Since September 2014, Santé Kildare has ranked 1st among the 15 GMFs and Super-clinics in CIUSSS du Centre-Ouest-de-l’Île-de-Montréal for Taux d’assiduité or “patient fidelity.”

10% effective? No – the flu vaccine is an EXCELLENT match!!

According to recent data from the Public Agency of Canada, 583 influenza viruses have been identified. The quadivalent vaccine that we gave children last Fall (Flulaval Tetra) covers 98.2% of these viruses.

The trivalent vaccine (Agriflu and Fluviral) covers 99.8% of the Influenza A viruses (including H3N2 and H1N1).

So why are so many people getting sick with the flu?

Regrettably, unlike the quadrivalent vaccine, the trivalent version does not vaccinate against the vast majority of the Influenza B viruses. Even so, the trivalent vaccine is a match against 62.3% of all indentified flu viruses this year.

Articles like the one below, published in December, warned about strains in Australia and Western Canada and speculated on their potential impact.

In reality, the flu vaccine is an excellent match – or in the words of the National Microbiology Laboratory – the circulating influenza viruses are “antigenically similar to components in the 2017-2018 Northern Hemisphere vaccine.”

The bottom line – get the Flu vaccine.

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!

 

Kids need real exercise!

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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.

 

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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.

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

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What are the barriers and solutions?

 

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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.

 

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Aug4#3

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

No need to worry…Casino Montreal still has unlimited free parking!

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The running meter is a distraction that interferes with medical appointments.”
Dr. Rajendra Kale, former editor CMAJ

Our Facebook post last week on plans to reduce parking fees at Quebec hospitals was our most popular yet. Parking fees can be excessive and their appropriateness has been extensively debated.

In the March 6, 2012 issue of the Canadian Medical Journal (CMAJ), doctors debated the merit and necessity of charging patients for parking. Dr. Tom Closson, President and CEO of the Ontario Hospital Association, argued that parking fees are one of the most common ways of making up the deficit of hospital operating budgets. He stresses that provincial government cutbacks to hospitals eliminate “crucial revenues that hospitals use to fund clinical research and front-line patient care.” He admonishes the Journal’s editorial board, “surely CMAJ has something to say about these and other more relevant issues, instead of banging away on the populist drum about parking fees.

Dr. Tim Meagher of the MUHC takes the opposing position, “I support free hospital parking for patients. I would probably also support free transport to and from hospital visits, reimbursement for time lost from work due to hospital visits, and reimbursement for myriad of ancillary costs that hospital visits generate.”

Dr. Rajendra Kale, editor in chief of the CMAJ, writes “”Parking fees amount to a user fee in disguise.” He urges Canadian hospitals to follow the example set in Scotland and Wales where hospital parking fees are abolished “because they burden (the) patient.” Dr. Kale concludes, “Those opposed to scrapping parking fees for patients need to recognize that such fees are, for all practical purposes, user fees and a barrier to health care. Using revenue generated from such surrogate user fees for health care is against the health policy objective of the Canada Health Act and could become the subject of a legal challenge.”

This opinion was supported by Dr. Brian Goldman, Host of CBC’s White Coat, Black Art, “I think hospital parking fees should be abolished because they punish patients.”
The highlights of the new hospital parking plan, starting April 1, are:
Hospital visitors will be able to park for free at hospitals in Quebec for the first 30 minutes, instead of paying as much as $10 for that first half hour.
• A flat daily rate will not be applied until a vehicle has been parked for more than four hours, a big change from the current practice of charging the maximum daily rate after 90 minutes.
• Health care institutions must offer weekly and monthly parking passes, as well as books of tickets, at reduced rates.
• Health care institutions must offer daily parking passes that allow motorists to come and go without penalty.

 

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The truth about GMF’s

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“Created to improve access, Montreal clinics often turn away patients,” published in the Gazette on February 15, 2017, is a misleading and misrepresentative article. It makes false assumptions and reaches incorrect conclusions.
The article states that “there are 86 family medicine groups in Montreal that rely on government funding to stay open longer than private doctors’ offices.” The author contends that “fewer than half the clinics are actually open seven days a week.”
The reality is GMFs are neither super-clinics nor general walk-ins. They are grouped, private, family medicine practices that offer care to a defined, registered patient population. Emphasis is placed on assiduité, fidélisation and prise en charge. In other words, GMFs prioritize their own patients while super-clinics or GMF-reseau (known previously as cliniques-reseau) are designed primarily for patients who do not have a family doctor.
These distinctions are available at: http://www.msss.gouv.qc.ca/professionnels/statistiques-donnees-services-sante-services-sociaux/acces-premiere-ligne/ and http://sante.gouv.qc.ca/systeme-sante-en-bref/groupe-de-medecine-de-famille-gmf/.
GMFs do not all receive the same funding and are not expected to maintain the same number of operating hours or days. While larger GMFs are open 68 hours/week, smaller GMFs only need to be open 5 or 6 days/week.
Yes – GMF walk-in clinics generally extend appointments to non-registered patients whenever possible. “All” patients can come irrespective of age, gender or medical history. Clinics, doctors, nurses are all working to improve access and help patients in need. But the GMF is not a “general” walk-in clinic – and hasn’t been since their inception in the early 2000s.
At the end of the day, the article should have asked – “can patients obtain timely appointments with their own family doctor?” Bottom line – register with a family doctor.

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“We are drowning in information but starved for knowledge.” John Naibitt

“We can just Google it!” writes Dr. Jalees Rehman of the University of Illinois at Chicago in Scientific America on August 2, 2012.  “Identifying the websites with the most accurate and relevant information are critical skills that are necessary for navigating our way in the digital information jungle, but unfortunately, these skills are rarely taught. In most cases, inaccurate or irrelevant information on the internet merely delays us for a few minutes until we do find the answer to what we are looking for. However, when it comes to medical information, inaccurate or irrelevant information could potentially have a major detrimental impact on our well-being.

I invite you visit the sites below (and at our newest website feature: Patient Resources –www.santekildare.ca/services/patient-resources/) which provide diverse, relevant and reliable medical information.  Some help calculate risk for cancer, osteoporosis and heart disease, while others prepare patients for appointments, review medications, discuss controversies in screening and limitations in treatments, and provide patients with easy-to-understand information about prevention and management of common illnesses.

With apologies to J.K.Rowling, “Understanding is the first step to healing.”

 

ctf

CTFPHC

The Canadian Task Force on Preventive Health Care (CTFPHC) has been established by the Public Health Agency of Canada (PHAC) to develop clinical practice guidelines that support primary care providers in delivering preventive health care.

Patient Engagement in Guideline Development: The CTFPHC involves members of the public in its guideline development process. Specifically, the CTFPHC uses feedback from the public to guide the search for evidence on the guideline topic and to develop knowledge translation tools to accompany the guidelines

http://canadiantaskforce.ca/tools-resources/videos/

http://canadiantaskforce.ca/general-public/general-information/

 

choosing wisely

 

Choosing Wisely Canada

Choosing Wisely Canada is a campaign to help physicians and patients engage in conversations about unnecessary tests, treatments and procedures, and to help physicians and patients make smart and effective choices to ensure high-quality care. Unnecessary tests, treatments and procedures do not add value to care. In fact, they take away from care by potentially exposing patients to harm, leading to more testing to investigate false positives and contributing to stress for patients. And of course unnecessary tests, treatments and procedures put increased strain on the resources of our health care system.

http://choosingwisely.ca/

my cancerIQ

My CancerIQ

Designed by Cancer Care Ontario (CCO), My CancerIQ is a website that helps you understand your risk for cancer and what you can do to help lower that risk.

A series of risk assessments estimate your risk of cancer compared with other Ontarians of the same sex age 40 and over. At the end of each assessment you’ll receive a personalized risk assessment and action plan with tips and resources based on your personal risk factors.

https://www.mycanceriq.ca/

 

lungs

Lung Foundation Australia

Lung Foundation Australia Primary Care Respiratory Toolkit supports the promotion of lung health as well as the early diagnosis and best practice management of lung disease. Evidence shows that Chronic Obstructive Pulmonary Disease is under-recognised, under-diagnosed and under-managed. The Primary Care Respiratory Toolkit has been developed to redress this.

The Lung Age Estimator has been developed to support clinicians to motivate current smokers to quit, by providing a graphic illustration of estimated lung age.

http://doctorwidget.com/alf/ignition/index.php/alf_pcrt#

 

medstopper

Medstopper

Medstopper is a tool to help clinicians and patients make decisions about reducing or stopping medications. By entering the list of medications a patient is receiving, Medstopper sequences the drugs from “more likely to stop” to “less likely to stop”, based on three key criteria: the potential of the drug to improve symptoms, its potential to reduce the risk of future illness and its likelihood of causing harm. Suggestions for how to taper the medication are also provided.

http://medstopper.com/

 

shift

Canadian Patient Safety Institute

Established by Health Canada in 2003, the Canadian Patient Safety Institute (CPSI) works with governments, health organizations, leaders, and healthcare providers to inspire extraordinary improvement in patient safety and quality.

Shift to Safety offers tips and tools for talking to you healthcare team. Empower yourself with information to help you ask good questions, connect with the right people, and learn as much as you can to keep you or a family member safe while receiving healthcare.

http://www.patientsafetyinstitute.ca/en/toolsresources/questions-are-the-answer/pages/default.aspx

 

calcounter

Calorie Counter

How many calories should you eat?  One-size-fits all recommendation do not work – each plan needs to be customized to each individual. Science tells us that 1 pound of fat is equal to 3500 calories so, in theory, a daily calorie deficit of 500 should result in 1 pound per week fat loss. Regrettably, in reality things don’t quite work that efficiently.

http://www.bmimedical.ca/calculator.aspx

 

tec

CVD Calculator

This Cardiovascular disease (CVD) calculator from the Therapeutics Education Collaboration uses both Framingham and the new ASCVD formulas.  It displays benefit estimates for all treatments – diet, lifestyle and medications. The calculator promotes itself as the BEST tool for calculating cardiovascular risk.

http://chd.bestsciencemedicine.com/calc2.html

 

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Journal of the American Medical Association

Explore the latest patient information from The JAMA Network, including easy-to-understand information about prevention and management of common illnesses.

http://jamanetwork.com/collections/6258/for-patients

 

Calcium Calculator

osteoporosis

 

osteoporosis

Fracture Risk Assessment

http://www.shef.ac.uk/FRAX/tool.aspx?country=19

ZIKA – 10 things you should know:

mosquito
1. Pregnant women and those planning a pregnancy should avoid travel to countries or areas in the United States (including South Florida and Texas) with reported mosquito-borne Zika virus.

2. All travellers should protect themselves from mosquito bites. Zika virus infection is caused by a virus which is primarily spread by the bite of an infected mosquito.

3. It can be transmitted from an infected pregnant woman to her developing fetus

4. Zika virus can be sexually transmitted, and the virus can persist for an extended period of time in the semen of infected males. Cases of sexual transmission from an infected male to his partner have been reported. Only one case of sexual transmission has been reported from an infected female to her partner.

5. Symptoms of Zika virus can include fever, headache, conjunctivitis (pink eye) and skin rash, along with joint and muscle pain. The illness is typically mild and lasts only a few days and the majority of those infected do not have symptoms.

6. Experts agree that Zika virus infection causes microcephaly (abnormally small head) in a developing fetus during pregnancy and Guillain-Barré Syndrome (a neurological disorder).

7. Zika virus has been reported in Canada in returned travellers from countries with ongoing Zika virus outbreaks.

8. For women planning a pregnancy, it is strongly recommended that you wait at least 2 months before trying to conceive if you just returned from a country with reported mosquito-borne Zika virus.

9. For male travelers, it is strongly recommended that you wait at least 6 months before trying to conceive if you just returned from a country with reported mosquito-borne Zika virus. If your partner is pregnant, it is strongly recommended that men consider using condoms or avoid having sex for the duration of the pregnancy.

10. It is strongly recommended that men consider using condoms or avoid having sex with any partner for 6 months if you just returned from a country with reported mosquito-borne Zika virus.

https://www.cdc.gov/zika/
https://travel.gc.ca/travelling/health-safety/travel-health-notices/152

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Le Quinoa, option santé à essayer

Plante herbacée dans la famille des betteraves et des épinards, le quinoa
est riche en fer et en protéines, sans gluten et faible en matières grasses. Essayez-le dans vos salades comme choix santé pour relever vos repas pique-niques cet été!
Voici quelques recettes pour vous inspirer!

http://recettes-de-chefs.ca/genevieve-filion/salade-de-quinoa/

http://www.recettes.qc.ca/recette/salade-de-quinoa-avec-amandes-feta-et-legumes-d-ete-164691

https://www.ricardocuisine.com/recettes/6030-salade-de-quinoa-de-ricotta-d-epinards-et-d-oignons-rouges

http://www.troisfoisparjour.com/fr/web/trois-fois-par-jour/recettes/lunchs-salades/salade-de-quinoa-poulet-pois-chiches-brocoli-et-sauce-au-cari