Crowded Thunder Bay hospital to convert lounges to patient rooms

Thunder Bay's regional hospital is planning to convert some family lounges into much needed space for patients.

The hospital was keeping patients in hallways and alcoves, but that no longer complies with the city's new fire codes.

Now, the plan is to convert seven sun rooms currently used as lounges for the families of patients, into spaces for patient beds.

Andree Robichaud, the CEO of the Regional Health Sciences Centre, said she hopes the extra space will free up the hallways which are currently crowded with beds occupied by patients whose treatment has finished.

CEO of the Regional Health Sciences Centre Andree Robichaud. (CBC)

"Is it the ideal care? No," Robichaud said. "They should be in the community in either a long-term care facility or in an assisted living facility. But we're going to provide the best care that we can."

The rooms will be renovated and equipped with the standard privacy curtains and call bells.

Most of the patients that will get the new rooms are 'alternate level of care' patients, Robichaud said, but ultimately it will be up to the doctors and nurses of each unit to decide where each patient goes.

As of Thursday the hospital said there were 59 'alternate level of care' patients and six waiting in the emergency room to be admitted to the hospital.

Robichaud said she is not sure how long they will use the sun rooms for patients because it depends on when more community space becomes available.

Currently the hospital is looking into other places within and outside the hospital as well, she added.

The conversion will also affect families who used the space as a place to gather.

"That's very inconvenient for the families and I hope that they understand that we're very tight for space and that our priority is for patient care," she said. "So we apologize for any inconvenience that we're creating for the families."

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Soft-drink makers accused of using 'Big Tobacco playbook'

Recent studies that cast doubt on the benefits of diet soda and suggest consuming pop can lead to aggression in children come at a time when major soft-drink manufacturers are waging a controversial marketing battle to put a healthy spin on sugar-sweetened beverages.

One of the most proactive is Coca-Cola, which produced ads earlier this year that tout how easy it is to work off the calories in a serving of Coke. A version that aired in the United Kingdom was banned in July by authorities who said it misled consumers.

Canadian obesity expert Yoni Freedhoff says the emphasis on health is "deceptive" and signals a last, desperate attempt to legitimize an industry that is increasingly viewed as a health risk.

"I do think that the writing is on the wall," says the founder of Ottawa's Bariatric Medical Institute and an authority on weight issues. "I don't think there's anything more clear-cut as not good for people, in my mind, than sugar-sweetened beverages. There's nothing nutritionally beneficial about them.

"I think that this really is the Big Tobacco playbook that [soft-drink producers are] playing from."

A controversial New York City department of health ad that was part of a campaign to limit the size of sodas that could be served in restaurants and other facilities. (Reuters)

Freedhoff is referring to an influential paper published in 2009 called The Perils of Ignoring History: Big Tobacco Played Dirty and Millions Died. How Similar Is Big Food?

Written by two obesity researchers — Yale University's Kelly Brownell and Kenneth Warner from the University of Michigan — the paper says that after studies began linking smoking to lung cancer in the 1950s, the cigarette industry stressed the importance of the public's health and promised a number of "good-faith changes."

What followed, say Brownell and Warner, was a prolonged marketing "playbook" that emphasized personal responsibility, paid scientists to deliver dubious research and criticized any science that suggested harms associated with smoking, among other tactics.

David Moran, director of sustainability at Coca-Cola Canada, calls the comparison "unfair and not accurate."

"There's no way that you can consume tobacco in any way that's healthy," says Moran. "But with our products, you can consume them in a healthy, active lifestyle."

Making connections with good health

For a number of years, medical experts have cited soft drinks as one of the leading causes of obesity, diabetes and heart disease.

In June, a study from Purdue University in Indiana suggested that despite their low calories and sugar content, diet soft drinks can still contribute to weight gain and diabetes.

Meanwhile, a U.S. study of preschoolers released on Aug. 16 reported that consuming several servings of pop a day is associated with behaviour problems such as aggression.

At the same time, soft drink manufacturers have in recent years introduced products that advertise nutritional benefits.

In the mid-2000s, Coca-Cola brought out Diet Coke Plus, which the company described as "Diet Coke with Vitamins and Minerals." In 2009, the Dr Pepper Snapple Group introduced a line of 7Up flavours said to contain antioxidants.

In 2008, however, the U.S. Food and Drug Administration ruled that Diet Coke Plus made improper nutritional claims; the drink has since been discontinued in the U.S.

In July, the Dr Pepper Snapple Group agreed to stop fortifying its 7Up drinks with vitamins and claiming they contain antioxidants, after a California consumer filed a federal class action lawsuit.

According to the complaint, the packaging of 7Up varieties such as regular and diet Cherry Antioxidant and Mixed Berry Antioxidant suggested the antioxidant came from fruit, when in fact there is no fruit content in 7Up.

Fighting obesity

Coke's Moran says the marketing approach is slightly different in Canada, because Health Canada has strong restrictions on touting the nutritional value of soft drinks.

Even so, beverage makers have taken a pro-active stance in the fight against obesity. Earlier this year, Coca-Cola Canada launched a campaign called "Coming Together," which aims to raise awareness of ways to reduce weight gain.

Not everyone liked N.Y. Mayor Michael Bloomberg's campaign to limit soft-drink sizes, including a judge who quashed the city law earlier this year. (Kathy Willens / Associated Press)

The company also renewed a partnership with ParticipAction, the national not-for-profit that promotes physical activity.

"Our focus has been a lot on calorie awareness," says Moran, who emphasizes that Coca-Cola also produces lower-calorie products, such as diet drinks and flavoured waters.

Part of the "Coming Together" campaign is an ad called "The Calorie Dictionary," which suggests some simple ways a person could work off the 160 calories in a 13.5-ounce bottle of Coke, including five minutes of skateboarding (45 calories), yelling (13 calories) or demolition work (39 calories).

Freedhoff says the ad is "purposely deceptive," saying it's unclear in the commercial that a person would have to complete a combination of these activities — not just one of them — to work off the serving of Coke.

He adds that diet is much more important than exercise in determining weight gain.

But not everyone is opposed to the ad campaign.

"Healthy living is the issue here, and so calorie-counting is a part of that, and certainly if you start drinking the Big Gulps, your toll is going to go up very quickly," says Michael Mulvey, a marketing professor at the University of Ottawa.

"At least [Coke is] initiating a dialogue — they're showing a partial solution to the problem. In a way, it is offering some balance to the other array of ads that they have that say this is a pause that refreshes or this is a treat or this is a bonding experience."

The art of 'health-haloing'

Claire Tsai, a marketing expert at the Rotman School of Management, concedes that some of the anti-soft drink rhetoric nowadays compares it to cigarettes, but she says there is a critical distinction between the two products.

"The biggest difference between soft drinks and tobacco is that tobacco is linked with lung cancer, a fatal disease, while obesity is linked with other fatal diseases, but it's not the only thing that causes those fatal diseases," she says.

"So it's unlikely that we'll see a class-action lawsuit in the context of soft drinks."

Mulvey adds that "with tobacco, a lot of [the criticism] has been motivated by secondary smoke and all the people that didn't have the choice" in consuming it.

Freedhoff says Coke, like many food and beverage manufacturers, is simply engaging in "health-haloing," a marketing practice in which companies create associations between their products and healthy living.

"These are incredibly savvy marketers, incredibly savvy sales people," says Freedhoff.

"Not having these ads would be better than having them, but [they] are a lesser evil than further vilification of soft drinks by the public and by public health officials."

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Persistent wounds 'a big issue' in Canada

Persistent wounds including diabetic foot ulcers and bedsores can lead to severe complications and are widespread in Canada, but some can be prevented, according to a new report.

The Canadian Institute for Health Information (CIHI) report released Thursday looks at certain wounds that don't heal well.

Reduced blood flow is one of the reasons people with diabetes are more prone to foot ulcers (Lucy Nicholson/Reuters)

"We found that compromised wounds were a big issue," Kathleen Morris, CIHI's director of health system analysis in Toronto, said in an interview.

"It's an important aspect of health care because it's very painful and very distressing for patients, and it sometimes leads to significant health consequences."

Morris said compromised wounds don't heal well, perhaps because of a skin infection or chronic condition such as diabetes that can make healing more difficult. Another category is pressure ulcers or bed sores that are more likely in people with restricted mobility, for example, if they're in a wheelchair or confined to a bed.

No health-care sector was immune. Nationally, "compromised wounds" were reported in :

• Almost four per cent of acute patients in hospital — the only sector for which data was available from all Canadian hospitals. In 2011-2012, more than 117,000 people in acute care had compromised wounds.
• Almost seven per cent of home-care clients.
• Almost 10 per cent of long-term-care clients.
• Almost 30 per cent of hospital-based continuing care clients in some provinces. The hospitals treat people with chronic conditions such as those with diabetes of peripheral vascular disease.

To prevent compromised wounds, the report's authors suggest:

• Turning bedridden patients frequently to prevent pressure ulcers.
• Having people with diabetes undergo regular foot checkups.
• Reducing surgical site infections.

People with diabetes are more likely to have wounds that don't heal properly because of their reduced foot blood flow and sensation. That's why it's important to inspect the skin regularly, to identify any cuts or blisters promptly to a health-care team, Morris suggested. Keeping the feet in good condition by wearing well-fitting shoes with closed toes can also help.

Dr. Ron Linden, medical director of the Judy Dan Research & Treatment Centre in Toronto, uses hyperbaric medicine to try to treat diabetic ulcers.

Canada spends $1.5 billion a year on diabetic amputations, Linden said.

"The earlier you start treating these wounds, the easier it is to treat them. If the patients come late, where the wounds are already necrotic or the wounds are gangrenous, there's no other alternative than amputation," Linden said.

The object is to recognize that the wounds will occur and to treat them as soon as possible, he said.

Mary Anne Kecskemethy has Type 2 diabetes. She's had one foot amputated and came to Linden's clinic today to check how lesions on her remaining foot are healing.

"It's black," she said, her voice breaking on learning the bad news that her big toe became bruised without her realizing it. "Any kind of damage to my foot creates more problems."

Laura Teague is a registered nurse and nurse practitioner for the wound care program at St. Michael's Hospital in Toronto, where she focuses on pressure ulcers.

"We have a program that identifies risk of pressure ulcer, and when patients are identified as high risk we put certain measures in place," Teague said. "One of those measures is putting the patient on an appropriate patient redistribution mattress and we also put a turning schedule into place for patients."

Since many factors influence the onset and severity of pressure ulcers, Teague said not all of the wounds are preventable.

With files from CBC's Kim Bruhuber and Jill English

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Tylenol to get health warnings on cap in U.S.

Johnson & Johnson says its U.S. bottles of Extra Strength Tylenol will bear a new warning label on the cap to alert users to potentially fatal risks of taking too much of the pain reliever. (Johnson & Johnson/Associated Press)

Bottles of Tylenol sold in the U.S. will come with warning labels on the cap to alert people that the popular painkiller contains acetaminophen that can damage the liver when taken in excess.

Acetaminophen is a medicinal ingredient in more than 470 products, according to Health Canada's online database.

It's also found in more than 600 common over-the-counter and prescription products in the U.S., including brands like Nyquil cold formula, Excedrin pain tablets and Sudafed sinus pills.

The label change is prompted by the concern that people may not realize the risk of overdosing if they take more than one of these products at the same time, or even same day.

The new cap message will read: "Contains acetaminophen" and "Always read the label."

"At this time, the cap text messaging is being introduced on Tylenol bottles sold in the US market based upon a number of factors that are specific to the U.S. market, including the prevalence of simultaneous usage of multiple acetaminophen products by a significant portion of the U.S. adult population," Shelley Kohut, director of communications and public relations at Johnson & Johnson said in an email to CBC News.

"Our commitment is to continue to assess and evaluate the needs of Canadian consumers and to provide information and educate, as appropriate, to support the continued safe and effective use of our products."

Kohut said Tylenol meets Health Canada's 2009 labelling standard for acetaminophen.

The U.S. move comes as Johnson & Johnson faces more than 85 personal injury lawsuits in U.S. federal court that blame Tylenol for liver injuries and deaths. The U.S. Food and Drug Administration is also planning to curtail the use of some acetaminophen products.

Dr. David Juurlink, a drug safety researcher at Sunnybrook Health Sciences Centre in Toronto, said the U.S. change is sensible.

"Almost everyone has this in their medicine cabinet," Juurlink said in an interview. "It's a drug that if taken to excess can cause severe and sometimes fatal liver injury and I'm not sure how widely known that is."

In 2012, Dr. Rod Lim and his team at London Health Sciences Centre reported a case of the 22-day-old boy that they successfully treated in the emergency department at a community hospital after an accidental overdose of acetaminophen.

Identifying all products that contain acetaminophen is useful so parents don't mistakenly give more than one product containing the drug to their child at the same time, Lim said.

"People remember what they take for a single dose. They say, 'I take two tablets,'" Lim said. "The problem is they're used to taking it every four hours but they'll exceed the maximum daily dose within 16 hours. So it's confusing for consumers to think of what they can take and how often and not realize that they can't take it continuously for that day."

For example, taking two, 500-milligram tablets or capsules of acetaminophen every four hours from 8 a.m. to midnight for example adds up to five grams. The maximum dose for a day is 4 grams.

Acetaminophen overdoses occur when the liver is unable to detoxify high doses of the drug and liver failure results. If an overdose occurs, people can do well if they get to a hospital early, Juurlink said.

But Juurlink also fears that the warning changes might also spur deliberate overdoses, which he speculates make up the majority of severe liver injuries from Tylenol that come to medical attention.

In Canada, Tylenol's manufacturer, McNeil Consumer Healthcare, a division of Johnson & Johnson, recently introduced a website to give consumers information on the safe and responsible use of over-the-counter medicines, including products containing acetaminophen.

Gerry Harrington is director of public affairs for Consumer Health Products Canada, which represents manufacturers, marketers, and distributors of consumer health products including over-the-counter medications.

"There are significant differences between the Canadian and American experience with acetaminophen overdose, including a higher fatality rate and a greater incidence of narcotic combination products in the U.S.," Harrington said in an email. "For these reasons, I think it's too early to say whether such an initiative would be appropriate in Canada."

A spokeswoman for Health Canada said the department is aware of the labelling changes in the U.S. and is evaluating them as part of its continual surveillance of acetaminophen products.

Bottles of Extra Strength Tylenol in the U.S. will have the new label starting in October.

With files from The Associated Press, CBC's Amina Zafar and Jill English

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Soft-drink makers accused of using 'Big Tobacco playbook'

Recent studies that cast doubt on the benefits of diet soda and suggest consuming pop can lead to aggression in children come at a time when major soft-drink manufacturers are waging a controversial marketing battle to put a healthy spin on sugar-sweetened beverages.

One of the most proactive is Coca-Cola, which produced ads earlier this year that tout how easy it is to work off the calories in a serving of Coke. A version that aired in the United Kingdom was banned in July by authorities who said it misled consumers.

Canadian obesity expert Yoni Freedhoff says the emphasis on health is "deceptive" and signals a last, desperate attempt to legitimize an industry that is increasingly viewed as a health risk.

"I do think that the writing is on the wall," says the founder of Ottawa's Bariatric Medical Institute and an authority on weight issues. "I don't think there's anything more clear-cut as not good for people, in my mind, than sugar-sweetened beverages. There's nothing nutritionally beneficial about them.

"I think that this really is the Big Tobacco playbook that [soft-drink producers are] playing from."

A controversial New York City department of health ad that was part of a campaign to limit the size of sodas that could be served in restaurants and other facilities. (Reuters)

Freedhoff is referring to an influential paper published in 2009 called The Perils of Ignoring History: Big Tobacco Played Dirty and Millions Died. How Similar Is Big Food?

Written by two obesity researchers — Yale University's Kelly Brownell and Kenneth Warner from the University of Michigan — the paper says that after studies began linking smoking to lung cancer in the 1950s, the cigarette industry stressed the importance of the public's health and promised a number of "good-faith changes."

What followed, say Brownell and Warner, was a prolonged marketing "playbook" that emphasized personal responsibility, paid scientists to deliver dubious research and criticized any science that suggested harms associated with smoking, among other tactics.

David Moran, director of sustainability at Coca-Cola Canada, calls the comparison "unfair and not accurate."

"There's no way that you can consume tobacco in any way that's healthy," says Moran. "But with our products, you can consume them in a healthy, active lifestyle."

Making connections with good health

For a number of years, medical experts have cited soft drinks as one of the leading causes of obesity, diabetes and heart disease.

In June, a study from Purdue University in Indiana suggested that despite their low calories and sugar content, diet soft drinks can still contribute to weight gain and diabetes.

Meanwhile, a U.S. study of preschoolers released on Aug. 16 reported that consuming several servings of pop a day is associated with behaviour problems such as aggression.

At the same time, soft drink manufacturers have in recent years introduced products that advertise nutritional benefits.

In the mid-2000s, Coca-Cola brought out Diet Coke Plus, which the company described as "Diet Coke with Vitamins and Minerals." In 2009, the Dr Pepper Snapple Group introduced a line of 7Up flavours said to contain antioxidants.

In 2008, however, the U.S. Food and Drug Administration ruled that Diet Coke Plus made improper nutritional claims; the drink has since been discontinued in the U.S.

In July, the Dr Pepper Snapple Group agreed to stop fortifying its 7Up drinks with vitamins and claiming they contain antioxidants, after a California consumer filed a federal class action lawsuit.

According to the complaint, the packaging of 7Up varieties such as regular and diet Cherry Antioxidant and Mixed Berry Antioxidant suggested the antioxidant came from fruit, when in fact there is no fruit content in 7Up.

Fighting obesity

Coke's Moran says the marketing approach is slightly different in Canada, because Health Canada has strong restrictions on touting the nutritional value of soft drinks.

Even so, beverage makers have taken a pro-active stance in the fight against obesity. Earlier this year, Coca-Cola Canada launched a campaign called "Coming Together," which aims to raise awareness of ways to reduce weight gain.

Not everyone liked N.Y. Mayor Michael Bloomberg's campaign to limit soft-drink sizes, including a judge who quashed the city law earlier this year. (Kathy Willens / Associated Press)

The company also renewed a partnership with ParticipAction, the national not-for-profit that promotes physical activity.

"Our focus has been a lot on calorie awareness," says Moran, who emphasizes that Coca-Cola also produces lower-calorie products, such as diet drinks and flavoured waters.

Part of the "Coming Together" campaign is an ad called "The Calorie Dictionary," which suggests some simple ways a person could work off the 160 calories in a 13.5-ounce bottle of Coke, including five minutes of skateboarding (45 calories), yelling (13 calories) or demolition work (39 calories).

Freedhoff says the ad is "purposely deceptive," saying it's unclear in the commercial that a person would have to complete a combination of these activities — not just one of them — to work off the serving of Coke.

He adds that diet is much more important than exercise in determining weight gain.

But not everyone is opposed to the ad campaign.

"Healthy living is the issue here, and so calorie-counting is a part of that, and certainly if you start drinking the Big Gulps, your toll is going to go up very quickly," says Michael Mulvey, a marketing professor at the University of Ottawa.

"At least [Coke is] initiating a dialogue — they're showing a partial solution to the problem. In a way, it is offering some balance to the other array of ads that they have that say this is a pause that refreshes or this is a treat or this is a bonding experience."

The art of 'health-haloing'

Claire Tsai, a marketing expert at the Rotman School of Management, concedes that some of the anti-soft drink rhetoric nowadays compares it to cigarettes, but she says there is a critical distinction between the two products.

"The biggest difference between soft drinks and tobacco is that tobacco is linked with lung cancer, a fatal disease, while obesity is linked with other fatal diseases, but it's not the only thing that causes those fatal diseases," she says.

"So it's unlikely that we'll see a class-action lawsuit in the context of soft drinks."

Mulvey adds that "with tobacco, a lot of [the criticism] has been motivated by secondary smoke and all the people that didn't have the choice" in consuming it.

Freedhoff says Coke, like many food and beverage manufacturers, is simply engaging in "health-haloing," a marketing practice in which companies create associations between their products and healthy living.

"These are incredibly savvy marketers, incredibly savvy sales people," says Freedhoff.

"Not having these ads would be better than having them, but [they] are a lesser evil than further vilification of soft drinks by the public and by public health officials."

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Persistent wounds 'a big issue' in Canada

Persistent wounds including diabetic foot ulcers and bedsores can lead to severe complications and are widespread in Canada, but some can be prevented, according to a new report.

The Canadian Institute for Health Information (CIHI) report released Thursday looks at certain wounds that don't heal well.

Reduced blood flow is one of the reasons people with diabetes are more prone to foot ulcers (Lucy Nicholson/Reuters)

"We found that compromised wounds were a big issue," Kathleen Morris, CIHI's director of health system analysis in Toronto, said in an interview.

"It's an important aspect of health care because it's very painful and very distressing for patients, and it sometimes leads to significant health consequences."

Morris said compromised wounds don't heal well, perhaps because of a skin infection or chronic condition such as diabetes that can make healing more difficult. Another category is pressure ulcers or bed sores that are more likely in people with restricted mobility, for example, if they're in a wheelchair or confined to a bed.

No health-care sector was immune. Nationally, "compromised wounds" were reported in :

• Almost four per cent of acute patients in hospital — the only sector for which data was available from all Canadian hospitals. In 2011-2012, more than 117,000 people in acute care had compromised wounds.
• Almost seven per cent of home-care clients.
• Almost 10 per cent of long-term-care clients.
• Almost 30 per cent of hospital-based continuing care clients in some provinces. The hospitals treat people with chronic conditions such as those with diabetes of peripheral vascular disease.

To prevent compromised wounds, the report's authors suggest:

• Turning bedridden patients frequently to prevent pressure ulcers.
• Having people with diabetes undergo regular foot checkups.
• Reducing surgical site infections.

People with diabetes are more likely to have wounds that don't heal properly because of their reduced foot blood flow and sensation. That's why it's important to inspect the skin regularly, to identify any cuts or blisters promptly to a health-care team, Morris suggested. Keeping the feet in good condition by wearing well-fitting shoes with closed toes can also help.

Dr. Ron Linden, medical director of the Judy Dan Research & Treatment Centre in Toronto, uses hyperbaric medicine to try to treat diabetic ulcers.

Canada spends $1.5 billion a year on diabetic amputations, Linden said.

"The earlier you start treating these wounds, the easier it is to treat them. If the patients come late, where the wounds are already necrotic or the wounds are gangrenous, there's no other alternative than amputation," Linden said.

The object is to recognize that the wounds will occur and to treat them as soon as possible, he said.

Mary Anne Kecskemethy has Type 2 diabetes. She's had one foot amputated and came to Linden's clinic today to check how lesions on her remaining foot are healing.

"It's black," she said, her voice breaking on learning the bad news that her big toe became bruised without her realizing it. "Any kind of damage to my foot creates more problems."

Laura Teague is a registered nurse and nurse practitioner for the wound care program at St. Michael's Hospital in Toronto, where she focuses on pressure ulcers.

"We have a program that identifies risk of pressure ulcer, and when patients are identified as high risk we put certain measures in place," Teague said. "One of those measures is putting the patient on an appropriate patient redistribution mattress and we also put a turning schedule into place for patients."

Since many factors influence the onset and severity of pressure ulcers, Teague said not all of the wounds are preventable.

With files from CBC's Kim Bruhuber and Jill English

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Gold bar, $10K found in alarm clock box donated to hospital

A 70-year-old woman who thought she'd won an alarm clock at a Princess Margaret hospital fundraiser last week was surprised when she opened the box to find a wad of bills and a tiny gold bar.

"I had no idea there was something that big in the box," said Gloria Lee, whose husband Martin was a cancer researcher at the Toronto hospital before his death in 2009.

Inside the box, which had been resealed by its original owner, Lee found $10,000 in cash and a bar of gold worth more than $7,000.

"I was in shock. I was in total shock," she said.

Inside the box there was a note from an elderly Scarborough resident, noting that he wanted to donate the money and gold to the Princess Margaret Cancer Centre.

Hospital never checked box

The man lives in a community housing building and wants to remain anonymous.

Officials at the hospital said they never thought to look inside.

"We don't get a chance to open every gift that comes in. This one looked sealed, we put it in the storeroom to be used for any number of the special events that we have in a year," Kevin Shea, spokesperson for the cancer foundation.

With the memory of her husband in mind, the thought of keeping the money and gold never occurred to Lee.

"He would be proud of me that I continue his legacy," she said.

Before his death, Martin Lee's cancer research was using nano-particles from gold to treat tumours.

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Tylenol launches new cap label to curb overdoses in U.S.

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Bottles of Tylenol sold in the U.S. will soon bear red warnings alerting users to the potentially fatal risks of taking too much of the popular pain reliever.

The unusual step, disclosed by the company that makes Tylenol, comes amid a growing number of lawsuits and pressure from the federal government that could have widespread ramifications for a medicine taken by millions of people every day.

Johnson & Johnson says its U.S. bottles of Extra Strength Tylenol will bear a new warning label on the cap to alert users to potentially fatal risks of taking too much of the pain reliever. (Johnson & Johnson/Associated Press)

Johnson & Johnson says the warning will appear on the cap of new bottles of Extra Strength Tylenol sold in the U.S. starting in October and on most other Tylenol bottles in coming months. The warning will make it explicitly clear that the over-the-counter drug contains acetaminophen, a pain-relieving ingredient that's the leading cause of sudden liver failure in the U.S.

"We're always looking for ways to better communicate information to patients and consumers," says Dr. Edwin Kuffner, vice president of McNeil Consumer Healthcare, the Johnson & Johnson unit that makes Tylenol.

Overdoses from acetaminophen send 55,000 to 80,000 people to the emergency room in the U.S. each year and kill at least 500, according the U.S. Centers for Disease Control and Prevention and the Food and Drug Administration.

Acetaminophen can be found in more than 600 common over-the-counter and prescription products used by nearly one in four American adults every week, including household brands like Nyquil cold formula, Excedrin pain tablets and Sudafed sinus pills.

Tylenol is the first of these products to include such a warning label on the bottle cap. McNeil says the warning is a result of research into the misuse of Tylenol by consumers. The new cap message will read: "CONTAINS ACETAMINOPHEN" and "ALWAYS READ THE LABEL."

The move comes at a critical time for the company, which faces more than 85 personal injury lawsuits in federal court that blame Tylenol for liver injuries and deaths. At the same time, the U.S. Food and Drug Administration is drafting long-awaited safety proposals that could curtail the use of Tylenol and other acetaminophen products.

The changes do not apply in Canada, Kayce Thomas, a spokeswoman for Johnson & Johnson said Friday. "This is something that we're continually evaluating."

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Antioxidant supplement overload can be 'hazardous'

Research into antioxidant supplements such as vitamins A, C and E suggests the pills are more likely to do harm than ward off cancer and heart disease.

Antioxidants are thought to prevent and limit damage to our body's cells caused by free radicals as we age.

Water-soluble antioxidants like Vitamin C don't pose a major health problem. (Joe Raedle/Getty )

While it's difficult to overdose on antioxidants in fruits and vegetables, it's easier when taking a pill with high concentrations, said Prof. Jim Kehrer of the pharmacy department at the University of Alberta in Edmonton.

Advertisers have put forth the idea that a little is good, more is better and a lot is great but that isn't really correct, said Kehrer, who has been researching the effects of free radicals since the 1970s.

"You get to a point, and sometimes early, that the high doses become hazardous," Kehrer said in an interview with CBC News.

"The good thing about antioxidants is that you have to take absolutely massive doses to get overt toxicity. But that doesn't mean that there can't be subtle effects building up over many periods of years if you take more than you should be getting."

Taking antioxidants in excess can overwhelm free radicals that cells use to talk to one another and function properly, which Kehrer said is probably part of the reason why taking too many isn't as good as taking the right amount.

Eating a mixture of fruits and vegetables has a safety factor built in to prevent exposure to massive doses while getting beta carotene from carrots, lycopene from tomatoes and polyphenols from grapes, for example, said Venket Rao, a professor emeritus in the nutritional sciences department at the University of Toronto.

Rao said a megadose is five to 10 times the Estimated Average Requirement or EAR, which varies by age and sex. A single capsule of vitamin E for example wouldn't be a megadose, but a man aged 25 to 50 who takes multiple capsules that approach 1,000 mg/day and above could be getting a megadose, he explained.

Studies in Canada, the U.S., Australia, Italy, Finland and elsewhere have shown that giving megadoses of antioxidants like vitamin E to people with lung cancer and cardiovascular diseases actually promotes oxidative stress instead of countering it, Rao said.

Oxidative stress results when there is an imbalance between free radicals and the body's ability to detoxify them or repair the damage.

"That's the paradox," Rao said. "We have evidence that antioxidants are good for you, but we also have well-controlled clinical studies showing that at megadoses they could be harmful to you. So what do you believe in?"

For example, a 2009 review of randomized trials on antioxidants published by the Cochrane Library concluded that "Antioxidant supplements need to be considered medicinal products and should undergo sufficient evaluation before marketing."

High levels of vitamin A can cause severe liver damage, Kehrer said. He suggested that people need a better grasp of good nutritional intake and not try to overdo selected chemicals.

At the produce section of a grocery store in Toronto, shopper Bora Skenderi called the marketing a fad.

"You hear about all the super foods," Skenderi said. "If you lead a healthy lifestyle, you get all the antioxidants."

"I think that fresh is best," said shopper Patrice Brennan. "The only time that I really go for the antioxidants is in the winter when I can't really buy fresh."

With files from CBC's Kim Brunhuber

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Marijuana more risky for teens than previously thought

Teenagers smoke pot outside the Vancouver Art Gallery: Some studies say it is riskier than previously thought for youth to smoke pot. (CBC)

As the debate about legalizing marijuana heats up in Canada, a new study suggests the drug might be riskier for teens to consume than had been previously thought.

Researchers from the Université de Montréal and New York's Icahn School of Medicine at Mount Sinai Hospital conducted a review of 120 studies examining cannabis and teenage brain development, and concluded there is strong evidence early cannabis use puts some teens at risk of developing addiction and mental health problems as adults.

Dr. Didier Jutras-Aswad, with the Université de Montréal's psychiatry department, is a co-author of the review, which was published this month in the journal Neuropharmacology. He says that in adolescence, the brain is still fine-tuning how different areas, such as learning and memory, interact and it appears that marijuana use alters that process.

"When you disrupt this, actually, development, during adolescence, notably through cannabis use, you can have very pervasive, very negative effects in the long-term, including on mental health and addiction risk," he told CBC News.

'The question is not about whether cannabis is good or bad, but who is more likely to suffer from problems.'—Dr. Didier Jutras-Aswad, Université de Montréal

Some studies have also found links between early cannabis use and schizophrenia, but Jutras-Aswad says it seems clear there is a wide risk profile that includes genetics and behavioural traits in addition to age.

"For me, the question is not about whether cannabis is good or bad, but who is more likely to suffer from problems in cannabis, because we know for most people that will not happen," he said.

However, the study's authors point out that there is a widespread perception that marijuana is of little harm and the current discussions about access, such as Liberal Leader Justin Trudeau's calls for legalization, ignore the drug's impact on vulnerable populations — in particular, teenagers.

Vancouver pot activist Jodie Emery says she questions how conclusive the evidence about cannabis's harmful effects on the teenage brain is, but also says legalization for adults doesn't have to mean open access for youth.

"We're not saying legalize marijuana for teenagers. That's not the message here. That's not what we're talking about. We're saying legalize it for responsible adults, who are right now being arrested and persecuted," Emery said.

With files from the CBC's Lisa Johnson

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Soft-drink makers accused of using 'Big Tobacco playbook'

Recent studies that cast doubt on the benefits of diet soda and suggest consuming pop can lead to aggression in children come at a time when major soft-drink manufacturers are waging a controversial marketing battle to put a healthy spin on sugar-sweetened beverages.

One of the most proactive is Coca-Cola, which produced ads earlier this year that tout how easy it is to work off the calories in a serving of Coke. A version that aired in the United Kingdom was banned in July by authorities who said it misled consumers.

Canadian obesity expert Yoni Freedhoff says the emphasis on health is "deceptive" and signals a last, desperate attempt to legitimize an industry that is increasingly viewed as a health risk.

"I do think that the writing is on the wall," says the founder of Ottawa's Bariatric Medical Institute and an authority on weight issues. "I don't think there's anything more clear-cut as not good for people, in my mind, than sugar-sweetened beverages. There's nothing nutritionally beneficial about them.

"I think that this really is the Big Tobacco playbook that [soft-drink producers are] playing from."

A controversial New York City department of health ad that was part of a campaign to limit the size of sodas that could be served in restaurants and other facilities. (Reuters)

Freedhoff is referring to an influential paper published in 2009 called The Perils of Ignoring History: Big Tobacco Played Dirty and Millions Died. How Similar Is Big Food?

Written by two obesity researchers — Yale University's Kelly Brownell and Kenneth Warner from the University of Michigan — the paper says that after studies began linking smoking to lung cancer in the 1950s, the cigarette industry stressed the importance of the public's health and promised a number of "good-faith changes."

What followed, say Brownell and Warner, was a prolonged marketing "playbook" that emphasized personal responsibility, paid scientists to deliver dubious research and criticized any science that suggested harms associated with smoking, among other tactics.

David Moran, director of sustainability at Coca-Cola Canada, calls the comparison "unfair and not accurate."

"There's no way that you can consume tobacco in any way that's healthy," says Moran. "But with our products, you can consume them in a healthy, active lifestyle."

Making connections with good health

For a number of years, medical experts have cited soft drinks as one of the leading causes of obesity, diabetes and heart disease.

In June, a study from Purdue University in Indiana suggested that despite their low calories and sugar content, diet soft drinks can still contribute to weight gain and diabetes.

Meanwhile, a U.S. study of preschoolers released on Aug. 16 reported that consuming several servings of pop a day is associated with behaviour problems such as aggression.

At the same time, soft drink manufacturers have in recent years introduced products that advertise nutritional benefits.

In the mid-2000s, Coca-Cola brought out Diet Coke Plus, which the company described as "Diet Coke with Vitamins and Minerals." In 2009, the Dr Pepper Snapple Group introduced a line of 7Up flavours said to contain antioxidants.

In 2008, however, the U.S. Food and Drug Administration ruled that Diet Coke Plus made improper nutritional claims; the drink has since been discontinued in the U.S.

In July, the Dr Pepper Snapple Group agreed to stop fortifying its 7Up drinks with vitamins and claiming they contain antioxidants, after a California consumer filed a federal class action lawsuit.

According to the complaint, the packaging of 7Up varieties such as regular and diet Cherry Antioxidant and Mixed Berry Antioxidant suggested the antioxidant came from fruit, when in fact there is no fruit content in 7Up.

Fighting obesity

Coke's Moran says the marketing approach is slightly different in Canada, because Health Canada has strong restrictions on touting the nutritional value of soft drinks.

Even so, beverage makers have taken a pro-active stance in the fight against obesity. Earlier this year, Coca-Cola Canada launched a campaign called "Coming Together," which aims to raise awareness of ways to reduce weight gain.

Not everyone liked N.Y. Mayor Michael Bloomberg's campaign to limit soft-drink sizes, including a judge who quashed the city law earlier this year. (Kathy Willens / Associated Press)

The company also renewed a partnership with ParticipAction, the national not-for-profit that promotes physical activity.

"Our focus has been a lot on calorie awareness," says Moran, who emphasizes that Coca-Cola also produces lower-calorie products, such as diet drinks and flavoured waters.

Part of the "Coming Together" campaign is an ad called "The Calorie Dictionary," which suggests some simple ways a person could work off the 160 calories in a 13.5-ounce bottle of Coke, including five minutes of skateboarding (45 calories), yelling (13 calories) or demolition work (39 calories).

Freedhoff says the ad is "purposely deceptive," saying it's unclear in the commercial that a person would have to complete a combination of these activities — not just one of them — to work off the serving of Coke.

He adds that diet is much more important than exercise in determining weight gain.

But not everyone is opposed to the ad campaign.

"Healthy living is the issue here, and so calorie-counting is a part of that, and certainly if you start drinking the Big Gulps, your toll is going to go up very quickly," says Michael Mulvey, a marketing professor at the University of Ottawa.

"At least [Coke is] initiating a dialogue — they're showing a partial solution to the problem. In a way, it is offering some balance to the other array of ads that they have that say this is a pause that refreshes or this is a treat or this is a bonding experience."

The art of 'health-haloing'

Claire Tsai, a marketing expert at the Rotman School of Management, concedes that some of the anti-soft drink rhetoric nowadays compares it to cigarettes, but she says there is a critical distinction between the two products.

"The biggest difference between soft drinks and tobacco is that tobacco is linked with lung cancer, a fatal disease, while obesity is linked with other fatal diseases, but it's not the only thing that causes those fatal diseases," she says.

"So it's unlikely that we'll see a class-action lawsuit in the context of soft drinks."

Mulvey adds that "with tobacco, a lot of [the criticism] has been motivated by secondary smoke and all the people that didn't have the choice" in consuming it.

Freedhoff says Coke, like many food and beverage manufacturers, is simply engaging in "health-haloing," a marketing practice in which companies create associations between their products and healthy living.

"These are incredibly savvy marketers, incredibly savvy sales people," says Freedhoff.

"Not having these ads would be better than having them, but [they] are a lesser evil than further vilification of soft drinks by the public and by public health officials."

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Doctor's tweets raise concern over ER safety

Emergency room doctors were concerned about overflow of admitted patients, says Rosemary Henderson, QEH medical director. (CBC)

A doctor's Twitter account tweets are raising questions about the Queen Elizabeth Hospital's emergency services.

Dr. Trevor Jain tweeted Tuesday that a QEH emergency room physician had resigned over safety concerns.

Five hours later, Jain tweeted about a second doctor thinking of leaving for the same reason.

Jain declined to be interviewed by CBC News, but said he stands by his tweets.

Dr. Rosemary Henderson, the hospital's medical director, admits her emergency room doctors were concerned about their patient load.

But Henderson said she had to download extra patients on them because there was a shortage of doctors overseeing admitted patients in the hospital. One of the hospitalists — doctors who care for admitted patients who do not have a family physician — who would normally care for nine patients, was not available.

"That was a temporary situation, but it did cause considerable consternation in the emergency department," said Henderson.

Extra 4 to 6 patients

The overflow of patients had to go somewhere and the increased patient load raised safety concerns among her doctors.

"This creates problems in the emergency department in that physician's attention is then diverted from their emergency department population to the admitted patients. It creates a longer wait time for the emergency department patients," said Henderson.

The ER is supposed to be staffed by 10 full-time doctors and supplemented by contract doctors.

Between July and August, the ER was asked to take an extra four to six patients on seven occasions. In the past year, that number was usually one or two patients for up to two days, said Henderson.

The doctor who has resigned is a locum physician who had only six more shifts left in her contract. The doctor who threatened to resign is a part-time physician.

Hospital staff are trying to convince the two doctors to stay, said Henderson.

She added that the situation should be resolved next week when staffing returns to normal.

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Freya-28 birth control pills recalled over faulty pack

Health Canada is announcing a recall of Freya-28 birth control pills after a pharmacy reported a placebo pill was found in place of an active one in a faulty package.

Packages of the pills made by Mylan Pharmaceuticals should have three rows of active pills that are white and one row of placebo pills that are green.

Health Canada says missing one or more active pills could reduce the contraceptive's effectiveness and result in an unplanned pregnancy.

Those using the pill can return unopened packages to their pharmacists and are being asked to report any adverse reactions potentially related to recalled pills to Health Canada.

The company's other birth control product — Freya-21 — is not affected.

Packages of Freya-28 should have three rows of active pills that are white and one row of placebo pills that are green. (Health Canada)

The Freya-28 pills voluntarily recalled from the Canadian market bear the lot numbers 3739F001B and 3739F002B.

The latest recall comes after a major birth control recall involving the drug Alysena 28 earlier this year.

One lot of the product contained too little active drug and too much placebo, leaving women who took it vulnerable to becoming pregnant.

The lot sold by Apotex contained about 50,000 faulty packets and was distributed across Canada.

Women using birth control pills take the drugs for 21 days each menstrual cycle. Because of the risk that they might not remember to resume taking their pills at the right time, many oral contraceptives are packaged with a pill for each of the 28 days in a cycle — 21 are drug and seven are placebos.

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Canada 'way behind' on home-care help, patient advocates say

When patient advocate Donna Davis helped a friend navigate the transition from hospital to home care, she encountered a vexing problem.

Hospital and home-care workers "just tell you what to do," Davis recalls. "It's that paternalistic: 'We will make the decision for you. We will tell you when to go home. We will tell you how to go home'."

Davis, a Saskatchewan nurse and the co-chair of Patients for Patient Safety Canada, said that experience reinforced her belief that patients and their caregivers need to be front and centre in the health-care continuum instead of, often, on the sidelines, especially while transferring between the different parts of the system.

"As a patient you need to know: What have you done?" she says, particularly when moving from a hospital to a home-care situation.

Last year, an estimated 1.4 million Canadians used home care, a 55 per cent rise from three years earlier. Home care is largely provided by a variety of for-profit and non-profit private agencies, and is not without its problems, as CBC News documented on Monday in the story of Lynn Burkitt, 52, of Medicine Hat, Alta.

Burkitt has been suffering for most of the past year after two rolls of festering packing tape left a gaping abscess in her chest following surgery. The packing tape was left in to treat an infection following a double mastectomy, but due to communication problems between the hospital and the home-care agency looking after her it was not changed as it should have been.

"I had no clue [there was packing inside]," said Burkitt. "And I've had surgeries before. If I would've known that, I would've told them" what to look for.

'Not prepared' for influx

Communication between the different sectors in the health-care system is one of the key trouble spots identified in a recent Canadian report. Published last month, the Safety at Home study found about one in 10 home-care patients experience an adverse event of some kind, and that more than half of those incidents are preventable.

Two rolls of packing gauze were discovered in Lynn Burkitt during a third surgery. Before it was discovered, she says the wound smelled rotten and her entire right side felt like it was burning. (CBC)

Advancing technologies and an aging population are fueling the push toward home care.

Plus, overcrowded hospitals are under immense pressure to free up beds, which can contribute to the types of communication breakdowns like Burkitt experienced, says Davis.

"When you're trying to relieve pressure at one end, sometimes it has a ripple effect and it causes pressure on another end" of the system, she says. "The staff are very conscious that we need to get this bed empty so we can get patient A in here for their knee replacement."

These kinds of pressures are not likely to let up soon. "The increase in demand is going to continue and the fact is we're not well prepared for it," said Dr. Sholom Glouberman, president of the Patients' Association of Canada.

'Kaleidoscope' of care

Diane Doran, the scientific director of the University of Toronto's Nursing Health Services Research Unit, notes that patients often deal with a rotating cast of nurses and personal-care workers, each with their own style of delivering care.

Patients can "encounter this kaleidoscope of different care providers," she says, and this can increase the risk of communication breakdowns.

Diane Doran is the Scientific Director of the Nursing Health Services Research Unit at U of T, an Adjunct Professor at the University of Technology in Sydney, Australia, and an Adjunct Professor at Queen's University in Kingston, Ont. (University of Toronto School of Nursing)

Doran was one of the co-leads on the two-year Safety at Home study, which found that the most serious adverse events experienced by patients in the home are falls, medication errors and infections — which are many of the same risks encountered in hospitals.

That finding spurred the Canadian Patient Safety Institute, an Edmonton-based non-profit agency that funded part of the study, to start adapting some of its safety tools for hospitals to the home environment.

The organization is now in the process of refocussing its campaigns on everything from washing hands to keeping medications straight so that both home-care workers and family caregivers can understand them better.

"It's crucial that we do everything we can to ensure that environment is safe," said the institute's CEO, Hugh MacLeod. "Because if we don't, the consequence will be we will have significant traffic to our ERs."

Canada 'way behind'

MacLeod says the organization has vowed to prioritize home-care safety issues over the next five years — a sign of the times.

"There has been a very significant shift from acute care to home care," he says. "The public is demanding this shift."

While more attention is being paid to how patients are taken care of in the home, Dr. Glouberman says that home care is one of the most underfunded parts of the health-care system and has traditionally received little support.

"We have a general problem in Canada: our health-care system was built around hospitals and doctors. That's its history. Because [of that], the development of care in communities has been rather poor, and has been slower than it should be."

Canada lags "way, way behind" other developed countries in providing support to patients being cared for in the community, Glouberman says, adding that we need to increase the range of services available in communities to include more physiotherapy, occupational therapy, transportation help and house support.

In Britain, for example, district nurses visit post-operative patients to assess safety needs in the house, which can include installing bars in bathtubs and adding ramps. These precautions can go a long way to preventing falls.

Doran says that their study of home care across Canada found that often that type of risk assessment wasn't done, but even when it was, it wasn't acted upon because of confusion over whose responsibility it was.

A key recommendation in the Safety at Home study is that home-care agencies turn their case managers into "quarterbacks" who will field patient calls, visit them regularly and liaise with other parts of the health-care system on their patients' behalf.

The use of electronic charts would also go a long way to making sure that details about a patient's care don't get lost between the multiple caregivers and transfers.

Dr. Glouberman notes it would also ease the heavy burden on caregivers by allowing them to do tasks such as accessing home-care schedules and booking appointments online.

Doctors, nurses and personal care workers also need to understand that patients are more knowledgeable than ever on health-care issues.

"Health-care providers have to be willing to accept that knowledge," says Davis. Patients "are taking more of an interest. They're not as complacent anymore."

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Antioxidant supplement overload can be 'hazardous'

Research into antioxidant supplements such as vitamins A, C and E suggests the pills are more likely to do harm than ward off cancer and heart disease.

Antioxidants are thought to prevent and limit damage to our body's cells caused by free radicals as we age.

Water-soluble antioxidants like Vitamin C don't pose a major health problem. (Joe Raedle/Getty )

While it's difficult to overdose on antioxidants in fruits and vegetables, it's easier when taking a pill with high concentrations, said Prof. Jim Kehrer of the pharmacy department at the University of Alberta in Edmonton.

Advertisers have put forth the idea that a little is good, more is better and a lot is great but that isn't really correct, said Kehrer, who has been researching the effects of free radicals since the 1970s.

"You get to a point, and sometimes early, that the high doses become hazardous," Kehrer said in an interview with CBC News.

"The good thing about antioxidants is that you have to take absolutely massive doses to get overt toxicity. But that doesn't mean that there can't be subtle effects building up over many periods of years if you take more than you should be getting."

Taking antioxidants in excess can overwhelm free radicals that cells use to talk to one another and function properly, which Kehrer said is probably part of the reason why taking too many isn't as good as taking the right amount.

Eating a mixture of fruits and vegetables has a safety factor built in to prevent exposure to massive doses while getting beta carotene from carrots, lycopene from tomatoes and polyphenols from grapes, for example, said Venket Rao, a professor emeritus in the nutritional sciences department at the University of Toronto.

Rao said a megadose is five to 10 times the Estimated Average Requirement or EAR, which varies by age and sex. A single capsule of vitamin E for example wouldn't be a megadose, but a man aged 25 to 50 who takes multiple capsules that approach 1,000 mg/day and above could be getting a megadose, he explained.

Studies in Canada, the U.S., Australia, Italy, Finland and elsewhere have shown that giving megadoses of antioxidants like vitamin E to people with lung cancer and cardiovascular diseases actually promotes oxidative stress instead of countering it, Rao said.

Oxidative stress results when there is an imbalance between free radicals and the body's ability to detoxify them or repair the damage.

"That's the paradox," Rao said. "We have evidence that antioxidants are good for you, but we also have well-controlled clinical studies showing that at megadoses they could be harmful to you. So what do you believe in?"

For example, a 2009 review of randomized trials on antioxidants published by the Cochrane Library concluded that "Antioxidant supplements need to be considered medicinal products and should undergo sufficient evaluation before marketing."

High levels of vitamin A can cause severe liver damage, Kehrer said. He suggested that people need a better grasp of good nutritional intake and not try to overdo selected chemicals.

At the produce section of a grocery store in Toronto, shopper Bora Skenderi called the marketing a fad.

"You hear about all the super foods," Skenderi said. "If you lead a healthy lifestyle, you get all the antioxidants."

With files from CBC's Kim Brunhuber

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Infection risk at New Brunswick hospital affects nearly 2,500 women

Miramichi Regional Hospital's colposcopy clinic in New Brunswick has not been following sterilization standards in all cases for the past 14 years, officials announced on Wednesday. (Courtesy of Horizon Health Network)

Nearly 2,500 women who underwent biopsies at the Miramichi Regional Hospital's colposcopy clinic in New Brunswick may be at risk of HIV and other infections because standard sterilizing procedures weren't always followed over a 14-year period, Horizon Health Network officials say.

The 2,497 current and former patients who had the procedure will receive a registered letter in the mail, offering that they have blood tests to check for HIV, hepatitis C and hepatitis B, said Dr. Gordon Dow, an infectious disease specialist.

He emphasized, however, that the risk of infection is "very, very small."

"I am very confident there will not be a single case of infection acquired through this process," Dow said during a news conference Wednesday.

A colposcopy is a diagnostic procedure used to closely examine a woman's cervix, vagina and vulva for signs of disease, such as cancer. It is often performed if a Pap test has come back with abnormal results.

Employee flagged sterilization issue

The forceps used during biopsies between May 1999 and May 24, 2013, were not always sterilized in accordance with the North American standard, which has been in place for more than 50 years, officials said.

In some cases, the instruments were put through a high-level disinfection process instead.

High-level disinfection destroys "99.99 per cent of blood-borne pathogens such as hepatitis B, hepatitis C and HIV," said Dow.

"The estimated risk of contracting hepatitis B is 1 in 47,000 procedures; however, the risk of becoming ill is 1 in 156,000 procedures," he said.

"The risk of contracting hepatitis C or HIV is less than one in a million procedures when using high-level disinfection cleaning."

Horizon Health Network president and CEO John McGarry said an employee who flagged the issue and the process was corrected immediately.

McGarry said the problem started 14 years ago when patient volumes at the clinic grew and there weren't enough forceps for the number of patients seen during a day.

All the instruments would be sterilized the night before, but "the decision was made" a few would have been "reprocessed" during the day to meet the demand, he said.

McGarry declined to identify who made that decision. "We're not considering disciplinary action at this time," he said.

"We sincerely apologize for the error and assure you that your well-being is our main concern," McGarry said.

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Canada 'way behind' on home-care help, patient advocates say

When patient advocate Donna Davis helped a friend navigate the transition from hospital to home care, she encountered a vexing problem.

Hospital and home-care workers "just tell you what to do," Davis recalls. "It's that paternalistic: 'We will make the decision for you. We will tell you when to go home. We will tell you how to go home'."

Davis, a Saskatchewan nurse and the co-chair of Patients for Patient Safety Canada, said that experience reinforced her belief that patients and their caregivers need to be front and centre in the health-care continuum instead of, often, on the sidelines, especially while transferring between the different parts of the system.

"As a patient you need to know: What have you done?" she says, particularly when moving from a hospital to a home-care situation.

Last year, an estimated 1.4 million Canadians used home care, a 55 per cent rise from three years earlier. Home care is largely provided by a variety of for-profit and non-profit private agencies, and is not without its problems, as CBC News documented on Monday in the story of Lynn Burkitt, 52, of Medicine Hat, Alta.

Burkitt has been suffering for most of the past year after two rolls of festering packing tape left a gaping abscess in her chest following surgery. The packing tape was left in to treat an infection following a double mastectomy, but due to communication problems between the hospital and the home-care agency looking after her it was not changed as it should have been.

"I had no clue [there was packing inside]," said Burkitt. "And I've had surgeries before. If I would've known that, I would've told them" what to look for.

'Not prepared' for influx

Communication between the different sectors in the health-care system is one of the key trouble spots identified in a recent Canadian report. Published last month, the Safety at Home study found about one in 10 home-care patients experience an adverse event of some kind, and that more than half of those incidents are preventable.

Two rolls of packing gauze were discovered in Lynn Burkitt during a third surgery. Before it was discovered, she says the wound smelled rotten and her entire right side felt like it was burning. (CBC)

Advancing technologies and an aging population are fueling the push toward home care.

Plus, overcrowded hospitals are under immense pressure to free up beds, which can contribute to the types of communication breakdowns like Burkitt experienced, says Davis.

"When you're trying to relieve pressure at one end, sometimes it has a ripple effect and it causes pressure on another end" of the system, she says. "The staff are very conscious that we need to get this bed empty so we can get patient A in here for their knee replacement."

These kinds of pressures are not likely to let up soon. "The increase in demand is going to continue and the fact is we're not well prepared for it," said Dr. Sholom Glouberman, president of the Patients' Association of Canada.

'Kaleidoscope' of care

Diane Doran, the scientific director of the University of Toronto's Nursing Health Services Research Unit, notes that patients often deal with a rotating cast of nurses and personal-care workers, each with their own style of delivering care.

Patients can "encounter this kaleidoscope of different care providers," she says, and this can increase the risk of communication breakdowns.

Diane Doran is the Scientific Director of the Nursing Health Services Research Unit at U of T, an Adjunct Professor at the University of Technology in Sydney, Australia, and an Adjunct Professor at Queen's University in Kingston, Ont. (University of Toronto School of Nursing)

Doran was one of the co-leads on the two-year Safety at Home study, which found that the most serious adverse events experienced by patients in the home are falls, medication errors and infections — which are many of the same risks encountered in hospitals.

That finding spurred the Canadian Patient Safety Institute, an Edmonton-based non-profit agency that funded part of the study, to start adapting some of its safety tools for hospitals to the home environment.

The organization is now in the process of refocussing its campaigns on everything from washing hands to keeping medications straight so that both home-care workers and family caregivers can understand them better.

"It's crucial that we do everything we can to ensure that environment is safe," said the institute's CEO, Hugh MacLeod. "Because if we don't, the consequence will be we will have significant traffic to our ERs."

Canada 'way behind'

MacLeod says the organization has vowed to prioritize home-care safety issues over the next five years — a sign of the times.

"There has been a very significant shift from acute care to home care," he says. "The public is demanding this shift."

While more attention is being paid to how patients are taken care of in the home, Dr. Glouberman says that home care is one of the most underfunded parts of the health-care system and has traditionally received little support.

"We have a general problem in Canada: our health-care system was built around hospitals and doctors. That's its history. Because [of that], the development of care in communities has been rather poor, and has been slower than it should be."

Canada lags "way, way behind" other developed countries in providing support to patients being cared for in the community, Glouberman says, adding that we need to increase the range of services available in communities to include more physiotherapy, occupational therapy, transportation help and house support.

In Britain, for example, district nurses visit post-operative patients to assess safety needs in the house, which can include installing bars in bathtubs and adding ramps. These precautions can go a long way to preventing falls.

Doran says that their study of home care across Canada found that often that type of risk assessment wasn't done, but even when it was, it wasn't acted upon because of confusion over whose responsibility it was.

A key recommendation in the Safety at Home study is that home-care agencies turn their case managers into "quarterbacks" who will field patient calls, visit them regularly and liaise with other parts of the health-care system on their patients' behalf.

The use of electronic charts would also go a long way to making sure that details about a patient's care don't get lost between the multiple caregivers and transfers.

Dr. Glouberman notes it would also ease the heavey burden on caregivers by allowing them to do tasks such as accessing home-care schedules and booking appointments online.

Doctors, nurses and personal care workers also need to understand that patients are more knowledgeable than ever on health-care issues.

"Health-care providers have to be willing to accept that knowledge," says Davis. Patients "are taking more of an interest. They're not as complacent anymore."

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Preinvasive breast cancer label may affect treatment choice

Women seem less likely to chose surgery for a preinvasive lesion of the breast depending on how the condition is described, researchers propose.

Ductal carcinoma in situ or DCIS is a "preinvasive malignancy" that could cause no harm during the patient's lifetime. Doctors have proposed watchful waiting for DCIS but it's unclear how to implement the strategy. For some clues, researchers surveyed women about the choices they would make when the condition is described using different terminology.

The terminology used to describe DCIS has an impact on patients' perceptions of treatment alternatives, researchers say. (Eric Gaillard/Reuters)

When DCIS was described to 394 healhy U.S. women without a history of breast cancer using the term noninvasive cancer, 53 per cent (208 of 394) preferred nonsurgical options, researchers said in today's issue of JAMA Internal Medicine.

In comparison, 66 per cent (258 of 394) preferred nonsurgical options when the term was breast lesion and 69 per cent (270 of 394) preferred nonsurgical options when the term was abnormal cells.

"We conclude that the terminology used to described DCIS has a significant and important impact on patients' perceptions of treatment alternatives," Zehra Omer of Massachusetts General Hospital — Institute for Technology Assessment and her co-authors said in their research letter.

"Health care providers who use 'cancer' to describe DCIS must be particularly assiduous in ensuring that patients understand the important distinctions between DCIS and invasive cancer."

In the survey, participants were reminded that risks (developing invasive breast cancer and death) and benefits were the same for all three scenarios describing the diagnosis. The order of scenarios was varied randomly across participants.

The participants were highly educated and numerate with higher than average income. It's possible that patients with DCIS could respond differently than those in the survey, the researchers said.

For DCIS patients, factors such as age and tumour grade are also important compared with the general scenarios in the survey.

Last month, Dr. Laura Esserman of the University of California, San Francisco, one of the authors of the latest paper, proposed that the definition of cancer should be narrowed to exclude some forms of the disease that are unlikely to cause harm, including DCIS. The JAMA commentary was based on recommendations from a working group of the U.S. National Cancer Institute.

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Developmental risks rise in extremely premature infants

Ottawa researchers have found between 14 and 31 per cent of extremely premature infants, born between 22 and 25 weeks gestation, have severe developmental problems by the ages of four to eight.

The research took data pooled from more than 700 children who were born extremely prematurely to have the best estimate to date for the risk of certain developmental problems in this group.

The research is published in JAMA Pediatrics by Dr. Gregory Moore and colleagues from the Ottawa Hospital Research Institute, the Children's Hospital of Eastern Ontario Research Institute and the University of Ottawa.

A doctor cover the eyes of a premature baby in the natal intensive care unit of a public maternity hospital in Venezuela in 2011. (REUTERS/Jorge Silva)

Severe developmental problems are defined as having at least one of the following characteristics: an IQ more than three standard deviations below the mean, cerebral palsy without the ability to walk independently, no useful vision or no useful hearing.

There was no significant difference in the percentage of children having severe developmental problems whether they were born at 22, 23, 24 or 25 weeks gestation.

Decrease in developmental problems with each extra week of gestation

However, there was a six per cent decrease in developmental problems with each extra week of gestation when moderate developmental problems were included in the analysis.

There were fewer surviving children at 22 and 23 weeks' gestation so that data has been considered less reliable.

In a press release issued on Monday, Moore, a neonatologist at The Ottawa Hospital and CHEO, and an assistant professor at the University of Ottawa, said doctors have not been able to provide expectations to parents with babies born extremely premature, until now.

Reseachers at CHEO Research Institute worked with collegues at the Ottawa Hospital Research Institute and the University of Ottawa on this study. (CBC)

"This new data is not perfect, but the data and discussion about its limitations will give parents a much better picture than they had before of what to expect and consider when making decisions with their physicians and medical team about the care for their baby," said Moore.

"Of course, it is important for parents to remember that every baby is different, and it is impossible to predict how one will develop," he said.

To come up with the new estimates, researchers analyzed data from 738 children from nine studies in Europe, Australia, New Zealand and the United Kingdom, all conducted after 2004.

Studies from North America were not included because they did not fit the desired high-quality criteria.

All the studies had detailed birth records linked with cognitive testing of the same children between ages four and eight years.

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Cronut burger illnesses at CNE came from maple bacon jam

The cronut burger has become a trendy food item, but it will no longer be sold by a vendor at the Canadian National Exhibition after 223 developed food poisoning, and Toronto Public Health determined the maple bacon jam topping was the culprit. (Joshua Errett/CBC News)

It wasn't the half-doughnut, half-croissant bun. It wasn't the beef patty. It wasn't the optional egg or bacon.

The part of the cronut burger contaminated with the Staphylococcus aureus toxin, which caused food-borne illness in 223 people at the Canadian National Exhibition last week, was the maple bacon jam topping, according to Toronto Public Health's lab reports and inspection of vendor Epic Burgers and Waffles.

"New lab results indicate that the maple bacon jam, which is one component of the cronut burger, is the cause of food-borne illnesses at the CNE," said Dr. David McKeown, Toronto's medical officer. "We have ensured the contaminated product is not served. There is no risk to the public."

The investigation also ruled that Epic Burgers and Waffles could reopen its food stall at the CNE because the contaminated topping was from an outside vendor — Le Dolci.

However, a statement from Epic Burgers and Waffles said it would reopen its food stand but not serve the cronut burger.

"As a result of this finding, Epic Burgers and Waffles have decided to remove the Cronut Burger from our menu and we will no longer do business with the aforementioned supplier," said the statement.

Symptoms reported by people who ate the cronut burger ranged from an upset stomach, to diarrhea, fever, vomiting, abdominal cramps and dehydration.

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Right-to-die debate in spotlight at Stratford Festival forum

(Listen to Karin Wells' full documentary on the Stratford Festival Forum debate on legalized euthanasia in the audio player to the left of the page, or visit The Sunday Edition's site.)

"When Phil decides that his time has come, the only legal way he can hasten his death is by refusing all food and water. And I think that's cruel," said a middle-aged woman sitting in the front row of the Stratford Festival's Forum on Writing about the Right to Die.

The audience broke into applause.

'When your mother is suffering, you do whatever she asks.'—Playwright Itai Erdal

Phil, her husband, was sitting bent over in his chair next to her. He has had Parkinson's disease for 16 years, and he was clear that the time was approaching when his quality of life would be unacceptable.

"But, the decision about when I'm going to do it is hard," he said. "My medical support team is on-side."

There was more applause.

The Stratford Festival has added 150 Forum events to its season to supplement its regular playbill – all of them spinning off issues raised in the plays and directed at a theatre-going public that wants more.

Itai Erdal's play, How to Disappear Completely, chronicles the assisted-suicide death of his mother. (CBC)

"They want to unplug from their day to day and get a chance to feel and think," Stratford artistic director Antoni Cimolino said. "They are not content to simply do that in the theatre – they want to immerse themselves in the world of the plays all of the time."

In this latest forum, 500 people paid $10 a ticket to hear playwrights Judith Thompson and Itai Erdal, and American writer Zoe Fitzgerald Carter, on the issue of the right to die.

"This is Stratford with a greater sense of engagement in the world that we have today," Cimolino said.

The Stratford Festival Forum seemed more at home discussing assisted suicide than the Canadian Medical Association at itsannual meeting in Calgary last week. The CMA backed away from any decisions and referred the question for further study.

In contrast, the forum participants in Stratford, Ont., included people with severe disabilities and women in their 60s helping their mothers up the stairs – members of the public with a vested interest in the subject who could not afford to wait for further study.

The panel moderated by writer Alex Bulmer, a woman who lost her sight in her 20s, did not dwell long on "writing" about the right to die. The audience clearly wanted to get to the nub of the issue and discuss the realities faced by Erdal and Carter, who both had mothers who chose the time of their own deaths.

Erdal's play How to Disappear Completely chronicles the death of his mother. She lived in Israel, where assisted suicide is illegal, and was diagnosed with lung cancer 12 years ago. He flew from Vancouver back to Jerusalem and looked after her for the last nine months of her life.

"She made it clear to everyone", he said "that she does not want to suffer pain. When your mother is suffering you do whatever she asks. She asked me — will you help me. I will try but I don't know."

The hospice team came every week, and every week Erdal would ask for more morphine.

"They looked the other way," he said. "It is illegal, but it happens every day in every place in the world.

'What is choice? People are coerced. We change our minds – nothing should be iron-clad.'—Playwright Judith Thompson

"It was never a question of what was the right thing to do. It was a question of will I have the guts to do the right thing. It was the hardest thing I ever did."

It is never made clear whether Erdal or his mother ultimately administered the extra morphine.

Judith Thompson sounded a more cautionary note.

In her play The Thrill, she takes off from the story of American disability rights activist Harriet McBryde Johnson. In 2003, Johnson debated ethicist Peter Singer on his proposition that parents should be given the right to euthanize their severely disabled children.

She also spoke out on the case of Terri Schiavo, the Florida woman whose doctors said was in a persistent vegetative state. Schiavo was kept on life support for 15 years while her parents and her husband fought it out in the courts. Ultimately her feeding tube was withdrawn and she died.

Judith Thompson's play The Thrill takes off from the story of American disability rights activist Harriet McBryde Johnson, who in 2003 debated ethicist Peter Singer on his proposition that parents should be given the right to euthanize their severely disabled children. (CBC)

"How do we know what people really want?" Thompson says. "Looking at that picture of her I thought, no, she's really there and she suffered a lot. Then I began thinking about our terror of dependency."

On the question of choice, she asked: "What is choice? People are coerced." And she added, "We change our minds – nothing should be iron-clad."

The audience weighed in, too. During the forum a hospice nurse spoke of dignity and a painless beautiful death.

A geriatrician from Indiana stood up and said, "That's a myth. There are many symptoms that the doctors cannot control," and she listed intolerable itching and hallucinations from pain medication.

"I have had patients with neuromuscular diseases who know they cannot ask anyone else to kill them. They have killed themselves as soon as they got the diagnosis."

And while no one in the Stratford audience on that summer day voiced any fundamental objection to the legalization of assisted suicide, a sense of caution hung in the air highlighing the fact that there are no easy answers in this debate.

[The Sunday Edition on CBC radio spends its first hour this week at the Stratford Forum. There are interviews with playwrights Judith Thompson and Itai Erdal, and voices from the forum discussion. Karin Wells is this week's guest host sitting in for Michael Enright.]

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Ovarian cancer screening test finds early-stage disease

Using blood test measurements to check for a marker of early stage ovarian cancer could work as a screening strategy, say researchers who caution it is not yet ready for doctors to use.

Ovarian cancer is not common but can be deadly because it is hard to detect early when symptoms may be absent or vague. The goal of screening is to find tumours accurately when they are at a treatable stage.

A screening strategy for ovarian cancer is needed to minimize unnecessary operations. (Andrew H. Walker/Getty Images for Ovarian Cancer Research Fund)

In Monday's issue of the journal Cancer, researchers in the U.S. report on 4,051 post- menopausal women who had an initial blood test for CA125, a protein that is high in many, but not all, women with ovarian cancer and could also be elevated from harmless cysts. The women were placed in three categories based on the findings.

Over 11 years, 83 per cent of the women remained in the normal-risk category and had the blood test annually.

About 14 per cent were in the intermediate group and had to repeat the test in three months.

Almost 3 per cent were considered to be at high risk and were referred for transvaginal ultasound as a second step of the screening and a consultation with a gynecologic oncologist.

All four women in the study with invasive ovarian cancer were part of the study for at least three years with low-risk scores on the blood test before their CA125 levels rose.

"Given the relatively low prevalence of ovarian cancer in the general population, a screening strategy that minimizes unnecessary operations due to false positive values in crucial," Dr. Karen Lu of the University of Texas MD Anderson Cancer Center in Houston and her co-authors concluded.

The generally accepted limit for balancing risk with benefit would be detecting 10 per cent of invasive ovarian cancers among those who had surgery. In this study, that "positive predictive value" was 40 per cent.

The researchers said the two-step strategy for ovarian cancer screening in postmenopausal women was excellent at identifying patients without ovarian cancer who did not undergo surgery.

"It is not practice-changing at this time," Lu's team said.

The researchers said they are waiting for the results of a randomized study currently being conducted in the U.K. with the same risk algorithm on 200,000 women to address whether deaths from ovarian cancer decrease with the screening.

Other biomarkers for ovarian cancer are also being studied.

The study was funded by MD Anderson, the U.S. National Foundation for Cancer Research, Golfers Against Cancer, the Tracey Jo Wilson Foundaiton, the Mossy Foundation, the Norton family and Stuart and Gaye Lynn Zarrow.

Several study authors have consulted for diagnostic testing companies.

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Double mastectomy leads to 'calamity of errors,' review of home care

Lynn Burkitt asked for a double mastectomy, hoping to rid herself of worry after a scary bout with breast cancer.

But what the 52-year-old from Medicine Hat, Alta., got instead was a series of surgeries and mishaps that left her with a gaping, infected abscess in her chest. Two rolls of packing gauze were left rotting inside her, undetected by home care staff.

"You could've put your fist inside my chest," Burkitt said of the initial abscess. "They have made such a mess of my chest that I look like a freak."

The open wound is now the size of a poker chip, slowly healing but still debilitating the Alberta woman.

"If I had known what was going to happen, I would never have done" the double mastectomy, she says now.

Burkitt's case caused Alberta Health Services to review procedures at Medicine Hat Regional Hospital and institute new rules for communicating more clearly with home care.

It has also shed a new light on the burgeoning world of home care services. A recent study published last month by in the BMJ Quality & Safety journal estimated that one in every 10 patients in home care experiences an adverse event and that more than half of these events are preventable.

The number of patients recovering in their own homes instead of hospitals is exponentially rising as hospitals try to reduce overcrowding and expensive lengthy hospital stays. Last year, an estimated 1.4 million Canadians received home care, a 55 per cent rise from three years earlier.

'Felt like it was on fire'

Burkitt's woes began in 2010 when she underwent radiation therapy on her right breast following a diagnosis of ductal carcinoma in situ (DCIS), a common type of non-invasive cancer.

Less than two years later, in January 2012, her right breast became swollen and hot to the touch. Doctor after doctor examined it and suggested a myriad of possible causes from shingles to a return of cancer.

When Burkitt had a mammogram, there was no sign of cancer but still the pain persisted. With a strong family history of cancer, she said the fear weighed heavily on her.

"I just said, 'You know what, give me a double mastectomy because this way I don't ever have to worry about cancer coming back'."

On June 6, 2012, Burkitt underwent the operation at Medicine Hat Regional Hospital. Within days, she felt ill.

Burkitt underwent a second surgery to drain an infection. After that, she felt much better and recalls calling her doctor a hero. But in the coming weeks, more troubling issues began.

"My breast was very red, very swollen," she says. "The smell was just horrific. It's hard to even describe. It just smelled rotten."

"It was extremely painful. I could hardly move. I've never felt so terrible in my life. … My whole right side just felt like it was on fire."

Home care nurses took care of Burkitt every day, but "it was getting worse and worse," she says.

Hospital reviewed patient safety

She made multiple trips to the emergency room and doctors prescribed antibiotics, but it wasn't until she underwent a third surgery that the culprit was found.

Two rolls of packing gauze were discovered in Lynn Burkitt during a third surgery. Before it was discovered, she says the wound smelled rotten and her entire right side felt like it was burning. (John Rieti/CBC)

"When I came to, I found out the second surgeon had left two rolls of packing tape inside of me that rotted and they had to pull it all out," said Burkitt. "So I ended up with a big hole in my chest, which has not healed."

While it's normal procedure for a surgeon to leave packing gauze in an open wound, that packing must be changed on a regular basis.

Medical experts suggest that home care nurses should have seen the gauze sticking out of the abscess and replaced it daily as the wound slowly healed from the inside out.

But Burkitt says home care staff didn't see the gauze deep inside the wound because the surgeon stitched the sides of the wound together, obscuring it from view. Also, she says there was no documentation passed along to alert caregivers of the packing gauze.

In a letter dated Jan. 10, 2013, Alberta Health Services apologized for Burkitt's experience with the packing gauze and vowed to review its processes to prevent such a situation from happening again.

Burkitt said she asked the hospital months ago to detail what changes had been made, but never heard back.

Alberta Health Services told CBC News that it conducted a patient safety review at Medicine Hat Regional Hospital into continuity of care and communication among caregivers.

"A number of steps have been taken to ensure patient safety in similar circumstances," the written statement said.

'Calamity of errors'

The health authority says that among the changes being made at the hospital is a new "visual alert" on patient charts to alert caregivers to special needs. It is also educating employees on the need to document instructions when patients transfer between parts of the system.

Nadine Henningsen, executive director of the Canadian Home Care Association, said Burkitt's case sounds like a "calamity of errors."

"It seems that if anything could go wrong, it did go wrong," she said.

Home care brings the added benefit of helping patients avoid potentially dangerous hospital-acquired infections and recouping in their own surroundings.

But with acute-care patients discharged from earlier and earlier, workers in the home-care sector are dealing not only with more patients but also with more serious wounds. The combination has left many areas open to improvement.

Burkitt says that early on, a fist could fit into the wound. Now, it's the size of a loonie. (John Rieti/CBC)

Henningsen notes that, as in Burkitt's case, "communication is usually one of the biggest challenges that break down when you're transferring from one setting to another."

In fact, one of the biggest issues identified in the Safety At Home: A Pan-Canadian Home Care Study was lack of coordination across health-care sectors and failures in communication.

As for Burkitt, she says that lack of communication had a devastating effect for her.

Her relationship with her partner suffered, she's been unable to work for the past year and daily dressings prevent her from leaving town to visit family members.

Also, she can't wear a prosthesis or bra because of the hole. As she says, "It robbed me of over a year of my life."

Medicine Hat Regional Hospital's statement on Lynn Burkitt's case (PDF)
Medicine Hat Regional Hospital's statement on Lynn Burkitt's case (Text)

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