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At least 775 records · Page 43Linked to original sources
PubMed2000

Litigation in Canada against anesthesiologists practicing regional anesthesia. A review of closed claims.

PURPOSE: To review the pattern of malpractice litigation related to regional anesthesia in Canada. SOURCE: The Canadian Medical Protective Association (CMPA) provided with information about all anesthesia claims that closed in the years 1990-1997. PRINCIPAL FINDINGS: In the period 1990-97 there were 7,909 closed legal actions involving all CMPA members (56,000). Of these, there were 310 cases involving anesthesiologists, of which 61 cases (approximately 20%) were related to regional anesthesia. Forty-two involved neuraxial blocks, and the legal outcome was favourable (dismissed or judgement in favour of the defendant doctor) in 37 claims. Nineteen claims involved peripheral nerve blocks. All these had favourable legal outcomes. Overall, 10% of regional anesthesia claims have unfavourable outcomes, compared with 28% of all anesthesia related claims and 30% of all CMPA members' claims. The degree of disability in the regional anesthesia claims were: none 10%; minor 49%; major 36%; catastrophic 5%. There were no deaths in the malpractice claims involving regional anesthesia, compared with 17% in the all anesthesia group and 11% in all members' claims. CONCLUSION: Twenty percent of all anesthesia claims in Canada are related to regional anesthesia. The legal outcome of these claims is favourable in 90%. Unfavourable clinical outcome is associated with catastrophic or major injury. There were no deaths in the regional anesthesia claims.

Anesthesia, Conduction↗
PubMed2006

Organ utilization among deceased donors in Canada, 1993-2002.

BACKGROUND: Optimizing organ utilization from consented donors is a critical need, given a static organ donation rate. We report changes in the characteristics of donors and organ utilization patterns in Canada over a ten-year period. METHODS: For the decade spanning the years 1993-2002, data were extracted from the Canadian Organ Replacement Register (CORR), the national transplant registry. A donor was defined as a deceased person from whom at least one vital organ was retrieved and transplanted. RESULTS: The donor pool is aging (median age of donors increased eight years over the decade), with proportionately fewer donors dying from head trauma (motor vehicle collisions) and proportionately more from cerebrovascular accidents. At least four organs were utilized from approximately half the donors. These donors were significantly younger every year over the sampling period when compared with donors where < or = three organs were utilized. In 2002, utilization rates were: 87.0% (kidneys), 85.0% (livers), 42.2% (hearts), 30.6% (pancreata), 28.3% (lungs), and < or = 1% (intestines). There was increased utilization of donor pancreata, lungs and liver over the decade, but a flat utilization pattern for hearts, and a small decline in kidney utilization. Utilization rates vary from province to province. CONCLUSIONS: Trends in the Canadian organ donor pool are characterized by an increasing age and a shift towards cerebrovascular diseases as primary causes of death. In order to improve organ utilization and understand regional variability, the scope of data provided to the national registry requires enhanced detail to address the factors that lead to non-utilization. Addressing the low utilization rates for hearts and lungs is especially critical, given the need for thoracic transplantation in Canada.

Adult↗
PubMed2001

Economic implications of hip fracture: health service use, institutional care and cost in Canada.

As the burden of illness associated with hip fracture extends beyond the initial hospitalization, a longitudinal 1 year cohort study was used to analyze levels of health service use, institutional care and their associated costs, and to examine patient and residency factors contributing to overall 1 year cost. Patients in the study were aged 50 year and over, and had been admitted to an acute care facility for hip fracture in the Hamilton-Wentworth region of Canada from 1 April 1995 to 31 March 1996. Health care resources assessed included initial hospitalization, rehospitalization, rehabilitation, chronic care, home care, long-term care (LTC) and informal care. Regression analysis was used to determine the effects of age, gender, residence, survival and days of follow-up on 1 year cost. The mean 1 year cost of hip fracture for the 504 study patients was 26,527 Canadian dollars (95% Cl: $24,564-$28,490). One year costs were significantly different for patients who returned to the community ($21,385), versus those who were transferred to ($44,156), or readmitted to LTC facilities ($33,729) (p < 0.001). Initial hospitalization represented 58% of 1 year cost for community-dwelling patients, compared with 27% for LTC residents. Only 59.4% of community-dwelling patients resided in the community 1 year following hip fracture, and 5.6% of patients who survived their first fracture experienced a subsequent hip fracture. Linear regression indicated place of residence, age and survival were all important contributors to 1 year cost (p < 0.001). While the average 1 year cost of care was $26,527, the overall cost varied depending on a patient's place of residence, age, and survival to 1 year. Annual economic implications of hip fracture in Canada are $650 million and are expected to rise to $2.4 billion by 2041.

Aged↗
PubMed1999

Elevated lead exposure in American woodcock (Scolopax minor) in Eastern Canada.

We investigated the degree and incidence of elevated lead (Pb) accumulation in the American woodcock (Scolopax minor) in eastern Canada by measuring the concentration of Pb in undamaged wing bones of 1,588 birds from Ontario, Quebec, Nova Scotia, and New Brunswick. Overall median bone-Pb concentrations were 21 microgram/g (DW) for adults and 11 microgram/g for young of the year. A high proportion of birds had elevated Pb concentrations, compared with other wild bird species. Fifty-two percent of adults and 29% of young of the year had bone concentrations exceeding 20 microgram/g. Pb concentration varied significantly with age, gender, and geographical region (p </= 0.0001). Mean Pb concentrations were lower for young of the year than for adults and lower for males than for females in both age groups. Atlantic Canada (New Brunswick and Nova Scotia) tended to have the highest frequency of individuals with elevated Pb accumulation. Potential sources of Pb exposure in woodcock include ingestion of spent lead shot from hunting, ingestion of Pb-contaminated soil, and/or ingestion of Pb-contaminated earthworms.

Aging↗
PubMed2003

Mortality, morbidity, and costs of ruptured and elective abdominal aortic aneurysm repairs in Nova Scotia, Canada.

Ruptured abdominal aortic aneurysms (RAAA) have a 78-94% mortality rate. If cost-effectiveness of screening programs for abdominal aortic aneurysms (AAA) are to be assessed, direct costs for RAAA repairs and elective AAA (EAAA) repairs are required. This study reports mortality, morbidity, and direct costs for RAAA and EAAA repairs in Nova Scotia in 1997-1998 and also compares Nova Scotia and U.S. costs. We performed a retrospective study of 41 consecutive RAAA and 48 randomly selected EAAA patients. Average total costs for RAAA repair were significantly greater than those for EAAA repair (direct costs: $15,854 vs. $9673; direct plus overhead costs: $18,899 vs. $12,324 [pricing in 1998 Canadian dollars]). Intensive care unit length of stay and blood product usage were the most substantial direct cost differentials ($3593 and $2106). Direct cost for preoperative testing and surveillance was greater in the EAAA group ($839 vs. $33). Estimates of U.S. in-hospital RAAA and EAAA repair costs are more than 1.5 times Nova Scotia costs. Direct in-hospital RAAA repair costs are $6181 more than EAAA repair costs. These in-hospital cost data are key cost elements required to assess the cost-effectiveness of various screening strategies for earlier detection and monitoring of AAA within high-risk populations in Canada. Further studies are required to estimate cost per quality-adjusted-life-year gained for various AAA screening and monitoring strategies in Canada.

Aged↗
PubMed2006

Examination of the trend in Canada toward geographic centralization of aneurysm surgery during the endovascular era.

Unlike in the United States, endovascular aneurysm repair (EVAR) has not been widely disseminated in Canada but has remained limited to large-volume vascular surgery units. Since the development of the endovascular program at our hospital, we have experienced a growth in our aneurysm practice and the area of referral. The purpose of this study was to compare the geographic referral area of our aneurysm practice between 1997 (prior to the introduction of EVAR) and 2003 (EVAR and open surgery). Our prospective database was reviewed to identify patients who underwent elective open aneurysm repair in 1997 and 2003 and those who underwent EVAR in 2003. Each patient's county of residence was identified, allowing for grouping of patients into one of four geographic regions (I-IV) increasingly more distant from our hospital. Proportions were compared with the chi(2) test. In 1997, 105 patients underwent open abdominal aortic aneurysm repair, with the majority of patients originating from the two regions in closest proximity to our hospital (I, 34%; II, 46%; III, 18%; IV, 2%). This contrasts with the 2003 EVAR group (n = 63), which had a higher proportion of patients referred from greater distances (I, 13%; II, 27%; III, 27%; IV, 33%) (p < 0.001). The 2003 open group (n = 165) did not differ statistically with respect to region of origin (I, 18%; II, 41%; III, 21%; IV, 19%) compared to their 2003 EVAR counterparts (p = 0.075) but did have a higher proportion of patients from the more distant regions compared to the 1997 open group (p < 0.001). During the last 5 years, we have experienced a doubling of our elective aneurysm case volumes as well as a trend for patients to be referred from greater distances for both EVAR and open repair. This suggests a trend in Canada toward increased centralization of aneurysm care in centers providing both endovascular and open surgical alternatives.

Aortic Aneurysm, Abdominal↗
PubMedDate not supplied

Cost effectiveness of Elidel in the management of patients with atopic dermatitis in Canada.

BACKGROUND: With increasing pressure on health care resources, it is necessary to demonstrate that new treatments are both effective and cost effective. OBJECTIVE: The purpose of this study was to assess the cost effectiveness of pimecrolimus (Elidel) compared to usual therapy in the treatment of both adults and children with atopic eczema in Canada. METHODS: Analysis was performed using a decision model which estimated the incremental cost per quality adjusted life year (QALY) gained from both a societal and health care perspective. RESULTS: For children, Elidel leads an incremental cost per QALY of 38,000 dollars from a societal perspective. For adults, the incremental cost per QALY was 35,000 dollars. CONCLUSION: Elidel will lead to an overall increase in costs but with an improvement in clinical outcomes. The cost effectiveness ratios for Elidel were consistently below 50,000 dollars per QALY gained. Given previous funding decisions in Canada, Elidel may be considered a cost-effective use of health care resources.

Adolescent↗
PubMed2006

Supply of human allograft tissue in Canada.

There is relatively little known about the supply for allograft tissues in Canada. The major aim of this study is to quantify the current or "Known Supply" of human allograft tissue (bone, tendons, soft tissue, cardiovascular, ocular and skin) from known tissue banks in Canada, to estimate the "Unknown Supply" of human allograft tissue available to Canadian users from other sources, and to investigate the nature and source of these tissue products. Two surveys were developed; one for tissue banks processing one or more tissue types and the other specific to eye banks. Thirty nine sites were initially identified as potential tissue bank respondent sites. Of the 39 sites, 29 sites indicated that they were interested in participating or would consider completing the survey. A survey package and a self-addressed courier envelope were couriered to each of 29 sites. A three week response time was indicated. The project consultants conducted telephone and email follow-up for incomplete data. Unknown supply was estimated by 5 methods. Twenty-eight of 29 sites (97%) completed and returned surveys. Over the past year, respondents reported a total of 5,691 donors (1,550 living and 4,141 cadaveric donors). Including cancellous ground bone, there were 10,729 tissue products produced by the respondent banks. Of these, 71% were produced by accredited banks and 32% were ocular tissues. Total predicted shortfall of allograft tissues was 31,860-66,481 grafts. Through estimating Current supply, and compiling additional qualitative information, this study has provided a snapshot of the current Canadian supply and shortfall of allograft tissue grafts.

Calcification, Physiologic↗
PubMed2006

Assessment of the potential of the rock gunnel (Pholis gunnellus) along the Atlantic coast of Canada as a species for monitoring the reproductive impacts of contaminant exposures.

Evaluating the impacts of point source discharges on fish species in estuarine environments can be challenging because of a paucity of resident species. We evaluated the biology of rock gunnel (Pholis gunnellus) at three relatively uncontaminated sites in the Bay of Fundy, along the Atlantic coast of Canada. Rock gunnel are seasonally resident (April to November) in tide pools, but little was known about their life history in Atlantic Canada or their potential for use for monitoring environmental quality. Fish were collected between April and November, and ranged from 2.46 g-15.2g in weight and 97 mm-170 mm in length, with a maximum age of 7 years. Both males and females were similar in size, and both reached sexual maturity at a size of 5.5 g. Organ weights and condition indices of fish were stable from spring when they returned from offshore (April to May) until late summer (August to September), but fall fish (October to November) had slightly larger gonads, livers and condition indices. Rock gunnel may be a useful indicator to provide insight into local impacts of point sources over a short time period. However, they do not provide adequate information on reproductive development and performance since they are not exposed to onshore contaminants during the periods of gonadal development that have most commonly found to be sensitive to anthropogenic stressors.

Animals↗
PubMed2007

The sero-prevalence of antibodies to trypanosoma cruzi in Latin American refugees and immigrants to Canada.

BACKGROUND: Chagas' disease is caused by infection with the protozoan agent Trypanosoma cruzi. An estimated sixteen to eighteen million people are infected in Latin America. Outside of endemic regions, Chagas' disease may be transmitted through the transfusion of infected blood components, congenital infection and organ transplantation. We sought to determine the sero-prevalence of antibodies to T. cruzi in a community sample of Latin American refugees and immigrants to Canada. METHODS: This was a sero-prevalence study in Latin American refugees and immigrants living in Canada. Eligible subjects were born in South America, Central America or in Mexico. Participants were recruited from a variety of community settings, as well as from medical clinics. Serum was tested by enzyme-linked immunoassay for antibodies to T. cruzi. RESULTS: A total of 102 participants were enrolled. One sample tested positive for antibodies for T. cruzi. The seroprevalence in our sample was 1.0% (95% CI: 0.2%- 5.3%). INTERPRETATION: We found a low sero-prevalence of Chagas' disease in a community sample of Latin American immigrants and refugees. Physicians who treat Latin American immigrants should consider the risk profile and clinical status of the individual in their decision to screen for Chagas' disease.

Adolescent↗
PubMed2005

Isolation and metabolite production by Penicillium roqueforti, P. paneum and P. crustosum isolated in Canada.

Penicillium roqueforti, P. crustosum and P. paneum grow on ensiled grain and recycled feed unless properly treated. The former two species occur also on cut lumber in Canada. These are known to produce a number of secondary metabolites including roquefortine. In cooler dairy production areas, including Scandinavia and North America, cattle toxicosis has been associated with silage contaminated by these fungi. We collected strains associated with cow or cattle toxicoses. The principal metabolites were determined making use of a new extraction method and analysis combining HPLC, LC/MS/MS, and LC/NMR. Penicillium roqueforti and P. crustosum required amino acid nitrogen for metabolite formation and their toxins were formed under conditions of low oxygen (20-30% saturation). Production of roquefortine C occurred on depletion of the available nitrogen and penitrem A on depletion of carbon source. Yield was reduced by excess carbon. Medium osmotic tension (aw) affected metabolite production by the two species differently. Penicillium paneum was associated with ill-thrift of dairy cows and P. roqueforti was associated with more serious symptoms. Our data suggest a physiological basis for the common occurrence of roquefortine C in silage without serious consequences and the alternative, the presence of roquefortine C and toxicoses. The strain isolated from lumber was the best producer of the toxins studied. This is the first report of the toxigenic potential of P. roqueforti and P. paneum from Canada.

Animals↗
PubMed2006

Photosynthesis research in Canada from 1945 to the early 1970s.

This history traces the development of photosynthesis research in Canada from 1945 to 1975, starting with the work of Gleb(1) Krotkov and his students, Paul Vittorio, Tony(1) Bidwell, Don(1) Nelson, Jim(1) Craigie, Bruce Tregunna, Andreas Hauschild, Geoff Lister and others in the Department of Biology at Queen's University, Kingston, Ontario. They focused on the influence of taxonomy and light quality on the path of carbon into early products, photorespiration and photosynthesis in young trees. During the same period, Ken(1) Clendenning and one of the authors (PRG) at the National Research Council of Canada (NRCC) laboratory in Ottawa began studies of chloroplast photoreduction and leaf carboxylases. They were joined by Don(1) Mortimer, who showed that the path of carbon varies with species of plant and by Morris Kates, who studied phospholipid enzymology in chloroplasts and leaves. Stan(1) Holt researched the chemistry and distribution of chlorophylls in different taxa. In 1952, Ralph Lewin joined NRCC's new Atlantic Regional Laboratory in Halifax, Nova Scotia, followed by Jim Craigie, Jack McLachlan and Tony Bidwell who mainly investigated the products of photosynthesis in marine algae. Tony Bidwell continued these studies in 1959 at the Department of Botany, University of Toronto. Dave(1) Canvin joined the staff at Queen's in 1965 and became involved in solving the mystery of photorespiration. Tony Bidwell returned to Queen's in 1969 and studied photosynthesis of algal chloroplasts using an 'artificial leaf.' In 1965, Don Nelson established a group at Simon Fraser University in Burnaby, British Columbia that included his former student, Geoff Lister who produced the first photosynthetic action spectra for trees, and Bill(1) Vidaver, who showed the useful relation between chlorophyll fluorescence and photosynthetic activity. In 1970, Mário Fragata headed a group at the Université du Québec à Trois Rivières, Québec, that began with studies of Photosystem II in chloroplasts and particles.

Canada↗
PubMed1985

The control of organics in drinking water in Canada and the United States (standards, legislation and practice).

Both the United States and Canada have a federal form of government, but approaches used in the two countries to ensure the safety of drinking water supplies differ. The Environmental Protection Agency currently enforces regulations for 10 organic chemicals (including 6 pesticides) under the Safe Drinking Water Act and provides advice on others through its health advisory program. Canada, however, does not have similar legislation, but rather provides health-related guidelines for 21 organic chemicals (including 16 pesticides) which are used by the provincial agencies responsible for drinking water supplies. Both countries are in the process of revising their standards and will include a variety of additional synthetic organic chemicals. Where possible, standards are set using a calculated acceptable daily intake usually derived from animal feeding experiments. Procedures for setting standards for carcinogens involve a blend of risk estimation coupled with consideration of the feasibility of reducing the risk in light of socio-economic factors. Most drinking water treatment plans in North America utilize 'conventional' treatment. Some now employ modifications in order to minimize trihalomethane formation. A few use aeration or granular activated carbon to remove synthetic organic chemicals.

Canada↗
PubMed1993

Trends in asthma and chronic obstructive pulmonary disease therapy in Canada, 1985 to 1990.

BACKGROUND: In the mid and late 1980s, numerous changes were recommended in the management of obstructive lung diseases. We analyzed drug sales to determine whether these recommendations have resulted in recent changes in prescription drugs used in airway management. METHODS: Data on prescription sales in Canada from 1985 to 1990 were obtained from an international pharmaceutical market research organization. Data from a random sampling of physicians that reported patients seen along with the diagnosis and prescriptions given were also reviewed. RESULTS: From 1985 to 1990, there was a 38% increase in prescriptions of all airway drugs. Prescriptions increased significantly for inhaled drugs as follows: inhaled beta 2-agonists, 70%; inhaled steroids, 139%; cromoglycate, 88%; and ipratropium bromide, 204%. Theophylline prescriptions, by contrast, fell significantly, by 19%. Although theophylline was the most commonly prescribed airway medication in 1985, inhaled beta 2-agonists were the most commonly prescribed drug in 1990, and these changes in proportional use were significant. Increases in ipratropium bromide usage was accounted for by increases in prescriptions for chronic obstructive pulmonary disease. Increases in nonsteroidal antiinflammatory drugs were accounted for by asthma prescriptions. CONCLUSIONS: The increase in airway medication prescriptions dispensed in Canada is consistent with an increase in the number of patients treated, an increase in the severity of disease treated, or both.

Anti-Inflammatory Agents↗
PubMed1994

Salmonella enteritidis in Canada.

During the last few years the prevalence of Salmonella enteritidis in people in Canada has increased slightly from 9 to 12% of all Salmonella isolates. Nation-wide surveys showed a low prevalence of S. enteritidis in poultry flocks: S. enteritidis was isolated from environmental samples of 2.7% of layer flocks and of 3% of broiler flocks. The overall prevalence of S. enteritidis-contaminated eggs from two flocks with infected hens was less than 0.06%. With the exception of S. enteritidis phage type (PT) 4, which has not been isolated from poultry in Canada, the phage types that occur most commonly in poultry (PT 8, 13 and 13a) are also the most prevalent in people. Phage typing was the most effective method for subdividing S. enteritidis strains. Eighty-three percent of the S. enteritidis isolates from poultry and its environment were sensitive to antimicrobial agents. The reasons why strains of the same phage type differ in virulence need to be elucidated.

Animals↗
PubMedDate not supplied

Health care technology in Canada (with special reference to Quebec).

In Canada, all citizens are insured for health services. Health care is a provincial responsibility. The federal role is limited to health care financing, health protection including regulation of pharmaceuticals, and environmental health. The health care system represents a balance among government direction, consumer choice, and provider autonomy. Canada has largely controlled the costs of health care by funding and management mechanisms, the most important of which is the global budget formula used to fund hospitals. This paper discusses the Canadian health care system, with particular emphasis on the province of Quebec. In 1988, the provincial government of Quebec established the first Canadian body dedicated to technology assessment. Since then, a national coordinating office and several other provincial bodies have developed. The work of these and other evaluation efforts has had a growing influence on technology management decisions, particularly those dealing with procurement of capital-intensive technologies. Expanding this influence into the realm of technology use, especially for low-cost, high-volume technologies, remains a challenge.

Canada↗
PubMed1994

The impact of laparoscopic cholecystectomy in Canada and Australia.

The introduction of laparoscopic cholecystectomy in Canada and Australia has been associated in each country with an increase in the rates of all cholecystectomies following a period where these had remained constant. Estimated costs of cholecystectomies to health programs declined by about 13% in Canada after the laparoscopic procedure became widely available, and about 2% in Australia. Days lost to patients because of surgery, and associated costs to them, decreased in each country. Neither country is realising the potential savings through use of laparoscopic cholecystectomy because of the increase in the number of procedures. The utility of these additional operations remains unclear. These trends associated with the advent of laparoscopic cholecystectomy suggest the need for caution in the introduction and application of other minimal-access surgery techniques.

Australia↗
PubMed1994

Health care in Canada: a system in turmoil.

Canada, in common with most countries, is re-examining its health care system. The main reasons for the reappraisal are the rising cost of health care and the growing unease that the cost is fast outstripping the capacity of the tax base to support it. This paper examines the way in which Canada's provinces are attempting to meet this health care challenge. It does this from two perspectives: first, through a consideration of the steps taken to control and/or cut costs and, second, by an exploration of the developing debate about rationing. The paper concludes with some comments about the potential policy implications of such issues.

Canada↗