Latest news with #OttawaHospital
CBC
a day ago
- Health
- CBC
Virtual dermatology care coming to Nunavut
The Ottawa and Qikiqtani General Hospitals are working to bring virtual dermatology care to Nunavummiut, to help alleviate the need for patients to fly out of the territory for care.
Medscape
6 days ago
- Health
- Medscape
What Comes Next After Failure of Injectable HIV Medication?
While the injectable HIV treatment regimen cabotegravir/rilpivirine (Cabenuva) is an increasingly important option, including for people who have struggled with adherence to daily tablets, it comes with a caution that must be discussed with each patient. Around 1.5% of people who switch to the injections experience virologic failure, often despite perfect adherence to the injection schedule. While this rate is not higher than for daily oral HIV regimens, failures are frequently accompanied by resistance-associated mutations. Since cabotegravir is an integrase inhibitor — as are dolutegravir and bictegravir, the most frequently used anchor drugs in modern HIV treatment — the development of resistance to integrase inhibitors risks significantly limiting future HIV treatment options. Virologic failure on cabotegravir/rilpivirine is therefore considered 'a low incidence, but high consequence event' (a phrase shared by Saye Khoo at the Conference on Retroviruses and Opportunistic Infections earlier this year). But there is limited data and a lack of guidance on the most effective regimens to use following failure associated with resistance. 'In reality, what people do in case of failures with cabotegravir/rilpivirine is that they base their therapy on genotypic results,' explained Pierre Giguère, MSc, clinical pharmacy specialist at the Ottawa Hospital, Ottawa, Ontario, Canada. 'We like to go with agents for which there are no mutations that could predict treatment failure. And in situations with cabotegravir/rilpivirine, when you have dual-class resistance mutations, like in our cases, what's left are the protease inhibitors.' The protease inhibitor darunavir — typically boosted with cobicistat or ritonavir — has become 'the pillar of therapy' in these situations, he said in an interview. However, he and his colleagues reported an unusual case series of six patients at the International AIDS Society Conference on HIV Science this week. Each one was successfully treated with bictegravir/emtricitabine/tenofovir alafenamide (Biktarvy), a single-tablet daily regimen based on an integrase inhibitor. All patients had major mutations associated with both integrase inhibitors and non-nucleoside reverse transcriptase inhibitors. Despite this, all achieved viral suppression to below 20 copies/mL after switching to the bictegravir-based regimen and have maintained this for between 6 and 18 months. This approach emerged unexpectedly during clinical practice. The first patient was a woman who initially chose to switch to the bictegravir-based regimen because she could not tolerate the pain she experienced at the injection site. However, samples taken at the time of her switch subsequently revealed that she had a virologic breakthrough with resistance to integrase inhibitors (148R) and reverse transcriptase (101E). Given that this regimen would not normally be recommended in these circumstances, her clinicians considered taking her off the bictegravir she had already started but decided against it as she was now virally suppressed. 'What would be the motivation to change therapy in a patient who is currently on a simple regimen that is working?' asked Giguère. 'So, the decision was to keep following this patient closely, making sure that she remains suppressed. And that was our patient zero.' The next five patients to go on the regimen were the next five patients to experience virologic failure on cabotegravir/rilpivirine at the hospital. 'We decided just to keep going with the Biktarvy, based on that n of one experience, which ended up being an n of two, and now is an n of six,' Giguère said. Three of the subsequent patients had mutations at both positions 138 and 148. While cabotegravir frequently selects for these mutations, and they rapidly confer a significant loss of susceptibility to cabotegravir, that is not the case for bictegravir. 'From an in vitro perspective, you would not suspect that these mutations would much impact bictegravir susceptibility,' Giguère said. 'But what has been lacking has been clinical data.' Laura Waters, MD, consultant physician in sexual health and HIV medicine at Central and North West London NHS Foundation Trust, London, England, described the approach as 'brave.' She noted that while other cases of patients switching to integrase inhibitors after failure of cabotegravir/rilpivirine have been reported, they did not generally involve people who had integrase inhibitor resistance mutations. 'But as we're learning more and more, resistance isn't absolute, and both our second-generation integrase inhibitors have high inhibitory quotients, and so we would expect that virologic suppression would be possible for many individuals,' she told Medscape Medical News. She said she would be worried about the durability of the response. For three of the five cases reported, follow-up was for less than 1 year, while the patient observed the longest had 20 months of follow-up. 'The concern is around forgiveness: What happens if somebody misses a dose? What happens if somebody takes a cation-containing treatment or supplement that reduces integrase concentrations further?' For his part, Giguère stresses the importance of defining a safe approach that can be implemented when virologic failure on cabotegravir/rilpivirine occurs. 'I think we have to be able to come up with a simple, well-tolerated backup regimen in the case of failure,' he said. For the moment, it's not clear that the bictegravir-based regimen is the right one, but he hopes other clinicians will try to replicate the experience. 'Time will tell if the effect is long-lasting, and we need more people to confirm it.' The study received no funding. Giguère reported having no relevant financial relationships. Waters had received speaker and advisory fees from Merck Sharp & Dohme (MSD), ViiV Healthcare, Janssen Pharmaceuticals, and AbbVie. She is also an investigator on trials funded by Gilead Sciences, MSD, and ViiV Healthcare with funding provided to her institution.
CTV News
10-07-2025
- Health
- CTV News
Ottawa hospital ER wait times exceed provincial average
CHEO, the Children's Hospital of Eastern Ontario, located on Smyth Road in Ottawa is seen in this undated file photo. Three Ottawa hospitals have some of the longest wait times in Ontario for a first assessment by a doctor in a hospital emergency room, and all five ERs in Ottawa exceed the provincial average. Statistics from Health Quality Ontario show the average wait time for a first assessment by a doctor in the emergency room was two hours in May. CHEO and the Queensway-Carleton Hospital tied for the third longest wait time in Ontario to see a doctor in May, at 3.6 hours. The wait time for a first assessment at the Queensway-Carleton Hospital increased from 3.4 hours in April. The average wait time was 3.3 hours at CHEO. The wait time for a first assessment by a doctor in the ER at the Ottawa Hospital Civic Campus was 3.5 hours in May, up from 3.3 hours in April and 2.9 hours in March. Patients waited an average of 2.6 hours for a first assessment in the ER at the Montfort Hospital in May, while the average wait to see a doctor was 2.1 hours at the Ottawa Hospital General Campus. The Windsor Regional Hospital – Metropolitan Campus had the longest wait for a first assessment in the ER in Ontario in May, at four hours. Patients waited an average of 3.5 hours for a first assessment by a doctor at the Winchester District Memorial Hospital emergency department. Time in the hospital All Ottawa hospitals continue to exceed the provincial target for the average length of stay in the ER for low-urgent patients not admitted to hospital. The average stay in the ER across Ontario was 3.2 hours in May, while the target time is four hours. In Ottawa, the average length of stay in the ER for low-urgent patients not admitted to hospital ranged from 6.1 hours at the Montfort Hospital, 5.4 hours at CHEO, 5.4 hours at the Queensway-Carleton Hospital, 5.1 hours at the Ottawa Hospital Civic Campus and 4.8 hours at the General Campus. The Kingston Health Sciences Centre's Kingston General had the longest length of time in the ER for low-urgent patients not admitted to hospital, with patients spending an average of 6.4 hours in the ER.
CTV News
09-07-2025
- Health
- CTV News
Parking fees generate millions of dollars in revenue for Ottawa's largest hospital
Patients, staff and visitors paid millions of dollars to park at the Ottawa Hospital last year, as Ottawa's largest hospital saw a significant increase in parking revenue. The Ottawa Hospital's financial statements show the hospital took in $27.576 million in parking revenue during the 2024-25 fiscal year, up from $25,546 million in 2023-24. An Ottawa Hospital spokesperson says the $2 million in additional parking revenue is due to an increase in parking rates and an added 'off-site parking to support the hospital's growing needs.' 'Parking revenues support key capital projects, much-needed updates and improvements to the parking facilities at all three campuses, as well as buying medical equipment and building new patient care environments,' the hospital spokesperson said in a statement to CTV News Ottawa. 'These areas are not publicly funded for hospitals.' Last October, the Ottawa Hospital increased parking rates for patients, visitors and staff by 3.9 per cent. According to the Ottawa Hospital website, the short-term parking rates are $8.30 for 30 minutes to one hour, and a daily maximum of $15.60. A daily pass is $15.60, and a weekly pass is $52. The Ottawa Hospital has seen parking revenues increase from $19.984 million during the 2018-19 fiscal year to $20,860 million in 2022-23 and to $27.576 million last fiscal year. The Ottawa Hospital's new Civic Campus near Dow's Lake will include a parking garage with approximately 3,000 parking spaces. The Montfort Hospital told CTV News Ottawa parking revenues were $2.144 million for the fiscal year ending March 31, 2025. 'This amount was invested almost entirely in education and research through the Institut du Savoir Montfort, our knowledge institute,' a spokesperson for the Montfort Hospital said in a statement. At the Queensway-Carleton Hospital, parking revenue for the 2023-24 fiscal year was $4,887,871, up from $4,166,525 the year before. 'Proceeds from parking are re-invested in parking operations and care at the hospital. Parking proceeds help to fund things like medical equipment which are not funded by the government,' a spokesperson for the Queensway-Carleton Hospital told CTV News Ottawa. At CHEO, parking revenues are collected by the CHEO Foundation and distributed to CHEO 'as needed to support the most urgent priorities such as equipment, programs, family support or research,' the children's hospital told CTV News Ottawa. According to the CHEO Foundation's 2024 financial statement, the foundation earned $4.402 million from parking operations in 2024, up from $4 million in 2023. The Kingston Health Sciences Centre's fiscal report shows the Kingston, Ont. hospital received $796,000 from parking revenue in 2024-25, up from $650,000 the year before. In May, NDP MPP Jeff Burch introduced a motion in the Ontario Legislature, calling on the Ontario government to eliminate hospital parking fees at hospitals. The motion was defeated.
Ottawa Citizen
04-07-2025
- Health
- Ottawa Citizen
Ontario adding 20,000 publicly funded hip and knee surgeries at private clinics
Some Ontario residents will undergo hip and knee surgeries at private clinics under a $115 million expansion announced by Health Minister Sylvia Jones this week. Article content Jones said the move will add up to 20,000 OHIP-covered orthopedic surgeries and reduce wait times. The province issued a call for applications in what is being called a significant shift toward more privatization of health care across the province. Article content Article content Article content The long-promised move to creating standalone surgical facilities for orthopedic surgeries in Ontario has been promoted as a means of reducing wait times and taking pressure off hospitals. But critics note that many hospital operating rooms sit empty much of the time. With more funding, they could do more surgeries. Meanwhile, research from Alberta suggests a similar shift in provincial health dollars to private surgery operators has undermined the public health system, increased wait times for some key surgeries and increased health-care costs. Article content Article content At least one of the community surgical centres will likely be located in Ottawa. In 2023, the Ottawa Hospital formed a partnership with a group of orthopedic surgeons known as the Academic Orthopedic Surgical Associates of Ottawa. The group, known as AOAO, has been renting vacant operating room space at Riverside Hospital and performing orthopedic day surgeries on low-acuity patients on weekends. Article content Article content At the time, TOH President and CEO Cameron Love said the hospital planned to work with AOAO and the province to build a private, standalone surgical centre that would function as The Ottawa Hospital's 'high efficiency' orthopedic centre for patients requiring day surgery, leaving more complex cases for hospital operating rooms. He said the proposed facility would operate full time, in contrast to the weekend surgeries currently performed at Riverside. New rules around private surgical centres appear to prohibit groups from renting existing hospital space. Article content The plan for stand-alone orthopedic surgical centres comes a week after Jones announced a $155 million investment to add 57 surgical and diagnostic centres for MRIs, CT scans and GI endoscopy services, which provincial officials said would connect 1.2 million people to the services. The province has said it will announce the locations of those facilities in the coming weeks. Article content There have long been for-profit independent health facilities offering diagnostic and other procedures, along with cataract surgery in Ontario. There are currently 900 community surgical diagnostic centres in the province, the majority of which offer diagnostic imaging. The latest announcement represents a new expansion into standalone clinics for orthopedic surgeries, something done in other provinces, notably Alberta. Article content Research by Andrew Longhurst of the Alberta-based Parkland Institute has found that hip, knee and shoulder surgeries outsourced to private, for-profit providers in Alberta cost more and contribute to rising wait times for other surgeries, including colorectal cancer surgery. Article content In an interview, Longhurst said a key concern of the influx of health dollars to private operators is the negative impact it has on the public hospital system. Article content Article content 'Public hospitals are being starved of staff and funding, while private providers receive inflated payments for the lowest complexity surgeries,' Longhurst said. Article content Article content Among those concerns is that the opening of private surgical centres for the least complex cases worsens shortages of anesthsiologists and surgical nurses in the public system, increasing wait times for more complex cases, he said. Article content Longhurst also said funding privately-operated surgical centres also opens the door for upselling or extra billing. Article content 'We hope we don't see the pervasive extra billing we have seen in other provinces,' Longhurst said. But he noted that numerous Ontario patients have complained about being upsold or charged extra for cataract surgery and being unclear about costs, despite assurances from the province that upselling and extra billing would not happen. Article content Article content Longhurst said that unless a provincial government strictly limits procedures in standalone clinics to those covered by OHIP, the water can be muddied in terms of what is legal and what is extra billing by a privately owned clinic. Article content 'All of this – based on patterns and facts from other provinces – makes me quite concerned about the can of worms the government is opening.' Article content Provincial funding to the clinics will consist of facility costs per procedure – $6,530 for primary unilateral hip joint replacement procedures and $5,797 for primary unilateral knee joint replacement procedures. Article content In its call for applications, the Ministry of Health said that funding is considered a 'bundled payment,' meaning it should cover pre-operative and post-operative care and rehabilitation as well as the surgery. The province will not pay for the construction of the centre or any other associated costs. The document says facility costs 'may undergo periodic review or rate review under the sole discretion of the ministry, at any time.'
