships to help facilitate innovation in the healthcare technology space.

The Alzheimer’s project* will focus on the development of a prototype that will combine a patient’s clinical information with the image features from the patient’s magnetic resonance imaging (MRI). The results will provide physicians with all of the information they need to make a faster and more accurate diagnosis of the disease. Not only will the prototype help support the diagnosis of Alzheimer’s, but it will also help physicians predict its progression and ultimately improve treatment outcomes for patients. This project, which will be underway over the next two years, is the first of its kind in Canada and the ultimate goal is to commercialize the technology developed through the research in healthcare institutions across the country.

“Agfa HealthCare’s support is extremely important to achieving our goal of developing a functional prototype to help with the diagnosis of Alzheimer’s disease,” said Dr. Simon Duchesne, Principle Investigator of this project at the Centre de recherche Université Laval Robert-Giffard (CRULRG). “Through this joint project, we are developing innovative technology that will help improve the delivery of chronic care in Canada.”

“Research in the healthcare field represents an important niche at Université Laval,” said Edwin Bourget, Vice-President for Research and Innovation, Université Laval. “Most of the research centres are implemented in hospitals affiliated with Université Laval, among which, the Institut universitaire en santé mentale de Québec plays a major and determining role for mental health treatment, including Alzheimer’s disease, which is affecting so many Canadians today.”

For Agfa HealthCare, this Alzheimer’s project is about connecting the right people with the right information – and in order to do this, strategic partnerships are the key. The project falls under the Agfa HealthCare Institute, which was created to be a catalyst of innovations in Canada’s Health Informatics industry by facilitating close collaboration between government, the healthcare industry and universities across Canada to provide a fully integrated healthcare IT network across the continuum of care.

“Agfa HealthCare is excited to be a part of the Alzheimer’s initiative in partnership with the Université de Laval and the Minister of Economic Development, Innovation and Export Trade. With Alzheimer’s disease affecting so many Canadians, it is so important for us to contribute to the development of new techniques to help in the diagnosis and treatment of this disease,” said Dave Wilson, Vice President, Agfa HealthCare in Canada. “Through our expertise in the healthcare IT space and our strategic partnerships with institutions such as the University of Laval, we are opening up doors to new ways of improving the delivery of patient care in Canada.”

CHIME Issues Comments on Interim Final Rule on Standards, Certification

2010-03-15T16:06:00.001-04:00

ANN ARBOR, MI, March 15, 2010 – The College of Healthcare Information Management Executives (CHIME) has released the comments it will file today with the Office of the National Coordinator for Health Information Technology regarding the initial set of standards, implementation specifications and certification criteria for electronic health record technology.

The proposed regulations, issued as an interim final rule by ONC, were unveiled on December 30, 2009, and responses are due back to the government by March 15.

Previously, on February 26, CHIME filed its comments with the Centers for Medicare & Medicaid Services regarding the EHR Incentive Program. CHIME’s ONC letter closely parallels its comments to CMS. The Ann Arbor, Mich.-based organization has 1,400 members representing chief information officers and other top information technology executives at many of the nation’s largest hospitals.

In its comments today on the interim final rule, CHIME emphasized the importance of certification for supporting providers’ efforts to achieve meaningful use, saying it gives “healthcare providers a degree of assurance that the products they purchase will perform as promised…certification is meant to support providers, not pose an additional burden.”

CHIME’s comments place the lion’s share of responsibility on vendors that develop IT products, which it says builds on past experience in the healthcare IT space. The organization also urges ONC to provide more lead time as it creates future certification criteria, so as to provide more time for providers to implement new and upgraded systems in the future.

Previously, in its comments to CMS on meaningful use regulations, CHIME had requested that a “grandfathering provision” be implemented to grant certification to products that have already been certified by the Certification Commission for Health Information Technology.

CHIME noted that further clarification is needed in ONC’s interim final rule, particularly in describing how certification will apply to organizations that use multiple clinical systems as components to an overall electronic health record system. CHIME supports wording in the rule that requires only certification of individual EHR modules.
______________________________________________________________________________________
College of Healthcare Information Management Executives
3300 Washtenaw Ave, Suite 225 ·
Ann Arbor, MI 48104
Phone: (734) 665-0000
Fax: (734) 665-4922
staff@cio-chime.org · www.cio-chime.org
______________________________________________________________________________________
CHIME’s comments ask ONC to support a single standard for patient summary records; the current interim rule allows use of either the Health Level Seven (HL7) Clinical Document Architecture (CDA) Release 2 (R2) Level 2 Continuity of Care Document (CCD) or the ASTM Continuity of Care Record (CCR) to electronically exchange a patient summary record.

“CHIME disagrees with this approach and believes that the sharing of health information across providers is best facilitated with adoption of a single standard for patient summary records,” the comment letter states. “CHIME believes that the healthcare field is ready to transition to a single standard for patient summary records, and such a move will facilitate interoperability in a more timely fashion.” The organization believes the HL7 CDA CCD is more robust and easier to read.

Medication reconciliation requirements in the interim rule need to be adjusted so that providers can meet the requirement if clinical systems can “display simultaneously two or more medication lists and provide tools for the clinician to perform medication reconciliation and create a single medication list.”

For reporting quality data, CHIME advises against using the CMS Physician Quality Reporting Initiative (PQRI) 2008 Registry XML Specification, and the related implementation specifications, the PQRI Measure Specifications Manual for Claims and Registry. Instead, it suggests the continued development of quality data reporting standards, which are in process by HL7.

CHIME also seeks a standards-based approach for submitting data to public health agencies. Current proposals for submitting data provide wide latitude to agencies for determining the format in which they want to receive data.

In addition, CHIME comments on privacy and security standards included in the interim rule, particularly in areas of encryption and decryption of data, verification of data to ensure it hasn’t been altered in transit, and cross-enterprise authentication.

CHIME advises against placing too many requirements on data transmission within an organization. “Encryption of data in EHR databases and transactional systems would slow operation of the software, thus hindering adoption of EHRs by staff and physicians,” its comments state. “We ask that ONC and CMS carefully consider the risk vs. cost and performance issues during deliberations on this requirement.”

The letter to ONC from CHIME also included its previous comments on the proposed meaningful use regulations as an attachment.

Australia Substantially Increases Research Collaboration with China, According to Thomson Reuters Study

2010-03-09T10:54:00.002-05:00

New Zealand researchers double collaboration with Spain and Norway

PHILADELPHIA and LONDON, March 9 /CNW/ -- A study from Thomson Reuters released today shows broadening international collaboration in the research of Australia and, to a lesser degree, New Zealand, over the past 10 years. The United States continues to be the biggest contributor to Australian and New Zealand publications, but of special interest is a sizable increase of Australia's collaboration with China.

The study, Global Research Report: Australia and New Zealand, found that collaboration within the Asia Pacific region is notably changing. Though collaboration with Australia among some Asia Pacific nations (such as New Zealand, India, and Singapore) increased, and collaboration with China doubled (rising from 2.3 percent to 4.4 percent of all Australian outputs), collaboration with Japan remained unchanged. Likewise, Japan's rank as a contributor of co-authored papers with New Zealand fell from sixth to eighth.

"Researchers in Australia and New Zealand have been increasing their share of publications co-authored with international colleagues," said Jonathan Adams, director of research evaluation at Thomson Reuters. "We've seen a shift in geographic focus of these collaborations. While such countries as Russia and South Africa decrease in importance, there are increases in collaboration with Spain and Switzerland, and more importantly, with China and India."

Other key findings include:

-- Australia's share of world research publication output has grown

steadily from 2.85 percent in 1999 to 3.18 percent in 2008.

-- In the same period, the volume of Australian publications has risen

annually by an average of 5 percent -- a growth rate higher than that

of world publication averages.

-- Computer science, materials science, environment/ecology, and clinical

medicine are subject areas where Australia has increased its outputs,

consistent with its national research priorities.

-- Subject areas that have grown in the volume of outputs in New Zealand

are computer sciences, biology and biochemistry, immunology, and

neurosciences and behavior, consistent with the country's government

research, science and technology agenda.

The study is part of the Global Research Report series from Thomson Reuters that illustrates the changing landscape and dynamics of scientific research around the world and draws on data found in Web of Science(SM), available on the Thomson Reuters Web of Knowledge(SM), platform -- the world's largest citation environment of the highest quality scholarly literature.

For more information, please visit http://researchanalytics.thomsonreuters.com/grr/.

New studies showPCA3 prostate cancer marker can help guide repeat prostate biopsy decisions and predict risk of aggressive cancer

2010-03-08T08:59:00.001-05:00

More than 2,400 men tested in largest worldwide studies to date.

QUEBEC CITY, March 8 /CNW Telbec/ - DiagnoCure, Inc. (TSX: CUR), a life sciences company commercializing high-value cancer diagnostic tests and delivering laboratory services, announced that the clinical utility of the PROGENSA(R) PCA3 test, developed and commercialized by its partner Gen-Probe (NASDAQ: GPRO), was confirmed in two large worldwide studies, conducted in a subset of patients in GlaxoSmithKline's REDUCE trial of dutasteride. The results demonstrate that PCA3 can help determine whether men suspected of having prostate cancer should undergo a repeat biopsy and can predict the risk of having an aggressive cancer. The studies were presented last week at the American Society of Clinical Oncology's Genitourinary Cancers Symposium (ASCO GU) in San Francisco.

"This four-year multicenter worldwide study is the largest to date performed on DiagnoCure's PCA3 marker. It shows that the test can be useful in managing patients suspected of having prostate cancer. For doctors and patients struggling with the dilemma of the traditional PSA test that has a well-known low specificity, the PCA3 test, with a specificity of up to 80% (depending on the cut-off), can offer a more reliable answer. These results indicate that the PCA3 test can help reduce unnecessary prostate biopsies and help identify patients that have a more aggressive cancer, representing a step forward in personalized patient care," said Dr Yves Fradet, co-founder and President of DiagnoCure.

In the studies presented at the ASCO GU meeting, PCA3 was used to test urine samples from men enrolled in the REDUCE trial of GlaxoSmithKline's drug dutasteride. PCA3 testing was done on urine samples from 1,140 men in the placebo arm of the REDUCE trial, and from 1,308 men treated with dutasteride. All men underwent prostate biopsies two and four years after enrollment in the study.

The first PCA3 study presented at the meeting originated from the placebo arm of the REDUCE trial. This study, which was highlighted in ASCO's official press program, showed that PCA3 scores were significantly correlated with a positive prostate biopsy result, and that men who had higher PCA3 scores were more likely to have prostate cancer. Specifically, cancer was diagnosed in only 6% of men with very low PCA3 scores, but in 57% of men with very high PCA3 scores.

PCA3 scores also correlated with cancer aggressiveness (as defined by the Gleason Score): median PCA3 scores were higher in men with high-grade cancers than in those with low-grade cancers. Finally, the PCA3 test also predicted the likelihood of a positive prostate biopsy performed two years after the test.

The second PCA3 study originated from the patients treated with dutasteride in the REDUCE trial. This study demonstrated that PCA3 also can be used to predict prostate biopsy outcomes in men taking dutasteride. It confirmed earlier research that showed PCA3 outperforms serum PSA testing for prostate cancer detection, and improves diagnostic accuracy when combined with serum PSA testing and other clinical information.

About DiagnoCure

DiagnoCure (TSX: CUR) is a life sciences company commercializing high-value cancer diagnostic tests and delivering laboratory services that increase clinician and patient confidence in making critical treatment decisions. DiagnoCure Oncology Laboratories, a subsidiary of DiagnoCure Inc., launched in 2008 the Previstage(TM) GCC Colorectal Cancer Staging Test, the first GCC-based molecular test for the management of colorectal cancer. A major study published in the February 18, 2009, edition of the Journal of the American Medical Association demonstrated that GCC, to which DiagnoCure owns exclusive worldwide diagnostic rights, is the strongest independent predictor of colorectal cancer recurrence. More clinical studies are underway to confirm the clinical utility of the Previstage(TM) GCC test. The Company has a strategic alliance with Gen-Probe (NASDAQ: GPRO) for the development and commercialization of a second-generation prostate cancer test using PCA3, DiagnoCure's proprietary molecular marker. This test is available through laboratories in the U.S. using PCA3 analyte specific reagents (ASR) from Gen-Probe, in Europe as the CE-marked PROGENSA(R) PCA3 in vitro assay, and in Canada. A clinical study aimed at securing FDA approval for the commercialization of PROGENSA(R) PCA3 test in the U.S. is underway. For more information, visit www.diagnocure.com.

Proposed Rule for the Establishment of Certification Programs for Health Information Technology

2010-03-02T15:44:00.002-05:00

A Message from Dr. David Blumenthal, National Coordinator for Health Information Technology

March 2, 2010

Today the Secretary of the Department of Health and Human Services (HHS) released a notice of proposed rulemaking (NPRM) outlining the proposed approach for establishing a certification program to test and certify electronic health records (EHRs). The HITECH Act mandates the development of a certification program which will give purchasers and users of EHR technology assurances that the technology and products have the necessary functionality and security to help meet meaningful use criteria. While we are making significant strides toward modernizing our health care system, these efforts will only succeed if providers and patients are confident that their health information systems are safe and functional.

The proposed rule incorporates two phases of development for the certification program to ensure that eligible professionals and eligible hospitals are able to adopt and implement Certified EHR Technology in time to qualify for meaningful use incentive payments. The rulemaking process will take time, so this phased approach provides a bridge to detailed guidelines to support an ongoing program of testing and certification of health IT.

The first proposed program creates a temporary certification process under which the National Coordinator would authorize organizations to assume many of the responsibilities that will eventually be fulfilled under the permanent certification program. For the permanent certification program, the rule proposes transitioning much of the responsibility for testing and certification to organizations in the private sector.

Publication of the proposed rule on the Establishment of Certification Programs for Health Information Technology is an important first step in bringing structure and cohesion to the evaluation of EHRs, EHR modules, and potentially other types of health IT. The programs will help support end users of certified products, and ultimately serve the interests of each patient by ensuring that their information is securely managed and available where and when it is needed.

Your input is essential to bringing this important process to fruition. We encourage your participation in the open public comment period.

Additional information on both of these programs and how you can comment can be found through the HHS news release issued today and at the http://HealthIT.HHS.Gov website.

The vision of the HITECH Act is unfolding rapidly, and all of us at ONC look forward to continuing to work with you to achieve the meaningful use of EHRs.

Sincerely,

David Blumenthal, M.D., M.P.P.
National Coordinator for Health Information Technology
U.S. Department of Health & Human Services

OTN offering expertise, services and solutions to organizations and healthcare jurisdictions around the world

2010-03-02T09:39:00.000-05:00

[Another Great Canadian Success Story]

TORONTO, Feb. 26 /CNW/ - As one of the world's largest and most active telemedicine networks, the Ontario Telemedicine Network (OTN) will faciliate more than 100,000 clinical encounters and distance education opportunities for more than 300,000 people across nearly one thousand sites this year. Secure, reliable and responsive, OTN enables improved access to a variety of clinical programs and services for patients and educational opportunities for health care providers.

OTN's continued growth and success has resulted in global requests for its expertise and it has established a division to facilitate the efforts of other jurisdictions to develop their own telemedicine programs and services.

"OTN is now able to offer our expertise, services and solutions to organizations and healthcare jurisdictions around the world," says OTN CEO Dr. Ed Brown. "Using the skills, processes, technologies and services pioneered by OTN in Ontario since 1993, OTN can work with interested health care organizations and jurisdictions around the world to help them deliver a world-class Telemedicine service."

OTN offers a complete and comprehensive range of telemedicine solutions and services. From those just getting started to those considering scaling up an existing telemedicine operation to the next level, OTN can now offer healthcare jurisdictions around the world a comprehensive telemedicine offering so that they are able to focus on patient care.

In addition, OTN continues to respond to its goal of increased adoption of telemedicine by enabling a more efficient, inexpensive way to integrate telemedicine into a health care provider's practice. OTN has integrated Polycom's PC-based Converged Management Application (CMA) with OTN's sophisticated telemedicine tools and practices. "OTN has been a true innovator and leader in the telehealth market for a number of years," said Dr. Deborah Jeffries, director of Healthcare Markets at Polycom. "We're honored to work with the team at OTN, and we're excited to demonstrate our combined solutions at HIMSS10."

Demonstrations will be featured at both the OTN booth No.6210 and the Polycom booth No.6201.

For further information: Rhona Lahey, Government and Media Relations, (613) 867-9498, rlahey@otn.ca

Gartner enters into Agreement to Acquire AMR Research, Inc.

2010-03-01T17:41:00.000-05:00

STAMFORD, Conn., December 1, 2009 — Gartner, Inc. (NYSE: IT), the leading provider of research and analysis on the global information technology industry, today announced that it has agreed to acquire AMR Research, Inc. for approximately $64 million in cash, subject to certain closing adjustments. With projected full year 2009 revenues of approximately $40 million, AMR Research is a leading research and advisory services firm serving supply chain management and IT professionals. The firm is recognized for its research focused on the intersection of business processes and technology for the supply chain professional.

The acquisition of AMR Research is expected to expand Gartner's suite of research offerings and also complement its consulting and events businesses. Moreover, the addition of AMR Research’s experienced sales team should enhance Gartner's ability to further penetrate the vast market opportunity for syndicated research. The combination is also expected to drive operational efficiencies and cost savings.

Gene Hall, Gartner's chief executive officer, said, "AMR Research is an excellent strategic fit for Gartner. The firm is the market leader for research related to supply chain management, which is inextricably linked to IT and has become a central and growing issue for many organizations. We expect the acquisition to give us immediate presence in this market and the ability to generate substantial synergies by selling AMR Research products to Gartner clients and Gartner products to AMR Research clients. The addition of AMR Research’s team of approximately 40 research analysts and 45 sales executives should enable us to offer expanded resources to our clients and increase our opportunities for growth."

The Advisory Board Company and HIMSS Analytics to Collaborate to Solve Health Care IT Challenges

2010-03-01T17:17:00.002-05:00

New Suite of Services will Combine HIMSS Analytics’ Deep IT Knowledge and Database with the Advisory Board’s Best Practice Operational and Clinical Expertise

WASHINGTON, D.C. -- (March 1, 2010) – The Advisory Board Company and HIMSS Analytics™ LLC are collaborating to provide a new level of business-oriented information technology (IT) research to health care executives and IT leaders. Through this affiliation, data from the HIMSS Analytics™ Database will be provided to The Advisory Board Company as the foundation for new and expanded services and projects.

Both organizations recognize that hospitals and health systems now face mounting pressures to reach the full potential of their IT systems and drive broad performance improvement for their institutions. This initiative will help IT professionals meet these challenges by pairing HIMSS Analytics’ deep IT knowledge and rich database with the Advisory Board’s best practice operational and clinical expertise. David E. Garets, President and Chief Executive Officer of HIMSS Analytics, and Mike Davis, Executive Vice President of HIMSS Analytics, will leave HIMSS Analytics at the end of March to join The Advisory Board Company and lead the effort.

“We are thrilled to tap into the deep data resources of HIMSS Analytics,” said Robert Musslewhite, Chief Executive Officer of The Advisory Board Company. “CIOs across our 2,600+ hospital and health system members face key challenges in change management, performance improvement, and transparency. Together with HIMSS Analytics data, we will provide CIOs and other executives with a new level of support as they work to implement key information systems and drive real gains for their institutions.”

With the proposed rules for meaningful use for the electronic health record now under review, internal and market forces are converging to require more integrated clinical models in order to deliver higher-value health care. In this context, innovative workflow processes and clinical practice, built upon sound IT choices and strong implementation execution, are critical to future hospital and health system success. The Advisory Board Company, together with HIMSS Analytics data, will enable hospital and health systems to improve technology adoption by physicians and other important stakeholders, leverage the technology to impact care delivery, and drive continued value from IT investments.

“The addition of HIMSS Analytics’ data on IT processes and environments, costs and management metrics, and purchasing decisions will greatly enrich the work that we do with our member CIOs,” said Musslewhite. “This initiative also provides an outstanding opportunity for us to serve the broader executive suite in a more in-depth way on technology issues that are strategically important to the future success of their institutions. We are particularly excited about the IT knowledge and expertise that Dave and Mike bring to the Advisory Board. This is a winning combination, and I am confident that it will create tremendous value for our members and for all the additional members who come on board to take advantage of this work.”

“Successful IT choices require deep expertise on the environment in which the system will operate,” said H. Stephen Lieber, President and CEO of Healthcare Information Management Systems Society (HIMSS). “The Advisory Board’s nuanced understanding of best practices in the clinical and operational setting of hospitals provides a critical perspective to IT leaders. For our part, HIMSS Analytics is excited about this new chapter in our work. Together, HIMSS Analytics and the Advisory Board will support IT users, business users, and clinical users across the full project planning and implementation cycle to yield successful IT projects that drive real returns. We look forward to a long and fruitful relationship.”

For more information or to register for The Advisory Board Company’s Web conference on the new suite of services for health care IT leaders, visit www.advisory.com/public/cio.

About The Advisory Board Company

The Advisory Board Company provides best practices research, analysis, executive education and leadership development, software tools, and installation support services primarily to the health care industry, focusing on business strategy, operations, and general management issues. The Company provides best practices and research through discrete programs to a membership of approximately 2,800 organizations, including leading hospitals, health systems, pharmaceutical and biotech companies, health care insurers, medical device companies, colleges, universities, and other education institutions. Members of each program are typically charged a fixed annual fee and have access to an integrated set of services that may include best practice research studies, executive education seminars, customized research briefs, web-based access to the program’s content database, and software tools.

About HIMSS Analytics

HIMSS Analytics is a wholly owned not-for-profit subsidiary of the Healthcare Information and Management Systems Society (HIMSS). HIMSS Analytics collects and analyzes healthcare information related to IT processes and environments, products, IS department composition and costs, IS department management metrics, healthcare trends and purchase-related decisions. HIMSS Analytics delivers high quality products, services and analytical expertise to healthcare delivery organizations, healthcare IT companies, state governments, financial companies, pharmaceutical companies, and consulting firms. Visit www.himssanalytics.org for more information.

A Longwoods Publishing working relationship with HIMSS Analytics will survive this collaboration.

CGI Selected by Sunnybrook Health Sciences Centre for Health Enterprise Content Management

2010-02-23T09:17:00.003-05:00

Fairfax, Virginia; Toronto, Ontario, February 23, 2010 - CGI Group, Inc. (NYSE: GIB; TSX: GIB.A), today announced it signed a multi-year, $2.2 million contract with Sunnybrook Health Sciences Centre, Toronto, Ontario (Sunnybrook). CGI will implement its Sovera®, enterprise content management and workflow automation solution while providing ongoing software maintenance and support services to the system’s users.

CGI’s Sovera complete digital records management system provides secure, instant access to patient information enterprise-wide which results in increased staff productivity, improved customer service, and enhanced patient care. Built on two award-winning platforms, IBM Enterprise Content Management and Datacap Taskmaster for Capture and Forms Processing, Sovera automates medical records workflow processes including: medical coding, chart review, analysis and completion, and records release.

Sunnybrook comprises 3 campuses with 10,000 staff, physicians and volunteers who serve more than one million patients each year. Over the last 60 years, Sunnybrook has evolved from its original role as a Veterans’ hospital into a centre of excellence in patient care, education and research.

“We chose CGI’s Sovera solution after a comprehensive market search and a review of CGI’s and Sovera’s integration capabilities,” said Sam Marafioti, CIO of Sunnybrook. “We needed a solution that met our technical and business objectives to enhance clinical productivity and the effectiveness of our clinical staff, while continuing quality of care and ensuring patient safety.”

“We are very pleased to partner with Sunnybrook Health Sciences Centre to implement our content management solution in their medical records area” said Steve Bock, Director of the Healthcare Solutions Group at CGI. “Sovera will help Sunnybrook meet their business goals and objectives of reducing costs, improving efficiencies, and creating a paperless environment while maintaining their outstanding standard for patient care.”

CGI in Healthcare

CGI provides a full suite of health IT solutions with an emphasis on electronic medical records (EMR), health information exchange (HIE), quality initiatives and operational efficiency improvements. Website: www.cgi.com/healthcare.

About CGI

Founded in 1976, CGI Group Inc. is an information technology and business process services firm. CGI and its affiliated companies employ approximately 26,000 professionals. CGI provides end-to-end IT and business process services to clients worldwide from offices in the United States, Canada, Europe and Asia Pacific as well as from centers of excellence in North America, Europe and India. As at December 31, 2009, CGI's order backlog was $11.4 billion. CGI shares are listed on the NYSE (GIB) and the TSX (GIB.A) and are included in the S&P/TSX Composite Index as well as the S&P/TSX Capped Information Technology and MidCap Indices. Website: www.cgi.com.

Arbitrator Rules in MGEU's Favour on HCSS Part-Time Vacation Entitlement

2010-02-22T21:53:00.000-05:00

February 5, 2010

In December, an arbitration was held on the issue of vacation for part-time employees in Health Care Support Services. The MGEU is pleased to announce that the arbitrator’s decision, which was handed down today, upheld the MGEU’s position in its entirety.

The arbitrator ruled that the language proposed by the Union will become part of the collective agreement. The decision confirms that part-time employees’ actual vacation entitlement will be based on years of service and not pro-rated on an employee’s EFT.

The new language (which was designed to fit into the South Eastman collective agreement and will have to be modified to fit into some of the other MGEU agreements) will read as follows:

20:05 Delete in its entirety and replace with the following:

20:05 Annual Vacations

(a) Entitlement to Vacation Pay
Part-time employees shall earn and accrue entitlement to vacation pay on a pro-rata basis in accordance with the following formula:

Hours Paid at Regular Rate/ Full-time Hours = Pro-rating factor

[Example of Entitlement to Vacation Pay:

Employee A is a part-time employee, listed as .5EFT. In the previous year, A worked more than .5 of the full-time hours, and in fact worked 1410 hours. A's entitlement to vacation pay would be based on a pro-rating factor of:

1410/2015 = .7 pro-rating factor]

(b) Entitlement to Vacation Time
Actual entitlement to vacation time for part-time employees shall be based on years of service as provided for in Article 16:03.

[Example of Entitlement to Vacation Time: Employee A is in his/her 5th year of employment. Employee A is entitled to 20 working days per year of vacation time. For greater certainty, the term "working days" means days on which Employee A is regularly scheduled to work.]

(c) Entitlement to Receive Vacation Pay and Vacation Time
(i) Initial Selection of Vacation Time
Part-time employees shall have an initial right to indicate their preference to dates on the basis of the procedure set out at Article 16:05. During this initial procedure for vacation selection, part-time employees shall be allowed to indicate their preference up to a maximum on the basis of the pro the following formula:

Pro-rating factor x entitlement to vacation time = number of vacation days (working days)

[Example of Initial Selection: During the initial selection procedure set out at Article 16:05, Employee A shall have the right to indicate in writing his/her preference as to the following maximum number of vacation dates:

.7 x 20 = 14 working days]

(ii) Selecting the Balance of the Vacation Time
After the initial selection set out in sub-section (i) above has been completed, the selection of the balance of vacation time shall be at the option of the part-time employee but shall be governed by the last sentence of paragraph 1 of Article 16:05.

[Example of Selecting the Balance of Vacation Time:
Employee A would have the option to select the following number of working days in order to exhaust his/her vacation time entitlement:

.3 x 20 = 6 working days

Alternate Example: In the event that Employee A chose to select 12 working days of vacation time in the initial selection, Employee A would have the option to later select up to 8 working days in order to exhaust his/her vacation time entitlement.]

(iii) Operational Requirements
The provisions of Article 16:05 dealing with operational requirements apply equally to the selection procedures set out in sub-sections (i) and (ii) above.

(iv) Receipt of Vacation Pay
Unless a part-time employee requests to be paid in accordance with one of the four options set out below, and to the extent that he or she still has unused vacation pay, a parttime employee shall be paid his or her regular rate of pay for the number of hours he or she was scheduled to work on the working day taken as vacation time. An employee may choose to request to receive vacation pay in accordance with the one of the four options:

(a) partial pay divided equally over his/her entire vacation time entitlement; or

(b) full pay for vacation days up to such point as his or her vacation pay is exhausted; or

(d) partial or full vacation pay as set out above for a portion of the vacation time and the balance of vacation pay in a lump sum regardless of whether the part-time employee intends to take any unused vacation time at a future date in the vacation year.

20:06 Delete

Wound care teleassistance: unique in Canada

2010-02-19T13:42:00.000-05:00

February 17, 2010 (Sherbrooke, QC) – A new service is being launched today: wound care teleassistance, also known as téléassistance en soins de plaies (TASP). With this service a nurse can use a camera to film her patient’s wound, while at the same time an expert nurse in another institution can receive the images. They can then hold an online discussion to evaluate the patient’s wound and plan treatment. TASP increases access to care, allows treatment of patients in their own communities, reduces visits to emergency centres and can prevent chronic wound complications. Because it is based both on a clinical network of specially trained nurses and standardized methods, TASP is unique in Canada.

TASP is a project of the Réseau universitaire intégré de santé de Sherbrooke (RUIS), a network that covers an area that includes Estrie, part of Montérégie and Centre-du-Québec. Expert nurses from the Centre hospitalier universitaire de Sherbrooke (CHUS) were the first to provide real-time support via remote access to their colleagues from the Estrie health and social services centres (CSSS). Ten expert nurses distributed among the different RUIS institutions will soon be able to coach other nurses located in more than 70 points of service.

“Our institution was the first in Estrie to offer a virtual wound care clinic linked to the CHUS professional team. Our patients were pleasantly surprised and satisfied with the live service they received. They are happy they can stay in their community and have easy access to specialized services. In fact, this new technology will be implemented this spring in our Lambton point of service and a little later, during the year, at the St. Ludger point of service,” Pierre Latulippe, executive director of CSSS du Granit, said.

An expanded role for nurses

The expert nurses and about 80 other nurses from RUIS’s CSSS will be specially trained in the virtual clinic technology and will all adopt the same wound care methods. Two CHUS nurses developed the chronic wound care frame of reference, Aidez-moi, s’il-vous-« plaie »!, a training tool that will be used throughout the RUIS. Standardization of care involves 35 hours of training and continuing education through the virtual network.

“Wound care teleassistance expands the role of nurses, because the service depends on their expertise. They themselves will be able to establish a treatment plan, provide care, perform specialized techniques and monitor patients suffering from pressure ulcers, lower limb ulcers, diabetic foot ulcers and other complex chronic wounds. These activities increase their autonomy and their leeway to make decisions. This is a new way of sharing fields of professional practice,” Céline Gervais, director of nursing and the CHUS, pointed out. Wound care teleassistance was made possible thanks to a partnership with the Ministère de la Santé et des Services sociaux du Québec (MSSS) and Canada Health Infoway, which invested nearly $4 million in the project. The service is supported by a massive IT structure that uses wireless technology. The sound and images are sent securely and confidentially via the MSSS’s private telecommunications network, known as the Réseau de télécommunications sociosanitaire (RTSS). This totally secure network guarantees data integrity and confidentiality.

“Wound care is often complex and there are few specialized nurses in this field. The wound care teleassistance project will ensure access to state-of-the-art treatment for the population within the territory of the RUIS de l’Université de Sherbrooke. It will also permit home care for patients who otherwise would have had to stay in the hospital for days, even weeks,” said Dr. Michel A. Bureau, executive director with the Direction générale des services de santé et de médecine universitaire of the Ministère de la Santé et des Services sociaux.

"Technological innovations, such as teleassistance, are bringing specialized care to patients and communities in need,” said Louise Beauchesne, executive regional director, Quebec, Canada Health Infoway. “The wound care teleassistance program in Quebec is another example of how investments in electronic health record systems is improving access to care when patients need it most.”

“Telehealth is the way of the future, because it facilitates access to services, supports regional autonomy and reduces professional isolation. RUIS de l’Université de Sherbrooke is therefore extremely proud of the implementation of wound care teleassistance. All the partners spared no effort and we take our hats off to them. No doubt in the near future, other telehealth services will be rolled out in our territory, in the primary interest of the patient,” concluded Patricia Gauthier, executive director of the CHUS and president of RUIS de l’Université de Sherbrooke.

About RUIS de l’Université de Sherbrooke

In 2003, the MSSS divided Québec into four integrated university health networks (RUIS), each attached to a Faculty of Medicine (Sherbrooke, McGill, Montréal and Laval). The objective was to assure the regions of support in the organizing and continuity of care and services as well as to give tangible support to specialized care and training activities, and academic renewal. Within the clinical context, RUIS de l’Université de Sherbrooke covers the areas of Estrie, part of Montérégie and Centre-du-Québec. This is why CHUS, the main partner of the Université de Sherbrooke, is called upon to serve nearly one million people for certain specialized forms of care.

Photos and video at: http://www.chus.qc.ca/Fr/profetablis/teleassistance-soins-plaies.asp

- 30 -

For more information:
Colette Pellerin
Director of Communications and Public Affairs
Centre hospitalier universitaire de Sherbrooke
819 346-1110 extension 29035
cpellerin.chus@ssss.gouv.qc.ca

Dan Strasbourg
Director, Corporate Communications
Canada Health Infoway
Tel: (416) 595-3424
dstrasbourg@infoway-inforoute.ca

Deaths related to narcotic pain relievers have doubled since 1991: Study

2010-01-25T22:12:00.000-05:00

Introduction of OxyContin linked to a five-fold increase in deaths TORONTO, December 7, 2009 - Deaths from opioid use in Ontario have doubled—from 13.7 deaths per million residents in 1991 to 27.2 deaths per million residents in 2004—according to a new study led by physicians at St. Michael's Hospital and the Institute for Clinical Evaluative Sciences (ICES) in Toronto.

Researchers also found that the addition of a long-acting form of oxycodone (OxyContin) to the province's drug formulary in January 2000 corresponded with a five-fold increase in oxycodone-related deaths. "Many doctors are aware that prescription opioids can have fatal side effects by depressing breathing and decreasing level of consciousness," explains lead author Dr. Irfan Dhalla, a physician at St. Michael's Hospital. "But we suspect most will be surprised to learn just how many deaths occur each year in Ontario from prescription opioids."

Opioids, also known as narcotic pain relievers, are among the most commonly prescribed medications in Canada. They are used to treat people with moderate-to-severe acute or chronic pain.

The researchers manually reviewed nearly 7,100 files at the Office of the Chief Coroner for Ontario. They then linked these files with provincial data on physician visits and medication prescribing. They also analyzed data from IMS Health Canada—an organization that tracks the sales of prescription drugs.

Here are the researchers' key findings:

Prescriptions for oxycodone rose by more than 850 per cent during the study period. This increase was much larger than for any other opioid. Oxycodone accounted for about one-third of the almost 7.2 million prescriptions for opioids dispensed in Ontario in 2006.
The increase in deaths was especially pronounced after OxyContin was added to the provincial drug benefit plan in 2000. Over the next five years, deaths related to any opioid increased by 41 per cent, and the number of deaths related to oxycodone (the active ingredient in OxyContin) rose fivefold.
Deaths from prescription opioids in Ontario far outnumbered those from heroin.
Most opioid-related fatalities (54 per cent) were accidental. The manner of death was undetermined in 22 per cent of cases and deemed to be suicide in 24 per cent.
Most people whose deaths involved an opioid had visited a doctor and received a prescription for the drug in the month before they died.

"These findings highlight the tremendous societal burden of opioid-related morbidity and mortality and morbidity" says the study's co-author Dr. David Juurlink, a senior scientist at the Institute for Clinical Evaluative Sciences (ICES) and a staff physician at Sunnybrook Health Sciences Centre in Toronto. "Patients and doctors may not fully appreciate the potential danger of these drugs, particularly when they are taken in combination with other sedating drugs or alcohol."

Based on the study findings for Ontario, the estimated annual national incidence of opioid-related deaths in 2004 (27.2 deaths per million population) came somewhere between the incidence of death from HIV infection (12 deaths per million) and the incidence of death from sepsis, or severe infection (40 deaths per million).

To reduce the number of deaths related to opioid prescriptions, the researchers suggest the creation of real-time electronic databases accessible to physicians and pharmacists. This would make it harder for people to obtain opioids improperly from multiple doctors or pharmacies and easier for health care providers to predict and prevent potentially dangerous drug interactions. The researchers also call for more and better education about the risks of opioid use and suggest greater restrictions on opioid prescribing.

. . .

About opioids and oxycodone
Opioids, also known as narcotic pain relievers, are among the most commonly prescribed medications in Canada. They are used to treat people with moderate-to-severe acute or chronic pain. Opioids have many side effects, and can cause death by depressing breathing and decreasing consciousness.

OxyContin was introduced onto the public drug formulary in Ontario in 2000. The public formulary lists drugs that the province has agreed to pay for under its drug benefits plan.

In March of 2007 the report of the Methadone Maintenance Treatment Practices Task Force warned that:

• Use of other drugs – such as Oxycontin – is alarming, especially the increasing use of prescription drugs in First Nations communities.
• It is too easy to access drugs on the Internet, in schoolyards and in physicians’ offices.
• It is common knowledge that some physicians overprescribe.
• There is a need for a provincial drug strategy.

Contact: Julie Saccone
sacconej@smh.toronto.on.ca
416-864-5047
St. Michael's Hospital

“What Do Patients Want? A Critical Look at Healthcare Delivery in Canada”

2009-12-23T13:06:00.002-05:00

Longwoods.com

Transcript of a Presentation made at Breakfast with the Chiefs

Tuesday, September 15, 2009 – Toronto, ON

University of Toronto, Health Sciences Building,

Room 610, 155 College Street, Toronto, ON

Speaker: André Picard, Journalist, The Globe and Mail

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Note to Reader: This is the transcript of a presentation by journalist André Picard. Live presentations are not meant to be papers or articles unless they are thoroughly edited and even rewritten. To do so loses the flavour, and so we have limited our edits to provide you with a document that resembles Mr. Picard’s presentation. We have made only minor repairs. For the actual presentation made at Breakfast with the Chiefs, please visit here.

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Moderator

André Picard is a celebrated author and the public health reporter at the Globe and Mail. He spoke at our own Breakfast with the Chiefs session most recently and here he is, introduced by Anton Hart.

Anton Hart

Ladies and gentlemen, we never introduce our speakers because they’re well known to us, and André, you are no exception. André Picard.

[applause]

André Picard

Great. Thanks, Anton, and thank you for the kind introduction. I’ve set my stopwatch so that I finish on time. I hope to keep it relatively brief, so there are questions and heckling and stuff, because I know when you have the opportunity to get a journalist up live, you’ve got to vent, so I don’t want to deny you that opportunity.

There’s a lot of talk these days about healthcare south of the border, with President Barack Obama trying to do the seemingly impossible, which is reform the dysfunctional $1.3-trillion a year healthcare system in the US. And I use the term “system” there loosely, because they don’t really have one.

But the debate, like the health system itself, has been dominated largely by vested interests. I’m watching it, just like you do, from afar. People like the insurance industry and dogmatists from all across the political spectrum – right and left. Rarely in that debate do we hear from patients, or more specifically, from patients without a political agenda or not hired by a group with a message to sell. Rarer still is to hear patients articulate what they want or expect from a health system. And that’s not unique to the US discussion; we have the same problem in Canada.

So I want to spend the time I have this morning, that you’ve graciously provided me with, this podium, to try and ask and answer that question: What do patients want? Sort of a twist… I live in Quebec, so it’s a twist on the age-old question, “What does Quebec want?” But maybe what patients want is a little simpler, if that’s possible. But I think it’s a fundamental question, and unfortunately it’s one that we almost never ask; we never just sit back and just take a step back and say: What do patients want and how can we give it to them? And even if we do ask it, we rarely wait to hear the answer, because we don’t necessarily want to hear it, depending on our position of power.

I once wrote a story that showed that doctors allow patients to speak on average for 24 seconds before they interrupt them – that’s the kind of science we need to read about. I dare say that many healthcare administrators and policy makers are even more impatient than doctors. I’m not sure they give patients even 24 seconds before interrupting and telling them what they think or what they should think.

Now there are those of you in the audience who will say – and maybe fairly – that you can’t answer the question: What do patients want? That’s an impossible question. There are too many kinds of patients; there are a whole myriad of them, and that’s true. There are all kinds of kinds of conditions. And there are an even more vast number of responses to health-related predicaments. But I still believe that patients share a lot of common traits. We can get a sense of what a Patient with a capital “P” really is.

First and foremost, nobody wants to be a patient. There are the defining criteria, I think. There’s one exception that I can think of and that’s pregnancy, and I’ll come back to that one later. But it reminds me of the old Woody Allen joke. He would say, “Why would I want to join a club that would have me as a member?” That’s a bit how patients feel – you don’t want to be there.

As much as Canadians love medicare, and nurses and doctors and their hospitals, nobody wants to be in a position to use them – to be sick or wounded, or demented or whatever condition they have. It’s strange then, given this near universal desire to not be sick, that we do so very little to keep people well and to give them the tools to stay well. That’s a fundamental flaw in our system. You know that well, and I’m not going to harp on that one too much, although I’ll do my fair bit of harping today – don’t worry.

You know that we invest a pittance in physical health and even less in mental health, and we pay the price for it at the end of the line. I often write in the paper that in Canada we have a sickness care system, not a healthcare system, and I think we have to fix that. There has to be a fundamental change. But if we look south of the border, it’s a bit frightening. It tells us how difficult fundamental change is going to be. It’s going to hurt and we have to realize that, and I think we should take our pain in small doses, not all at once, so we should start changing gradually now and not wait for a crisis.

Now we can talk about this growth contradiction and why do we invest only in sickness and not in health a bit later if you want, but as I said, I think you know that dilemma very well. I want to get back to talking about the typical patient.

When they require medical care, patients want the care to be good, they want it to be quick, and they want it to be easy to understand. I don’t think it’s any more complicated than that. But those are fairly basic and essential demands that they have. In other words, Canadians want the care to be there when they need it; to me that is the rallying cry of medicare, that’s what it’s all about. Be it a visit to ER for a broken arm, a bypass surgery for a clogged artery or arteries, radiation for breast cancer, monitoring of blood gases for people with COPD, or a long-term care bed for a patient with Alzheimer’s, they all want the same thing – good care, quick care, available care. These desires, once again, are near universal – you won’t get any debate among patients about that. Care should be easy to access and easy to understand – that should be our goal; it’s what you should do every morning when you get up and go to work.

But navigating the healthcare system is something else entirely. It can be of dizzying complexity, even for the most savvy patient, and it shouldn’t be. It shouldn’t be as difficult as it is, and I’ll again come back to this issue a little later.

Another expectation of patients or of Canadians is that their care will be free, and I use the term “free” in quotes here. I’m using it very loosely in the Canadian sense of “free,” meaning we pay for it with our taxes. I’m not sure if that’s in Wikipedia, but that should be the Canadian definition. In other words, the typical patient believes they should not have to pay for care out of pocket – that it should be covered by their beloved medicare. After all, that’s where about 40% of our tax dollars go – 40% and counting, I’d say. Again, there are some important subtleties here, and I’ll return to them in a little bit. But again, that’s a pretty universal feeling.

I’ve laid out the expectations of Canadians as I see them, and I don’t think they’re unreasonable. Prompt, good, accessible insured care from birth until death – that’s what we expect. That’s what we can afford. We’re one of the richest countries in the world. For $172 billion a year, and that’s our current level of spending until CIHI publishes their next numbers, with another $10 billion or so every year. For that kind of money, there’s no reason we can’t deliver that on that promise. But those expectations are far too often unfulfilled. So I want to ask you why that is. Why can’t we do the seemingly simple and the desired? We have the money for it, we have the ability to do it. Why don’t we deliver? One reason I think is that no one is speaking up for the patient, and that’s what I want the focus of my talk to be this morning.

In our healthcare system, the patient is all too often an afterthought. They’re not the centre of our being and our doing. In our healthcare system, we have an endless supply of lettered organizations. I saw a few of them roll by there; we’ve got OMA, OHA, ONA and so on. All the “O” words in this province and the “C” words nationally; and that stands for Canadian, those of you with a filthy mind.

[laughter]

Absent from the list, and I could do a long list because I write about acronyms all the time, notably absent from the list is something like OPA. Where’s the Ontario Patients Association or organization? In fact, in Canada there are more organizations to defend doctors against lawsuits from patients than there are organizations speaking for patients. That tells us something about our system, and we’re not even a litigious system. But there’s a big hole there in my view.

Sure, there are all sorts of patient representatives on boards and lobby groups and institutions, have patient councils and the like, and this gives these groups credibility – but I’m not sure it gives patients what they need. For all the talk of patient centredness and the like, in my experience, more often than not, this is tokenism; let’s get a patient on there, it’ll make us look good. Patients don’t have enough real power in these groups, and that’s why they’re taken for granted.

Now I’m only aware of two significant organizations where the word “patient” is in the name in Canada, and I come across a lot of groups, thousands of them. There’s the Patient Safety Institute – that has the magic word Patient in it, but it’s not strictly speaking a patient group, as you know. It was only created after our system admitted, with much reluctance, that adverse events kill about 24,000 patients a year. That’s a pretty heavy price to pay to have a group with the word patient in it. So that’s not a patient group, strictly speaking. The only other group I’m aware of that speaks broadly and directly for patients is the Conseil pour la protection des malades, a Quebec group; very small, unknown outside the borders and largely unknown inside the borders of Quebec. That’s the only truly patient-centred group that speaks broadly, not for a specific disease concern. I’m a bit baffled as to why we don’t have one in Canada.

Now, there are those who will say, hold on, we do have a lot of patient groups. We have the Canadian Cancer Society, Heart and Stroke, the Lung Association, etc. Now it’s true these consumer groups play an important role. I think they play a fundamental role in our health system, but they have specific and narrow concerns – and that’s not a knock on them, that’s their jobs. The patient, when you look at this collection of groups, has been reduced to a collection of body parts or disease entities, and that’s not good. These groups, for all the good they do, are not speaking for the patient as a whole and for their broad concerns across the whole care spectrum, and they’re not necessarily patient controlled. So again, I don’t think that that voice of the patient is there, and I hope I’ve convinced you that the voice of patients is not being adequately heard and that that needs to be remedied. It probably shouldn’t be remedied by people in this room, it should be remedied by patients, but give them the tools to do it and I think it’ll happen.

Now I want to shift gears a bit and give you a sense what I think patient representatives would be saying if they were given an opportunity and a forum and a group to express themselves, just as you have many groups represented here on the professional side. But maybe I should only tell you what they’re going to say after you’ve given them a group and given them money to create it, because you might not like what I say. So just take this and put it in your pocket and still help them set up those patient groups, regardless of what I say.

I want to state upfront that my comments aren’t based on any scientific inquiry or anything scientific. In fact, I’ve made a determined effort this morning to have no numbers in my speech; it’s early in the morning, no PowerPoint because I have a… I go into anaphylactic shock. I’m allergic to PowerPoints now; I go to too many conferences. This is an impressionistic view that I have of what I think patients would tell you, if they were given the opportunity in a formal structure to do so. But I hope it’s a fair representation based on the time I’ve been in the health system. I’ve been doing this job for a couple of decades, and have a couple of decades of experience as a caregiver to parents with long-term chronic illnesses. So that’s where the background comes from and that’s where my views come from, and I should mention that while I live in Quebec my parents lived in Ontario, so some of these comments I hope hit close to home – only the bad ones, not the good ones.

What I hear first and foremost from patients, and this is not something we read in the newspaper or hear on the news very often, is something very important. I hear that we deliver really good medical care in this country. That’s reflected in satisfaction ratings. If you read them, they’re consistently very, very high, and we have to distinguish here between polls that poll patients and polls that poll the public. One of the paradoxes of Canada is the people who are in the health system love it and those who are not in it think it’s a disaster, but there’s another Canadian trait. So I think, look at the satisfaction ratings; we do a great job of delivering medical care. We do the plumbing well is the way I would put it. We have top-notch medical professionals, state-of-the-art medical equipment and an infrastructure that – I tried to find something good to say about it, let’s just say it’s passable. I’ll come back to the infrastructure issue a little later.

On the medical side, the bottom line is this: our outcomes are as good as anyone in the world, and we should be proud of that and that matters to patients. Now, I don’t want to give you the… I don’t want you to get swelled heads at the top, I’ll knock this down a bit later, but this isn’t all about medical care. In Canada, I think our social safety net is a really key contributor to the health of people, and we shouldn’t forget that. But today I’m talking about the health system, and it does a good job. So the care is good. I think we also do the business side well. When they look at us south of the border, if they’re honest, they’re envious of what they see – a very well administered system, cost efficient. Our administrative costs are a fraction of those in the US because we actually have a system and they don’t.

I often hear that our health system is bureaucratic and it has a lot of fat in it. Personally, I don’t see a lot of evidence of that claim. I think that’s largely political rhetoric, and it comes largely from people who are not in the health system. I just don’t think it’s true. It’s an easy thing to say, but there’s not much basis in fact.

We also do access and fairness well. That’s one of the keys to healthcare – is that it be fair and it be accessible. Thanks to our publicly funded insurance system, no one in Canada is denied basic medical care, and we often go well beyond the basics. Again, we compare well to any country in the world on that stage, and this matters to patients too. They believe in fairness. At the risk of this sounding like a jingoistic homage to medicare, let me also say there’s a lot of room for improvement. So let me get into some of that.

To me there’s something really essential missing from our system, and something that leaves patients and their family members really frustrated. I don’t think we do customer service very well, and that’s one of my bugaboos. If you read my column, you know I write about this often. I know it’s a crude way of putting it. People don’t like the word consumer or customer, but when you come right down to it, patient-centred care and family-centred care has to begin and probably end with good customer service. The person has to matter, and as I said before I’m not convinced that that’s the case right now. What does good customer service mean in healthcare? To me, it means anticipating needs, delivering care with respect – with a capital “R,” making it easy to navigate the care system and making amends when things go wrong. Now ask yourselves how many of those things we do consistently every day. I don’t think it’s enough of them.

In Canada we talk a good game about patient-centred care, but we don’t walk the talk nearly often enough. It starts right at the front door of our institutions. I spend a lot of time in hospitals. I’ve literally been to hundreds of hospitals around the country. I even go on my holidays; I drop in because I’m perverse in that way, just to see what hospitals are like. My children have also been kind enough as to have things happen to them so that I visit hospitals in remote areas. That’s always fun too, especially if you have a Quebec medicare card, which is like the plague in Ontario. But we won’t talk about portability today. So I’ve been to a lot of these hospitals and I’ve been lost in most of them, and I could tell you they’re not welcoming places. Most hospitals are dizzying mazes. They’re really difficult to get around, to navigate. To me they’re almost a metaphor for our care journey in Canada. You know, you got a good arrow pointing down a hall and then there’s no other arrow… [laughter] because somebody has painted or it’s been worn out by the shoe prints; I don’t know. To me, there’s a nice metaphor in there for what goes on when you walk around a hospital. I’m sure you’re all on Pill Hill here; I’m sure you’re familiar with what I’m talking about. At least when we put in new arrows, we should at least paint over the old ones, because I’ve made many circular journeys around your institutions.

I think hospitals are also for the most part ugly and uncomfortable. We seem to have an affection for neo-Stalinist architecture in Canada. We have these big grey institutions with endless hallways painted… I was trying to think of polite ways of describing them, but puke green and piss yellow is the only colour chart I seem to have found in most hospitals.

I try to understand why this is; I think it’s sort of the presbyterian background of Canada; a small lower-case “p” on presbyterian, but you know we don’t want to give the impression that we’re wasting money by actually making places look nice. I think that’s sort of a pretty short-sighted view of how we should care. I think our institutions should look nice. They should inspire confidence, and the marginal amount of extra money it would cost would certainly be worth it. I also think it’s hard to expect good health in an institution that looks pallid and unhealthy. We have to take that lesson. I have been often to the Alberta Children’s Hospital, called the Lego Hospital – beautiful spot. It inspires confidence in your care. That’s what all our hospitals should look like. There’s actually light in that hospital – imagine – patient rooms that have windows. In some places I’ve been, that doesn’t exist.

Now all too often, people in our healthcare institutions are as grey and grumpy as the institutions themselves. That’s another big drawback for me, as a patient or as a family member of a patient. They don’t look you in the eye. When someone speaks to you the most likely thing you’re going to hear in a Canadian hospital is: take a seat, wait, fill out a form. Not welcoming words, and I know there’s all kinds of reasons this happens; people are overworked, etc., but I don’t want to hear the excuses anymore. I want better customer service, and I think patients want it.

When patients go to hospitals, they’re frightened, and the way they’re treated makes the visit all the more frightening. They’re often isolated; they have nobody to talk to. I can’t tell you how many times my mother, who suffered from COPD and dementia and a number of other conditions later in life, I can’t tell you how often she was just stuck in a hallway for hours without… literally, without a pot to pee in. Too many people get treated like that. It’s insulting. They’re isolated, as I said. They don’t have anybody to ask simple questions to. Everybody’s too busy. That’s not good enough; that’s not good healthcare.

As I mentioned, because my mother had COPD, she lived with it for 15 years after they gave her two weeks to live. I always, at every public forum, like to thank doctors for their incompetency, thank you very much. The two-week death watch was prolonged for a decade and a half, and she got to see her grandchildren grow up, which was wonderful; but that’s an aside. In that time, she spent a lot of time in the health system and in hospital in particular – in the ER, on the ward, in the ICU, CCU, you name it. She went through the whole alphabet of our health system, many times. As I said, my mother loved her care. She loved her nurses, especially her home care nurse, etc. Never had anything bad to say about them. But she hated one thing above all. She hated the coldness of the reception she got, especially at hospital. In the hospital, and she lived in a small town, they knew who she was, but they treated her every single time as if she had never been there before. Even though my mom was a “frequent flyer,” medical staff asked her the same questions and got her to fill out the same forms every time. Even Air Canada treats its frequent flyers better than that, and that’s saying something.

Now you’ll notice I focus my comments here and my negative comments on hospitals and I’ve done so deliberately, because our system is hospital-centric. I think a little too hospital-centric. I think we have too many hospitals in Canada and too many hospital beds. I know that might get me lynched in this crowd, but I’m going to express the views I have. I think much of what we do in hospitals can and should be done elsewhere, and we should aim for that. I promised before I’d come back to the example of childbirth. To me that’s the most glaring example. The number one reason for admission to Canadian hospitals is still childbirth. How ridiculous is that? If we had a health system that was patient-centred, we’d have birthing centres and midwives coming to the home, and we’d stop treating childbirth as an illness. We have to get pregnant women out of hospitals. The vast majority of them don’t belong there.

I also think we have too many acute care hospital beds as I said, but conversely the most glaring shortcoming in our system today, again in my opinion, is the lack of available and appropriate long-term care beds. There’s a real yawning gap there of care, and one again that doesn’t get nearly enough attention. Our hospitals are filled, people say, “Oh, we need more beds; our hospitals are full.” Well, our hospitals are full of bed blockers – people who should be in more appropriate care. They should be receiving home care and supportive care in nursing homes or specialized care in long-term care facilities, and our medicare system should facilitate that. We shouldn’t have this ridiculous changeover where one day you’re a hospital patient and the next day, “Oh, by the way, we’re going to reclassify you and it’s going to cost you $2,000 a month.” There’s some real perversities in our system that we have to deal with, that people shouldn’t have to endure.

When we talk about wait times, it’s great that we’re doing hip replacements, etc. a little faster, but when we talk about wait times that’s what our focus should be. It should be on the intolerable and often inhumane waits for placements in long-term care. I can’t tell you how many hundreds and thousands of Canadians are suffering because of this. It should be a priority. But again, patients don’t have a voice, and in particular, seniors don’t have a voice. They’re a group that doesn’t speak out, that takes it on the neck all the time, and it’s awful the way we treat them by and large.

The move from acute care to long-term care is a transition, and transitions, as you know, are really important. Transitions are where we fail. I saw in the recent Longwoods, after I had written my speech, I saw a little title of an article about the hand-off. The hand-off is where things are going wrong, and while I wouldn’t use the football metaphor, I think that’s entirely correct. That’s where everything breaks down.

We do have these wonderful pockets of care all along the way, but our connections between them fail all too often, and that’s what frustrates people. There’s no reason that we can’t deliver a continuum of care, because we have all the elements in place, but we’re just not connecting them.

So, you know where these problems are occurring? They’re occurring in the transition from the family doctor to the specialist, from diagnosis to surgery, from surgery to home care, from ER to ICU, from acute care to long-term care. That’s where all the breakdowns are occurring.

Transitions are when patients are most vulnerable. Transitions are when patients fall through the cracks, and some of them don’t get found; they fall pretty far.

A big part of the problem, I think, is tracking, and to do tracking better we need electronic health records. Now that’s not today’s subject, and I know a lot of people have now broken out into a cold sweat because I’ve said e-health, but I do owe it to you and to myself to say a few words on the topic. I think to have patients dependent on paper records in 2009 is really an act of contempt; it’s a travesty in our health system. We live in an era of instant communication. We have someone sitting here sending Twitter posts, but we cross the street to these billion-dollar institutions and we still have paper records. It doesn’t make any sense. We have to be able to transmit health information in a modern fashion – we’re in the horse-and-buggy era in the communication of health information. It’s unconscionable and it’s bad patient care, and we have to deal with it as a priority, no matter how politically uncomfortable it makes us.

I have no intention today of delving into the politics behind the lack of electronic health records, in this province in particular. Apparently, it’s a sore point here, I’m not sure, but I’ve heard. But – let me say this as bluntly and quickly as possible – what do patients think about this? I don’t think patients care about who expensed their choco-bits. I don’t think they care that much about consultant fees. I think they care about the job being done. They care about the quality of care. As long as we depend on paper records, healthcare will not be as good as it should be. For me, the dithering and the politicking that surrounds the creation of e-health records is a symbol of misplaced priorities. This province doesn’t have electronic health records because more time, money and effort has gone into turf protection than into improving the collection and dissemination of information in electronic records. I know that, and I think all of you know it. So let’s get on with the job, and I won’t embarrass some of you any further now.

Customer service – I want to come back to that, but e-health is a key part of it. Customer service from the welcome desk right through to the electronic health record is not merely a series of activities. It’s a question of culture, and that’s why it’s not happening. It’s the culture that has to change. In Canadian healthcare we have a culture that says the needs of the system almost always take precedence over the needs of the individual patient. Maybe that’s the downside of believing in the collectivity, but you can believe in the collectivity and not put the demands of a system over those of the individual. We can balance the two. We have a culture that says investing in customer service is not a priority.

I’ve spoken extensively about patients, and maybe I realize that I haven’t been clear enough about how I define the term. We need to recognize that medical conditions don’t just affect individuals. When I talk about patients, I’m speaking much more broadly. Medical conditions affect entire families. Sometimes they affect entire communities depending on how they hit, but let me limit it to families, and that’s particularly true of chronic illnesses like heart disease or COPD or psychiatric illnesses. They involve a whole bunch of people, and a lot more than one person suffers and a lot more than one person has to be cared for.

In our system we treat patients… I think we treat them pretty badly, but we treat their families even worse. We talk a good game about including families in care, but the reality to me is we dump a crushing burden of responsibility on them and we provide very little support. Again, we can’t limit our care to the disease entity, to the person.

We send people home quicker and sicker, but we provide little training to their unpaid caregivers. There’s an army of unpaid caregivers out there. We provide niggling amounts of home care. We provide virtually no respite care for long-term caregivers; we burn them out. It’s not unusual for caregivers to die within months of their partner dying, and we’re killing them, to be blunt about it.

We also have a bizarre double standard about privacy. This is another thing that used to drive my mother crazy. We demand all kinds of things of loved ones, but when they ask for even the most basic information, we throw up our hands and say, “Sorry, we have Privacy Legislation.” Well, to the average individual, that’s nonsense. Families have a right to care without the additional burden of a bureaucratic blindfold. If the rules don’t work now, let’s fix the rules. Let’s make our system more patient-friendly and more family-friendly.

In discussing what patients want from a healthcare system and what they think of the health system, you’ll notice there are some pretty big topics that I didn’t touch on. Some of you may wish I didn’t touch on e-health either, but so be it. I’ve not, in all the time I’ve been prattling on so far, mentioned the words public or private, and I’m not going to do so at any length. I think the private/public rhetoric distracts us from the discussion of what really matters, and what really matters to me is what do patients want and how can we deliver it?

I don’t think the private/public discussion that takes up so much political time and so much air space really matters to patients, ultimately. Honestly, they could care less if their physician works in a private clinic, a public clinic, if their hospital is administered by the Ministry of Health, the Shriners, Wal-Mart… Honestly, people don’t really care about that. My mother always used to say, by the way, that she got much better customer service at Wal-Mart than at the hospital. They would actually remember her name. They would bring out the cart to carry her little oxygen tank as soon as they saw her in the parking lot. That’s customer service. Now, I don’t want to take the metaphor too far; I don’t want our hospitals to be Wal-Mart, but if you can do that with paying seniors minimum wage at Wal-Mart, God knows we can do it in our hospitals – there’s no excuse for not doing it.

What matters to people is not public or private. It’s the quality and consistency of care. What matters is that they can depend on the care to be there and that their insurance program – which we call medicare – is there for them. Now that’s all I intend to say on the private/public topic. As I said, it takes up way too much time and air space. I just wanted you to know that I’m ignoring the issue deliberately. It’s not an oversight, and if you want to talk about it more in the question period I’ll be happy to go on then.

Another thing I didn’t mention is the Canada Health Act, which if I recall my Canadian history was brought down by Moses on a tablet of stone [laughter]. I’m a bit… It’s been a little while since I was in high school, but I think that’s how we got the Canada Health Act or maybe it was Monique Bégin, I don’t know. I didn’t talk about those bureaucratic underpinnings of the system, and again, that’s deliberate. This notion that medicare defines us as a nation is something I hear over and over again, and once again I think this is nonsense. I would hate to live in a country that’s defined by an insurance program. There’s a lot more that defines us than that. Medicare is good; it’s a nice program, it’s a smart program, but it’s a publicly administered, state-funded insurance program, period. That’s how we should treat it, and as long as we get caught up in this religious admiration of medicare we’re never going to allow it to be updated and modernized and fixed, and it needs a lot of modernization.

Now that being said, I want to talk about the CHA a little bit, because again there is too much drama behind it and too much sense put to its meaning and how important it is. It’s a piece of legislation like any other, not a very well written piece of legislation, but it has some important elements. The most important of which are, as you know, the five program criteria. We often describe these as the guiding principles of medicare, but they’re actually program criteria. If your province doesn’t fulfill these, technically, they don’t get money from the federal government. In reality that’s not true, but at least on paper it’s true. Let’s do a little reminder of what they are. This is what was carved on those tablets of stone by the Lord himself:

Public Administration – The Provincial Health Insurance Plan must be administered on a non-profit basis and audited yearly.

Comprehensiveness – The Provincial Health Insurance Plan – this is my favourite quote from the Act – “Must ensure all insured health services.” [laughter] I don’t know about you guys, but I had to take Philosophy 101 in university and that wouldn’t have cut the mustard, but there you go. That is what it is.

Universality – All insured health services must be provided on “uniform terms and conditions.” Again, a nice vagueness there.

Portability – Insured health services must be paid at a rate set by the Province even if a patient is treated in another jurisdiction. Well, I mentioned before I have a Quebec health insurance card, so I won’t talk about that.

Accessibility – The Provincial Health Insurance Plan must provide “reasonable access” to services and must provide “reasonable compensation” to medical practitioners.

There are our five guiding principles. That’s why I don’t want our country to be based on this, thank you very much. Those are important to know, but this isn’t going to inspire people to go out in the streets. This isn’t going to inspire love. Medicare is something more than that; it’s more than the Canada Health Act, but that’s its basis, so let’s not lose sight of that. It’s an insurance program, it’s nice – la-de-da. While it’s not mentioned by name, I do think that there are other principles that are implied in there that are important.

I think why we have those five elements is they’re designed to ensure fairness and equity; not necessarily equality – equity and equality are different words – but that’s what the goal of the Act was, among other things, and to stop doctors from extra billing, but that’s the fundamental philosophy behind it – let’s have fair, equitable healthcare. I think Canadians by and large believe in that. They believe in fairness and equity, and that’s why they support medicare, even though they’re not conversant with all the nitty-gritty of the circular arguments within the legislation.

I also think there’s a sixth principle that’s implicit in there, and it’s one we don’t talk about nearly enough. I think that’s accountability, or some people call it affordability. But I think that’s where the patient service comes in, or the customer service. I think there’s an accountability there that’s implied in all those measures that we again don’t respect enough.

Canadians are a practical lot of people. Not many people believe that all medicare can be provided to all people at all times on an unlimited basis. I think Canadians are more realistic than that. Patients know intuitively that there are limits to the care. Again, this is another topic I write about and I get lots of hate mail about, but I think people know that; that there are… We have to set in-points. We can’t just fund everything forever and without limits. I think people accept this notion that care has to be rationed in some way, and I know I’m using the ugly “r” word, but to me rationing is not a bad word. It’s a reasonable expectation and something we have to do in an insurance system, public or private or otherwise. People have to know that; we have to be honest with them about that.

The problem isn’t rationing, the problem isn’t saying that some stuff isn’t being covered. The problem is that we’re not clear in any way to patients on how the lines are being drawn. There’s a constantly moving target and again, it’s not fair to them. To me, the most glaring public policy failure in the healthcare field today is our unwillingness to define what’s in and out of the medicare basket of services. I think we owe it to ourselves to do that, and it doesn’t have to be a set list. It can be a way of determining criteria, but we have to set those limits. Patients want to know them and they should know them. Instead, what we do is we perpetuate the fiction that there are no limits, and that’s why our spending is not controlled in any honest way. And that’s, I think, dishonest and counterproductive.

How am I doing for time? I’m okay. Yesterday I was at the University of Ottawa. I was at a forum for new medical students. I go and speak to the new university students. I was in this very lecture hall with the U of T students last week, yesterday U of O. It’s always fun to meet the green-behind-the-ears, up-and-coming students. They all think they’re going to be wonderful and they’re never going to be cynical like you guys and me. I go there and I try and burst their bubble. Anyhow, I was on a panel of people from different backgrounds who were offering up advice to these young people with really dauntingly impressive résumés on how they can be better doctors in the future. So just at the start of their career, trying to get them and say “listen,” put these evil thoughts in their head that there’s more to doctoring than talking to one patient in their room and billing; that it’s much more complex than that. One of my fellow panelists was Yves Brunet. He’s a patient who’s lived 25 years with HIV/AIDS – more than half his life – and he offered up what I thought was the most important advice of the day to these would-be doctors, and I want to read you a quote from him. He said, “Look me in the eyes. Look every patient in the eyes and tell them the truth. Do it honestly and do it compassionately.” And I thought in those two sentences, Mr. Brunet summed up all the advice you really need to deliver for patient-centred care. That’s what it’s about; it’s about looking people in the eyes and telling them the truth – even when it’s uncomfortable, even when it’s difficult. Listening to people matters too. Mr. Brunet had a wonderful expression. He said, “Grow a third ear. You can never listen enough to the patient. If they’re in a profession where they interrupt people after 25 seconds, they need maybe four ears – maybe not just three.” So listening to people matters, and it matters a lot to them, especially when they’re scared and they’re sick and their families are frightened. They don’t know how they’re going to pay for their cancer drug – that’s all very frightening. They need to be listened to.

Care that’s not centred around the patient and the family cannot be technically efficient. It can be technically efficient and it can be medically effective, but it will never be good care. We have to go beyond the technical aspect; the humanity of the care matters. To provide good care you have to do a lot more than treat a condition. You have to treat a person – the whole person – and sometimes you have to treat their family too. Patients are not just vessels for a disease or a health condition. They’re not just billing numbers or cost centres. Patients are physical, emotional and spiritual beings, and for all the good and bad that implies. They’re not always easy. You have to treat them in the context of their lives. You have to take into account their support system or lack thereof, their family, their income and so on. Those measures will tell you as much about a person’s health as their blood pressure or their blood gases. They’re vital measures, and we don’t do those vital measures enough in our system. We’re too technical.

Every health problem a person has, every encounter they have with the health system, is a journey. Now that’s a cliché, but there’s often some truth to clichés. Right now, we pay attention to only a little part of that journey. Generally the part people spend in a doctor’s office or in a hospital bed – it’s all institutional. We focus too much on the institution. The journey, no matter how long or how short, often seems disjointed to patients. There’s all kinds of silos within our health system, and even more when you try to connect with other systems like social services or housing or education. Things that are really… get people healthy and keep them healthy.

There’s a horrible disconnect between hope, health and social services that results in a lot of waste of health dollars. Now, that may be a subject for another day. We could talk about that for a long time, but I want to put it out there – health does not work in isolation, and people’s health is not strictly about providing sickness care. It’s about engaging people more broadly as citizens, not just as patients.

Now I’ve spoken today about the importance of giving patients a voice, and I don’t want you to think it’s sufficient to have a single organization, say an Ontario Patient Association or something similar. That’s not what I’m talking about. That would be a start. High-profile advocates who stage press conferences and publish reports can play an important role, but they’re only a small part of what’s required. People need, in the jargon of the social sciences, multiple platforms. They need to be able to tell their stories all along the journey. That’s so important to express yourself, to be heard and to be listened to. Patients need to be able to speak to their front-line healthcare provider, but nurses and doctors are so busy they have seemingly no time for those conversations anymore. Healthcare is suffering as a result.

Patients also need to get their views heard up the chain of command; to be able to express their dissatisfaction and yes, their satisfaction – because there’s a lot of that too – to administrators and ministry officials, policy makers and politicians.

To me, without good communication, we can’t have good healthcare. I think it’s an essential component. Feedback needs to be an integral part of delivering care as well. There needs to be follow-up, not just treatment. I know there’s a lot of patient satisfaction stuff going on, particularly in this province. That’s not too bad; that’s a good start, but a lot of it strikes me as formulaic – a lot of pre-set questions that generate predictable answers. Maybe that’s a bit too critical of your feedback surveys, but that’s again my impression of them.

Be a little braver and a little bolder. Ask patients and their families about the journey, and let them tell you how to improve it. Ask them some open-ended questions. That’s when you get interesting stories. Some institutions are implementing storytelling initiatives, and those are great. I applaud those. I think they’re an important initiative, but again these have to be more than corporate arts-and-crafts projects – they have to be real, they have to have meaning. While letting patients tell their stories is important, listening to them is more important still, and while talking and listening is all well and good, there’s no point to the exercise if we don’t act on what we learn.

The key to patient-centred care is better communication. It requires a dialogue, not monologues in parallel, which is what I think we have now. Communication needs to be an integral part of patient care, not an afterthought or a bureaucratic task to check off the list. There needs to be, in my view, patient and family representatives within the system and there are some – patient advocates and family advisory councils and the like. But again, this can’t just be tokenism; they have to have a real voice, and they have to have real power. In our health system we’re all for giving patients and families a voice, but we rarely give them any real power. It’s a little scary. We need to do more than talk about patient-centred care; we need to live it.

And I’ll wrap up there, and if you have any questions, I’d be happy to answer them. Thank you.

[Applause/music]

[End of recording]

Can Walnuts Reduce the Risk of Heart Disease?

2009-12-21T20:07:00.001-05:00

Want to reduce your risk of heart disease? The California Walnut Commission makes it simple. Eat Walnuts. And the U.S. Food and Drug Administration agrees. Sort of. The following claim is allowed on packages of walnuts. "Supportive but not conclusive research shows that eating 1.5 oz of walnuts per day, as part of a low saturated fat and low cholesterol diet, and not resulting in increased caloric intake may reduce the risk of
coronary heart disease." How do walnuts do this? They are rich in many healthful ingredients such as polyunsaturated fats, antioxidants, fiber and folic acid. It has even been demonstrated that blood levels of total cholesterol, the so-called bad or LDL cholesterol, and triglycerides decrease when walnuts are added to the diet, while levels of the beneficial HDL cholesterol increase. Seems simple. But science is never that simple.

The studies cited by the walnut industry have been largely critiqued for their small numbers or short duration. A typical example is a study conducted in Spain at the Lipid Clinic in Barcelona, where researchers substituted walnuts for about one-third of the calories from olives, olive oil, and other monounsaturated fats in a Mediterranean diet. For the first time Spanish scientists found that a whole food, not its isolated components, demonstrated a beneficial effect on heart health. Walnuts were found to increase the elasticity of arteries by 64 per cent, and to reduce cell adhesion molecules associated with hardening of the arteries by 20 per cent.

And so, many public health professionals are concerned that the new guidelines for claims will prove to be misleading. So where does all this leave the consumer- other than scratching his head in the produce aisle? Well, nuts have notoriously been prey to the mistaken perception that all fatty foods are bad. Health claims on packaging can help clarify that and educate consumers so that they may make informed choices at the supermarket as nutrition science unfolds. But there is still concern. Food producers touting their products’ benefits all over the packaging may result in consumers paying more attention to health claims and less to calories. It is worthwhile noting that despite the many advertisements promoting the genuine benefits of increased fiber consumption, fiber intake has remained static since 1990. What has increased since then is calorie consumption. The consumption of 4000 calories a day, not unusual for many people, is not healthy, no matter what their source! Additionally, many health claims placed on produce packaging are presented as “quick fixes”. Be very wary. One food isn’t going to make a significant difference. In the end, it’s everything you eat that really counts. But given that food labeling remains under the control of the FDA in the U.S., consumers can rest assured that producers will be restricted to making claims that are, at minimum, scientifically qualified.

In Canada, we are more restrictive and such claims are not allowed. The clever consumer will however recognize that health claims are most often used as marketing tools and that good health cannot come wrapped neatly in any one package.

Joe Schwarcz, McGill, Office for Science & Society

First mom to deliver in new facility on September 12, 2010 will receive a year's supply of diapers, cleaning service for a year and much more

2009-12-21T17:51:00.000-05:00

September 12, 2010 is not only the move date for Sunnybrook's Women & Babies Program from its downtown site to 2075 Bayview Avenue, but also a lucky day for a family delivering their baby at the new facility.

The first couple delivering a baby in Sunnybrook's new facility on Sunday, September 12, 2010 will receive a "diapers for a year" courtesy of Babies R Us, a year's worth of baby clothes from Snug-a-bug, learning toys for baby's first year and a spa package from Elizabeth Milan Spa. See contest rules and regulations for full details

"If you're thinking about starting a Sunnybrook family or adding to your family, now is the time," says Dr. Jennifer Blake, Chief of Obstetrics and Gynaecology at Sunnybrook. "The new home for the Women & Babies Program includes welcoming birthing rooms where women can progress through labour, delivery and recovery in the same suite. There are comfortable and private spaces for visitors and an advanced operative birthing suite."

The new facilities at Sunnybrook will include:

20 private Labour, Birth, Recovery and Postpartum (LBRP) rooms, where women will journey from labour and delivery to postpartum recovery, all in the same comfortable room
48 beds for neonatal intensive care which will provide around the clock care for 1,200 of Ontario's critically ill and premature infants
Three operative birthing rooms for high-risk, Caesarian section and multiple births
A 23 bed High Risk Antenatal Unit for moms-to-be experiencing pregnancy complications
Access to critical care expertise in the areas of heart, cancer and neurosciences, all of which are located at the Bayview campus

"The new facilities, designed with input from patients and families, will provide a state-of-the-art environment for our world-class Women & Babies team," says Dr. Barry McLellan, President and CEO of Sunnybrook.

The Andre Picard Files: Summer of 09 to the year end

2009-12-21T13:52:00.002-05:00

Drugs made in China: opportunity or threat? Dec 11, 2009

The man from Pfizer: Should Big Pharma help steer health research? Dec 03, 2009

Rich v. poor: The lives we can expect from our income Nov 27, 2009

Base breast-screening on reason, not passion Dec 14, 2009

Reader questions on H1N1 answered Nov 02, 2009

Forget poppies – vets deserve flu vaccine Nov 11, 2009

Flu-shot impatience: Let's try a dose of reality Nov 04, 2009

Here's a radical health care idea: Put the patient first Oct 22, 2009

Our two-tiered health system: a rural-urban split Oct 16, 2009

Stop the conflusion: Here are the H1N1 facts Oct 09, 2009

Note to MPs: Our kids are more important than your re-election Oct 02, 2009

To find a global solution to cancer, we need a global conversation Oct 01, 2009

Burying the story won't stop suicide Sep 19, 2009

We do have to put a price on life Oct 03, 2009

With more than 500 aboriginal women missing, action is overdue Sep 03, 2009

New Brunswick has betrayed its doctors - and the public Aug 28, 2009

At 25, the Canada Health Act deserves better from our leaders Aug 21, 2009 EDT

We need fewer barriers to abortion, not more Aug 27, 2009

We could learn a few things from the U.S. Aug 07, 2009

Poor leadership is the real listeria culprit Jul 22, 2009

Trans fatty acids are good for the heart?

2009-12-14T19:27:00.000-05:00

(Winnipeg, December 1, 2009) Research scientists at St. Boniface Hospital and University of Manitoba have published a study suggesting that vaccenic acid (VA) – a natural trans fatty acid found in small amounts in milk and dairy products like yogurt and cheese – could actually aid in reducing the incidence of heart disease. This finding indicates that we can no longer assume that all trans fats are harmful.

The study, published in the Journal of Nutrition in collaboration with scientists from the University of Laval, was led by Dr. Grant Pierce, a member of the Institute of Cardiovascular Sciences at St Boniface Hospital and a Professor of Physiology within the Faculty of Medicine at the University of Manitoba. The work indicated that a diet fed to animals including the trans fat vaccenic acid helped protect against atherosclerotic plaque buildup in arteries – the primary cause of blockages resulting in a heart attack or stroke. The study measured actual reductions in arterial plaque by eating natural trans fats ‐ by as much as 31%.

“It is clear from our study that not all trans fats cause harm to our blood vessels. Industrially hydrogenated trans fats are found in vegetable shortening and baked goods like cookies and donuts. Eating these trans fats caused mice to develop plaques, whereas eating natural trans fats did not. In fact, our research demonstrates that natural trans fats actually prevented plaque buildup,” said Dr. Chantal Bassett, a graduate student in Dr. Pierce’s lab and lead author on the paper.

Dr. Pierce, Executive Director of Research at St. Boniface Hospital explained, “This research has important significance for the meat and dairy industries. Meat and dairy products contain natural trans fats, mainly in the form of vaccenic acid. These meat and dairy trans fats may have been a concern to us prior to our study. We can now consume these products with confidence that it is a healthy part of our diet.”

Isabelle Neiderer, Director of Nutrition for Dairy Farmers of Canada, adds “These interesting findings add to the growing scientific evidence showing that industrial and natural trans fats have different effects on blood lipids and cardiovascular risk and they also lend support to a recent WHO scientific review which stated that natural trans fats, in amounts usually consumed, do not seem to be a risk factor for coronary heart disease.

“This is another great example of how Canadian research is leading the way in helping Canadians and citizens around the world to make healthier nutritional decisions,” said Dr. Peter Liu, Scientific Director at the Canadian Institutes of Health Research’s Institute of Circulatory and Respiratory Health. “Educating Canadians on the differences between natural, healthy and industrial manufactured unhealthy trans fatty acids in their diet will help to further lower their cholesterol levels and their chance of developing heart diseases.”

Powerful World Alliance of Health Researchers Announces Landmark Pact on Priorities In Fight Against Humanity’s Most Fatal Diseases

2009-11-19T17:29:00.000-05:00

Agencies managing 80% of global public health research funding set first priorities for common, concerted assault on heart and lung diseases, other “Chronic Non-Communicable Diseases”

An alliance of institutions collectively managing an estimated 80 percent of all public health research funding worldwide today announced their first targets for concerted action in the fight against “chronic non-communicable diseases” (CNCDs).

Lowering hypertension (high blood pressure), and reducing tobacco use and the indoor pollution caused by crude cooking stoves in developing countries -- which together factor into roughly 1 in 5 deaths each year -- were chosen as initial priorities for the unprecedented coordinated research program under the new Global Alliance for Chronic Disease.

The priorities were set earlier this month in New Delhi, India, at the Alliance’s inaugural scientific summit.

Three new member institutions (the South African Medical Research Council, the Qatar Biomedical Research Institute, and the National Institute of Mental Health (NIMH) of the US National Institutes of Health) as well as a new category of partner institution (see appendix 1), were welcomed by the Alliance’s six charter institutions:

Australia National Health and Medical Research Council
Canadian Institutes of Health Research
Chinese Academy of Medical Sciences
Indian Council of Medical Research
U.K. Medical Research Council, and
U.S. National Institutes of Health, specifically its National Heart, Lung, and Blood Institute (NHLBI), the Fogarty International Center, now joined by NMIH (the three NIH members sharing one vote on the Alliance board).

The World Health Organization (WHO) is an observer on the board of the Alliance, created last June to support clear and coordinated research funding priorities in the battle against chronic, non-communicable diseases (CNCDs), namely:

Cardiovascular diseases (mainly heart disease and stroke)
Several cancers
Chronic respiratory conditions, and
Type 2 diabetes.

According to the WHO, of the 58 million deaths recorded in 2006, CNCDs caused about 60 percent.

Of the 35 million deaths caused by CNCDs, the Alliance’s first three research funding priorities are associated with 11.5 million of them (about one third; broken down below).

CNCDs cause twice as many deaths as the combined total of HIV/AIDS, tuberculosis, malaria, maternal and peri-natal conditions, and nutritional deficiencies.

The health impact and socio-economic cost of CNCDs is enormous and rising, upending efforts to combat poverty.

The Alliance’s multi-country, multi-disciplinary research in the first three priority topics, to be contracted next year, will focus in particular on the needs of low and middle income countries, and on those of low income populations of more developed countries.

They also agreed in New Delhi to commission several scoping initiatives to prepare future joint research related to obesity and diabetes, to be led by the Alliance’s acting Executive Director, Prof. David Matthews of Oxford University.

In total, Alliance members expect to invest tens of millions of dollars in their first coordinated research programmes over five years.

Members agreed that the research must, among other things:

Involve local policymakers from the outset, with a commitment to scale up successfully tested programs
Measure clinical outcomes – for example, a reduction in the incidence of stroke, not just a drop in the incidence of hypertension
Not draw human and other resources away from any local health care system
Create a tool-kit to be used later to scale up and replicate successfully tested programs
Include a training / capacity building component.

Alliance members also agreed at their board meeting in New Delhi to fund a program to identify the world’s “Grand Challenges in Mental Health” under the leadership of the US National Institute for Mental Health, in association with Alliance Board Chair Abdallah Daar and Vikram Patel, of the London School of Hygiene & Tropical Medicine and the Sangath Centre in Goa, India.

The Alliance expanded its mandate to include mental illnesses because of their link to CNCDs and the rising toll they take globally, including 1 million suicides annually, eating disorders and alcoholism leading to death by injury. Some experts predict mental health problems will become the world’s second leading cause of disease burden by the early 2020s.

Says Dr. Pamela Collins, Associate Director for Special Populations and Director, Offices for Special Populations, Rural Mental Health Research and Global Mental Health at NIMH: “Working with in house and extramural program staff, NIMH develops global projects and provides technical consultation to the international mental health community. We are excited to be working with the Alliance and look forward to developing the Grand Challenges in Global Mental Health.”

It was agreed in New Delhi that Canada’s International Development Research Centre will host the Alliance secretariat. Ottawa-based IDRC was chosen from among six expressions of interest from around the world.

And, at the invitation of the Chinese Academy of Sciences, China will host the Alliance’s next scientific and Board meeting in 2010.

Hypertension
According to the World Health Organization, hypertension (high blood pressure) is the leading cause of cardiovascular deaths, causing 5 million premature deaths each year.

Experts estimate 1 billion people worldwide are affected by hypertension, with 1.5 billion victims predicted by 2025.

The World Hypertension League (WHL), an umbrella organization of 85 national hypertension societies and leagues, estimates that over half those with hypertension are unaware of it.

This major cause of illness, including strokes, is very poorly addressed in developing countries.

Tobacco
Tobacco (including India’s high-nicotine, flavored, filterless bidi products, dubbed “cigarettes with training wheels” by health authorities), is expected to kill 1 billion people prematurely this century.
The challenge is to reduce this toll, especially in the developing world, which is increasingly targeted by tobacco companies as western markets diminish.

Almost 5 million people died from smoking worldwide in 2000, rough half of them living in developing countries and half in rich nations.

At least half of these adults die between 30 and 69 years of age, losing decades of productive life. Cancer and smoking deaths have fallen sharply in men in high-income countries but are expected to rise globally unless smokers in low- and middle-income countries stop before or during middle age.

Indoor air pollution from cooking stoves
About 3 billion people cook their meals with wood, dung, coal and other solid fuels over open fires or on primitive stoves inside their homes.

As a result, the WHO estimates that 1.5 million people die prematurely each year.

The Alliance program will, among other goals, develop and evaluate new designs capable of large scale manufacturing, along with local and regional commercialization strategies.

Mental Health
According to the WHO, “mental, neurological, and substance use disorders are common in all regions of the world, affecting every community and age group across all income countries. While 14% of the global burden of disease is attributed to these disorders, most of the people affected - 75% in many low-income countries - receive no treatment or care.

Estimates in 2001 suggested that about 450 million people worldwide suffer from mental or neurological disorders or from psychosocial problems such as those related to alcohol and drug abuse. Many of them suffer silently and alone without care on the frontiers of stigma, shame, exclusion and death.

Major depression is now the leading cause of disability globally and ranks as the 4th leading cause of disease burden global, rising to the 2nd leading cause by the early 2020s, according to WHO prediction.

Globally in 2001, 70 million people suffered alcohol dependence, about 50 million had epilepsy and 24 million had schizophrenia. For every successful suicide (1 million in 2001), the WHO estimates between 10 and 20 people attempt it.

* * * * *
Quotable quotes:
Abdallah S Daar, Chair of the Alliance, Professor of Public Health Sciences at the University of Toronto and University Health Network’s McLaughlin-Rotman Centre for Global Health: “Our 2007 study in Nature identified the Grand Challenges in chronic non-communicable diseases. This month in Delhi, some of the world’s leading CNCD experts discussed potential early research funding priorities, such as the link between undernutrition in early life and the risk of diabetes and heart disease later, the connection between tuberculosis, diabetes and chronic obstructive lung disease, the strength of evidence for nutritional advice given to the public, and the growing epidemic of diabetes and obesity in developing countries. At future scientific and board meetings we will return to these and other topics, but for now we wanted to pilot the concerted research approach that, once successfully demonstrated for one condition, can be used for others.”

Dr. Elizabeth Nabel, Director, NHLBI: “Alliance members intend to jointly develop the request for proposals and combine on the peer review of those received, coordinate funding by Alliance members and partners, create standardized data gathering tools and databases, and harmonize evaluation methods. The Alliance represents an important new vehicle for making optimal use of limited global resources available to reduce the enormous toll of these largely-preventable diseases.”

Dr. David Matthews, Professor, Oxford University and acting Executive Director of the Alliance: “The epidemic of chronic disease in the world has accelerated. We urgently need to understand how to reverse the trend, not just in small trials, but in all the world communities. This new initiative will provide urgently needed resources to find and implement solutions”

Dr. Alain Baudet, President, Canadian Institutes of Heath Research: “We know quite a lot about how to manage chronic diseases on a small scale. The challenge is how to scale up interventions, especially in low resource settings. For Canadians, this includes our own aboriginal populations, whose health outcomes need to be improved dramatically. For example, they have some of the highest incidence of diabetes type 2 in the world.”

Prof. Warwick Anderson, CEO of the Australia National Health and Medical Research Council: “Australia has some of the most advanced medical care in the world, yet our aboriginal population continues to suffer from high levels of both infectious and chronic diseases, including mental illness. They have high rates of diabetes, and many wind up with end-stage kidney failure, requiring prolonged dialysis or transplantation. We must address chronic diseases seriously and urgently.”

Sir Leszek Borysiewicz, Director, Medical Research Council of the UK: “We wanted to take an engineering approach: what is the problem, how can we bring different people together to design a solution, develop a plan to implement the solution, and then scale it up. We wanted policymakers to be involved from the beginning. This is implementation science. And that is what we need now.”

Dr. V.M. Katoch, Director-General, Indian Council of Medical Research: “India has become the diabetes capital of the world; its people suffer from cardiovascular diseases at an early age and millions suffer chronic lung diseases as a result of smoking tobacco and our own type of cigarettes, the bidi, which the government is unable to regulate or tax. And indoor pollution from old fashioned cooking stoves is a major cause of chronic lung diseases, especially among children and women. These problems cannot afford to wait to tackle these problems.”

Prof. Depei Lu, President, Chinese Academy of Medical Sciences: “China has a huge population, and CNCDs and mental health problems constitute a huge burden of disease and disability. The Alliance provides a mechanism for us to work with our colleagues around the world to identify how best to address these conditions. We welcome the Alliance to China next year.”
* * * * *
Appendix 1
Partner organizations:

The National Institute of Medical Research, Tanzania
The World Heart Federation,
The Pan American Health Organization

* * * * *
Media contacts at member institutions:
National Heart, Lung, and Blood Institute (NHLBI) of the U.S. National Institutes of Health:
+1-301-496-4236

nhlbi_news@nhlbi.nih.gov

Canadian Institutes of Health Research
+1-613-941-4563; +1-613-808-7526 (m)

mediarelations@cihr-irsc.gc.ca

U.K. Medical Research Council
Ms. Hazel Lambert, +44-(0)-207-670 5301; +44 (0) 20 7637 6011

press.office@headoffice.mrc.ac.uk

Australia National Health and Medical Research Council
Ms. Carolyn Norrie, +61 (02) 6217 9342; +61-0422 008 512 (m)

carolyn.norrie@nhmrc.gov.au

Telemedicine Provides Psychiatric Lifeline for Kids in Crisis

2009-11-19T12:47:00.002-05:00

TORONTO (November 19) - Every year, thousands of youngsters in Ontario experience a mental health crisis, yet the vast majority end up waiting months for psychiatric assessment and treatment because of the severe shortage of these specialists. Now a groundbreaking new program is bridging the gap between kids and care.

Nearly 20 per cent of young people under the age of 18 in the province are affected by a mental illness or disorder. Astoundingly, only one in six of these will actually receive the mental health services they require.

"Imagine being the parent of a child in serious mental crisis. And then imagine arriving at a hospital emergency department and being told that it will be months before the child can be properly assessed by a psychiatrist.That is the sad reality for many families," says Dr. Ed Brown, CEO of the Ontario Telemedicine Network (OTN).

OTN's live, two-way video conferencing technology is assisting hospitals to provide more immediate care to this vulnerable population. The program, called the Virtual Emergency Room, was launched in 2008 by Ontario Shores Centre for Mental Health Sciences, Lakeridge Health, Peterborough Regional Health Centre and Ross Memorial Hospital. The program allows young patients with an urgent mental health problem that require specialist intervention to be assessed within 72 hours. The participating psychiatrists are able to link to these youngsters using OTN's network.

Dr. Gabby Ledger is a child/adolescent psychiatrist at Ontario Shores Centre for Mental Health Sciences and is one of three physicians at the hospital currently providing care through the Virtual Emergency Room.

"Kids suffering with untreated serious mental illness are at risk. They may begin failing in school, pulling away from their peers and families, becoming socially isolated. They may end up living on the streets or in the most severe cases, they may try to take their own lives," says Dr. Ledger. "That's why the VER program is so important; it allows us to reach these kids before their mental health problems worsen."

Anne (real case, name changed to protect identity), a parent,, understands first hand what can happen when access to these specialists is limited. For years, her son struggled with mental illness, purposely harming himself on many occasions. Doctors told Anne that his issues were behavioural and that he was just seeking attention. Anne's son attempted suicide at 13 years old.

"I was so frustrated...for years I had been telling doctors something wasn't right and no one would listen. Even after his suicide attempt, it would have taken months to see a child psychiatrist. The VER allowed him to be seen within a week. We are so grateful that he is finally getting help."

Suicide is the second leading cause of death among young people in Canada and accounts for more deaths in this age group than cancer and AIDS combined. And for every young person who dies by suicide, there are an estimated 200 attempted suicides.

By linking to any of the four hospitals via the OTN system, the participating psychiatrists are able to provide more immediate care to more young patients at risk. The program serves children and youth who suffer from complex mental health issues such as bi-polar disorder, psychosis and severe behavioural disturbances.

The technology also helps address geographic distances. The Central East LHIN stretches from Victoria Park (Scarborough) to Algonquin Park, so there is a lot of ground to cover and not enough child/adolescent psychiatrists to serve the area.

"The program has been incredibly well received by patients, their families and referring physicians," says Dr. Ledger. "They are usually so relieved when they discover how quickly they can be seen."

The Ontario Telemedicine Network (OTN) is an independent not-for-profit organization funded by the Government of Ontario. OTN is a secure, encrypted video network that helps deliver clinical care and professional education among health care providers and patients.

For more information, visit www.otn.ca or contact:

Damage control is the name of the game in Berlin on Monday as politicians rush to deny that they are receiving a better, safer swine flu vaccine than ordinary Germans. The first of 50 million doses arrived in Germany on Monday

2009-10-29T16:33:00.000-04:00

One might think that the arrival in Germany of the first of 50 million doses of swine flu vaccine on Monday might be cause for celebration. But with news breaking over the weekend that top government officials in Berlin will be injected with an alternative vaccine -- one widely seen as safer -- a debate about an alleged two-class medical system has erupted.

SPIEGEL over the weekend reported that Chancellor Angela Merkel, a number of her ministers and other government officials would receive a vaccine manufactured by the pharmaceutical company Baxter -- the same vaccine that the German military opted for, as was reported last week.

The mass-circulation tabloid Bild on Monday plastered the story on its front page on Monday, assuring its readers that "experts are accusing the government" of serving up "second class medicine" to ordinary Germans. Click on the title for the continuation of this story.

Someone in your house have the sniffles? Watch out for the refrigerator door handle. The TV remote, too.

2009-10-27T09:22:00.000-04:00

WASHINGTON - Someone in your house have the sniffles? Watch out for the refrigerator door handle. The TV remote, too. A new study finds that cold sufferers often leave their germs there, where they can live for two days or longer.

Scientists at the University of Virginia, long known for its virology research, tested surfaces in the homes of people with colds and reported the results Tuesday at a major conference on infectious diseases.

Doctors don't know how often people catch colds from touching germy surfaces as opposed to, say, shaking a sick person's hand, said Dr. Birgit Winther, an ear, nose and throat specialist who helped conduct the study.

Two years ago, she and other doctors showed that germs survived in hotel rooms a day after guests left, waiting to be picked up by the next person checking in.

For the new study, researchers started with 30 adults showing early symptoms of colds. Sixteen tested positive for rhinovirus, which causes about half of all colds. They were asked to name 10 places in their homes they had touched in the preceding 18 hours, and researchers used DNA tests to hunt for rhinovirus.
"We found that commonly touched areas like refrigerator doors and handles were positive about 40 per cent of the time" for cold germs, Winther said.

All three of the salt and pepper shakers they tested were contaminated. Other spots found to harbour the germ: six out of 18 doorknobs; eight of 14 refrigerator handles; three of 13 light switches; six of 10 remote controls; eight of 10 bathroom faucets; four of seven phones, and three of four dishwasher handles.

Next, the researchers deliberately contaminated surfaces with participants' mucus and then tested to see whether rhinovirus stuck to their fingers when they turned on lights, answered the phone or did other common tasks. More than half of the participants got the virus on their fingertips 48 hours after the mucus was smeared.

The study was sponsored by Reckitt-Benckiser Inc., makers of Lysol, but no products were tested in the research. The study, designed by doctors with no ties to the company, was an effort to lay the groundwork for future research on germs and ways to get rid of them.

In a separate study, the university's Drs. Diane Pappas and Owen Hendley went germ-hunting on toys in the offices of five pediatricians in Fairfax, Va., three times during last year's cold and flu season.

Tests showed fragments of cold viruses on 20 per cent of all toys tested - 20 per cent of those in the "sick child" waiting room, 17 per cent in the "well child" waiting room, and 30 per cent in a sack of toys that kids are allowed to choose from after being good for a shot.

"Mamas know this," Hendley said. "They say, `We go to a doctor for a well-child checkup, the kids play with the toys and two days later they have a cold.'"

There is no proof that the remnants themselves can infect, but their presence suggests a risk, said Dr. Paul Auwaerter, an infectious-diseases specialist at Johns Hopkins University. He was familiar with the study but had no role in it.

Doctors have long advised frequent hand-washing to avoid spreading germs. Wearing surgical masks and using hand sanitizers also can help, a novel University of Michigan study found.

About 1,000 students who live in dorms tested these measures for six weeks during the 2006-07 flu season. They were divided into three groups: those who wore masks, those who wore masks and used hand sanitizer, and those who did neither.

The two groups who used masks reported 10 per cent to 50 per cent fewer cold symptoms - cough, fever, chills - than the group who used no prevention measures.

Researchers note that the study was not "blinded" - everyone knew who was doing what, and mask wearers may have been less likely to report cold symptoms later because they believed they were taking steps to reduce that possibility.

The federal Centers for Disease Control and Prevention paid for the study.

The conference was a joint meeting of the American Society for Microbiology and the Infectious Diseases Society of America.

Electronic records have already provided one big change. eRecords in the US

2009-10-16T08:58:00.000-04:00

The debate over health care reform is proving to be a no-holds barred battle but, as New York Times' David Pogue reports, electronic records have already provided one big change.

Actor Dennis Quaid ("I'm not really a doctor. I don't even play one on TV!") is a believer that computerized health systems save lives.

In 2007, his newborn twins were victims of a terrible medical mistake.

"About a week after we brought them home from the hospital, they started to develop what turned out to be a staph infection," he said. "They were supposed to receive a 10-unit dose of heparin. And the nurse had the wrong bottle and gave them a 10,000 unit dose each of the drug. And they were in real danger of dying."

Watch thisCBS video.

Unlearning. A book by Dr. Alejandro R. Jadad

2009-10-13T12:21:00.000-04:00

Reposted from Monday, October 13, 2008

Dr. Alejandro R. Jadad writes:
"I just published my first non-medical book, entitled "Unlearning", which I am using to explore the impact of combining online publishing, social networking and the notion of "Freeconomics".

The book can be downloaded for free or purchased at:

http://www.lulu.com/content/4132419

I hope you enjoy it. Feel free to share it with anyone you think might find this interesting.

------------------------------------

Here is an excerpt:
------------------------------------
I still remember my maternal grandfather quoting
[Benjamin] Franklin’s words:

“For Life is a kind of Chess, in which we have often points
to gain, and competitors or adversaries to contend with, and in
which there is a vast variety of good and ill events, that are, in
some degree, the effects of prudence or the want of it.”

Many years later, when I was in my late teens and already
a medical student, my grandfather’s image and Franklin’s
words came to me suddenly, while I was playing as the
captain and goalkeeper of my university in-door soccer team.
I could see the entire field from under the goalposts and was
shouting instructions to my teammates. I suddenly felt like
the King on a Chessboard, being the target of the opposing
team, unable to move from my box and hoping that my
teammates would follow my commands. I also realized that, at
the same time, in my life outside the pitch, I was a
dispensable pawn at the hospital where I was training as an
intern, with little control over my future. It was my superiors,
not me, who would decide where and when I would work, and
what role I would play in the war against diseases. I replayed
the words from Franklin’s essay and realized that I could
easily replace the word Chess for game, making his
statements even more prescient:

“Life is a kind of game, in which we have points to gain,
and competitors or adversaries to contend with, in which there
is a variety of good and ill events, that are, in some degree, the
effects of prudence or the want of it”.

At that moment, feeling like a piece on a board, I started
to suspect that not just Chess, but all games in general, are
much more than enactments of life. They may be signaling to
us, constantly, that life itself is a game.

This thought set me on a path that proved to be much
more challenging and exciting than I could have ever
anticipated.

Perhaps, I wondered, by looking at the nature and
structure of games, I could gain valuable insights about my
own life and how to live it.

North West LHIN honoured with International Public Participation Award

2009-10-05T20:34:00.001-04:00

The North West Local Health Integration Network (LHIN) was honored Monday night with the Innovation Award by the International Association for Public Participation (IAP2) at the 17th annual conference in San Diego, California.

The North West LHIN’s project, Share Your Story, Shape Your Care, won this award for innovative practices to involve remote communities in strategic planning for health care delivery. Through the use of multiple public participation efforts and techniques that included significant use of web-based and social media, the North West LHIN gathered stories and ideas, and reached out to more than 800 participants over a huge geographic region in Ontario, Canada.

The Core Values Awards honour projects and organizations that represent the best practice internationally in the field of public participation in decision-making. The awards are evaluated against IAP2’s seven Core Values for public participation practice.”

Share Your Story, Shape Your Care demonstrated the effective use of web-based technologies and social media in a public participation process that aimed to involve and include patients, families, health providers, and the public. The information gathered through this initiative informed the North West LHIN’s 2010-2013 health services plan.

“Share your Story, Shape your Care” was not afraid to experiment with social media tools and new technologies for online dialogue—and it paid off. The project is now a model and source of inspiration for engaging people across a large geographical area creatively and effectively” said Sandy Heierbacher, Core Values Award judge and Director of the National Coalition for Dialogue and Deliberation (NCDD).

Core Values Awards competition are reviewed and evaluated by a judging panel composed of past Core Values Award winners, experienced public participation practitioners and academics in the field of public participation.

IAP2 is an international association of members who seek to promote and improve the practice of public participation in relation to individuals, governments, institutions, and other entities that affect the public interest in nations throughout the world. Currently, IAP2 has over 1,500 active members in 26 countries. The annual Core Values Awards competition coincides with IAP2’s international conference. More information about the International Association for Public Participation and the Core Values is available from the IAP2 website: www.iap2.org.

OUTSTANDING CONTRIBUTIONS TO PATIENT CARE RECOGNIZED

2009-10-05T20:05:00.000-04:00

NEWS RELEASE

October 5, 2009

Ministry of Health Services
BC Patient Safety and Quality Council

OUTSTANDING CONTRIBUTIONS TO PATIENT CARE RECOGNIZED

VICTORIA – Seven teams from each of B.C.’s health authorities and one individual from Vancouver received BC Patient Safety and Quality Council awards for advancing patient safety and quality of care, announced Health Services Minister Kevin Falcon.

“Kudos to all of the health professionals who treat thousands of patients every single day,” said Falcon. “These awards recognize the efforts of teams throughout the province ensuring that patients receive safe, high-quality care.”

Excellence in Quality and Patient Safety recipients:

· Surgical Safety Collaborative, Fraser Health

· Falls Prevention Teams, Interior Health

· Managing Obstetrical Risk Efficiently, Northern Health

· John Ruedy Immunodeficiency Clinic, Providence Health Care

· Transfer of Care for Cardiac Surgical Patients from Cardiac OR to Pediatric Intensive Care Unit, Provincial Health Services Authority

· BC IHC Quality Assurance Program for Breast Cancer Biomarker Assessment, Vancouver Coastal Health Authority

· Admission Medication Reconciliation Program, Vancouver Island Health Authority

Leadership in Quality and Patient Safety recipient:

· Dr. Julian Marsden

The 2009 BC Patient Quality and Safety Awards recognize the dedication of those in the health field who have managed to implement new best practices in patient safety and quality improvement in addition to the daily demands of their profession.

“By working together, we can improve patient outcomes,” said Dr. Marsden, recipient of the Leadership in Patient Quality and Safety award. “And, ultimately, create a community of health-care professionals spanning different disciplines and geographical areas.”

Sponsored by the BC Patient Safety and Quality Council, the awards support the council’s objective to support health authorities and other service delivery partners in their continuous effort to improve the safety and quality of care.

“The winners of the BC Patient Quality and Safety awards exemplify the best of the best” said Dr. Doug Cochrane, BC Patient Safety and Quality officer. “Through collaboration and innovation in the health-care profession, we continue to improve patient safety and maintain a high level of quality patient care.”

The council was created in 2008 to provide advice and make recommendations to the Minister of Health Services on matters related to patient safety and quality of care. By bringing health stakeholders together in a collaborative partnership, the council aims to promote best practices and inform a provincially co-ordinated patient safety and quality improvement framework.

Since 2001, the province has made many improvements to best practices in patient care, including expanding B.C.’s PharmaNet system to reduce medication errors and adverse events. In 2005, the Province announced $10 million to continue to strengthen patient safety in B.C., including the BC Patient Safety Task Force (now the BC Patient Safety and Quality Council), the Provincial Infection Control Network and the first academic chair in patient safety at the University of British Columbia. In 2007, government announced one-time funding of $2.3 million for a province-wide patient safety learning and reporting system.

Visit www.bcpsqc.ca for more information on the work of the BC Patient Safety and Quality Council.

-30-

BACKGROUNDER

EXCELLENCE AWARD RECIPIENTS

Fraser Health

Surgical Safety Collaborative

The Surgical Safety Collaborative, launched at the end of 2007, involves ten teams working in hospitals across Fraser Health. The collaborative completed an improvement charter which established a set of evidence-based interventions to reduce the likelihood of infection following surgery.

These included:

Providing antibiotics 60 minutes prior to surgical incision.
Discontinuing those antibiotics within 24 hours after surgery ends.
Clipping hair versus razor shaving.
Keeping patients “warm” – as close to 36º as possible.
Ensuring that the surgical team makes a final verification (surgical pause) of the correct procedure on the correct site and for the correct patient.

Over the course of 16 months, improvement was seen in all elements of the established interventions. Work to maintain the results and support a community of practice is ongoing.

Interior Health

Falls Prevention Teams – Brookhaven Care Centre & Penticton Regional Hospital

In 2008, Brookhaven Care Centre in West Kelowna participated in the Safer Healthcare Now! National Collaborative on Falls in Long-Term Care. Over a one-year period, the team reduced the use of restraints by 53 per cent without an increase in falls among residents. The fall risk screening tool they developed is currently being implemented as the first regional fall prevention strategy.

Penticton Regional Hospital has succeeded in developing a comprehensive, multidisciplinary fall prevention program. During the initial year of the 2007 pilot program there were 43 per cent fewer falls and a 57 per cent reduction in the number of residents identified as having a high risk of falling. In the past year, the team continues to focus on improving their program, including expansion to other units within the hospital.

Both falls prevention teams are sharing their successes and challenges throughout Interior Health through the Acute Care Fall Prevention Community of Practice which meets monthly via teleconference.

Northern Health

Managing Obstetrical Risk Efficiently (MORE^OB)

Launched in 2006, the MORE^OB program is a comprehensive patient safety, professional development and performance improvement program for obstetrical healthcare providers. Activities within the program include environmental scans, patient satisfaction surveys, staying current with new evidence and best practices, participating in workshops and skills drills.

The program has seen improved statistics on the number of labour inductions, mothers who received an epidural, use of intermittent auscultation (listening using a stethoscope), number of caesarean-section deliveries, and newborns with cord blood gases after delivery.

Providence Health Care

John Ruedy Immunodeficiency Clinic

In partnership with Vancouver Coastal Health and the UBC Skills Enhancement Program, the BC Centre for Excellence in HIV/AIDS developed a program to help physician’s access state-of-the-art HIV/AIDS medical education. The program is offered through the John Ruedy Immunodeficiency Clinic (IDC) at St. Paul’s Hospital. Through the adoption of a patient registry, the IDC has made significant improvements in screening and immunizations.

In 2005, the registry showed that only 30 per cent of patients were being screened and receiving immunization as recommended. As of December 2008 the following improvements were seen:

57 per cent increase in documented Syphillis Screening.
57 per cent increase in documented Pneumoccocal vaccination rates.
67 per cent increase in patients (female) with a documented Cervical Pap Smear.
55 per cent increase in documented chest x-rays.
61 per cent increase in patients with >200 CD4s with a documented TB Skin Test.

The interdisciplinary IDC team is committed to achieving a target of 95 per cent for all of these measures. This model of service delivery and clinical quality has served as a framework of innovation for others within Providence Health Care.

Provincial Health Services Authority

Transfer of Care for Cardiac Surgical Patients from Cardiac OR to Pediatric Intensive Care Unit, BC Children’s Hospital

The BC Children’s Hospital provides expert care for the province’s most seriously ill or injured children. Prior to this initiative, there were delays in transferring a patient from the operating room (OR) to the pediatric intensive care unit (PICU) as beds were not always ready. The following changes were developed to achieve safe and efficient patient handover:

Determination of best practice for post-operative transfer of care;
Identification and implementation of standardized processes;
Creation of support tools to assist staff in these standardized processes;
Elimination of redundancy; and
Clarification/definition of roles and responsibilities for all team members.

A plan for sharing these standards of care with other surgical teams has been developed.

Vancouver Coastal Health Authority

B.C. IHC Quality Assurance Program for Breast Cancer Biomarker Assessment

The B.C. Immunohistochemistry Testing (IHC) Quality Assurance Program, led by Dr. Blake Gilks, Dr. Robert Wolber and Mr. John Garratt, is the first program of its type and scope in the world. The program provides every hospital laboratory in the province with better outcomes of breast biopsy testing.

In the 1990’s microscopic testing of breast biopsies was developed called IHC testing. By the late 1990’s, the method for placing up to 500 tiny portions of different patient tumours (tissue microarrays) on a single microscopic test slide was developed.

Dr. Gilks immediately realized using tissue microarrays could provide the means of assuring good performance of IHC tests. Using frozen tissue biopsies, Dr. Gilks and his team were able to confirm how well the new IHC tests performed. From their own research and knowledge from the research of other organizations, the team initiated the Quality Assurance Program. A possible national program could ultimately benefit women across Canada.

Vancouver Island Health Authority

Admission Medication Reconciliation Program

Royal Jubilee and Victoria General Hospital are participating in a program during the patient admission process, which reconciles a patient’s home medications upon admission to the hospital for surgery. The medication reconciliation program has demonstrated a 96 per cent decrease in unintentional medication discrepancies.

Currently, a multi-disciplinary team has been formed to begin the process of implementing medication reconciliation at the Royal Jubilee Emergency Department to improve patient safety when transitioning patients to another facility or back into the community.

LEADERSHIP AWARD RECIPIENT

Dr. Julian Marsden

Dr. Marsden has been a member of the emergency department at St. Paul’s Hospital (SPH) since 1992. In 1994, he was appointed a clinical instructor in the UBC department of family practice, and was the emergency-family medicine residency program director from 1996-2006.

Dr. Marsden was integral in launching the provincial Evidence to Excellence (E2E) project, aiming to accelerate improvements in clinical and operational practices in emergency departments across the province. With colleagues at UBC and SPH, and funding provided by the Ministry of Health Services, he developed a plan for how to share knowledge and expertise across the province.

The expected benefits include:

· Increased capacity of the emergency department, reduction in physician’s time, and the ability of emergency departments to respond to changes in demand and other stresses.

· Ensure adherence to evidence-based practice despite disparate sites, and improvement in patient outcomes.

· Create a community of interdisciplinary emergency staff across B.C. who share knowledge and guidance that respects multiple sites.

· Improve access to care and quality of care through the implementation of cost-effective strategies.

· Create consistent performance indicators to determine implementation success.

· Provide evaluation reports of the implementation strategies and their effectiveness.

There are approximately 33 teams from 26 emergency departments across B.C. participating in the project.

As chair of E2E, he has been the driving force behind the project. He has embraced technology to connect clinicians and administrators across the province. He is a firm believer that rural sites should be enabled to tap into resources not currently available to them to improve the quality of care for their patients.

Dr. Marsden’s vision, passion and leadership have enabled him to link this broad community, the university and the ministry in such a successful partnership. He is leading the way in promoting the idea that emergency department staff do not work in a vacuum and need to work together to improve patient care.

-30-

Media contact:

Bernadette Murphy

Media Relations Manager

Ministry of Health Services

250 952-1887 (media line)

250 213-9590 (cell)

Influenza Prevention and Care (Ontario Government) Updated October 05, 2009

2009-10-05T19:40:00.000-04:00

E-mail Print Accessibility

This year it's a different flu season

Every fall there is some kind of flu going around. But this year it’s a different flu season. There will be seasonal flu and H1N1 flu. Ontario is prepared to protect people from both kinds of flu.

Vaccines

With two types of flu viruses circulating, it’s important to know when to schedule your shots.
A vaccine will be available for both seasonal flu and H1N1 flu. Vaccines will be delivered in a way that best protects everyone.
Be sure to talk to your health care provider about what’s best for you and your family.

Tips to stay healthy

There are things you can do every day to protect against the flu and to help prevent it from spreading. One of the most important is to wash your hands often and wash them thoroughly.

What to do if you have symptoms

The flu can be a serious illness for some. But most people recover by resting at home. If you think you have H1N1 flu or seasonal flu, try to stay home and get as much rest as you can. This will help you to get better and it prevents others from catching the flu.

For More Information

For information about seasonal flu, H1N1 and pandemic preparedness call ServiceOntario, Infoline at 1-866-532-3161 (Toll-free in Ontario only)
TTY 1-800-387-5559. In Toronto, TTY 416-327-4282
Hours of operation : 8:30am - 5:00pm
Telehealth Ontario at 1-866-797-0000
TTY: 1-866-797-0007
Hours of operation : 24 hours, 7 days a week
To find health care options in your community, visit ontario.ca/healthcareoptions or call 1-866-330-6206
If you don’t have a health care provider, you can register for the Health Care Connect program at ontario.ca/healthcareconnect or call: 1-800-445-1822

Download the brochure or order online from ServiceOntario

Ont. hospitals to use surgical checklist to improve patient safety starting next year

2009-10-04T21:59:00.000-04:00

By Maria Babbage (CP)
TORONTO — Ontario hospitals will be required to use a surgical safety checklist and report on their compliance starting next spring as part of a government effort to improve patient safety, The Canadian Press has learned.

Hospitals already report on eight indicators of patient safety, such as C. difficile rates and hand washing.
The new rules, to be announced Thursday, will require hospitals to report publicly twice a year on whether they're following the checklist, starting July 31, 2010. However, the first report is expected to include data about operations performed between April 1 and June 30.

The checklist includes 26 common tasks and items that surgeons and staff carry out to ensure patient safety in the province's operating rooms, such as checking equipment, confirming patient information and reviewing resuscitation plans. The checklist is divided into three sections: tasks that must be completed before the anesthesia, before the incision and before the patient leaves the operating room. It even requires surgeons, anesthesiologists and nurses to introduce themselves by name and role before the patient goes under the knife. The checklist will apply to all surgeries and hospitals will have to report on the number of surgeries in which the checklist's tasks were completed.

Government sources say the list, which was developed in consultation with experts and the Ontario Hospital Association, will make the province's patient safety reporting regime the most comprehensive in North America. They cite a study published in the New England Journal of Medicine in January that showed the implementation of surgical checklists helped reduce deaths and complications among patients. The announcement will mark the first anniversary of public reporting of C. difficile rates in Ontario, which have declined by 30 per cent since hospitals started reporting them.

The province extended mandatory reporting of the infection and other hospital-acquired infections in the wake of an outbreak that caused or contributed to dozens of deaths in Ontario hospitals in 2007 and 2008.
In 2007, the Ontario coroner's office determined that C. difficile caused or contributed to 18 deaths at a Sault Ste. Marie hospital and suggested hospital overcrowding and out-of-date facilities may have contributed to the outbreak. A Toronto-area hospital also battled more than a dozen cases that year that were positively identified as the same virulent strain that has claimed some 2,000 lives in Quebec since 2003.

In 2008, Joseph Brant Memorial Hospital in Burlington reported that C. difficile caused 62 patient deaths and 115 other infections between May 2006 and December 2007. C. difficile is one of the most common infections in hospitals and nursing homes. The bacterium, which is found in feces, causes diarrhea and more serious intestinal conditions such as colitis. Seniors and patients requiring prolonged use of antibiotics are at greater risk of infection, which can occur through physical contact after touching a contaminated surface.

Ont. hospitals to use surgical checklist to improve patient safety ...
The Canadian Press-
Surgical Checklist for Ontario Hospitals
580 CFRA Radio -
More coverage (1) »

Ontario's doctors support collaboration among health care professionals -- sort of

2009-09-30T18:37:00.002-04:00

TORONTO, Sept. 29 /CNW/ - At an appearance today before the Ontario Legislative Standing Committee on Social Policy, Ontario's doctors will stress the importance of health care professionals working together to enhance and strengthen the delivery of safe and quality care to patients. The Standing Committee is listening to oral submissions from stakeholders as the government moves ahead with proposed legislation that would expand the scope of practice of some health care providers.

"Ontario's doctors firmly believe that collaboration between health care professionals is the best way to strengthen and enhance the delivery of safe, high quality care to patients," said Dr. Suzanne Strasberg, President of the Ontario Medical Association (OMA). "We know that when physicians, nurse practitioners, pharmacists, dieticians and other health professionals work together we can and often do, deliver a more comprehensive level of care to our patients."

The OMA applauded several aspects of the proposed legislation including:

- Requiring all regulated health professionals to have professional
liability protection;
- Creating an independent expert drug committee that will streamline
regulatory processes, support colleges in developing their drug
lists while keeping pace with the changing health care landscape;
and
- Setting parameters for HPRAC to make recommendations regarding
changes to health professions statutes.

However, Dr. Mark MacLeod, President-Elect of the OMA will raise some concerns at the hearing about several proposals within the legislation. Specifically, with respect to pharmacists being granted the ability to 'adjust, adapt or extend' a prescription, Dr. MacLeod pointed out that this may create separate practice silos between a prescribing physician and a pharmacist and this type of fragmented treatment may diminish the quality of patient care.

Dr. MacLeod reiterated the OMAs long standing position that collaboration among health professionals results in a more comprehensive level of care being delivered to patients. The OMA strongly believes that if nurse practitioners are able to prescribe, dispense, sell, or compound drugs, then their prescribing power must be carefully regulated. More importantly, all drugs should be vetted and approved by the proposed independent expert drug committee rather than the College of Nurses of Ontario.

"The number one priority for Ontario's doctors throughout this entire process has been and remains patient safety because the level and quality of care that a doctor can provide should not be substituted for expediency," said Dr. MacLeod. "Ontario's doctors have offered constructive recommendations that we believe will protect patient safety by ensuring that all health care professionals maintain collaborative relationships with physicians."

Ontario government's lawsuit against the tobacco industry

2009-09-30T18:32:00.001-04:00

TORONTO, Sept. 29 /CNW/ - The Canadian Cancer Society is pleased the Ontario government is suing tobacco companies to recover tobacco-related health care costs.

"The lawsuit filed today will begin the process of holding the industry accountable for the harm they have done to the health of Ontarians," says Rowena Pinto, Senior Director, Public Affairs, Ontario Division, Canadian Cancer Society. "The tobacco industry's addictive products are responsible for 30% of cancer deaths."

Cost-recovery litigation could significantly benefit public health. In other jurisdictions, litigation has resulted in restrictions on the marketing practices of the tobacco industry.

Benefits of litigation:
- Justice: lawsuit against the tobacco industry will hold them accountable for their destructive behaviour.
- Truth: through the court process, tobacco industry documents will become public. Documents released through the court process, will shed light on the many deceptive and destructive practices pursued by the industry for decades. The public will finally understand that this is an industry that operates outside the rules of normal
business.
- Compensation: potentially billions of dollars could be recovered as compensation for health care and other costs.
- Health: the process of litigation could result in greater restrictions on tobacco industry marketing and sales practices. For example, more restrictions on tobacco advertising.

Background:
- 13,000 people die of tobacco related illness every year in Ontario.
- Tobacco use is responsible for 30% of cancer deaths.
- Tobacco-related health care costs currently total more than $1.6 billion per year in Ontario.
- British Columbia, Saskatchewan, Manitoba, New Brunswick, Newfoundland, and Nova Scotia have already passed similar legislation.
- British Columbia and New Brunswick have begun the process of suing the tobacco industry.

The Canadian Cancer Society is a national community-based organization of volunteers whose mission is the eradication of cancer and the improvement of the quality of life of people living with cancer. When you want to know more about cancer, visit our website www.cancer.ca or call our toll-free, bilingual Cancer Information Service at 1 888 939-3333.

For further information: Christine Koserski, Ontario Provincial Office, Canadian Cancer Society: (416) 323-7030, ckoserski@ontario.cancer.ca

In a pandemic more than twice as many hospital patients will require intensive care, with less than half the staff

2009-09-28T15:49:00.001-04:00

When the Hamilton Health Sciences (HHS) Pandemic Influenza Planning Committee contemplated how the triage process would be enacted at its hospitals, numerous gaps were identified:

How is critical care triage operationalized in different care settings within the hospital (e.g., emergency department, hospital wards, ICU)?
Who can function as a "triage officer"? What skills are required? If there is a single triage officer in each institution, what happens when these officers are needed in two places at once?
Should these life and death decisions, made under extremely stressful circumstances, rest on the shoulders of single individuals? What are the risks of this model for triage officers and healthcare organizations? What supports do triage officers require?
What procedural and institutional structures ensure triage decisions are of high quality, consistent (across time, triage officers and different hospitals), efficient, ethical and evidence-based? How should decisions be documented?
What happens if the demand for critical care is so great that it cannot be managed using the Ontario Health Plan for an Influenza Pandemic process? How should choices be made between patients with the same clinical priority for critical care (i.e., SOFA score)?

Hamilton Health Sciences is the first hospital in Canada to develop a detailed critical care triage protocol for bedside application. In this article, we present (1) the rationale and process HHS undertook to create this protocol, (2) highlights and key innovations of the protocol and (3) issues arising from preliminary testing of the protocol.

Copies of the paper can be downloaded at http://www.longwoods.com/home.php?cat=609