The Canadian Medical Device Industry Adopts a Code of Conduct

Douglas C. Thomson, CEO
Canadian Orthopaedic Association

The subject of the relationship between health care professionals and industry has sometimes been said to be a tricky one to traverse. One’s view on the subject is often unconsciously coloured by the particular vantage point that the observer has at any given time.

Attendees of the COA/AOA Combined Annual Meeting in Victoria in June of 2002 will recall that one of the guest speakers was Dr. Jerome P. Kassirer. His recent book, “On the Take, How Medicine’s Complicity with Big Business Can Endanger Your Health” has received considerable attention in the United States. Dr. Kassirer has recently been in the news in Canada as he (and others) quit the Board of the Canadian Medical Association Journal over an issue of editorial independence.

Workshop on Setting National Research Priorities in Scoliosis

Douglas Hill, P. Eng. MBA
Clinical Engineer
Edmonton, AB

A workshop focusing on establishing national priorities in scoliosis research was held in Edmonton on December 9, 2005. This was the second meeting of surgeons and scientists interested in advancing scoliosis research from the laboratory to clinical application. It continued in the spirit of the first meeting held in Quebec City in September 2003 chaired by Dr. Hubert Labelle. The attendees in Edmonton adopted the name of Canadian Paediatric Spinal Deformity Study Group.

One Year After Chaoulli - uncertainty and clinical gridlock

Douglas C. Thomson, CEO
Canadian Orthopaedic Association

Dennis Jeanes
Special to the Canadian Orthopaedic Association

It’s been a little more than a year since Canada’s Supreme Court upset the proverbial applecart with its historic decision in the Chaoulli case. The Supreme Court determined that Canadians have a fundamental right to timely delivery of health services - and that the Quebec government’s failure to do so voided its monopoly on health care insurance, because it violated a citizen’s right to security of person.

Quebec was given a year to respond before the judgment came into full effect, which meant either substantially improving timely delivery of care (an impossibility) or making provisions to introduce into the province private health insurance (and by extension, more private health care).

New Initiatives from BJD Canada: Bone and Joint Health Canada

James P. Waddell, M.D., FRCSC
Coordinator, Canadian National Action Network
Toronto, ON

The Bone and Joint Decade Canada is launching a new initiative tentatively entitled “Bone and Joint Health Canada”. We want to address the two principle issues we see as pivotal to improving musculoskeletal care in Canada. The first is access to care – not just for hip and knee replacement patients but for all MSK patients requiring both non-surgical and surgical treatment. We have an excellent opportunity at this time to engage in planning with provincial and federal government agencies regarding improved access to care. The second issue is MSK education. This education should not be thought of as medical student education only but also continuing education for practitioners, appropriate education for allied health personnel and, of course, improved educational content in the undergraduate curriculum.

Canadian Orthopaedic Nurses Gain Certification

Bob Harris, RN MScN ACNP
London, ON

Valerie MacDonald, RN MSN CNS
Vancouver, BC

Lynda Mandzuk, RN BN
Winnipeg, MB

The Canadian Orthopaedic Nurses Association (CONA) is pleased to announce that Orthopaedic Nursing Certification is a reality! This major achievement fits closely with CONA’s long held commitment to continuing education and quality patient care. Beginning in 2006, orthopaedic nurses in Canada can become certified in orthopaedic nursing and use the designation ONC(C).

Background
The Canadian Nurses Association Certification Programme is a voluntary process by which nurses can demonstrate competency in their nursing specialty by writing a certification examination. Since 1984 CONA has worked diligently to meet the requirements to be considered a specialty and to develop an orthopaedic certification examination. Canadian orthopaedic nursing experts in consultation with a professional psychometric company have developed the examination.

Introduction
We are pleased to present Part II of the two-part osteoporosis feature in our Themes section. Part I appeared in Bulletin #72 February/March edition.

Special thanks to Dr. Earl R. Bogoch (Toronto, ON) for his contributions as guest editor of this feature. – Ed.

Falls Are Not Accidents – and They Are Preventable!!

Karim Khan, M.D., PhD
Associate Professor
Departments of Family Practice and Orthopaedics
Centre for Hip Health
University of BC
Vancouver, BC

Dr. Maureen Ashe, PT, PhD
Senior Research Fellow
School of Rehabilitation Sciences and GF Strong Rehabilitation Centre,
Vancouver, BC

Falls among seniors represent a major health care problem that is associated with direct costs that exceed one billion dollars annually in Canada. Over one third of those aged 65 year or more fall annually. Although a majority of these falls cause no injury, all falls among seniors warrant evaluation by a family physician or physiotherapist, so that future falls can be prevented. About one fifth of falls are associated with injury, such as a cut, bruise, or fracture; the most serious harmful effects of falls are head injuries and hip fractures. Unfortunately, these injuries are far too common – in Canada there are over 20,000 hip fractures annually among seniors. In addition to the injuries described, both injurious and non-injurious falls can contribute to seniors being frightened to move about. Their mobility is thus restricted which, in turn, compromises health through inactivity and quality of life through social isolation.

Pharmaceutical Agents for the Treatment of Osteoporosis

Thomas A. Einhorn, M.D.
Professor and Chairman
Department of Orthopaedic Surgery
Boston University School of Medicine
Boston, MA

Osteoporosis is a chronic, progressive disease characterized by low bone mass, microarchitectural deterioration, decreased bone strength, and a consequent increase in fracture risk. In the United States alone, the number of people aged 50 and older estimated to be at risk for osteoporosis is 44 million and this represents 55% of the US population in this age group¹. In North America, osteoporosis is the most prevalent musculoskeletal condition associated with an increase in mortality; due to its association with hip fractures. Over the course of the past two decades, substantial advances have been made in the diagnosis and treatment of this disease and there now exist several new pharmaceutical agents that have been shown to improve the ability to treat osteoporosis and reduce the incidence of fractures. This article will provide a brief background on the cellular processes that are targets of these pharmaceutical interventions and provide a review of pharmacological strategies currently available for osteoporosis treatment.

New Treatment Modalities for Osteoporosis

Sophie A. Jamal, M.D., PhD, FRCPC
Toronto, ON

Introduction
Over the past decade there have been numerous advances concerning the pharmacologic treatment of osteoporosis and related fractures. For example, the bisphosphonates, alendronate and risedronate can now be prescribed once weekly, and our treatment armamentarium has expanded to include the anabolic agent - parathyroid hormone.

In addition, there has been an increased understanding of the factors which regulate osteoclast and osteoblast activity. This has led to the development of “targeted” pharmacologic agents which influence bone remodeling. The advantage of these highly specific agents is that they may be more potent and may be associated with fewer side effects than the treatments currently available for osteoporosis. The following section will review three of these targeted treatment modalities: 1) denosumab, a monoclonal antibody to receptor activator of nuclear factor – κß ligand (RANKL), 2) strontium ranelate an agent that can both stimulate bone formation and inhibit bone resorption and 3) inhibitors to cathepsin K that, in vitro, are potent antiresorptives.

Operative Fixation of Osteoporotic Fractures

Julie A. Switzer, M.D.
Assistant Professor, University of Minnesota
Director of Geriatric Trauma
Department of Orthopaedic Surgery

Although other aspects of the geriatric orthopaedic trauma patient, such as dementia, inadequate nutrition, and a reduced capacity for rehabilitation are important, none affects our ability to provide excellent care to this vulnerable population as much as the diminished bone quality of osteoporosis. Good fracture reduction and adequate implant fixation in osteoporotic bone, present profound challenges to our surgical skills.

Your Partner In Patient Care

Angelique Berg
Executive Director

Debbie Gates
Communications and Education Manager

Canadian Orthopaedic Foundation

Imagine the time you could liberate with a real resource where your patients can get answers to their non-medical questions and an understanding ear when they need to talk – time already in short supply. Imagine your confidence in referring the patient to that resource, accessible from a computer or anywhere there are telephones. Imagine the simplicity of giving your patient a postcard, and assuring them that the answers and support they seek is in their own hands. Imagine their comfort in having their questions answered in their own home, and their gratitude to you for having given them the power to help themselves.

James P. Waddell, M.D., FRCSC
A.J. Latner Professor & Chairman
Toronto, ON

The Orthopaedic Residency Programme at the University of Toronto is part of the Department of Surgery Training Programme. The Department of Surgery Training Programme, known as the Gallie Training Programme, started over 70 years ago under the leadership of W.E. Gallie, Chairman of the Department of Surgery and Dean of the University of Toronto Medical School. This training model in which residents were exposed to multiple surgical disciplines before focusing their training exclusively on the specialty of their choice was the first of its kind and has been widely copied, initially in Canada, then the United States and now is a model for training in much of the world.

PubMed for Orthopaedic Surgeons

Myles Clough, M.D., FRCSC
Kamloops, BC

The US National Library of Medicine codifies the subject matter of thousands of medical journals including over 100 orthopaedic ones. This information, the abstracts and the references are all stored in the Medline Database. PubMed is an Internet site giving access to this database. By using PubMed effectively, one can search the literature efficiently and accurately from one’s home computer.