1. Editorial: Cutting Healthcare costs through reform measures: proposals from four provinces
   
   
2. St. Amant: Interesting, Challenging and Rewarding
   
   
3. September & October 2010 Health Observances
   
   
4. The latest clinical, academic and community research in wound care
   
   
5. “Do These 'Genes' Make Me Look Fat?”
   Fat Loss Is
   
   
   

Editorial: Cutting Healthcare costs through reform measures: proposals from four provinces

by Jennifer (Jay) Sherwood, BScN, MEd.
It seems to me that ever since I have been involved in health care there has been discussion and wringing of hands about the sustainability of publicly funded care with accompanying proposals to reduce spending and/or produce more revenue. The year 2010 is no exception with at least four provinces proposing changes that address different parts of each provincial system and in three provinces at least, challenge some sacred cows!
Starting at the west coast, British Columbia has approved a province wide change in the funding formula for hospitals, Alberta is conducting consultations to develop the framework of the “Alberta Health Act”, Ontario has announced dramatic changes in how pharmacists are paid to push certain products and Quebec is proposing a health tax for each medicare recipient and a further 25 dollar tax for each physician visit. To be sure, each of the remaining provinces will be watching carefully at the outcomes of these proposed reforms and may adopt them if it can be shown that changes enhance the province's ability to sustain the system.
British Columbia - Traditionally hospitals in BC and elsewhere finance their operations through a system of block grants. It is proposed to replace the block funding model with a system that pays hospitals for each procedure they perform. The proposed funding system is called patient-focused funding.
Over the past few years, outcomes of a number of pilot projects implemented through the Lower Mainland Innovation and Integration Fund showed that patient focused funding improves access to care over a wide range of services. This funding model is seen as part of the reform agenda to improve patient care while containing costs of health care.
With block funding there is no attachment of funds to specific priorities or targets. With patient focused funding hospitals will receive financial incentives for delivering services at competitive prices, and allows the funding to follow the patient, a principle that has been advocated by health professionals for some time.
Findings from each of the pilot projects showed overall there was improved management of resources and dollars and more timely care for patients without any reduction in quality. British Columbia has consistently been rated as the best province when it comes to reducing wait times for surgeries. It is believed that these times can be further reduced by implementing the new funding model.
While patient-focused funding will only be applied province wide to acute care delivery, it may be eventually expand to other health care services in the province.
Alberta - Over the years, Alberta has held all kinds of consultations, and symposiums etc. into the subject of health reform that resulted in one of two ways. The first result was that the proposed reforms were so far reaching that they were soundly rejected by Albertans (e.g. the “Third Way”) or that the proposed changes were seen as tinkering with the system rather than real reform. This time though it looks as if something might be happening.
The latest reform activities came out of a report from the Minister's Advisory Committee on Health. This committee has 16 members, all health professionals, experts or academics. The committee recommended that the government completely overhaul health legislation, simplify the system and improve access to care.
The first step in responding to the recommendations of the Advisory Committee is to re-write the legislation governing health care. Government representatives say that a new Alberta Health Act would include all the principles of the Canada Health Act, plus the addition of principles of it specific to Alberta. It is also proposing a patient charter of rights that would come with a definition of patient responsibilities. A series of workshops are being held around the province that bring together invited guests to discuss what might be contained in new legislation.
Ontario - Access to better drugs has contributed to people's health and longevity. However, improved drugs come at a high price and long patents. Once the patents expire, generic drug manufacturers can produce these drugs at a reduced price. To encourage pharmacies to sell their brand generic manufacturers pay them a “professional allowance”. In the spring of this year, Ontario's Minister of Health and Long Term Care. Deb Matthews, announced changes to the province's drug system. According to her, people in Ontario pay too much for generic drugs. She announced that the cost of generic drugs will be cut by at least 50%.
To accomplish the cost reduction in generic drug prices there were two main announcements. First, there would be a province wide ban on professional allowances and second, the cost of generic drugs would be lowered to up to 25% of the cost of the original brand.
The regulations governing these changes were slated to come into effect in July 2010. There is still some resistance to the changes among both the big pharmacy chains and the independent pharmacies.
Quebec - In April, the Charest government in Quebec proposed two new fees for health care services. One would be a new tax (called a “health contribution”) that would be phased in over three years. This year it would be $25, raised to $100 in 2011 and to $200 in 2012. The other would be a $25 charge for each visit to a doctor. Both of these fees would be collected at tax time. It is thought that by not collecting the fee at the doctor's office the proposal would not be considered a user fee and therefore allowable under the Canada Health Act.
While it is reported that there has been widespread opposition, particularly to the doctor's visit tax, in Quebec, it has been observed that the federal government is taking a “wait and see” approach. It is thought that if the proposed tax on doctors' visits holds up in Quebec that it could have an effect across
the country.
Summary - Of the four provinces, Ontario and British Columbia have implemented the proposals. Alberta is still consulting and the controversial user fee (that is not a user fee) has yet to be implemented in Quebec. Since delivery of health care is a provincial responsibility, it is refreshing to note that it is the provinces that are taking these initiatives to respond to challenges in their systems.

References
Council of Canadians. Quebec proposes health care user fees. www.canadians.org/campaignblog/?p=3206
Drug System Renewal. Ministry of Health and Long Term Care. Toronto, ON. www.health.gov.on.ca/en/pro/.
Fayerman, Pamela, Rob Shaw and Richard Watts. New health-care funding model unveiled. Canwest News Service and Times Colonist. April 13, 2010. www.timescolonist.com
Thompson, Graham. Health-care reform needs reforming. Edmonton Journal, June 17,2010. www.edmontonjournal.com

St. Amant: Interesting, Challenging and Rewarding

St. Amant's River Road Place, located in Winnipeg, Manitoba plays a unique role within the Winnipeg Regional Health Authorities' array of specialized services.
“Our care team staff are energetic, innovative and passionate about what they do,” said Wayne Reimer, Director of River Road Place. “We're currently recruiting Registered Nurses, Licensed Practical Nurses and Respiratory Therapists and we're looking for people who fit this description and want to be part of something special.”
St. Amant's River Road Place is home to approximately 200 individuals with profound intellectual and physical disabilities, most of whom also have chronic and complex health care needs that require 24 hour medical care. River Road Place also supports an additional 40 to 50 Manitoba families each year by providing out-of-home respite care for a family member. From small children to older adults, each client has a highly individualized support plan in order to enjoy an active lifestyle and the best possible quality of life.
Rita O'Rourke is a Registered Nurse who came to work at St. Amant because other nurses told her what a great place it is to work.
“I was recruited by some friends of mine. But I also used to see clients come to the hospital when they needed emergency care and could tell that they were very well cared for, so I knew that the level of care was really good,” said O'Rourke.
Lisa Tao is a Respiratory Therapist that recently made the move from Toronto to Winnipeg to work at River Road Place.
“I wanted to work with really professional staff and in a challenging and rewarding environment,” said Tao. “The other staff are really great, I really like it here.”
The Nurses and Respiratory Therapists at River Road Place are the leaders of the care teams and are supported by a set of Resident Assistants who provide the majority of the direct care. Nurses and R.T.s work in close collaboration with other on-site specialists including: Occupational Therapy, Physiotherapy, Speech Language Pathology,
Dietary, Social Work, Psychology, Pharmacy, Education and Recreation.
Ashleigh Verstraete, a new grad from the BN program at the University of Manitoba decided to work at
St. Amant after checking out other health care facilities during her rotations and practicums.
“You have a more intimate relationship with the clients and there's a lot more teamwork at St. Amant than I've seen at other places,” she said. “It's a great place to work and you get to use the majority of your skills here. On a daily basis I do inhalations, respiratory care, catheterizations, wound care, and of course assessment.”
One of the things O'Rourke worried about in making the transition from her eight year stint in the Emergency Room over to St. Amant was whether she would be able to keep up her nursing skills.
“Nursing at St. Amant is way more than you think it is. It's interesting, challenging and way more rewarding than anything I ever did in acute care,” said O'Rourke.
Interested in learning more about a career in nursing at St. Amant? Check out their website at www.stamant.mb.ca.

September & October 2010 Health Observances

These are September and October 2010 calendars of annual health observances and recognition dates for healthcare. Health observances are days, weeks, or months devoted to promoting particular health concerns. This information will come in handy for community relations programs as well as employee appreciation events. Health professionals, teachers, hospital staff and community groups can use these special times to sponsor health promotion events, stimulate awareness of health risks or focus on disease prevention.
The year long 2010 calendar can be obtained from www.charityvillage.com. The months of September and October have reproduced directly from the website and the edited for space.
September - Month Long Observances
o Addiction Recovery Awareness Month: Ontario
o Arthritis Month: National
o Big Brothers Big Sisters Month; National
o Breakfast for Learning Month; National
o Childhood Cancer Awareness Month; International
o Muscular Dystrophy Month; National
o Ovarian Cancer Awareness Month; National
September - Week Long Observances
1st Week
o International Suicide Prevention Awareness Week
3rd Week
o Learn @ Work Week; National
o National Massage Therapy Awareness Week
o National Prostate Cancer Awareness Week
4th Week
o National Forest Week
o Self-Help Awareness Week; Ontario
September Daily Observances
8th - International Literacy Day
10th - World Suicide Prevention Day; International
2nd Sunday - Terry Fox Run; National
16th - International Ozone Day
18th - Alzheimer Coffee Break Day; National
21st - World Alzheimer's Day; International
21st - International Day of Peace
4th Sunday - Police & Peace Officer's National Memorial Day
4th Sunday - AIDS Walk Canada; National
October - Month Long Observances
o Autism Awareness Month: National
o Brain Tumour Awareness Month: National
o Breast Cancer Awareness Month: National
o Canada Library Month: National
o Car Safety Month: National
o Child Abuse Awareness Month: National
o Community Living Awareness: National
o Community Support Month: Ontario
o Eye Health Canada Month; National
o Foster Family Month; British Columbia
o Fundraiser for Farley Month; Ontario
o Innovation in Eye Care Month; National
o Investor Education Month; International
o Islamic History Month; National
o Learning Disabilities Awareness Month; National
o Lupus Awareness Month; National
o National Flu Prevention Awareness Month
o National Occupational Therapy Week
o Sudden Infant Death Syndrome (SIDS)Awareness
Month; National
o Celiac Awareness Month; National
o Women's History Month; National
o Healthy Workplace Month; National
October Weekly Observances
1st Week
o Be Kind To Animals Week/Animal Health Week; National
o Meals on Wheels Week; Ontario
o Mental Illness Awareness Week; National
o World Breastfeeding Week
2nd Week
o Citizenship Week; National
o National Family Week
o Fire Prevention Week; National
o World Space Week; International
3rd Week
o Amnesty International Week; National
o Foster Family Week; National
o National Cooperative Week
o National School Safety Week
o Ontario Dental Hygiene Week; Regional
o Ontario Library Week; Regional
o YWCA Week Without Violence; National
4th Week
o National Block Parents Week; National
o Waste Reduction Week ; National
Last Week
o Disarmament Week; International;
o Red Ribbon Celebration for a drug-free world; International
October Daily Observances
1st - International Day for Older Persons
1st - International Music Day
1st Monday - World Habitat Day; International
5th - International World Teacher's Day
10th - World Hospice and Palliative Care Day; International
10th - World Mental Health Day; International
2nd Wednesday - International Day for Natural Disaster Reduction
2nd Thursday - World Sight Day; International
16th - World Food Day; International
17th - International Day for the Eradication of Poverty
18th - Persons Day; National
18th - World Menopause Day; International
20th - National Microfinance Day
3rd Sunday - National Psoriasis Walk
24th - United Nations Day and World Development Information Day; International

The latest clinical, academic and community research in wound care

Earlier this year in March, the Canadian Association of Wound Care (CAWC) launched the CAWC Institute offering education on wound management and prevention in three and four day educational events. The goal is to improve the health of Canadians suffering from acute and chronic wounds by providing unbiased, evidence-informed education to healthcare professionals interested in wound care.
CAWC educational events offered through the CAWC Institute are delivered by an interprofessional faculty with the help of regional wound care leaders across Canada. These educational programs are recognized by professional organizations, associations and governments, and are designed to enhance and support clinical practice as well as improve quality of care for patients.
CAWC Institute's Level 1 program translates basic wound management knowledge to support a best practice approach to patient care including wound healing principles, wound preparation, pressure ulcers, venous leg ulcers and diabetes foot ulcers. Level 2 offers interactive learning and practice of wound care skills including local wound care, debridement, infection control and dressing selection. Lower leg assessment and compression therapy as well as foot care and foot wear, pressure, friction and shear management are also taught. Finally CAWC Institute Level 3 helps you plan and integrated recommended steps and methods of transferring and sustaining prevention knowledge into practice with a focus on pressure ulcer and diabetes foot ulcer prevention. All participants receive a CAWC Institute certificate upon completion of each level.
The CAWC Institute builds on the former S-Series offered by the CAWC to healthcare professionals, however it is now offered throughout the year. In fall 2010, the CAWC Institute program is being offered in:
o Vancouver, BC from 23 to 26 September
o Moncton, NB from 21 to 24 October
o Winnipeg, MB from 18 to 21 November
o Montreal, QC from 25 t 28 November (French only)
o Toronto, ON from 2 to 5 December
Physicians, nurses and other health professionals interested in receiving advanced wound care education may be more interested in attending the CAWC Institute's L-4 International Interprofessional Wound Care Course (IIWCC) offered with the University of Toronto. This 8-month course is designed for those with some training and experience in wound care. The IIWCC consists of two 4-day residential weekends held in Toronto, ON, 12 self-study modules and an elective related to your day-to-day professional activities. This year's program begins October 14th to 17th, and the second weekend is April 29th to
May 2nd, 2011.
Finally, the CAWC 16th Annual Professional Wound Care Conference is the largest educational gathering for wound care in Canada. Over 1,000 physicians, nurses, ETs, therapists, surgeons, chiropodists, podiatrists, occupation and rehabilitation specialists are expected to attend this year from November 4th to 7th in Calgary, Alberta. The level of education, number of session and quality of speakers will showcase the best clinical practices in wound care as well as profile the latest clinical, academic and community research that may translate into quality improvements in clinical practice.
For more information, please visit the CAWC website at: www.cawc.net.

“Do These 'Genes' Make Me Look Fat?”
Fat Loss Is
All About Insulin

by Tyron Piteau, B.H.K., C.H.E.K Level 2
When it comes to weight/fat loss, it's very simple:
1) eat less, 2) exercise, 3) repeat, 4) forever! It's really that simple, however unfortunately it requires hard work and a long term approach.
Weight loss can become SO SIMPLE when we understand one simple thing: controlling insulin. When it comes to weight/fat loss it's all about INSULIN! Let me explain. If you've been struggling to lose weight this WILL really help in understanding what's going on.
Buckle up. If I harp on any particular food you enjoy; there's no need to worry as I won't say you can never eat that food again (sounds like a mild form of torture) as you can enjoy ALL your favourite foods on your Cheat Day once per week. (For those who don't know the premise behind a Cheat Day it's part of the Unstoppable Fat Loss Nutrition System program and it's necessary to keeping your metabolism elevated and your body in fat burning mode as strange as it sounds...it works!)
Natural Weight Management: Since plants AND animals are much more nutrient-dense than your typical processed carbohydrates you will meet your nutrient needs in fewer calories than with the typical SAD (Standard American Diet) that's so prevalent today. Secondly, when your diet consists of an ample amount of protein and fat it has been shown by food scientists to provide greater and longer satiety (satisfaction levels) than you get from a high carb diet. Finally, and the real kicker, when you consume fewer carbohydrates and, as a result, produce less insulin, your hunger and cravings (caused by insulin removing glucose from the bloodstream after high-carb meals or snacks - yup those can be a thing of the past if you want) will subside and you'll intuitively moderate your caloric intake.
“Essentially 80% of your ability to reduce excess body fat is determined by how you eat, with the other 20% depending on proper exercise, other healthy lifestyle factors and genetic factors.” Mark Sisson
When you give your body the right signals by the foods you eat, your genes stop storing body fat and start burning it, as well as begin increasing lean muscle tissue, which results in a loss of one to two pounds of fat per week and that's on the conservative end. You could in fact safely lose more than that per week in the initial stages as the rate of your success depends on how aggressive you are in keeping dietary insulin levels moderated, thereby extracting more of your caloric needs from fat stores.
Unfortunately when we produce too much insulin over time, as is the case with the modern diet that is high in processed carbohydrates, several things go wrong. First, your ability to store glycogen (stored form of glucose) in your muscle and liver cells is compromised, so it's easy to exceed storage capacity with a typical moderate-to-high-carb modern diet. So now what happens is when your muscle and liver cells become saturated with glycogen, any glucose that is left in the bloodstream that isn't used immediately by your organs such as your brain and muscles gets converted into triglycerides in the liver and sent to fat cells for storage.
To make the matter worse, when blood insulin levels are high, those same fat cells not only store the excess glucose but the fat you ate at your last meal. Additionally, high insulin signals the fat cells to hold on to the fat and not release it for energy. This is the reason that someone could exercise 14 hours per week and STILL not lose a pound! Research has proven it. So if this cycle of consuming high insulin-promoting meals perpetuates, fat cells swell up and we gain weight. Eventually, muscle and liver cells start to become insulin resistant (not good!), meaning their receptors become desensitized to the storage signals produced by insulin, and this is especially the case among people who don't exercise much. Because inactive and sedentary people's bodies are unfamiliar with burning fat and inefficient at replenishing energy from dietary nutrients, insulin takes ingested carbohydrates and fats, bypassing the liver, to the fat cells!
Continuing this process leads to greater weight gain and ultimately severe obesity. Eventually even your fat cells will become resistant to further storage because we only have a fixed amount of fat cells. If this occurs, the body's defense against glucose has reached its max. The resulting blood glucose toxicity and insulin damage leads to even greater risk for diabetes, heart attack, blindness, the need for limb amputation and other disasters. Not a pretty picture.
So as you can see in this brief explanation it really does come down to insulin and how we control it by what we eat. To learn more about how to lose weight and keep it off I recommend you read a book called The Primal Blueprint by Mark Sisson (MarksDailyApple.com). He covers in greater details than I have here about how insulin is THE key when it comes to getting and keeping the body and look you want. This approach of controlling insulin is what I incorporate in my business and with my clients and has been part of what has helped us get the results and success we have so far.

About the Author:
Tyron Piteau, B.H.K., is a real world fat loss expert and owner of The Maker's Body Personal Training and Boot Camp. For your FREE Rapid Fat Loss Starter Kit including home workouts (with videos) and a nutrition jump start program as well as a FREE fitness session
and consultation visit www.MakersBody.com, call
(604) 626-2342 or email MakersBody@gmail.com.

References:
Sisson, Mark., The Primal Blueprint. Primal Nutrition, Inc., Malibu, CA, 2009.