Tag Archives: guideline

Scott Moir refutes online allegations of breaking quarantine guideline

Scott Moir says he is in Florida during the pandemic to support his fiancee, and not because he’s on “vacation.”

Moir, 32, took to social media on Thursday because he felt he need to defend the couple from online attacks.

The Canadian figure skater posted a video on Instagram and Twitter on Thursday, explaining that he and fiancee Jackie Mascarin are in Tampa, Fla., because Mascarin works as a physician’s assistant in the respiratory unit of a local hospital.

Moir, of London, Ont., also said the pair were planning to return to their home in Ilderton, Ont., next week, though not via plane.

“The people who are stepping foot in the hospital, front-line workers, first responders, they’re heroes in a time like this and they’re putting their families at risk for the good of the society,” Moir said. “And I feel like as a life partner I should stay here in Tampa and support [Mascarin].”

Moir appears to have posted the video over claims he went to a resort outside of Canada in mid-March, after quarantine guidelines intended to help stop the spread of COVID-19 were put into place.

Moir was supposed to participate in the opening act of the figure skating world championships in Montreal, one of the first major events cancelled over concerns about coronavirus. The event was scheduled to begin Mar. 16.

“There’s people saying that I’ve been back and forth and that I went on vacation after worlds and fact of the matter is we’re in Tampa and we have been in Tampa and we’re in isolation and we’re following the guidelines,” Moir said.

Some others are now claiming it is irresponsible for him to return to Canada, citing those same guidelines and saying he could put others at risk by travelling across borders.

In the video, Moir said he and Mascarin would have “an incredible quarantine action plan” upon their return to Ontario.

“We are Canadians and we wanna help and that’s the whole reason Jackie wanted to be a physician’s assistant — she wanted to help people in need — so we decided that we would stay down here for a couple months and now that that’s done we’re headed home next week.”

Moir won five Olympic medals, including ice dance gold in 2010 and 2018, alongside long-time figure skating partner Tessa Virtue. Virtue has remained in Canada throughout the pandemic alongside boyfriend and Toronto Maple Leafs defenceman Morgan Rielly in Vancouver.

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Family doctors should begin screening patients for alcohol addiction at age 12, B.C. guideline says

Family doctors in British Columbia are being urged to annually screen every patient starting at age 12, in a move to prevent alcohol addiction, a leading cause of social and economic harms.

The guideline developed by the BC Centre on Substance Use and endorsed by the province encourages primary-care doctors to provide treatment and ongoing care themselves unless a complicated addiction has taken hold.

Dr. Keith Ahamad, an addiction specialist at St. Paul’s Hospital who helped write the guideline, said most alcohol-related issues including withdrawal management can be treated by family physicians but patients needing help are often not identified or treated.

“We’re not saying, ‘Oh, I think you have an alcohol addiction. Here’s a piece of paper, call this number,”’ Ahamad said in a recent interview.

“By putting the responsibility on the person with the health issue, you’re waiting for people to get really, really sick and then we’re forced to treat the downstream consequences of addiction, which for alcohol include liver disease, heart disease, various brain disorders and a whole host of cancers, not to mention the criminal justice and social fallout of alcohol addiction.”

Dr. Keith Ahamad, back left, an addiction medicine physician at St. Paul’s Hospital and a researcher a the B.C. Centre on Substance Use, is pictured while working at a new Overdose Emergency Response Centre opened by the provincial government at Vancouver General Hospital on Dec. 1, 2017. (Darryl Dyck/Canadian Press)

There were 17,000 alcohol-related deaths across Canada in 2017, up by 2,000 fatalities from three years earlier, according to the Canadian Institute for Substance Use Research at the University of Victoria.

Ahamad said B.C.’s guideline, announced Wednesday, is the first in the country. It provides family doctors with a screening tool and urges them to provide ongoing support for patients with chronic alcohol use, as well as offering physicians online training.

It recommends prescribing under-used medications to curb cravings instead of potentially addictive drugs, such as Valium.

Family doctors are also advised to educate patients about Canada’s low-risk drinking guidelines, which recommend no more than 10 drinks a week for women, limited to two drinks per day, and up to 15 drinks a week for men, not exceeding three drinks a day.

By putting the responsibility on the person with the health issue you’re waiting for people to get really, really sick.– Dr. Keith Ahamad, addiction specialist at St. Paul’s Hospital

Judy Darcy, B.C.’s mental health and addictions minister, said the “groundbreaking” guideline was necessary to curb the effects of high-risk drinking, including lost jobs and family crises.

She said 20 per cent of people in B.C. over age 12 are classified as heavy drinkers, which highlights the need for early intervention.

“That’s huge, and it really means we need to start early,” Darcy said.

B.C. Minister of Mental Health and Addictions Judy Darcy described new guidelines for screening for alcohol addiction as ‘groundbreaking.’ (Darly Dyck/Canadian Press)

New guideline might push users to ask for help

Russell Purdy, 33, began drinking at 16 and excessively a year later when he became a junior hockey player.

“At 23 years old is when I started to notice that every time I was out drinking, I would only remember a portion of the night and everything would be in a blackout until I woke up the next morning,” Purdy said.

He also started using cocaine and got involved in “illegal activities” to fund his habit and his mortgage, but lost his relationship because of denial about his addiction.

Russell Purdy, 33, suffered from addictions for years before going into treatment. (Darryl Dyck/Canadian Press)

His family doctor from childhood to his mid-20s, when the doctor retired, never asked whether he was using alcohol or drugs.

“That’s the thing I always find so odd when I look back at my story. We never talked about my drinking or drug use. We’d had conversations about everything else, even sexual activity, but we never once had a conversation about was I drinking? If I was drinking, how much I was drinking, was I using drugs?”

It was only when Purdy saw his doctor for damage and infections caused by snorting cocaine that he was asked any questions. By then, his addiction was so entrenched that he minimized his use of drugs and alcohol, he said.

“If somebody would have asked the questions earlier and could have been proactive rather than reactive to my situation I could have been saved from a lot of poor decisions and a lot of things in my life that I feel regret about but I’ll have to live with.”

The new guideline in B.C. “might spur the idea in somebody’s mind to start getting some help,” he said.

We’d had conversations about everything else … but we never once had a conversation about was I drinking? If I was drinking, how much I was drinking, was I using drugs?​​​​– Russell Purdy

After Purdy walked out of a family Christmas event in 2017, his family paid for 51 days of residential treatment before he spent five months at a recovery house in Surrey, B.C., where he now works as a program manager.

Dr. Rupi Brar, an addiction specialist, said more community services in languages other than English are needed for people who often end up suffering in silence, especially because of the stigma of addiction.

The Roshni Clinic in Surrey offers treatment in Punjabi and Hindi, but Brar said it’s the only such facility in one of the largest South Asian communities in the country.

“Unfortunately, we are seeing far more South Asian men in their 20s and 30s who are coming to hospital with end-stage liver disease,” said Brar, who has worked at Roshni.

“What you see is more binge drinking in the first-generation Canadians and when you take the history you hear that they had uncles, fathers, other men in their families who had what they would have described as alcohol-use disorders themselves.”

A bartender pours a craft beer at a pub in Fredericton, N.B., on June 16, 2017. (Stephen MacGillivray/Canadian Press)

Brar said that just like in any other community, educating patients about the genetic and biological aspect of addiction, similar to conditions such as diabetes and high blood pressure, should be part of the process of removing barriers to treatment.

“Slowly that tide is turning and there’s that change and accepting that this is not their fault, it’s a medical condition and there’s treatment for it,” said Brar.

“A lot of trauma associated with substance use can be tied to family trauma and success can be tied to family support, keeping in mind that families themselves need support.

“Family counselling in the context of treatment of substance use disorders is a key component that I don’t think we do a great job of in the system right now.”

Tim Stockwell, director of the Canadian Institute for Substance Use Research, said alcohol has overtaken tobacco in its cost to the economy, at $ 14.6 billion in 2014.

“It’s way ahead of opioids and all the illicit drugs put together, and in terms of the economic costs, alcohol has crossed over as the leading cause of health and economic costs,” he said.

Beer is pictured on the shelves of a liquor store in Vancouver on July 12. The director of the Canadian Institute for Substance Use Research said alcohol has overtaken tobacco in its cost to the economy, putting it at $ 14.6 billion in 2014. (Ben Nelms/CBC)

Dr. Leslie Buckley, chief of addictions for the Centre for Addiction and Mental Health, said she is especially concerned about excessive drinking by young women, who historically drank less than men, but are now likely to drink equal amounts.

“It’s what some people call the pinking of the alcohol industry and the focused marketing on women, whether it be brand names or logos that might be particularly appealing to women.”

A study published in the Canadian Medical Association Journal in July showed that between 2013 and 2016, alcohol-related visits to emergency departments in Ontario jumped by 240 per cent for women 24 to 29 years old.

The Canadian Institute for Health Information said earlier this year that 26 per cent of hospital stays among youth involved alcohol between April 2017 and March 2018.

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Colorectal cancer screening may not be best for all, new guideline says

Routinely screening everyone aged 50 to 79 for colorectal cancer may not be the best approach, a panel of Canadian and international experts say.

Colorectal cancer is the most commonly diagnosed cancer in Canada affecting about 25,000 a year. It is the second leading cause of cancer death in Canada in men, and the third leading cause of death in women.

Currently, Canadian gastroenterology guidelines call for screening to begin at age 50 for those without a diagnosed parent, child or sibling. 

Dr. Gordon Guyatt, professor of medicine at McMaster University in Hamilton, chaired a panel to review the latest evidence on screening to reduce the risk of developing or dying of colorectal cancer by removing precancerous growths called polyps.

Most guidelines recommend starting screening at age 50. At that point, the risk of developing colorectal cancer over the next 15 years is about one to two per cent.

“We ended up suggesting … if your risk is over three per cent, perhaps not a bad idea to go through screening,” Guyatt said. “If it’s under three per cent then for you the benefits might not be worth the harms and burdens.”

As a result, the new guideline says those at lower than average risk may favour holding off on screening. 

Individualized approach

In Wednesday’s issue of BMJ, the panel suggested individuals turn to an online calculator called Magicapp. Users can plug in their age, sex, family history of colorectal cancer, body mass index, smoking status, ethnicity and other information to estimate your risk of developing colorectal cancer in the next 15 years.

Dr. Linda Rabeneck, vice president of prevention and cancer control at Cancer Care Ontario, said the panel called for a more individualized approach to colorectal screening to help people make an informed decision.

“It’s fair to say that’s not what we’re doing today in colorectal cancer screening in general not just in Canada but beyond if you look in Europe and so forth,” Rabeneck said.

The gastroenterologist said everyone over 50 is invited to screening. Then the interval between screens stays the same even though the risk increases with age.

But the cancer field is moving away from taking a blanket approach to the whole population and refining it to consider an individual’s risk.

“On balance I think that this is something we need to think hard about,” she said.

Dr. Desmond Leddin, an adjunct professor in gastroenterology at Dalhousie University in Halifax, said he would not change current practice based on the new guideline. He has another priority.

“All Canadians should have access to a family doctor since in our system they are gatekeepers to care,” Leddin said in an email.

“I agree with the authors that the risks and benefits of screening should be weighed up and that is best done in a conversation with a family doctor. Many people do not have a family doctor and some provinces send the screening test directly to the patient.”

‘Seismic shift’

The researchers had gold-standard randomized control trial data on tens of thousands to compare sigmoidoscopy, a scope of the lower part of the colon, to no screening to draw on for their review.

But for newer screening with an at-home fecal test called fecal immunochemical test (FIT) and colonoscopy of the entire organ, the trials aren’t yet complete. Instead, the authors used models filled with assumptions, Rabeneck said.

A journal editorial published with the study called the move away from organized screening and towards informed choice a “seismic shift.”

Philippe Autier at the International Prevention Research Institute in Lyon, France, wrote that the objective of public health policies is to persuade people to attend screening and to maximize uptake. Screening messages tend to overstate benefits and downplay potential consequences.

In contrast, the individualized approach “is increasingly regarded as the most appropriate way to discuss cancer screening,” Autier said.

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Research lacking on medical marijuana, new prescription guideline suggests

A new guideline for medical marijuana, developed by Edmonton researchers, warns family doctors that the risks may outweigh the benefits for the vast majority of patients.

The guideline, published Thursday in the Canadian Family Physician journal, suggests the benefits of medical cannabis may be overstated, and research on it’s medicinal properties is sorely lacking.

Canadian doctors should think twice before prescribing the drug, said Dr. Mike Allan, who led the research team.

“While enthusiasm for medical marijuana is very strong among some people, good quality research has not caught up,” Allan, the director of evidence-based medicine at the University of Alberta, said in a statement.

The guideline was based on a review of clinical trials involving medical cannabis.

The document will be distributed to 30,000 physicians across Canada, and is intended as a new protocol for doctors to use when deciding whether or not to prescribe marijuana.

‘In general we’re talking about one study, and often very poorly done.’– Dr. Mike Allan

Thousands of Canadians are already prescribed medical marijuana, and that number is expected to rise after marijuana is legalized this summer.

Family doctors face increasing pressure from patients asking for medicinal pot. But the study authors suggest there is little data for physicians to rely on before making that decision.

Guideline authors found that, in most cases, the number of randomized studies involving medical cannabis was extremely small.

In the rare instances where research did exist, the studies were narrow in scope or poorly executed, said Allan.

“In general, we’re talking about one study, and often very poorly done,” Allan said in a statement.

“For example, there are no studies for the treatment of depression.” 

There was also only one study on anxiety and it was unscientific, said Allan. In that trial, half of the 24 patients involved received a single dose of cannabis derivative and scored their anxiety doing a simulated presentation.

“This is hardly adequate to determine if lifelong treatment of conditions like general anxiety disorders is reasonable,” said Allan.

Proven treatments

Researchers concluded there is adequate evidence for the use of medical cannabinoids to treat a handful of specific medical conditions, including nerve pain, palliative cancer pain, muscle tightness associated with multiple sclerosis or spinal cord injury, and nausea from chemotherapy.

Even in those specific cases, the benefits were found to be generally minor, said Allan.

“Medical cannabinoids should normally only be considered in the small handful of conditions with adequate evidence, and only after a patient has tried a number of standard therapies,” Allan said in a statement.

“Given the inconsistent nature of medical marijuana dosing and possible risks of smoking, we also recommend that pharmaceutical cannabinoids be tried first before smoked medical marijuana.”

While the researchers found limited evidence supporting the use of medical cannabinoids, the side-effects were common and consistent. Common side effects included sedation, dizziness and confusion.

‘Better research is definitely needed’

Allan acknowledged the guideline may prove controversial, since the debate over medical marijuana is divisive.  

“This guideline may be unsatisfactory for some, particularly those with polarized views regarding medical cannabinoids,” Allan said.

“Better research is definitely needed — randomized control trials that follow a large number of patients for longer periods of time. If we had that, it could change how we approach this issue and help guide our recommendations.”

The research was overseen by a committee of 10 medical professionals, including doctors, pharmacists, nurses and patients, and was peer-reviewed by 40 others.

Medical colleges have released some general guidelines for primary-care providers and have cautioned physicians against prescribing marijuana.

A trio of advisories prepared by the Alberta College of Family Physicians in 2017 summarized the scientific literature, or lack thereof, that dealt with medicinal marijuana.

Documents released by the colleges of physicians and surgeons in both British Columbia and Alberta cite the absence of reliable evidence to demonstrate the effectiveness of cannabis as medication.

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