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Alberta doctors speak out against AHS review recommendations targeting surgery – CBC.ca

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Some Alberta doctors are pushing back against recommendations in the recently released Alberta Health Services performance review that call for cutbacks and even the removal of government funding for dozens of surgeries.

One section of the $2-million report, conducted by Ernst and Young for the Alberta government, takes aim at a list of 44 surgeries (more than 50,000 cases) defined by the U.K.’s National Health Service as “of limited clinical value.”

The report recommends a targeted reduction could result in $47 million to $100 million in savings.

The review also recommends working to remove these procedures from Alberta’s list of insured services — something the province is now saying won’t happen.

Adult abdominal hernia repairs, which were performed 8,658 times in Alberta in 2018-19, top that list.

Some of the procedures listed as having “limited clinical value” in the AHS Performance Review report conducted for the province by Ernst and Young. (Ernst and Young)

“This section of the report paints a picture that’s not accurate at all,”  said Dr. Parveen Boora, a general surgeon at the Chinook Regional Hospital in Lethbridge.

According to Boora, the NHS recommendations cited in the report — and used to justify targeted cuts — contain the same criteria doctors here in Alberta already use.

Surgeons, he says, are fixing hernias only when it’s medically necessary.

“It doesn’t say not to fix them. It doesn’t say fixing them all is of limited clinical value. It basically says that if they are of a certain subtype or if they are symptomatic or if they have caused complications, they should fix them,” he said.

“And that’s already the criteria we use to decide on fixing hernias.”

The AHS review defines “limited clinical value” as “procedures where the evidence of clinical effectiveness is deemed to be weak or absent. Many times, alternative therapeutic approaches exist that reduce the risk of patient harm and promote more efficient use of OR capacity.”

It goes on to say that detailed clinical reviews “alongside AHS’s clinical experts” are required to adequately assess the appropriateness of the procedures.

Boora says its clear to him that the authors of the report are not doctors and don’t understand Alberta’s medical system.

“They did not go and audit 8,700 charts and determine whether or not it met the NHS’s criteria. They just word matched,” he said.

“People who work in the field of medicine would see something like that and right away they’d be like, ‘you’re not interpreting that right. There’s something wrong here.’ So when you see something like that in a report, it would suggest to me that  there wasn’t somebody there who knew how to interpret the guideline.”

Dr. Sean Gregg, a Red Deer surgeon, says he performed two life-saving abdominal hernia surgeries last week and he believes most, if not all, of the adult abdominal hernia repairs done in Alberta are medically necessary. (Submitted by Dr. Sean Gregg)

‘Life-saving’ surgery

Dr. Sean Gregg, a Red Deer surgeon, has similar concerns.

“I did two hernia surgeries last week. Both of those patients would have died within several days because their bowel was dead. It was stuck in their hernia, How could you ever say that’s not of clinical value?” said Gregg.

“Those lives were saved.”

According to Gregg, most, if not all, of the abdominal hernia surgeries performed in Alberta are medically necessary. 

“I am extremely pessimistic about the ability to translate these recommendations into the kind of numbers that they’re predicting because the low value care that they’re talking about. It just doesn’t exist in real life,” he said, pointing to the report’s suggestion that a targeted reduction of this surgery list could net a savings of up to $100 million.

Gregg believes that while the AHS performance review may contain some important recommendations, it missed the mark when it comes to surgery.

Dr. Fiona Mattatall, a Calgary-based gynecologist, says tubal ligation is mostly used as a form of contraception in women for whom other forms of birth control have failed and also for women who can’t afford other birth control methods. (CBC News)

Tubal ligation

The list also includes female sterilization (tubal ligation), a procedure that was conducted 1,095 times in Alberta last year

“My first response was disbelief. My second was anger,” said Dr. Fiona Mattatall, a Calgary-based gynecologist who was shocked when she read the report.  

“‘Limited clinical value’ would be the opposite of how I would describe this surgery. It’s of significant clinical value both for a woman to be able to control her birth control but also … risk reduction for ovarian cancer.”

According to Mattatall, tubal ligation is done mostly for contraception in women for whom other forms of birth control have failed and also for women who can’t afford other birth control methods.

Tubal ligation is the only funded form of birth control for women in Alberta

“I think it’s important both for reproductive freedom for women but particularly for women of limited socio-economic status,” she said

Mattatall says the criteria recommended by the NHS and cited in the report as a reason for reducing these surgeries are already being used by physicians who perform tubal ligations.

She notes the Alberta health-care system is different.

“What’s different in the NHS  is that under their program, all contraception is paid for by the NHS. So a woman can have an IUD, or birth control pill, condoms, tubal, her partner can have a vasectomy — all at no cost to the patient. Very different here in Alberta.”

No plans to delist

Alberta’s Health Minister, Tyler Shandro, insists the province has no plans to stop funding the surgeries listed in the report.

In a statement emailed to CBC News, Shandro’s press secretary, Steve Buick wrote: ” We’re not de-insuring hernia repairs, mastectomies or any of the procedures listed in the report.”

Buick said the list reflects the NHS’s concerns about inappropriate use or overuse of some procedures in the U.K. and “the AHS review recommends that AHS continue its own work to ensure appropriate care in Alberta, in consultation with clinicians.”

He pointed to work that’s been done for years by AHS and doctors to reduce the use of MRIs, CT scans and anti-psychotic drugs in continuing care as examples.

“Decisions on the appropriateness of surgery for a patient will continue to be made by medical professionals at AHS, not by politicians,” he said.

Health Minister Tyler Shandro says the provincial government has no plans to delist any of the surgeries noted in the AHS performance review report. (CBC)

Opposition not convinced

Despite the minister’s commitment to maintain coverage for the surgeries, NDP Leader Rachel Notley continues to raise questions about the aim of the report.

“I’m very concerned that we’re actually looking at delisting or reducing coverage for any kind of health-care procedure that makes a difference in the lives of Albertans,” she said.

“They’re identifying them as procedures that they need to look at whether they’ll continue to offer,” Notley said. “If they’re not offering them, then presumably people will have to buy them.… I’m not at all comforted by the assurances of the minister.”

The review is now in the hands of AHS officials, who have been given until May 13 to develop an implementation plan.

For his part, Boora says the problems he sees with the report’s recommendations on surgery are making him question the work behind dozens of other recommendations found in the review.

“It does make me then wonder: So what else in this report is being put forward without an understanding of how to interpret recommendations, for example, or how to actually provide health care. That’s … what stood out to me.”

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What’s the greatest holiday gift: lips, hair, skin? Give the gift of great skin this holiday season

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Give the gift of great skin this holiday season

Skinstitut Holiday Gift Kits take the stress out of gifting

Toronto, October 31, 2024 – Beauty gifts are at the top of holiday wish lists this year, and Laser Clinics Canada, a leader in advanced beauty treatments and skincare, is taking the pressure out of seasonal shopping. Today, Laser Clincs Canada announces the arrival of its 2024 Holiday Gift Kits, courtesy of Skinstitut, the exclusive skincare line of Laser Clinics Group.

In time for the busy shopping season, the limited-edition Holiday Gifts Kits are available in Laser Clinics locations in the GTA and Ottawa. Clinics are conveniently located in popular shopping centers, including Hillcrest Mall, Square One, CF Sherway Gardens, Scarborough Town Centre, Rideau Centre, Union Station and CF Markville. These limited-edition Kits are available on a first come, first served basis.

“These kits combine our best-selling products, bundled to address the most relevant skin concerns we’re seeing among our clients,” says Christina Ho, Senior Brand & LAM Manager at Laser Clinics Canada. “With several price points available, the kits offer excellent value and suit a variety of gift-giving needs, from those new to cosmeceuticals to those looking to level up their skincare routine. What’s more, these kits are priced with a savings of up to 33 per cent so gift givers can save during the holiday season.

There are two kits to select from, each designed to address key skin concerns and each with a unique theme — Brightening Basics and Hydration Heroes.

Brightening Basics is a mix of everyday essentials for glowing skin for all skin types. The bundle comes in a sleek pink, reusable case and includes three full-sized products: 200ml gentle cleanser, 50ml Moisture Defence (normal skin) and 30ml1% Hyaluronic Complex Serum. The Brightening Basics kit is available at $129, a saving of 33 per cent.

Hydration Heroes is a mix of hydration essentials and active heroes that cater to a wide variety of clients. A perfect stocking stuffer, this bundle includes four deluxe products: Moisture 15 15 ml Defence for normal skin, 10 ml 1% Hyaluronic Complex Serum, 10 ml Retinol Serum and 50 ml Expert Squalane Cleansing Oil. The kit retails at $59.

In addition to the 2024 Holiday Gifts Kits, gift givers can easily add a Laser Clinic Canada gift card to the mix. Offering flexibility, recipients can choose from a wide range of treatments offered by Laser Clinics Canada, or they can expand their collection of exclusive Skinstitut products.

 

Brightening Basics 2024 Holiday Gift Kit by Skinstitut, available exclusively at Laser Clincs Canada clinics and online at skinstitut.ca.

Hydration Heroes 2024 Holiday Gift Kit by Skinstitut – available exclusively at Laser Clincs Canada clinics and online at skinstitut.ca.

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Here is how to prepare your online accounts for when you die

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LONDON (AP) — Most people have accumulated a pile of data — selfies, emails, videos and more — on their social media and digital accounts over their lifetimes. What happens to it when we die?

It’s wise to draft a will spelling out who inherits your physical assets after you’re gone, but don’t forget to take care of your digital estate too. Friends and family might treasure files and posts you’ve left behind, but they could get lost in digital purgatory after you pass away unless you take some simple steps.

Here’s how you can prepare your digital life for your survivors:

Apple

The iPhone maker lets you nominate a “ legacy contact ” who can access your Apple account’s data after you die. The company says it’s a secure way to give trusted people access to photos, files and messages. To set it up you’ll need an Apple device with a fairly recent operating system — iPhones and iPads need iOS or iPadOS 15.2 and MacBooks needs macOS Monterey 12.1.

For iPhones, go to settings, tap Sign-in & Security and then Legacy Contact. You can name one or more people, and they don’t need an Apple ID or device.

You’ll have to share an access key with your contact. It can be a digital version sent electronically, or you can print a copy or save it as a screenshot or PDF.

Take note that there are some types of files you won’t be able to pass on — including digital rights-protected music, movies and passwords stored in Apple’s password manager. Legacy contacts can only access a deceased user’s account for three years before Apple deletes the account.

Google

Google takes a different approach with its Inactive Account Manager, which allows you to share your data with someone if it notices that you’ve stopped using your account.

When setting it up, you need to decide how long Google should wait — from three to 18 months — before considering your account inactive. Once that time is up, Google can notify up to 10 people.

You can write a message informing them you’ve stopped using the account, and, optionally, include a link to download your data. You can choose what types of data they can access — including emails, photos, calendar entries and YouTube videos.

There’s also an option to automatically delete your account after three months of inactivity, so your contacts will have to download any data before that deadline.

Facebook and Instagram

Some social media platforms can preserve accounts for people who have died so that friends and family can honor their memories.

When users of Facebook or Instagram die, parent company Meta says it can memorialize the account if it gets a “valid request” from a friend or family member. Requests can be submitted through an online form.

The social media company strongly recommends Facebook users add a legacy contact to look after their memorial accounts. Legacy contacts can do things like respond to new friend requests and update pinned posts, but they can’t read private messages or remove or alter previous posts. You can only choose one person, who also has to have a Facebook account.

You can also ask Facebook or Instagram to delete a deceased user’s account if you’re a close family member or an executor. You’ll need to send in documents like a death certificate.

TikTok

The video-sharing platform says that if a user has died, people can submit a request to memorialize the account through the settings menu. Go to the Report a Problem section, then Account and profile, then Manage account, where you can report a deceased user.

Once an account has been memorialized, it will be labeled “Remembering.” No one will be able to log into the account, which prevents anyone from editing the profile or using the account to post new content or send messages.

X

It’s not possible to nominate a legacy contact on Elon Musk’s social media site. But family members or an authorized person can submit a request to deactivate a deceased user’s account.

Passwords

Besides the major online services, you’ll probably have dozens if not hundreds of other digital accounts that your survivors might need to access. You could just write all your login credentials down in a notebook and put it somewhere safe. But making a physical copy presents its own vulnerabilities. What if you lose track of it? What if someone finds it?

Instead, consider a password manager that has an emergency access feature. Password managers are digital vaults that you can use to store all your credentials. Some, like Keeper,Bitwarden and NordPass, allow users to nominate one or more trusted contacts who can access their keys in case of an emergency such as a death.

But there are a few catches: Those contacts also need to use the same password manager and you might have to pay for the service.

___

Is there a tech challenge you need help figuring out? Write to us at onetechtip@ap.org with your questions.

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Pediatric group says doctors should regularly screen kids for reading difficulties

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The Canadian Paediatric Society says doctors should regularly screen children for reading difficulties and dyslexia, calling low literacy a “serious public health concern” that can increase the risk of other problems including anxiety, low self-esteem and behavioural issues, with lifelong consequences.

New guidance issued Wednesday says family doctors, nurses, pediatricians and other medical professionals who care for school-aged kids are in a unique position to help struggling readers access educational and specialty supports, noting that identifying problems early couldhelp kids sooner — when it’s more effective — as well as reveal other possible learning or developmental issues.

The 10 recommendations include regular screening for kids aged four to seven, especially if they belong to groups at higher risk of low literacy, including newcomers to Canada, racialized Canadians and Indigenous Peoples. The society says this can be done in a two-to-three-minute office-based assessment.

Other tips encourage doctors to look for conditions often seen among poor readers such as attention-deficit hyperactivity disorder; to advocate for early literacy training for pediatric and family medicine residents; to liaise with schools on behalf of families seeking help; and to push provincial and territorial education ministries to integrate evidence-based phonics instruction into curriculums, starting in kindergarten.

Dr. Scott McLeod, one of the authors and chair of the society’s mental health and developmental disabilities committee, said a key goal is to catch kids who may be falling through the cracks and to better connect families to resources, including quicker targeted help from schools.

“Collaboration in this area is so key because we need to move away from the silos of: everything educational must exist within the educational portfolio,” McLeod said in an interview from Calgary, where he is a developmental pediatrician at Alberta Children’s Hospital.

“Reading, yes, it’s education, but it’s also health because we know that literacy impacts health. So I think that a statement like this opens the window to say: Yes, parents can come to their health-care provider to get advice, get recommendations, hopefully start a collaboration with school teachers.”

McLeod noted that pediatricians already look for signs of low literacy in young children by way of a commonly used tool known as the Rourke Baby Record, which offers a checklist of key topics, such as nutrition and developmental benchmarks, to cover in a well-child appointment.

But he said questions about reading could be “a standing item” in checkups and he hoped the society’s statement to medical professionals who care for children “enhances their confidence in being a strong advocate for the child” while spurring partnerships with others involved in a child’s life such as teachers and psychologists.

The guidance said pediatricians also play a key role in detecting and monitoring conditions that often coexist with difficulty reading such as attention-deficit hyperactivity disorder, but McLeod noted that getting such specific diagnoses typically involves a referral to a specialist, during which time a child continues to struggle.

He also acknowledged that some schools can be slow to act without a specific diagnosis from a specialist, and even then a child may end up on a wait list for school interventions.

“Evidence-based reading instruction shouldn’t have to wait for some of that access to specialized assessments to occur,” he said.

“My hope is that (by) having an existing statement or document written by the Canadian Paediatric Society … we’re able to skip a few steps or have some of the early interventions present,” he said.

McLeod added that obtaining specific assessments from medical specialists is “definitely beneficial and advantageous” to know where a child is at, “but having that sort of clear, thorough assessment shouldn’t be a barrier to intervention starting.”

McLeod said the society was partly spurred to act by 2022’s “Right to Read Inquiry Report” from the Ontario Human Rights Commission, which made 157 recommendations to address inequities related to reading instruction in that province.

He called the new guidelines “a big reminder” to pediatric providers, family doctors, school teachers and psychologists of the importance of literacy.

“Early identification of reading difficulty can truly change the trajectory of a child’s life.”

This report by The Canadian Press was first published Oct. 23, 2024.

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