St Boniface Hospital Research Articles

Novel Mechanisms Related to DHA’s Atheroprotective Effects in Endothelial Cells: eNOS Activity Is Regulated by DHA via p38MAPK and MSK

Abstract Objectives Our laboratory previously reported that docosahexaenoic acid (DHA) activates p38 mitogen-activated protein kinase (MAPK) differently in growing and quiescent human endothelial cells, which represent the atherogenic and healthy states in vivo, respectively. Endothelial nitric oxide synthase (eNOS) activity differs between these two states. Since eNOS can be regulated by p38MAPK and mitogen-stimulated kinase (MSK) is a p38MAPK substrate involved in cell proliferation and inflammation, we hypothesized that DHA's atheroprotective actions require eNOS activation via the p38MAPK/MSK pathway. Thus, our objective was to investigate the role of p38MAPK/MSK in the eNOS response to DHA and determine whether the proposed pathway is growth state-sensitive. Methods EA.hy926 cells were cultured on Matrigel-coated plates to sub-confluent and quiescent states and treated with DHA ± SB202190 or SB747651A, inhibitors of p38MAPK and MSK, respectively. eNOS activation was quantified by Western blot detection of Ser1177 phosphorylation. Results eNOS activation by DHA in EA.hy926 cells was concentration-, time-, and growth state-dependent. p38MAPK inhibition suppressed eNOS activity in sub-confluent cells and increased eNOS activity in quiescent cells, while MSK inhibition suppressed eNOS activity in both growth states. eNOS activity remained suppressed with DHA treatment under MSK inhibition and showed no dose- or growth state-dependent effects. In contrast, when p38MAPK was inhibited, high dose DHA activated eNOS in sub-confluent cells, but dose-dependently decreased the elevated eNOS activity of quiescent cells. Conclusions eNOS activity in endothelial cells is modulated by DHA via p38MAPK and MSK. The growth state-dependent regulation of p38MAPK and eNOS by DHA provides novel insight into the molecular mechanisms of DHA's atheroprotective actions in relation to health status. Funding Sources Research Manitoba, St Boniface Hospital Foundation, University of Manitoba - GETS

Randomised controlled trial protocol for the PROTECT-CS Study: PROTein to Enhance outComes of (pre)frail paTients undergoing Cardiac Surgery

IntroductionIn the past 20 years, the increasing burden of heart disease in an ageing population has resulted in cardiac surgery (CS) being offered to more frail and older patients with...

Red Blood Cell Transfusion and the Use of Intravenous Iron in Iron Deficient Patients Presenting to the Emergency Department

Background: Red blood cell (RBC) transfusions are often used to treat patients with iron deficiency who present to the emergency department (ED) with symptomatic anemia. Intravenous (IV) iron is the preferred treatment in this setting, as it has been shown to increase hemoglobin concentration rapidly and durably. We aim to determine the incidence of iron deficiency anemia (IDA) and the management of these patients in the ED setting. Objectives: To evaluate the incidence of IDA, the frequency of RBC transfusion and iron supplementation, and factors associated with RBC transfusion. Study Design: Retrospective cohort study of all adult patients presenting to the St Boniface Hospital (Winnipeg, CAN) ED from January 2014 to January 2019. Methods: We used electronic data from the Emergency Department Information System (EDIS) and Laboratory Information Services (LIS) databases to identify patients presenting with IDA, defined as anemia (hemoglobin <120 g/L) with either a transferrin saturation less than 20% or ferritin less than 30 umol/L, or mean corpuscular volume (MCV) of < 75 fL. A ferritin greater than 100 umol was used to exclude IDA, regardless of MCV. We extracted patient demographics, diagnoses, markers of iron storage, RBC transfusion and use of IV iron. Multivariate logistic regression analysis was used to evaluate factors associated with RBC transfusion. Results: Of 39222 patients, 17945 (45%) were anemic. Of the anemic patients, iron parameters were ordered in 1848 (10.3%) patients, and IDA was present in 910 (5.1 %). In the IDA population, 95 patients (10.4 %) received 1 RBC unit, and 197 patients (21.6 %) received 2 or more units. Oral iron and IV iron were prescribed for 64 (7 %) and 14 (1.5 %) patients, respectively. Our logistic regression model demonstrated that hemoglobin concentration was the main determinant of whether patients received RBC transfusion. Other variables including patient age, cardiac symptoms, heart rate, blood pressure, and CTAS score were not associated with increased likelihood of receiving RBC transfusion. Conclusion: Iron parameters were infrequently ordered in the evaluation of anemia in the ED, with limited use of oral and IV iron. The decision to transfuse RBCs was primarily influenced by hemoglobin concentration, but not other surrogates of hemodynamic instability. An interventional study to improve education and access to oral and IV iron is planned to reduce unnecessary RBC transfusions and their associated risks in patients with IDA. Disclosures No relevant conflicts of interest to declare.

Novel Mechanisms Related to DHA’s Atheroprotective Effects in Endothelial Cells: Modulation of Histone H3 Modification via Activation of p38MAPK Signaling

Abstract Objectives Docosahexaenoic acid (DHA) is known for its protective effects against cardiovascular disease, which has been the leading cause of death worldwide for 2 decades. The molecular mechanisms responsible for DHA's atheroprotective effects, however, remain largely unknown. DHA has been found to activate p38 mitogen-activated protein kinase (MAPK) differently in growing and quiescent human endothelial cells, which represent dysfunctional and healthy states in vivo, respectively. This study was designed to characterize the activation pattern of p38MAPK in endothelial cells in response to DHA treatment and to identify possible downstream targets by which DHA exerts its protective effects. Methods EA.hy926 cells were cultured on Matrigel-coated plates to sub-confluent, confluent, and quiescent states. The cells were treated with DHA to establish concentration (10 μM to 150 μM) and time course (10 min to 24 h) curves, with or without SB202190, a p38MAPK-specific inhibitor. The activation of p38MAPK and its downstream targets was quantified by Western blotting. Histone H3 modifications upon DHA treatment were tested with an ELISA-based kit. Results The activation of p38MAPK by DHA in EA.hy926 cells was concentration-, time-, and growth state-dependent. Upon p38MAPK inhibition, activation of mitogen and stress activated kinase 1 (MSK1), a downstream target of p38MAPK, declined. This reduction was attenuated by low concentrations of DHA in quiescent endothelial cells but not confluent or sub-confluent cells. Since MSK1 can act on histone H3 and other chromatin binding proteins like cAMP response element-binding protein (CREB), H3 modifications were monitored. In the confluent state, DHA caused a 6-fold increase in total H3, with a concomitant decrease in most methylation, acetylation, and phosphorylation marks, including H3K9me1/3, H3K27me2, H3K36me1/3, H3K9ac, H3K18ac, H3S10ph, and H3S28ph. Conclusions This study showed that DHA may exert its effects in endothelial cells via the p38MAPK signalling pathway, and MSK1 may be a downstream effector possibly leading to epigenetic changes. The results provide novel insights regarding DHA's atheroprotective actions and identify new therapeutic targets with potential for treating atherosclerosis. Funding Sources Research Manitoba, St Boniface Hospital Foundation-Research Without Borders.

Impact of Out-of-Pocket Expenses for Surgical Care on Households in Rural Haiti: A Mixed-Methods Study

Introduction: Affordability is a key component of essential surgical care. In Haiti, a low-income country, patients can incur substantial costs when seeking surgical care. These have not previously been described. The present study aims to report costs to patients to access surgery and the lived experience of patients and families seeking care at St. Boniface Hospital (SBH) in southern Haiti. Methods: We conducted an explanatory, sequential mixed methods study among 159 patients at SBH who received surgical care between July-August 2017. We recorded patients’ socio-demographic and economic characteristics and their surgical interventions. Using the World Health Organization (WHO) and World Bank definitions for catastrophic health expenditure, we estimated the proportion of patient households that experienced catastrophic expenditure through direct, indirect, and total household expenditures. We then conducted semi-structured interviews with 18 patients and used narrative analysis and grounded theory to synthesize this interview data into key ideas and themes. Results: The median total household expenditure on surgery-related expenses in the month prior to the interview was USD 385∙6, slightly more than half of per capita gross domestic product in Haiti (USD 729∙3). Patients commonly paid for surgical costs through loans and donations (69∙8%). Using the World Health Definition, direct and indirect expenditures were catastrophic in 76∙7% of households. Using the World Bank Development Indicator, 86% of households experienced catastrophic health expenditure. Qualitative results revealed prominent themes in barriers to care including the burden of care-seeking, care-seeking journeys, and social suffering. Discussion and Conclusion: Catastrophic health expenditure rates for patients seeking surgical care at in rural Haiti are significant. Opportunities for improvement include broadening the range of surgical services at each facility, collaborating with local surgical providers to reduce cost, and increasing national access to health insurance and subsidies to account for the indirect payments. Funding Statement: This project received funding support from Harvard Medical School. Declaration of Interests: MP, RP, AB, EO, AK, CM, and CL have nothing to disclose. BA reports grants from Mercy Ships to perform outcomes research, outside the submitted work. Ethics Approval Statement: This study received ethical approval from the Institutional Review Board (IRB) of the Harvard Medical School Office of Human Research Administration and the Research and Ethics Committee at St. Boniface Hospital. All participants provided verbal informed consent.

Dietary Flaxseed Protects against Post‐Myocardial Infarction Arrhythmias and Injury

Dietary Ω‐3 polyunsaturated fatty acids (Ω‐3 PUFAs) have been associated with a lower incidence of cardiovascular events and sudden cardiac death. Flaxseed is one of the richest plant sources of Ω‐3 PUFAs and has been observed to retard the progression and accelerate the regression of atherosclerotic plaque. The aim of the study was to examine the effects of dietary flaxseed on heart function and arrhythmias that develop after a myocardial infarction (MI). The left anterior descending coronary artery was ligated in rats to induce the MI. Rats were randomized into five groups: sham MI with normal chow, MI with normal chow, MI with 10% milled flaxseed supplementation (flax), MI with 4.4% supplemented flax oil rich in alpha‐linolenic acid (ALA), and MI with flax lignan secoisolariciresinol diglucoside (SDG) supplementation (0.44%). Animals were fed with their respective diets for two weeks before and for 8 weeks after the surgery. Echocardiography and continuous ECG recordings were obtained after ligation to confirm the induction of the MI, to check for arrhythmias and to assess cardiac function. Histological examination was also performed to evaluate cardiac fibrosis. Dietary supplementation with flax, ALA, and SDG significantly reduced the incidence of arrhythmia. Hearts obtained from flax, ALA, and SDG supplemented animals exhibited the smallest infarct size (12.39±0.77%, 13.70±1.20%, 11.63±1.36% vs. 34.02±3.22%, p<0.001). The left ventricle in the flax group was significantly less dilated compared to the control group (6.41±0.22 mm vs. 8.26±0.28 mm, p<0.001). A significantly small percentage of myocardial fibrosis and levels of tumor necrosis factor‐α were observed in all flax groups compared to the MI group (p<0.001). Together, this study generates evidence for a beneficial effect of flaxseed in patients post MI for the prevention of arrhythmias and ventricular remodeling.Support or Funding InformationThis work was supported by AAFC, CIHR, SaskFlax, Western Grain Research Foundation, Pizzey's Ingredients and St Boniface Hospital Foundation.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Antibiotics in a Haitian neonatal intensive care unit: findings from a Plan-Do-Study-Act quality-improvement project

BackgroundIn the critical care setting, delay in the administration of antibiotics has been associated with as much as a three-fold rise in mortality. Working in a neonatal intensive care unit (NICU) in rural Haiti, we attempted to reduce the time between patient admission and the administration of the first dose of antibiotics and to reduce the frequency of dosing errors by implementing a Plan-Do-Study-Act (PDSA) cycle-based quality improvement project. MethodsThe study took place at St Boniface Hospital—a 130 bed hospital serving 2·3 million people in rural Haiti. A retrospective chart review was done for every patient admitted to the 24-bed NICU over a 2-week period. Baseline data were recorded by noting the time of patient admission and the time of administration of the first doses of antibiotics. In addition, the dosage of each antibiotic was checked for accuracy. Two subsequent 2-week data collections were performed over 6 months, interspersed with PDSA cycles. These cycles included training and interventions to: improve staff awareness about the risks of delaying treatment and of incorrect dosing; identify barriers to care; introduce nurse-initiated standing orders; review data; and disseminate results to the staff. This study was approved by the Research Ethics Committee at St Boniface Hospital. FindingsThe baseline data collection between Jan 29, 2018, and Feb 11, 2018, included 26 patients; period 2 (April 25, 2018 to May 8, 2018), included 33 patients; and period 3 (July 5–18, 2018), 28 patients. At baseline, mean delay in antibiotic administration was 6·2 h (95% CI 4–8·4). In periods 2 and 3, mean delays were 0·6 h (0·35–0·85) and 0·4 h (0·16–0·64), respectively. At baseline, dosing errors were noted in 13 of 22 ampicillin orders (59%) and four of 22 gentamicin orders (18%). Four patients received antibiotics other than ampicillin or gentamicin. In periods 2 and 3 there were no errors reported. In the baseline period, two of 26 patients (7·6%) received the first dose of antibiotic within 1 h and in periods 2 and 3, 30/33 (91%) and 24/28 patients (86%), respectively, received antibiotics within 1 h. InterpretationIn a low-resource setting, errors in antibiotic dosing and delays in administration of antibiotics to newborns admitted to the NICU can be successfully reduced using a PDSA-based quality improvement project. This approach does not require expensive interventions nor new technology but it does have the potential to reduce neonatal morbidity and mortality. FundingNone.

Surface analyses of orthopedic fixation screws submitted different artificial rest soil.

Event Abstract Back to Event Surface analyses of orthopedic fixation screws submitted different artificial rest soil. Rodrigo Franca1, Michelle Alfa2, Nancy Olson2, L’hocine Yahia3 and Edward Sacher4 1 University of Manitoba, Dental Biomaterials Research Lab, Canada 2 University of Manitoba, St-Boniface Hospital Research Center, Canada 3 École Polytechnique de Montréal, Laboratoire d’Innovation et d’Analyse de Bioperformance, Canada 4 École Polytechnique de Montréal, Regroupement Québecois de Matériaux de Pointe, Canada Implantable plates, screws and wires are frequently held in the surgical instrument tray, and are reprocessed every time the instruments are used. There have been questions raised about this practice but there is a lack of data to demonstrate organic residuals on reprocessed implantable plates, screws or wires. The objective of this study was to determine is surface analysis techniques could be used to detect such residual organic material on stainless steel malleolus screws. New malleolus screws were compared to ones that had been coated in purified lipopolysaccharide or Artificial Test Soil (ATS) containing lipopolysaccharide. X-ray photoelectron spectroscopy (XPS), scanning electron microscopy (SEM) and surface time-of flight secondary ion mass spectrometry (TOF-SIMS) were used to assess the fixation screws. Organic material was visualized on the LPS and ATS-LPS inoculated screws but not on the new unsoiled screws. This was further supported by the peaks observed at masses between 40 – 100 D on TOF-SIMS spectra of the LPS inoculated and ATS-LPS inoculated screws. After deconvolution of high resolution XPS analyses, the LPS inoculated screws showed a carbon and oxygen oxidized state whereas the ATS-LPS inoculated screws showed predominantly C-NO (nitroso). In conclusion, our data demonstrated that surface analysis can detect organic residuals present in fixation screws. The XPS data confirmed that LPS reacted predominantly with positively charged surface metallic ions (Fe+ and Cr+) whereas proteins reacted with the surface oxide layer of fixation screws forming C-NO. The application of these surface analysis techniques will be helpful in determining if the reprocessing of such items results in an accumulation of organic material that might lead to aseptic loosening when implanted. Keywords: biomaterial Conference: 10th World Biomaterials Congress, Montréal, Canada, 17 May - 22 May, 2016. Presentation Type: Poster Topic: Surface and interfacial characterization Citation: Franca R, Alfa M, Olson N, Yahia L and Sacher E (2016). Surface analyses of orthopedic fixation screws submitted different artificial rest soil.. Front. Bioeng. Biotechnol. Conference Abstract: 10th World Biomaterials Congress. doi: 10.3389/conf.FBIOE.2016.01.02947 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 27 Mar 2016; Published Online: 30 Mar 2016. Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Rodrigo Franca Michelle Alfa Nancy Olson L’hocine Yahia Edward Sacher Google Rodrigo Franca Michelle Alfa Nancy Olson L’hocine Yahia Edward Sacher Google Scholar Rodrigo Franca Michelle Alfa Nancy Olson L’hocine Yahia Edward Sacher PubMed Rodrigo Franca Michelle Alfa Nancy Olson L’hocine Yahia Edward Sacher Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Resident trainees do not affect patient satisfaction in an outpatient gastroenterology clinic: a prospective study conducted in a Canadian gastroenterology clinic.

There is little literature regarding how a gastroenterology trainee affects a patient's interpretation of care during outpatient clinic visits. Improving patient satisfaction is desirable and benefits may include enhanced patient compliance as well as providing trainees with areas for improvement. To evaluate patient satisfaction in an outpatient gastroenterology clinic when seen by a trainee and attending physician versus an attending physician alone. The secondary objective was to evaluate physician characteristics that play a role in creating a positive clinical experience. A randomized prospective survey study was conducted over an 11-month period (July 2012 to June 2013) at St Boniface Hospital (Winnipeg, Manitoba). Two gastroenterology fellows (postgraduate year 4 and 5) and nine internal medicine residents (postgraduate year 1 to 3) comprised the 'trainee' role, while three academic clinicians comprised the 'attending' role. Patients included individuals seen for an initial consultation and were >18 years of age. A total of 211 patients comprised the final study group, with 118 in the attending group and 93 in the trainee group. In univariate analysis, patients more often had a very good experience when seen by an attending physician alone versus a trainee and attending physician (73% versus 56%; P=0.016); however, on multivariate analysis, there was no significant difference in patient satisfaction (OR 0.89; P=0.931). Physician factors found to be associated with high patient satisfaction on multivariate analysis included: addressing all patient concerns (OR 27.56; P=0.021); giving the patient a preliminary diagnosis (OR 78.02; P=0.006); and feeling the physician was thorough (OR 72.53; P=0.029). The present study did not reveal a difference in patient satisfaction if a patient sees an attending physician alone or with a trainee. Moreover, to improve patient satisfaction in a gastroenterology clinic, physicians should address all patient concerns, provide a preliminary diagnosis and appear to be thorough in their assessment. Further work to increase patient awareness on the role of residents in teaching hospitals is warranted to further promote careers in gastroenterology.

Results OF A PHYSICIAN ALERT SYSTEM FOR ANTICOAGULATION OF ATRIAL FIBRILLATION DETECTED ON CARDIAC IMPLANTED ELECTRONIC DEVICES

Results OF A PHYSICIAN ALERT SYSTEM FOR ANTICOAGULATION OF ATRIAL FIBRILLATION DETECTED ON CARDIAC IMPLANTED ELECTRONIC DEVICES

RATIONALE AND DESIGN OF THE PROGRAM FOR THE IDENTIFICATION OF “ACTIONABLE” ATRIAL FIBRILLATION (PIAAF): SYSTEMATIC IDENTIFICATION TO DETECT PREVIOUSLY UNDIAGNOSED OR UNTREATED AF IN THE COMMUNITY

strated that AF detected on cardiac implanted electronic devices (CIED) predicts a higher risk of stroke. Here we describe the results of a physician alert system for anticoagulation for AF detected on CIED. METHODS: Starting in 2013, the nurse-led pacemaker clinic at St Boniface Hospital implemented a physician alert system notifying referring physicians to the presence of AF on a CIED, and to suggest initiation of anticoagulation if CHADS2 > 1 and no contraindications. We reviewed patients who had these alerts from March 2013 to January 2014 using the pacemaker database and the St Boniface Hospital charts for demographics, stroke (CHADS2 and CHA2DS2VaSc) and bleeding (HASBLED) risk profile. We also reviewed the Manitoba Drug Program Information Network (DPIN) for prescription information regarding anticoagulation. Univariate and multivariate analysis were used to determine if risk factors were predictive of anticoagulation prescription. RESULTS: There were a total of 177 patients who had AF detected and alert produced, of which 126 had a CHADS2 > 1 (71%.) There were 72 males (57%) with a mean age of 82 9. Overall prevalence of risk factors for thromboembolism are listed in table 1. Overall 52 patients (41%) were started on anticoagulation (18 on vitamin K antagonist and 34 on non vitamin K antagonist) with the majority (39/52, 75%) started in the first 3 months. Overall there was no noticeable difference in the rates of anticoagulation for those with thromboembolism risk factors and those without (table 1) as well as for bleeding risk factors, except for prescription for ASA. On multivariate analysis, only being on ASA (OR 0.20 (0.08 0.46), and AF episodes lasting > 4 hours (OR 2.85 (1.07 7.56), p 1⁄4 0.035) were predictive of anticoagulation. CONCLUSION: In this analysis of a physician alert system for anticoagulation for patients with AF diagnosed on CIED, 41% of patients for whom alerts were produced were started on anticoagulation. There remains significant room for education with regards to anticoagulation for care providers of patients with CIED and AF. 456 RATIONALE AND DESIGN OF THE PROGRAM FOR THE IDENTIFICATION OF “ACTIONABLE” ATRIAL FIBRILLATION (PIAAF): SYSTEMATIC IDENTIFICATION TO DETECT PREVIOUSLY UNDIAGNOSED OR UNTREATED AF IN THE COMMUNITY

Multicenter Canadian Experience with the HeartWare HVAD

Purpose The HeartWare HVAD is a third generation centrifugal pump that has recently completed a US bridge to transplant clinical trial. The device is available in Canada under the Special Access Program since 2010. We describe our multicenter experience with this device. Methods and Materials We collated the cumulative experience with the HVAD device at 5 centers (Vancouver General, Toronto General, University of Alberta, St Boniface Hospital and Queen Elizabeth II). Followup was 100% complete until death, transplant or explant and consisted of 75 patients supported for an average of 219 + 200 days (range 1-842 days). Results The average age was 51 + 14 years (range 6-72) with 33 females and 42 males. Eleven patients (15%) were over the age of 65. There were 5 deaths within 30 days (7%) and a total of 10 deaths (13%). 26 pts were successfully bridged to transplant (n=24) or explant (n=2) while 39 pts remain under HVAD support (52%). A total of 11 patients have been supported for over one year with 3 patients supported >2 years. In the elderly cohort, 8 patients remain supported with 2 deaths and 1 successful transplant. Two patients in the entire cohort suffered from pump thrombosis of which one underwent successful thrombolysis while the other underwent successful pump exchange. There were 7 patients (9%) who suffered from GI bleeds and 16 patients (21%) who suffered from a neurologic complication. Only 2 of 11 elderly patients suffered from a stroke. Conclusions Our multicenter Canadian report represents “real-world” clinical experience with the HeartWare HVAD. The results are strikingly similar to those reported in the ADVANCE trial with the exception of a higher rate of neurologic complications. The GI bleeding rate appears to be lower than the trial report, suggesting that anticoagulation parameters may have been lower in this experience. These data continue to support the use of the HVAD in Canadian centers and the low rate of pump malfunction supports its use in non-transplant eligible patients who require prolonged periods of circulatory support.

Serum Sickness After Antithymocyte Globulin Administration in a Cardiac Transplant Patient

Serum Sickness After Antithymocyte Globulin Administration in a Cardiac Transplant Patient

A century of progress in palliative care

care in Canada, it is interesting to reflect on how palliative care has been influenced by medical developments during the 20th century. During the early part of the past century, a major preoccupation was with the need for earlier diagnosis and therefore improved cure rates with diseases such as cancer and cardiac disease. New diagnostic techniques such as electrocardiography and radiography were seen as major aids in achieving this goal. Although advances were made in the field of Robert Pope, The Sparrow anaesthesia, little attention was paid to pain control outside the operating theatre. Palliative care as a formal discipline did not exist. The promise that science offered in terms of cures overshadowed whatever could be achieved in palliative care. During the middle of the century, there was increased recognition of cardiovascular mortality, the need for specialised cancer treatment centres, and the link between cancer and smoking. There were major technological advances including organ transplantation, vaccines, and pharmacological developments. Palliative care and pain management continued to receive very little attention from the medical community, and remained an unrecognised issue in the excitement generated by new medical developments. However, because technological and pharmacological advances were seen to have a limited impact on morbidity and mortality in Canada, the ageing of Canada's population became topical. The greater focus placed on geriatric care in Canadian medical schools and medical literature was followed by an increasing interest in both palliativecare issues and pain management. The palliative-care movement in Canada during the 1970s was stimulated by the pioneering work of Cecily Saunders in the UK. Canada's first palliative-care units were opened in the mid-1970s at the Royal Victoria Hospital in Montreal and St Boniface Hospital in Winnipeg. Palliative-care programmes have subsequently been developed from coast to coast. However such programmes range from rudimentary volunteer services to sophisticated and comprehensive clinical and academic palliative-care programmes.

Throat Colonization of Neonatal Nursery Staff byUreaplasma urealyticum:an Infection Control or Occupational Health Consideration?

Very low birth weight infants often have protracted respiratory tract colonization with Ureaplasma urealyticum. To determine whether prolonged contact with very low birth weight infants resulted in higher rates of upper respiratory tract colonization with this organism for caregivers, throat swabs for U urealyticum culture were obtained from medical, nursing and other support staff working in the neonatal intensive care and level II nurseries at the Health Sciences Centre and the St Boniface Hospital in Winnipeg, Manitoba. Throat colonization by U urealyticum was demonstrated in 7.3% (95% ci 0 to 15.6%) of 41 nurses working in the intensive care nurseries but in none of the 48 nurses working in other locations or the 66 other individuals tested (P=0.02). However, throat colonization was not significantly higher among the neonatal intensive care nurses than among the women delivering at one of the study institutions. Close contact with very low birth weight infants appears to constitute a minimal risk for increased throat colonization with U urealyticum among hospital staff members.