A comprehensive simulation for wait time reduction and capacity planning applied in general surgery

This paper describes the use of operational research techniques to analyze the wait list for the Division of General Surgery at the Capital District Health Authority in Halifax, Nova Scotia, Canada. A discrete event simulation model was developed to aid capacity planning decisions and to analyze the performance of the division. The analysis examined the consequences of redistributing beds between sites, and achieving standard patient lengths of stay, while contrasting them to current and additional resource options. From the results, multiple independent and combined options for stabilizing and decreasing waits for elective procedures were proposed.     

A Preterm Birth Prevention Project in Nova Scotia,Canada

Objective: The Halifax County Preterm Birth Prevention Project was designed to evaluate the effectiveness of a population-based preterm birth (PTB) prevention program in Nova Scotia from January 1995 through June 1997 (n = 10,326). Methods: Preterm birth rates, adjusted for risk status and maternal age, were evaluated over time in Halifax County and compared to non-Halifax County parturients in Nova Scotia. Physician participation was evaluated by means of a mailed survey. Results: There was no appreciable change in the overall (<37 weeks) or early (<34 weeks) PTB rates within or outside Halifax County during the intervention period compared to the preintervention period. Although not significant, the very (<30 weeks) PTB rate in Halifax County decreased by 40% from 0.53 to 0.32%, while outside Halifax County it remained stable (0.43–0.42%). There was a statistically significant decrease in early and very PTB associated with spontaneous labour, as well as an apparent shift in the timing of delivery from very preterm to preterm (30 weeks). Participation among responding physicians was greater for high-risk than low-risk women, but full compliance with project recommendations was low. Conclusion: The overall ineffectiveness of the Halifax County Preterm Birth Prevention Project may reflect the reluctance of practitioners to fully incorporate the recommended prevention strategies into their practice. However, such interventions may reduce the risk of spontaneous early preterm birth.     

Direct and indirect measures of patient satisfaction with physicians' services

This research examines alternative measures of patient satisfaction. Three measures were compared: (1) a direct measure to evaluate how the patient felt about his own personal physician, (2) an indirect measure that assessed attitudes about physicians in general, and (3) a measure designed to be intermediate between these two. Responses to the three measures were found to differ: the levels of satisfaction increased with the directness of the measure used; indirect evidence that this relationship could not be attributed solely to a patient's reluctance to criticize his own physician is also provided.The three measures were compared in terms of their association with other assessments of outcome and with indicators of the process of care. Although none of the associations was statistically significant, high scores on the intermediate measure tended to correspond with better outcomes and higher scores on the process of care. These findings are at least compatible with the contention that an intermediate measure provides the most valid assessment of patient satisfaction.Dr. Stewart, a National Health Research Scholar, was formerly with the Department of Epidemiology and Preventive Medicine, University of Western Ontario, and is now with the Department of Preventive Medicine, Dalhousie University, Halifax, Nova Scotia, Canada, B3H 4H7. Dr. Wanklin, is Professor in the Department of Epidemiology and Preventive Medicine, University of Western Ontario. Dr. Stewart has been supported by a Fellowship from the Physician's Services Incorporated Foundation (Ontario) and by a National Health Research Scholarship from Health and Welfare Canada. The authors wish to thank Drs. W. Weston, B. Halliday, D. Fuller, A. Hegde, P. Bartlett, and the staff and patients of the Tavistock Family Health Centre for their participation in this research.     

HIV counselling and testing in Nova Scotia: the provincial strategy in the context of an international debate

Nova Scotia, as a small province in Atlantic Canada, provides health care professionals and policy analysts with unique challenges for developing and implementing a strategy for accessible and acceptable HIV counselling and testing. Despite universal health care in Canada, barriers and challenges persist in relation to HIV counselling and testing programs and services in Nova Scotia. It is therefore necessary to examine the unique circumstances in the provision of programs and services in Nova Scotia prior to the possibility of adopting international HIV counselling and testing standards and guidelines being implemented in other jurisdictions. Nova Scotia's provincial strategy on HIV/AIDS promotes a harm-reduction approach for different populations in various service settings, recognizing the diverse circumstances and experiences of people living in Nova Scotia. By contrast, the Centers for Disease Control (CDC) recommended strategy promotes opt-out testing and in some instances alters the requirement of informed consent. As the Public Health Agency of Canada (PHAC) revises the national HIV counselling and testing policies, it is imperative to address the unique characteristics of Nova Scotia's provision of services, and how divergent strategies have the potential to address or compound the barriers to access that exist in this province's communities.     

Rising to the challenge: portering services at the Queen Elizabeth II Health Sciences Centre

With the recent formation of the Queen Elizabeth II Health Sciences Centre in Halifax, Nova Scotia, a number of challenges have arisen that must be addressed. One involves the porter service, which faces increased demands since every department has new and often expanded duties for porters. This paper identifies obstacles facing the porter service and develops recommendations, which may also be of interest to other healthcare facilities facing similar challenges.     

Q fever update, Maritime Canada

Since the 1990s, reports of Q fever in Nova Scotia, Canada, have declined. Passive surveillance for Q fever in Nova Scotia and its neighboring provinces in eastern Canada indicates that the clinical manifestation of Q fever in the Maritime provinces is pneumonia and that incidence of the disease may fluctuate.     

The hepatitis B immunization strategy in Nova Scotia: is it effective?

Since 1987, both hepatitis B disease and hepatitis B vaccine utilization have increased dramatically in Nova Scotia. We present a review of hepatitis B vaccine utilization relative to the occurrence of disease in Nova Scotia. In the two regions with the highest incidence rates, cases have been increasingly associated with lifestyle-related risk factors. Vaccine utilization was primarily for occupational risks. The current provincial hepatitis B immunization strategy is to recommend immunization to targeted high-risk groups. This strategy was judged to be ineffective. The cost of the vaccine is the most important deterrent for adopting an expanded or universal immunization strategy. The pooling of hepatitis B vaccine orders across Canada is suggested as a means to effect significant reductions in the cost of vaccine. Provincial programs would then be able to expand coverage to include populations at immediate risk and youngsters prior to the start of high-risk activity.     

Development of a computer linkage system for a blood recipient notification program in Nova Scotia

OBJECTIVES: To assess the potential uses of computer-assisted record linkage in the surveillance of infectious diseases, using the Nova Scotia blood recipient notification program as the example. METHODS: We developed a computer-assisted, multiple-pass, probabilistic record linkage to link records for blood recipients identified by the Nova Scotia notification program (Nova Scotia Phase I Blood Bank File information) with corresponding Nova Scotia Health Card Registration File records to obtain current mailing addresses to contact potentially living recipients. We used variables available from both files (e.g., name, date of birth, gender, and health care registration number) to link records, after eliminating duplicates/deceased cases. RESULTS: Among 23,925 eligible records in the Nova Scotia Phase I Blood Bank File (1984-1990), there were 1,818 (7.8%) duplications and 8,675 deceased cases, leaving 13,432 cases for linkage. 8,713 (65%) cases were successfully linked to the 1998 Health Card Registration Data File for current mailing addresses. INTERPRETATION: Multiple-pass linkage seems acceptable for maximizing detection of correctly matched records for look-back projects. To overcome quality/lack of information obstacles, future look-back linkages should explore the use of supplementary data files (tax files, voter lists, license files, other provincial databases) to obtain most current addresses.     

Making Canadian healthcare facilities 100% smoke-free: a national trend emerges

When the Calgary Health Region, the Mental Health Centre in Penetanguishene and Capital Health in Nova Scotia declared their sites 100% smoke-free (both buildings and grounds) in May of 2002 and May of 2003 respectively, the change was considered radical and foolish by some. Since then, the move to 100% smoke-free healthcare facilities has become a national trend in Canada, with many facilities following suit and many others planning to make the change. In this article, the authors reflect on what they have learned in these three jurisdictions and offer some advice for healthcare facilities preparing to implement smoke-free property policies.     

The value of music for hospitalized infants.

Infants are very responsive to stimuli and may be even more vulnerable to the adverse effects of hospitalization than older children. Play techniques are effective in helping older children cope with the emotional effects of hospitalization; however their potential may be limited with small infants. Music therapy could offer a more direct and effective means of constructive interaction with this easily overlooked and underestimated age group. This paper reviews the results of a three-month trial of music therapy in an infant ward at the Izaak Walton Killam Hospital for Children, Halifax, Nova Scotia.     

An environmental radionuclide baseline study near three Canadian naval ports.

This paper summarizes an environmental radionuclide baseline study undertaken for the Department of National Defence in Canada. The purpose of the project was to establish levels of radionuclides present in the environment around areas where nuclear propelled vessels may be berthed. Specifically, this report describes environmental baselines near Halifax (Nova Scotia), Esquimalt (British Columbia), and Nanoose Bay (British Columbia). Valued ecosystem component samples were taken from dairy farms, beef producers, market gardens, vegetables, tree fruits and berries within the study areas, as well as marine bivalves (mussels and clams), salmon, seaweed, and food from native fisheries. Numerous naturally occurring isotopes were detected and quantified. The only non-naturally occurring isotope positively identified was in the form of trace quantities of 131I, measured in the Halifax study zone (attributed to local hospital cancer therapy). 137Cs is the only other anthropogenic radionuclide detected. Its origin may be the combination of fallout from the Chernobyl accident and fallout from atmospheric nuclear weapon tests. The results indicate that nuclear-powered vessels have not resulted in activity levels that would contribute a significant radiation exposure to the public, the biota, and the environment within the three study zones.     

Legionellaceae in the potable water of Nova Scotia hospitals and Halifax residences.

Water was cultured from 39 of 48 hospitals (7 Halifax hospitals and 32 non-Halifax hospitals) in the province of Nova Scotia and from 90 residences (74 private dwellings, 16 apartments) in Halifax to determine the frequency of legionella contamination. Six of seven Halifax hospitals had Legionellaceae isolated from their potable water compared with 3 of 32 non-Halifax hospitals (P < 0.0001). Overall, 19 of 59 (32%) of the water samples from Halifax hospitals were positive for legionellae compared with 5 of 480 (1%) samples from non-Halifax hospitals (P < 0.0000). Five of the six positive Halifax hospitals had Legionella pneumophila serogroup 1 and 1 had L. longbeachae serogroup 2 recovered from their potable water. Legionella contamination was associated with older, larger (> or = 50 beds) hospitals with total system recirculation. These hospitals also had water with a higher pH and calcium content but lower sodium, potassium, nitrate, iron and copper content. Fourteen of the 225 (6.2%) water samples from Halifax residences were positive for legionellae -8% (6/74) of the single family dwellings were positive, compared with 25% (4/16) apartments. The positivity rate of 15.7% for the 19 electric hot-water heaters in Halifax homes was not significantly different from the 32% positivity for Halifax hospitals. L. longbeachae accounted for 2 of the 14 isolates of legionellae from Halifax homes.     

A team approach to improving colorectal cancer services using administrative health data

Background  

Colorectal cancer (CRC) is the third most commonly diagnosed cancer in Canada and accounts for 11.9% of all cancer-related mortality. Fortunately, previous studies have provided evidence of improved outcomes from access to timely and appropriate health services along the disease trajectory in CRC. As a result, the CIHR/CCNS Team in Access to Colorectal Cancer Services in Nova Scotia (Team ACCESS) was created to build colorectal cancer (CRC) research capacity in Nova Scotia (NS) and to study access to and quality of CRC services along the entire continuum of cancer care.     

Adapting Prehospital Care to a Large Rural Geographic Area: A Review of the Emergency Health Services Nova Scotia Implementation

Nova Scotia is building a system of prehospital care based on four principles: “Fail Safe” government ownership; “Full Service” advanced life support capable; “High Performance” resource efficiency; and “Fiscally Responsible” performance goals, incentives and penalties. Emergency Health Services Nova Scotia exercises funding and regulatory control through service provided by a private contractor. Benefits include improved fleet and equipment management, information systems, 911 dispatch and performance tracking, medical control and paramedic care, and public accountability. Problems include rural dispatch, budget costs, labour issues and stakeholder communication.     

COVID-19 street reallocation in mid-sized Canadian cities: socio-spatial equity patterns

InterventionStreet reallocation interventions in three Canadian mid-sized cities: Victoria (British Columbia), Kelowna (British Columbia), and Halifax (Nova Scotia) related to the COVID-19 pandemic.Research questionWhat street reallocation interventions were implemented, and what were the socio-spatial equity patterns?MethodsWe collected data on street reallocations (interventions that expand street space for active transportation or physical distancing) from April 1 to August 15, 2020 from websites and media. For each city, we summarized length of street reallocations (km) and described implementation strategies and communications. We assessed socio-spatial patterning of interventions by comparing differences in where interventions were implemented by area-level mobility, accessibility, and socio-demographic characteristics.ResultsTwo themes motivated street reallocations: supporting mobility, recreation, and physical distancing in populous areas, and bolstering COVID-19 recovery for businesses. The scale of responses ranged across cities, from Halifax adding an additional 20% distance to their bicycle network to Kelowna closing only one main street section. Interventions were located in downtown cores, areas with high population density, higher use of active transportation, and close proximity to essential destinations. With respect to socio-demographics, interventions tended to be implemented in areas with fewer children and areas with fewer visible minority populations. In Victoria, the interventions were in areas with lower income populations and higher proportions of Indigenous people.ConclusionIn this early response phase, some cities acted swiftly even in the context of massive uncertainties. As cities move toward recovery and resilience, they should leverage early learnings as they act to create more permanent solutions that support safe and equitable mobility.     

Socioeconomic determinants of mortality in two Canadian provinces: multilevel modelling and neighborhood context

The influence of individual and contextual socioeconomic variables on mortality is compared in two Canadian provinces, Manitoba and Nova Scotia. Although differing substantially in size, ethnic mix, and history, both provinces provide greater access to health and social services as well as fewer income inequalities than the United States. A total of 8032 Manitoba respondents (followed from 1996-97 to 2002) and 2116 Nova Scotia respondents (followed from 1990 to 1999) were linked to the appropriate Canadian census as a source of neighborhood characteristics. Data were analyzed using individual- and multi-level logistic regression. Well-educated and higher income individuals were less likely to die during follow-up. No significant direct effect was found between neighborhood socioeconomic characteristics and mortality. However, both provinces showed an increased importance of individual income vis-à-vis mortality in advantaged neighborhoods relative to disadvantaged neighborhoods. Additional Manitoba analyses showed a "healthy mover" effect among respondents changing place of residence, regardless of whether they moved to more advantaged or more disadvantaged neighborhoods. The findings are discussed in the context of differences in health and health care among Canada, the United States, and other OECD countries.     

Overweight Nova Scotia children and youth: the roles of household income and adherence to Canada's Food Guide to Healthy Eating

OBJECTIVE: Poor diet quality has been observed in Nova Scotia children and youth, characterized by low intake from the traditional four food groups and a high intake from the Other Foods category. In this study, we addressed how household income and adherence to Canada's Food Guide to Healthy Eating influenced weight status category in Nova Scotia children and youth. METHODS: During the 2005-06 school year, data were collected from 2,296 students and their parents, across Nova Scotia. Questionnaires and anthropometric measurements were obtained from grades 3, 7 and 11 students. The grade 3 students were excluded from the dietary intake assessment. The information collected from the online 24-hour food recalls and food frequency questionnaires were analyzed for adherence to Canada's Food Guide to Healthy Eating recommendations. A general linear model was employed to examine the relationships between household income, food group and weight status category. RESULTS: Overall adherence to Canada's Food Guide to Healthy Eating was low among grades 7 and 11 students. Fewer servings from Grain Products, Milk Products and Vegetables and Fruit were observed in at risk of overweight and overweight students. At risk of overweight and overweight were significantly related to lower household income in grades 3 and 11. Our results show that the rates of overweight in Nova Scotia students are double those reported by the 2004 Canadian Community Health Survey. CONCLUSION: Household income and dietary intake play significant roles in weight status among Nova Scotia children and youth.     

Diet quality and cancer incidence in Nova Scotia,Canada

Cancer rates in the province of Nova Scotia, Canada, are among the highest in the country and coincide with elevated rates of risk factors such as smoking, poor diet, and obesity. To investigate the importance of diet on cancer, using data from the 1990 Nova Scotia Nutrition Survey, we developed a diet quality score reflecting compliance with 17 nutrient recommendations. The survey data were subsequently linked with the provincial cancer registry, and the relationship between diet quality and cancer was quantified using logistic regression. Our results support an inverse relationship between diet quality and cancer, although limited statistical power resulting from our small study sample did not reveal any statistically significant relationships. We estimated that cancer incidence could potentially be reduced by approximately 35% through improved diet quality. On the basis of poor diet, nutrition-related factors (high body mass index), our estimates of the preventable fraction of cancer, and the high provincial cancer rates, we recommend health promotion strategies aimed at improving diet quality in Nova Scotia.     

An incremental cost analysis of telehealth in Nova Scotia from a societal perspective

We examined the costs of telehealth in Nova Scotia from a societal perspective. The clinical outcomes of telepsychiatry and teledermatology services were assumed to be similar to those for conventional face-to-face consultations. Cost information was obtained from the Nova Scotia Department of Health, the Canadian Institute for Health Information, and questionnaires to patients, physicians and telehealth coordinators. There were 215 questionnaires completed by patients, 135 by specialist physicians and eight by telehealth coordinators. Patient costs for a face-to-face consultation ranged from $240 to $1048 (all costs in Canadian dollars), whereas patient costs for telehealth were lower, from $17 to $70. However, from a societal perspective, the overall cost of providing face-to-face services was lower than for telehealth: the total costs for face-to-face services ranged from $325 to $1133, while the total costs for telehealth services ranged from $1736 to $28,084. A threshold analysis showed that, above a certain patient workload, telehealth services would be more cost-effective than face-to-face services from a societal perspective. This workload is attainable in Nova Scotia.     

A histopathological examination of,and analysis for polychlorinated hydrocarbons in,inshore Atlantic cod (Gadus morhua)

In a sample of 100 live Atlantic cod (Gadus morhua) collected near the entrance of Halifax Harbour, Nova Scotia, in August 1980, 73% had histopathological lesions in their livers similar to those produced by toxicants such as polychlorinated hydrocarbons. These lesions were characterized by fatty degeneration and, in a few samples, desquamation of the epithelia of bile ducts. Only 8% of the fish sampled, all males and at the lower end of the size spectrum, had liver tissue with apparently normal parenchyma. The remaining 19% had early indications of pathologic alterations.The concentrations of several common polychlorinated hydrocarbons found in the environment were determined in the cod livers and there was no apparent concentration-histopathologic relationship.