Canadian Scientists Develops World’s Most Advanced Drug to Protect the Brain After a Stroke (PSD95 inhibitor)

“There is hope that this new drug could be used in conjunction with other treatments, such as thrombolytic agents or other means to restore blood flow to the brain, in order to further reduce the impact of stroke on patients,” said Dr. Tymianski. “These findings are extremely exciting and our next step is to confirm these results in a clinical trial.”

Feb 27th: PET Report | TRIUMF : Canada's National Laboratory for Particle and Nuclear Physics (PET/CT scans)

"There is a human element to be considered in determining the value of a PET scan: The present report identifies numerous healthcare policies and provides considerable statistical information to describe the impact of PET imaging on cancer treatment. But it is also important to note that the impact of any healthcare policy goes beyond statistics to have a direct impact on individual patients and their families."

 
PET Report

The Use of Positron Emission Tomography (PET) for Cancer Across Canada: Time for a National Strategy

On Monday, February 27, 2012, TRIUMF/AAPS released a report surveying the utilization of PET imaging technolgoy for clincial care of cancer across Canada. The full report is available here in PDF format (about 3 MB). Susan Martinuk's briefing slides are available here. Helen Branswell's coverage on CTV.ca via the Canadian Press Pamela Fayerman's coverage in the Vancouver Sun

Cancer is a growing challenge to Canadians and an increasing burden on healthcare budgets. A ground-breaking report released today suggests that access to, and utilization of, leading-edge medical-imaging technology for the diagnosis, staging, and monitoring of cancer treatment varies widely from province to province, putting cancer patients in some areas at a distinct disadvantage.
The technology, called Positron Emission Tomography, is often coupled with Computerized Tomography (CT) and is known as PET/CT imaging. PET imaging is already widely used and integral to cancer care in most developed nations, and increased utilization of this technology could provide more clinically-effective and cost-effective treatment for cancer patients in Canada. A nationally coordinated strategy to take up this technology and standardize its use could bring Canada back to the forefront of global cancer care.

"Canada conducted 42,620 scans in 2009; 22,400 (51%) of those were carried out in the province of Quebec."

(PDF) Table of Contents

1.0 Summary of Key Findings....................................................................................................3
2.0 Preface ................................................................................................................................7
3.0 Executive Summary............................................................................................................11
4.0 Introduction to Positron Emission Tomography (PET)........................................................23
5.0 Clinical Effectiveness of PET Imaging in Oncology............................................................33
6.0 Cost Effectiveness..............................................................................................................43
7.0 Status of PET Imaging in Canada.......................................................................................47
8.0 Status of PET Imaging in British Columbia.......................................................................61
9.0 Status of PET Imaging in Alberta.......................................................................................69
10.0 Status of PET Imaging in Saskatchewan...........................................................................77
11.0 Status of PET Imaging in Manitoba....................................................................................83
12.0 Status of PET Imaging in Ontario.......................................................................................89
13.0 Status of PET Imaging in Quebec..................................................................................... 103
14.0 Status of PET Imaging in Nova Scotia ............................................................................. 113
15.0 Status of PET Imaging in New Brunswick....................................................................... 119
16.0 Status of PET Imaging in Prince Edward Island.............................................................. 125
17.0 Status of PET Imaging in Newfoundland......................................................................... 131

18.0 Findings: An Opportunity to Improve the Cancer Care of Canadians............................. 137

19.0 Conclusions: Time for a National Strategy...................................................................... 149

Canadian Doctors for Medicare: Neat, Plausible and Wrong: The Myth of Health Care Unsustainability

Neat, Plausible and Wrong: The Myth of Health Care Unsustainability

The “Sustainability” Myth The assertion that Medicare is “unsustainable” has been repeated so many times[1] that in some circles it has become accepted as indisputable fact. Critics[2] of...
[+] Read full story

UPDATE: Additional Web sites Selling MMS Sodium Chlorite Solution Not Authorized for Oral Consumption by Humans - Health Canada Advisory 2012-02-23

......Health Canada would also like to remind Canadians that there are no therapeutic products containing sodium chlorite authorized for oral consumption by humans. MMS may cause serious health problems that include poisoning, kidney failure and harm to red blood cells that reduces the ability of the blood to carry oxygen. Additional health problems may also include abdominal pain, nausea, vomiting, and diarrhoea.
Consumers should consult their health care practitioner if they have used or are using MMS products and report any adverse reaction to Health Canada.

Health Canada has notified distributors identified to date that the sale of sodium chlorite for human consumption is in contravention of the Food and Drugs Act. We have also requested that identified distributors remove product from the Canadian market. As such, the websites (www.miracle-mineral-supplement.com and www.mms1.ca) may or may not be operational. (Blogger's Note: the first website is still operational, the second website 'not found' - updated 11:14pm Feb 25th)

open access: Impact of electronic medical record on physician practice in office settings: a systematic review

Impact of electronic medical record on physician practice in office settings: a systematic review:

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

Background:
Increased investments are being made for electronic medical records (EMRs) in Canada. There is a need to learn from earlier EMR studies on their impact on physician practice in office settings. To address this need, we conducted a systematic review to examine the impact of EMRs in the physician office, factors that influenced their success, and the lessons learned.

Results:
For this review we included publications cited in Medline and CINAHL between 2000 and 2009 on physician office EMRs. Studies were included if they evaluated the impact of EMR on physician practice in office settings. The Clinical Adoption Framework provided a conceptual scheme to make sense of the findings and allow for future comparison/alignment to other Canadian eHealth initiatives.In the final selection, we included 27 controlled and 16 descriptive studies. We examined six areas: prescribing support, disease management, clinical documentation, work practice, preventive care, and patient-physician interaction. Overall, 22/43 studies (51.2%) and 50/109 individual measures (45.9%) showed positive impacts, 18.6% studies and 18.3% measures had negative impacts, while the remaining had no effect. Forty-eight distinct factors were identified that influenced EMR success.
Several lessons learned were repeated across studies:

(a) having robust EMR features that support clinical use;
(b) redesigning EMR-supported work practices for optimal fit;
(c) demonstrating value for money;
(d) having realistic expectations on implementation; and
(e) engaging patients in the process.

Conclusions:
Currently there is limited positive EMR impact in the physician office. To improve EMR success one needs to draw on the lessons from previous studies such as those in this review.

Steven Lewis: This Just In: Systems Designed to Fail, Fail :: Longwoods.com (apology, inquiries, restitution....)

Blogger's Note: Steven Lewis is always worthwhile reading, this particular essay discusses several widely known national traumatic events of which harm was caused to many due to system failures, in part;  Longwoods Publishing (sometimes) requires registration (free/sometimes free)

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Essays -0001

This Just In: Systems Designed to Fail, Fail

Steven Lewis

"First there is the disaster that comes to light long after the fact. Then there is the inquiry. Then there is the scathing report that meticulously unearths the causes of the disaster. Then there is the apology (they're allowed now - it's the law!). Then there is restitution. Finally there is the commitment: never again. And then the same thing happens, somewhere else, again, and again, and again....."

"It is delusional to believe that everything is now out in the open, with nothing more to uncover. It's not just the outliers who cause harm; because medicine is so fraught with unjustifiable variations in practice, it is certain that the errors resulting from "satisfactory" practice far outnumber the misdeeds of the visibly incompetent. The graveyards are filled with anonymous victims whose stories will never surface in a public inquiry." 

open access: Canada - Predictors of Home Care Expenditures and Death at Home for Cancer Patients in an Integrated Comprehensive Palliative Home Care Pilot Program Longwoods - Healthcare Policy

Blogger's Note: see excerpts/notes in italics

Purpose:

Empirical understanding of predictors for home care service use and death at home is important for healthcare planning. Few studies have examined these predictors in the context of the publicly funded Canadian home care system. This study examined predictors for home care use and home death in the context of a “gold standard” comprehensive palliative home care program pilot in Ontario where patients had equal access to home care services.

"....Care at home in the final weeks of life and an adequately supported home death is a goal expressed by most patients with a terminal illness (Higginson and Sen-Gupta 2000 (excerpt from abstract.......Respondents indicated preferences for home death (range 49%-100%), except one study of patients in the care of a continuing care team in London where only 25%-29% of patients wanted a home death, and inpatient hospice was the most favored option.........Only 2 of the studies provided longitudinal data, and 9 of the 18 had major deficits in design or reporting..........) ;

Teirnan et al. 2002 (Blogger's Note: this study was from Dublin and the abstract does not indicate whether cancer patients were included);

Townsend et al. 1990).  

It is also a health system policy imperative (Romanow 2000) (Blogger's Note: no reference/link provided)............."

open access: 2011 Progression-free survival in advanced ovarian cancer: a Canadian review and expert panel perspective | Dr A. Oza | Current Oncology (topics: eg chronic disease, 1st line therapy...)

Blogger's Note: may require registration (free); note also list of useful (international) reference papers

                                                                                        


Ovarian cancer is leading cause of gynecologic cancer mortality in Canada. To date, overall survival ( os ) has been the most-used endpoint in oncology trials because of its relevance and objectivity. However, as a result of various factors, including the pattern of sequential salvage (outdated term)  therapies, measurement of os and collection of os data are becoming particularly challenging. Phase ii and iii trials have therefore adopted progression-free survival ( pfs ) as a more convenient surrogate endpoint; however, the clinical significance of pfs remains unclear. This position paper presents discussion topics and findings from a pan-Canadian meeting of experts that set out to

• evaluate the relevance of pfs as a valid endpoint in ovarian cancer;
• reach a Canadian consensus on the relevance of pfs in ovarian cancer; and
• try to address how pfs translates into clinical benefit in ovarian cancer.
  
  
  ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Recommendations for future investigations include these:

• Ensure that trials are designed to evaluate pfs , os , and other clinically relevant endpoints such as disease-related symptoms or qol .
• Incorporate interim futility analyses intended to stop accrual early when the experimental regimen is not active.
• Stop trials early to declare superiority only when compelling evidence suggests that a new treatment provides benefit for a pre-specified clinically relevant endpoint such as os or symptom relief.
• Importantly, discourage early release of secondary endpoint results when such a release might increase the frequency of crossover to the experimental intervention.

2011 Cancer System Performance Report-Canadian Partnership Against Cancer

Blogger's Note: 

a specific search of the entire document 'ovary'/'ovarian' found 2 results in the form of references below: 

115.   Du Bois A, Rochon J, Lamparter C, Pfisterer J. 

Pattern of care and impact of participation in clinical studies on the outcomeof ovarian cancer.   Int J Gynecol Cancer. 2005;15:183-191.

("The purpose of this study was to evaluate the pattern and quality of care for ovarian cancer in German") 

                                       ~~~~~~~~~~~~~
116.  Du Bois A, Reuss A, Pujade Lauraine E, Harter P, Ray CoquardI, Pfisterer J.

Role of surgical outcome as prognostic factor inadvanced epithelial ovarian cancer: A combined exploratory analysis of 3 prospectively randomized phase 3 multicentertrials. Cancer. 2009;115(6):1234-1244. 

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January 30, 2012

Measuring the performance of cancer control to maximize impact
The Partnership releases 2011 Cancer System Performance Report

Measuring the performance of the cancer system provides information that will inform initiatives to optimize quality in cancer control. The Partnership's System Performance Initiative is a collaboration with national and provincial partners to develop a consistent approach to evaluate, compare and identify areas for improvement across Canada's cancer control continuum. As part of this initiative, the Partnership is pleased to release the 2011 Cancer System Performance Report, an annual publication that helps shape this work.

Read more here.

Click here to read or download the 2011 System Performance Report. (pdf automatic download)

 ...............................................................................................

About the 2011 Report

This 2011 Report is the Partnership’s third report on the performance of the Canadian cancer system. The first two reports were produced in 2009 and 2010. As in the previous reports, this year’s is organized along the
dimensions of the cancer control continuum: Prevention, Screening, Diagnosis, Treatment, Research, Patient Experience (previously Supportive Care and Survivorship), and Long-Term Outcomes. Also bundled with the 2011 Report is Lung Cancer in Canada: A Supplemental System Performance Report.

A chapter titled Developmental and Interim Indicators has been added this year and includes indicators that are still under development and require some additional refinement or validation before they can be included as
performance indicators. This chapter also includes indicators that are not the preferred measures of performance or the specific domain but that are still useful to show until better indicators become available. Interim indicators
are also included because they are used internationally and allow for inter-jurisdictional comparisons.

open access: Jan 2012 Archives of Pathology & Laboratory Medicine Online - The Practice of Pathology in Canada: Decreasing Pathologist Supply and Uncertain Outcomes

Abstract (and full text):  

Context.—

Pathology organizations in the United States are preparing for a new era of health care reform. Trends in the supply of pathologists in Canada's managed care system may provide some useful insights in any analysis and projection of future pathologist needs in the United States.

Objective.—In this study, population-based Canadian databases were used to devise a parameter for physician supply, cancer cases per physician. The trend in this supply parameter for pathologists was compared to that for radiation oncologists.


Results.—
The annual number of new cancer cases increased from 129 300 to 171 000 from 1999 to 2009. The absolute numbers of both pathologists and oncologists also increased in this time period. However, while the increase in the number of radiation oncologists led to an 8.2% decrease in cancer cases per radiation oncologist, the modest increase in the number of pathologists led to an increase of 17.1% in cancer cases per pathologist.

Conclusions.—

There is a trend toward a decreasing supply of Canadian pathologists relative to that of cancer demands. This finding confirms an earlier population-based study showing a decreased supply relative to population and number of clinical physicians. It is uncertain whether this decreased supply is a result of appropriate application of new, efficient methods or whether health care has been rationed or adversely impacted. Outcome measures to monitor Canadian pathology practice quality are clearly needed.

Commentary to article Gilbert (Dove Project) - Early detection of ovarian cancer in symptomatic women : The Lancet Oncology

The Lancet Oncology, Early Online Publication, 17 January 2012

doi:10.1016/S1470-2045(11)70405-3

Early detection of ovarian cancer in symptomatic women

JR van Nagell a

"Since Goff and co-workers1 first reported that many women with ovarian cancer have symptoms of abdominal bloating, early satiety, pelvic pain, and urinary urgency, frequency, or both, questions have arisen as to whether assessment of these symptoms could lead to earlier detection of this cancer. The Diagnosing Ovarian Cancer Early (DOvE) pilot project reported in The Lancet Oncology by Gilbert and co-workers2 seeks to answer this question. Clinical examination, measurement of CA-125 concentrations in serum, and transvaginal ultrasonography (TVUS) were used in 1455 women older than 50 years who had symptoms associated with ovarian cancer. 11 ovarian cancers were detected, which yielded a prevalence of one per 132 women (0·76%), or about ten times that observed in screening studies in the USA, UK, and Japan.3—5."

"Whether assessment of symptomatic women with multiple methods will lead to detection at earlier stages or increase survival needs to be tested in larger numbers of cases. That the assessment algorithm used in the DOvE project identified most patients with symptomatic ovarian cancer when their disease was still resectable, however, is encouraging. Optimum cytoreduction is associated with a notable survival advantage in patients with ovarian cancer, and was achieved in eight (73%) of 11 women in the study group versus 33 (44%) of 75 women in a control group of patients with ovarian cancer who had been referred to a local gynaecological oncology clinic (p=0·075). The degree of cytoreduction, however, also depends on factors other than tumour burden, including the location of disease and experience of the surgeon. To continue this project beyond the pilot phase, it will be important to document disease substage and note tumour volume before debulking (in study and control cases) to establish whether assessment-driven interventions affect tumour burden. Although the DOvE algorithm successfully identified 11 cases of ovarian cancer, 1444 (99.2%) symptomatic women did not have ovarian cancer. In the next phase of this study, the positive and negative predictive values of each symptom must be critically assessed to identify the profile of highest risk. Additionally, the duration of symptoms before ovarian cancer detection should be recorded for the study and control populations. In this way, it should be possible to investigate whether a public education campaign alters the time from symptom onset to detection of disease in patients with ovarian cancer."
..................................................................................................................

Assessment of symptomatic women for early diagnosis of ovarian cancer: results from the prospective DOvE pilot project

Prof Lucy Gilbert MD et al

abstract: Variation and Consternation: Access to Unfunded Cancer Drugs in Canada

".... The majority of respondents felt all methods of accessing unfunded intravenous cancer drugs should be available (76% in their own center; 60% in private clinics) and used these methods to access these medications (81% in their own institution; 62% in private clinics)...."



Conclusion:
Access to effective but unfunded cancer drugs varies across Canada. Policymakers need to consider whether this is consistent with articulated values of the system and whether currently planned processes address these inconsistencies. Key stakeholders need to consider the merits of the different means of accessing these drugs to appropriately and fairly integrate access into publically funded health care systems like that of Canada and other systems like that of the United States, which could face similar limits in the future.

The Elephant in the Canadian Health Care System | thepatientfactor.com

video: Patient Safety Advocates Talk About the Bureaucracy in Canadian Health Care - Leslie Worthington/Val Lee - Winnipeg

1)  video: Sisters Leslie Worthington and Val Lee (Winnipeg)
The Patient Factor.com

2)The Patient Factor: Leslie Worthington "Her Father's Voice"

video: A Patient Safety Advocate Talks About Transparency and Accountability in Canadian Health Care - Alice Little (Winnipeg)

The Patient Factor.com

Essay - Steven Lewis - The Fraser Institute Wait Time Reports: Madness in the Method, but Method in the Madness :: Longwoods.com

Essays 2011

The Fraser Institute Wait Time Reports: Madness in the Method, but Method in the Madness

Steven Lewis

"The answer lies in its (The Fraser Institute) mission statement, helpfully reproduced at the end of the wait times report: “Our vision is a free and prosperous world where individuals benefit from greater choice, competitive markets, and personal responsibility.” Public health care sucks because it must suck, because it’s public. Therefore, let’s gather skewed estimates on a hot-button issue, retail them as hard data, and lure Canadians toward the promised land of private medicine."

Canada: Cancer wars: are we winning? - Health - CBC News

....But trying to answer the question of whether the war on cancer is being won means stepping into a contradictory tangle of statistics, anecdotes, hopes and fears.....

Clifton Leaf, author of an article in Fortune magazine called "Why We're Losing the War On Cancer," is one of the beneficiaries of the success against certain cancers affecting children.......
Leaf focuses on actual death rates, which haven't budged much in decades for the diseases that tend to be the hardest to treat: lung cancer, pancreatic cancer, liver cancer.

Ottawa cancer rates highest in Ontario - Health - but best breast cancer survival ratesCBC News

media: Canada: Leaving health care to provinces a dangerous strategy, Romanow says (eg. the political wars of healthcare)

Canadian Medical Association Journal: Nothing cutting edge about Canadian ehealth strategy, critics say

Blogger's Note: note the 'PC" reference to the billion dollar e-health scandal