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Quebec: University Hospitals on the Move
, , , , ,
G U E S T
The Society of Obstetricians and Gynaecologists of Canada COUNCIL MEMBERS 1996-1997
EDITORIAL
, , , , ,
Quebec: University Hospitals on the Move
PRESIDENT Dr. Nan Schuurmans - Edmonton PAST PRESIDENT: Dr. Garry Krepart - Winnipeg PRESIDENT ELECT Dr. Robert Reid - Kmgston EXECUTIVE VICE-PRESIDENT: Dr Andre B. Lalonde - Ottawa ASSOCIATE EXECUTIVE VICE-PRESIDENT' Dr Robert Kinch - Ottawa TREASURER, Dr. Antonm Rochette - Lorettev,lIe VICE PRESIDENTS, Dr. Thomas Baskett - Hal,fax Dr. Robert Gauthier - Montreal REGIONAL CHAIRS & DEPUTY CHAIRS WESTERN REGION Dr. Jan Chrostilaw - Wh,te Rock Dr Donald Davis - Medicine Hat CENTRAL REGION Dr Chu, K,n Yuen - W,nn'peg Dr. Th,rza Sm,th - Saskatoon ONTARIO REGION Dr Donna Fedorkow - Hamilton Dr Stephen Fairley - Thunder Bay OUEBEC REGION Dr CaJetan Gauth,er - Lev,s Dr. Vyta Sen,kas - Montreal ATLANTIC REGION Dr David A. Knickle - Charlottetown Dr Garth Christie - Fredericton PUBLiC REPRESENTATIVE Ms. Janet MacMilian - Halifax JUNIOR FELLOW REPRESENTATIVE Dr Robert Krushel - SI. John's ASSOCIATE MD REPRESENTATIVE Dr. T Riley - Oakville ASSOCIATE NURSING REPRESENTATIVE Ms. Maroe-Josee Trepan,er - Ottawa NATIONAL OFFICE EXECUTIVE VICE-PRESIDENT Dr Andre B. Lalonde DIRECTOR OF COMMUNICATIONS Marie Cous,neau 774 Echo Drive Ottawa, Ontaroo K1S SN8 tel : (613) 730-4192 or 1·800-561-2416 fax . (613) 730·4314
In Quebec, as in other provinces, the exponential growth ofhealth costs has forced govemment to make difficult choices on behalf of the population and health professionals. A few years ago, areform based on "Health for the citizen" emphasized the values of health promotion and selfmanagement by individuals themselves. One year ago, we reached the next step: closure or "change of mission" of several hospitals. In Quebec City, there will be only two matemity health centres, rather than six, and four gynaecological units Jean-Marie Moutquin, MD. instead of eight. In Montreal and Sherbrooke, the FRCSC, Director, Research Centre CHUO, Pavillon Saintproportion will be similar. With this reduction of Fran~ois d'Assise, Department facilities, the population will be redirected to conof Obstetrics and Gynaecology, Universite Laval, Ouebec centrated areas of medical expertise and advanced high technology. Of course, this reorganization of the health care system was carried out after appropriate consultation with the four medical schools. A dream will become reality: real university hospitals, following the example of the University Hospital (CHU) at Sherbrooke established decades ago. At the University ofMontreal, Hopital Sainte-}ustine becomes a perinatal and paediatric university hospital while the merged Notre-Dame, Saint-Luc and Hotel-Dieu will be the second CHU. At Laval University, we will have the Centre hospitalier universitaire de Quebec (CHUQ) formed by three pavillions (former CHUL, HotelDieu, Saint-Franc;:ois d'Assise). McGill University went a step further in deciding to build a new facility, hosting disciplines and professionals from the Royal Victoria, Montreal General hospital, and the Montreal Childen's hospitaL Already, administrative boards are operating, every health professional is mobilized, and meetings are held constantly to create a new culture within this reconstituted family. However, the essential is yet to come: a new paradigm for most of us that is the constant interaction of care, teaching, and research in every health activity that will be carried out in this new health centre. Several issues have to be addressed. Is there not an apparent discrepancy when the reduction of costs to be implemented in a university hospital is assessed as if it were a health centre without teaching and research? Training health professionals increases by 10 percent the standard health cost for the time taken at the bedside, the delay in nursing care due to the presence of students or even the investigational use of material and equipment. What about indirect cost of
JOURNAL SOGC
1211
DECEMBER 1996
Introducing
MIGRANAL Nasal Spray
A 5-HT1 agonist that starts
fast and offers long-lasting relief from migraine
5-HT1 agonist therapy • MIGRANAL relieves migraine headaches and associated symptoms 1 • Nasal administration bypasses the Gl tract
Fast onset of relief • Can be taken at any stage of the migraine 1•0 • Clinical response begins within 30 minutes 1 • MIGRANAL relieved up to 70% of migraines at 4 hours (n=105)2·t
Long-lasting relief tt • Long half-life: 10 hours 1 • 85% of responders had no return of migraine within 24 hours after taking MIGRANAL (n=73) 2 · Therefore, MIGRANAL may help avoid the need for repeated dosing, rescue medication, and the associated costs.
Generally well-tolerated in clinical trials 1 • Most common adverse events were transient and self-limiting, and may be attributable to the route of administration 2•3 : Rhinitis (25% incidence) reported as rhinitis, rhinorrhea, nasal/nose congestion, dryness, edema and excessive sneezing; other side effects observed included: nausea (9%), taste disturbance (7%) and vomiting (4%). 0 For best results, treatment should be initiated at the first sign/symptom of a migraine attack.
t Relief = from moderate/severe pain to mild/no pain tt Up to 24 hours with a single 2 mg dose
MIGRANAL is contraindicated in patients predisposed to vasospastic reactions. Please see Prescribing Information for more details.
rnMtGRANAl •Reg istered trademark
A SANDO%
MIG-96-IG-3531 E
SANDOZ CANADA INC. Oorvol, Ouibec H9R
~PS
(dihydroergotamine mesylate nasal spray)
Fast migraine relief that lasts
, , , dinical research in wards and dinics (information, consent, implementation of research interventions)? All our women in labour and on the gynaecological wards need to be informed that they will be sharing the tripie mission (care, training, research) of a university centre. Indeed, they will be provided with the highest dinical care from many health professionals at various levels of experience. Information has to be conveyed to these women taking into account their own values and sensitivities. Health professionals, induding nurses, midwifes, and technicians, will become partners not only in care, but also in every training and research activity. In some centres, we have still to work to attain this objective. Every obstetrician/gynaecologist eventually will be part of a practice plan; this is welcomed by most of us, but decisions on the details of this plan are not yet in place.
What about research? The tenure track is no longer ensured by universities which are under severe financial restrictions, and salary support or even grant fundings from Government agencies are running short. How will the university hospital generate soft monies for essential infrastructure and development and new recruitment? The long expected CHU is becoming a reality for the wrong reasons: budgetary restrictions in the health care system. We have to build it considering its ultimate goal; that is, improved health care based on high quality teaching derived from knowledge acquired within the centre by our scientists and teachers despite limited resources. The future will tell us whether we have succeeded with all these challenges.
J SOGe
1996;18:1211-13
Optimal health care begins vvith the biosam lers of choice Effective cancer and disease detection depend upon collecting the best possible biological sampies and getting them safely to the lab. Cytobrush Plus cell collector Endocervical sampling for Pap smears and STO tests. Cat. No. MED-1101
IV\edscand e
Gentle Touch Cytobrush Plus cell collector • Extra cushion tip for added patient comfort and safety. Cat. No. MED- 6101
JOURNAL SOGC
1213
DECEMBER 1996
Accellon Combi cervical biosampier • Sampling of both endo- and exocervical cells simultaneously. nme saving, cost saving, one step cell retrieval method. Cat. No. MED-8101 For turther information or sampies, please call,
MDS Ingram & Bell
20 Bond Ave. Don Mills ON M3B 1L9 Att: Gord Platt 416-444·7381 1-800·387·8088 Fax: 416-444-3894 1-800-859-8274
G U E S T
The Society of Obstetricians and Gynaecologists of Canada COUNCIL MEMBERS 1996-1997
EDITORIAL
, , , , ,
Quebec: University Hospitals on the Move
PRESIDENT Dr. Nan Schuurmans - Edmonton PAST PRESIDENT: Dr. Garry Krepart - Winnipeg PRESIDENT ELECT Dr. Robert Reid - Kmgston EXECUTIVE VICE-PRESIDENT: Dr Andre B. Lalonde - Ottawa ASSOCIATE EXECUTIVE VICE-PRESIDENT' Dr Robert Kinch - Ottawa TREASURER, Dr. Antonm Rochette - Lorettev,lIe VICE PRESIDENTS, Dr. Thomas Baskett - Hal,fax Dr. Robert Gauthier - Montreal REGIONAL CHAIRS & DEPUTY CHAIRS WESTERN REGION Dr. Jan Chrostilaw - Wh,te Rock Dr Donald Davis - Medicine Hat CENTRAL REGION Dr Chu, K,n Yuen - W,nn'peg Dr. Th,rza Sm,th - Saskatoon ONTARIO REGION Dr Donna Fedorkow - Hamilton Dr Stephen Fairley - Thunder Bay OUEBEC REGION Dr CaJetan Gauth,er - Lev,s Dr. Vyta Sen,kas - Montreal ATLANTIC REGION Dr David A. Knickle - Charlottetown Dr Garth Christie - Fredericton PUBLiC REPRESENTATIVE Ms. Janet MacMilian - Halifax JUNIOR FELLOW REPRESENTATIVE Dr Robert Krushel - SI. John's ASSOCIATE MD REPRESENTATIVE Dr. T Riley - Oakville ASSOCIATE NURSING REPRESENTATIVE Ms. Maroe-Josee Trepan,er - Ottawa NATIONAL OFFICE EXECUTIVE VICE-PRESIDENT Dr Andre B. Lalonde DIRECTOR OF COMMUNICATIONS Marie Cous,neau 774 Echo Drive Ottawa, Ontaroo K1S SN8 tel : (613) 730-4192 or 1·800-561-2416 fax . (613) 730·4314
In Quebec, as in other provinces, the exponential growth ofhealth costs has forced govemment to make difficult choices on behalf of the population and health professionals. A few years ago, areform based on "Health for the citizen" emphasized the values of health promotion and selfmanagement by individuals themselves. One year ago, we reached the next step: closure or "change of mission" of several hospitals. In Quebec City, there will be only two matemity health centres, rather than six, and four gynaecological units Jean-Marie Moutquin, MD. instead of eight. In Montreal and Sherbrooke, the FRCSC, Director, Research Centre CHUO, Pavillon Saintproportion will be similar. With this reduction of Fran~ois d'Assise, Department facilities, the population will be redirected to conof Obstetrics and Gynaecology, Universite Laval, Ouebec centrated areas of medical expertise and advanced high technology. Of course, this reorganization of the health care system was carried out after appropriate consultation with the four medical schools. A dream will become reality: real university hospitals, following the example of the University Hospital (CHU) at Sherbrooke established decades ago. At the University ofMontreal, Hopital Sainte-}ustine becomes a perinatal and paediatric university hospital while the merged Notre-Dame, Saint-Luc and Hotel-Dieu will be the second CHU. At Laval University, we will have the Centre hospitalier universitaire de Quebec (CHUQ) formed by three pavillions (former CHUL, HotelDieu, Saint-Franc;:ois d'Assise). McGill University went a step further in deciding to build a new facility, hosting disciplines and professionals from the Royal Victoria, Montreal General hospital, and the Montreal Childen's hospitaL Already, administrative boards are operating, every health professional is mobilized, and meetings are held constantly to create a new culture within this reconstituted family. However, the essential is yet to come: a new paradigm for most of us that is the constant interaction of care, teaching, and research in every health activity that will be carried out in this new health centre. Several issues have to be addressed. Is there not an apparent discrepancy when the reduction of costs to be implemented in a university hospital is assessed as if it were a health centre without teaching and research? Training health professionals increases by 10 percent the standard health cost for the time taken at the bedside, the delay in nursing care due to the presence of students or even the investigational use of material and equipment. What about indirect cost of
JOURNAL SOGC
1211
DECEMBER 1996
Introducing
MIGRANAL Nasal Spray
A 5-HT1 agonist that starts
fast and offers long-lasting relief from migraine
5-HT1 agonist therapy • MIGRANAL relieves migraine headaches and associated symptoms 1 • Nasal administration bypasses the Gl tract
Fast onset of relief • Can be taken at any stage of the migraine 1•0 • Clinical response begins within 30 minutes 1 • MIGRANAL relieved up to 70% of migraines at 4 hours (n=105)2·t
Long-lasting relief tt • Long half-life: 10 hours 1 • 85% of responders had no return of migraine within 24 hours after taking MIGRANAL (n=73) 2 · Therefore, MIGRANAL may help avoid the need for repeated dosing, rescue medication, and the associated costs.
Generally well-tolerated in clinical trials 1 • Most common adverse events were transient and self-limiting, and may be attributable to the route of administration 2•3 : Rhinitis (25% incidence) reported as rhinitis, rhinorrhea, nasal/nose congestion, dryness, edema and excessive sneezing; other side effects observed included: nausea (9%), taste disturbance (7%) and vomiting (4%). 0 For best results, treatment should be initiated at the first sign/symptom of a migraine attack.
t Relief = from moderate/severe pain to mild/no pain tt Up to 24 hours with a single 2 mg dose
MIGRANAL is contraindicated in patients predisposed to vasospastic reactions. Please see Prescribing Information for more details.
rnMtGRANAl •Reg istered trademark
A SANDO%
MIG-96-IG-3531 E
SANDOZ CANADA INC. Oorvol, Ouibec H9R
~PS
(dihydroergotamine mesylate nasal spray)
Fast migraine relief that lasts
, , , dinical research in wards and dinics (information, consent, implementation of research interventions)? All our women in labour and on the gynaecological wards need to be informed that they will be sharing the tripie mission (care, training, research) of a university centre. Indeed, they will be provided with the highest dinical care from many health professionals at various levels of experience. Information has to be conveyed to these women taking into account their own values and sensitivities. Health professionals, induding nurses, midwifes, and technicians, will become partners not only in care, but also in every training and research activity. In some centres, we have still to work to attain this objective. Every obstetrician/gynaecologist eventually will be part of a practice plan; this is welcomed by most of us, but decisions on the details of this plan are not yet in place.
What about research? The tenure track is no longer ensured by universities which are under severe financial restrictions, and salary support or even grant fundings from Government agencies are running short. How will the university hospital generate soft monies for essential infrastructure and development and new recruitment? The long expected CHU is becoming a reality for the wrong reasons: budgetary restrictions in the health care system. We have to build it considering its ultimate goal; that is, improved health care based on high quality teaching derived from knowledge acquired within the centre by our scientists and teachers despite limited resources. The future will tell us whether we have succeeded with all these challenges.
J SOGe
1996;18:1211-13
Optimal health care begins vvith the biosam lers of choice Effective cancer and disease detection depend upon collecting the best possible biological sampies and getting them safely to the lab. Cytobrush Plus cell collector Endocervical sampling for Pap smears and STO tests. Cat. No. MED-1101
IV\edscand e
Gentle Touch Cytobrush Plus cell collector • Extra cushion tip for added patient comfort and safety. Cat. No. MED- 6101
JOURNAL SOGC
1213
DECEMBER 1996
Accellon Combi cervical biosampier • Sampling of both endo- and exocervical cells simultaneously. nme saving, cost saving, one step cell retrieval method. Cat. No. MED-8101 For turther information or sampies, please call,
MDS Ingram & Bell
20 Bond Ave. Don Mills ON M3B 1L9 Att: Gord Platt 416-444·7381 1-800·387·8088 Fax: 416-444-3894 1-800-859-8274