Health news from Metronews.ca

Anaesthesiologists warned against action

The Canadian Press — Thu, 29 Mar 2012 16:41:00 -0400

VICTORIA - The B.C. government is using a legal hammer against anesthesiologists who are threatening to withdraw services in a contract dispute with the province.

Lawyers for health authorities have filed an application for an interim injunction to prevent any service withdrawal, and have also filed a civil claim that could be used against any doctor found in breach of their contract.

Interior Health CEO Robert Halpenny, speaking on behalf of all health authorities, says the anesthesiologists have created maximum confusion for patients, surgeons and other medical staff by threatening to withdraw services.

He says lawyers have sent the anesthesiologists a letter advising them they're bound by contracts they have signed to provide patient care.

Halpenny says health authorities will do whatever they can to maintain patient services, but they are also preparing for a withdrawal, sending letters to 3,237 patients warning that their surgeries might have to be rescheduled.

There will be no postonements for patients needing emergency or urgent surgery.

More cases of salmon virus in Nova Scotia

The Canadian Press — Thu, 29 Mar 2012 12:21:00 -0400

HALIFAX - The Canadian Food Inspection Agency says it could take months before a Nova Scotia fish farm at the centre of a salmon virus outbreak is removed from quarantine.

The federal agency says on its website that it has confirmed additional cases of infectious salmon anemia at a commercial aquaculture operation in the province.

It does not name the facility, but New Brunswick-based Cooke Aquaculture has said the virus was discovered at the company's operation in Shelburne Harbour.

Cooke Aquaculture first detected the virus during routine testing in February.

The agency says the facility will remain under quarantine until all fish have been taken from the site and all pens, cages and equipment have been disinfected.

The virus poses no threat to human health or food safety, but it can kill up to 90 per cent of the salmon it infects, depending on the strain.

Infectious salmon anemia first appeared at fish farms in Norway almost two decades ago, then in New Brunswick and later Scotland.

In the late 1990s, New Brunswick salmon farmers slaughtered more than a million fish amid an outbreak. The federal government paid out tens of millions of dollars to settle compensation claims.

The virus was discovered in farmed Nova Scotia salmon as early as 1999, but in much smaller numbers.

In age of gadgets, doctors try to keep human touch

Lauran Neergaard, The Associated Press — Thu, 29 Mar 2012 10:35:00 -0400

WASHINGTON - As the United States moves to paperless medicine, doctors are grappling with an awkward challenge: How do they tap the promise of computers, smartphones and iPads in the exam room without losing the human connection with their patients? Are the gadgets a boon or a distraction?

"That's the tension I feel every day," says Dr. Vincent WinklerPrins, a family medicine specialist at Georgetown University. The medical school is developing one of a growing number of programs to train new doctors in that balancing act, this one using actors as patients to point out the problems ahead of time.

Across the country at Stanford University this summer, medical students will bring a school-issued iPad along as they begin their bedside training — amid cautions not to get so lost in all the on-screen information that they pay too little attention to the patient.

Face your patient, excuse yourself to check the screen and put away the gadget when you don't really need it, say Stanford guidelines that specialists say make sense for physicians everywhere. And, of course, no personal Internet use in front of a patient.

"The promise of these devices to augment the delivery of clinical care is tremendous," says Stanford's Dr. Clarence Braddock. He uses a secure app on his iPad to pull up patient charts if he's called after hours, no matter where he is.

Braddock helped develop Stanford's standards understanding there are different hurdles. Middle-aged doctors may be less comfortable with the technology and take longer with it. Younger ones who grew up texting while multitasking may not realize how intrusive patients might find the devices. Even Braddock has a confession: To his embarrassment, his phone once beeped an email alert about a sports tournament while he was with a patient.

It's not just a matter of etiquette. If the doctor spends too much of your 15-minute visit typing or staring at a screen, you have to wonder: What if I have a symptom that just got missed?

"If the screen is turned away from the patient, they don't know if you're looking at their electronic health record or playing solitaire or looking up stocks," notes Dr. Glen Stream of the American Academy of Family Physicians. A longtime user of computerized records, Stream makes sure to show his patients what he's doing — especially when seeing pictures on the screen can help them better understand a health condition.

Electronic health records, or EHRs, are considered the future of health care for good reason — they can help prevent medical errors. For example, the systems can warn if doctors are about to prescribe a drug that could interact badly with another one the patient already uses. As these computerized charts become more sophisticated, they also have the potential to spur more efficient care: no more getting another X-ray just because you forgot to bring in your last scan if the doctor can call it up digitally.

About a third of doctors report using electronic records, double the number since 2008, says a report this month in the journal Health Affairs.

Georgetown's WinklerPrins limits screen time in front of his own patients by typing notes into their charts after they leave.

A group of actors gathered at Georgetown one recent morning, each there to play the role of an older diabetic seeking care for the first time since a spouse's death. WinklerPrins watched on a monitor outside the room as medical students conducted a 15-minute office visit. They used computerized records while giving each actor-patient test results, setting a treatment plan and sending an electronic prescription to the pharmacy.

Afterward, the "patients" offered valuable feedback. One was irritated that her would-be doctor got stuck e-prescribing and, her mind on the computer, kept repeating the same question rather than saying, "Give me a minute."

The students see the value of electronic health records but also how easy it is to be distracted.

Hopefully, the systems will get less clunky, WinklerPrins said: "We don't lose, in the meantime, the focus on the patient."

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EDITOR'S NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.

Spring into the coming season with a few treats for your visage

Janine Falcon, The Kit.ca — Wed, 28 Mar 2012 20:38:57 -0400

Point Taken

You’re only as precise as your tools. Sephora Pencil Sharpeners have a swing-out well to keep shavings neatly out of your kit. $6, sephora.com. Tweezerman Tweezers are pro favourites for getting at the tiniest strays. $30, sephora.com/canada.

Eye Opener

Replace that old, loose lash curler you’ve had forever.

The Sephora Lash Curler comes in peppy metallic colours and gives a really good curve with its silicone pad. $19.

Or try the Dior Heated Lash Wand instead. $31, both at Sephora.

It’s a Wash

Making up should always be good clean fun. Occasionally spritz Beauty So Clean Cosmetic Sanitizer Mist directly onto powder shadows, blushes and foundation to blitz bacteria build-up — it won’t hurt the finish. $13, at drugstores and beautysoclean.com.

Clinique Makeup Brush Cleanser is handy when you don’t have time for a thorough wash session. $17, clinique.ca.

Quo Toe Separators aren’t just for your toes — they’re also for brushes after you wash them. $3.29, Shoppers Drug Mart.

Get all the latest beauty know-how at the kit interactive magazine, at thekit.ca

Health minister faces Ornge committee

Romina Maurino, The Canadian Press — Wed, 28 Mar 2012 19:28:00 -0400

TORONTO - Ontario's embattled health minister told a special committee Wednesday she was "handcuffed" by rules that prevented her from acting sooner to stop the waste of taxpayer dollars at Ornge.

Deb Matthews and her deputy minister, Saad Rafi, came under heavy opposition fire during the committee into the government's handling of the troubled air ambulance service.

Both Progressive Conservatives and New Democrats questioned how the government could have taken months to act, given the clear problems discovered by the auditor general in a draft report handed to the ministry last fall.

Matthews argued Wednesday that because Ornge was a federally registered charity, she didn't have the authority to intervene, nor could she act in the face of the previous performance agreement with Ornge.

"I was really handcuffed, I could not take the kind of action that I think the public expected me to be able to take," Matthews said.

Matthews was at a loss, however, to explain how exactly she managed to get Ornge's board to resign just a few months later, and attributed the board's decision to voluntarily step aside to "significant pressure" from the media, the auditor and herself.

"I made it very, very clear that it was time for them to start co-operating with the auditor general and with the ministry staff," she said.

"I think they knew that the minute they released that compensation information the house of cards would fall, and that's exactly what happened."

Rafi also defended Matthews for failing to act immediately after the auditor general briefed ministry officials on a draft of his damning report during the election.

"It was my judgment ... not knowing the outcome (of the election), that this was not something to share," Rafi told the committee.

"There's a heightened sense of confidentiality during the writ period, particularly for audit documents."

Matthews said she became aware of the issues at Ornge after the election, and acted as promptly as she could given that she never saw a draft report until after she was re-appointed as health minister.

She had previously said the ministry received the report last September, but because she was campaigning for the Oct. 6 election it would have been "completely inappropriate" to pass it on to her. And Matthews said she didn't see the report until December, when the auditor complained he was being stonewalled by Ornge.

His scathing report, released this month, found the government gave Ornge $700 million over five years with virtually no oversight of how the money was spent.

Despite numerous red flags, the government failed to monitor the agency as it used the money to make "questionable'' business deals, the auditor said.

The opposition has been calling for Matthews' resignation for weeks, and both parties said Wednesday they were disappointed with the lack of real information to come out of the hearings.

"I've heard about five different things in the course of this hearing as to why the minister couldn't intervene and frankly, none of them hold water," Progressive Conservative Frank Klees said afterwards.

"There was a great deal of authority in the original performance agreement that allowed the Ministry of Health to oversee, to hold accountable, and as the ministry eventually admitted, they could simply stop funding if there was not a willingness to co-operate on the part of Ornge executives.

"I can tell you, they would have had their attention very quickly."

New Democrat France Gelinas said she didn't feel the government was being completely forthcoming.

"There's big holes in the story. It's completely out of character with the way the Ministry of Health usually functions," Gelinas said.

"There were some bigger pressures at place in this issue and they're not telling us what it was."

Ornge is currently under a police probe and subject to new legislation the Liberals say will bring more oversight to the agency.

Report: US cancer rates continue to fall

Mike Stobbe, The Associated Press — Wed, 28 Mar 2012 16:34:00 -0400

ATLANTA - Cancer rates in the U.S. continue to fall, according to a report released Wednesday.

The rate of new cancer cases has been inching down at a rate of about half a per cent each year since 1999. And the overall cancer death rate has dropped by 1.5 per cent annually in adults and 1.7 per cent in children.

"This is good news," said Dr. Marcus Plescia of the Centers for Disease Control and Prevention, one of four organizations that worked on the report. "There has been positive momentum for several years now and that continues."

The figures come from a report issued annually since 1998 by a group of government agencies and other organizations, including the CDC and the American Cancer Society. The new report includes nearly every cancer case reported in the United States through 2008.

Health officials say cancer rates have been going down thanks to better screening, treatment advances, and efforts to prevent some cancers by reducing smoking and other unhealthy behaviours.

One pay-off from anti-smoking efforts: In 2008, for the second consecutive year, lung cancer death rates declined for women. Lung cancer death rates for men have been falling since the 1990s.

Prostate cancer death rates continued to fall, and colon cancer death rates for men and women continued to drop. Rates of new cases of those diseases fell, too.

The breast cancer death rate also continues to decline, but the rate of new breast cancer cases — which was falling in the years 1999 through 2004 — has levelled off since then. Health officials believe that's partly related to a plateau in breast cancer screening rates.

While there's a lot of good news in the report, the authors noted some looming concerns. One is increases in skin cancer cases and deaths, which experts believe are being boosted by the use of tanning beds. "I think this is a future epidemic in the making," said Plescia, director of the CDC's Division of Cancer Prevention and Control.

The authors also cited the nation's weight problem. Two out of every three adults is overweight or obese, and that seems to be contributing to rising case rates for cancers of the esophagus, uterus, pancreas and kidney. Excess weight triggers production of insulin and certain hormones that can play a role in cancer growth, experts say.

"For people who do not smoke, excess weight and lack of sufficient physical activity may be among the most important risk factors for cancer," John Seffrin, the Cancer Society's chief executive officer, said in a statement.

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Online:

Report: http://wileyonlinelibrary.com/journal/cancer-report2012

Efforts made to find missing hard drives: minister

The Canadian Press — Wed, 28 Mar 2012 16:31:00 -0400

REGINA - Health Minister Don McMorris says efforts are being made to track down eHealth Saskatchewan computers that were mistakenly given away.

The agency which oversees electronic health records said Tuesday that 44 computers meant for recycling or reuse were picked up by a refurbishing company before the hard drives had been removed and destroyed.

McMorris says it was human error.

He says 37 of the hard drives have since been located.

He also says the head of eHealth Saskatchewan has indicated she's pretty confident that the risk of personal information being released is minimal.

CEO Susan Antosh has said the computers were used for IT support and testing.

Alberta Liberals would make sure doctor is in

The Canadian Press — Wed, 28 Mar 2012 16:11:00 -0400

RED DEER, Alta. - The Alberta Liberals say they have a plan to make sure the doctor is always in — no matter where people live.

Leader Raj Sherman says a Liberal government would put up $100 million to help train more doctors as general practitioners to work in small towns.

Sherman, an emergency room doctor, says incentives are the way to go.

Campaigning in Red Deer for the April 23 election, he noted it can take a decade to become a doctor, and medical students put down roots in larger centres during that time.

He said small communities are being forced to offer doctors huge financial incentives to come and work.

Otherwise some communities wouldn't have health care within 100 kilometres, which, Sherman said, amounts to no health care at all.

Health Canada warns about use of mothballs

The Canadian Press — Wed, 28 Mar 2012 13:43:00 -0400

TORONTO - Health Canada is introducing new labelling requirements for mothballs, a move aimed at reducing the risk the products pose.

The department says it has been re-evaluating naphthalene, an active ingredient in mothballs and moth flakes used to control moths and larvae that eat clothes.

The labelling changes will include a reduction in the maximum application rate and directions to store the products well sealed and out of the reach of children and pets.

The new labelling will also instruct consumers to use mothballs and moth flakes in well-ventilated areas and in indoor settings only.

The department says the new packaging should be aimed at discouraging children from accidentally eating loose mothballs and to minimize the escape of vapours while the product is being stored.

Exposure to naphthalene vapours can cause headaches, nausea, dizziness and vomiting, and ingestion of mothballs or over-exposure to mothball-treated fabrics can lead to hemolytic anemia, the abnormal breakdown of red blood cells.

Some hide memory lapses due to fear of stigma

Sheryl Ubelacker, The Canadian Press — Tue, 27 Mar 2012 21:50:00 -0400

TORONTO - Cynthia first noticed she was having trouble with her memory a couple of years ago while reading books, one of her favourite pastimes. From one day to the next, she found herself unable to recall the plot, the main characters or the setting.

At work, she would discover she was repeating comments and asking questions she'd already had answered.

"If I was having a conversation with somebody — and it was pretty detailed, pretty long — all of a sudden I'd jump in with something I'd already said. And the person would look at me strangely," said the Toronto-area woman, who asked that her real name not be used.

Cynthia, in her late 50s, has been diagnosed with mild cognitive impairment (MCI), a condition that falls between the mental decline that's normal with aging and the far more debilitating diagnosis of progressive dementias like Alzheimer's disease.

Many people experiencing the symptoms of mild cognitive impairment, including lapses in memory and sometimes difficulty with everyday tasks, often make great efforts to hide their condition from family, friends and co-workers, worried about the stigma surrounding people with dementia.

"During a meeting, I would repeat myself, so I've taken to writing notes like crazy during meetings," said Cynthia, who has kept her diagnosis from most of her family members.

"Nobody (at work) knows. And I'm not telling them ... I don't want them to say things like, 'Why don't you just retire?' Or I don't want them to think that because I have mild cognitive impairment, I can't do my job.

"My career is really, really important to me."

Dr. Kelly Murphy, a clinical neuropsychologist at Toronto's Baycrest Centre for Geriatric Care who works with MCI patients, said many people don't want others to know what they're trying to cope with.

"They don't want others to attach a greater significance to slips that (most people) make from time to time," she said. "They don't want to be seen as less capable. And if they make a slip, they may be even more self-conscious ... when they're with people who might think. 'Oh, that's because you have mild cognitive impairment and maybe it's getting worse.'"

Murphy said people with MCI typically are trying to hold on to the perception they have of themselves as vital, capable people — despite their impairment.

"They've got a wealth of other cognitive abilities. They're still just as intelligent as they've always been, they can still solve problems. So they can use those other skills to continue to function very well."

Murphy said some people with MCI can make the mistake of isolating themselves because of embarrassment about their memory deficits and the stigma associated with dementia. But she said that is the worst thing a person with the condition can do.

Research has shown that continuing to work, volunteering and engaging in such leisure activities as playing bridge or just plain socializing can be protective of the brain and often slow cognitive decline.

And while some people with MCI will go on to develop Alzheimer's or another dementia, others will not and some may even improve.

That's why it's critical for anyone experiencing worrisome and possibly worsening memory problems to seek a diagnosis from their doctor, said Dr. Tiffany Chow, a behavioural neurologist at Baycrest.

While MCI can be a forerunner of Alzheimer's disease, for others their cognitive problems could be due to a vitamin deficiency, untreated depression or an underlying vascular condition that affects the health of brain cells.

Chow said some people's reaction to having memory lapses and putting off getting a diagnosis is akin to how some people deal with fears they might have cancer.

"There are some people that know something's wrong and they're worried that it's cancer," she said. "So they don't go to the doctor and it gets worse and harder to treat the longer you wait. So that avoidant behaviour becomes your downfall.

"And there is a similar thing here with the concept of mild cognitive impairment. There are a lot of people who like to joke with each other, 'Oh, I must have had a senior's moment,' or 'Ha, ha, you didn't remember to meet me at a certain time, you must be getting Alzheimer's disease.'

"But that joking is our present-day culture's way of trying to reconcile the fact that we're all worried, that the quality of our aging will be hampered by something scary called Alzheimer's disease."

Chow said while there is still much for clinicians to learn about mild cognitive impairment, research suggests there are simple steps that can help slow the progression of memory loss.

"The absolute gospel truth is our science has revealed that all those things your mother told you apply," she said.

That means a healthy diet high in fish, omega-3 fatty acids and leafy green vegetables, as well as regular exercise — plus looking after one's psychosocial health.

"The details of that are to become integrated with your supportive community, whether that's your immediate family or people outside of your home or colleagues. The less isolated you are, the less isolated you feel, the lower your risk of getting Alzheimer's disease," Chow said.

"These kinds of things can have a fairly powerful effect in terms of conversion to Alzheimer's disease."