Will hospital closures mean physician unemployment in Ontario?

Dr. Duncan Sinclair, the former dean of medicine who heads the commission charged with restructuring Ontario''s health care system, said something dramatic was needed to revamp the system. He wasn''t kidding. His commission recently called for the closure of 3 hospitals in Ottawa and 10 more in Toronto. In a wideranging interview with Charlotte Gray he talks about the commission''s goals and their potential impact on physicians.     

Infant feeding practices: 1984-85 versus 1977-78.

In 1979 and 1980 the Canadian Paediatric Society''s Nutrition Committee published guidelines for professionals counselling mothers of infants on feeding practices. The practices in 1984-85 of mothers in Toronto were determined for comparison with the practices identified in a similar study conducted in Toronto and Montreal in 1977-78 to ascertain if practices had changed in favour of the recommendations. Between July 1984 and February 1985, 404 metropolitan Toronto mothers of infants were interviewed. Compared with the 1977-78 group of mothers, more of the 1984-85 mothers had chosen to breast-feed and fewer had stopped breast-feeding in the first month. As well, fewer of the 1984-85 infants had been fed unmodified cow''s milk in the first 6 months of life and introduced to solid foods before 4 months of age. We conclude that major changes in infant feeding practices had occurred since 1977-78 and that the 1984-85 practices corresponded closely to the infant feeding guidelines.     

Toronto centre hopes to cash in on growing demand for private health services

When the CMA held its 1996 annual meeting, part of the debate on the future of health care involved the "appropriate balance of the roles of the public and private sectors" in delivering health care. The King''s Health Centre in Toronto is now doing its own balancing act: providing publicly funded care to Canadians, and private care to non-Canadians and Canadians who can afford it. This article discusses some of the niche markets King''s is attempting to develop.     

Eminent pathologist,educator—surgeon and ethicist receive CMA honours

During the CMA''s 128th annual meeting in Winnipeg in August, 33 physicians were awarded senior membership in the association and 2 physicians and an ethicist were honoured for their outstanding contributions to medicine. Pathologist Donald Penner of Winnipeg was awarded the CMA''s highest honour, the F.N.G. Starr Award. Toronto surgeon and educator Donald Wilson received the Medal of Service, and Montreal ethicist David Roy was awarded the Medal of Honour.     

Issues in determining financial competence in the elderly.

With the ever-increasing numbers and relative proportion of elderly in the population, physicians are now frequently facing the difficult task of determining the financial competence of vulnerable individuals. The determination of financial competence in the elderly is still a very poorly defined issue. In this paper an attempt is made to clarify the existing law and the physician''s legal obligations. The Mental Health Act, Powers of Attorney Act and Mental Incompetency Act, as they relate to a patient''s financial competence, are reviewed. The difficulties in the clinical application of these laws are illustrated by two reports of patients referred to the geriatric psychiatry service of Sunnybrook Medical Centre, University of Toronto. Some general principles and practical guidelines are proposed to help physicians deal more effectively with this issue.     

Multiculturalism and AIDS: different communities mean different educational messages required

Having a multitude of different ethnic communities forces Canada''s AIDS educators to use many different methods to deliver their messages. These range from an AIDS bingo game that has been used to educate natives in northern Manitoba to attempts to take AIDS education to the streets of Toronto. With AIDS education, reports Olga Lechky, one message definitely does not fit all.     

The World Medical Association: can hope triumph over experience?

The World Medical Association was set up in 1947 in the wake of outrage about war crimes committed by doctors in Hitler''s Germany. For nearly 50 years it has lurched from one controversy to another, arguing within itself about its funding, its voting system, and the representativeness and political affiliation of some of its member medical associations. The BMA withdrew from the association in 1984, supporting a breakaway "Toronto" group including Canada, the Scandinavian countries, the Netherlands, Ireland, and Jamaica. All but Britain and Jamaica have now rejoined and membership is growing, but the association is still struggling to gain credibility and clout. After 20 years of part time stewardship the recent appointment of a new full time secretary general has fuelled expectations that internal reforms will be implemented, and the WMA''s standing and profile improved.     

Regional program for the study of glomerulonephritis. Central Committee of the Toronto Glomerulonephritis Registry.

The Toronto Glomerulonephritis Registry, a regional program for studying the natural history of the different types of glomerulonephritis and the effects of drug therapy on them, was established 6 years ago in Toronto. Data for all patients with histologic evidence of glomerulonephritis seen at the 16 participating hospitals are collected on standard forms and stored in a computer. Randomized controlled trials of different types of therapy for five types of glomerulonephritis have been started under the coordination of the central registry. In view of the registry''s low cost and high potential benefit, greater support for such projects is needed. Other centres should consider establishing similar registries to promote more rapid collection of cases and thus allow better evaluation of the development and treatment of this major cause of renal failure.     

Cost analysis of the Kozak protocol as used in an Ontario hospital in the treatment of children with epidermolysis bullosa.

Conventional treatment of epidermolysis bullosa is often unsuccessful. The Kozak protocol is an alternative that has been given considerable public support in Ontario. The incremental cost of this treatment program at the Hospital for Sick Children, Toronto, was examined. The departments of nursing, pharmacy and food services each kept records of salaries and supply costs applicable to the care of nine patients with epidermolysis bullosa who were treated in the fiscal year 1982-83. The selected direct costs to the hospital were compared with the projected costs if these patients had been treated in Dr. Kozak''s clinic in West Germany or under the financial arrangements offered to Dr. Kozak by the Ontario minister of health. At a total incremental cost of +255.92 per patient-day, care at the Hospital for Sick Children may not currently be the least expensive means of offering the Kozak protocol to Ontario children. However, the major expense of the program, the nurses'' salaries, could be reduced if the patients'' parents were to assume many of the nursing tasks; this would make the hospital''s program the most cost-effective method of treating children with epidermolysis bullosa.     

Smallpox and its control in Canada

Edward Jenner''s first treatise in 1798 described how he used cowpox material to provide immunity to the related smallpox virus. He sent this treatise and some cowpox material to his classmate John Clinch in Trinity, Nfld., who gave the first smallpox vaccinations in North America. Dissemination of the new technique, despite violent criticism, was rapid throughout Europe and the United States. Within a few years of its discovery, vaccination was instrumental in controlling smallpox epidemics among aboriginal people at remote trading posts of the Hudson''s Bay Company. Arm-to-arm transfer at 8-day intervals was common through most of the 19th century. Vaccination and quarantine eliminated endemic smallpox throughout Canada by 1946. The last case, in Toronto in 1962, came from Brazil.     

Hospitals' response to the buckle-up baby legislation in Ontario.

Drivers in Ontario are legally responsible to ensure that infants and toddlers are restrained in a child safety seat or by a lap belt. In 1982 the minister of health sent a memorandum to all medical officers of health and the administrators and medical directors of all public hospitals in Ontario, urging them to encourage and assist parents in protecting their newborn children with safety seats. In 1983 the Toronto General Hospital established the Cooperative Hospital Infant Restraint Program (CHIRP) to study the feasibility of a "loaner" program for hospitals in metropolitan Toronto. The authors describe CHIRP and its objectives. They also report the results of a questionnaire they sent in 1984 to all Ontario hospitals that had a newborn or pediatric service to assess their response to the minister''s memorandum.     

Dietary Management of the Malabsorption Syndrome

The purpose of this report is to emphasize the importance of strict dietary control of patients suffering from the malabsorption syndrome and to announce the availability of a gluten-free bread-substitute, called “Unimix”, from the Scientific Development Committee, Room 14, Medical Building, University of Toronto. Science a gluten-free diet is difficult to follow because of the widespread use of wheat flour and other cereals in the production of many common foods, a suggested gluten-free meal pattern is presented, which conforms with Canada''s Food Guide and permits a number of choices of menu within certain limits.     

Physician-patient privilege: the legal assault continues.

The confidentiality of patient records, particularly in cases where sexual assault is alleged, has been called into question by two recent Supreme Court decisions. Toronto lawyer Marilou McPhedran discusses the recent Beharriell and O''Connor decisions and how they affect physicians.     

Natural History of Isolated Patent Ductus Arteriosus and the Effect of Surgical Correction: Twenty Years' Experience at The Hospital for Sick Children,Toronto

Seven hundred and forty-four cases of patent ductus arteriosus were diagnosed at The Hospital for Sick Children, Toronto, in the 20-year period from 1947 to 1966. Of these 705 have been treated surgically. It is concluded that operation is best performed between 6 and 12 months of age. Isolated ductus arteriosus is rarely a cause of congestive heart failure, and is more likely to be so in the presence of the rubella syndrome. Failure associated with the anomaly in the neonatal period can usually be successfully managed by medical treatment. Spontaneous closure after one month of age is not to be expected. Surgical treatment at the appropriate time prevents the subsequent development of Eisenmenger''s complex.     

Leaner health care budgets prompt hospitals to Toronto area to pool resources.

Tighter health care budgets are prompting dozens of hospitals in the Toronto area to work together to become more efficient and save money. Projects range from sharing physicians'' expertise to combining forces to make equipment purchases. As budgets become tighter, more large-scale projects are likely.     

Arteriosclerotic femoral artery aneurysms.

Arteriosclerotic aneurysms of the femoral artery are uncommon lesions that occur in elderly men. In 30 patients 36 aneurysms were repaired at the Toronto Western Hospital from January 1965 to June 1977. Half of the patients presented with ischemia and one quarter with an enlarging mass, and one quarter had no symptoms. Two thirds had other aneurysms and one third had suffered from cerebral or myocardial ischemia. The technique of repair changed from reconstructive aneurysmorrhaphy before 1970 to use of an interposition arterial prosthesis thereafter. Minimal groin dissection, internal control of blood flow in the deep femoral artery, and use of an appropriate arterial prosthesis provided excellent results. Surgical repair is recommended for most symptomatic ones when the patient''s life expectancy is more than 2 years.     

Toxicological Statistics for Barbiturates,Other Sedatives,and Tranquillizers in Ontario: A 10-Year Survey

A steady increase in the number of cases of poisoning due to barbiturates, tranquillizers and non-barbiturate sedatives has been noted for Ontario by the Attorney-General''s Laboratory, Toronto, during the period 1955-1964 on the basis of submitted material. Five cases of poisoning by barbiturates were recorded in 1955 and 193 in 1964.Urine and blood samples from persons charged with driving motor vehicles while under the influence of drugs were also examined. In 1958 only one such case was reported to the Laboratory, whereas 25 cases were recorded in 1964; barbiturates were detected in 18 of these 25. Patients must be warned of the risks of ingesting alcohol while receiving barbiturate treatment.     

Cerebrovascular disease in children

The stroke syndrome in adults encompasses a limited number of lesions occurring over an extended age-span. In children the syndrome includes a wide variety of lesions seen in only one and one-half decades. This general review examines common aspects of the syndrome as it is seen in children. Attention is paid to cerebrovascular occlusive disease, arteriovenous malformations, intracranial aneurysms, spontaneous intracerebral hematomas and cerebrovascular complications of cardiac surgery. Conclusions are based on the authors'' experience in treating patients in the Hospital for Sick Children, Toronto     

Graduate Education in Medical Microbiology: A Report of Five Years' Experience with the Course Leading to the Diploma in Bacteriology,University of Toronto

During the last five years, 48 graduates have taken the formal Diploma in Bacteriology course offered by the School of Hygiene, University of Toronto. This course provides instruction by lectures, seminars, and practical work in bacteriology, virology, immunology, parasitology, sanitary bacteriology, and statistics. A graduate course of this type presents many advantages as it is possible to cover a considerable area of knowledge in the relatively short space of one academic year. Of the 48 students, 23 held degrees in medicine, and 25 in veterinary science, arts, or science. Eleven diplomates continued further formal studies by enrolling in Master''s or Ph.D. programs. Twenty diplomates are now engaged in university teaching in Canada or overseas. Almost all of the remaining 28 are employed in hospital, public health, or veterinary laboratories.