14 Sept 2015
LACK OF SECURITY IN ONTARIO HOSPITALS.
NO CONTROL OF MATERIAL BROUGHT INTO HOSPITALS. UNLIKE USA, NO CONTROL OF PEOPLE ENTERING WARD AREAS.
ONTARIO LIBERAL GOVERMENT CUTS PAYMENTS TO MDs by 4.45% on OCTOBER 1,2015
OMA President’s Update: Government Imposes Further Cuts
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13:24 (2 hours ago)
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PRESIDENT’S UPDATE
Vol. 20, No.17 September 14, 2015
Government Imposes Further Cuts
The
Ontario government has informed the OMA that effective October 1, 2015,
it will impose an additional estimated $235 million in cuts to
physician services payments in order to offset its deliberate
underfunding of health care in this province.
The Ministry’s plan includes:
• An additional 1.3% across the board discount for fee-for-service payments (from 3.15% to 4.45%).
• A further 1% discount on all professional billings in excess of $1 million (in addition to the discount above).
• A
series of targeted fee-for-service cuts, including fee adjustments in
the areas of diagnostic imaging, point of care laboratory testing,
echocardiography, diabetes management, intravitreal injection and pre-operative consultation for low-risk surgery.
The
government had earlier signaled its intent to impose further cuts to
physicians, and the OMA strenuously objected to the government’s plans
and approach. The OMA has now received notice from the Ministry that it
will move forward on October 1. We have posted the government’s
implementation plan in its entirety on our website (https://www.oma.org/Member/
The
OMA Economics, Research and Analytics Department is conducting an
impact analysis that we will make available to members as soon as
possible. I have spoken directly to the leaders of those Sections most
affected by the Ministry’s targeted cuts.
The
Wynne government’s determination to fund the health care needs of
Ontarians on the backs of our members marks an ongoing pattern of
contempt toward the medical profession and public deception.
The
OMA is vehemently opposed to these measures, which we consider unfair
and unlawful. I will be seeking an urgent meeting with Minister Hoskins
to address these matters directly.
The
OMA has consistently delivered the message to government that we need
innovative solutions to tackle the challenges of an aging, growing
population. Failing to do so threatens our ability to offer the
high-quality patient care Ontarians rightly expect. The government is
ignoring this message, instead telling physicians that we must provide
care under the constraints of their imposed hard-cap on physician
services funding.
The
OMA Board will meet Wednesday and Thursday this week, and we will
provide a more comprehensive update and action plan to members shortly
thereafter.
Dr. Mike Toth MD(Univ.Western Ont. 1984) GP AYLMER,ONT. (popn 7,100)
OMA President
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12 Sept 2015
RESISTANCE OF ONTARIANS TO PAY FOR MEDICAL SERVICES
COMMENT. Ontarians pay fortunes for Sports and Toys but think it political heresy to pay for medical .
care.. Many Ontarians have OHIP supplemented by Private insurance paid by various levels of Government and Unions. Large sums of money are spend on FISHING inc ICE FISHING;; GOLF (many Municipal Courses) HUNTING (BOW & RIFLE); ICE HOCKEY, good pads cost $3000; POWER BOATING;(incl JET SKIS) SAILING; SKIING (inc SNOW BOARDS), and SNOWMOBILES. Low OHIP fees for MDs subsidize Ontarians' playtime.
Ontario MDs still have no contract.
The "poor" get free Dentistry; Drugs; Eye`exams and specs;Orthotics (insoles & shoes).;& transportation.
Dr A Franklin
Fellowship for Freedom in Medicine(Canada)
care.. Many Ontarians have OHIP supplemented by Private insurance paid by various levels of Government and Unions. Large sums of money are spend on FISHING inc ICE FISHING;; GOLF (many Municipal Courses) HUNTING (BOW & RIFLE); ICE HOCKEY, good pads cost $3000; POWER BOATING;(incl JET SKIS) SAILING; SKIING (inc SNOW BOARDS), and SNOWMOBILES. Low OHIP fees for MDs subsidize Ontarians' playtime.
Ontario MDs still have no contract.
The "poor" get free Dentistry; Drugs; Eye`exams and specs;Orthotics (insoles & shoes).;& transportation.
Dr A Franklin
Fellowship for Freedom in Medicine(Canada)
11 Sept 2015
TORONTO OLFACTORY NERVE CLINIC
Toronto's first clinic for olfactory nerve analysis.and olfactory nerve loss rehabilitation.
OHIP-paid consult with ENT Alexander J. OSBORN MD(Baylor 2005) PhD
OHIP does not pay $60 cost-price of testing material. Also $100 cost for rehabilitation.
180 Dundas St West, Ste 2003.(steps to front door) better access on Northern side of building (123 Edward Sr.)
Indoor parking
Postgrad Med J. 2006 Apr; 82(966): 239–241.
PMCID: PMC2579627
Effects of ageing on smell and taste
This article has been cited by other articles in PMC.
Abstract
Disorders
of taste and smell commonly present diagnostic dilemmas to the medical
profession. This may be secondary to the lack of knowledge and
understanding of these conditions. There seems to be a low level of
interest in the disorders, when compared with disruption of the other
senses such as sight and hearing. Nevertheless, impairment of these
senses are common and may be life threatening, especially when they
involve the elderly patient. The aetiology of the conditions is
widespread, and extend beyond the content of this article. This article
will relate only to how the ageing process may contribute to sensory
dysfunction. It will focus on how the ageing process changes the normal
anatomy and physiology of the senses, how this effects the person's
quality of life, and the current management of these conditions.
Keywords: aged, olfaction disorders, taste disorders
The effects of ageing on smell
The sense of smell is often taken for granted, that is until it deteriorates. As we get older, our olfactory function declines.1,2
Not only do we lose our sense of smell, we lose our ability to
discriminate between smells. It has been reported that more than 75% of
people over the age of 80 years have evidence of major olfactory
impairment, and that olfaction declines considerably after the seventh
decade.1 A more recent study found that 62.5% of 80 to 97 year olds had an olfactory impairment.3 However, it is widely accepted that taste disorders are far less prevalent than olfactory losses with age.4
There
are numerous theories on why the sense of smell deteriorates as we age,
I shall attempt to outline a few of these. Various anatomical and
physiological theories have been presented. We are aware that both the
number of fibres in the olfactory bulb, along with olfactory receptors
decrease noticeably with age.1
The bulb losses may well be secondary to sensory cell loss in the
olfactory mucosa, along with a general deterioration in central nervous
system cognitive processing functions. Even in the absence of disease,
olfactory receptor neurones undergo apoptosis at a baseline rate in each
person. Mammals have the ability to replace these cells, however this
process degenerates with ageing.5
This results in a reduction in the surface area of olfactory
epithelium, along with reduced numbers of olfactory receptor neurones.
In addition, it is thought that age related olfactory dysfunction is
related to an increase in receptor cell death.2
Activation of the piriform/amygdalar region and the orbitofrontal
cortex has been shown to be reduced in older subjects when exposed to
stimulation.6
In some cases, olfactory loss may be secondary to age related
appositional bone growth resulting in the pinching off of the olfactory
fila as they traverse the ethmoid bone.7
Certain general diseases such as liver disease and non‐otolaryngological cancers seem to influence olfactory function.8
Another contributing factor when considering age related olfactory
deterioration is mild cognitive impairment and Alzheimer's disease.
Electrophysiological results of patients with Alzheimer's disease and
pre‐clinical Alzheimer's disease confirm olfactory dysfunction.9
The effects of ageing on taste
Gustatory
dysfunction may indeed be related to the normal ageing process.
However, in many cases, what is perceived as a taste defect is truly a
primary defect in olfaction. Other than smell dysfunction, the most
frequent causes of taste dysfunction are prior upper respiratory
infection, head injury, drug use, and idiopathic causes.10,11,12
Chewing problems associated with tooth loss and dentures can also
interfere with taste sensations, along with the reduction in saliva
production. When presenting to the clinician, older patients with
impaired taste should be thoroughly evaluated for oral and pharyngeal
disease such as candidiasis. One theory is that normal ageing produces
taste loss because of changes in taste cell membranes involving altered
function of ion channels and receptors.13 Taste bud loss is thought to contribute less to this problem with no relation between taste acuity and number of papillae.14
Rather than whole mouth gustatory dysfunction, regional deficits are
much more common. It has been reported that there is a higher prevalence
of localised losses on the tongue in elderly subjects than in young
subjects.4 Despite their wide prevalence, most elderly people are unaware of regional taste deficits.
Smell and taste disorders: the consequences
The
theory behind the deterioration of these senses in the elderly person
has been covered, however effects on the person's lifestyle along with
the dangers associated with such disorders needs to be considered. The
world is a different place without the sense of smell. Pleasant
experiences such as the smell of flowers in spring, the aroma of fresh
coffee, or even a Sunday roast are lost forever. Contrast this with the
smell of garlic on an acquaintance's breath cutting a conversation
short.
Unfortunately,
smell and taste disorders in the elderly person are commonly
overlooked, as they are not considered critical to life. However, this
may not be the case. Decreased smell function is a contributory factor
in the age related increases in accidental gas poisonings and explosions
that can endanger public safety. Decreased smell and taste results in
appetite suppression resulting in weight loss, malnutrition, impaired
immunity, and deterioration in medical conditions.1,4,15 Nutritional problems are an important sequelae from smell and taste disorders.17
It has been reported that the elderly person requires a twofold to
threefold higher concentration of salt to detect it in tomato soup.17 The tendency toward higher salt and sugar intake in the elderly diet can aggravate health hazardous conditions.18 When the sense of smell is decreased or distorted, disability and decreased quality of life are reported.19
In addition to these problems, such conditions may be responsible for a
high degree of anxiety and depression in the elderly person. Anxiety in
the inability to taste and enjoy food, and fears that the symptom is
indicative of an underlying disorder. There is also a higher incidence
of depression in those who develop anosmia.11
Investigation of smell and taste disorders
When
a patient presents with a problem with their smell and taste, it is
important to fully investigate the problem regardless of their age.
Investigation is focused on the possible causes of such disorders as
outlined in the box. This includes a detailed history and examination
that may often lead to the cause of the problem, as is the case with
local causes such as nasal polyposis.
More extensive
testing with haematological and biochemical investigations are
frequently required to discover the various nutritional and endocrine
causes of smell and taste disorders.21 Radiological investigation such as computed tomography is necessary to detect neurological causes for the disorder.
It
is only when other causes have been ruled out that the ageing process
may be suspected as the important contributor to a smell and taste
disorder.
Management of smell and taste disorders
When
a patient presents with such a disorder, they initially need
counselling and reassurance that they do not have a malignant disease or
infection. Once diminished smell is diagnosed, the goal of management
entails preventing injury related to this. Visual stimulating gas
detection devices are good for those with a gas stove, as the person may
not be able to smell gas leaks. Relatives or neighbours need closer
involvement to check for spoiled food that if eaten could lead to food
poisoning. People who have taste disorders may benefit from flavour
enhancement of their foods. Flavours are mixtures of odorant molecules
that can be extracted or blended from natural products, or synthesised
based on chromatographic and mass spectrographic analysis of natural
products. Flavour enhancers supplement, enhance, or modify the original
taste or aroma of a food but do not have a characteristic taste or aroma
of their own. Salt is the most widely used additive in flavour
enhancement, but others such as monosodium glutamate are also commonly
used. Flavour enhancement for the elderly and sick can improve food
palatability and acceptance, increase lymphocyte counts, reverse or slow
functional decline, and improve overall quality of life. It also has
the potential to compensate for anorexia.22
An additional study found that flavour enhancement for elderly
retirement home residents resulted in improved immune status as
determined by T and B cell levels and improved grip strength.22 Taste and odour stimulation has also been shown to increase the rate of salivary IgA in the elderly person.23
Summary
This
article has briefly summarised what is known about ageing and smell and
taste disorders. More research is required in this field, along with
increased awareness to discover new management options to benefit those
with these disorders.
Footnotes
This article is part of a series on ageing edited by Professor Chris Bulpitt.
Funding: none.
Conflicts of interest: none declared.
References
1. Doty R L, Shaman P, Applebaum S L. et al Smell identification ability: changes with age. Science 19842261441–1443.1443 [PubMed]
2. Doty R L, Snow J B. Age‐related alterations in olfactory structure and function. In: Margolis F, Getchell T, eds. Molecular neurobiology of the olfactory system. New York: Plenum Press, 1988355–374.374
3. Murphy C, Schubert M S, Cruickshanks K J. et al Prevalence of olfactory impairment in older adults. JAMA 20022882307–2312.2312 [PubMed]
4. Bartoshuk L M. Taste. Robust across the age span? Ann N Y Acad Sci 198956165–75.75 [PubMed]
5. Doty R L, Bromley S M. Smell. In: Asbury AK, McKhann GM, McDonald WI, eds. Diseases of the nervous system. Cambridge: Cambridge University Press, 2002595–609.609
6. Cerf‐Ducastel
B, Murphy C. FMRI brain activation in response to odors is reduced in
primary olfactory areas of elderly subjects. Brain Res 200398639–53.53 [PubMed]
7. Kalmey J K, Thewisson J G, Dluzen D E. Age‐related size reduction of foramina in the cribriform plate.Anat Rec 1998251326–329.329 [PubMed]
8. Landis B N, Konnerth C G, Hummel T. A study on the frequency of olfactory dysfunction. Laryngoscope 20041141764–1769.1769 [PubMed]
9. Peters J M, Hummel T, Kratzsch T. et al
Olfactory function in mild cognitive impairment and Alzheimer's
disease: an investigation using psychophysical and electrophysiological
techniques. Am J Psychiatry 20031601995–2002.2002 [PubMed]
10. Bromley S M, Doty R L. Taste. In: Asbury AK, McKhann GM, McDonald WI, et al, eds. Diseases of the nervous system. Cambridge: Cambridge University Press, 2002610–620.620
11. Moore‐Gillon V L. Abnormalities of smell. In: Mackay IS, Bull TR, eds. Scott‐Brown's otolaryngology. 6th ed. Oxford: Butterworth Heinemann, 199751–58.58
12. Miller I J. Anatomy of the peripheral taste system. In: Doty RL, ed. Handbook of olfaction and gustation. New York: Marcel Dekker, 1995521–547.547
13. Mistretta C M. Ageing effects on anatomy and neurophysiology of taste and smell. Gerodontology 19843243–248.248 [PubMed]
14. Mavi
A, Ceyhan O. Bitter taste thresholds, numbers and diameters of
circumvallate papillae and their relation with age in a Turkish
population. Gerodontology 199916119–122.122 [PubMed]
15. Miletic I D, Schiffman S S, Miletic V D. et al Salivary IgA secretion rate in young and elderly persons. Physiol Behav 199660243–248.248 [PubMed]
16. Mattes R D, Cowart B J. Dietary assessment of patients with chemosensory disorders. J Am Diet Assoc 19949450–56.56 [PubMed]
17. Stevens J C, Cain W S, Demarque A. et al On the discrimination of missing ingredients: aging and salt flavour. Appetite 199116129–140.140 [PubMed]
18. Corwin
J, Loury M, Gilbert A N. Workplace, age and sex as mediators of
olfactory function: data from the National Geographic smell survey. J Gerontol Psychol Sci 199550B179–186.186 [PubMed]
19. Miwa T, Furukawa M, Tsukatani T. et al Impact of olfactory impairment on quality of life and disability. Arch Otolaryngol Head Neck Surg 2001127497–503.503 [PubMed]
20. Schiffman S S, Graham B G. Taste and smell perception affect appetite and immunity in the elderly. Eur J Clin Nutr 200054S54–S63.S63 [PubMed]
21. Cowart B J, Young I M, Feldman R S. et al Clinical disorders of smell and taste. Occup Med 199712465–483.483 [PubMed]
22. Schiffman
S S, Warwick Z S. Effect of flavor enhancement of foods for the elderly
on nutritional status: food intake, biochemical indices, and
anthropodometric measures. Physiol Behav 199353395–402.402 [PubMed]
23. Sciffman S S, Miletic I D. Effect of taste and smell on secretion rate of salivary IgA in elderly and young persons. J Nutr Health Aging 19993158–164.164 [PubMed]
MASTOCYTOSIS & MAST CELL ACTIVATION SYNDROME
www.mastocytosis.ca
Med. Advisory Comm: Dr Gary SIBBALD MD(Tor. 74) FRCPC ( Int.Med 78 & Derm 7m9)
Womens' College Hosp.(U.Tor)
Med. Advisory Comm: Dr Gary SIBBALD MD(Tor. 74) FRCPC ( Int.Med 78 & Derm 7m9)
Womens' College Hosp.(U.Tor)
HYGIENE in PHARMACIES
Loose pills`are usually counted on a plastic tray with a spatula. Not washed between dispensing. No gloves worn. Hands not washed.
Safer to buy branded meds in blister packs or sealed containers. Also prevents errors due to similar white pills of many generic meds.In Ontario Pharmacy "assistants" are often allowed to dispense.
Dr.A.Franklin MBBS(Lond.) DPH(Tor.)
Comments invited
Safer to buy branded meds in blister packs or sealed containers. Also prevents errors due to similar white pills of many generic meds.In Ontario Pharmacy "assistants" are often allowed to dispense.
Dr.A.Franklin MBBS(Lond.) DPH(Tor.)
Comments invited
1 Sept 2015
UK DAILY MAIL: NHS to introduce BAR CODES.
The
technology will also help prevent never events - those deemed so serious
they should never happen, including leaving surgical equipment inside a
patient during an operation.
Mr Kelsey will today say the NHS is ready to implement the new plans.
He
will outline a time frame by which every clinical commissioning group
(CCG) must deliver their plans to eradicate the use of paper.
And
he will provide clarity on what is expected, issuing a set of key
digital standards that healthcare providers must implement as part of
their standard NHS contract.
We
need to consign to the dustbin of history the industry in referral
letters, the outdated use of fax machines and the trolleys groaning with
patients' notes. As well as saving precious resources, technology can
dramatically reduce errors
Tim Kelsey, NHS England's national director for patients and information
By
October, all discharge summaries for patients transferring from
hospital to the care of their GP must be completed electronically.
NHS
England said: 'This will help to ensure that a patient's transition out
of hospital is as smooth and safe as possible and enable doctors and
nurses to care for them more effectively straight away.'
Next year, this will be broadened out to include discharge to social care.
Trials
have shown that giving GPs instant access to discharge summaries online
reduces the risk of error, allowing doctors to immediately see what
drugs their patients are on and what procedures they have had while in
hospital.
The
Government estimates the cost of storing and moving paper around the
NHS is between £500,000 to £1 million for each trust - money which they
say could be better invested in more doctors and nurses.
'Every
day, care is held up and patients are kept waiting while an army of
people transport and store huge quantities of paper round our healthcare
system,' Mr Kelsey will say.
'This approach is past its sell by date.
'We
need to consign to the dustbin of history the industry in referral
letters, the outdated use of fax machines and the trolleys groaning with
patients' notes.
'As
well as saving precious resources, technology can dramatically reduce
errors. Urgent action is a moral imperative where paper is the currency
of clinical practice.'
The health service aims to become
paper-free at the point of care within the next five years. It means
when patients turn up at appointments in both primary and secondary
care, medics will have immediate access to their history, clinical notes
and test results
He will add: 'The NHS needs to get over the idea that we've had too many false starts and we can't do technology.
'While
bringing our own systems into the digital age, we must do more to help
the public and clinicians take advantage of the game-changing
opportunities on offer to improve outcomes for patients.'
Last
autumn, the NHS set out its bold vision for the future, outlining the
change needed to bring the health service into the 21st century.
It included a more effective use of technology and data to support new and improved models for delivering patient care.
Health bosses say the evidence for digitalised records improving patient safety is 'clear'.
They
point to the example of electronic prescribing systems, which support
clinicians to ensure the right medication is provided to the right
patient in the right dosage.
Those systems have halved medication errors, yet only 14 per cent of NHS trusts currently use the technology.
In
addition, a study published in the British Medical Journal, found that
death rates at two major hospitals fell by more than 15 per cent when
nurses were given handheld computers to monitor patients' vital signs.
The
drop in mortality represented more than 750 lives saved in a single
year across the two sites, which could equate to tens of thousands of
lives across the NHS.
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