Ontario Medical Association fonds, 1972-1973, 1977-1978, 1980-1982, 1984-1985

This archive contains materials relating to the Ontario Medical Association. The bulk of the materials are correspondence. A complete administrative history of the association is available from, The first 100 years : a history of the Ontario Medical Association / Glenn Sawyer, Toronto : The Association, 1980? (R15 O58 S39 1980).

Pelham Cares Inc. fonds, 1980-2015

The beginnings of Pelham Cares occurred in 1982 when the Mayor of Pelham, Eric Bergenstein, received a letter from Janet Hassall, a social worker with Niagara Regional Home Care. Hassall requested that a Social Service Committee be established in Pelham to address gaps in community services, a practice that several other communities in the Region had adopted. Such committees were commonly composed of church parishioners, so Bergenstein contacted Canon J. Nowe of the Holy Trinity Anglican Church, who expressed an interest in participating in such a committee. Bergenstein arranged a meeting in June, 1982 at the United Church Hall in Fonthill, for any interested parties to learn more about the existing Social Service Committees in the Region. The meeting was not part of a Town Council project, but rather an initiative undertaken by Mayor Bergenstein in a personal capacity. Subsequent meetings chaired by Eric Bergenstein were held throughout the remainder of that year, during which the name of Pelham Cares was decided, a steering committee established, and services to be offered were determined. These initially included “visits with the lonely, the shut-ins, at home, hospital or on an outing ; run errands for those who are “stuck”; step in, in emergencies, or regularly, to free a parent or spouse who can’t otherwise get a “break”; in emergencies, provide food, clothing, furniture, medicine and other necessities”. The first official meeting of Pelham Cares occurred in January 1983. Currently, the main services offered by Pelham Cares are a food bank; transportation services to medical appointments; and sponsorship programs to allow youth with limited financial means to participate in sports, recreational and educational activities. The organization also provides emergency food, supplies or short term accommodation due to fire or other catastrophic loss, as well as providing referrals to appropriate organizations or agencies. Pelham Cares is dependent on the funding from community partners such as service clubs, citizens, local businesses, financial institutions and churches. These services are provided by volunteers and one part-time employee. A permanent location for Pelham Cares was established in 2014 with the purchase of a property on Highway 20 East in Fonthill, after a 30 years search for a permanent facility.

In Search of Advice for Physicians in Entry-Level Medical Markets

We consider entry-level medical markets for physicians in the United Kingdom. These markets experienced failures which led to the adoption of centralized market mechanisms in the 1960's. However, different regions introduced different centralized mechanisms. We advise physicians who do not have detailed information about the rank-order lists submitted by the other participants. We demonstrate that in each of these markets in a low information environment it is not beneficial to reverse the true ranking of any two acceptable hospital positions. We further show that (i) in the Edinburgh 1967 market, ranking unacceptable matches as acceptable is not profitable for any participant and (ii) in any other British entry-level medical market, it is possible that only strategies which rank unacceptable positions as acceptable are optimal for a physician.

What are the components of humanized childbirth in a highly specialized hospital? : an organizational case study

Many studies have focused on the concept of humanization of birth in normal pregnancy cases or at low obstetric risk, but no studies, at our knowledge, have so far specifically focused on the humanization of birth in both high-risk, and low risk pregnancies, in a highly specialized hospital setting. The present study thus aims to: 1) define the specific components of the humanized birth care model which bring satisfaction to women who seek obstetrical care in highly specialized hospitals; and 2) explore the organizational and cultural dimensions which act as barriers or facilitators for the implementation of humanized birth care practices in a highly specialized, university affiliated hospital in Quebec. A single case study design was chosen for this thesis. The data were collected through semi-structured interviews, field notes, participant observations, selfadministered questionnaire, relevant documents, and archives. The samples comprised: 11 professionals from different disciplines, 6 administrators from different hierarchical levels within the hospital, and 157 women who had given birth at the hospital during the study. The performed analysis covered both quantitative descriptive and qualitative deductive and inductive content analyses. The thesis comprises three articles. In the first article, we proposed a conceptual framework, based on Allaire and Firsirotu’s (1984) organizational culture theory. It attempts to examine childbirth patterns as an organizational cultural phenomenon. In our second article, we answered the following specific question: according to the managers and multidisciplinary professionals practicing in a highly specialized hospital as well as the women seeking perinatal care in this hospital setting, what is the definition of humanized care? Analysis of the data collected uncovered the following themes which explained the perceptions of what humanized birth was: personalized care, recognition of women’s rights, humanly care for women, family-centered care,women’s advocacy and companionship, compromise of security, comfort and humanity, and non-stereotyped pregnancies. Both high and low risk women felt more satisfied with the care they received if they were provided with informed choices, were given the right to participate in the decision-making process and were surrounded by competent care providers. These care providers who humanly cared for them were also able to provide relevant medical intervention. The professionals and administrators’ perceptions of humanized birth, on the other hand, mostly focused on personalized and family-centered care. In the third article of the thesis, we covered the dimensions of the internal and external components of an institution which can act as factors that facilitate or barriers that prevent, a specialized and university affiliated hospital in Quebec from adopting a humanized child birthing care. The findings revealed that both the external dimensions of a highly specialized hospital -including its history, society, and contingency-; and its internal dimensions -including culture, structure, and the individuals present in the hospital-, can all affect the humanization of birth care in such an institution, whether separately, simultaneously or in interaction. We thus hereby conclude that the humanization of birth care in a highly specialized hospital setting, should aim to meet all the physiological, as well as psychological aspects of birth care, including respect of the fears, beliefs, values, and needs of women and their families. Integration of competent and caring professionals and the use of obstetric technology to enhance the level of certainty and assurance in both high-risk and low risk women are both positive factors for the implementation of humanized care in a highly specialized hospital. Finally, the humanization of birth care approach in a highly specialized and university affiliated hospital setting demands a new healthcare policy. Such policy must offer a guarantee for women to have the place of birth, and the health care professional of their choice as well as those, which will enable women to make informed choices from the beginning of their pregnancy.

Radiopaque materials from natural polymers: Special emphasis on chitosan and natural rubber

The present work is to impart radiopacity in various natural polymers like chitosan, natural rubber and derivatives of chitosan and to characterize it. This thesis collated the radiopaque properties of these radiopaque polymers and various technological applications in the medical field. The applications of radiopaque polymers leads to an exploitation of radiopaque properties like X-ray visibility, optical density, effective atomic number, attenuation coefficient of biopolymers like chitosan, chitosan formate, chitosan acetate, carboxy methyl chitosan and natural rubber. The radiopaqe properties of these materials highly depend upon the size, shape, amount of radiopacifier and crystallinity of the radiopaque material. Radiopaque chitosan microspheres were prepared by cross linking with glutaraldehyde followed by the encapsulation of barium sulpahte. The effect of different emulsion systems on the morphology of chitosan microspheres were studied. The study concentrates radiopaque natural rubber for shielding applications. It reveals that to improve the particle size, morphology and crystalline phase of the zinc oxide particles, a novel method for the preparation of zinc oxide is adopted. A detailed radiopacity study was done in natural rubber containing 100phr precipitated zinc oxide prepared from different zinc salts. One of the significant findings of this investigation is that NR vulcanizates containing precipitated zinc oxide (from zinc acetate) shows higher attenuation coefficient. These interesting findings reveal the applications of these natural radiopaque systems in various fields like surgical tools, medical tubings, catheters, radiation shielding,etc.

Tailored Ion Imprinted Polymer Materials for the Preconcentrative Separation of Noble Metals

Tailored ion imprinted polymer materials for the preconcentrative separation of noble metals. This study deals with the synthesis, separation,characterization and analytical application of the noble metals especially palladium and platinum. Platinum group metals(PGM) are currently receiving world wide attention. This group include Palladium(Pt),rhodium(Rh), ruthenium(Ru), iridium(Ir) and osmium(Os).PGM are used as catalysts for a wide variety of hydrogenation, oxidation, isomerization,cyclization,dehydrogenation and dehalogenation reactions.The corrosion resistance of PGM enables them to use in jewellery,electrical and glass industries,extrusion of synthetic fibres,manufacture of laboratory utensils,dental and medical devices. This study clearly establishes selective recovery of platinum from other noble and transition elements.

Dielectric studies of polyvinyl-acetate-based phantom for applications in microwave medical imaging

Phantoms that exhibit complex dielectric properties similar to low water content biological tissues over the electromagnetic spectrum of 2–3 GHz have been synthesized from carbon black powder, graphite powder and polyvinyl-acetate-based adhesive. The materials overcome various problems that are inherent in conventional phantoms such as decomposition and deterioration due to the invasion of bacteria or mold. The absorption coefficients of the materials for various compositions of carbon black and graphite powder are studied. A combination of 50% polyvinylacetate- based adhesive, 20% carbon black powder and 30% graphite powder exhibits high absorption coefficient, which suggests another application of the material as good microwave absorber for interior lining of tomographic chamber in microwave imaging. Cavity perturbation technique is adopted to study the dielectric properties of the material.

Dielectric properties of certain biological materials at microwave frequencies.

In the medical field, microwaves play a larger role for treatment than diagnosis. For the detection of diseases by microwave methods, it is essential to know the dielectric properties of biological materials. For the present study, a cavity perturbation technique was employed to determine the dielectric properties of these materials. Rectangular cavity resonators were used to measure the complex permittivity of human bile, bile stones, gastric juice and saliva. The measurements were carried out in the S and J bands. It is observed that normal and infected bile have different dielectric constant and loss tangent. Dielectric constant of infected bile and gastric juice varies from patient to patient. Detection and extraction of bile stone with possible method of treatment is also discussed.

Development and microwave characterization of selected biocompatible materials and conducting polymers

The 20th century witnessed the extensive use of microwaves in industrial, scientific and medical fields. The major hindrance to many developments in the ISM field is the lack of knowledge about the effect of microwaves on materials used in various applications. The study of the interaction of microwaves with materials demanded the knowledge of the dielectric properties of these materials. However, the dielectric properties of many of these materials are still unknown or less studied. This thesis is an effort to shed light into the dielectric properties of some materials which are used in medical, scientific and industrial fields. Microwave phantoms are those materials used in microwave simulation applications. Effort has been taken to develop and characterize low cost, eco-friendly phantoms from Biomaterials and Bioceramics. The interaction of microwaves with living tissues paved way to the development of materials for electromagnetic shielding. Materials with good conductivity/absorption properties could be used for EMI shielding applications. Conducting polymer materials are developed and characterized in this context. The materials which are developed and analyzed in this thesis are Biomaterials, Bioceramics and Conducting polymers. The use of materials of biological origin in scientific and medical applications provides an eco-friendly pathway. The microwave characterization of the materials were done using cavity material perturbation method. Low cost and ecofriendly biomaterial films were developed from Arrowroot and Chitosan. The developed films could be used in applications such as microwave phantom material, capsule material in pharmaceutical applications, trans-dermal patch material and eco-friendly Band-Aids. Bioceramics with better bioresorption and biocompatibility were synthesized. Bioceramics such as Hydroxyapatite, Beta tricalcium phosphate and Biphasic Calcium Phosphate were studied. The prepared bioceramics could be used as phantom material representing Collagen, Bone marrow, Human abdominal wall fat and Human chest fat. Conducting polymers- based on Polyaniline, are developed and characterized. The developed materials can be used in electromagnetic shielding applications such as in anechoic chambers, transmission cables etc

Development of hybrid UV VCSEL with organic active material and dielectric DBR mirrors for medical, sensoric and data storage applications

Lasers play an important role for medical, sensoric and data storage devices. This thesis is focused on design, technology development, fabrication and characterization of hybrid ultraviolet Vertical-Cavity Surface-Emitting Lasers (UV VCSEL) with organic laser-active material and inorganic distributed Bragg reflectors (DBR). Multilayer structures with different layer thicknesses, refractive indices and absorption coefficients of the inorganic materials were studied using theoretical model calculations. During the simulations the structure parameters such as materials and thicknesses have been varied. This procedure was repeated several times during the design optimization process including also the feedback from technology and characterization. Two types of VCSEL devices were investigated. The first is an index coupled structure consisting of bottom and top DBR dielectric mirrors. In the space in between them is the cavity, which includes active region and defines the spectral gain profile. In this configuration the maximum electrical field is concentrated in the cavity and can destroy the chemical structure of the active material. The second type of laser is a so called complex coupled VCSEL. In this structure the active material is placed not only in the cavity but also in parts of the DBR structure. The simulations show that such a distribution of the active material reduces the required pumping power for reaching lasing threshold. High efficiency is achieved by substituting the dielectric material with high refractive index for the periods closer to the cavity. The inorganic materials for the DBR mirrors have been deposited by Plasma- Enhanced Chemical Vapor Deposition (PECVD) and Dual Ion Beam Sputtering (DIBS) machines. Extended optimizations of the technological processes have been performed. All the processes are carried out in a clean room Class 1 and Class 10000. The optical properties and the thicknesses of the layers are measured in-situ by spectroscopic ellipsometry and spectroscopic reflectometry. The surface roughness is analyzed by atomic force microscopy (AFM) and images of the devices are taken with scanning electron microscope (SEM). The silicon dioxide (SiO2) and silicon nitride (Si3N4) layers deposited by the PECVD machine show defects of the material structure and have higher absorption in the ultra violet range compared to ion beam deposition (IBD). This results in low reflectivity of the DBR mirrors and also reduces the optical properties of the VCSEL devices. However PECVD has the advantage that the stress in the layers can be tuned and compensated, in contrast to IBD at the moment. A sputtering machine Ionsys 1000 produced by Roth&Rau company, is used for the deposition of silicon dioxide (SiO2), silicon nitride (Si3N4), aluminum oxide (Al2O3) and zirconium dioxide (ZrO2). The chamber is equipped with main (sputter) and assisted ion sources. The dielectric materials were optimized by introducing additional oxygen and nitrogen into the chamber. DBR mirrors with different material combinations were deposited. The measured optical properties of the fabricated multilayer structures show an excellent agreement with the results of theoretical model calculations. The layers deposited by puttering show high compressive stress. As an active region a novel organic material with spiro-linked molecules is used. Two different materials have been evaporated by utilizing a dye evaporation machine in the clean room of the department Makromolekulare Chemie und Molekulare Materialien (mmCmm). The Spiro-Octopus-1 organic material has a maximum emission at the wavelength λemission = 395 nm and the Spiro-Pphenal has a maximum emission at the wavelength λemission = 418 nm. Both of them have high refractive index and can be combined with low refractive index materials like silicon dioxide (SiO2). The sputtering method shows excellent optical quality of the deposited materials and high reflection of the multilayer structures. The bottom DBR mirrors for all VCSEL devices were deposited by the DIBS machine, whereas the top DBR mirror deposited either by PECVD or by combination of PECVD and DIBS. The fabricated VCSEL structures were optically pumped by nitrogen laser at wavelength λpumping = 337 nm. The emission was measured by spectrometer. A radiation of the VCSEL structure at wavelength 392 nm and 420 nm is observed.

Valor predictivo del índice de severidad para gangrena de fournier en el Hospital Universitario de la Samaritana

La GF es una infección fulminante, afecta cualquier edad y género. Se ha descrito el índice de severidad de gangrena de Fournier (ISGF), el cual es útil para evaluar el pronóstico de estos pacientes. OBJETIVO. Reportar nuestra experiencia con esta patología en los últimos 12 años y evaluar el valor predictivo del ISGF de manera retrospectiva. METODOS Se analizaron las historias clínicas de los pacientes con GF de los últimos 12 años en el HUS. Se determinaron los factores asociados a mortalidad y se realizó un análisis de calibración y discriminación del ISGF. RESULTADOS Se recolectaron 40 pacientes todos del género masculino con una edad promedio de 60.3 años (+ /– 14.9). La comorbilidad y causa más frecuente fueron hipertensión arterial y causas urológicas. El patógeno más frecuente fue E. coli. El porcentaje mortalidad en nuestra población fue del 15%. El promedio de ISGF y ISGF ajustado fue: 4.9 y 9.83 ; 9.83 y 4.91 para los fallecidos y los no fallecidos respectivamente, existiendo una diferencia estadísticamente significativa para los dos. (p < 0,05). En el análisis de correlación, discriminación y concordancia, el ISGF sobreestima mortalidad y en ISGF ajustado subestima mortalidad, pero tiene una buena correlación con mortalidad DISCUSIÓN: En nuestro hospital, la GF es una patología poco frecuente; a pesar de esto, se cuenta con un diagnóstico rápido y a su vez un manejo inmediato. Hasta el momento la conducta quirúrgica inmediata y el pronto inicio de antibioticoterapia continúan siendo la mejor opción terapéutica. Existe una relación entre el índice de severidad y la sobrevida de los pacientes, lo cual puede convertirlo en un parámetro útil en la evaluación de estos pacientes. Sin embargo se necesitan estudios prospectivos para validar la escala en nuestra población

Concordancia entre laboratorios serológicos y ultrasonografía hepatobiliar como pruebas diagnósticas en coledocolitiasis

La coledocolitiasis es una patología que requiere una aproximación adecuada para determinar su manejo dadas las posibles complicaciones por omisión en su diagnostico o la realización de procedimientos terapéuticos. La colangiopancreatografía retrógrada endoscópica (CPRE) es una opción en su manejo, pero es un procedimiento invasivo con riesgos de morbilidad y mortalidad considerables. El objetivo del estudio es determinar la correlación existente entre los resultados de pruebas serológicas, el diámetro hallado de la vía biliar por ecografía, así como el diagnostico radiológico de coledocolitiasis y las CPRE realizadas en el Hospital Universitario de la Samaritana (HUS) entre el 01/05/2009 y 31/08/2010. Materiales y Método: Estudio de concordancia de pruebas diagnósticas. Donde a través de la recolección de la información a través de un cuestionario sobre identificación de pacientes con diagnóstico presuntivo de coledocolitiasis, resultados serológicos, hallazgos ecográficos de la vía biliar y el reporte de CPRE se realizo un análisis descriptivo de la población, se calcularon los valores de sensibilidad, especificidad y cocientes de probabilidades, además de determinar el grado de concordancia entre las pruebas utilizando los paquetes estadísticos Stata v. 11 (StataCorp; Tx, USA) y SPSS v. 18 (SPSS Inc.; Ill, USA) Dada la evidencia actual ningún indicador utilizado de forma única (historia clínica, ecografía, marcadores serológicos) es capaz de determinar el diagnostico de coledocolitiasis con suficiente precisión, sin embargo en pacientes mayores cuya clínica sugiere patología biliar obstructiva, existen algunos puntos de corte que hacen parte de algoritmos en la literatura, los cuales son una guía para determinar la necesidad de CPRE y se pueden utilizar en nuestra institución

Factores de riesgo de caídas intrahospitalarias en pacientes de 65 años o mayores en la Fundación Cardioinfantil

Las caídas intrahospitalarias son un problema permanente que cada vez toma mayor importancia en los servicios de hospitalización de las instituciones de cuidado agudo, sin embargo no hay claridad sobre los factores de riesgo más importantes modificables ya que la mayoría de las escalas de medición y conductas de prevención son extrapoladas de los estudios realizados en instituciones de cuidado crónico. El problema cobra mayor importancia en esta época ya que su incidencia impacta en forma negativa los indicadores de calidad de una institución y genera discapacidad y muerte. Materiales y métodos: Es un estudio de casos y controles basado en los registros de caída y en las historias clínicas de una institución de cuidado agudo La Fundación Cardioinfantil – Instituto de Cardiología en Bogotá (Colombia). Se evaluaron las Historias clínicas y registros del comité de caídas intrahospitalarias de 479 pacientes 245 casos y 234 controles desde enero de 2002 a julio de 2010. Resultados: Se evaluaron 60 variables y se realizo una caracterización descriptiva del mecanismo de caída y las consecuencias de la caída. Se obtuvo como resultado 16 variables con OR significativos estadísticamente, de las cuales solo 6 terminaron la regresión logística con gran significancia estadística (p= menor 0.001), dentro de las cuales se destacan: Discapacidad, Diagnostico cardiovascular y delirium. Conclusiones: Existen factores de riesgo posiblemente modificables en instituciones de cuidado agudo entre los cuales hay comunes con centros de cuidado crónico y otros propios de hospitales entrenados para la atención del paciente agudo. Palabras clave: Caidas. Hospital. Lesiones. Factores de riesgo, casos y conttroles

Desarrollo de un nuevo protocolo de cirugía general, que disminuya las devoluciones de medicamentos e insumos al almacén de cirugía del Hospital Méderi

Esta tesis surge como una oportunidad de mejora en el almacén de cirugías del Hospital MÉDERI, debido a la recurrente devolución de medicamentos e insumos solicitados por las auxiliares de enfermería para las cirugías generales, lo cual repercute directamente en pérdidas de productividad laboral por los re-procesos, un aumento en los errores humanos y posibles pérdidas de medicamentos e insumos. Tras esta clara oportunidad de mejora, se toma la decisión de evaluar el proceso interno del almacén de cirugías con el fin de conocer el punto crítico que genera esta situación; dando como resultado los protocolos de cirugías, los cuales al haber sido diseñados varios años atrás basados en una demanda presentada en ese momento, no están acorde con la realidad que se vive actualmente el almacén de cirugía. Por lo tanto se decidió implementar un pronóstico de promedio móvil, para identificar la demanda real que se presentan en el Hospital MÉDERI, esto seguido de una identificación gráfica comparativa que permitiera definir el nuevo protocolo de cirugía general, lo cual permite disminuir la cantidad de material solicitado, con lo cual se generan disminuciones significativas en el inventario, perdidas y un aumento en la productividad.

Análisis de la percepción de calidad en salud, aplicado al Hospital Universitario Mayor Méderi.

El presente trabajo nace del interés en las posibles diferencias que pueden llegar a presentarse dentro del Hospital Universitario Mayor Méderi, en torno a la calidad de servicio prestada por el centro médico, y la percepción de calidad percibida por el paciente.