Patient health management: a promising paradigm in Canadian healthcare.

Disease management, or the focused application of resources to achieve desired health outcomes, began in Canada in 1971 with the introduction of a universal healthcare program and a single government payor. Although relatively unfocused and nonrestrictive by contemporary standards, this program was successful in terms of outcomes. However, it is expensive, and Canada's rapidly aging population is fueling a growing demand for more efficacious medical therapies. As a result, isolated services are being restricted in an effort to reduce costs. As a result of these changes and low prescription and patient compliance rates for efficacious therapies, total system costs have risen, there is a growing concern about deterioration of health outcomes, and stakeholders are dissatisfied. To optimize healthcare outcomes and reduce costs, a new paradigm--patient health management (PHM)--has emerged. With PHM, clinical and cost outcomes are continually measured and communicated to providers in an attempt to promote more efficacious care. PHM also seeks to avoid restrictive practices that are now associated with detrimental health outcomes and increased costs. PHM has proved successful when applied to acute and chronic cardiac disease treatment. It remains untested for most other diseases, but available data suggest that the comprehensive, evidence-based disease and systems management that characterizes PHM is likely to achieve the best health outcomes for the most people at the lowest possible costs.

Incidence and susceptibility of aerobic Gram-negative bacilli from 20 Canadian intensive care units: 1989-1993.

OBJECTIVE: To assess the prevalence of antibiotic resistance in Canadian intensive care units. DESIGN: The antimicrobial profiles of 1939 Gram-negative bacilli isolated in 20 Canadian intensive care units were analyzed using a custom designed MicroScan panel. SETTING: The majority of the hospitals were tertiary care institutions, but some community hospitals were included. PATIENTS: Adult intensive care unit patients were the sources of isolates. MAIN RESULTS: Pseudomonas aeruginosa was the most frequently isolated microorganism overall, with Escherichia coli the most common initial isolate. Comparison of initial and repeat isolates showed that P aeruginosa readily acquired resistance to all antibiotic classes except the aminoglycosides. Enterobacter aerogenes developed resistance to ciprofloxacin and Enterobacter cloacae demonstrated resistance to all beta-lactam antibiotics except for imipenem on repeat isolation. Other Enterobacteriaceae remained susceptible. Historical comparison with data derived four years previously from 15 of the centres showed increased resistance of P aeruginosa and Acinetobacter species to ciprofloxacin while other susceptibility patterns remained stable. CONCLUSIONS: The prevalence of Gram-negative resistance in Canadian hospitals is less than that reported in surveys done in some other countries, and was relatively stable over four years.

Saccharopolyspora hirsuta strain 367 releases JHJ-1, a bacteriophage capable of propagation on old mycelium.

Bacteriophage JHJ-1 was isolated from Saccharopolyspora hirsuta strain 367 NRRL 12045 as an endogenous but virulent phage. The plaque size was not self-limiting, since a few p.f.u. could completely lyse a lawn. Electron microscopy showed that this phage belonged to group B of Bradley's morphological classification. The JHJ-1 genome is a linear DNA molecule of 41.1 kbp with cohesive ends and a G + C content of 68.8-70.0 mol%. The DNA cleavage map was established for 12 restriction endonucleases. The host range is apparently very narrow, being limited to two strains of S. hirsuta (NRRL 12045 and NRRL B-5792). However, JHJ-1 did not lytically infect S. hirsuta strain 367 UC 8106. Phage JHJ-1 was shown, by Southern blot analysis, to lysogenize both S. hirsuta NRRL 12045 and UC 8106. It thus appears to behave as a virulent mutant of a temperate phage on one, but not on the other, JHJ-1 lysogen.