La clique demeurera ouverte pendant la saison des Fêtes. Prière de noter que nos services sont réservés uniquement à notre clientèle enregistrée; nous ne sommes PAS une clinique publique sans rendez-vous. SVP consulter notre page Facebook pour les heures de clinique en ce temps des Fêtes/ We will be open during the holidays. Please note that our services are for registered clientele ONLY. We are NOT a public walk-in clinic. Please check our Facebook page for extended hours and additional holiday clinics.

Health care with no heart

Sadly – these cuts will not be the exception – they will become the norm.

Please understand that this IS the Minister of Health’s plan. His focus is reorganization, cost-saving and “efficiency” – NOT care – and definitely not care for all.

Remember Bill 10? In its own words: “This bill modifies the organization and governance of the health and social services network…in order to facilitate and simplify public access to services, improve the quality and safety of health care and make the network more efficient and effective.”

“The bill establishes a new system of governance for the regional and supraregional institutions by specifying, among other elements, the composition of their boards of directors… appointed by the Minister of Health and Social Services.”

“The Minister is granted new powers…in particular the power to prescribe rules relating to their organizational structure and management and the power to work with the general management in cases of actions incompatible with the rules of sound management….”

Bill 10 passed in February 2015, abolishing the Board of Directors of individual health institutions and organizations (including the Jewish General, Mount Sinai, Mackay, etc). They were replaced by the CIUSSS, a supraregional agency, led by a team handpicked by the Minister of Health.

In the words of former Liberal MNA, Clifford Lincoln: “It’s such a huge reorganization of the health system that it buries the individual, it buries the client, it buries the patient, it buries the individual institutions and their boards into one, big, mega-reorganized system.”

This is why it should come as no surprise that Francine Dupuis, associate CEO of the CIUSSS West-Central Montreal, justifies the cuts because Miriam Home and Services has “not properly managing its day program for years.”

How has the Miriam Home failed? After all, its purpose is “to ensure that persons with intellectual disabilities be seen and treated as persons, experience love and friendship, experience continuity in their lives, be afforded personal security, be adaptively cared for, be treated with respect and dignity, have access to opportunities to make choices and exercise their rights, learn skills, be given means to compensate for their deficiencies and disabilities, have a decent and appropriate place to live, have a meaningful employment or occupation and have life-long opportunities for growth.”

Apparently not anymore. Dr. Barrette now determines every institution’s purpose – and to quote Francine Dupuis, the “Ministry of Health and Social Services has made it very clear it will no longer allow Miriam Home to provide rehabilitation services to clients whose condition can’t improve.”

The CIUSSS does NOT share the same vision as Miriam Home. The CIUSSS aims to “ensure real integration of services provided to the population.” Its “values” include: commitment to our clientele, collaboration, transparency, courage, respect and innovation.” The list does NOT include Miriam Home qualities like respect, dignity, access, meaning or growth.

Regrettably, we have a health system that promotes efficiency over care and selects services based on risk–return tradeoff. Today we are cutting services for apparently “babysitting” adults with intellectual and developmental deficits. After all, the CIUSSS had determined that they “take too many medications.” Apparently, quality of life, maintaining care, choices, personal security, don’t matter anymore.

Who can we cut next? Children with disabilities? Frail elderly? Palliative patients? Drug addicts? Alcoholics? Do they have good prospects for improvement? What is their cost-benefit?

We have a commitment to care for all. No one said health care was cheap – but common sense and dignity are still free!

 

New Flu Information for 2017-2018 from cdc

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New Flu Information for 2017-2018 from cdc.gov/flu

Getting an annual flu vaccine is the first and best way to protect yourself and your family from the flu. Flu vaccination can reduce flu illnesses, doctors’ visits, and missed work and school due to flu, as well as prevent flu-related hospitalizations.

What’s new this flu season?

A few things are new this season:

  • The recommendation to not use the nasal spray flu vaccine (LAIV) was renewed for the 2017-2018 season. Only injectable flu shots are recommended for use again this season.
  • Flu vaccines have been updated to better match circulating viruses (the influenza A(H1N1) component was updated).
  • Pregnant women may receive the flu vaccine

What flu vaccines are recommended this season?

This season, only injectable flu vaccines (flu shots) are recommended. Some flu shots protect against three flu viruses and some protect against four flu viruses.

Live attenuated influenza vaccine (LAIV) – or the nasal spray vaccine – is not recommended for use during the 2017-2018 season because of concerns about its effectiveness.

What viruses will the 2017-2018 flu vaccines protect against?

There are many different flu viruses and they are constantly changing. The composition of flu vaccines is reviewed annually and updated as needed to match circulating flu viruses. Flu vaccines protect against the three or four viruses (depending on vaccine) that research suggests will be most common. For 2017-2018, three-component vaccines are recommended to contain:

  • an A/Michigan/45/2015 (H1N1)pdm09-like virus (updated)
  • an A/Hong Kong/4801/2014 (H3N2)-like virus
  • a B/Brisbane/60/2008-like (B/Victoria lineage) virus

Quadrivalent (four-component) vaccines, which protect against a second lineage of B viruses, are recommended to be produced using the same viruses recommended for the trivalent vaccines, as well as a B/Phuket/3073/2013-like (B/Yamagata lineage) virus.

When should I get vaccinated?

You should get a flu vaccine before flu begins spreading in your community. It takes about two weeks after vaccination for antibodies to develop in the body that protect against flu, so make plans to get vaccinated early in fall, before flu season begins. CDC recommends that people get a flu vaccine by the end of October, if possible. Getting vaccinated later, however, can still be beneficial and vaccination should continue to be offered throughout the flu season, even into January or later.

Children who need two doses of vaccine to be protected should start the vaccination process sooner, because the two doses must be given at least four weeks apart.

Can I get a flu vaccine if I am allergic to eggs?

The recommendations for people with egg allergies are the same as last season.

  • People who have experienced only hives after exposure to egg can get any licensed flu vaccine that is otherwise appropriate for their age and health.
  • People who have symptoms other than hives after exposure to eggs, such as swelling, respiratory distress, or vomiting; or who have needed epinephrine or another emergency medical intervention, also can get any licensed flu vaccine that is otherwise appropriate for their age and health, but the vaccine should be given in a medical setting and be supervised by a health care provider.

Protective Actions

What should I do to protect myself from flu this season?

CDC recommends a yearly flu vaccine for everyone 6 months of age and older as the first and most important step in protecting against this serious disease.

In addition to getting a seasonal flu vaccine, you can take everyday preventive actions like staying away from sick people and washing your hands to reduce the spread of germs. If you are sick with flu, stay home from work or school to prevent spreading flu to others. In addition, there are prescription medications called antiviral drugs that can be used to treat influenza illness.

What should I do to protect my loved ones from flu this season?

Encourage your loved ones to get vaccinated.

Do some children require two doses of flu vaccine?

Yes. Some children 6 months through 8 years of age will require two doses of flu vaccine for adequate protection from flu. Children in this age group who are getting vaccinated for the first time will need two doses of flu vaccine, spaced at least 28 days apart. Children who have only received one dose in their lifetime also need two doses.

What can I do to protect children who are too young to get vaccinated?

Children younger than 6 months old are at high risk of serious flu complications, but are too young to get a flu vaccine. Because of this, safeguarding them from flu is especially important. If you live with or care for an infant younger than 6 months old, you should get a flu vaccine to help protect them from flu.

How effective will flu vaccines be this season?

Influenza vaccine effectiveness (VE) can vary from year to year among different age and risk groups and even by vaccine type. How well the vaccine works can depend in part on the match between the vaccine virus used to produce the vaccine and the circulating viruses that season. It’s not possible to predict what viruses will be most predominant during the upcoming season.

Will this season’s flu vaccine be a good match for circulating viruses?

It’s not possible to predict with certainty if the flu vaccine will be a good match for circulating flu viruses. The flu vaccine is made to protect against the flu viruses that research and surveillance indicate will likely be most common during the season. However, experts must pick which flu viruses to include in the flu vaccine many months in advance in order for flu vaccines to be produced and delivered on time. Also flu viruses change constantly (called drift) – they can change from one season to the next or they can even change within the course of one flu season.

How long does a flu vaccine protect me from getting the flu?

Multiple studies conducted over different seasons and across flu vaccine types and influenza virus subtypes have shown that the body’s immunity to influenza viruses (acquired either through natural infection or vaccination) declines over time.

Can the flu vaccine provide protection even if the flu vaccine is not a “good” match?

Yes, antibodies made in response to vaccination with one flu virus can sometimes provide protection against different but related flu viruses. A less than ideal match may result in reduced vaccine effectiveness against the flu virus that is different from what is in the flu vaccine, but it can still provide some protection against flu illness.

In addition, it’s important to remember that the flu vaccine contains three or four flu viruses (depending on the type of vaccine you receive) so that even when there is a less than ideal match or lower effectiveness against one virus, the flu vaccine may protect against the other flu viruses.

Can I get vaccinated and still get the flu?

Yes. It’s possible to get sick with the flu even if you have been vaccinated (although you won’t know for sure unless you get a flu test). This is possible for the following reasons:

  • You may be exposed to a flu virus shortly before getting vaccinated or during the period that it takes the body to gain protection after getting vaccinated. This exposure may result in you becoming ill with flu before the vaccine begins to protect you.
  • You may be exposed to a flu virus that is not included in the seasonal flu vaccine.

    flu2017

Kids need real exercise!

sept5

Last year my children told me that their class had new furniture. I did not understand. When I went for parent-teacher interviews, I fell out of my seat – literally and figuratively! What’s up with the wobble chair?

 
Now I understand that kids fidget and squirm during class. Adults do the same during long meetings as well. I also know that there is scant research that kids with ADHD can benefit from wobble chairs – but we should not treat an entire class as if they have a hyperactivity disorder.

 
The vast majority of children don’t have a medical disorder – they simply lack sufficient physical activity.

 
The World Health Organization (WHO) defines ‘health’ as a state of complete physical, mental and social well-being. Health Canada describes ‘healthy living’ as making choices that promote physical, mental, social and spiritual health. Health Canada notes: “All Canadians need a physically active, healthy lifestyle, beginning in their early years. Unfortunately, poor nutrition, inactivity, childhood obesity and declining fitness are common.”

 

about PA

 

The Canadian Physical Activity Guidelines recommend a MINIMUM of 60 minutes of moderate-vigorous intensity aerobic exercise daily.

 

sed beh

 

Aerobic exercise means activity that increases heart rate and sweat production. It is doubtful that teachers will encourage kids to reach aerobic levels on the wobble chairs.
The proportion of children and youth aged 5 to 17 meeting physical activity guidelines are shocking: According to Statistics Canada, only 13% of boys and 6% of girls are getting an average of at least 60 minutes of moderate-to-vigorous physical activity daily.

chart1

On average, kids are sedentary 700 + minutes (over 11 hours) each day.

chart2

 

What are the barriers and solutions?

 

strategies

 

Simply – not the wobble chair!

 

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Recordings in the Office

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Recording doctor appointments can be beneficial – but certain rules need to be respected. Specifically, the recording’s location – public versus private – has certain implications.
The following are concerns and recommendations of the Canadian Medical Protective Association (CMPA):
Privacy issues in public areas
Patients recording in public areas of a doctor’s office, such as waiting rooms and other common spaces, could possibly capture other people who are not involved in the patient’s healthcare encounter. The recordings could include identifiable information about another patient or staff which could breach a person’s privacy.
Impact on the doctor-patient relationship
A patient may have valid reasons for wanting to record a clinical encounter in a private area such as an examination room. They may want to have an accurate record of the physician’s advice, or to share the information with a family member. However, the recording of a clinical encounter by a patient without the physician’s knowledge can be perceived as reflecting a lack of confidence in the relationship on the part of the patient.
Impact on the medical record
Any recording made at the time of the clinical encounter (i.e. contemporaneously) could be considered part of the medical record.

 

Our Policy
Recordings should only be made in private areas. Patients should avoid taking photos and making video and audio recordings in the waiting room or other public areas in order to protect the privacy of other patients and staff members.
Recordings in private locations should be transparent and obtained with the mutual consent of the patient and physician. A copy should be provided and added to official patient health record. The recorded conversations should never be posted on public websites or on social media without the knowledge and approval of all affected parties. the absence of trust and openness may negatively impact the doctor-patient relationship.

 

Aug4#2

Aug4#3

West Nile Virus

mosquito

 

First, the good news… no human cases reported in Canada so far in 2017.

mapWN

 

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Be vigilant – infected mosquitoes have been detected in Ottawa and Toronto this week.

West Nile Virus spreads through the bites of infected mosquitoes. The “high” season starts in July. Remember, mosquitoes reproduce in stagnant water – even if there is a small amount.

What to do?
Take the follow precautions:

  • Use insect repellent than contains DEET, picaridin or lemon eucalyptus
  • Apply to exposed skin – do not use insect repellent on children < 6 months old
  • If you are outdoors at the end of the day, wear light-coloured long-sleeves shirts and pants
  • Install screens on windows
  • Eliminate water that accumulates outdoors – ie. Buckets and barrels
  • Maintain swimming pools – avoid water collected on covers
    Cover garbage cans.

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WNSM

Let’s be clear: Kids should NOT smoke marijuana

smoking

This week, the federal government’s tabled Bill C-45 would allow adults to legally possess and use small amounts of recreational marijuana. The bill would make it a criminal offence to sell pot to minors but it would not be crime for youth to possess small amounts of it.
The introduction of the Bill was met with a strongly worded editorial in the Canadian Medical Association Journal:

“Simply put, cannabis should not be used by young people. It is toxic to their cortical neuronal networks, with both functional and structural changes seen in the brains of youth who use cannabis regularly.”
The CMAJ references the Position Statement of the Canadian Pediatric Society. Scientific evidence strongly links marijuana use in youth to:

1. cannabis dependence and other substance use disorders
2. the initiation and maintenance of tobacco smoking
3. an increased presence of mental illness, including depression, anxiety and psychosis
4. impaired neurological development and cognitive decline
5. diminished school performance and lifetime achievement

 
The Canadian Medical Association recommends that the minimum age to buy and use marijuana be set at 21 instead of 18 years.  Furthermore, the CMA stresses that restrictions be imposed on the quantity and potency of marijuana that young people can purchase and use until the age of 25.

 
Dr. Brian Goldman, in his blog “White Coat, Black Art” writes, “I agree that high potency marijuana use in young people is risky.  But I don’t think that legislation is the solution.  Canada has one of the highest rates in the world of young people using marijuana.  As many as 60 per cent of 18 year olds have tried it at least once.  The absence of legislation hasn’t made it that difficult for youth to obtain it. Researchers doubt that bill C-45 or any law for that matter will curb the use of cannabis by young people.  Colorado has had legal marijuana for some time now, and that state has seen no increase or decrease in young people using the drug.”

 
He correctly concludes, “The federal government should stop suggesting that the law is intended to prevent kids from using marijuana, since that kind of message is likely to make the drug more attractive to teens.”

 
As debate Bill C-45 is debated and inches towards legislation, let’s make sure that we put our children’s health first.

 

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Screen Time: We Need a Plan

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” No child should have a phone in their bedroom unsupervised.”
Dr. Leonard Sax, Pediatrician

 

It is always interesting to see which Facebook posts attract the most attention. An interview with Dr. Leonard Sax in the Wichita Eagle, “Why kids today are out of shape, disrespectful – and in charge,” drew considerable interest – even Facebook commented  “This post is performing better than 90% of other posts on your Page.”
The article, http://www.kansas.com/news/nationworld/national/article56473378.html, describes the “reordering of families.” Dr. Sax argues that families are facing a “crisis of authority” where kids are given too much control and are effectively put in charge. “The parent makes a recommendation, but the child makes the final decision. I know of cases where the kid was clearly making the wrong decision and the parents knew it but nevertheless felt completely powerless to overrule their child. The child is the one who suffers.”
He continues, “The same is true with regard to a cellphone in the bedroom. You now find kids at 10, 12, 14, 16 years of age who have their phone in their bedroom at two (o’clock) in the morning. You take the device at night and you put it in the charger, which stays in the parents’ bedroom. No child should have a phone in their bedroom unsupervised.
That’s not just my opinion. That is the official teaching of the American Academy of Pediatrics (AAP) in guidelines published (in) October 2013. But you would be astonished, or maybe you wouldn’t be, how many parents find that an impossible recommendation. They feel that they have no authority over their child in many domains.”

So, what does the AAP actually say and recommend:

According to a recent study, the average 8- to 10-year-old spends nearly 8 hours a day with a variety of different media, and older children and teenagers spend >11 hours per day.1
Presence of a TV set in a child’s bedroom increases these figures even more, and 71% of children and teenagers report having a TV in their bedroom.1 Young people now spend more time with media than they do in school—it is the leading activity for children and teenagers other than sleeping.1,2
Nearly all children and teenagers have Internet access (84%), often high-speed, and one-third have access in their own bedroom.
In a recent study, two-thirds of children and teenagers report that their parents have “no rules” about time spent with media.1 Many young children see PG-13 and R-rated movies—either online, on TV, or in movie theaters—that contain problematic content and are clearly inappropriate for them. Few parents have rules about cell phone use for their children or adolescents. There is considerable evidence that a bedroom TV increases the risk for obesity, substance use, and exposure to sexual content.1,2-8.
Give, these concerns, the American Academy of Pediatrics recommends:

  • Limit the amount of total entertainment screen time to Discourage screen media exposure for children.
  • Keep the TV set and Internet-connected electronic devices out of the child’s bedroom.
  • Monitor what media their children are using and accessing, including any Web sites they are visiting and social media sites they may be using.
  • Co-view TV, movies, and videos with children and teenagers, and use this as a way of discussing important family values.
  • Model active parenting by establishing a family home use plan for all media. As part of the plan, enforce a mealtime and bedtime “curfew” for media devices, including cell phones. Establish reasonable but firm rules about cell phones, texting, Internet, and social media use.

 

1. Rideout V. Generation M2: Media in the Lives of 8- to 18-Year-Olds. Menlo Park, CA: Kaiser Family Foundation; 2010
2. Strasburger VC. Health effects of media on children and adolescents.Pediatrics. 2010;125(4):756–767pmid:20194281
3. Staiano AE. Television, adiposity, and cardiometabolic risk in children and adolescents. Am J Prev Med. 2013;44(1):40–47pmid:23253648
4. Hanewinkel R. Longitudinal study of exposure to entertainment media and alcohol use among German adolescents. Pediatrics. 2009;123(3):989–995pmid:19255030
5. Jackson C. A TV in the bedroom: implications for viewing habits and risk behaviors during early adolescence. J Broadcast Electron Media. 2008;52(3):349–367
6. Adachi-Mejia AM. Children with a TV in their bedroom at higher risk for being overweight. Int J Obes (Lond).2007;31(4):644–651pmid:16969360
7. Kim JL. Sexual readiness, household policies, and other predictors of adolescents’ exposure to sexual content in mainstream entertainment television. Media Psychol.2006;8(4):449–471
8. Gruber EL.. Private television viewing, parental supervision, and sexual and substance use risk behaviors in adolescents [abstract]. J Adolesc Health.2005;36(2):107

https://www.healthychildren.org/English/news/Pages/Managing-Media-We-Need-a-Plan.aspx
http://pediatrics.aappublications.org/content/132/5/958

Nurse Practitioners: What’s the deal?

Many of you may have noticed nurse practitioners popping up in your family medicine clinics lately. If you haven’t noticed them yet, you are very likely going to notice more of them soon. The Quebec government has invested $25 million dollars to help train new nurse practitioners in Quebec. Their goal is to have at least 2,000 primary care nurse practitioners trained in Quebec by 2025. We still have a long way to go to meet this goal; there are only 428 nurse practitioners in Quebec.

So what is a nurse practitioner? Simply, they are a family doctor for healthier people. Nurse practitioners are nurses who have gone back to school and received a Master’s degree and extra medical training. They are qualified to write prescriptions for certain medications, they can send you for blood tests, x-rays, ultrasounds, and other tests, and they can do procedures like stitches.

A nurse practitioner can follow healthy people from babies to older adults for their regular check ups. They can also follow healthy pregnant women until they are 32 weeks pregnant. You will also see them in walk-in clinics because they are able to manage most of the acute issues that bring people to a walk-in clinic.  If you are followed by a nurse practitioner all of your health needs are managed by the nurse practitioner much like if you had a family doctor.

Nurse practitioners are not completely alone. They work in partnership with family doctors who are there to act as the nurse practitioner’s specialist. Much like your doctor may send you to see a specialist, like a cardiologist, a nurse practitioner can “refer” to their partner physician. The nurse practitioner may discuss your case with their partner physician or, if needed, the doctor may see you for a visit.

The goal of the nurse practitioner is to help improve access to primary care. Nurse practitioners are able to help relieve the burden of the family doctors by following their own caseload. This increases the number of Quebecers who have a family doctor and it also allows family doctors to follow more complex cases.

 

https://www.oiiq.org/sites/default/files/rapport-statistique-2014-2015.pdf

http://www.cbc.ca/news/canada/montreal/quebec-super-nurses-1.4041873

Jennifer Reoch

Santé Kildare Nurse Practitioner Candidate

Santé Kildare à l’épicerie!

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Notre première édition de la visite santé au supermarché IGA Lipari fut un grand succès, nous remercions tous les participants qui se sont joint à nous!

Notre nutritionniste du GMF Sante Kildare Caryn a su nous  guider à choisir sainement et à comprendre le fonctionnement des coulisses alimentaires.

La lecture des emballages et les choix à privilégier n’ont plus de secrets suite à cette visite interactive et dynamique.

Nous planifions offrir plusieurs présentations sur la promotion de la santé dans les prochain mois, restez aux aguets! Au programme : nutrition chez les personnes âgées, diabète, soutien aux aidants naturels et plus encore!

Au plaisir de vous rencontrer bientôt!