Month: August 2023

From U of T News

The Toronto offices for Kamran Khan’s BlueDot, which uses artificial intelligence to flag potential infectious disease outbreaks around the world, are located at the edge of Lake Ontario – appropriate for a company that, similar to a lighthouse, signals when there’s danger ahead.

“We use the internet as a medium for surveillance to detect early signals of outbreaks anywhere in the world before they’re officially reported by public health agencies,” explains Khan, a scientist at Unity Health Toronto and a professor in the department of medicine in the University of Toronto’s Temerty Faculty of Medicine and the Dalla Lana School of Public Health.

He breaks BlueDot’s work down into three key components: identifying threats early, rapidly assessing their risks and likely trajectories, and helping organizations to turn these insights into swift action.

“The whole purpose here is to compress time, because ultimately, time is the enemy when you’re dealing with an outbreak,” says Khan, a member of U of T’s Centre for Vaccine Preventable Diseases.

BlueDot’s intelligence platform combines a computer’s ability to understand human language, known as natural language understanding (NLU), and machine learning, a form of AI that imitates humans’ ability to learn and gradually become more accurate. The platform sorts through massive volumes of online information – ranging from news reports, social media sites, government websites, and more – from around the globe, in more than 130 languages, every 15 minutes of every day.

From CTV News

New research suggests “surgical sexism” is baked into the Canadian health-care system, revealing surgeons are paid less for procedures on female patients than they are for comparable surgeries on male patients.

The Toronto-based study, published in the Canadian Journal of Surgery earlier this month, found doctors are compensated on average 28 per cent less for operations on female patients than they are for similar procedures performed on male patients.

“The overarching message when we hear about studies like this is that society or the Ministry of Health doesn’t value women’s health to the degree that it should,” Dr. Andrea Simpson, an OB/GYN at St. Michael’s Hospital, told CTV News Toronto.

For the study, Sunnybrook Hospital OB/GYN Dr. Michael Chaikof said his research group created a list of common procedures performed exclusively on female patients and paired it with equivalent surgeries for patients with a male reproductive anatomy.

Then, they collected data on how much doctors were paid for these procedures in eight provinces and compared the lists.

The result: doctors performing surgeries on female patients made nearly $44 less per procedure than they did on male patients.

For example, a surgeon is paid over 50 per cent more for untwisting a testicle than for untwisting an ovary, despite the latter requiring a more technical internal procedure.

“There is nowhere in Canada where you earn more for operating on a female patient than a male patient,” Chaikof said.

From the Toronto Star

A man with a history of attacking strangers on TTC property “presents a danger to the public” if he doesn’t take his antipsychotic medication, a judge said this month as courts increasingly point to the urgent need for more housing and mental health services to deal with random assaults.

Ontario Court Justice Hafeez Amarshi sentenced Nigel White to jail for yet another series of assaults at a subway station this year. Amid a number of seemingly random attacks on Toronto public transit, Amarshi’s ruling lays bare the limitations of the criminal justice system in dealing with the problem.

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The rising number of incidents on the TTC is the result of a system that is failing to cope due to a lack of resources, said community psychiatrist Dr. Samuel Law with St. Michael’s Hospital, noting the need for better followup for individuals leaving jails with mental health issues.

“Just having more cops on the TTC is not going to solve this; it’s actually much harder,” he said. “It’s the bigger work of building our community infrastructure and treating this more seriously.”

From CMA

Team-based care can improve patient access and alleviate pressure on family physicians. 

But in a survey of over 9,000 people in Canada, only 15% of respondents said they had access to health professionals in their primary care clinic beyond a doctor, nurse or nurse practitioner. 

The research is part of OurCare, a national project to engage the public on the future of primary care in Canada. It’s led by Dr. Tara Kiran, who is the Fidani Chair in Improvement and Innovation at the University of Toronto and a family physician with the St. Michael’s Hospital Academic Family Health Team.

Ahead of her appearance at the CMA’s 2023 Health Summit, we spoke to Dr. Kiran about why Canada needs more team-based care— and what it will take to make it the norm.

We’re in the middle of a massive primary care crisis— six million Canadians have no family doctor. Why talk about team-based care?

It is indeed a crisis. Primary care is the front door to the health system— and when you look at demographic trends, both for physicians and the population, you can see that there won’t be enough family doctors to go around for years to come. 

That’s where team-based care comes in. We need to build a system that expands the capacity of our existing family doctors and other primary care clinicians so they can serve more patients. 

How would team-based care improve capacity in primary care?

Not every problem needs to be seen by a family doctor. People with diabetes who have stable blood sugar levels can often be seen by a nurse. Physiotherapists have incredible skill when it comes to assessing musculoskeletal conditions. Social workers can connect seniors to meal supports or other programs in the community. 

We really have to rethink the structure of primary care so we maximize the value of both physicians and other health professionals.

From Global News

Thomas Mohr, an Oakville man who became homeless after his leg was amputated, continues living in his vehicle at an Oakville shopping plaza. It’s now been 238 days.

Mohr had been a carpenter for decades. After he lost his leg due to medical reasons, the 69-year-old claims the government has refused to cover the costs of a customized prosthetic. He has what is called a ‘bulbous stump,’ meaning the base of his limb is larger in width than his knee. Mohr’s family has been trying to raise money since to get him a prosthetic from the U.S. that costs C$80,000 so that he can return to work.

Global News’ initial story was published on June 20. Mohr said two days later, he was approached by outreach workers with Halton region accompanied by police officers to provide housing support.

When asked why officers were present, Halton police spokesperson Ryan Anderson said: “At that time officers assisted Halton Housing Help in connecting an individual with a temporary residence. The HRPS was not involved with the seizure of a truck or any other personal belongings.”

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“This case is really a microcosm of so many issues we’re facing,” said Dr. Andrew Pinto, director of The Upstream Lab at St. Michael’s Hospital. “One is the ‘silo-ing’ between his health providers, the housing authorities, the social services agencies.”

Pinto said that in addition to there being a lack of cohesion among governments and social services agencies, the system has failed Mohr and so many others trying to access housing with a disability.

“We have not dedicated anything like we needed to in terms of adequate housing, particularly for people who have a disability,” he said.

“We have tremendous waitlists of years and years where people are waiting to access affordable housing.”

Halton Region told Global News that it responded once it learned of Mohr’s case.

From Sudbury.com

The risk of opioid addiction has prompted some Ontario doctors to study how prescribing Oxycodone for pain after childbirth has resulted in some new mothers continuing to use the drugs for weeks and months afterward.  

Details were published this week in the current edition of the Canadian Medical Association Journal (CMAJ).  

The study was authored by Jonathan S. Zipursky, Karl Everett, Tara Gomes, J. Michael Paterson, Ping Li, Peter C. Austin, Muhammad Mamdani, Joel G. Ray and David N. Juurlink, a group of doctors and researchers connected with Sunnybrook Health Sciences Centre, the Institute of Health Policy, Management, and Evaluation at the University of Toronto, ICES (Institute for Clinical Evaluative Sciences), the Faculty of Pharmacy at U of T, and the Li Ka Shing Knowledge Institute at St. Michael’s Hospital.

The study said Oxycodone was increasingly being prescribed for postpartum analgesia (pain relief) in lieu of codeine owing to concerns regarding the neonatal safety of codeine during breastfeeding.

The authors wrote that among postpartum mothers “we found that an initial prescription for Oxycodone was not associated with a higher risk of persistent opioid use relative to codeine overall, although a disproportionately high risk of persistent use after initiation of oxycodone was seen after vaginal delivery.”

The study was carried out over an eight-year period in Ontario involving more than 70,000 patients between the ages of 12 and 60 who gave birth and filled a prescription for medications containing either codeine (30 per cent) or Oxycodone (70 per cent).

“We chose codeine as the comparator because it has historically been perceived as a ‘weak opioid’ and, until recently, was the preferred opioid prescribed postpartum,” the study authors write. “Owing in large part to concerns about neonatal safety with breastfeeding, codeine has been supplanted over the past decade by more potent opioids (including oxycodone). In the last decade, in Ontario, Oxycodone has become the most commonly prescribed opioid postpartum.”

The study further stated that a key outcome was an increased use of prescription opioids.

From Global News

Opioid deaths among those aged 15 to 24 surged during the first year of the pandemic, according to research led by the Ontario Drug Policy Research Network at Unity Health Toronto. That figure came partly through contaminated drugs used recreationally, according to Dr. Tara Gomes, a scientist at Unity Health Toronto who leads the research group.

“We might be seeing increasing harms because teens and young adults are more likely to be using drugs occasionally,” she explained.

“Our drug supply is incredibly unpredictable and potent, and so if you’re only using drugs once in a while, then when you use them, if you are exposed to a very high dose or a drug that has multiple different substances in it, then you can be at really high risk of an overdose.”

At the beginning of July, police said five people had taken an unknown drug that was likely an opioid near Toronto’s waterfront; one died. In April, police said four people suffered overdoses in the downtown after taking a drug believed to contain fentanyl. Many other similar warnings have been issued across the province.

From The Globe and Mail

For years, large numbers of Quebeckers didn’t have timely access to doctors, creating a pool of potential clients, matched by a pool of unhappy doctors itching to leave the public system. Meanwhile, a significant court case led to the normalization of a competing system outside of medicare.

Quebec has some of the worst indicators for access to primary care. According to Statistics Canada, in 2021, one in five Quebeckers (21.6 per cent) didn’t have a regular health care provider, compared with 10.3 per cent in Ontario and 14.5 per cent nationally.

Those numbers mirror a poll of 9,000 Canadians conducted last fall for OurCare, a countrywide initiative looking at the future of primary care. The survey found that 31 per cent of Quebec respondents didn’t have a family doctor or nurse practitioner they could see regularly, compared with 22 per cent nationally.

Of those without a regular primary-care provider, 37 per cent in Quebec said they have had to pay a fee for non-urgent care, compared with 21 per cent across Canada.

OurCare’s lead investigator, Tara Kiran, said the poll doesn’t differentiate whether respondents paid a doctor or other professionals, such as nurses or pharmacists.

“People who didn’t have access … are turning to all sorts of places to try and get care that’s not urgent but worrisome. And in many cases, they have to pay out of pocket,” said Dr. Kiran, a family physician and scientist at St. Michael’s Hospital and the University of Toronto.

The migration of GPs out of RAMQ is “a crisis for us right now,” said Nebojsa Kovacina, a researcher for OurCare in Quebec.

From CBC News

Three and a half years after the virus behind COVID-19 began its rampage around the world — eventually killing tens of thousands of Canadians — a group of top medical experts is calling on federal officials to launch a full national inquiry into Canada’s pandemic response.

In a sweeping set of editorials and analysis papers published on Monday in the British Medical Journal (BMJ), more than a dozen physicians and health advocates are shining a spotlight on what they’ve dubbed the country’s “major pandemic failures,” from the devastation in long-term care homes, to vaccine hoarding, to higher death rates among lower-income communities. 

Those shortcomings all played out against the backdrop of the country’s complex, fragmented health-care system. That decentralized approach, the authors argue, led to dramatic differences in how each province handled the spread of SARS-CoV-2, the virus first reported in Canada in Jan. 2020.

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“We weren’t closing the gaps, and by then, really we should have,” said Dr. Sharmistha Mishra, an infectious disease epidemiologist at the University of Toronto and Unity Health.

Governments still need to push for workplace improvements to address those systemic issues, she argued, including adequate sick days, strategies to reach communities with lower incomes and higher population densities, and ensuring vaccine equity. 

Op-ed in The Globe and Mail by Sharmistha Mishra, Tania Bubela, and Sharon Strauss

Scientific reviews detail “what” happened and “why”. What worked and what didn’t; how can we repeat successes and avoid, or at least mitigate, failures?

In reviewing the ‘what’ and the ‘why’ of the COVID-19 pandemic response, researchers use rigorous methods to tease apart the policies and intervention strategies that worked, how they worked, and for whom. The approach is analogous to understanding a medication. What’s the right dose and formulation? What populations does it work in? What are the potential side effects? When should it be replaced by a new, better medication?

We need to ask the same questions about how the epidemic was managed and how we did or did not use evidence in making decisions. What type of evidence informed decisions about policies, programs, and the allocation of resources? Why did it take so long to do research to collect evidence on health inequities and the social determinants of health? We know that the burden of the pandemic was not equally felt across communities. Why, then, was that evidence not used to provide science advice and inform policies, and services?

We argue that part of the problem was the types of research and insights that were privileged over others, and the voices that were excluded from advisory or decision-making tables. Saying that equity was at the core of an advisory group, report, or recommendations did not make it so. In reality, the tables and the evidence considered mirrored existing structural inequities in science, scholarship and decision-making. Questioning why means looking deeper than a word search for “equity” or “diversity”.