Prevention should be the preferred insurance program for all physicians.

Recent fee increases announced to the Canadian Medical Protective Association (CMPA) and the Ontario government''s plan to stop its CMPA rebate program for the province''s physicians have put the spotlight on medical liability insurance. In this examination of the role played by the CMPA, Ottawa lawyer Karen Capen notes that quality service and attention to physician-patient communication will in most cases ensure a litigation-free professional life.     

Humane handling of end-of-life issues the aim of program at U of O medical schools.

The University of Ottawa medical school has launched a program to help students deal with end-of-life issues. One of its speakers is a cancer patient upset with a physician''s handling of his case. Organizers hope to gauge the impact of the program through a study of its effectiveness.     

Weep for Adonais

A 1995 motor-vehicle crash brought a tragic end to the promising medical career of Michael Agapitos, a specialist in physical medicine and rehabilitation who graduated from the University of Ottawa in 1982. The death of the popular young Ottawa physician and the subsequent court case involving the driver of the other vehicle have had a major impact on the victim''s family and patients, Nicole Baer reports.     

Tailoring family medicine residency programs to meet community needs

This paper describes how members of the Department of Family Medicine of the University of Ottawa developed lists of problems and procedures common and important in family practice in Canada and, on the basis of these lists, drew up guidelines for content in the 2-year residency program for family medicine. A computerized data retrieval system is used to monitor every resident''s practice to ensure that he or she gains appropriate exposure to common problems and procedures.     

Cervical cancer screening: are the 1989 recommendations still valid? National Workshop on Screening for Cancer of the Cervix.

Although screening for cervical cancer has been shown to be effective in reducing the morbidity and mortality associated with this disease, and despite many attempts to encourage the development of provincial programs, as of 1995 no province had a comprehensive screening program for cervical cancer. Participants at the Interchange ''95 workshop, held in Ottawa in November 1995, reviewed the recommendations of the 1989 National Workshop on Screening for Cancer of the Cervix and identified factors that have impeded their implementation. Participants discussed the need for comprehensive information systems, quality control and strategies to increase recruitment of unscreened and underscreened women. They concluded that the formation of a Cervical Cancer Prevention Network involving key stakeholders will facilitate the development and implementation of provincial programs to ensure optimal screening. They agreed that, in the interim, recommendations for practising physicians should remain as they were following the 1989 workshop.     

CMA conference to look at role research plays when critical policy decisions are being made

Physician leaders will meet in Ottawa Feb. 28 and Mar. 1 for the CMA''s 9th Annual Leadership Conference to examine how evidence, research and data influence health policy. For information or to register contact CMA Meetings and Travel Department, 800 663-7336, ext. 2274; fax 613 731-8047.     

The private sector invades medicare's home town

If Canada''s medicare system has a home town it is probably Ottawa, where the system was first welded together 30 years ago. Charlotte Gray reports that there is a certain irony now that examples of private health care are sprouting up in the nations''s capital.     

The National Forum on Health is talking,but is anybody listening?

The federal government''s National Forum on Health is organizing a series of discussion groups across the country to focus on problems facing Canada''s health care system. Although a great deal of time and money is being spent on this and other forum projects, Charlotte Gray asks whether anyone is listening. She says many provincial governments are treating the forum with “elaborate disdain” and the only governments that appear willing to give it a chance to work are found in have-not provinces that rely on Ottawa for handouts in the form of transfer payments.     

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.     

Medical fund took off like a rocket,but will budget bring it down to earth?

In 18 months the Canadian Medical Discoveries Fund (CMDF) has attracted investments worth $180 million to spend on biotechnology and medical research. Although eight initial investments totalled only $9.7 million, Dr. Cal Stiller, chair and CEO of the fund''s management corporation, says there are many good Canadian-based technology firms and research projects that merit investment. Examples include a London, Ont., firm that is bringing a 3-D ultrasound-imaging system to market, and world-class genetics research at the University of Ottawa. However, the federal government recently changed tax rules for venture-capital funds, making them less attractive to investors. How will this affect the effort to build a health-research industry in Canada?     

Young Children's Probability of Dying Before and After Their Mother's Death: A Rural South African Population-Based Surveillance Study

Background

There is evidence that a young child''s risk of dying increases following the mother''s death, but little is known about the risk when the mother becomes very ill prior to her death. We hypothesized that children would be more likely to die during the period several months before their mother''s death, as well as for several months after her death. Therefore we investigated the relationship between young children''s likelihood of dying and the timing of their mother''s death and, in particular, the existence of a critical period of increased risk.

Methods and Findings

Data from a health and socio-demographic surveillance system in rural South Africa were collected on children 0–5 y of age from 1 January 1994 to 31 December 2008. Discrete time survival analysis was used to estimate children''s probability of dying before and after their mother''s death, accounting for moderators. 1,244 children (3% of sample) died from 1994 to 2008. The probability of child death began to rise 6–11 mo prior to the mother''s death and increased markedly during the 2 mo immediately before the month of her death (odds ratio [OR] 7.1 [95% CI 3.9–12.7]), in the month of her death (OR 12.6 [6.2–25.3]), and during the 2 mo following her death (OR 7.0 [3.2–15.6]). This increase in the probability of dying was more pronounced for children whose mothers died of AIDS or tuberculosis compared to other causes of death, but the pattern remained for causes unrelated to AIDS/tuberculosis. Infants aged 0–6 mo at the time of their mother''s death were nine times more likely to die than children aged 2–5 y. The limitations of the study included the lack of knowledge about precisely when a very ill mother will die, a lack of information about child nutrition and care, and the diagnosis of AIDS deaths by verbal autopsy rather than serostatus.

Conclusions

Young children in lower income settings are more likely to die not only after their mother''s death but also in the months before, when she is seriously ill. Interventions are urgently needed to support families both when the mother becomes very ill and after her death. Please see later in the article for the Editors'' Summary     

Ottawa researchers enter home stretch in race to produce artificial heart

An Ottawa team is in a fierce race to produce an artificial heart. If it wins, the prize will be huge: a worldwide market worth billions of dollars. The team, led by Dr. Tofy Mussivand, brings together scientists and entrepreneurs. The goal is to produce a heart that improves patients'' quality of life and doesn''t leave them tethered to a machine in hospital. Current plans are to complete clinical tests by 2000 and to have a commercial product ready for market in 2001-2. Several other groups are also racing the clock.     

Jane Fulton: Cat among the pigeons?

Few bureaucratic appointments have raised as many eyebrows as the announcement that controversial health economist Jane Fulton would become Alberta''s deputy minister of health. A staunch supporter of private health care, Fulton joins the Alberta ministry just as Premier Ralph Klein''s Progressive Conservatives gear up for a battle with Ottawa over two-tier medicine.     

An artificial heart with the right connection.

Led by Dr. Tofy Mussivand at the University of Ottawa Heart Institute, a team of Canadian medical scientists, engineers, economists, physicians and medical devices manufacturers is working to bring a prototype artificial heart closer to clinical trials. Key to this effort is the development of an electrical connector that can function for a long period in the harsh environment of the human body. Such a connector will enable various components of the artificial heart, such as the internal battery, to be replaced independently. As well as being of obvious benefit to people with end-stage heart disease, a Canadian-made artificial heart has export potential that should help to redress the country''s large trade deficit in medical devices.     

Furious passion confronts the cool logic behind a CEO's hospital appointment

First, Ontario decided it would close or reduce the operations of 3 Ottawa hospitals and combine 2 others. When the board for the combined hospital named a Parti Québécois confidant the new hospital''s CEO, it hoped David Levine''s background would go unnoticed. As Charlotte Gray reports, it didn''t, and Levine became the lightning rod for a lot of anger.     

Rh immunization in Manitoba: progress in prevention and management.

For two decades the perinatal mortality caused by erythroblastosis has been decreasing in Manitoba. The improved management of Rh-immunized pregnancies has lowered the death rate among affected infants from 10.8% to 3.4%, while the prevention of Rh immunization has reduced its incidence from 9.1 to 2.2 per 1000 total births. In its first 6 years and 8 months Manitoba''s antenatal prophylaxis program, in which immunoglobulin is administered to Rh-negative women at 28 weeks'' gestation, reduced the incidence of Rh immunization during pregnancy by 93%. In combination with post-abortion and postpartum prophylaxis the antenatal treatment has provided a protection rate of 98.6% among primigravidas at risk. Further improvements are expected.     

Innovative HIV/AIDS program launched in Ottawa.

Collaboration among 31 social and health care agencies and the provincial government has resulted in an innovative program for Ottawa-area patients with HIV infection or AIDS. The target group is the homeless and people with "unstable" housing who live in the city''s downtown core, a group at high risk of contracting HIV. The education of family practitioners will be an important part of the program.     

Nurse Practitioner and Physician's Assistant Clinics in Rural California: Part I: Issues

The primary health care needs of at least 26 rural California communities are being served by nurse practitioners (NP''s) or physician''s assistants (PA''s). All of these have physician supervision and support. NP''s and PA''s have proved to be acceptable and effective. With 230 rural areas in California identified as having unmet health care needs, this type of service is likely to increase and should be supported.NP/PA clinics serve total populations or concentrate on Indians, Chicanos or the poor. Many barriers have been overcome, especially over the past four years, to allow these clinics to flourish and increase in number. The availability of nurse practitioners and physician''s assistants has increased due to support to schools and to school policies. Clinic funding has greatly improved; federal funds for general rural clinics, Indians, migrants, family planning and maternalchild health have been greatly supplemented by California state funds. Beginning in 1978, rural NP and PA services can be reimbursed by Medicare and Medi-Cal (California''s Medicaid program).Since 1975 state laws have defined PA and NP roles broadly, and these roles are more precisely defined at the local level. Although nurse practitioners and physician''s assistants generally cannot prescribe or dispense drugs (a major problem in many clinics), demonstration legislation allows special pilot projects to do both. As remaining funding and legal problems are corrected, NP''s and PA''s will serve an even greater role in rural areas.     

Prenatal care: a comparative evaluation of nurse-midwives and family physicians

We review various organ procurement strategies from ethical and practical perspectives to understand why these strategies have been relatively unsuccessful. We propose that the CMA recommend the implementation of a required-request policy in hospitals. We also propose a possible new approach in which people from the age of 18 years would voluntarily enrol in an organ donation program, agreeing to permit all usable organs to be taken for transplantation at the time of death. In return they would have priority for receiving organs made available by the program. We believe that this program would save lives, respect the donor''s autonomy and satisfy the principles of justice and beneficence.