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 Canadian
Medical Association Journal
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Highlights of this issue
Respiratory disease prevention in long-term care facilities
Influenza prevention in Alberta facilities
Guidelines for baseline staging in primary breast cancer At diagnosis of breast cancer, all women undergo some staging work-up to rule out distant disease that would preclude conventional therapy. Staging tests are expensive, time consuming and anxiety provoking. Robert Edward Myers and colleagues from the Breast Cancer Disease Site Group of the Cancer Care Ontario Practice Guidelines Initiative have reviewed the evidence and indications for the tests commonly used in Ontario, namely bone scanning, liver ultrasonography and chest radiography. On the basis of their findings, they make recommendations for staging according to the pathological stage of the breast tumour. Hospital closure and coronary revascularization
 Brenda Hemmelgarn and associates tracked the outcomes of patients undergoing coronary artery bypass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA) during the 21 months before and the 24 months after the March 1996 closure of a Calgary hospital and the resultant centralization of coronary revascularization procedures from 2 facilities to a single location. The rate of CABG rose from 51.6 per 100 000 before to 67.3 per 100 000 after the hospital closure; the corresponding PTCA rates were 129.8 and 143.6 per 100 000. The burden of comorbidity was significantly higher after than before the closure. The mean length of hospital stay, after adjustment for comorbidity, was significantly lower after than before the closure for CABG patients (by 1.3 days) and for PTCA patients (by 1.0 days). The adjusted death rates among CABG patients were slightly lower after than before the closure.
Copyright 2001 Canadian Medical Association or its licensors |
Influenza and pneumococcal pneumonia are major causes of morbidity and death among elderly people. Colin Stevenson and associates report the results of serial surveys of vaccination coverage and influenza outbreak management in Canadian long-term care facilities. In 1999, the mean reported rates of influenza vaccination were 83% among residents and 35% among staff, and the mean rate of pneumococcal vaccination among residents was 71%; all 3 rates were higher than those in 1991, but they remain suboptimal. Having an infection control practitioner at the facility and obtaining consent for vaccination on admission to the facility were associated with higher influenza and pneumococcal vaccination rates among residents. Facilities with higher influenza vaccination rates among residents and staff reported lower rates of influenza outbreaks (p = 0.08 and 0.03 respectively). Amantidine prophylaxis was judged effective in controlling 76% of the influenza A outbreaks, but only 50% of the facilities had policies for its use. Given the effectiveness of staff vaccination in controlling outbreaks, commentators Elizabeth Rea and Ross Upshur ask to what extent physicians have an obligation to adopt behaviours to protect their patients.
In a second article on influenza vaccination, Margaret Russell reports results from a 1999 survey of long-term care facilities in Alberta. The mean rates of vaccination among staff and residents were 30% and 91% respectively, and only 85 of 136 responding facilities provided staff vaccination rates. All but 2 facilities reported that staff vaccination was voluntary. Use of a travelling vaccination cart, offering vaccination on night shift, and monitoring and providing feedback on staff vaccination rates — all effective strategies to increase staff vaccination coverage — were infrequently used. Standing orders for resident vaccination were used by only 84 of the facilities. Resident vaccination rates were significantly associated with requirements for consent: 91% with oral consent required, 87% with written consent required and 95% with no written or oral consent required.