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Small group of Ontario family MDs orders too many unnecessary tests, study finds

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A small group of Ontario family doctors is responsible for ordering a disproportionate amount of unnecessary screening tests on patients, new research shows.

A paper published Friday in JAMA Network Open found that 441 primary care physicians in the province order nearly 40 per cent of tests considered “low-value.”

This subset of the province’s 11,448 family doctors demonstrates “a general pattern of overuse,” according to the study by researchers at the Institute for Clinical Evaluative Sciences (ICES) and Women’s College Hospital.

Lead author Dr. Sacha Bhatia said the findings are relevant because they can help better target future efforts to reduce low-value care.

“The reality is that most doctors don’t get a lot of feedback on how they’re doing. But if we know who needs this the most, we can make big strides to improve the care patients get and save much needed health-care dollars in the process,” he said.

Researchers looked at the ordering rates of four low-value screening tests between 2012 and 2016. They correctly hypothesized that physicians who frequently order one of these tests are more likely to frequently order at least one of the others as well.

The four tests studied are:

  • Repeat bone density tests, formally known as dual-energy X-ray absorptiometry (DXA) scans. This kind of screening is done to look for conditions such as osteoporosis. Evidence shows there is little value in having more than one of these scans within a two-year period.
  • Electrocardiograms (ECGs) for patients 40 and older who are considered at low risk of cardiovascular disease.
  • Chest X-rays for patients at low risk for cardiopulmonary disease.
  • Pap tests on women younger than 21 and older than 69, a demographic considered at low risk for cervical cancer.

These four tests were studied because of an abundance of evidence showing they are overused and that there is much variation in how often doctors order them.

They have been identified as low-value by Choosing Wisely Canada, which is part of an international clinician-led campaign, running in 20 countries, aimed at reducing the frequency of low-value care.

Bhatia, a cardiologist, is the evaluation lead for Choosing Wisely Canada. He is the director of the Women’s College Hospital Institute for Health System Solutions and Virtual Care. Bhatia is also an adjunct scientist with ICES

He explained that low-value tests are not particularly helpful in diagnosing or treating disease. They also include tests for which the harms of undertaking them outweigh the benefits. For example, patients may be unnecessarily exposed to radiation.

Bhatia noted that it costs only about $5 to do one ECG. But the concern, he said, is that unnecessary ECGs are being done in large numbers and can result in patients getting even more tests they may not need. This is because screening tests can cause false positive results that require some further testing to rule out real disease. But this additional testing may be more invasive and expensive.

A report released last year by the Canadian Institute for Health Information and Choosing Wisely revealed that Canadians have more than 1 million potentially unnecessary tests, treatments and procedures annually.

The report found that 30 per cent of selected tests, treatments and procedures are potentially unnecessary. They waste health system resources, increase wait times for patients in need and can lead to patient harm.

The JAMA study was a retrospective one, which saw researchers pore over data on health-care claims held by ICES.

They identified 2,394 Ontario family doctors who see the most patients and order the most tests.

Researchers found that 18.4 per cent of this group — or 441 doctors — orders 39.2 per cent of all of the low-value tests.

“When you look at the overall trends on how doctors order these tests, most actually practise reasonably well. But for the minority who order these tests unnecessarily — the one in five — we can see clearly where there is a big opportunity for change,” Bhatia said.

Doctors with increased odds of frequently ordering low-value tests are male, further removed from medical school graduation (meaning they are older), and receive much of their income by billing OHIP on a fee-for-service basis. They are also more likely to be graduates of Canadian medical schools.

Theresa Boyle is a Toronto-based reporter covering health. Follow her on Twitter: @theresaboyle



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Political dynasties at stake as B.C. voters cast ballots in municipal elections

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Some political dynasties are at stake in Metro Vancouver as municipal elections take place across British Columbia today — the country’s first municipal elections of the year.

CBC News will have full coverage throughout the day, including local radio specials in the evening starting when polls close at 8 p.m. PT, as well as live coverage on Facebook and extensive resources on our website. 

This is the first province-wide municipal vote since new campaign finance rules that limit corporate and union donations were implemented last fall. 

It’s also an election that will see big change in some Metro Vancouver cities, where more than a dozen long-term mayors are not seeking re-election.

But even in cities where incumbents remain, there is potential for major change as residents struggle with rapid growth, a housing crisis, ongoing gang conflict and transportation woes. 

(Tina Lovgreen/CBC)

Change coming for Vancouver

Vancouver Mayor Gregor Robertson was one of the first to announce he would no longer be in the seat he has held for a decade.

Robertson says he has no regrets as he leaves behind a prosperous city with an extensive cycling network. He also passes along a housing crisis, which affects municipalities across the province, that has been a big issue in the election.  

Robertson’s municipal party, Vision Vancouver, chose not to run a mayoral candidate after the one they had chosen, Ian Campbell, stepped down four days before nominations closed.

Unlike most large cities in Canada, Vancouver doesn’t have a ward system. Instead, politicians form parties that run candidates on council, the school board and park board. Montreal also has municipal political parties.

From left to right: Wai Young, Shauna Sylvester, Kennedy Stewart, Ken Sim and Hector Bremner are some of the mayoral candidates running in Vancouver.

The vacuum left behind after Robertson’s decision not to run ushered in a flood of candidates aligned with nine civic political parties, some of them splinter groups from more established parties, and several candidates running as independents. 

There are 158 candidates on the city’s long ballot — 21 of them vying for top spot. 

Long-term incumbents at risk in Surrey, Burnaby

In Surrey, the region’s second most populated city, Mayor Linda Hepner is also stepping down.

Her party, Surrey First, has been in power for a decade with a stronghold that currently includes all seats on council.

There are eight people running to replace her. Tom Gill is running as Surrey First’s mayoral candidate. Bruce Hayne was with the party but has formed his own, Integrity Now.

And former mayor Doug McCallum has stepped back into the limelight 13 years after he was last in office. 

Candidates for mayor of Surrey are, from top left to bottom right: Pauline Greaves, John Wolanski, Rajesh Jayaprakash, Imtiaz Popat, Doug McCallum, Franç​ois Nantel, Bruce Hayne and Tom Gill. (City of Surrey)

Some of the main issues in Surrey include concerns about an ongoing gang war and whether the city should form its own police force (it’s currently serviced by the RCMP). 

Candidates and voters are also divided over a planned $1.65 billion light rail transit system, with some keen to replace it with the faster SkyTrain system already implemented in parts of Metro Vancouver.

In Burnaby, the epicentre of the country’s battle for and against the Trans Mountain Pipeline, former firefighter Mike Hurley is challenging incumbent mayor Derek Corrigan and his party the Burnaby Citizens Association.

Corrigan has served council for 31 years. He is a staunch opponent to the pipeline. But many have criticized him for « demovictions » that have razed affordable rental homes in favour of new, higher-priced condominiums. 

Hurley, a political novice, is campaigning on a promise of revisiting how the city manages growth.

Victoria and Vancouver Island

In the provincial capital, it’s shaping up to be a three-way contest for the mayor’s chair between incumbent Lisa Helps and two challengers without previous electoral experience: business consultant Stephen Hammond and political consultant Mike Geoghegan.

In 2014, Helps unseated the last mayor, Dean Fortin, by only 89 votes

Victoria has shed its sleepy reputation as home to « newlyweds and nearly deads » and ushered in a more urban, modern vibe.

But the rising popularity of the city has seen skyrocketing rents, pushing housing and affordability to the top of the agenda. How people get around a busier city is also shaping up to be a ballot box issue.

Affordability is a major issue across Vancouver Island, with tent cities popping up throughout the region. 

Okanagan and the Southern Interior

The Okanagan is B.C. ‘s traditional and reliable conservative heartland.

It is changing, however. This election, the municipal campaign in Kelowna is a battle over the city’s identity. And the two men leading the race personify the possibilities.

Colin Basran’s tenure as mayor has been marked by growth and development, but urban problems like homelessness and crime have followed that success.

Kelowna mayoral candidates, from left, Bobby Kennedy, Colin Basran, Bob Schewe and Tom Dyas debated leadership, inclusiveness and the issue of homelessness in an election forum hosted by CBC Kelowna and UBC Okanagan. (Brady Strachan/CBC)

Enter Tom Dyas, promising a return to the Okanagan’s more conservative roots — he’s a no-nonsense, tax-cutting, small businessman reminiscent of the valley’s Socred past.

Meanwhile in Penticton and Vernon, the growing homeless population and each city’s response has dominated the discussion.

In smaller communities, where there are few condos and little foreign investment, the election has been fought on the traditional questions of transparency, taxes and accountability.  



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One dead in Kennedy subway station stabbing

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A man is dead after being stabbed in Kennedy subway station Saturday night, Toronto police say.

Toronto paramedics responded to reports of a stabbing inside Kennedy subway station in Scarborough at around 5:15 p.m. When paramedics arrived, they found one man had been seriously injured.

Toronto police say a fight broke out between two men inside the station, with one man receiving stab wounds.

The victim, a 25-year-old man, was taken to hospital where he was pronounced dead, according to Toronto paramedics.

Police have arrested one male suspect in the parking lot of Kennedy station. The subway is closed at Kennedy station so the homicide unit can continue their investigation.

Shuttle buses are operating both ways between Warden subway station and Scarborough Centre and picking up and dropping off passengers at Kennedy station.

Marjan Asadullah is a breaking news reporter, working out of the Star’s radio room in Toronto. Follow her on Twitter: @marjanasadullah



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Manitoba burn survivors share struggles, hope at annual conference – Winnipeg

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It was the first time 18-year-old Dawson Blahey from Arborg, Man., shared his life-changing story with a large group.

Blahey suffered third-degree burns to his face, legs, chest and feet after a campfire explosion when he was just four years old.

“My dad was pouring fuel, and it was humid out and it blew up,” Blahey said.

But the large group to whom Blahey spoke on Saturday is one that can understand what he has been through.

Dawson Blahey suffered third-degree burns on his body when he was just four years old.

They are members of the Mamingwey Burn Survivor Society, which gathers for an annual conference every year. The society hears from doctors and other health professionals about ways to cope with their injuries, and they also get a chance to share their stories with others in the same boat.

RELATED: Volunteers rally to help family of worker burned in grain elevator fire

“There’s a bond when you can talk to someone else who went through a similar experience,” Mamingwey chair Barbara-Anne Hodge said.

“When you’re burned, there’s physical pain, permanent scars, and to meet with others who have walked that path is very powerful.”

Mamingwey is an Ojibway term meaning “butterfly.”

“A butterfly starts as a caterpillar and emerges out of the cocoon. We apply that to our burn survivors, and the white bandages are the cocoon,” Hodge said.

Blair Lundie came out of those bandages three years ago after he was burned in a high-voltage explosion.

“A panel fell over on a high-voltage system, and the panel arced like a lightning bolt, and I turned away just in time to block the impact,” Lundie said.

Blair Lundie was burned in a high-voltage explosion.

RELATED: Crash in North Dakota covers Manitoba man in hot tar

While he still struggles to deal with his new reality, groups like Mamingwey are a huge help for him.

“They are my support because I can talk amongst them, and they understand what I’m feeling on an everyday basis,” Lundie said.

For Blahey, breaking out of his cocoon for the first time is an experience he doesn’t regret.

“Don’t be scared to talk about it,” said Blahey. “Talking about it is the best thing you can do,”

WATCH: Edmonton-area teen returns from unique camp for burn victims






© 2018 Global News, a division of Corus Entertainment Inc.



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