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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Report helps healthcare workers spot fabricated illness in kids

It's a rare, insidious form of child abuse, and it often goes undetected.

But caregiver-fabricated illness in children (CFIC) is real, and healthcare providers need to know how to spot it, says Dr. Harriet MacMillan, a pediatrician and researcher at McMaster University.

'It's hard for people to actually conceive that caregivers would fabricate illness.'—Dr. Harriet MacMillan, McMaster University

She hopes a new report she's co-authored, appearing in the September issue of the medical journal Pediatrics, gives clinicians the tools to identify the hard-to-diagnose condition.

CFIC occurs when a caregiver — usually a parent — fakes or induces an illness in a child. This results in unnecessary visits to a healthcare provider and sometimes leads to harmful treatment.

The phenomenon is difficult to detect, MacMillan says. Physicians don't often suspect that an adult bringing a child into a clinic has invented the youngster's illness.

"It's hard for people to actually conceive that caregivers would fabricate illness," said MacMillan. "If you think about it, people working with children are basically trained to trust the histories that are provided to them."

Red flags

But CFIC has its red flags. MacMillan's article, written with Northwestern University pediatrician Emalee Flaherty, details a laundry list of signs that an adult is causing, or trying to convince a healthcare professional of, a child's illness. Some of the most frequently reported ailments include rashes, allergic reactions, urinary tract infections and vomiting — all possible indicators of poisoning — as well as breathing and eating problems.

In other cases, a caregiver falsely reports that child has an emotional or behavioural problem, attention deficit/hyperactivity disorder or a learning disability. Some even claim that a child has suffered sexual abuse, even though they know the claim is false.

"I think what's important in this article that we really try to highlight is that it's not just symptoms of physical illness, but also psychiatric illness," MacMillan stresses.

Identifying a case of CFIC requires other detective skills. Questioning whether a child's symptoms match up with what a caregiver is reporting, taking a close look at medical records, even asking to interview the child one-on-one — all of these methods help clinicians make an informed diagnosis, MacMillan says.

"It's about looking at the whole clinical picture."

CFIC is relatively rare, occurring in approximately 0.5 to two out of every 100,000 children, studies suggest. However, the phenomenon is likely "underreported," MacMillan says.

Terminology

The condition is often to referred to as Munchausen Syndrome by proxy. But MacMillan and Flaherty discourage the use of that term, arguing it takes the focus away from the mistreatment of the victims.

"We are saying that we use this particularly terminology because it emphasizes the child's exposure to risk and harm rather than the motivation of the caregiver who is doing this," MacMillan said. "People working with children need to recognize this as a kind of child maltreatment."

Dr. Harriet MacMillan is a professor in the department of psychology and behavioural neuroscience at McMaster University. (McMaster University)

Though the article doesn't establish the type of adult who fabricates a child's illness, MacMillan says perpetrators often have certain characteristics. They are typically mothers and often work in, or are very knowledgeable about, the healthcare field. Many yearn for the attention of doctors and nurses. Some have a history of feigning being ill themselves.

MacMillan says there is much work to be done on the long-term impacts of CFIC on the victims, and to oversee what treatments the children receive. She hopes monitoring programs will be established to combine information that healthcare providers gather on the CFIC cases they handle. This will help researchers better understand the phenomenon.

"What's key here, hopefully, for clinicians to take away from this is the need — in addition to their obligation to report to child protection services — to gather the comprehensive information from medical records. That's key generally, but it's also particularly important with this condition."

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Artists 'better protected' against dementia, study finds

Art and music are less vulnerable to cognitive decline, a new Canadian study suggests.

Neurologists at St. Michael's Hospital in Toronto found that artists suffering from vascular dementia may still be able to draw spontaneously and from memory, despite being unable to complete simple, everyday tasks.

"We discovered that there is a disproportion between the degree that artists lose some of their memory function, their orientation and other day-to-day cognitive functions. But at the same time, some of their art form is preserved," Dr. Luis Fornazzari, a neurological consultant at St. Michael's Hospital memory clinic and lead author of the paper, told CBC News.

Artists compared with non-artists are better protected, he added. "Due to their art, the brain is better protected [against] diseases like Alzheimer's, vascular dementia, and even strokes. They have more reserve in their brain in order to give functions.

"So [we know], based on other neuroscience studies, that art in any of its forms uses different neuronal avenues inside the brain to do their work. And the activity, the talent and the art per se gives reserve when the brain requires that reserve."

'Exceptional' artistic skills

The study, released Thursday in the Canadian Journal of Neurological Sciences, looks at the last few years of the late Mary Hecht, an internationally renowned sculptor, who was able to draw spontaneously as well as complete detailed sketches of faces and figures, from memory, despite suffering from severe vascular dementia.

'Art should be taught to everyone. It's better than many medications and is as important as mathematics or history.'—Dr. Luis Fornazzari, St. Michael's Hospital memory clinic

"Mary Hecht was a remarkable example of how artistic abilities are preserved in spite of the degeneration of the brain and a loss in the more mundane, day-to-day memory functions," Fornazzari said.

Hecht, who died in April 2013 at the age of 81, was wheelchair-bound due to previous strokes. She was unable to tell time, name certain animals or remember any words she was asked to recall.

But she could quickly sketch an accurate portrait of a research student from the hospital's memory clinic. She could also draw a free-hand sketch of a lying Buddha figurine and reproduce it from memory a few minutes later — as well as an accurate sketch of famed cellist Mstislav Rostropovich after learning of his death earlier on the radio.

While she was drawing and showing medical staff her drawings, Hecht spoke articulately without hesitation about art, the researchers found.

"This is the most exceptional example of the degree of preservation of artistic skills we've seen in our clinic," said Dr. Corinne Fischer, director at the St. Michael's Hospital memory clinic.

"Most of the other studies that have been done in this area looked at other kinds of dementia such as Alzheimer's disease or frontal temporal dementia, while this is a case of cognitive reserve in a patient with fairly advanced vascular dementia," she added.

Alzheimer's patients also studied

Fornazzari told CBC that details from previous cases of patients suffering from Alzheimer's disease, including one musician who could still play the piano and learn new music, were also included in the study.

One of Hecht's drawings after being diagnosed with advanced vascular dementia. (St. Michael's Hospital)

"We noticed for instance that some of the artists lost their speech. They couldn't talk," he said. "But at the same time, the art was totally preserved. The same [results occurred] not only with painters but with musicians."

In a separate study in 2011, Fischer also looked at bilingual patients with Alzheimer's and discovered they had twice as much cognitive reserve as their counterparts who only spoke one language.

Fornazzari said he believes educators should take the findings seriously and encourage schools to teach the arts – whether sculpture, painting or music – rather than cutting back on them.

"Art opens the mind," he said. "It should be taught to everyone. It's better than many medications and is as important as mathematics or history."

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Personnelle cold and flu products recalled

A cold and flu drug maker is recalling many of its Personnelle products because of a labelling error.

The recall is for certain lots of Personnelle Cold and Flu-in-One Extra Strength and Personnelle Flu Relief, manufactured by Vita Health Products, Health Canada said today.

"Important warnings and overdose information are printed on the inside of the box. Since there are no directions to check the inside of the box, consumers may miss this important consumer safety information," the regulator said.

Consumers who bought the products are asked to read the warnings on the inside of the product's packaging.

Anyone who used the products and has concerns about their health should consult a health-care practitioner.

The Winnipeg-based company and Health Canada said there have been no reports of adverse events associated with the products.

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