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Introducing a blood conservation coordinator

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HHS blood conservation coordinator Christa Chernesky checks a patient’s blood pressure. Chernesky’s role involves trying to reduce the number of hospital blood transfusions during and after surgery, and conserving donated blood.

Christa Chernesky is on a mission to tell people about her role as Hamilton Health Sciences (HHS)’ blood conservation coordinator.

Just like it sounds, her goal is to try and reduce the number of hospital blood transfusions during and after surgery, and conserve donated blood as a precious resource.

“Staff and patient education is a big part of my focus,” says the registered nurse based at HHS’ West End Clinic/Urgent Care Centre. Her position as the hospital’s blood conservation coordinator is funded through the province’s Ontario Transfusion Coordinators (ONTraC) program.

“It’s really about optimizing the patient’s own blood so that a transfusion isn’t required.”

The program’s goal is to identify patients with anemia (caused by low iron levels) before surgery and treat them with iron supplements so they won’t need a transfusion of donated blood during or after surgery. At HHS, the focus is on cardiac patients who are booked for major planned surgeries. Chernesky is currently working to expand the program to all HHS sites, starting with Juravinski Hospital for certain cancer patients.

“Cardiac and oncology departments are among our largest users of blood products during surgery,” she says.

Preventing anemia to save blood products

Chernesky works with doctors and nurses to identify patients who may be anemic, and offers these patients further testing and the opportunity to take oral iron supplements, or in some cases intravenous infusions, to bolster their iron levels before surgery.

Christa Chernesky, HHS blood conservation coordinator

“It’s really about optimizing the patient’s own blood so that a transfusion isn’t required,” says Chernesky. “This would help reduce blood transfusions and save donated blood for patients who need it most, such as trauma patients arriving at the emergency department.”

HHS is one of 23 Ontario hospitals with a staff member in this role. These hospitals represent about 70 per cent of blood used provincially.

While the ONTraC program has been around for 20 years, it’s not well-known, says Chernesky, who took on the coordinator’s position in June after 14 years of nursing at HHS.

“When I told my colleagues about my new job, many didn’t even realize this position existed,” says Chernesky.  “I’m hoping to change that by promoting the ONTraC program to staff, physicians and patients with the goal of expanding it as a best practice.”

Blood conservation is an evidence-based approach to transfusion medicine, meaning that it’s based on scientific evidence. It’s endorsed by the World Health Organization and represents an international initiative and best practice in promoting bloodless medicine.

“Blood is basically a liquid organ, and while transfusions using donated blood are generally considered safe, there are some risks.”

Chernesky works with other health-care professionals including blood transfusion team members, doctors and nurses to promote alternatives for certain surgical patients. These patients are at higher risk of needing a blood transfusion during or after their operation, mostly because their anemia went undiagnosed or untreated.

What is anemia?

Anemia is a late sign of iron deficiency, and leaves people feeling tired, having heart palpitations and being short of breath. Anemia happens when a person doesn’t have enough red blood cells, which carry oxygen from the lungs to tissues and cells. The body needs oxygen in order to survive, so having anemia increases the risk of needing a blood transfusion during or after surgery.

“In order to protect your brain, heart and organs, you’ll need more oxygen so the surgical team will need to transfuse you if your blood cells aren’t carrying enough to start off with,” says Chernesky, who predicts more cases of anemia as the cost of living and food continues to rise.

Fewer blood donations available

“Blood is basically a liquid organ, and while transfusions using donated blood are generally considered safe, there are some risks,” says Chernesky. “About one in 100 people will have a mild reaction such as a rash or fever. About one in 1,000 will have a more serious reaction that could be life-threatening.”

Reducing the number of transfusions helps manage blood supply shortages, especially with the pandemic when fewer people are donating, says Chernesky, who would eventually like to see an organized screening program in place to test all surgical patients for anemia.

“It would be better for patients, surgical teams and the health-care system too,” she says. “While implementing a screening program would be costly, there are much greater costs involved with blood transfusions including longer hospital stays, greater risk of infection, and increased mortality.”

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Canada to donate up to 200,000 vaccine doses to combat mpox outbreaks in Africa

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The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.

It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.

Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”

Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.

Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.

A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.

On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.

Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”

But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”

“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.

Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.

Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.

Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.

“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.

“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”

This report by The Canadian Press was first published Sept. 13, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

The Canadian Press. All rights reserved.

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How many Nova Scotians are on the doctor wait-list? Number hit 160,000 in June

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HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.

The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.

Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.

“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”

The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.

A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.

Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.

“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.

Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.

The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.

“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.

This report by The Canadian Press was first published Sept. 11, 2024.

The Canadian Press. All rights reserved.

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Newfoundland and Labrador monitoring rise in whooping cough cases: medical officer

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ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.

Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.

Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.

Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.

The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.

“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.

Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.

Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.

Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.

A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.

This report by The Canadian Press was first published Sept. 10, 2024.

The Canadian Press. All rights reserved.

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