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Canadian ICUs brace for COVID-19 resurgence on top of the flu – CBC.ca

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Intensive care physicians and nurses share their concerns as they brace for an influx of patients that threatens to overwhelm hospitals due to the resurgence of the coronavirus and the flu.

When Canadians successfully flattened epidemic curves during the summer, the goal was to prevent hospitals and intensive care units from facing a crush of too many patients with COVID-19 all at once. Health officials wanted to avoid what happened in hospitals in New York City, where refrigerated trailers were used as temporary morgues.

But the recent surge of new coronavirus cases in all provinces beyond Atlantic Canada has already thwarted surgery plans and led to the cancellation of surgeries such as hip replacements at one hospital in Toronto and postponements in Edmonton.

Dr. Bram Rochwerg, an associate professor at McMaster University and critical care lead at the Juravinski Hospital in Hamilton, anticipates a surge of patients with COVID-19, and he worries they won’t be able to accommodate them all as more surgeries resume.

Unlike in the spring, beds and crucial staffing need to be reserved for medical and surgery patients, too. Traditionally, autumn in hospitals means scrambling for health-care workers such as nurses and respiratory therapists to backfill those sick with the cold and flu or who need to stay home to care for sick children.

“We’re all worried about it,” Rochwerg said. “You see the provincial [COVID-19] numbers creep up day by day. We see that critical care numbers [of ICU patients] creep up.”

ICU nurse Patty Tamlin prepares to work with COVID-19 patients in Toronto. Cardiac arrests in hospital are now treated as protected code blues requiring full PPE, which can be fatiguing to wear. (Byron Piedad)

The challenge, Rochwerg said, is to find a balance between adding restrictions to protect vulnerable populations such as residents in long-term care homes while preserving crucial aspects of society.

Lessons learned

Rochwerg also pointed to several lessons physicians worldwide have learned to help take better care of patients critically ill with COVID-19 during the resurgence.

“We should treat them like we would any other patient,” he said. “Sometimes, you just need [to insert] a breathing tube.”

When patients are on a ventilator, it takes the skilled hands of four to six hospital staff, including a respiratory therapist who regularly checks the breathing set up and tubing to ensure the airway is protected, as well as nurses to safely turn or “prone” them onto the stomach to improve ventilation.

WATCH | COVID-19 resurgence raises hospital capacity concerns:

There is growing concern that Ontario hospitals and ICUs, especially in Ottawa and Toronto, may not have enough capacity for COVID-19 patients after weeks of rising infections. 1:55

The importance of getting patients up and out of bed, including those on ventilators when possible, as well as excellent nursing care and other day-to-day supportive care can’t be minimized.

“Supportive care is not the sexy part of it, but it’s so crucial,” Rochwerg said.

It gives patients’ bodies time to heal themselves, he said.

Fear of flood of sick patients

Patty Tamlin, registered nurse working in critical care at a hospital in Toronto’s east end, said she’s also concerned about the coming cold-and-flu season.

“One of the biggest concerns is you may be overrun by patients,” Tamlin said.

A nurse tends to a patient suspected of having COVID-19 in the ICU at North York General Hospital in Toronto in May. It can take up to six staff to safely turn a patient on a ventilator onto their stomach. (Evan Mitsui/CBC)

Her message to Canadians? “Tell everyone to get their flu shot.”

In the spring, the Ontario government created more beds for patients needing long-term ventilated care at a rehabilitation hospital. Even if administrators find more space for more beds, adding temp agency nurses can only go so far, she said.

“It’s going to be a long time,” Tamlin said. “It’s fatiguing … to have this constantly on our head all the time about COVID on top of our regular work.”

Experience, though, has helped ICU staff to prepare for a resurgence of COVID-19 patients.

“The more you do something, the more comfortable you are with going in and out of a room,” for example, to perform CPR during a “protected code blue” for cardiac arrest when wearing full personal protective equipment, which can be exhausting. The masks, gowns and gloves need to be donned and removed carefully to avoid health-care workers contaminating themselves.

Dr. Eddy Fan, medical director of the Extracorporeal Life Support (ECLS) program at Toronto’s University Health Network, said the increase in COVID-19 cases so far is “manageable.”

Extracorporeal membrane oxygenation (ECMO) is like an artificial heart and lung machine to support the sickest patients. People with COVID-19 who were intubated at hospitals across Ontario and didn’t improve with conventional therapy were transported to Toronto General for ECMO. 

Still, Fan said, “We’re going to need to brace ourselves for another potential flood of very sick patients.”

During the spring, patients were transferred to Toronto General, but family members could not visit. Fan said cutting off patients from their relatives harmed morale not only among loved ones, but it pained people working in the hospital, too.

Dr. Eddy Fan is medical director of the Extracorporeal Life Support program and a scientist at Toronto General Hospital Research Institute. Fan said doctors now recognize how similar COVID-19 is to other viral infections, as well as some important differences. (Submitted by Eddie Fan)

But influenza season also typically brings patients with lung failure who may need ECMO.

“Their families ask questions like ‘they’re dying of the flu?'” Fan said. “COVID is no different as a viral infection. We see even young patients come with very severe lung failure requiring ECMO.”

During Toronto’s first wave of COVID-19, the team successfully treated a 22-year-old with ECMO.

While respiratory failure from COVID-19 can resemble that of the flu, doctors say the scale is much larger.

Dr. Gregory Haljan, head of Surrey Memorial Hospital’s critical care department in British Columbia, said influenza has vaccines and medical treatments to shorten symptoms and improve death rates. COVID-19 doesn’t, aside from corticosteroids for severe cases.

When Haljan and his co-authors across the Lower Mainland looked at 117 people with COVID-19 who were admitted to ICU between Feb. 20 and April 17, they found the mortality rateranged from one in six to one in 10.

In comparison, the first studies from China and Italy showed mortality rates as high as one in two or one in three.

A clinician demonstrates how to use a device applied to the finger to monitor oxygen levels over a video conference. Virtual hospitals to keep patients safe at home help prevent hospitals from being overwhelmed by COVID-19 cases. (Women’s College Hospital)

Safety ‘our primary focus’

Haljan credited having time to prepare, Dr. Bonnie Henry’s “outstanding” leadership as the provincial health officer, the support of British Columbians, hard work and luck.

“We never got overwhelmed,” he said.

To prevent being overwhelmed, Haljan said the hospital and its health region focused on basics, including:

  • Engaging patients in the community and long-term care homes through a virtual hospital to keep patients safe at home.
  • Improving communication with centralized repositories of information to avoid mixed messages.
  • Adapting as the science changes.

“It can be a challenge in that things change very, very slowly because safety is our primary focus,” said Haljan, who works at one of the hospitals caring for among the highest volume of patients in the emergency department, according to the Canadian Institute for Health Information.

“Research is how we keep change safe.”

Haljan said that includes research  not only on vaccines and drugs but also measuring patterns and assessing them in areas such as delivering health services.

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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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