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Background: Health care systems contribute significantly to greenhouse gas emissions. One source of these emissions is single-use products. Examination table paper does not confer protection against microbial contamination and thus can be omitted while following infection control standards. The objective is to eliminate the routine use of examination table paper in outpatient oncology clinics at BC Cancer. Methods: A quality improvement approach was used. Examination tables continued to be disinfected using wipes between patients, but table paper was not used. Plan-do-studyact cycles were performed at four regional cancer centres. Results: Pre-intervention, the cancer centres used 19 to 69 rolls of paper monthly. Postintervention, usage declined to 0 to 2 rolls monthly. This was associated with annual cost savings of $3974 and a reduction of 32 501 kg of carbon dioxide emissions. Conclusions: The use of examination table paper can be eliminated in outpatient clinics, resulting in both cost savings and a reduction in carbon dioxide emissions. [ABSTRACT FROM AUTHOR]

Background: The Interior Health Authority Physician Quality Improvement initiative implemented a dyadic leadership model in 2018. The model pairs medical and operational partners to foster a culture of learning, trust, and shared vision. Successful dyadic partnerships facilitate alignment of core values, develop collaborative relationships, demonstrate transparent communication, value complementary competencies, and model mutual respect. Methods: The rapid review methodology and survey design are published in a white paper titled "Dyadic Leadership Model--Why It Works." This article discusses the dyadic leadership factors supported through the rapid review and survey. Participant impact statements from the survey results support the discussion. Conclusions: The dyadic leadership model has become the expectation of new participants in the Interior Health Authority Physician Quality Improvement program. Feedback from cohort alumni has expressed the strength of the dyadic partnership. This model has become a core component of the program, as it provides valuable links between medical and operational partners. [ABSTRACT FROM AUTHOR]

The article focuses on the policy paper "Looking Beyond the Numbers: Planning British Columbia's Physician's Workforce," released by the British Columbia Medical Association (BCMA). It emphasizes the need for better coordination in physician workforce planning. It cites the stakeholders influencing physician resource planning, including the provincial government, health authorities and universities. The recommendations given by the paper include the establishment of a provincial committee.

The article deals with the policy paper submitted by the British Columbia Medical Association (BCMA) to the government which includes recommendations for addressing the challenges facing the British Columbia health care system.

This article focuses on a report from the C. D. Howe Institute in Canada which supports the use of capitation payments versus fee-for-service for primary care physicians.

For physicians, dissatisfaction with electronic medical records often stems from being overwhelmed by redundant data entry tasks, while for patients dissatisfaction can result from being unable to access their data. The collaborative health record is a way to improve communication and engagement between patients and their health care teams while recognizing that health concerns do not always arise during regular office hours. During conversion of records from paper to electronic formats over the past 2 decades, quantity rather than quality was emphasized, and physicians were given incentives to move quickly from paper workflows in hard copy form to paper workflows in digital form. This has resulted in "systems of record" rather than "systems of engagement," which need to be improved by involving the patient, the physician, and other health care team members in meaningful interactions. Such a collaborative system can allow for patient engagement, integration of patientreported outcome measures, and asynchronous communication. By ensuring that physicians have the best tools, health care may see the same remarkable returns on investment that digitalization has afforded other industries. [ABSTRACT FROM AUTHOR]

A BC family physician found that moving from paper to electronic records was a slow and sometimes frustrating process, but one that eventually made office staff happier and led to better patient care. Along the way the physician learned many lessons, including the importance of adding appropriate clinical content to the records system. Today the Health Data Coalition is making good use of this kind of valuable information. With a platform that gives users access to a robust source of medical information while protecting patient and physician privacy, this new data-sharing initiative is expected to improve patient outcomes, physician experiences, and the costeffectiveness of health care delivery. [ABSTRACT FROM AUTHOR]

Background: Surgical complications after liver transplantation are known to contribute to morbidity and mortality. Evaluation of complication rates is a crucial part of assessing transplant program performance and identifying areas for improvement. A study was proposed to determine complication rates and outcomes using BC Transplant data. Methods: Patients undergoing deceased-donor liver transplantation from 2007 to 2011 were identified via the prospectively and independently managed BC Transplant database. Both paper and electronic records were reviewed for 191 patients who underwent 201 individual transplant procedures. The records included operative reports, radiology studies, outpatient clinic notes, and all available follow-up information obtained at Vancouver General Hospital until 31 August 2014. Rates of surgical complications and mortality were calculated and compared with published rates from other centres. Results: The retrospective review of records revealed an in-hospital mortality rate of 5.2% and a 1-year mortality rate of 8.4%. Complications occurred in 107 of 201 transplants. Half of all patients (53.2%) experienced a reoperative, biliary, or vascular complication. The most common complications were a planned or unplanned reoperation (32.3%), a bile leak (9.0%) or anastamotic stricture (16.9%), and hepatic artery thrombosis (7.5%). Conclusions: Rates for 1-year inhospital mortality, biliary complications, and hepatic and portal vein thrombosis in deceased-donor liver transplantation in BC were similar to rates found in the literature. Rates for hepatic artery thrombosis appeared higher than those reported in the literature and further investigation is needed to identify factors that may be contributing to this complication in transplant recipients. [ABSTRACT FROM AUTHOR]

Background: Family physicians with enhanced surgical skills/obstetric surgical skills contribute significantly to surgical care delivery in rural British Columbia. This environmental scan documents their practice locations and procedural scope. Methods: Practice locations of enhanced surgical skills physicians/obstetric surgical skills physicians were identified using public data and professional networks. These data were collected between January 2022 and April 2023. Numbers of surgical procedures performed were determined using MSP billing data for fiscal year 2021-2022. Results: Overall, 11 enhanced surgical skills physicians and 21 obstetric surgical skills physicians were practising in 17 of the 45 rural communities. Five communities had enhanced surgical skills physicians/obstetric surgical skills physicians as the sole surgical providers. Common procedures billed by these physicians included colonoscopies (n = 559), C-sections (n = 404), and inguinal/femoral hernia repairs (n = 52). Conclusions: A number of family physicians provide core surgical services in rural BC, sometimes as the only surgical providers at their hospital. Despite the limitations of the data collected, due mostly to a high turnover of surgical providers in rural sites, our study shows that enhanced surgical skills physicians and obstetric surgical skills physicians are integral to the well-being of rural patients and the health care systems they access. Concerted efforts should be made to recruit and retain these key surgical providers in our province. [ABSTRACT FROM AUTHOR]

Dr. Ahmer A. Karimuddin, a colorectal surgeon at St. Paul's Hospital, has been elected as the new president of Doctors of BC. He has extensive experience in the medical field and has held various roles within Doctors of BC. Dr. Karimuddin aims to address the challenges faced by physicians in the post-pandemic world and inspire positive change in the healthcare system. He believes that by focusing on individual patient care and acknowledging their frustrations, improvements can be made. The text also emphasizes the importance of balance in physicians' lives and the role of the Specialist Services Committee in improving healthcare. Additionally, it highlights the need for diversity, equity, and inclusion in healthcare and the importance of involving physicians in decision-making processes. [Extracted from the article]

The author reflects on the challenges and accomplishments in the medical sector in British Columbia in 2011 and offers an outlook for 2012. He mentions the negotiation in 2011 to renew the Physician Master Agreement. He cites the release of the policy papers "Enhancing Surgical Care in BC: Improving Perioperative Quality, Efficiency, and Access" and "Planning British Columbia's Physician Workforce." He anticipates new programs for physicians, patients and the health care system.

The article focuses on the policy paper "Enhancing Surgical Care in BC: Improving Perioperative Quality, Efficiency and Access," released by the Council on Health and Economic Policy (CHEP) of the British Columbia Medical Association (BCMA). It cites the topics covered by the paper such as preoperative preparation of the patient, operating room scheduling and start time. It explains the importance of the association between quality and efficiency.

The article offers information on the Annual Business Meeting of Doctors of BC (BCMA), a system comprised of doctors, and General Assembly held in Vancouver, British Columbia (B.C.), on June 6, 2015. Topics discussed include views of BCMA chief executive officer (CEO) Allan Seckel on updates of the court case Dr Wang vs. the BCMA, views of Audit and Finance Committee chairman Mark Corbett on update on association finances and several photographs from the meeting.

The article discusses the Shared Care Youth Transition Initiative introduced by British Colombia health organization Doctors of BC and the Ministry of Health to address recommendations of the 2012 policy paper "Closing the Gap," on the needs of chronic care youth as they transition to adulthood. Topics covered include the survival rate of youth with chronic health conditions and disabilities, negative impacts of lack of transition planning and preparation, and the development of the approach.

Background: In British Columbia, a significant proportion of children with neurodevelopmental disorders are unable to access recommended medical investigations/assessments due to behavioral complexity such as aggression and self-injury; consequently, examinations/investigations under anesthesia are often required. However, difficulties in coordination result in fragmented and traumatic service provision. Methods: Within a larger quality improvement project, an initial chart review of patients aged 2 to 18 years who underwent anesthesia at BC Children's Hospital was conducted to describe the current state of sedation in children with behavioral complexity. Patients were identified from the operating room slate for a randomly selected week in January 2021. Results: Seventeen percent of patients (31/185) who accessed the operating room during the review period met the criteria for behavioral complexity. Of these, 16% received an add-on procedure in the operating room. Fifty-two percent of patients had not had any blood work done for at least 1 year before the date of their procedure. Conclusions: It was impossible to efficiently characterize all missed opportunities to conduct physical examinations and medical assessments of children with behavioral complexity who are seen at BC Children's Hospital for sedated procedures, which highlights significant gaps in care optimization for these patients. [ABSTRACT FROM AUTHOR]

Background: Hyperkalemia is a common condition, occurring in up to 10% of hospitalized patients. Al though severe hyperkalemia is a life-threatening condition, there is little consistency in the management of high serum potassium. We conducted a quality improvement project aimed at increasing the proportion of hyperkalemia cases managed according to the best available evidence and reducing the cost of treatment. Methods: A pocket-sized guideline outlining the management of hyperkalemia according to the best available evidence was distributed to internal medicine residents. Cases of hyperkalemia occurring in a 2-week period before the guideline was distributed (observational phase) were reviewed retrospectively and compared with cases occurring in two 2-week periods after the guideline was distributed (intervention phase). Results: A review of paper charts and electronic health records indicated that before the intervention, hyperkalemia was managed according to the best available evidence in 63% of cases. After the intervention, cases were managed according to the best available evidence in 94% of cases. In addition, the overall cost incurred per case declined from $16.74 to $7.51. Conclusions: Providing residents with a user-friendly guideline for hyperkalemia increased the proportion of cases managed according to best available evidence and significantly reduced the cost associated with treatment. [ABSTRACT FROM AUTHOR]

The author discusses the consultation paper under the medical association Doctors of BC focusing on governance structure and processes. He encourages members to provide feedback on the alternatives presented in the board structure focusing on a single governing body , or a dual formation with a board and a representative group. He also explains an overview of the current management composed of elected medical practitioners representing geography and practices.

The article discusses the closure of the College of Physicians and Surgeons of BC (CPSBC) medical library and explores alternative ways the library could be repurposed to better serve registrants. The author suggests that the library could have provided valuable assistance in research methodologies, statistical analyses, literature reviews, and skill development. The closure of the library is seen as a step backward that may limit access to articles and hinder progress in disease management. The author emphasizes the exemplary service provided by the library staff and supports the proposal for Doctors of BC to take over the library. Another article highlights the lack of universal oral thiamine coverage in BC, which is a missed opportunity for alcohol harm reduction. The article argues for the inclusion of oral thiamine on the BC PharmaCare Plan C formulary to improve access to affordable vitamin B1 for individuals with severe alcohol use disorder. The Eastside Illicit Drinkers Group for Education advocates for the benefits of thiamine supplementation and believes that broader coverage is necessary to realize the clinical benefits on a larger scale. [Extracted from the article]

The article discusses the closure of the College of Physicians and Surgeons of BC (CPSBC) medical library and the impact it has on healthcare professionals. The closure of the library, without warning, has caused shock and a sense of loss among practitioners who relied on its services. While the CPSBC cited a decrease in library usage as the reason for closure, many argue that the library provided valuable assistance and resources that cannot be easily replaced by internet sources. Suggestions have been made for the Doctors of BC to take over the operation of the library or establish a partnership with the University of British Columbia's library. The closure of the library raises concerns about limited access to unbiased and original medical information and the potential for a narrower perspective in healthcare decision-making. [Extracted from the article]

The article discusses the challenges faced by patients and physicians when dealing with anorectal complaints, particularly hemorrhoids. Patients often attribute various symptoms to hemorrhoids, which can hinder them from seeking appropriate medical help. The article emphasizes the importance of taking a comprehensive history and performing a thorough physical examination to accurately diagnose anorectal pathologies. It also highlights the significance of patient-tailored treatment regimens and the need to educate patients about the underlying triggers of their symptoms. The article concludes by emphasizing the importance of considering more serious conditions, such as colorectal neoplasms, when managing patients with rectal bleeding. [Extracted from the article]

The author provides his views on physician-assisted death in British Columbia. Issues raised include the promotion of advance care planning by the Doctors of BC, the organization's policy paper "It's Time to Talk: Advance Care Planning in British Columbia," and the advantages of having an end-of-life plan.

Background: Publicly funded telephone interpretation for family physicians in British Columbia has been available since 2017 through Provincial Language Services. However, there has been no published literature on its usage. Methods: We performed a quantitative and descriptive analysis of data from Provincial Language Services for all users who accessed telephone interpretation through the Primary Care Telephone Interpreting Service Pilot Project from 2017 to 2020. These data were then compared with publicly available data on populations and physicians in BC. Results: Of 23 484 interpreted telephone calls between November 2017 and December 2020, most (86%) were made in Vancouver. Arabic and Farsi represented 58% of all calls. There were 15.1 calls per 100 people with limited English proficiency during the study period. Average call duration was 21 minutes (range 1 to 266). Monthly usage increased from 164 calls in November 2017 to 927 calls in December 2020. In 2020, an estimated 1.9% of primary care visits involving language barriers used telephone interpretation. Conclusions: Uptake of interpretation services has increased but remains low among BC family physicians; barriers to this should be explored. [ABSTRACT FROM AUTHOR]

Background: Inhaler therapy is a cornerstone treatment for asthma and chronic obstructive pulmonary disease. Propellants used in pressurized metered-dose inhalers contain potent greenhouse gases that contribute to climate change. Dry powder inhalers and soft mist inhalers do not use propellants and have a lower carbon footprint. Methods: We conducted a retrospective longitudinal analysis of community-dispensed inhaler prescriptions in the Fraser Health region in British Columbia from 2016 to 2021 and calculated the resulting carbon footprint. We modeled three scenarios for switching inhalers to lower-carbon alternatives. Results: The average annual carbon footprint of inhalers was 8478 tonnes of CO2 equivalent (tCO2e), which was 21.8% of the reported total emissions from Fraser Health facilities. Different prescribing scenarios for inhalers can eliminate 1217 to 6607 tCO2e annually. Conclusions: Encouraging switches to lowcarbon inhalers offers an opportunity to reduce health care-associated carbon emissions and potentially improve respiratory care. [ABSTRACT FROM AUTHOR]

Background: Embedding a palliative approach into management of advanced heart failure remains an important yet challenging aspect of the current care model. Methods: Late-stage heart failure patients were interviewed about their health care journey, and themes were extracted by multidisciplinary partners. The project team created two original interactive tools for patient and provider perspectives. Results: The tool for patients and their carers supplements discussions with clinicians regarding prognosis. It focuses on recognizing signs and symptoms of heart failure progression and exacerbation and outlines skills for adapting to this transition. The aim of the clinician tool is to support clinicians' skills in caring for advanced heart failure patients. It includes guidance through the stages of care and interactive links to further information and support. Conclusions: Two novel tools were created to address gaps in existing heart failure guidelines and patient education regarding advanced heart failure trajectory that were identified by patients and their providers. [ABSTRACT FROM AUTHOR]

The article offers information on the Maintenance of Certification (MOC) program and a revised MAIN PORT web application developed by the Royal College of Physicians and Surgeons of Canada.

This article discusses research on improvements in disability in multiple sclerosis patients.

The article focuses on the policy paper produced by Doctors of British Columbia to highlight mental health resources, services and programs for patients, families and physicians. Topics covered include the mental health challenges experienced by transition-age youth, the need for government and health authorities to address system capacity issues and the promotion of tools to assess mental health concerns.

For medical professionals and administrative staff, the prospect of managing a medical emergency in the office can generate a great deal of unease, particularly when such events are infrequent and challenging to prepare for. Given the rapidly evolving, life-threatening nature of anaphylaxis, successful management relies on prompt recognition and treatment. To ensure swift management of anaphylaxis, medical clinic personnel, particularly those in practices that administer immunotherapy, must make a concerted effort to prepare for these events. Although international guidelines for anaphylaxis management are widely available, a considerable discrepancy exists between those recommendations and their implementation in practice, thus necessitating a revised approach to medical training for anaphylaxis. Simulation training facilitates the development of emergency management skills in a controlled setting, thereby providing opportunities to gain valuable experience prior to actual events. Given the challenges associated with the COVID-19 pandemic, mobile or virtual simulation programs could offer logistically feasible, accessible, and cost-effective opportunities to enhance preparedness for in-office anaphylaxis at the point of care. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to an article related to ophthalmologist and optometrist to public, that was published in the previous issue.

This article focuses on the tenth anniversary of the 500-page report "The Health of Canadians: The Federal Role," also known as the Kirby Report, which was released by Canada's Standing Committee on Senate Social Affairs, Science and Technology on October 25, 2003.

This article focuses on a report from the University of Calgary's School of Public Policy in Alberta which held that the current pay-as-you-go model for funding medicare is unsustainable given the needs of an aging population.

The article discusses WorkSafeBC's policy on inguinal hernia claims. The policy limits the postoperative wage loss to 42 calendar days unless there are complications. In 2004, a paper issued by WorkSafeBC's Evidence Based Practice Group claims postoperative convalescence and return to work usually occurred in less than 42 says. WorkSafeBC is working with the British Columbia Medical Association on addressing the discrepancy between expected and actual convalescence period for injured workers.

A letter to the editor is presented in response to suggestions made by readers on the author's review of the article "Pharmacological Interventions for Traumatic Brain Injury," by Aaron Talsky and colleagues which appeared in the journal's Volume 53, 2011 issue.

A correction to an article on medical marijuana by Doctor Bob Vroom which appeared in the April 2011 issue is presented.

A letter to the editor is presented in response to a review of the article "Pharmacological Interventions for Traumatic Brain Injury," by Aaron Talsky and colleagues which appeared in the journal's Volume 53, 2011 issue.