Ont PublicService Retiree benefits. (NONE FOR OMA MEMBERS).

News Release Ontario Updates Public Sector Retiree Benefit Plans February 18, 2014 Sharing Cost Of Retiree Benefits Equally With Ontario Public Sector Employees The Ontario government will transition to a cost-sharing model for retiree benefits for employees retiring on or after Jan. 1, 2017. This will bring Ontario Public Service retiree benefits in line with other public sector organizations where retirees are often asked to contribute up to 100 per cent of their benefits premium. Current retirees from the Ontario Public Service will not be affected by these changes. Key features of the new model will: Require employees retiring on or after Jan. 1, 2017 to pay 50 per cent of their benefits premiums (e.g. life, health, dental and vision). Currently the government pays 100 per cent. Change the eligibility period for retiree benefits from 10 to 20 years for employees hired on or after Jan. 1, 2017. Taking a measured and moderate approach to Ontario's finances is part of the government's economic plan that is creating jobs for today and tomorrow. The comprehensive plan and its six priorities focus on Ontario's greatest strengths - its people and strategic partnerships. QUICK FACTS Employees who do not have 10 years pension credit in the pension plans by Jan. 1, 2017 will have to have at least 20 years of pension credits and retire to an immediate unreduced pension in order to qualify for retiree benefits. About 3,000 - 4,000 employees begin to receive a pension and retiree benefits from the Public Service Pension Plan or the OPSEU Pension Plan each year. There are more than 84,000 active members of the Ontario Public Service and other employers enrolled in Ontario Public Service pension plans. Retiree benefits are not a provision of the pension plans nor are they a pension benefit. (COMMENT Ont.MDs do not have similar juicy perks. They are Ont.Govt.CONTRACT WORKERS with FIXED RATES of PAY with the legal fiction of being "self-employed".)

Princess Margaret Cancer Hospital TOWN vs GOWN Patient care vs Research.

Life depends on choice of Cancer Hospital. In State medicine OHIP pays the same to Triple A and House League Cancer docs. The perks of First Class travel to International Conferences as an Invited Speaker comes to those who organise TRIALS. There is an conflict of interest between giving the Best available treatment to the Individual and the value of the person in a Trial. Patients are given papers to sign however Statistics Canada figures find that 46% of Canucks are FUNCTIONALLY ILLITERATE. They can read simple texts but can't fill forms. Immuno-compromized patients need high level of Hospital hygiene. The appearance of Staff does not give confidence. Habd-washing is not evident. Only the use of less-than-effective Ethyl alcohol gel. (ODETTE CANCER CENTRE @ SUNNYBROOK Hosp has higher level of hygiene and patient care. Possibly due to its location near the most wealthy part of Toronto: The Bridle Path)

FIBROSCAN: vibration-controlled transient elastography (VCTE).to estimate Hep.fibrosis & controlled attenuation parameter for Hep steatosis.

wwww.liverscan.ca $100 FEE NOT PAID BY Ont.Govt insurance(OHIP). NO NEED FOR GP REFERRAL. Liver Scan Direct is a medical diagnostics clinic based in Toronto that specializes in the non-invasive assessment of liver health using FibroScan® technology. Our mission is to provide patients who have liver problems rapid access to FibroScan® testing with interpretation of results by an internationally recognized expert (Dr. Robert P. Myers). Why wait months for a referral to a liver or gastroenterology specialist and then wait longer to undergo an invasive liver biopsy? No referral is necessary to be assessed at Liver Scan Direct. Any patient can contact us directly to schedule an appointment. We schedule appointments rapidly and provide results within 1-2 business days. In order to improve access for physicians and their patients with liver disease, Liver Scan Direct now offers FibroScan® clinics in 10 locations in southern Ontario (Toronto, Mississauga, Scarborough, Richmond Hill, Newmarket, Burlington, Waterloo, and Guelph). Dr. Robert P. Myers, MD, MSc, FRCPC Liver Scan Direct's medical consultant - Dr. Robert Myers - is an Associate Professor of Medicine, Hepatologist, and Director of the Viral Hepatitis Clinic at the University of Calgary. He is an internationally-recognized expert on the non-invasive assessment of liver disease, particularly FibroScan technology. Dr. Myers has published over 110 scientific studies, including the 2012 Canadian consensus guidelines for the management of hepatitis C (see below). Dr. Myers frequently lectures on this technology at international scientific meetings. Dr. Myers is an Associate Editor of the American Journal of Gastroenterology, a member of the Editorial Board of Hepatology (the premier journal in the field), past Chair of the Education Committee of the Canadian Association for the Study of the Liver, and a member of the National Education Advisory Committee of the Canadian Liver Foundation. In 2012, Dr. Myers was awarded a Queen Elizabeth II Diamond Jubilee Medal for his contributions to research and patient care in liver disease. Dr Robert Myers Selected FibroScan Publications by Dr. Myers 1. RP Myers, et al. Feasibility and diagnostic performance of the FibroScan XL probe for liver stiffness measurement in overweight and obese patients. Hepatology 2012;55(1):199-208. ​ 2. RP Myers, et al. Feasibility and reliability of the FibroScan S2 (pediatric) probe compared with the M probe for liver stiffness measurement in small adults with chronic liver disease. Ann Hepatol 2013; 12(1):100-7. ​ 3. Myers RP, et al. Controlled Attenuation Parameter (CAP): a noninvasive method for the detection of hepatic steatosis based on transient elastography. Liver Int 2012;32(6):902-10. ​ 4. RP Myers, et al. Transient elastography for the noninvasive assessment of liver fibrosis: a multicentre Canadian study. Can J Gastroenterol 2010;24(11):661-70.  5. RP Myers, et al. An update on the management of hepatitis C: consensus guidelines from the Canadian Association for the Study of the Liver. Can J Gastroenterol 2012;26(6):359-75.

CMAJ: LACRIMAL GLAND CALCULI

Lacrimal Gland Duct Stones Misdiagnosed as Chalazion This report is of three patients with lacrimal gland duct stones that were misdiagnosed as chalazion at a local clinic between 2010 and 2012. A review of clinical, imaging, and histopathologic manifestations are discussed. Clinical manifestations of lacrimal gland duct stones included conjunctival injection, lid swelling, tenderness, and ocular discharge, which are similar to chalazion symptoms. Computed tomography revealed a relatively well-defined, high-density mass near the lacrimal gland. Histopathologic examination of excised material revealed calcified amorphous stones. Intractable chalazion-like lesions at the lateral canthal area near the lacrimal gland should be carefully examined; imaging studies are required to confirm the presence of lacrimal gland duct stones, which require surgical removal. SOURCE: Kim SC, Lee K, Lee SU. Lacrimal gland duct stones: misdiagnosed as chalazion in 3 cases. Can J Ophthalmol. 2014;49(1):102–5.

HAEM CANCERS: MINIMAL RESIDUAL DISEASE MONITORING: SWISS MED.WEEKLY www.smw.ch

Review article | Published 22 January 2014, doi:10.4414/smw.2014.13907 Cite this as: Swiss Med Wkly. 2014;144:w13907 Minimal residual disease monitoring: the new standard for treatment evaluation of haematological malignancies? Mathieu Hauwel, Thomas Matthes Swiss Flow Cytometry School, Haematology Service and Clinical Pathology Service, Geneva University Hospital, Switzerland Summary Abbreviations ALL acute lymphoblastic leukaemia AML acute myeloid leukaemia ASO-PCR allele-specific oligonucleotide-PCR BCR B-cell receptor CLL chronic lymphocytic lymphoma CML chronic myeloid leukaemia CR complete remission cytoCR flow cytometry CR DNA deoxyribonucleic acid FISH fluorescent in-situ hybridisation FL follicular lymphoma iCR immunofixation CR IgH immunoglobulin heavy chain LAIP leukaemia-associated immunophenotype LSCs leukaemic stem cells MCFC multicolour flow cytometry MRD minimal residual disease mRNA messenger RNA NGS new generation sequencing NMR nuclear magnetic resonance PCR polymerase chain-reaction PET positron emission tomography PFS progression-free survival Ph Philadelphia chromosome RNA ribonucleic acid RT-PCR reverse transcriptase-PCR sCR serum free light chain ratio CR TCR T-cell receptor Minimal residual disease (MRD) refers to the small number of malignant cells that remain after therapy when the patient is in remission and shows no symptoms or overt signs of disease. Current treatment protocols for haematological malignancies allow most patients to obtain some form of MRD state, but cure seldom follows and in most cases fatal relapses occur sooner or later, leaving a bitter impression of having won a battle yet lost the war. MRD detection and quantification are used for evaluation of treatment efficiency, patient risk stratification and long-term outcome prediction. Whereas multicolour flow cytometry (MCFC) and polymerase chain reaction (PCR) based methods constitute the two most commonly used techniques for MRD detection, next generation sequencing will certainly be widely employed in the future. As MRD reflects the nature of the malignant disease itself, including its sensitivity to the drug regimens applied, it constitutes the ideal method for surveillance and patient follow-up. The morphological examination of peripheral blood or bone marrow smears, although still an indispensable part of routine laboratory testing, is clearly insufficient for patient management, and clinicians should not ask themselves whether to look for MRD or not, but how and when. Key words: minimal residual disease; flow cytometry, next generation sequencing; PCR; acute lymphoblastic leukaemia; acute myeloid leukaemia; chronic myeloid leukaemia; multiple myeloma, lymphoid neoplasm

Feb 8-11 Royal.York Hotel Can Digestive Diseases & Can.Assn.for Liver Study.: FAECAL CALPROTECTIN

No press room = No media present-including CMAJ & Ont.Med. Review) Impressive exhibition (50+) but few visitors. Norwegian-developed SWISS ALPCO system offers OFFICE & LAB test for FAECAL CALPROTECTIN. Diff.Diag.of Abdom.pain,cramping,diarrhoea. INFLAMMATORY Bowel Disease (IBD) vs. Irritable Bowel Syndrome(IBS) Using Buhlmann Calprotectin assay HIGH LEVELS = IBD (CROHN & ULCERATIVE COLITIS)LOW LEVELS = IBS (suspect FOOD INTOLERANCE & COELIAC DISEASE) Used in Teaching Hospitals: Hamilton, London, Toronto . Stool collected using EasySampler kit @ $8. Extraction using $300 Vortex. "Schebo Quick Prep" for Solid stool "Smart-prep" for solid/liquid stool OFFICE CALchek Blue @ $25/test; LAB/OFFICE: QUANTUM blue using $2500 small casette Quantitative tester.LABORATORY HIGH VOLUME: CALPROTECTIN ELISA. www.alpco.com Values below 50 microgram/gram Unlikely to be inflammation Values above 50 to 100 = mild inflammatory disease: aet NSAID; diverticulae; IBD in remission. Values above 100= ACTIVE ORGANIC DISEASE. GP referral to Specialist imperative. url http://www.alpco.com/content/products/Calprotectin_Assay.aspx

SERUM FREE LIGHT CHAIN ANALYSIS (NOT PAID BY OHIP if orded by GPs & General Medical Clinics)

"BINDING SITE FREELIGHT" serum free light chain analysis Now available PRIVATELY by Gamma Dynacare laboratories. Provided free by OHIP at selected Oncology clinics. Freelite™ Serum Free Light Chain Assays (UK) Freelite™ is a major breakthrough for the detection and monitoring of Multiple MyelomaFreelite Logo (MM) and other B-cell dyscrasia. Freelite™ assays were developed by Binding Site to measure free lambda and free kappa immunoglobulin light chains. Our expertise in the manufacture of antibodies has enabled us to provide a quantifiable, highly specific, automatable free light chain assay for serum. Significant clinical evidence indicates the benefit of Freelite™ serum free light chain assays in initial screening for monoclonal gammopathies. Other benefits include the identification of AL amyloidosis and Nonsecretory MM patients missed by conventional electrophoretic methods, use as a prognostic indicator for progression in myeloma, for risk stratification of MGUS patients, and rapid evaluation of treatment efficacy. Freelite™ is a sensitive, specific marker of kappa and lambda free light chains (FLC) in serum and provides quantitative measurement of: Free kappa in serum Free lambda in serum The serum free kappa/free lambda ratio (κ/λ) The serum free light chain ratio is a strong indicator of monoclonality and is valuable for distinguishing monoclonal from polyclonal diseases.