Post-ICU syndrome signals need for better care

Nadine Foster remembers only two things from the five weeks she spent in the intensive care unit: a woman’s voice telling her she was in hospital in Edmonton, and hallucinating that her brother-in-law was playing a practical joke by dressing up like a doctor.

She came close to death so often, her survival was viewed as a miracle.

“Not having any memory of it is sometimes a little troubling,” she says. “It’s like it was the most significant thing that happened to me, but I didn’t feel it. I’ve got the scars from the surgeries. I’ve got the long-term health complications. But it’s like it happened to my family, to everyone else.”

Amnesia wasn’t the only thing Foster took home from the hospital. She had a surgically-created opening to help expel bodily waste. Muscle loss had robbed her of the ability to walk. She couldn’t concentrate long enough to read. She would sleep up to 16 hours a day, yet still feel exhausted.

“I was shocked,” says Foster, a forensic health nurse who worked with troubled youth. “I had no idea, even as a nurse, that I would suffer so much afterward and that it’s such a long, slow climb back to normal life.”

Worse, because of the way many ICU survivors are discharged from hospital – spending time in a medical ward before moving on to a rehab hospital, long-term care facility or home – many feel abandoned and unsupported in their recovery.

“For some patients who come to the ICU, they never get back to where they were before the ICU,” says Orla Smith, a critical care nurse at St. Michael’s hospital who has experience managing the unit and its research portfolio. Click here to read more. (Photo courtesy of Pixabay.)


What’s it really like to practice medicine in the U.S.?

Recently, Canadian physicians have travelled south of the border to espouse the advantages of Canada’s health care system, while American politicians vilify socialist-style health care.

Proposed tax changes to limit income sprinkling and changes to incorporation have led some Canadian physician groups to predict mass migration to the United States.

Is the grass really greener on the other side of the border? Is the health care in the United States as bad as critics say? We asked health care providers who’ve worked in both Canada and the U.S. to share their experiences. Click here to read more. (Photo courtesy of Pixabay.)



House calls on the rise in Ontario

Since 2011, the number of house calls in Ontario has grown by nearly 100,000, from less than 270,000 to more than 365,000, according to numbers provided by the Ministry of Health and Long-Term Care. What’s getting doctors out of the office? (Photo courtesy of NegativeSpace)





Does consuming more probiotic bacteria really make us healthier?

Probiotics, bacteria that when eaten in sufficient quantities can be beneficial, have become common on grocery store shelves. They’re found naturally in fermented foods like kimchee, sauerkraut or kefir, and added during the manufacturing process into some dairy products, cereals, juice, baked foods and fermented meats, like sausage.

Their popularity is based on the notion that boosting the number of “good bacteria” in one’s body to fend off infections and other ailments is akin to calling in ground troops to fight off a foreign invader. It sounds logical that the more soldiers in the fight, the better the odds of winning.

The problem is, scientists haven’t figured out yet which bacteria to call on, how many are needed, or even how they do battle with “bad bacteria.” (Photo courtesy of Pixabay)

Colorectal cancer screening can prevent cancer – so why don’t more people do it?

Colon cancer is the second-most common cancer in Canada, and the second-leading cause of cancer death in the country, estimated to have killed 9,300 Canadians in 2016 alone.

Yet a simple screening test can not only detect cancer but also prevent cancer from developing by identifying pre-cancerous polyps which can then be removed before they turn cancerous. That’s far better than breast or prostate cancer screening tests, where evidence remains weak or divided on their value.

While mammograms have become routine, data from colorectal cancer screening programs across the country show many Canadians still aren’t taking advantage of simple, at-home screening tests.

At the same time, those whose screening returns a positive result often wait longer than is recommended for a follow-up colonoscopy.

Does more education for health care providers equal better care?

In recent years, nurses, physiotherapists, audiologists, speech therapists, and pharmacists have all increased their entry-to-practice requirements, with registered nurses needing at least a bachelor degree, and physio and other therapists obligated to obtain a master’s degree to be considered for licensing.

By 2020, all pharmacy schools in Canada will move to a doctorate degree, adding a year to their training and bringing the total time in school to at least eight years. In the meantime, physician assistants are feeling the pressure to move, as their American counterparts have begun to do, from a master’s to a doctorate as the first step to practice.

These ever-advancing requirements to enter into practice are known as “degree creep.” But does the drive for more time in the classroom actually improve patient care? (Photo courtesy of Pixabay)

Grief a lonely place in the health care system

Studies show grief can trigger a range of physiological symptoms, including pain, headaches, dizziness, fatigue, loss of sleep or appetite or trouble with digestion, as well as myriad psychological reactions, such as depression or fearfulness. In some cases, it can make mourners more susceptible to illness.

If the death is unexpected, accidental, a homicide or suicide, there may also be residual feelings of guilt or anger or even trauma.

For most, the intensity of grief diminishes over time. Finding support in family and friends, or in community bereavement groups where they’re able to speak with others going through a similar type of grief, can be helpful. But at a time when there’s more emphasis on end-of-life care and attempts to support death at home, as well as new challenges presented by medically assisted death, patchwork services available to those left behind isn’t enough. (Photo courtesy of Irina Anastasiu)


Medical residency mismatch 

The number of Canadian medical graduates unmatched with a residency training program has reached unprecedented levels, with students and faculty concerned about the growing gap between students and necessary training.

Since 2009, the number of unmatched Canadian graduates has been steadily increasing, moving from 11 in 2009 to 68 in 2017.

“This represents 68 students who have spent on average eight to 10 years of undergraduate education to become physicians, incurring great debt, and utilizing taxpayer dollars to facilitate their education,” says Mel Lewis, a student affairs associate dean at the University of Alberta.

“There’s a lot of anxiety,” says Franco Rizzuti, president of the Canadian Federation of Medical Students. “Students are starting to grasp at straws, trying to understand what’s going on.” (Photo courtesy of Pixabay)

Can Endgame Tobacco radically reduce cigarette smoking? 

Smoking can feel like a public health success story; an issue in the past. But more than 37,000 Canadians still die of tobacco-related causes every year. A push called Endgame Tobacco has a goal to drive the number of smokers down from around 20 percent today to less than five percent by 2035.

What makes Endgame Tobacco different is that its goal is more aggressive and to achieve it, the proposed actions are more radical. At an October 2016 summit, the group discussed possibilities such as establishing quotas on the number of cigarettes available for sale and raising the legal age to obtain cigarettes to 21 to bring it in line with proposed age restrictions on the purchase of marijuana. (Photo courtesy of Pixabay)

Patient engagement a new frontier for drug makers

“Patient engagement” is a frequently used word in healthcare circles, with hospitals, clinics, advocacy groups and even regulators seeking ways to consult directly with patients and caregivers and to reflect their views in decision-making processes.

Pharmaceutical companies have been slower to adopt patient engagement strategies, largely because legal and compliance teams often caution researchers to maintain a distance between themselves and patients. But they too are now beginning to look for ways to better incorporate patient feedback, both on drugs on the market and drugs in development.

Yet it’s an uneasy relationship, with pharmaceutical companies wary of falling afoul of advertising and marketing regulations, patient groups worried about perceived corporate influences and patients uncertain that their health priorities will trump profit potential. (Photo courtesy of Start-Up Stock Photos)


Can an essential medicines list fix gaps in drug coverage?

Canada is the only country with universal health care that does not have a form of universal drug coverage. An “essential medicines” list includes common drugs used to prevent or treat illnesses and chronic conditions that would be covered by the public health system regardless of a person’s age or income. It could help close gaps in coverage – with some projections estimating it would cover 90 percent of prescriptions – and reduce the financial pressures that keep some patients from getting the medications they need.

Such a list is different from current publicly funded drug plans, which contain many more drugs but are only available to some people, such as those 65 years of age or older. Critics, however, say an essential medicines list is a half-measure that could ultimately reduce choice for Canadian patients. (photo courtesy of Pixabay)


Are home care complaints being heard?

It’s no secret that home care in Canada is stretched, with increasing pressures from earlier discharges, an aging population, patients with serious chronic conditions and others who, thanks to new medical advances and a continued push away from institutional care, are living at home with levels of medical fragility that would not have been seen even a decade ago. That can leave people like White in the dark about where to turn when they have complains about the care they’re receiving, or worse, leave them feeling vulnerable to retribution if they complain. As the system in Ontario undergoes changes to merge CCACs into the Local Health Integration Networks, is it time to revamp its processes? (photo courtesy of Life of Pix)


Is Canadian research falling prey to predatory publishing? Healthcare journalism in Canada

When many legitimate academic journals moved to an open access model, a cottage industry of unscrupulous but enterprising entrepreneurs soon emerged. Predatory publishers, as they’re called, charge publication fees to authors without providing the editorial and publishing services associated with legitimate journals.

Over the past decade, this has ballooned into a massive trade that some feel has fundamentally warped the academic publishing and peer review process. It has become increasingly difficult to tell real from fake. (photo courtesy of Unsplash)




Healthcare journalism in CanadaSick & Tired: How can hospitals help patients get the sleep they need?

Poor sleep can have a host of harmful effects on a patient’s recovery, causing poor memory recall, slower wound healing, less vitality and strength, along with more vulnerability to feeling pain. So what can hospitals do to help patients get the sleep they need? (photo courtesy of Pixabay)


Pressure injuries the ‘scarlet letter’ of patient careHealthcare journalism in Canada

Linda Murphy visited her mother-in-law regularly at her nursing home, noting she was becoming more isolated as her Alzheimer’s disease advanced. She was already mostly bedridden after breaking both hips in two separate falls. But Murphy never looked at her mother-in-law’s skin.

“I never made a habit of checking her feet or legs,” says Murphy, who lives in Ottawa. “We were just pretty ignorant of all of what could happen.”

So Murphy was stunned when staff from the nursing home called to say they’d sent her mother-in-law in an ambulance to a hospital for an emergency consultation with a surgeon. A raw spot on her heel mentioned earlier that week had suddenly developed into an infected pressure sore.

“The surgeon was very, very blunt,” Murphy remembers. “Her leg had to go. I think you can imagine how that caught us off guard. Not to mention my mother-in-law.”

The surgeon amputated the leg from the knee down to keep the wound from causing further damage.

“The experience after that was pretty brutal,” Murphy says. “With dementia, you don’t understand what’s happened to you and can’t necessarily recall that you’ve had an operation. It was pretty grim for her.”

Severe pressure injuries – aka ‘bedsores’ – have been declared a “never event” for hospitals. But can all pressure injuries really be prevented?

(photo courtesy of Matthias Zomer)


Should fear of Zika virus keep Canadians from travelling this winter?Healthcare journalism in Canada

Cooler temperatures got you thinking about a winter escape? Here’s what you need to know about travel and the Zika virus.

(photo courtesy of Pixabay)





Wait time targets miss the mark with patientsHealthcare journalism in Canada

Wait time targets for cardiac care, cancer care, diagnostic imaging, cataract surgery and hip and knee surgeries were set without involving patients. Do they reflect a patient’s experience of waiting for care?

(photo courtesy of Jeshoots)




Chronic pain: do patients get the care and treatment they deserve? Healthcare journalism in Canada

A long wait for specialist care is not unusual for those in pain. But the longer chronic pain goes unaddressed, the more disabling it can become, with patients often plagued by sleeplessness, anxiety or depression.

“It’s a silent epidemic,” says Hance Clarke, director of pain services and medical director of the Pain Research Unit at Toronto General Hospital. “You may be suffering in pain, but no one can see it. You’ve got all your limbs, your lungs are working fine, your heart is working fine, you’re not dying of cancer. But you’re living every day with disability.”

(photo courtesy of Pixabay)




family medicine residency Canada

Is Canada’s family medicine residency too short & too urban?

Canada has the shortest residency program for family medicine in the world, “with ever increasing expectations for service by family physicians,” says Nancy Fowler, executive director of Academic Family Medicine with the College of Family Physicians of Canada.

“What I see, looking at medical students finishing now, is that their knowledge base is so dramatically better than what mine was at the same stage, but what I don’t see – and the question really is why – is the confidence to go out and do stuff,” says John Soles, past president of the Society of Rural Physicians of Canada.

The question of how to build “clinical courage” – proceeding in the face of uncertainty and fear, as Soles defines it – is at the heart of the debate about expanding family medicine residency.

It’s also spurred recommendations to move some family medicine training out of urban teaching hospitals and into rural and remote settings, to give trainee physicians more experience practicing with limited technology or specialist support. Read more here.

(photo courtesy of Pixabay)