Chemotherapy orders may be error-prone, study finds

Preparing chemotherapy for cancer patients at Canadian hospitals is potentially prone to errors, say researchers who embedded themselves in the system to see what improvements could be made.

Since a cancer patient in Edmonton died in 2006 after an infusion pump was wrongly programmed to deliver a strong dose of fluorouracil over four hours instead of four days as intended, oncologists, pharmacists, nurses and researchers have been searching for ways to prevent a similar occurrence.

When hospital chemotherapy treatments are prepared in a sterile area, it's safer to use one solution at a time, researchers say. (Eric Gaillard/Reuters)

Now Rachel White, a human factors specialist at Toronto's University Health Network, and her team have adapted an approach that anthropologists use to learn about native cultures.

Their aim is to explore how common the sources of error are in hospitals and to find safer options by giving health-care workers on the frontlines an authoritative voice.

"We don't want people to be afraid," White reassured patients Tuesday in an interview with CBC News, noting the health care field is full of well trained professionals helping people.

"The power of taking the human factors approach is that we have a special lens to look at the world with, and that lens allows us to see problems before they happen."

Safety-critical industries like aviation and nuclear plants apply engineering design principles and the research methods of psychology to prevent human errors. White would like to see them applied more in Canadian hospitals.

Writing in the Journal of Oncology Pharmacy Practice, White's team concluded that widespread changes in Canadian oncology pharmacies are necessary.

For the exploratory study, White and co-author Andrea Cassano-Piche embedded themselves at six cancer treatment centres of various sizes across the country for one week each in 2008 and 2009. They observed and interviewed medical oncologists, oncology pharmacists, pharmacy technicians, oncology nurses and administrative clerks as they did their work.

The potential errors they identified wouldn't normally be picked up, so the frequency is unknown, but the impacts are potentially catastrophic.

The solutions, which are already being adopted, include:

• Working with just one chemotherapy preparation at a time in the hospital pharmacy's safety cabinet to prevent mixing errors.
• Keeping the correct label and its bag paired at all times instead of piling orders separately like a short-order cook's.
• Having a second person check that the volume and concentration of chemotherapy is correct when drugs aren't available in a ready-to-use liquid form.

White praised co-author Dr. Tony Fields, head of Edmonton's Cross Cancer Institute, for his courage in apologizing for the error and working with colleagues across the country to identify the issues and introduce the changes.

A broader 2011 report by the same team reported more than 230 adverse events involving chemotherapy in Canada, though some may have been duplicates.

Since then, hospital staff members have received more training on operating the pumps and clearer, pre-printed order forms are now used.

A 2004 study estimated that preventable medical errors in hospital contribute to between 9,000 and 24,000 deaths in Canada a year. Other safety measures have been introduced since then, such as surgical checklists.

With files from CBC's Amina Zafar

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New Glasgow woman fights for insulin pumps for kids

A Nova Scotia woman has started a petition to convince the provincial government to pay for insulin pumps for children, which can cost thousands of dollars each.

Tammy MacLaren said the issue became a personal one for her when her community started raising money to buy an insulin pump for Madison Moulton, a 10-year-old girl who was diagnosed with Type 1 diabetes when she was 14 months old.

MacLaren's children go to school with Madison.

"I just couldn't let it go," said MacLaren.

"I just could not believe that there was, in our wonderful Nova Scotia, there was not some sort of funding."

Madison got her first insulin pump when she was two and a half years old, paid in part through fundraising. Medical insurance won't cover the equipment because Madison was diagnosed with diabetes at an early age.

The pump, which allowed the 10-year-old to live her life free of multiple daily needle injections, failed late last year and her family was faced with finding money to pay for a new one.

"I panicked a little bit as I think anyone would do," said Dayle Crouse, Madison's mother.

"It was quite a cost."

Crouse said it cost $7,700 for a new pump, plus hundreds more dollars each month for supplies. The New Glasgow community quickly raised thousands of dollars to cover the cost.

Tammy MacLaren has started a petition to try to get insulin pumps for children funded by the province. (CBC)

Madison said the new pump allows more flexibility in what she eats because a pump, unlike a needle, can change the amount of insulin at the touch of a button.

"It lets me do a lot more than if I just took needles," she told CBC News.

"I can be more active and do a lot more things."

Two weeks ago, MacLaren launched an online petition calling on the provincial government to pay for insulin pumps for children under the age of 18. As of Wednesday morning, the site had more than 1,900 signatures.

According to the Canadian Diabetes Association, Nova Scotia and Prince Edward Island are the only two provinces that do not provide any funding for insulin pumps.

The organization, which has been lobbying the province for years, estimates it will cost the government $650,000 annually to provide the service. They say it will result in fewer doctor and hospital visits, saving the system $1.5 million over the next 20 years.

Dave Wilson, the Minister of Health and Wellness, said he's aware of the costs surrounding pumps.

"We're going to look at this seriously," he told CBC News.

"It is a priority for me and we will hopefully make some decisions in the near future on that."

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OPP, hospital launch mental-health program

People with mental health problems who are picked up by the OPP, will soon get better access to medical help.

The Essex County OPP on Wednesday formally launched the Community Outreach and Support Team (COAST), a joint initiative with Hôtel-Dieu Grace Hospital in Windsor, Ont.

The program is aimed at reducing the amount of time police spend dealing with calls that would be better handled by the health-care system

"By default, it seems, police have become social workers in their respective communities," said Fran Chalmers, the manager of the Community Crisis Centre at Hôtel-Dieu Grace Hospital.

She said when officers respond to a mental-health call, it diverts resources away from fighting crime.

Under the Mental Health Act, police must bring people they believe are suffering from a mental illness and are a danger to themselves or others to hospital.

Police must stay with patients until a doctor takes over. That can take hours.

"That's a high use of police resources," Chalmers said.

As part of the program, constables partner with a crisis workers.

The team does not respond to 911 calls. The two partners are not first-responders.

Instead, they respond to referrals from other OPP officers in the field. They also respond to calls from neighbours, friends and doctors.

The team will provide on-site risk and mental-health assessment.

"We're hoping that with a program like COAST that, over time, there will be less individuals that need to be transported to hospital to receive this care," Chalmers said.

Chalmers called the partners "highly-trained individuals."

"They have to learn how to respond to a person in distress," she said.

Chalmers said tone of voice, choice of words, clear directive language and physical approach are all important.

COAST has been used in other Ontario communities, such as Hamilton.

According to the program there:

• 1 in 5 Canadians (6 Million people) will develop a mental illness at some time in their lives.
• At any given time, at least one percent of the population (approximately 300,000 Canadians) is likely to have a serious and persistent mental illness.
• It is estimated that schizophrenia affects approximately one per cent of Canadians.
• Mood disorders affect about 10 per cent of Canadians.
• Anxiety disorders affect about 12 per cent of Canadians.

The COAST Hamilton's crisis line is answered 24 hours a day, seven days a week.

The mobile team there consists of a mental health worker and a police officer who respond to crisis calls between the hours of 8 a.m. and 1 a.m. daily.

The COAST program officially launched Wednesday morning at Hôtel-Dieu Grace Hospital.

The Windsor Police Service had its own COAST program. It lasted two years. Chalmers said it may soon return.

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Tennis elbow? Steroid shots not best long-term fix

Commonly used steroid shots may worsen tennis elbow in the long run and increase chances that the painful condition will reappear, a small study found.

By contrast, patients who got dummy injections alone or with physical therapy were more likely to completely recover after a year and much less likely to have a recurrence than those given steroids.

Croat Goran Ivanisevic checks his elbow during a 1996 tournament. Studies show that steroid shots shouldn't be the main treatment for tennis elbow. (Jasper Juinen/Reuters)

While the Australian study results echo previous findings, injections of cortisone or similar steroids are still widely recommended by doctors to treat tennis elbow and similar conditions, probably because they can provide short-term pain relief.

The results from this study and others show that steroid shots shouldn't be the main treatment for tennis elbow, said researcher and co-author Bill Vicenzino the University of Queensland.

His study appears in Wednesday's Journal of the American Medical Association.

So-called tennis elbow is caused by repetitive activity or overuse of the arm, which can cause small tears in tendons that attach to the elbow bone. Rest, applying ice, and over-the-counter pain medicine can help relieve symptoms.

The study involved corticosteroids, often used medically to reduce inflammation. These are different from hormone-related anabolic steroids used to treat certain diseases but which are banned in many professional sports because they can build muscle and improve performance.

The researchers enrolled 165 adults aged 18 and older; each had tennis elbow in one arm for longer than six weeks. They were divided into four treatment groups: a single steroid injection; a shot of a dummy liquid; a steroid shot plus about eight weekly half-hour sessions of physical therapy; or a dummy injection plus physical therapy.

After four weeks, steroid patients fared best, but after one year, those who didn't get a steroid shot did better. All the patients who had physical therapy without steroids and 93 percent who got just dummy injections reported complete recovery or much improvement, versus about 83 percent of those who had steroids with or without physical therapy.

A recurrence of tennis elbow was reported by about half of the patients in both steroid groups, compared with just 5 percent of the physical therapy patients and 20 percent in the placebo group.

Despite the differences, more than 80 percent of patients in each group were much better or recovered after one year, showing that tennis elbow generally improves over time regardless of treatment.

One reason steroid injections aren't always the best choice is that they reduce the pain without fixing the underlying problem, so patients are more likely to resume activity too soon, said Dr. Michael Perry, a sports medicine specialist at Northwestern Memorial Hospital in Chicago.

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Checking up on patients helps resolve drug reactions

Calling patients after they get their prescriptions could help identify side-effects related to the medications, Canadian researchers have found.

Many patients don't realize they're experiencing an adverse drug event, and doctors often don't ask. To try to prevent this problem, researchers used automated calls to check in with 629 patients at family practices in Quebec three days and again 17 days after a prescription with four simple "yes-or-no" questions.

Pharmacists' calls helped patients to manage some adverse drug reactions. (Derik Holtmann/Belleville News Democrat/Associated Press)

"The system is identifying the patient who has a problem, the pharmacist is talking to them and they change their prescription in such a way that the patient can continue to take the medications or take an alternative medication," said study author Dr. Alan Forster, scientific director of performance measurement at the Ottawa Hospital.

The system identified 46 per cent of adverse drug events and influenced how 40 per cent of those were managed, the researchers said in Monday's online issue of JAMA Internal Medicine, formerly Archives of Internal Medicine.

It's the first time that automated calls have been used to help patients this way, Forster said.

Symptoms related to medications also didn't last as long, compared with the normal system.

The main benefit was with compliance, which is important for blood pressure, diabetes and heart medications that can improve health if the drugs are taken. When provincial drug plans pay for medications that sit on a shelf then the patient doesn't derive any benefit.

In the automated calls, patients were asked about if they'd filled the prescription, had any symptoms or problems related to the medication and if they wanted to speak to a pharmacist. If the patient said yes, the pharmacist was emailed and called back.

The Canadian Institutes of Health Research is now funding a randomized control trial of the system to see if it improves patients' health in a cost-effective manner.

'Reaching out is necessary but not sufficient'

A journal editorial accompanying the study called reaching out to patients to identify adverse drug reactions exciting and highly promising, but not yet ready for widespread use.

"For most people, the simple act of reaching out is necessary but not sufficient," wrote Dr. Michael Steinman of San Francisco Veterans Affairs Medical Center.

Steinman suggested combining the approach with efforts to educate and encourage patients to be active partners in their own care.

David Gardner, a pharmacy professor at Dalhousie University in Halifax, agreed the study exposes a bigger issue: Failing to get followup care.

"Right now in community pharmacies, we have sometimes the technician say to the patient picking up their pills, 'Do you want to speak to the pharmacist?' The patient looks over and sees a busy pharmacist and says, 'Oh no, I won't bother.' But that patient may have five important questions that could affect their wellness."

With files from CBC's Pauline Dakin

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Boomers too optimistic about health

A new report from the Heart and Stroke Foundation baby boomers may be less healthy than they think.

There is no quick fix for a healthy lifestyle, says Dr. Beth Abramson of the Heart and Stroke Foundation. (Heart and Stroke Foundation)

The 2013 report card on the health of Canadians shows 80 per cent of Canadian baby boomers think their doctor would rate them as healthy, but many don't have healthy eating habits, more than half are inactive, one in 10 drinks heavily and one in five smokes.

"A lot of us know that we should be making lifestyle changes, but it's harder to make a lifestyle change than take a pill and everyone's looking for that quick fix," said foundation cardiologist Dr. Beth Abramson.

"There is no quick fix. We need to get out there and try and lead healthier lives. It's a small change in our everyday routine. It can have a long lasting impact in the future."

Gordon Phillips of Stanley Bridge, P.E.I. had a heart attack more than a year ago. He feels he always took pretty good care of himself, but the attack made him more aware of his health. "It's run through my mind a number of times: why do we also wait for something to happen before we start doing these things," said Phillips.

"We can preach it all we want, but we're not doing it. Why are we not exercising more from day one? Why wait till something happens to do it? It's an uphill battle then to get yourself back into some kind of physical condition."

The Heart and Stroke Foundation is encouraging Canadians to take their online quiz to see if they are at risk.

For mobile device users: How would you rate your health lifestyle?

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Researchers try to measure diabetes risk for Inuit

The Public Health Agency of Canada is doing research on diabetes in Nunavut's Kitikmeot region.

The project is called CanRisk, and it will help develop a tool to identify Inuit who are at a high risk of developing diabetes.

Dr. Howard Morrison, with the Public Health Agency of Canada, said the project is taking place in all Kitikmeot communities

People are being offered a $50 food voucher if they take part.

"To have people complete a questionnaire that relates to their likely risk of developing or being diabetic and having an oral glucose tolerance test taken at the same time, and then relating the results of those questions to their likelihood of them being diabetic or pre-diabetic," he said.

Morrison said the study is a follow to work done in Finland where they developed a similar tool.

A nurse tests an Inuit woman's blood pressure. Researchers are in the Kitikmeot region to test peoples risk of developing diabetes. (CBC)

He said the study has been conducted throughout southern Canada, but nothing has been done in the North, so there is little information about the risk of diabetes for Inuit.

Morrison said that as eating habits change and people eat more processed foods, it's important to gather this information.

Morrison said the field work will be completed by the end of March.

Participants will be informed if they are at risk for diabetes or have the disease.

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Sperm counts lower with more TV time

Men who watch television for 20 hours per week have almost half the sperm count of those who watch very little television or none at all, a new study has found.

US researchers recruited 189 young men aged between 18 to 22, questioned them about their exercise, diet and TV habits and asked them to provide a sperm sample.

Men in the top quarter of TV-watchers — those who watched for 20 hours or more — had a 44-per cent lower sperm count than those who watched least, meaning they said they watched "none or almost none."

Another big factor was exercise, according to the study, published online in the British Journal of Sports Medicine.

Men who exercised for 15 or more hours weekly at a "moderate to vigorous" rate had a 73-per cent higher sperm count than those who exercised less than five hours per week.

None of the sperm levels was so low that the man would have been unable to father a child.

Semen quality appears to have declined over several decades, according to studies conducted in several countries.

It is unclear why this has happened but scientists suspect that sedentary lifestyles may warm the scrotum and affect semen concentrations. Physical inactivity has also been linked to increased levels of oxidative stress, in which rogue oxygen compounds degrade cells.

Previous studies into physical activity and semen quality have focused on elite athletes, such as professional marathon runners and cyclists.

"We were able to examine a range of physical activity that is more relevant to men in the general population," study co-author Jorge Charravo, assistant professor of nutrition and epidemiology at Harvard School of Public Health in Boston tells AFP.

The study was limited by the relatively small number of volunteers and the fact that only a single sperm sample was provided, the authors acknowledge.

Merits of moderate exercise

While the study was small, it was well designed and attempted to control for variables such as diet, body mass index and smoking that might differ between the two groups of me, says Dr. Allan Pacey, senior lecturer in andrology at the University of Sheffield.

"I would agree that there is evidence to suggest that moderate exercise could change men's physiology sufficiently to improve testicular health," says Pacey, who was not involved in the study.

"However, it remains to be seen if coaxing a TV watching couch potato into doing some regular exercise could actually improve his sperm count. Or whether there exists an unknown fundamental difference between men who like exercise and those who do not," he says.

But before worried men grab their sportsbag, he urges caution.

"It's important to note that other research suggests that doing too much exercise can be harmful to sperm production and this study did not examine the type and intensity of exercise their participants were undertaking.

"My advice would be everything in moderation — and that includes time in the gym as well as watching TV (or perhaps both at the same time!)"

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Coke's obesity ad campaign criticized

Coca-Cola's new advertising campaign positions itself as part of the solution to North America's obesity epidemic, but nutrition experts caution it's a distraction from the food and beverage industry's contributions to the problem.

The ads, which are available online and run in the U.S., won't be seen on Canadian airwaves until April.

Steve Cahillane, president and CEO of Coca-Cola Refreshments, which sells pop, as well as energy and sports drinks. (M. Spencer Green/Associated Press)

One clip points to the drink as only one of many sources of the overabundance of calories that drive obesity, saying "All calories count no matter where they come from."

The company said it wants to play a leading role in finding solutions for obesity, such as by reducing the calories per serving of its products, putting the calorie counts prominently on the front of cans, and creating a smaller portion can.

"It's about telling people, 'Hey, we have products that are great, they can be good in a balanced lifestyle, but remember they contain calories and you have to balance them with activity,'" Nicola Kettlitz, president of Coca-Cola Canada, said in an interview.

Dr. Yoni Freedhoff, the director of the Bariatric Medical Institute in Ottawa, called sugar-sweetened beverages the number 1 single contributor of calories to North American diets.

"I think what Coca-Cola is trying to do, is to be able to say to the world: 'Look, we're part of the solution, we're not part of the problem, and we don't need things like soda taxes, and cup size limits because we are already working on it.' So this is their way to try to avoid further legislation that would affect their sales."

Coke maintains it's offering many zero-calorie options and that pop consumption has decreased. What's omitted, Freedhoff said, is that sales of their other sugar-sweetened products, such as sports and energy drinks, are climbing steadily.

Dr. Robert Lustig, a pediatric endocrinologist at the University of California at San Francisco, argues sugar and the food and beverage industry have caused the obesity epidemic.

Lustig said the new ads, part of the $3 billion a year the company spends on advertising, are an attempt to distract from their role in creating a generation of overweight, unhealthy people.

The pop maker sees a calorie as a calorie, regardless of whether it comes from carrots or cheesecake.

"They're all the same as far as Coke is concerned," Lustig said. "Problem is, science doesn't support that."

Coke's calories come from sugar — 10 teaspoons or 42 grams — in a single can of regular soda that has no other nutrients.

With files from CBC's Kelly Crowe and Marijka Hurko

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Boomers too optimistic about health

A new report from the Heart and Stroke Foundation baby boomers may be less healthy than they think.

There is no quick fix for a healthy lifestyle, says Dr. Beth Abramson of the Heart and Stroke Foundation. (Heart and Stroke Foundation)

The 2013 report card on the health of Canadians shows 80 per cent of Canadian baby boomers think their doctor would rate them as healthy, but many don't have healthy eating habits, more than half are inactive, one in 10 drinks heavily and one in five smokes.

"A lot of us know that we should be making lifestyle changes, but it's harder to make a lifestyle change than take a pill and everyone's looking for that quick fix," said foundation cardiologist Dr. Beth Abramson.

"There is no quick fix. We need to get out there and try and lead healthier lives. It's a small change in our everyday routine. It can have a long lasting impact in the future."

Gordon Phillips of Stanley Bridge, P.E.I. had a heart attack more than a year ago. He feels he always took pretty good care of himself, but the attack made him more aware of his health. "It's run through my mind a number of times: why do we also wait for something to happen before we start doing these things," said Phillips.

"We can preach it all we want, but we're not doing it. Why are we not exercising more from day one? Why wait till something happens to do it? It's an uphill battle then to get yourself back into some kind of physical condition."

The Heart and Stroke Foundation is encouraging Canadians to take their online quiz to see if they are at risk.

For mobile device users: How would you rate your health lifestyle?

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