Nair R.,Vancouver Island Health Authority
Journal of orthopaedic surgery (Hong Kong) | Year: 2014
18 English-language studies published between January 2003 and April 2013 were retrieved from the MEDLINE database using the key word 'total wrist arthroplasty'. In most studies, total wrist arthroplasty achieved improvement in pain and function over time. In a meta-analysis, the revision rate was 17% for third-generation implants. The survival rate was 92% for fourth-generation implants at 4 years. Complication rates ranged from 0% to 100% for third-generation implants and from 6% to 47% for fourth-generation implants. Results of total wrist arthroplasty vary greatly; longer-term studies are needed to determine its cost-effectiveness.
Miller D.B.,Vancouver Island Health Authority
Canadian Journal of Diabetes | Year: 2014
The importance of glycemic control in hospitalized patients has been a relatively recent revelation. There is somewhat contradictory evidence concerning the optimal glycemic target in critically ill patients. There is only indirect evidence in non-critically ill patients. This article reviews the evidence for glycemic targets in hospitalized patients. It also investigates which hospital-based treatments can act as barriers to attaining optimal blood glucose levels in hospital and system barriers to attaining those optimal levels.The systematic approach to and evaluation of in-hospital diabetes management has a short history. The first large clinical trial, the DIGAMI trial of peri-myocardial infarction insulin therapy, was published in 1995 (1). The first guideline discussion of in-hospital diabetes management occurred briefly in 2003, more fully in 2008 and 2013 (2-4) by the Canadian Diabetes Association; in 2005 and annually since then by the American Diabetes Association (5,6). Recently, there have been many more publications on the topic. A recent PubMed search, limited to the last 5 years, "hospital" and "diabetes" as a Medical Subject Headings (MeSH) major topic, revealed more than 5000 English-language clinical trials (PubMed.gov; accessed 6 Oct 2013). Still, relatively little is certain about appropriate glycemic targets in hospital. This has left us, in 2014, with consensus recommendations only for glycemic targets in non-critically ill patients from both the Canadian Diabetes Association Clinical Practice Guidelines (4) and the American Diabetes Association Standards of Medical Care in Diabetes (6).This article reviews recommended glycemic targets in various in-hospital populations and the barriers to obtaining them. © 2014 Canadian Diabetes Association.
St. John P.D.,University of Manitoba |
Tyas S.L.,University of Waterloo |
Montgomery P.R.,Vancouver Island Health Authority
International Journal of Geriatric Psychiatry | Year: 2015
Objective To determine if the modified mini-mental state examination (3MS) predicts functional status and if any effect on function is observed within the normal range of cognition. Design Cohort study. Setting Community-dwelling older adults in the Canadian province of Manitoba sampled in 1991 and followed in 1996. Participants Baseline sample of 1751 adults aged 65+ from a representative registry. Five years later, 1028 participants remained in the community and had no missing data. Measurements The 3MS, age, gender, education, living arrangements, self-rated health, and depressive symptoms were self-reported. Functional status was assessed using the Older Americans Resource Survey, which was dichotomized into no/mild disability versus moderate/severe disability. Results Baseline 3MS score predicted baseline functional status. This effect was a gradient across the entire 3MS score, extending into the normal range with no apparent threshold. In logistic regression models, the unadjusted odds ratio (OR, 95% confidence interval) for the association of 3MS score with disability was 0.94 (0.93, 0.95); the adjusted OR was 0.96 (0.95, 0.98) in models including age, gender, education, and other covariates. Baseline 3MS score also predicted functional status 5 years later: The unadjusted OR for disability was 0.94 (0.92, 0.95); the adjusted OR was 0.97 (0.95, 0.99). Again, the risk of functional impairment at time 2 was a gradient effect, extending into the normal range of baseline 3MS score. Conclusions The 3MS predicts functional decline, and this effect is a gradient effect. These results support the hypothesis that cognition is a continuum in risk. Copyright © 2014 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.
John P.,University of Manitoba |
Montgomery P.,Vancouver Island Health Authority
Journal of Geriatric Psychiatry and Neurology | Year: 2013
Objectives: 1. To determine if Self-Rated Health (SRH) predicts dementia over a five period in cognitively intact older adults, and in older adults with Cognitive Impairment, No Dementia (CIND); and 2. To determine if different methods of eliciting SRH (age-referenced (AR) versus unreferenced) yield similar results. Design: Prospective cohort. Population: 1468 cognitively intact adults and 94 older adults with CIND aged 65+ living in the community, followed over five years. Measures: Age, gender, education, subjective memory loss, depressive symptoms, functional status, cognition, SRH and AR-SRH were all measured; dementia was diagnosed on clinical examination. Those with abnormal cognition not meeting criteria for dementia were diagnosed with CIND. Results: In those who were cognitively intact at time 1, and had good SRH: 69.4% were intact; 6.0% had CIND; 6.9% had dementia, and 17.7% had died at time 2, while in those with poor SRH: 44.9% were intact, 11.1% had CIND, 9.1% had dementia, and 34.8% had died (p<0.001, chi-square test). In multinomial regression models SRH predicted dementia and death. In those with CIND at time 1 and good SRH: 2.3% were intact: 18.6% had CIND; 34.9% had dementia and 44.2% had died at time 2, while in those with poor SRH: 4.8% were intact, 31.0% had CIND, 19.0% had dementia, and 43.6% had died (p=0.30, chi-square test). In multinomial regression models, this was not significant. AR-SRH analyses were similar. Conclusions: In cognitively intact older adults SRH predicts dementia. In older adults with CIND, SRH does not predict dementia. © The Author(s) 2012.
Pennock M.,Vancouver Island Health Authority |
Ura K.,Center for Bhutan Studies
Environmental Impact Assessment Review | Year: 2011
The incorporation of population health concepts and health determinants into Health Impact Assessments has created a number of challenges. The need for intersectoral collaboration has increased; the meaning of "health" has become less clear; and the distinctions between health impacts, environmental impacts, social impacts and economic impacts have become increasingly blurred. The Bhutanese concept of Gross National Happiness may address these issues by providing an over-arching evidence-based framework which incorporates health, social, environmental and economic contributors as well as a number of other key contributors to wellbeing such as culture and governance. It has the potential to foster intersectoral collaboration by incorporating a more limited definition of health which places the health sector as one of a number of contributors to wellbeing. It also allows for the examination of the opportunity costs of health investments on wellbeing, is consistent with whole-of-government approaches to public policy and emerging models of social progress. © 2010 .
Weinerman R.,Vancouver Island Health Authority
Healthcare quarterly (Toronto, Ont.) | Year: 2011
This article describes a new and innovative training program to assist family physicians to better care for their patients with mental health conditions. Trained family physician leaders train other family physicians. The training package includes a wide range of tools that can be used by physicians in their own offices. Preliminary results indicate that physicians want to be trained, and data indicate a high degree of success for the training module. Some 91% of physicians who attended the training indicated that it had improved their practice, and 94% indicated that it had improved patient care. The training materials are online for those who wish to learn more.
St. John P.D.,University of Manitoba |
Tyas S.L.,University of Waterloo |
Montgomery P.R.,Vancouver Island Health Authority
International Journal of Geriatric Psychiatry | Year: 2013
Background Frailty and depressive symptoms are common issues facing older adults and may be associated. Objectives To determine if: (i) depressive symptoms are associated with frailty; (ii) there is a gradient in this effect across the range of depressive symptoms; and (iii) the association between depressive symptoms and frailty is specific to particular types of depressive symptoms (positive affect, negative affect, somatic complaints, and interpersonal relations). Method Secondary analysis of an existing population-based study was conducted. Population In 1991, 1751 community-living adults aged 65+ years were interviewed. Measures Depressive symptoms were measured using the Center for Epidemiologic Studies - Depression (CES-D) scale. Frailty was graded from 0 (no frailty) to 3 (moderate/severe frailty). Age, gender, education, marital status, self-rated health, and the number of comorbid conditions were self-reported. Analyses Logistic regression models were constructed with the outcome of no frailty/urinary incontinence only versus frailty. Results Depressive symptoms were strongly associated with frailty, and there was a gradient effect across the entire range of the CES-D scale. The odds ratio and 95% confidence interval was 1.08 (1.06, 1.09) per point of the CES-D in unadjusted models. After potential confounding factors were adjusted, the adjusted odds ratio (95% confidence interval) was 1.03 (1.01, 1.05). Positive affect, negative affect, and somatic complaints were all associated with frailty, whereas interpersonal relations were not associated with frailty. Conclusions Depressive symptoms are associated with frailty. Clinicians should consider assessing frail older adults for the presence of depression. Copyright © 2012 John Wiley & Sons, Ltd.
Miller D.B.,Vancouver Island Health Authority
Canadian Journal of Diabetes | Year: 2011
Basal-bolus-supplement insulin is the standard way patients on a multiple daily injection (MDI) insulin program take insulin at home. However, in many hospitals, this physiological approach to insulin delivery is supplanted by sliding-scale insulin, wherein fast- or rapid-acting insulin only is given subcutaneously and only in response to particularly high blood glucose levels. Evidence has mounted that sliding-scale insulin leads to an increase in blood glucose and an increase in serious hospital morbidity compared to basal-bolus-supplement. To highlight this evidence, the Vancouver Island Health Authority has tried an educational approach, combined with changes to clinical order sets, in an effort to replace sliding-scale insulin with basal-bolus- supplement. Initial results have been disappointing, and on-going efforts are required to understand why the sliding scale appears so deeply entrenched.
News Article | February 17, 2017
VICTORIA, BC--(Marketwired - February 17, 2017) - Victoria's Bob Strachan, FCPA, FCMA, C.Dir was honoured with a Lifetime Achievement Award by the Chartered Professional Accountants of British Columbia (CPABC). The award recognizes Strachan's sustained distinction in his career, community service, and work within the accounting profession. Bob Strachan, FCPA, FCMA, C.Dir is principal of Bob Strachan & Associates. Before founding his firm in 2013, he held a number of management positions as an accountant with the Capital Regional District (CRD) from 1986 to 2013. Previously, he held roles with the Vancouver Island Health Authority and the Province of BC. While at the CRD, Strachan was a lead in the implementation of a new enterprise risk management program, enterprise information system, and corporate asset management program. Under his leadership, the CRD received numerous awards from the Government Finance Officers Association for excellence in financial reporting. Strachan is highly regarded for his contributions to the accounting profession, and played a pivotal role in the unification of Canada's profession. He led the CMA Canada board through merger discussions and developed unification strategies. In 2012, he was co-chair of the National Steering Committee that helped to develop the CPA Collaboration Accord and oversaw the formation of CPA Canada. Strachan went on to serve as vice-chair and chair of the CPA Canada board. Strachan worked with CPA boards in every province to ensure that unification of the profession was fully integrated within the national and provincial partnership. In addition, Strachan served on the CMABC board, including as chair (2001-2003), and on the CMA Canada board, including as chair (2009-2011). He is the former chair of CPA Canada's Nominating and Governance Committee, and chaired CPA Canada's President and CEO Search Committee. Today, Strachan is a member of CPA Canada's Corporate Oversight and Governance Board and the Chartered Professional Accountants' Education Foundation of BC. Strachan has generously shared his expertise with other organizations, including by serving on the boards of the Financial Management Institute of Canada (Victoria chapter) and Camosun College Foundation (chair), as well as with Royal Roads University's Master of Arts in Leadership program and the Province of BC's Accounting Policy Advisory Committee. He also makes time to volunteer. Strachan has served as a director of Leadership Victoria, and coached and served in executive positions with amateur sports organizations. Strachan obtained his CMA and fellowship designations in 1995 and 2004, respectively. Quote Richard Rees, FCPA, FCA, president and CEO, CPABC "Bob is truly deserving of the Lifetime Achievement Award. Throughout his career, he has dedicated his time towards the betterment of the accounting profession and his community. His contributions are invaluable and we are extremely proud of Bob's achievements." NOTE TO JOURNALISTS: Publication quality photos of the recipients are available. About CPA British Columbia The Chartered Professional Accountants of British Columbia (CPABC) is the training, governing, and regulatory body for almost 35,000 CPA members and 5,500 CPA students and candidates. CPABC carries out its primary mission to protect the public by enforcing the highest professional and ethical standards and contributing to the advancement of public policy. CPAs are recognized internationally for bringing superior financial expertise, strategic thinking, business insight, and leadership to organizations.
Daniels T.R.,St Michaels Hospital |
Younger A.S.E.,University of British Columbia |
Penner M.,University of British Columbia |
Wing K.,University of British Columbia |
And 2 more authors.
Journal of Bone and Joint Surgery - Series A | Year: 2014
Background: Surgical treatments for end-stage ankle arthritis include total ankle replacement and ankle arthrodesis. Although arthrodesis is a reliable procedure, ankle replacement is often preferred by patients. This prospective study evaluated intermediate-term outcomes of ankle replacement and arthrodesis in a large cohort at multiple centers, with variability in ankle arthritis type, prosthesis type, surgeon, and surgical technique. We hypothesized that patient-reported clinical outcomes would be similar for both procedures. Methods: Patients in the Canadian Orthopaedic Foot and Ankle Society (COFAS) Prospective Ankle Reconstruction Database were treated with total ankle replacement (involving Agility, STAR, Mobility, or HINTEGRA prostheses) or ankle arthrodesis by six subspecialty-trained orthopaedic surgeons at four centers between 2001 and 2007. Data collection included demographics, comorbidities, and the Ankle Osteoarthritis Scale (AOS) and Short Form-36 (SF-36) scores. The preoperative and latest follow-up scores for patients with at least four years of follow-up were analyzed. Sensitivity analyses excluded ankles that had undergone revision. A linear mixed-effects regression model compared scores between the groups, adjusting for age, sex, side, smoking status, body mass index, inflammatory arthritis diagnosis, baseline score, and surgeon. Results: Of the 388 ankles (281 in the ankle replacement group and 107 in the arthrodesis group), 321 (83%; 232 ankle replacements and eighty-nine arthrodeses) were reviewed at a mean follow-up of 5.5 ± 1.2 years. Patients treated with arthrodesis were younger, more likely to be diabetic, less likely to have inflammatory arthritis, and more likely to be smokers. Seven (7%) of the arthrodeses and forty-eight (17%) of the ankle replacements underwent revision. The major complications rate was 7% for arthrodesis and 19% for ankle replacement. The AOS total, pain, and disability scores and SF-36 physical component summary score improved between the preoperative and final follow-up time points in both groups. The mean AOS total score improved from 53.4 points preoperatively to 33.6 points at the time of follow-up in the arthrodesis group and from 51.9 to 26.4 points in the ankle replacement group. Differences in AOS and SF-36 scores between the arthrodesis and ankle replacement groups at follow-up were minimal after adjustment for baseline characteristics and surgeon. Conclusions: Intermediate-term clinical outcomes of total ankle replacement and ankle arthrodesis were comparable in a diverse cohort in which treatment was tailored to patient presentation; rates of reoperation and major complications were higher after ankle replacement. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2014 By The Journal Of Bone And Joint Surgery, Incorporated.