CodeBlueBlog: Are Canadian Health Care Consumers Morons?

*****************

THE AWARD WINNING MEDICAL WEBLOG

April 2005

Sun	Mon	Tue	Wed	Thu	Fri	Sat
					1	2
3	4	5	6	7	8	9
10	11	12	13	14	15	16
17	18	19	20	21	22	23
24	25	26	27	28	29	30

About

Links

http://
Search Popdex:
For Dictionary: Type In Word Then Click "Partial" Submit Button

Webster's Online Dictionary
The Rosetta Edition™

English Non-English
Blogroll Me!
DISCLAIMER This is a personal web site, reflecting the opinions of its author. It is not a production of my employer, and it is unaffiliated with ANY hospital, medical center, medical practice or other physicians. Statements on this site do not represent the views or policies of anyone other than myself. The information on this site is provided for discussion purposes only, and are not medical recommendations. I offer no guarentee as to the accuracy of anything stated and the information here is at times, highly speculative and does not constitute advice to/not to diagnose or treat. Any personal medical issues the reader may have should be referred immediately to the reader's private physician and under no circumstances should anyone delay, change, or alter any medical treatment or planned treatment or diagnosis based on anything read on this site. Under no circumstances does any herein contained information represent a medical recommendation.
Best of the Web
Logial Fallacies
Word of the Day
Quackwatch
Undisclosed Location
Grand Rounds Archive
Blogstreet
Daypop Top 40
Carnival of the Vanities
Link to hosts and updates
BLOGGER NEWS NETWORK
Breaking News in the Blogosphere
http://www.neolibertarian.net/blogs/
This work is licensed under a Creative Commons License.

Blog powered by Typepad

« Terri Schiavo To Be Executed Because She is Not A Murderer | Main | Serena Williams Wins Australian Open Despite Rib Dislocation! »

Are Canadian Health Care Consumers Morons?

Updates From The Frozen North...

The vaunted and much admired Canadian health care system (you know, the one that provides low-cost pharmaceuticals -- subsidized by Americans -- to Americans) is much in the news lately.

Difficult Difficile

What happens, in the hospital, if you overuse antibiotics, don't wash your hands, have poorly funded infection control staff and lightly trained personnel? You get rampant Clostridium difficile infection running through your patient population.

For those of you who are new to microbiology, the Clostridium family of bacteria is one of the nastiest bunch of bugs in the whole infection universe. Members of the Clostridium family cause botulism and tetanus. C. difficile causes severe, hard-to-treat diarrhea which can be fatal for hospitalized patients, especially those with immune system problems.

This week the Canadian government fessed up (partly) about the C. difficile infections ravaging their hospitalized patients. In fact, in one province alone, in a three month period last year, the government is now acknowledging that there were 1,400 cases, and an unfigured amount of deaths that they admit were probably at least 100 -- but likely much higher.

Notice how they only report one province and a three month period. Let's see...multiply that by twelve months of the year and ALL Canadian provinces and you get ... AN EPIDEMIC.

But Canada's health minister Phillippe Couillard isn't worried (thank God!) and actually says:

I would go myself to any of these hospitals with members of my family without any fear

He's a liar. He wouldn't expose himself or his family to one of those dirty hospitals, you can bet on that. He would ship his family off to Buffalo General or beyond. I certainly hope that there is a special place in the afterlife for health ministers who downplay ghastly epidemics for the sake of their political positions

But lying is effective, let's admit it. In this Yahoo news story about the horrible C. difficile epidemic, the opening line of the article is:

Quebec's hospitals are safe even though the province has reported that 1,406 people were infected by the potentially fatal C. difficile bacterium over three months late last year

Did the writer of this article choke on those words as he wrote them? How can a hospital be safe if when you go there you might get a NEW disease to add to the one you ALREADY have and the NEW disease can kill you? Safe? Do they think the Canadians are morons and would BELIEVE that?

Maybe.

Night of The Living Moron

You won't hear an uproar in Canada. That's because when people are not responsible for their health care they become health care morons. You see, if someone else pays the bills then one doesn't comparison shop, and one doesn't compare results. One doesn't get educated. You stay stupid. That way, when the Couillards of the world tell you that getting deadly bacterial infections in the hospital is not a problem -- you just accept it. Thank you sir, may I have another?

I think, Phillippe, that you should be afraid. Be very afraid. Then again, I'm sure that politically important people in Canada actually get the best health care available -- that's how nationalized systems work. The important people get sterile bed pans, hoi polloi get ... C. difficile.

Posted by Doctor CBB on January 30, 2005 at 10:20 AM | Permalink

Comments

Mark Steyn noted this at the end of a column last Fall.

http://www.washtimes.com/commentary/20041024-110608-1806r.htm

This provoked some heated and defensive reactions, e.g.:

http://www.chireader.com/hottype/2004/041029_1.html

More can be found by Googling "Mark Steyn Clostridium"

Posted by: Jim Hu | January 31, 2005 at 03:12 AM

See, National Health Care does produce universal coverage with regard to certain unique benefits, going boldy beyond a check of one's blood pressure each 6 months.

Posted by: Joe P. | January 31, 2005 at 03:29 PM

Some quick, back-of-the-envelope numbers: if we assume (and we shouldn't, but we will anyway) that c. diff cases are evenly spread throughout the provinces and through time, then, using Quebec as our baseline, there would be 22,478 cases in one year. By comparison, there were roughly (to extrapolate from NNISS data, somewhere around 62,952 cases of nosocomial methicillin-resistant staph (MRSA) infections in US hospitals last year. However, if we scale our not-binding-in-any-way c. diff figures from Canada's population to America's, that would work out to somewhere around 220,000 infections in the United States hospital system in one year.

That's a crisis right there.

In any case, I'm no fan of the Canadian hospital system (though I am watching the anti-chiro lawsuits up there with some interest), but I would argue your analysis of the economic problem is misguided.

Generally speaking, the health care system is not considered particularly likely to benefit from the efficiency usually gained from free markets. People are not good consumers of medical services, and are unlikely to ever be. This is in part due to the fact that their interactions with health care providers are both heterogenous and sporadic (thus inhibiting the collection and dissemination of data for rational market choices), and also that few people have the education or experience to make intelligent choices between providers. Given two coffeemakers, most consumers can make a choice on the merits; given two treatment protocols for an autoimmune disorder, most could not. (And thus enter the chiropractors, Pentacostal faith healers, and other quacks. Remind me sometime to mention the story of the chiropractor, the potatoes, and lupus.)

This doesn't even get into the issues of the "tragedy of the commons," which may take its most serious form not in the usual example of the environment, but in the public health system. In most markets, interactions between buyers take the form of information exchange and changes in the demand curve; in the health market, someone failing to get medical care for an infectious disease could radically change the cost of health care for all other consumers. This alone has interesting implications for any economic analysis of the health care market.

This does not, of course, mean that a government-managed system like Canada's is desirable, but I don't think that you can assign blame solely based upon the socialized nature of the system. (See the quality of today's VA hospital system for an example of a government-run health system that works, versus the VA system of ten years ago for one that doesn't.)

None of this changes the fact that walking through a Canadian long-term ward is like being in one of the middle levels of Dante's Hell, with damned souls stretching out their hands seeking aid. Regardless of the economic merits and demerits of government involvement in medicine, my personal belief is that Canadians aren't doing it right.

Posted by: WatchfulBabbler | February 04, 2005 at 05:11 PM

The Canadian healthcare system offers plenty to attack, but you do that attack no justice by this sloppy condemnation riddled with factual and logical errors.

To start with, Couillard is not the Canada's health minister, whether you spell his name right or not. He is Quebec's health minister, and as far as I am aware, there is no particular reason to believe that Quebec's current C. Difficile epidemic is shared by any other Canadian province, no more than it might be shared by neighboring U.S. states.

Extrapolating to all Canadian provinces and all 12 months is obviously an exaggeration: if you had an epidemic of measles in the Fall in Utah, could you just blithely assume that you had 200 times that epidemic in the whole U.S. of A.?

Besides, as you know perfectly well, C. Difficile is a common pathogen but also a common commensal, and you would find a lot of it anywhere you started doing testing. The whole controversy in Quebec is whether the recent findings really represent anything different from the usual pattern. It is genuinely unknown how many of these C. Difficile 'infections' are actually responsible for morbidity or mortality, and guesses range from no more than the 'usual' amount to maybe 2 or 3 times baseline.

Suggesting that Couillard is a liar when he claims that he would be comfortable getting treatment in a Quebec hospital is a needless slander. I suspect he is concerned about the epidemic but would genuinely not worry if he or a member of his family needed care in a Quebec hospital, and nor would I. If C. Difficile is killing anyone, it is very old, debilitated patients, not young healthy ones. Of course, that is no reason not to take reasonable measures to limit the spread of this disease, and if anything the measures that have been put in place in Quebec might be qualified as overdoing it, but hardly ignoring it.

Your final slam:
" Do they think the Canadians are morons and would BELIEVE that?
Maybe."

If I were in your place and had made such a statement about Americans, I think I would consider that an apology is in order.

Regards, WDeck

Posted by: wilber | February 08, 2005 at 08:22 AM

What a great article. I really enjoyed reading it because it is all true.

I am canadian from Quebec and my mother died of it in october and on top of the bacteria, she was badly treated by a few employees.

I opened a website www.Dyane.net and I put pictures of my mother before the bacteria and after she got it. She suffered a great deal. I also put copy of the letters that we send the organisms regarding all this. They all protect each other.

I have no respect for Couillard. We have sent him copy of the letters. He never had the decency to answer.

I was on TV one week before my mother died, and 2 weeks after she died on CBC News. CBC interviewed me and my sister for over an hour and we were on TV just for when we talked about the bacteria, but they mentioned nothing about the bad treatments.

Everybody hides everything including the news because they are afraid to be sued.

I said on TV that the health system in Quebec stinks and it is the truth. My mother went in for high blood pressure and it's not only the old people who die of it, or get it.

Thank you and continue your great work

Posted by: Dyane Deschênes | February 27, 2005 at 04:29 PM

My mother is currently suffering from a c. difficile infection contracted while recuperating from hip surgery in a rehab hospital in Toronto, which made me start to research the thing and I happened upon this website.

I'm not going to quarrel with anyone, but suffice it to say that, according to this webpage at least:
(http://www.medicalpost.com/mpcontent/article.jsp?content=20041031_205140_4420)
the particularly virulent strain of c. difficile that we Canadians are struggling with has been imported from the U.S. and is five times deadlier than the garden variety and not particularly easy to sanitize against as it produces spores that can live on hard surfaces for months--even after cleaning.

And, according to this webpage from the Canadian Medical Association Journal website; (http://www.cmaj.ca/cgi/content/full/171/11/1331)
the mortality rate for this superbug is now at approximately 18% of all who contract it. That's almost one in five, people!! Wake up!!!

Apparently, over 1,200 patients have died--after contracting c. difficile--in Quebec alone during the year starting April 1, 2003 and ending March 31, 2004--so THIS IS NOT ABOUT HEALTH CARE SYSTEMS OR POLITICS!!!

This is about the overuse of antibiotics (which has been rampant in every health care system on the planet) and the subsequent mutation and emergence of resistant strains of bacteria that do not respond to antibiotics anymore. All the crowing about good health care systems or the criticizing of bad health care systems will not bring back the 'good ole days' of newfound penicillin (the wonder drug.)

If it is true though, that this bug is a little 'present' from the U.S., then as a Canadian who is fighting to keep her mom alive, thanks a bunch.

Posted by: Maureen | March 15, 2005 at 08:12 PM

Maureen, I am very sorry about your mother. However, we do not have a C. difficile epidemic in the USA, so clearly the problem isn't ours. I read the article you refer too, and there doesn't seem to be any evidence it "came" from the US just because it was identified by the CDC. I seem to recall Canada's problems with SARS a few years back- we had a few cases here, but nothing like what went on up there. It, of course, originated in China. Furthermore, no one blames the Africans for HIV (though it started there), and in fact $2.4 billion of a TOTAL of $2.8 billion spent to fight AIDS in Africa this year ALONE is coming from the US. I find it ironic that you would engage in such Anti-Americansim- then say this isn't a political issue!

Also, it appears that Alberta has suffered from this outbreak with around 20 deaths so far.

I was recently in London, and over there they are extraordinarily concerned about MSRA (methicillin resistant staph aureus). It's rampant, for the same reasons Canada can't control infectious disease- manpower and space problems. Having people in 4-bed wards is a great way to spread disease- and that's what the best IHS hospital can offer. Which is why the British government is targeting for AT LEAST 15% of all health care be delivered privately by the year 2008.

I was taught you can get medical care good, fast or cheap, but not all three at the same time. I still believe it.

Posted by: Dani | March 15, 2005 at 10:14 PM

Dani;
Posting pertinent and current epidemiological information to a biased 'medical' blog that has a title screaming about 'Canadian Health Care Consumers' being 'Morons' is hardly "Anti-American"--but I suggest that the very nature and purpose of this blog is obviously (and xenophobically?) anti-Canadian.

Also, I suggest you check out some of your own U.S. authors before you embarrass yourself with spouting misinformation about there being no epidemic of c. diff. in the 'States.(e.g. "Clostridium difficile Colitis: An Increasingly Aggressive Iatrogenic Disease?"
from the 'Archives of Surgery' Oct 2002 issue 137: 1096 - 1100., out of Portland, Oregon, and Seattle, Washington--by Arden M. Morris; Blair A. Jobe; Mark Stoney; Brett C. Sheppard; Clifford W. Deveney; Karen E. Deveney--where they are stating that during a period of time between the years 1994 and 2000 the "overall mortality rate was 15.3%, increased from 3.5%" in the previous years--and their conclusions were that "The frequency of C difficile colitis remains high and seems to be associated with increasing mortality.")

(So it seems that if the rate in 2000 from this report was up to 15.3%, then for it to get to 18% by 2004 in Quebec makes sense in the time-line graph of this mutating bug.)

--And--
From the 'Annals of Surgery' 2002 Mar;235(3):363-72.
A report from the Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania "Fulminant Clostridium difficile: an underappreciated and increasing cause of death and complications." where these medical authors--Dallal RM, Harbrecht BG, Boujoukas AJ, Sirio CA, Farkas LM, Lee KK, and Simmons RL--state their conclusions about c. diff. infections over a two-year period between January 1989 to December 2000 in their surgical patients:

"C. difficile colitis is a significant and increasing cause of death. Surgical treatment of C. difficile colitis has a high death rate once the fulminant expression of the disease is present."

In every case I have researched, the statistics of c. diff. incidence and severity is rising--but no one wants to call it what it is--an epidemic. And, for the record, there's no 'epidemic' here in Canada either--according to our officials too who want to downplay the significance of the outbreaks--just like your officials are doing. And here I will quote from a Canadian official as to the real reason behind this general lack of interest (from the article in the Canadian Medical Association Journal at --http://www.cmaj.ca/cgi/content/full/171/5/436 ):

Pépin says part of the reason health officials may be reacting less vigorously to the outbreak is because most of those dying are elderly. "There's less reaction than if it had been an outbreak among younger patients."

The U.S. articles predate increased Canadian c. diff. infection rates, and I have found evidence that other countries were noticing increased rates of newly stubborn and fatal c. diff. infections before it landed in Canada too--the UK, Poland, Spain, France, Japan, to name just a few. And general nosocomial infection and mortality rates are rising too. According to Dr. Weinstein (chair: Division of Infectious Diseases, Cook County Hospital; director of Infectious Diseases Services for the Cook County Bureau of Health Services; and professor of Medicine, Rush Medical College) "in 1995, nosocomial infections [in the U.S.] cost $4.5 billion and contributed to more than 88,000 deaths—one death every 6 minutes."

So, sorry to burst your bubble there Dani, you've got it all backwards--I'm not anti-American. (How can I be when my beloved only child is American?) I just recognize that due to so much travel by people hosting new bugs--they get around! I'm sure someone from here brought it up from a vacation or a business trip, or someone there brought it up here the same way.

I'm just sad and distressed that my mom is so sick and there's no relief for her--and I'm not quite ready to give her up just yet. She's wasting away because she can't eat anything due to the c. diff., and now she's on her fourth reinfection. I want to get her out of the hospital and home. Maybe she'll be safer from reinfection at home.

maureen
***************
Sources:
[http://archsurg.ama-assn.org/cgi/content/abstract/137/10/1096]

[http://www.annalsofsurgery.com/pt/re/annos/abstract.00000658-200203000-00008.htm;jsessionid=C2u2KTAZzJ310maHgkYe6QFk2ssbkYikR6zioaybjkM6QJFXWVQY!-111031944!-949856032!9001!-1]

[http://www.cdc.gov/ncidod/eid/vol4no3/weinstein.htm]
**************************

Posted by: maureen | March 21, 2005 at 02:20 AM

With all the stories out there about rising health care costs. I'm surprised I don't see more focus on many of the discount companies that are out there.

My mother , along with my brother used to pay out about $500 a month on prescritions. They now have a card they they pay about $3.00 a month for and they save about $200 a month. I see that this company now has a website & they are providing other discount services as well.

They are at: http://www.econohealthbenefits.com

Posted by: M J | April 14, 2005 at 08:40 AM

Volume 23-06
15 March 1997

THE CANADIAN NOSOCOMIAL INFECTION SURVEILLANCE PROGRAM: RESULTS OF THE FIRST 18 MONTHS OF SURVEILLANCE FOR METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS IN CANADIAN HOSPITALS

Introduction

The emergence of organisms resistant to multiple antimicrobial agents is occurring worldwide. Among these organisms, methicillin-resistant Staphylococcus aureus (MRSA) has been found to have a major impact on patient care and has been responsible for numerous outbreaks in hospitals. The prevalence of MRSA increased from 65 years old, and only 13% were < 20 years old. Forty-two (10%) cases reporting ethnicity were Aboriginal; most (63%) of these resided on First Nations reserves in Manitoba and Alberta. For the 320 cases where the source of MRSA could be determined, 81% were thought to have been acquired in a hospital, 8% in a long-term care facility, and 11% in the community. Cases in the provinces of Manitoba, Saskatchewan, Alberta, and British Columbia were 1.6 times more likely to have been acquired in a community than were cases from elsewhere in the country (p = 0.05).

Most cases were on surgical (30%) or medical (27%) units at the time MRSA was cultured; 10% were in an intensive-care unit. Slightly more than half (52%) of patients had an infection due to MRSA, whereas 48% were colonized. The most common body sites and specimens from which MRSA was isolated were skin and soft tissue (37%), anterior nares (27%), sputum or other respiratory specimens (15%), urine (7%), and blood (3%). The majority of MRSA cultures were obtained as a result of a clinical indication (i.e. an infection was suspected) (Table 3). However, in 1996, the number of cultures obtained as part of an outbreak investigation significantly increased as compared to 1995 (p < 0.001). The number of cases thought to be epidemiologically linked to another MRSA case in the same hospital increased from 34% to 56% between 1995 and the first half of 1996 (p < 0.001) (Figure 1).

Antimicrobial-susceptibility testing indicated resistance to erythromycin (88% of isolates), clindamycin (62%), ciprofloxacin (76%), trimethoprim-sulfamethoxazole (40%), and rifampin (3%); no vancomycin-resistant isolates were identified.

A total of 288 MRSA isolates from 16 sites have been typed by PFGE. There were 52 distinct genotypes, of which 15 could be further subtyped. Most (70%) isolates could be grouped into one of six DNA profiles. Isolates with similar DNA profiles within a facility were often associated with a recognized epidemiologic link or outbreak. There were 11 DNA profiles; each was present in several hospitals across the country.

Figure 1
Epidemiologic link of a MRSA case to another MRSA case in the same hospital

Table 3
Indications for MRSA cultures in Canadian hospitals, January 1995 - July 1996

Reason for culture

1995
%

1996
(up to July)
%

Clinical indication

Outbreak investigation

Screening

Previous known carrier

Unknown

Discussion

The epidemiology of MRSA in Canadian hospitals has been different from that described in the United States and many other countries for most of the past 15 years. In the United States, for example, MRSA appeared to have spread rapidly and become endemic in many hospitals throughout the 1980s, with prevalence rates as high as 10% to 40% of all S. aureus isolates (1-4). In contrast, MRSA was not thought to be endemic in any Canadian community or health-care facility. There have been relatively few reports in Canada of institutional outbreaks of MRSA and these appeared to have been controlled by implementing stringent infection-control measures (5-10).

The results of the first 18 months of CNISP surveillance confirm that isolation rates of MRSA remain substantially lower in Canadian centres compared to those that have been reported in the United States. However, the occurrence of MRSA is variable in health-care facilities in different parts of the country. As noted recently, there has been a marked increase in MRSA isolation rates in Ontario in the past 1 to 2 years (13, 14); this increase has been largely attributed to the spread of a single clone of MRSA that has caused outbreaks in many Ontario centres. Elsewhere in the country, MRSA isolation rates appear to remain stable and low at < 2%. Most MRSA cases appear to be hospital-acquired, but a significant number of MRSA cases in Manitoba, Saskatchewan, and Alberta are community-acquired and associated with First Nations individuals living on reserves, as previously described (9,12). Although molecular typing of isolates by PFGE has indicated considerable genetic diversity, there has also been evidence of both intra- and inter-institutional spread of MRSA strains in Canada.

The results of this study may be limited due to the relatively small number of hospitals which participated in the surveillance. However, most of these hospitals are large, urban, tertiary-care centres. Whether these hospitals represent sites in Canada where MRSA is more likely to be found is unknown, but large tertiary-care hospitals in the United States have historically been associated with the highest rates of MRSA (1, 3). These results do provide an accurate "snapshot" of MRSA in tertiary-care hospitals across the country, and have relevance for other institutions because of the ease with which MRSA is transmitted between health-care facilities, including those which are smaller and community-based (1, 2).

Although challenging and costly, control of MRSA within hospitals has been feasible and considered to be cost-effective, provided aggressive control measures are implemented rapidly (15). Successful control of antimicrobial resistance also requires a good understanding of the extent and epidemiology of the problem. Continued surveillance is essential as the situation with MRSA and other antibiotic-resistant bacteria, such as vancomycin-resistant enterococci, is constantly evolving.

References

Boyce JM, Causey WA. Increasing occurrence of methicillin-resistant Staphylococcus aureus in the United States. Infect Control 1982;3:377-83.

Haley RW, Hightower AW, Khabbaz RF et al. The emergence of methicillin-resistant Staphylococcus aureus infections in United States hospitals. Possible role of the house staff-patient transfer circuit. Ann Intern Med 1982;97:297-308.

Panlilio AL, Culver DG, Gaynes RP et al. Methicillin-resistant Staphylococcus aureus in US hospitals 1975-1991. Infect Control Hosp Epidemiol 1992;13:582-86.

Voss A, Milatovic D, Wallrauch-Schwarz C et al. Methicillin-resistant Staphylococcus aureus in Europe. Eur J Clin Microbiol Infect Dis 1994;13:50-5.

Low DE, Garcia M, Callery S et al. Methicillin-resistant Staphylococcus aureus - Ontario. CDWR 1981;7:249-50.

Vortel JJ, Bell A, Farley JD et al. Methicillin-resistant Staphylococcus aureus (MRSA) in a British Columbia hospital - 1990. CDWR 1991;17:71-2.

Boyd N, Gidwani R. Colonization of methicillin-resistant Staphylococcus aureus in southwestern Ontario. CDWR 1991;17:72-3.

Nicolle LE, Bialkowska-Hobrzanska H, Romance L et al. Clonal diversity of methicillin-resistant Staphylococcus aureus in an acute-care institution. Infect Control Hosp Epidemiol 1992;13:33-7.

Embil J, Ramotar K, Romance L et al. Methicillin-resistant Staphylococcus aureus in tertiary care institutions on the Canadian Prairies 1990-1992. Infect Control Hosp Epidemiol 1994;15:646-51.

Simor AE, Augustin A, Ng J et al. Control of MRSA in a long-term care facility. Infect Control Hosp Epidemiol 1994;15:69-70.

Dammann TA, Wiens RM, Taylor GD. Methicillin-resistant Staphylococcus aureus identification of a community outbreak by monitoring hospital isolates. Can J Public Health 1988;79:312-15.

Taylor G, Kirkland T, Kowalewska-Grochowska K et al. A multistrain cluster of methicillin-resistant Staphylococcus aureus based in a native community. Can J Infect Dis 1990;1:121-26.

Green K, Low DE. MRSA in Ontario - results of questionnaire survey. Laboratory Proficiency Testing Program Newsletter No. 181, June 25, 1996:1-3.

McGeer A, Low DE, Conly J et al. The rapid emergence of a new strain of MRSA in Ontario: laboratory and infection control implications. Laboratory Proficiency Testing Program Newsletter No. 190, October 29, 1996:1-4.

Boyce JM. Should we vigorously try to contain and control methicillin-resistant Staphylococcus aureus? Infect Control Hosp Epidemiol 1991;12:46-54.

Acknowledgements

We are grateful to the laboratory and infection control staff in each of the participating hospitals for their valuable contributions to this study and to C. Scott for data management.

Participants in CHEC and CNISP included E. Bryce, MD, The Vancouver Hospital, Vancouver, BC; G. Taylor, MD, Walter MacKenzie Centre, Edmonton, E. Henderson, MD, Calgary General Hospital Bow Valley Centre, A. Kureishi, MD, Foothills Hospital, Calgary, AB; B. Tan, MD, Royal University Hospital, Saskatoon, SK; J. Embree, MD, L. Nicolle, MD, Health Sciences Centre, Winnipeg, MB; D. Gregson, MD, St. Joseph's Health Centre, London, J. Conly, MD, The Toronto Hospital, A. Matlow, MD, Hospital for Sick Children, A. McGeer, MD, Mount Sinai and Princess Margaret Hospitals, A. Simor, MD, Sunnybrook Health Science Centre, Toronto, D. Zoutman, MD, Kingston General Hospital, Kingston, ON; M. Miller, MD, Jewish General Hospital, D. Moore, MD, Montreal Children's Hospital, Montreal, M. Ishak, MD, Hotel-Dieu St. Jérome, St. Jérome, M. Gourdeau, MD, Hôpital de l'Enfant-Jésus, Quebec City, QC; W. Thompson, MD, The Moncton Hospital, Moncton, NB; J. Langley, MD, I.W.K. Hospital for Sick Children, L. Johnston, MD, Queen Elizabeth II Health Sciences Centre, Halifax, NS; J. Hutchinson, MD, Health Sciences Centre, St. John's, NF; W. Johnson, MD, M. Mulvey, MD, M. Ofner- Agostini, BScN, RN, MHSc, S. Paton, MN, RN, LCDC, Ottawa, ON.

Source: A Simor, MD, Department of Microbiology, Sunnybrook Health Centre, Toronto, M Ofner-Agostini, BScN, RN, MHSc, S Paton, MN, RN, Division of Nosocomial and Occupational Infections, Bureau of Infectious Diseases, LCDC, Ottawa, ON.

Posted by: steve webster | June 10, 2005 at 08:36 PM

Of course in the most markets, interactions between buyers take the form of information exchange and changes in the demand curve; in the health market, someone failing to get medical care for an infectious disease could radically change the cost of health care for all other consumers.

Posted by: Andrew Spark | February 10, 2006 at 03:34 AM

Posted by: Tomeczek | September 19, 2006 at 06:13 AM

Posted by: gandi | October 23, 2006 at 04:21 AM

Hello this is nice site. Thanks! FULL INFORMATION TRAVEL ONLINE SPORTS RULES |Interactive online |
http://www.travel.happyhost.org online web
http://www.travelonline.happyhost.org | free travel
http://www.life.happyhost.org | protective life insurance
http://www.tooth-whitening.host.sk | online tooth whitening
http://www.mac-cosmetic.host.sk | mac cosmetic online
http://www.mortage.host.sk | ameriquest mortgage
http://www.purse.host.sk | onine purse
http://www.meridia.happyhost.org | cheap meridia
http://www.buyalprazolam.happyhost.org | buy alprazolam
http://www.phentermine37.happyhost.org | phentermine
http://www.oreckair.happyhost.org | air line
http://www.deltaairline.happyhost.org | frlta
http://www.vacuum.happyhost.org vacuum | clinear
http://www.casinoeagle.happyhost.org | casino online
http://www.online-cheap-pharmacy-rx.com | online pharmacy
http://www.butalbital.online-cheap-pharmacy-rx.com
http://www.vicodin-rx.host.sk |vicodin addiction |
http://www.buy-norco.host.sk | buy norco |
http://www.carisoprodol.host.sk | carisoprodol 350mg |
http://www.casino-online.host.sk | casino consultant |
http://www.buy-lexapro.host.sk | lexapro weight gain |
http://www.phentermine.host.sk | westword fioricet phentermine |

Posted by: online pharmacy | October 27, 2006 at 12:33 PM

If you opt for double headers, then you know that both ends of the toy can be used; generally, double headers are the choice of individuals who want to use a dildo on both themselves and their partner. To what concerns strap-ons, the interesting fact about them is that they can be attached to a harness, if their users want it. Since the base of strap-ons is flat, it can be introduced in the harness - in a hole of the harness - without effort, so as to steady the dildo. After that, the "player" is strapped with the harness and from then on each individual's fantasies can be put into practice.

Vibrators we have the rabbit vibrator and the strap on vibrator also the double dildo vibrator inluding jelly dongs with multi action vagina and anus hand pump also vibrating pussy and ass and pleasure vibes for that g spot rabbit vibrators. We also have vibrating pillow, couples kit, silicone vibrators, rabbit vibe plus the cyberskin pussy. Also we have for you the jack rabbit vibrator, remote control panties vibrating thong g spot clit stimulation vagina and don't forget vibrating double dildo, vibrating pussy and ass sex toys and even mini vibrators clit stimulator. A great adult sex toy is the love machine

http://www.sextoysex.com/sex/start/view.html?a=adult-products&pnum=DJ6018-01

http://www.sextoysex.com/sex/start/view.html?a=adult-products&pnum=DJ6015-02

http://www.sextoysex.com/sex/start/view.html?a=adult-products&pnum=DJ6014-01

http://www.sextoysex.com/sex/start/view.html?a=adult-products&pnum=DJ5525-07

http://www.sextoysex.com/sex/start/view.html?a=adult-products&pnum=DJ5538-01

http://www.sextoysex.com/sex/start/view.html?a=adult-products&pnum=DJ5549-01

http://www.sextoysex.com/sex/start/view.html?a=adult-products&pnum=DJ1453-01

http://www.sextoysex.com/sex/start/view.html?a=adult-products&pnum=DJ5546-04

http://www.sextoysex.com/sex/start/view.html?a=adult-products&pnum=DJ5530-07

http://www.sextoysex.com/sex/start/view.html?a=adult-products&pnum=SE1080-10

http://www.sextoysex.com/sex/start/view.html?a=adult-products&pnum=PH9427-7

http://www.sextoysex.com/sex/start/view.html?a=adult-products&pnum=SE9510-12

http://www.sextoysex.com/sex/start/view.html?a=adult-products&pnum=SE7859-11

http://www.sextoysex.com/sex/start/view.html?a=adult-products&pnum=SE1990-00

http://www.sextoysex.com/sex/start/view.html?a=adult-products&pnum=SE2664-11

http://www.sextoysex.com/sex/start/view.html?a=adult-products&pnum=FUN16338

http://www.sextoysex.com/sex/start/view.html?a=adult-products&pnum=TO7524-6

http://www.sextoysex.com/sex/start/view.html?a=adult-products&pnum=TO7527-6

http://www.sextoysex.com/sex/start/view.html?a=adult-products&pnum=TO7461-7

http://www.sextoysex.com/sex/start/view.html?a=adult-products&pnum=SE0081-25

http://www.sextoysex.com/sex/start/view.html?a=adult-products&pnum=SE9705-20

http://www.sextoysex.com/sex/start/view.html?a=adult-products&pnum=SE9750-14

http://www.sextoysex.com/sex/start/view.html?a=adult-products&pnum=SE7012-01

http://www.sextoysex.com/sex/start/view.html?a=adult-products&pnum=SE0276-04

http://www.sextoysex.com/sex/start/view.html?a=adult-products&pnum=DJ6015-02

http://www.sextoysex.com/sex/start/view.html?a=adult-products&pnum=SE0773-14

http://www.sextoysex.com/sex/start/view.html?a=adult-products&pnum=SE0775-00

http://www.sextoysex.com/sex/start/view.html?a=adult-products&pnum=DJ5525-07

http://www.sextoysex.com/sex/start/view.html?a=adult-products&pnum=DJ5538-01

http://www.sextoysex.com/sex/start/view.html?a=adult-products&pnum=DJ5549-01

http://www.sextoysex.com/sex/start/view.html?a=adult-products&pnum=DJ1453-01

http://www.sextoysex.com/sex/start/view.html?a=adult-products&pnum=SE8113-01

http://www.sextoysex.com/sex/start/view.html?a=adult-products&pnum=SE8109-01

http://www.sextoysex.com/sex/start/view.html?a=adult-products&pnum=SE8112-01

http://www.sextoysex.com/sex/start/view.html?a=adult-products&pnum=SE7869-14

http://www.sextoysex.com/sex/start/view.html?a=adult-products&pnum=SE0774-04

http://www.sextoysex.com/sex/start/view.html?a=adult-products&pnum=PD1720-14

http://www.sextoysex.com/sex/start/view.html?a=adult-products&pnum=PD1719-11

http://www.sextoysex.com/sex/start/view.html?a=adult-products&pnum=SE0698-14

http://www.sextoysex.com/sex/start/view.html?a=adult-products&pnum=SE0277-12

http://www.sextoysex.com/sex/start/view.html?a=adult-products&pnum=SE0693-00

http://www.sextoysex.com/sex/start/view.html?a=adult-products&pnum=SE0691-14

http://www.sextoysex.com/sex/start/view.html?a=adult-products&pnum=SE0672-12

http://www.sextoysex.com/sex/start/view.html?a=adult-products&pnum=TO7721-7

http://www.sextoysex.com/sex/start/view.html?a=adult-products&pnum=PD1709-11

http://www.sextoysex.com/sex/start/view.html?a=adult-products&pnum=PD1709-12

Posted by: vibrator | November 10, 2006 at 11:43 PM

When you are tired of exercising but without any result, what do you do? You look for reasons behind your http://www.adipexpower.com weight loss failure. Have you noticed that you cannot control your eating you favorite foods whenever they are in front of you? This is the main reason behind why you are not losing weight. What do you do now? You can use http://www.adipexpower.com adipex, the famous diet pill. It is an appetite suppressant that helps you control your food cravings! Now, how do you http://www.adipexpower.com buy adipex? Let me tell you that you can http://www.adipexpower.com buy adipex online and even get http://www.adipexpower.com cheap adipex. You just need to be clever enough to identify the best deal and http://www.adipexpower.com order adipex from the website which offers discount. I am sure you can do it yourself!

Posted by: adipex | November 15, 2006 at 11:42 PM

The distribution of free http://www.viagracare.com viagra has ushered in a revolution in the sex lives of the elderly population in Brazil which has further spread shock waves across the world. Elderly men suffering from sexual incapability in Brazil have got their sexual potency back and so what’s wrong in you guys like you who are in their 20s and 30s to http://www.viagracare.com buy viagra and get rid of erectile dysfunction? The advent of the internet has opened up a wealth of information on http://www.viagracare.com viagra online and as such you can easily http://www.viagracare.com buy viagra online and drive away the curse of erectile dysfunction form your life. As you get hold of http://www.viagracare.com cheap viagra and apply the drug to your system all your erectile dysfunction woes would take a backstage and therefore you would be able to start off with a new life.

Posted by: viagra | January 01, 2007 at 11:07 PM

Posted by: teen ronde | July 02, 2007 at 03:21 AM

Posted by: annie | August 08, 2007 at 09:15 AM

Posted by: annie | August 08, 2007 at 09:16 AM

I can't be bothered with anything lately. My mind is like a fog. I've just been hanging out not getting anything done. I've more or less been doing nothing.

Posted by: adidas martial art | August 30, 2007 at 01:57 AM

Home schooling provides a better education, is worse for your child

Posted by: oil | September 08, 2007 at 03:34 PM

Sexism is, is not a problem in society

Posted by: John | October 01, 2007 at 07:41 PM

The U.S.-Mexican border fence works, doesn't work

Posted by: human | October 17, 2007 at 02:17 AM

The comments to this entry are closed.

2004 WINNER: BEST CLINICAL SCIENCES MEDICAL WEBLOG

What People Are Saying

"Dr. Boyle is a man of strong views and good will...read the weblog."
Brad DeLong-- Semi-Daily Journal
"My New Favorite Internet Obsession"
cripes, suzette
"Marvelous Medical Blog"
Ambivalog
"Entertaining and lluminating"
Counterpunch Magazine
"Enjoyable Weblog"
Alexander Cockburn
"I have found a new medical blog, and a blogging hero."
Liz Ditz-- I Speak of Dreams
"Your Blog Rocks!"
Allyson Dyar-- DyarStraights.Com
"A remarkable blog."
Eric Scheie – Cultural Values
"Good thoughts"
E. Moritz-- Life Liberty and the Pursuit of Happiness

CodeBlueBlog

health care also health·care (hlthkâr) n. :efforts made to maintain or restore health especially by trained and licensed professionals -- usually hyphenated when used attributively

*****************

THE AWARD WINNING MEDICAL WEBLOG

April 2005

About

Recent Posts

Archives

Links

Are Canadian Health Care Consumers Morons?

Comments

2004 WINNER: BEST CLINICAL SCIENCES MEDICAL WEBLOG

What People Are Saying

Around The Hospital

Nonmedical Consultants

Science

Sources

Technorati

	Webster's Online Dictionary The Rosetta Edition™
	English Non-English