Pulsimeter

Film review

Something the Lord Made. Directed by Joseph Sargent; HBO Films, 2004.

Something the Lord Made is a moving true story of the men and women willing to challenge the then-current cardiac law of nolitangere (do not touch). Unwilling to accept that the human heart cannot be operated on, these doctors pioneer the medical revolution of cardiac surgery that continues today. An unlikely surgical team, Dr Alfred Blalock (Alan Rickman) and Vivien Thomas (Mos Def), race against time to save one of Dr Helen Taussig’s (Mary Stuart Masterson) “blue babies” from certain death. Without intervention this young girl, born with tetralogy of Fallot, is destined to die of heart failure. Black and poor, Thomas is a carpenter by trade and has no formal medical training. His plans of becoming a doctor are ruined by the Great Depression, so he takes a job working in the laboratory of Blalock, the white, wealthy head of surgery at Johns Hopkins University. Despite numerous religious and social obstacles, they forge ahead, creating the Blalock-Taussig shunt. Not only is this movie an enjoyable look at the makings of modern medicine, but it is an equally fascinating tale of the struggle against racism.

Highly recommended.

—DRR

Book review

The Youth of British Columbia: Their Past and Their Future. Edited by Roger S. Tonkin and Leslie T. Foster. Victoria: Western Geographical Press, 2005. ISBN 0-919838-29-4. Paperback, 233 pages. $24.95.

This book brings those who care about young people up to date with what is happening to and for the youth of British Columbia. It explores many dimensions of the youth of British Columbia, both historically and conceptually. The authors of the various sections are experienced and knowledgeable and engage the reader in a compelling way.

The McCreary Society of BC has been collecting data for over a decade on how BC youth view their own health. It is unique data, acquired through questionnaires in schools, among street youth, and among youth with special needs. The information from these surveys has been extremely important in developing policy about health education and health care for youth. However, the scope of youth activities is far broader than health, and this amazing book has collected information on the many dimensions.

Adolescence is commonly considered the healthiest time in life. However, adolescents tend to engage in risky behavior, including drinking and drug use. The demographics make clear that low-income families, particularly in rural areas, have the highest occurrence of this type of risky behavior. Because of the decentralization and multidisciplinary approach to adolescent health, most communities have little awareness of the needs that are unique to youth.

It is no surprise that the leading cause of death among youth is injury and that most deaths from injuries could easily be avoided. Mental illness is also common. Fortunately, the rates of pregnancy, suicide, and smoking among BC youth seem to be decreasing.

For anybody interested in or working with youth, this book is a must. It is chock-full of data and information about the approaches that have been shown to work in BC. It emphasizes that youth are relatively underserved in BC and have unique needs. For those with a young person in their family, it is a particularly good read in order to understand what that young person is exposed to and the positive approaches that seem to work at this time in life and history.

—Judith G. Hall, MD
Vancouver

McManus wins technology innovation award

Dr Bruce McManus recently received the Lieutenant Governor’s Technology Innovation Award from the BC Innovation Council. Dr McManus was presented with the award on 6 November 2006 at the Fairmont Hotel Vancouver for leading contributions to health research in BC that have resonated around the world.

Dr McManus, a professor in the Department of Pathology and Laboratory Medicine at UBC, is also the director of the James Hogg iCAPTURE Centre for Cardiovascular and Pulmonary Research and scientific director of the Heart Centre at St. Paul’s Hospital, Providence Health Care campus.

An innovative research leader in the field of cardiovascular sciences, Dr McManus and his laboratory have made many breakthroughs that have catalyzed significant changes in clinical practice. Their revolutionary work has had an impact on areas ranging from the protection of transplanted hearts to prompting safer therapies for obesity. By showing for the first time the extent and mechanisms of enteroviral injury of heart muscle, Dr McManus caused a paradigm shift in therapeutic approaches for fulminant infections that often affect infants. Moreover, he and his team have addressed diverse and complex data sets through leading edge technological initiatives. In one such initiative, Dr McManus has collaborated with bioinformatics experts to initiate a novel computational environment for cardiovascular disease that captures research and clinical data with contextual meaning to allow researchers to accelerate and streamline experimentation.

Dr McManus co-leads a major Genome Canada project to identify and validate predictive and diagnostic biomarkers of acute and chronic allograft rejection in heart, kidney, and liver transplant recipients. A forerunner in applying new technological developments to his research, Dr McManus has engaged experts in informatics, biostatistics, immunology, proteomics, genomics, and metabolomics to conduct a large-scale search for these novel biomarkers. The results will save health system resources and save patients much pain and risk as the need for organ biopsy will be eliminated and personalization of immunosuppressive therapy will be possible.

Dr McManus’s achievements include devising a national strategic research plan for the Institute of Circulatory and Respiratory Health (CIHR) as its inaugural scientific director. He developed several major international programmatic and funding partnerships while building this strategy for heart, lung, blood vessel, blood, sleep, and critical care research. Especially committed to supporting young innovators, he has also established initiatives such as the National Young Investigators Research Forum for the respiratory and circulatory sciences.

The Innovation Council also presented four other awards:

• BC Science & Technology Champion of the Year Award: Dr Martha C. Piper, past president and vice-chancellor, UBC.

• Chairman’s Award for Career Achievement: Dr Michael Hayden, director and senior scientist, Centre for Molecular Medicine and Therapeutics, UBC.

• Eve Savory Award for Science Communication: Ms Shar Levine, freelance writer, designer, and marketing consultant and Ms Leslie Johnstone, freelance writer, designer, and Science Department head, Point Grey Secondary School.

• Frontiers in Research Award: Dr Luciana Duranti, professor, School of Library, Archival and Information Studies, UBC.

Congratulations to all the winners.

Mentors needed

As part of its Scientists & Innovators in the Schools program, Science World is hosting “Opening the Door—Health Sciences Edition” in Vancouver at Science World for students in grades 10 to 12 on Thursday, 23 November 2006. They need 8 to 12 volunteers in the health science/medical professions as mentors for this event, which takes place from 11:30 a.m. to 2 p.m. Please contact Ms Jennifer Scott, program coordinator, at 604 443-7551, 800 363-1611, or jscott@scienceworld.ca for more information or to volunteer. Expenses such as mileage and parking will be paid.

Genomic markers to help prevent ADRs in children

In September the Centre for Healthcare Innovation & Improvement at the Child & Family Research Institute and the Faculty of Pharmaceutical Sciences at the University of British Columbia announced a contribution of $500000 over 2 years by Eli Lilly Canada to a Genome Canada/Genome BC-sponsored research program.

The project, Genotype-Specific Approaches to Therapy in Childhood (GATC), is a BC-led national strategy to improve drug safety for children. The study aims to prevent adverse drug reactions in childhood by identifying predictive genomic markers for specific adverse drug reactions.

The study is led from two research centres within the Child & Family Research Institute at BC Children’s Hospital. Dr Bruce Carleton from the Centre for Healthcare Innovation & Improvement is a world leader in drug safety research and co-guest editor of the BCMJ’s September theme issue on patient safety (BCMJ 2006;48:324-341). Dr Michael Hayden, the director of the Centre for Molecular Medicine & Therapeutics, is an internationally recognized expert in pharmacogenomics.

The GATC program was funded by Genome Canada and Genome BC in 2004 and represents a partnership with several other universities including McGill, the University of Toronto, the University of Western Ontario, McMaster University, and the University of Kansas.

The GATC project hopes, within 5 years, to identify adverse drug reaction markers that may be used to predict and prevent drug toxicity in children. The markers developed will permit specific dosing recommendations for commonly used drugs based on a patient’s genetic makeup. 

Total funding for the GATC project is set at $8.4 million over 3 years. Half of this total is provided by Genome Canada through Genome BC. In addition to Eli Lilly Canada, other major contributors include the Canadian Genetic Disease Network, Provincial Health Services Authority, UBC Faculty of Pharmaceutical Sciences, the Child & Family Research Institute, and Pfizer Canada.

Incentives for full-service FPs

The General Practices Services Committee (GPSC) was established to encourage family practitioners to practise comprehensive and longitudinal family medicine in order to improve patient care and, at the same time, ensure that family practice remains viable by offering incentives that support a better quality of work life for practitioners. Based on these objectives, the GPSC developed a new, enhanced fee structure for family practitioners that came into effect 1 April 2006:

FP Obstetrical Premium—a continuation of the Full Service Family Practice Obstetrical Care Incentive Program introduced in 2003. It provides a 50% bonus on the MSC Payment Schedule delivery fee codes 14104 and 14109. The purpose of the payment is to encourage family practitioners to continue providing obstetrical care, giving women the benefit of choice and longitudinal care.

Maternity Network Initiative—eligible family practitioners receive a quarterly payment of $1250 (which includes additional CMPA subsidy with an approximate value of $650 per year) to cover the costs of group/network activities for their shared care of obstetric patients. The purpose of this initiative is to bring family practitioners together for mutual support so that they can offer obstetrical care in a planned and efficient manner. As of September 2006, FPs had created 115 maternity care networks throughout BC. This initiative has effectively stabilized the number of family practitioners providing maternity care in the province.

Chronic Disease Management Incentive Bonus—a continuation of the Full Service Family Practice Condition Payment introduced in 2003. These payments recognize the additional work of providing guideline-based care to patients over time, beyond the office visit payments. The program has been enhanced through an increased annual bonus amount for provision of clinical guidelines-based diabetes (14050) and congestive heart failure care (14051) from $75 to $125 per person and the introduction of a $50 bonus payment for clinical guidelines-based hypertension management (14052). Significantly more family practitioners are using the Diabetes Care Flow Sheets for the management of diabetes to improve the quality and consistency of care for their patients. As of September 2006, 70% of patients whose family practitioner billed for the diabetes incentive are being treated according to approved guidelines—a 66% improvement from when it was introduced 3 years ago. These patients are being tested and monitored at least twice a year for their diabetes and any corrective action can be taken in a much shorter time frame, resulting in better diabetes control. For questions or information about the care flow sheets for diabetes, congestive heart failure, or hypertension, call 800 952-2895.

One-Time Incentive Payments—this payment, now expired, allowed FPs to bill for at least 10 patients with diabetes or congestive heart failure (13050) by completing the patient flow sheets and/or having performed at least five deliveries (14104 or 14109) in the previous year. More than 2600 FPs applied for and received the lump sum payment of a maximum of $10000. This represents a total of $25.3 million paid out to family practitioners since the agreement was ratified in May 2006.

Patient Management Conference Fee—this fee recognizes the time and resources the FP contributes when requested to review the ongoing management of the patient in a facility or to determine whether a patient in a facility with complex supportive care needs can safely return to the community or transition to a supportive care or long-term facility. Family practitioners can bill $40 per 15 minutes or greater portion thereof (14015). This fee is for patient care conferences that take place in a facility.

Complex Patient Clinical Action Plan Fee—this fee is compensation for the creation of a coordinated clinical action plan for the care of the following community-based patients: the frail elderly (ICD-9 code V15), palliative care (ICD-9 code V58), end-of-life (ICD-9 code V58), or mental illness. The fee depends not on the diagnosis alone but rather the severity of the problem. As such, the fee is billable only when case conferencing and collaborative planning with other health care providers (e.g., specialists, psychologists, counselors), patients, and possibly family members is needed in order to develop the clinical action plan. Family practitioners can bill $40 per 15 minutes or greater portion thereof (14016).

For more information about the fees discussed in this article, please log in to the members’ home page on the BCMA web site and click on New Full Service Family Practice Incentive Program listed under What’s New/Members. 
For the latest news about the agreement, go to the 2006 Agreement News section on the members’ web site.

—Fiona Youatt
BCMA Communications