• April 2014

    • Plasma

      Paying for plasma – Canada’s double standard?

      Sandra Duvlock was 58 when she was diagnosed with dermatomyositis. The gradual inflammation of her muscles had gotten to the point where she was unable to walk, clean or feed herself. When this relatively rare disease was diagnosed, Duvlock was prescribed intravenous immunoglobulin (IVIG) treatment and long-term physical […]

    • The Rounds Table

      Too Much Tamiflu! Medicaid Expansion and Anti-influenza Medications

      This week: Oregon Medicaid Expansion and a systematic review of anti-influenza medications. Janice and Amol want you to: 1. Understand the effect of health care coverage expansion on health care utilization. 2. Understand the utility of randomized control trials in the formulation of causal inferences. […]

    • senior friendly hospitals

      How far along are we in making hospitals more ‘senior friendly’?

      Being hospitalized can have dramatic impacts on seniors’ wellness, and time spent in hospital contributes to loss of important functions such as strength and mobility – critical to their independence and wellbeing. Camilla Wong, a geriatrician at St. Michael’s Hospital in Toronto says “hospitalization robs […]

    • The Rounds Table

      Like A Surgeon: Surgical skill variation, new oral anticoagulants

        This week: Surgical skill in bariatric surgery and new oral anticoagulants for atrial fibrillation Nathan and Amol want you to: 1. Understand how peer assessed technical skill was found to be associated with complication rates at the individual surgeon level. 2. Recognize that peer […]

    • HCW_Injury

      Stubbornly high rates of health care worker injury

      Ann Smith starting working as a bedside nurse on an Edmonton general medical unit  in 2012, three years after graduating with her nursing degree. She was working a night shift when she entered the room of an elderly patient who had called for help to […]

    • The Rounds Table

      How I Met Your D-dimer: Weight loss, pulmonary embolism, and HIV

        This week: Weight loss in colorectal cancer screening, D-dimers in Pulmonary Embolism, and Gene Editing in HIV Nathan, Amol and Travis want you to: 1. Recognize that modifiable lifestyle factors such as inactivity, weight, diet, and alcohol consumption are under-appreciated risk factors for colorectal […]

  • March 2014

    • Physician wellness

      Physician health: reducing stigma and improving care

      John Bradford always prided himself on being psychologically tough. After all, he needed to be. As one of Canada’s top forensic psychiatrists, he analyzed some of the country’s most high-profile murderers including Paul Bernardo, Karla Homolka and Robert Pickton. In order to keep healthy and […]

    • The Rounds Table

      Fathers and grandfathers of science: checklists, statin myalgia and breast cancer

      This week: surgical checklists, statin myalgia and breast cancer radiotherapy Janice, Nathan, and Amol want you to: 1. Understand the effect of surgical safety checklist implementation on surgical complication rates. 2. Understand the use of n-of-1 trials in evaluating the association between statin use and myalgia. […]

    • eCigarette

      Regulating the ‘wild west’ of e-cigarettes

      E-cigarettes have exploded onto the market in recent years and there are multi-billion dollar questions swirling around them. Advocates say that they offer a safe and effective smoking cessation aid while opponents are concerned that they may erode the success of decades of tobacco reduction […]

    • The Rounds Table

      Prostatectomy, pharmacare, and protein mutations

      This week: prostatectomy, prescription drug costs, exome sequencing for rare mutations Learning objectives – Amol, Nathan, and Travis discuss: 1. Understand that radical prostatectomy improved overall and disease free survival and decreased metastasis compared with watchful waiting in men with localized prostate cancer of intermediate grade. […]

    • GregPrice

      Improvements suggested to the health system that failed Greg Price

      Greg Price died at the age of 31. His death may have been preventable had he been diagnosed and treated earlier for testicular cancer. He was left alone to navigate the health system and follow up on referrals, while experiencing major delays and the absence […]

    • The Rounds Table

      Too rich for my blood: obesity, palliative care, hepatitis c

      This week: obesity, palliative care, hepatitis c Learning objectives – Amol, Fahad, and Travis discuss: 1. Understand trends in obesity prevalence in adults and children. 2. Appreciate the effect of early palliative care on quality of life in patients with advanced cancer. 3. Recognize new therapeutic options in […]

    • Andreas Laupacis healthy debate editor in chief

      Introducing “The Rounds Table”, a weekly podcast about major new studies in medicine

      Dear Healthy Debate community, I’m pleased to announce that Healthy Debate is launching a new feature today – a podcast we’re calling The Rounds Table. Healthy Debate’s articles and opinion pieces are aimed at a general audience, but we also produce more specialized content in […]

    • G

      Should HPV vaccination programs be expanded to boys?

      Vaccination programs are based on the old adage that an ounce of prevention is worth a pound of cure.  Since 2007 Canada has had a vaccination program for the Human Papillomavirus (HPV) administered to girls, although the age of vaccination varies by province:  Grade 5 […]

  • February 2014

    • PoliceiStock_000001926087Small

      Improving hand offs between police and emergency departments

      Police have been described as “street corner psychiatrists.” They are often the community resource that responds at all hours when emergency calls come in for someone in mental health crisis. Police also serve a gatekeeper function in determining what services are required for an individual […]

    • Medical marijuana

      Medical marijuana: what doctors need to know about Canada’s new rules

      Herbal marijuana is not an approved drug in Canada, but court rulings have required reasonable access to a legal source of marijuana when authorized by a physician. On April 1st, Canada’s current regulatory system for medical marijuana will be replaced entirely by a new set […]

    • HockeyConcussionl

      Buyer beware – no quick fix for concussion symptoms

      The world is watching athletes in Sochi compete in sports such as hockey and downhill skiing. Concussion poses a risk, not only to the highly trained individuals competing in the Olympics, but also to ordinary Canadians who play sports occasionally. Concussions are the result of […]

    • Mandatory vaccine health care workers

      The evidence and politics of mandatory health care worker vaccination

      The United States Center for Disease Control reports that while only 44% of employees get the influenza or “flu” shot on a voluntary basis, that number rises to 89% when it is required or mandated by the employer. With vaccination rates of 45% among health care workers in some […]

  • January 2014

    • Homeless

      Sheltering Canada’s homeless

      “I’d do whatever I had to do to stay warm” recalls David, who was homeless on Toronto’s streets from 2000 to 2003. David said he spent the winter nights in emergency shelters, and bitter cold days in bank ATM lobbies or riding around on public […]

    • Andreas Laupacis healthy debate editor in chief

      A primer on Ontario’s health care system for primary health care boards of directors

      Last year, Healthy Debate published a primer on Ontario health care system for the boards of directors of hospitals. We’re very happy to now release a primer on the health care system specifically designed for the boards of directors of community governed primary health care […]

    • TargetsiStock_000004380091Small

      Missing the target on health care performance?

      Setting targets has long been a mechanism in industrial psychology to motivate managers and workers to achieve specific organizational objectives. In the last decade, targets have become important methods of driving performance improvement in health care. However, deciding where and when to set targets is […]

    • Prescription opioid abuse

      Canada’s prescription opioid crisis

      There is a prescription opioid crisis in Canada. While these drugs are effective in treating acute pain, and pain near the end of life, the evidence to support long-term use in patients with chronic pain is weak, and for many people the harms exceed the […]

  • December 2013

    • SafetyiStock_000008663081cropped

      Medical error disclosure: improving patient safety through better communication

      Monica Enderlin’s father was a healthy and active 74 year-old cabinetmaker who enjoyed sailing and spending time with his four children and wife of 47 years. In March of 2009, he was admitted to hospital in Edmonton with a non-resolving pneumonia. Soon after admission, his […]

    • Andreas Laupacis healthy debate editor in chief

      Healthy Debate needs your support

      Why Healthy Debate? We founded Healthy Debate with a simple goal: to create a destination where Canadians can go for credible, unbiased information about their health care system, and where patients, health care professionals and policy makers can come together and debate the challenges facing […]

    • antibiotic resistance

      Combating antibiotic resistance in Canada

      Michael’s Story Michael was a 75 year-old living in Canada’s Prairies. His wife recently spent five days in hospital for a scheduled hip replacement. At the time she was admitted to hospital, Michael was on a one-week course of Amoxicillin, an antibiotic medication to treat […]

    • physician assistant

      Integrating Physician Assistants in Canada

      After several decades working in the Canadian military, Physician Assistants (PAs) are being introduced into provincial health care systems. This year, Alberta launched a two-year demonstration project to integrate PAs into selected clinical practices. About a decade ago ago, PAs were introduced in  Manitoba and 2007 and […]

  • November 2013

    • Intensive care unit

      Conflict at the end of life: what happens when doctors and families disagree?

      Informed consent to medical treatment is one of the foundational pillars of Canadian medical law and the practice of medicine. Before administering a course of treatment, health care professionals are expected to ensure that their patients understand the benefits and risks of each option and […]

    • cord blood banking

      Cord blood banking in Canada

      Minutes after giving birth, blood from the umbilical cord is collected and sent off to a central cord blood bank to be cryogenically frozen.  Years later this cord blood could be used to cure some cancers and treat rare diseases. While to some this sounds […]

    • Breast Cancer Ribbon

      Accessing reconstructive surgery after breast cancer treatment

      One in nine Canadian women will develop breast cancer in their life time. The growth of screening programs means that breast cancer is being caught and treated earlier. Often, treatment involves surgery – lumpectomy or mastectomy. Increasingly, women are also choosing to undergo breast reconstruction […]

  • October 2013

    • Effect on health care restructuring on Alberta's health care professionals

      Decades of restructuring hurts morale of Alberta’s health care professionals

      This is the second of a two-part series on Alberta’s health care restructuring. This article examines the impact of constant change at the highest levels of administration on those who work within the health care system. Alberta Health Services (AHS) is the largest health care […]

    • REB paperwork

      Experts warn bureaucratic duplication in research ethics delaying important science

      Research on human subjects is essential to the advancement of patient care. Every life-saving drug, surgical technique and medical procedure was tested at some point in its development on humans. While research on humans has yielded enormous benefits, it can also carry risks to research […]

    • weight loss surgery Ontario costs Canada Alberta

      Weight loss surgery: what do we know about quality?

      Weight loss is a constant struggle for millions of Canadians, with one in four Canadian adults classified as obese. Losing weight is not easy. Many Canadians try to lose weight through diet, exercise, behavioral modification and medications. Bariatric, or weight loss surgery is often the […]

    • A brief history of restructuring in Alberta's care health system.

      Restructuring Alberta’s health system

      Alberta Health Services has had a tumultuous summer. There have been major changes at the highest levels of administration and governance of the province’s health system. A review of the recent history of restructuring in Alberta’s health system might be helpful to understand the recent […]

    • radiology

      Can quality be assured for diagnostic imaging?

      News headlines from across Canada are periodically dominated by scandals and errors in diagnostic imaging. The list grows each year, with errors exposed from coast to coast. The narrative follows the same arc – an error is discovered in an area of diagnostic imaging. A […]

  • September 2013

    • Nurse LPN RPN RN

      Evidence-based hospital nurse staffing: the challenges

      Health care providers are an important — and costly — resource for hospitals. Canadian hospitals spend about 60% of their overall budgets on health care providers’ salaries. Nurses, who provide most of the patient care at Canada’s hospitals, are often seen by hospital decision makers as a […]

    • urgent care

      Urgent surgery: a forgotten wait time?

      There is a growing body of research suggesting that patients with urgent surgical needs are waiting too long for surgery. From the time that they present to an emergency department to being booked in for surgery, they can experience many periods of prolonged waits. While wait times for elective surgery are measured in Canada, waits for urgent surgery are not.

    • Interprofessional education

      Have investments in interprofessional education led to changes in practice?

      As part of the 2003 Health Accord, the Federal Government made major investments in interprofessional education. This included contributing $28 million dollars to build training centres across Canadian colleges and universities. Investing in interprofessional education was motivated by the belief that changing the way health […]

    • Geriatrics

      Caring for Canada’s seniors will take our entire health care workforce

      Much of the focus on the health care needs of Canada’s aging population surrounds the shortage of physicians with expertise in care of older adults. But the country’s 75,000 licensed physicians represent only a small part of the Canadian health care workforce. By contrast, there […]

  • August 2013

    • Andreas Laupacis healthy debate editor in chief

      A primer on Ontario’s health care system for hospital boards of directors

      Lately I have found myself on a few health care boards in both Alberta and Ontario. I have been impressed by the dedication of the board members, and the depth and breadth of expertise they provide. I am also convinced that having many board members […]

    • caring for Canada's seniors

      Who will care for Canada’s seniors?

      Our health care system faces a disturbing paradox. While seniors represent the fastest growing age group in Canada, the country faces a growing deficiency of specialist physicians with expertise in caring for the elderly. But with seniors accounting for nearly half of all the country’s […]

    • Fewer hospital staff on weekends puts some patients at risk

      Fewer hospital staff on weekends puts some patients at risk

      In the modern economy, many industries, such as aviation, retail and manufacturing, no longer slow down over weekends. Yet hospitals have mostly resisted this trend, even though demand for many forms of health care is no less on weekends than on weekdays. While most hospitals […]

  • July 2013

    • Family care clinics

      Family Care Clinics – filling a gap or costly duplication?

      During her campaign for reelection in 2012, Alberta premier Alison Redford promised to create 140 Family Care Clinics (FCCs) over three years. She articulated a vision of primary care that would be one-stop, with many different health care providers under one roof. These clinics would […]

    • pay at risk

      The controversy over “pay-at-risk” for hospital executives

      “Pay-at-risk” became a political flash point in Alberta last month when Health Minister Fred Horne fired the Alberta Health Services board when it didn’t agree to withhold the at-risk part of the compensation package for about 100 executives. Alberta Health Services (AHS) had introduced pay-at-risk […]

    • Is there any role for industry in medical education?

      How much interaction should medical students have with industry?

      A drug company sales representative stands in front of a class of University of Toronto medical students and delivers her well-rehearsed sales pitch about the benefits of her company’s birth control pill. Hold on: Isn’t this sort of interaction between the pharmaceutical industry and med […]

    • Wait times for "non-priority" surgery

      Wait times for “non-priority” surgeries

      Katie’s story Three years ago, Katie (name and some details changed to protect her identity) was in a car accident on a rural road two hours outside of an urban centre. Her ankle was crushed in the accident, and after a delay of several hours […]

  • June 2013

    • Resident Duty Hours

      New recommendations for Canadian doctors-in-training focus on fatigue

      After finishing medical school, new doctors go through several years of post-graduate, on-the-job training – known as residency – in order to become licensed to practice independently. Historically, residency has involved very long hours spent in hospital, so that residents see a high volume of […]

    • Improving quality in Canada’s nursing homes requires “more staff, more training”

      Improving quality in Canada’s nursing homes requires “more staff, more training”

      Over 100,000 patients are cared for in Alberta and Ontario’s nursing homes every year. Many residents and families are quite happy with the care provided in nursing homes. However, news reports from home and abroad remind us that not all nursing home residents receive the […]

    • patients' need for emotional support

      Providing emotional care for patients in a technology-driven health system

      “They made me feel genuinely cared for. They listened, made eye contact with me, conveyed warmth and understanding in their voice and repeated back to me what I was saying.” — Sophia, about her visit to a chronic pain clinic, from a “care moment” prepared […]

    • Access to expensive drugs

      Access to expensive drugs: greater demand, improved transparency

      Each weekday, staff at the Exceptional Access Program (EAP) of the Ontario Ministry of Health and Long-Term Care receive between 250 and 300 requests for special prescription medications. These prescription drugs—typically expensive medications that are felt to be cost effective only when used to treat […]

    • Andreas Laupacis healthy debate editor in chief

      A request from Dr. Andreas Laupacis, Editor-in-Chief of Healthy Debate

      Dear Healthy Debate community, Working on Healthy Debate for the last few years has been enormously rewarding for our whole team. We’ve been delighted with the response from our community, and even a little surprised by how much our readership has grown. Healthy Debate has […]