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Investigating the truth behind sports drinks

Rhodes Scholarship recipient Braden O’Neill is a third-year MD student at the University of Calgary currently on a leave of absence to study at the University of Oxford in the Department of Primary Care Health Sciences.  

The Rhodes Scholarship, often dubbed the world’s most prestigious scholarship, is a postgraduate award supporting exceptional students and the academic elite. The scholarship includes tuition, college fees, and a stipend covering living expenses for two to three years of study at the University of Oxford. O’Neill is the 11th University of Calgary student to receive the scholarship since 1969. Once he has completed his studies at Oxford, he will return to the University of Calgary to complete his MD degree.


With the Olympics nearly upon us, and the Tour de France just having wrapped up, sport performance is the hot topic right now. Even our office here in Oxford – normally a hotbed of discussion about relative risks and numbers needed to treat – is abuzz with talk of who has tickets to what, and if Usain Bolt is really going to repeat his titles in the 100m and 200m.

A combination of Olympic fever and recent reports that being sedentary is really bad for us has people all over dusting off their runners and racquets and deciding to get back in shape.

And after a long workout there’s nothing quite like a specially-formulated sports drink to replace those electrolytes and help you recover.

Whether it’s ‘faster, stronger, for longer’, ‘enhances recovery’, or ‘gives you that extra boost’, sports product marketing is everywhere. Even the official drink of the Olympics this year is Powerade, whose ads claim that ‘Water is Not Enough’.

One of the research groups I work with here – the Centre for Evidence-Based Medicine – recently completed a study on sports performance products which I had the great privilege of being a part of. What we found didn’t quite support all those bold claims.

You can see the series of studies here – released last Thursday in the British Medical Journal (BMJ) – and we also helped with an hour-long BBC Panorama investigative journalism report on ‘The Truth Behind Sports Products’.

Here’s how this worked:

We poured through magazine adverts and found all the ones about sports products. We then looked at the websites for all these products, and extracted all the evidence that companies report backs up their claims. Then, we contacted all the companies and asked them if they agreed that they were making certain claims, and asked if they had any more evidence to back them up. There were lots of interesting responses, and you can see all their responses in a web appendix to the articles.

My personal favourite was from Nike, who directed our attention to a video of a shoe with a voice-over of someone explaining how it worked. Dear Nike: in a field where ‘high quality evidence’ means an appropriately powered randomized controlled trial, a video of a shoe doesn’t quite cut it.

Overall, here’s what we found:

Of 431 studies we assessed for quality and risk of bias, there were only three that were of sufficient quality to be able to trust their results. Most of the studies companies reference to underpin their claims are narrative reviews or position papers – in other words, expert opinion, which is the lowest level of evidence.

Then we went a bit further, and looked at specific common sports myths and the evidence behind them:

‘Branched chain amino acids improve performance or recovery after exercise’ No objective performance improvements, but there is decent evidence that people report that they help. (you can decide how to interpret that finding for yourself!)

‘Energy drinks with caffeine and other compounds improve sports performance’ Caffeine improves performance, if you want to abstain from it for seven days before you use it, and only if you are going to be exercising for more than 60 minutes at high intensity.

‘You should drink before you feel thirsty’ Ridiculous. Absolutely ridiculous. Your body is awfully good at regulating this and telling you when you need to drink something. Listen to it.

‘Urine colour to assess dehydration’ Surprisingly useless, unless you have been trained to be able to do this.

‘Compression garments improve performance or enhance recovery’ Maybe, if you want to wear them continuously for 24 hours after a workout.

‘Carbohydrate and protein combinations improve post-workout performance and recovery’ Useless. Stick to delicious Alberta beef instead.

So there you have it, just in time for the Olympics.

Our conclusions? Get some shoes you find comfortable and want to wear, and if you’re thirsty after exercising, have some water.

It’s all in the evidence.

Braden O’Neill
Proud University of Calgary Medicine Student
Email: boneill@ucalgary.ca
Follow me on Twitter @BradenONeill

Categories: Uncategorized

Baby Boomers Facing Hepatitis Time Bomb

By Mark G Swain, MD, MSc, FRCPC
Professor of Medicine and Cal Wenzel Family Foundation Chair in Hepatology
Snyder Institute for Chronic Diseases
Head, Division of Gastroenterology, University of Calgary 

Hepatitis C is a virus which was first identified in 1989. Very quickly it came to be appreciated that hepatitis C was a significant health issue, infecting roughly 250,000 Canadians; a five-fold higher number than are infected with HIV. Hepatitis C is mainly acquired through exposure to contaminated blood; through transfusions and through the use of intravenous drugs. In fact, after exposure to hepatitis C, even after one exposure, up to 85 per cent of people will keep the virus in their bodies for the rest of their lives. Hepatitis C lives in the liver where it multiplies, and as part of its’ life cycle, hepatitis C kills liver cells. In response to these dying liver cells the liver tries to heal itself with scar tissue, and in roughly 20 per cent of infected people after 2-3 decades of infection, the amount of scar tissue in the liver can get to the point where these individuals have developed cirrhosis of the liver. Many people believe that excessive alcohol intake is the cause of liver cirrhosis; however, there are in fact many causes of cirrhosis, with hepatitis C being an important cause of cirrhosis in Canada.

Typically people infected with hepatitis C have no symptoms, and so they do not suspect that they are infected. Over time they often forget that they have a risk factor for hepatitis C acquisition, and it is not until 20 or 30 years later that they are discovered to have hepatitis C infection, and in many instances have advanced liver scarring. This issue has been recently brought to light by the findings, in a large American study, of a significant increase in the incidence of hepatitis C infection amongst baby boomers (prevalence rate of 3 per cent of people within this age group). This finding in general reflects lifestyle choices made by individuals who lived during the 1960’s and 70’s, when experimentation with injection drugs occurred widely.  Often this experimentation took the form of a single exposure, and was soon forgotten. However, it is becoming increasingly apparent that hepatitis C was acting in a stealth fashion, silently destroying the livers of many of these people.  As a result of this, hepatitis C has now overtaken AIDS as a cause of death. Hepatitis C is currently the most common indication for liver transplantation in Canada; however, as a result of organ shortages up to 20 per cent of people with hepatitis C-related liver failure will die waiting for a liver transplant. In addition, hepatitis C-related cirrhosis leads to the development of liver cancer in up to 3 per cent of infected people per year.

Despite these concerning statistics, not all is doom and gloom for these baby boomers. Treatments for hepatitis C have made astounding breakthroughs through research over the past few years. Specifically, just recently Health Canada has approved 2 new therapies which, when combined with standard treatment protocols, can cure hepatitis C in up to 75 per cent of people infected with the most common type of hepatitis C in Canada. Unfortunately, these new therapies are very expensive, potentially limiting access to those infected and in need of treatment most. In Calgary we are fortunate to have a world leading Hepatitis Unit, located in the Snyder Institute of Chronic Disease at the University of Calgary, which has specialized expertise in the treatment of hepatitis C and its’ complications, providing those infected with leading edge hepatitis C care.

This column was written in response to a study from the US Centers for Disease Control and Prevention (CDC), published in the February 21 2012 issue of the Annals of Internal Medicine.

The research paper can be found here: http://www.annals.org/content/156/4/271.abstract

Categories: Uncategorized

Impressions from rural Laos

By:

Robert G Lee MD
Professor Emeritus
Department of Clinical Neurosciences

The district hospital at Virabouly, the site of a gold and copper mine started by Australians - and now taken over by Chinese.

In January 2012 my wife and I spent one month in Laos as part of the University of Calgary – Laos partnership project to improve medical education and train family doctors to serve in the rural areas of Laos. The family medicine training program has been very successful and has now produced more than 100 new family doctors in Laos since its inception in 2006. Most of my time during this visit (my 16th trip to Laos since 1999) was spent in the southern city of Savannakhet (SVK), one of the provincial training sites for the family medicine (FM) program, where I worked with other colleagues from Calgary and our Lao partners to conduct the end of year evaluations for first- and second-year FM residents. I also helped the Lao teachers conduct the orientation for the new batch of residents who are just starting the program.

Since a substantial part of the FM training takes place in rural villages and district hospitals, we were interested in visiting some of these sites. For three days in late January we travelled to the eastern regions of SVK province with Dr. Phetvilay, a remarkable young woman who was one of the first graduates from the FM program and who now serves as the coordinator for family medicine training at the SVK provincial hospital.

We visited four district hospitals.  Family Medicine graduates are working at three of them. Our first stop was at Phalansay,  Phetvilay’s home town – about two hours east of SVK city. This is the place where dinosaur footprints and some fossils have been discovered and we learned that it was Phetvilay’s father who actually first discovered the footprints and arranged for French paleontologists to start investigating.

From there we headed farther east to Phine where we stayed overnight. There is a district hospital there which has been renovated with funding from CIDA. It is clean and well maintained with mostly single rooms and en suite toilets for the patients – something we have not seen before in Laos. The hospital director is the only doctor but he has three medical assistants working with him, one of whom has some training in anesthesia so they are able to do Caesarians and other emergency surgery. It would be an ideal place for a family medicine grad to start working.

The OSCE exams for family medicine residents. Dr. Noot (in the background) is role playing as a mother with a child who has had a febrile seizure

The next day we travelled up part of the old Ho Chi Minh trail to a town called Virabouly where there is a district hospital with one of the FM grads working there.  Along the road to this town we passed several  Lao Teung villages, one of the ethnic minority groups in that part of Laos. We stopped at one of these villages to look around and take some photos. It was interesting to note that there seemed to be only one man in the village who spoke Lao and was able to communicate with Phetvilay. The poverty was even more obvious than what we have seen in other parts of rural Laos. We had a long discussion about this after we left and I asked Phetvilay what she would do if she were a senior government official and had a lot of money to improve the standard of living in villages like this. Without any hesitation she said she would put it into education. She said that as long as people in villages like this remain uneducated things will not change.

Our next stop was in Sephone where there is a good district hospital which has been renovated with assistance from Belgium. We met the director who took us on a tour of the hospital, and it was an impressive facility. One of the FM grads is working there but he was not around at the time of our visit.

From there we headed on to the Vietnamese border where we had lunch. This part of Laos is mostly scrub bush with no large trees – a reminder of the extensive defoliation from agent orange and other chemicals used by the Americans during the war. Along the way we had an interesting lesson from our driver on the different types of development assistance. The road from SVK city to Sephone is in terrible condition – full of potholes and broken pavement. From Sephone to the Vietnam border the road is as good  as the Transcanada  from Calgary to Canmore. Our driver told us that the eastern section had been built with assistance from Vietnam who sent in their own engineers who supervised the construction. The section from Sephone west to SVK city was built with assistance from Japan which gave the money to Laos and let them do it on their own  – draw your own conclusions!

One of the family medicine grads in the OR at the Virabouly District Hospital

The following day we visited another district hospital at Songkhone, a town about 70 km south of SVK city. This is a fairly new hospital which was built about five years ago with funding from JICA (Japan). The director and one of the FM grads who works there took us on an extensive tour. This is an impressive facility – like the hospital at Sephone, they do about 50 deliveries and 20 surgical procedures a month, and have a busy out-patient clinic. Both hospitals would be very good training sites for FM residents. Phetvilay thinks that, with the family medicine program expanding to three years, that it might be a good idea to add one or two more district hospitals as training sites – I fully agree.

For more photos, please visit: http://robertlee.smugmug.com/Travel-International/Laos-Jan-2012/21034273_VZX29T#!i=1672300763&k=vMDwQPJ

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I arrived in Oxford under deceptively sunny skies

Rhodes Scholarship recipient Braden O’Neill is a third-year MD student at the University of Calgary currently on a leave of absence to study at the University of Oxford in the Department of Primary Care Health Sciences.  

The Rhodes Scholarship, often dubbed the world’s most prestigious scholarship, is a postgraduate award supporting exceptional students and the academic elite. The scholarship includes tuition, college fees, and a stipend covering living expenses for two to three years of study at the University of Oxford. O’Neill is the 11th University of Calgary student to receive the scholarship since 1969. Once he has completed his studies at Oxford, he will return to the University of Calgary to complete his MD degree.


I arrived in Oxford under deceptively sunny skies. Some of the other Canadians met us upon our arrival, and took our bags and helped us with banal logistics like where to buy bed sheets and soap and plates. After being up for over 30 hours it was a welcome relief to have (somewhat) familiar faces to take care of us on the first day.

It was when I arrived at Rhodes House and saw Adele sitting there that I knew I would be well taken care of.

Many of you may be aware that Adele Meyers is not in fact in Oxford with me, although having benefited from her problem-solving abilities many, many times over the past few years it would be understandable how one might want her to come with. Those of you who are unfamiliar with Adele should know that she is essential to our Undergraduate Medical Education program in Calgary. Most of her work goes on behind the scenes, but what is obvious is that when there is a problem, she ameliorates it with grace and efficiency.

Rhodes House, which is the home and office of the Rhodes Scholarships, also has an Adele – her name is Mary Eaton and she has a similarly indefinable, transcendent role in the organization. Some say that she has worked for MI5 and/or the Queen. This may be quite accurate.

In his seminal biography of Sir William Osler, Dr. Harvey Cushing wrote about how all great institutions have this kind of defining figure, someone who maintains the institutional legacy while sitting comfortably outside its competitive hierarchy. I say this to indicate two things: that we are lucky as medical students in Calgary, and that University of Calgary Medicine is a truly great institution even when compared with some of the very best in the world. I couldn’t provide the first-hand account of this until recently, but I can now say with certainty that it is true.

Now that I am at an appropriately belated point in this post, I will undertake an introduction so that this all makes a bit more sense. My name is Braden O’Neill. I am a third-year MD student at the University of Calgary currently on a leave of absence to study for a DPhil at the University of Oxford in the Department of Primary Care Health Sciences. Yes, this is the same thing as a PhD, but at Oxford they have to be different and call it a DPhil. This experience has been made possible by an extraordinarily fortunate thing that happened to me – I was awarded a Rhodes Scholarship. Now you know me a little better. Let’s continue.

My first few weeks in Oxford have consisted primarily of tasks like obtaining a bank account (which is considerably more challenging over here than you can imagine), purchasing duvets, buying a bicycle, and having the lights stolen off it shortly thereafter. There have been some substantially less mundane moments, like sitting with my DPhil supervisor to talk about what I am going to be doing for the next three years. Briefly, my interest is in health literacy, and how it affects patients’ experiences of illness and their interactions with the health care system. I am also looking at how people use online resources to obtain and to share health information. This has broad implications for physician-patient interaction (think of patients who come to the clinic with internet printouts!) and related implications for medical education, but I am still mainly at the stage at which I am trying to replace the stolen lights from my bicycle. I will report back when I have something of consequence on those other subjects.

As I alluded to earlier, the University of Oxford is not really a university in the traditional sense of the word but rather a confederation of 38 constituent colleges in which you live, socialize, and work. It has also occurred to me that when I say the “traditional” sense of the word, what I really mean is that Oxford is the definition of traditional, and that every other university does things differently. But now I think we are into semantics.

I am at University College, which is the oldest, and famous for being the college Bill Clinton attended but from which he did not graduate. It also rejected Cecil Rhodes, who was promptly admitted to Oriel College just next door down the High Street. I will leave this to you to decide whether or not this was the right decision, but suffice it to say, I am here on his beneficence, and that what Mr. Rhodes ended up doing with his fortune (however it may have been earned) was an inspiring and visionary thing in a time when there was not a lot of that going on in the world. The history of the Rhodes Scholarship will be saved for another entry, but let’s just say it is in fact primarily about “rendering war impossible,” which is about as noble a cause as I can imagine. But I digress.

While Stephen Hawking did his undergraduate work at my college, he was denied re-acceptance for his graduate work and ended up at Cambridge; probably not the best decision the college has ever made.

Interesting fact: when Stephen Hawking was signing the college register, he made a significant error and had to cross out a line and start over (I got to see his signature a few hundred pages before mine in the book). Now when we sign the register, the head of the college watches over us to make sure we do it correctly!

Recently I had my “matriculation” ceremony, which is the formal ceremony where you are accepted as a student into the university. It involves getting up early on a Saturday and being very, very cold as you are arranged with military precision to take a group picture. Subsequent to this, you are brought by the head of your college (variously called the don, the dean, the head, the warden, the master, or various other names depending on the whim of your individual college) to the Sheldonian Theatre (designed by Sir Christopher Wren, who also designed St. Paul’s Cathedral in London) where you are presented to the vice-chancellor of the university who accepts you as a student. The best part of all of this is that you dress up in something called “sub fusc,” which involves a gown, white bow tie, white shirt, dark suit, and black socks. They are very particular about the black socks. Tourists actually plan to be in Oxford for matriculation day, which is the Saturday of first week of Michaelmas Term (this being the first of the Michaelmas, Hilary, Trinity three-term system here), so that they can take pictures. It was as amazing and overwhelming as it sounds.

After matriculation there is a tradition that you go to a pub and have a pint in your sub fusc, which I did with a friend who is a chemistry student from Germany. We drank warm, non-fizzy beer (I can report with certainty that Canadian beer is just better than British beer, and would challenge anyone who thinks otherwise) and talked about the future of point-of-care testing for malignancy. As you can appreciate, unusual and enlightening conversations abound around here, even (mostly?) in pubs.

The photo attached to this entry is of me in front of the Radcliffe Camera, which is one of the most beautiful buildings I have ever seen. It is a reading room for the Bodleian Library, which is essentially the main library at Oxford. The “Bod,” as it is called, has a copy of every book ever published in the U.K., and there is an electric train system that goes underneath it all so that if you need a book, someone puts it on a train and will deliver it to the desk of the reading room. I couldn’t make this stuff up if I tried.

For those unfamiliar with the University of Calgary Medicine hockey jerseys and are therefore wondering why I am holding a hockey jersey with a very strange animal on it in the picture with this article, let me inform you. One of our best-loved traditions is that every medicine class has an animal name. Mine is the Blobfish; at some point in the early 1990s the animals started getting progressively more unattractive. We then all get hockey jerseys with the animal on the front. I brought mine over to Oxford with me and could not have been prouder than to have a friend take a picture of me holding it in Oxford’s most iconic location immediately following the matriculation.

A final description of my next week, to give you a sense of the kind of outrageous, unbelievable opportunity this experience has already provided: on Monday, a seminar with Professor Paul Anand (who worked with Amaryta Sen on welfare economics), then dinner with the governor of Lagos, Nigeria; Wednesday, a talk and dinner with the former Australian foreign minister; then a black tie dinner on Friday for Rhodes Scholars “coming up” to Oxford (arriving at Oxford is called “coming up,” leaving is called “going down,” not sure why this is, but it is true); and then another black tie dinner on Saturday for the Sir Richard Doll Society, which is a medical society at one of the other colleges here.

I hesitate to make this statement because it will make me sound hopelessly bourgeois, but I really did just describe to you what can most appropriately be called an average week in Oxford. Again, I couldn’t make it up if I tried.

Hope you have enjoyed this inaugural entry, and keep looking if this interested you, because I will from time to time post updates here.

Thanks so much for reading. My email follows, and I would be happy to hear from anyone who has questions or comments!

With best wishes,

Braden O’Neill
Proud University of Calgary Medicine Student
Email: boneill@ucalgary.ca
Follow me on Twitter @BradenONeill

Categories: Uncategorized

Rebuilding Haiti

Dave Campbell (far right) and his fellow travellers on the journey to Bouly, Haiti

Second-year Faculty of Medicine  student Dave Campbell is doing a six-week medical elective in Haiti.  He wanted to write a blog about his time spent in the wounded nation.  We were happy to offer him the forum; this is his story.

The last two weeks of my elective in Haiti I did a clinical observership with the Internal Medicine Department of the Hôpital Bon Sauveur de Cange (HBSC) – the original hospital operated by the Boston-based international NGO Partners-in-Health (PIH). Cange is a remote village in Haiti’s Central Plateau. Many of its residents were originally inhabitants of the fertile Peligre valley, home to some of the most fertile land in all of Haiti. In the 1960s the river was dammed to provide electricity to many of Port-au Prince’s rich and powerful. This displaced many thousands of people away from their fertile valley to the arid and desolate mountaintops – which formed the small township of Cange.

PIH was started by Dr. Paul Farmer when he was a medical student at Harvard Medical School. He had been coming to the area for many years and was touched by the plight of the peasants in the area and founded the small clinic that is now the HBSC. PIH was founded upon the notion of social justice and strives to provide a preferential option for the poor. This was initially focused on providing second-line drugs for resistant tuberculosis (TB) and antiretroviral agents for HIV – neither of which were traditionally offered to individuals in resource-poor settings. They have since transitioned to a more comprehensive model including offering services in primary care, medicine, surgery, women’s health and rehabilitation. PIH petitioned the WHO and drug companies to make this possible for their patients. PIH now operates 12 hospitals throughout Haiti’s central plateau; they also have operations in a dozen other countries in Central and South America, Africa and Central Asia.

Paul Farmer is also a medical anthropologist and I have been a fan of his work and writings for many years, since I began my studies in medical anthropology. It was a like a dream come true to be able to spend some time at the epicentre of PIH activities and to see their model. I was able to meet many wonderful physicians – both Haitian and expatriates whose dedication and commitment to the PIH model of equitable access of healthcare for the poor was truly inspiring.  Many of the patients we saw had come from Port-au-Prince (three hours away) or even further because the PIH facilities have the reputation of being among the best hospitals in the country and also the only hospitals that are truly free. Many patients seen in the outpatient clinic (which sees nearly 300 patients per day) had walked or come in on the backs of donkeys from the surrounding mountains – some of whom had been on foot for six or seven hours. There are many people who bring bed spreads and sprawl out on a piece of concrete on the grounds as they await the results of various lab tests before being diagnosed and given treatment for their conditions.

While the work PIH does in the plateau central is amazing and inspiring, being involved in medical care in such a setting was also very sobering. Only those with the severest conditions were admitted the 24-bed medicine ward. There were many patients with advanced stage TB and HIV as well as cancer and congestive heart failure. As a second-year medical student it was one of my first opportunities to have patients that I felt responsible for and who I got to follow as they progressed through their illness – including being present when many patients that I had become close to passed away.

I was invited to be part of a small group of PIH people involved with the construction of a dispensary in Bouly, a small mountain village. In order to maximize my involvement we decided to make a trip to the community so that I could meet local leaders who will be helping us with construction and operation. It was a seven hour hike from the Boucan Carre hospital – the nearest health facility, which is also the furthest point reachable by vehicle. We hiked up and down two mountains and across four rivers. It was very strenuous and I could not imagine having to do that in a time of health crisis. This community is very over represented in cases seen in the Boucan Carre hospital and we hope that the building of this dispensary which will be staffed by a local nurse and a part-time physician can reduce this incredibly high burden of advanced disease in this community.

We are hoping to have the construction completed by January 2011 and to open immediately.

For anyone who would like to learn more about the incredible work done by Paul Farmer and Partners-in-Health, I recommend reading Mountains Beyond Mountains by Tracy Kidder. For anyone interested in Critical Medical Anthropology I also recommend any of Paul Farmer’s works, but notably, Pathologies of Power.

Thanks to everyone who read my blog from my elective in Haiti.

Categories: Uncategorized

Summer in Haiti an inspiration

My name is Dave Campbell. I am a second-year medical student at the University of Calgary. I am doing my six week summer elective in Haiti.  Rather than doing a clinical observership for the entire time, I have decided to spend the first four weeks doing a research project. Under the supervision of Dr. Wilfreda Thurston (Community Health Sciences), I designed a study entitled ‘Patient Perspectives of a New Prosthetics Provision Service in Rural Haiti’. Prior to entering medical school I obtained a Masters degree in Medical Anthropology and I also speak Haitian-Creole fluently.

Following the earthquake on January 12th, a group of American philanthropists as well as the philanthropic arm of the largest prosthetics provider in the United States (Hanger Prosthetics and Orthotics) joined together with Hôspital Albert Schweitzer (HAS) to form the Haitian Amputee Coalition for Prosthetics and Rehabilitation (HACPR).This body functions out of a building on the HAS campus in the rural community of Deschapelles in the L’Artibonite valley. It is unique among the eight prosthetics providers in the country in that it provides inpatient rehab services. When patients come here to receive their limb, they stay on a small compound about a mile from the hospital and go to the rehab centre everyday during their stay.

My study is important in that it provides local feedback to the program directors that are now at a decision point for the future of the project. I am conducting interviews and focus groups with prospective and retrospective users of the service. I am also utilizing participant observation as a means of collecting ethnographic data with the current patients.

I live at Escale, the amputee village, and follow patients to the clinic most days and spend a lot of time with them in order to be seen as an insider and this has allowed me to observe their natural interactions in a way that would not be possible through more traditional data gathering methods.

The past two and a half weeks have been wonderful! As much as I love to study medicine, it’s hard to beat a life where my life is to talk to people who I respect incredibly.

I would just like to tell the stories of a couple of the people that I have had the chance to live with for the past few weeks because they are inspiring and show the strength of the Haitian people. I have used pseudonyms to protect their identity.

Magda arrived here around the same time that I did. She is a middle-aged woman who is a below-knee amputee from an injury sustained in the earthquake. She always has such a wonderful demeanor about her, she is a very positive person and is truly a strength to her peers both during therapy sessions and just during the day-to-day lows that many people experience.

I knew her for 10 days before she really told me her story. One night she opened up about herself. She was in the market selling her wares during the earthquake. A pole fell and crushed her leg. Unfortunately at her home, not too far away, the situation was worse. Her husband was there with her two sons. Her husband and one of her children died, and the other boy had his hand amputated. Here is a woman who was quite poor to begin with who has now lost her leg, her business, her home, and most of her family–yet even with the extensive interactions I had had with her, you would never have guessed that this was the case. While she did tear up while telling me the story of her experience with January 12th, that was the only time I ever saw her without a huge smile on her face.

Magda was discharged from the program last Thursday. I thought of Magda today because I saw her earlier when she came in for a follow-up appointment–she was walking much better on her prosthetic limb and didn’t even bring her crutches with her for the appointment. The therapists were astounded by her progress in the past week while being away from formal rehabilitation. She said that she has to learn to walk again so that she can go back to selling her wares to support her and her son. She knows he is going to have difficulty being able to work in manual labour (which comprises the vast majority of jobs here), and wants him to go to university to get a good job. She realizes that without an advanced education, someone with a handicap such as his would struggle to get by in this environment.

I never cease to be amazed at the courage and resilience of the Haitian people, and I said that even prior to the earthquake. The citizens of this country have never had it easy and it is truly impressive to see how they deal with their enormous challenges with faith and hope for the future.

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Lack of strategies to manage MRI wait lists a key reason for excessive wait times

By Jordanna Heller

MRI wait times excessive

A new study headed by Dr. Tom Feasby, Dean of UCalgary’s Faculty of Medicine, shows that while Canada lags behind other countries in the number of diagnostic imaging devices, more machines are not the only solution to long wait times. The study’s authors say it is critical to prioritize MRI (magnetic resonance imaging) requests effectively.

“This study shows there are important deficiencies in the current system. We hope this research will help health system decision-makers and managers improve the provision of this important service,” says Feasby, the senior author of “Management of MRI Wait Lists in Canada,” published in Healthcare Policy.

A MRI provides detailed images of the body, and is technology that is being used more frequently, especially in the areas of abdominal, pelvic, cardiac and breast imaging. The technology can be used to evaluate tumours, show abnormalities in the heart, brain and joints.

To determine how requests for MRI studies are managed the study’s authors surveyed public MRI facilities in Canada. Although almost all of the facilities have some methods to triage MRI requests, less than half documented their guidelines for prioritization, and none used quality assurance methods to ensure guidelines were followed. The report determined that despite wait times of up to several years in some facilities, strategies to reduce wait times are diverse, uncoordinated and largely ineffective.

Dr. Derek Emery, one of the report’s authors, says, “most MRI facilities in Canada have a substantial wait list problem. Improvement in wait list management will be necessary for better access, fairness and quality in the provision of MRI services in Canada. We do not currently know the extent of inappropriate overuse of MRI, nor do we know the extent of inappropriate underuse.” Emery is an Associate Professor in the Department of Radiology and Diagnostic Imaging at the University of Alberta.

“This paper shows that many MRI centres do not employ effective and standardized processes to track and manage the appropriateness of the scans they perform. Such processes are crucial to ensure that patients in different regions of Canada have equitable access to MRIs, and that patients who really do need an MRI get one rapidly. This is a challenging problem, and needs the focused attention not only of radiologists, but particularly the physicians who are ordering the scans,“ says Dr. Andreas Laupacis,  a general internist, the Executive Director of the Li Ka Shing Knowledge Institute at St. Michael’s Hospital in Toronto, and a professor in the Departments of Medicine and Health Policy Management and Evaluation at the University of Toronto.

This study was supported by the CIHR (Canadian Institutes of Health Research).

Full text of the study available here.

About the Faculty of Medicine at the University of Calgary
UCalgary’s Faculty of Medicine is a national leader in health research with an international reputation for excellence and innovation in health care research, education and delivery. We train the next generation of health practitioners and move new treatments and diagnostic techniques from the laboratory bench to the hospital bedside, improving patient care. For more information visit http://medicine.ucalgary.ca. or follow us on twitter.com @UofCMedicine.