“If the government were listening to nurses, there would be a lot less issues in our health-care system. That’s because we’re working it. The people that are making decisions aren’t on the front lines doing what we do everyday. We’re doing it. Not them.
Doug Ford, it’s time to go.”
has been rising in long-term care homes, but we can do something about it – we’ve done it before
By Sid Feldman and Julie Weir
As health care providers working in longterm care (LTC), we’ve seen firsthand how antipsychotic medications are prescribed to residents, and why. Antipsychotics are often used to help manage behaviours such as agitation and aggression in older adults living with dementia. They may be helpful for some patients, but antipsychotics can do more harm than good for many, especially when used long-term.
Now a new report has highlighted this as a concerning trend: one in four LTC residents in Canada is taking an antipsychotic medication potentially unnecessarily. This number has been increasing over time.
It’s time we reversed the trend.
The report, using data from the Canadian Institute for Health Information (CIHI), found Canada’s national rate of antipsychotic use without a diagnosis of psychosis among LTC residents, which had previously dropped to 20 per cent before the COVID-19 pandemic, has climbed back to 24 per cent.
These drugs come with serious risks, including strokes, falls, fractures and even an increased rate of death. With every province and territory experiencing an increase of at least two per cent following the pandemic, it’s clear antipsychotic use in Canada is heading in the wrong direction.
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Antipsychotics should never be used without first doing a deep dive into understanding the meaning behind why behaviours might be happening and trying non-antipsychotic approaches first, like addressing pain or using music to help LTC residents feel calm and safe.
Canada has one of the highest rates of potentially inappropriate antipsychotic use among comparable countries, with a national rate of 24 per cent compared to the United States at 10 per cent, and Australia at 18 per cent.
The national snapshot also doesn’t tell the whole story. Canada’s use of these medications varies across every province and territory, and even down to the individual LTC home level. In other words, some regions have rates significantly higher than the national 24 per cent prescribing rate.
Caring for our most vulnerable older adults in LTC must be done differently. We’ve successfully tackled high rates of antipsychotic prescribing before, and we must do it again.
Before the COVID-19 pandemic, many LTC homes across Canada had effectively lowered their potentially inappropriate antipsychotic rates by focusing on person-centred approaches to care. This involves dementia care education focusing on knowing the history of the residents, including their preferences and routines.
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IIn new study, MRI combined with machine learning reveals presence of cancer cells with 85-per cent accuracy
Researchers have developed an artificial intelligence (AI) model to detect the spread of metastatic brain cancer using MRI scans, offering insights into patients’ cancer without aggressive surgery.
The proof-of-concept study, coled by McGill University researchers Dr. Matthew Dankner and Dr. Reza Forghani, alongside an international team of clinicians and scientists, demonstrated the AI model can detect the presence of cancer cells in surrounding brain tissue with 85-per-cent accuracy.
Researchers tested the model using MRI scans from over 130 patients who had surgery to remove brain metastases at The Neuro (Montreal Neurological Institute-Hospital). They validated the AI’s accuracy by comparing its results to what doctors observed in the tumour tissue under a microscope.
Brain metastases, the most common type of brain cancer, occur when cancer cells from other parts of the body spread to the brain. These tumours can be particularly aggressive when invasive cancer cells grow into surrounding healthy brain tissue, making them harder to treat.
“Our previous research found that invasive brain metastases are linked to shorter survival and a higher risk of tumour regrowth. These findings demonstrate the enormous potential of machine learning to soon improve our understanding of cancer and its treatment,” said Dankner, an Internal Medicine Resident at McGill and post-doctoral researcher at the Rosalind & Morris Goodman Cancer Institute.
The AI model detects subtle changes in the surrounding brain tissue that indicate cancer has spread, spotting patterns often too faint for traditional imaging methods that rely on human
interpretation. It was developed by Forghani’s lab during his time at the Research Institute of the McGill University Health Centre and the University of Florida College of Medicine.
Earlier this year, the researchers identified drugs that could potentially treat some brain metastases. However, to determine which patients may ultimately benefit from this approach, doctors need to know whether the cancer has spread into the surrounding tissue. Surgery is the most common solution, but it isn’t always an option for patients, especially if their tumours are hard to reach or their health makes surgery too risky.
“With further development, our AI model could become a part of clinical practice, which can help us catch cancer spread within the brain earlier and more accurately,” said Dr. Benjamin Rehany, a Radiology Resident at the University of Toronto and one of the primary authors of the publication.
While their work is still in the early stages, the researchers plan to expand the study with larger datasets and refine the AI model for clinical use.
The research was supported by the Canadian Cancer Society, the Cana-
dian Institutes of Health Research, the Brain Canada Foundation, Health Canada, Fonds de recherche du Québec - Santé, and the Fondation de l’Association des radiologistes du Québec.
“Machine learning prediction of brain metastasis invasion pattern on brain MRI scans” by Keyhan Najafian, Benjamin Rehany, Alexander
Nowakowski, Saba Ghazimoghadam, Kevin Pierre, Rita Zakarian, Tariq Al-Saadi, Caroline Reinhold, Abbas Babajani-Feremi, Joshua K Wong, Marie-Christine Guiot, Marie-Constance Lacasse, Stephanie Lam, Peter M Siegel, Kevin Petrecca, Matthew Dankner, and Reza Forghani was published in Neuro-Oncology Advances. n H
For the second consecutive year, mental health and substance use health services across Canada have received failing grades, highlighting the persistent gaps in access to care and the lack of substantial progress by provincial and federal governments.
According to the latest National Report Card survey from the Canadian Alliance on Mental Illness and Mental Health (CAMIMH), six of nine provinces and the federal government received a failing grade of F, raising alarms about their lack of action, and Canada’s ability to meet the growing demand for mental health and substance use health care services.
While British Columbia, Manitoba and Ontario have shown slight im-
Continued from page 4
SIX OF NINE PROVINCES AND THE FEDERAL GOVERNMENT RECEIVED A FAILING GRADE OF F, RAISING ALARMS ABOUT THEIR LACK OF ACTION, AND CANADA’S ABILITY TO MEET THE GROWING DEMAND FOR MENTAL HEALTH AND SUBSTANCE USE HEALTH CARE SERVICES.
provements and received marginally passing grades for mental health (D), the overall picture remains bleak despite the majority of Canadians expressing dissatisfaction and demanding action:
• Nine-in-ten Canadians (90%) consider timely access to mental health care services to be important, with two-thirds (67%) rating it as “very important”– yet there has been no
Homes were supported to use available resources and tools to gain a deeper understanding of why distressing behaviours were occurring amongst residents in the first place, to support their deprescribing efforts.
While all of the reasons for the rising rates of antipsychotic prescribing are not yet clear, the COVID-19 pandemic clearly contributed. During the global pandemic, we know the priorities of LTC homes had to shift away from a person-centred approach to focus on the isolation of symptomatic residents to prevent the spread of the virus and ensure the safety of all residents.
Many staff in homes felt that this approach didn’t feel very person-centred. Staff turnover was a significant problem as well, with staffing shortages leading to reduced time to complete caregiving tasks and caregivers who did not know residents as well.
Regardless of the reasons that brought us to this place, this is where
we are now, and it is time to get back to working toward quality improvements in care.
The rising trend in antipsychotic prescribing should serve as a wakeup call. We’ve already seen that real change is possible when care teams come together and have tools and supports to focus on the whole person.
So, what should be done now?
The report calls for a coordinated national response, including setting goals for LTC homes and supporting homes with quality improvement programs. These are necessary first steps in refocusing our attention to protect one of Canada’s most vulnerable populations.
Tackling this issue isn’t just about reducing antipsychotic medication use – it’s about ensuring every resident receives the best quality care, which is what we all strive for. Even in a system under strain, we can choose to do better. n H
Dr. Sid Feldman is a family and long-term care physician in Toronto, Chief of Family and Community Medicine at Baycrest Health Sciences and Long-Term Care Clinician Co-Lead for Choosing Wisely Canada. Julie Weir is a Registered Nurse and Long-Term Care Clinician Co-Lead for Choosing Wisely Canada.
meaningful progress made since last year.
• The majority of Canadians (83%) believe their provincial government must hire more mental health providers to address this gap.
• Moreover, Canadians feel governments are not doing enough to evaluate whether current mental health and substance use health services are working.
The survey findings reflect Canada’s chronic underfunding of mental health and substance use health services. Provinces allocate only six per cent of their total health budget to mental health
care – in stark contrast to other G7 nations like France (15%), Germany (11%) and the United Kingdom (9%) and CAMIMH’s call for 12 per cent. There is a clear need for improvement. The consequences of this systematic underinvestment are devastating:
• Untreated mental illness costs the Canadian economy an estimated $50 billion annually.
• More than 1 in 2 Canadians struggling with mental health say they are not receiving the help they need.
• Canada continues to face a substance use crisis, with an average of 20 opioid-related deaths occurring each day.
Mental health care is a growing concern for Canadians across all demographics. As the findings reveal, current efforts fall far short of addressing the demand for quality mental health and substance use health care. Without significant action, the gaps in access will continue to impact individuals, families and the economy. n H
Anew online survey revealed that 74 per cent of women in Canada have delayed a gynecology visit, with 83 per cent wanting more accessible and less invasive cervical cancer testing options, including at-home self-collection for human papillomavirus (HPV) tests.
The survey, conducted by The Harris Poll involving more than 500 adult women in Canada, it was found that while 69 per cent of women understand that cervical cancer is preventable through regular screenings, over half (58%) postponed visiting a gynecologist due to fear or discomfort. Moreover, 62 per cent of respondents reported being unsure about how often they should be screened for cervical cancer.
“The fact that women are skipping this potentially life-saving screening
due to fear makes it clear that the health system needs to make the process more comfortable, equitable and accessible,” said Dr. Jeff Andrews, a board-certified OB/GYN physician and Vice President, Medical Affairs at BD. “HPV self-collection at-home reduces both the discomfort and time associated with a pelvic exam and is a critical step forward in cervical cancer screening.”
“Self-collection at home for HPV testing is a game-changer in the fight against cervical cancer,” said Ivy Parks, President of BD-Canada. “By empowering individuals to collect their own samples, we are removing significant barriers to screening and making it easier for individuals to take control of their health. This initiative is vital in our efforts to ensure cervical cancer prevention becomes a reality for all.” n H
Afirst randomized clinical trial shows that semaglutide use in type 1 diabetes is associated with improved glucose management, weight loss and lower insulin requirements.
Semaglutide (known by its brandname Ozempic) has gained widespread attention for its weight loss benefits, but is officially approved for managing type 2 diabetes. While there is currently limited data on its risks and benefits for those with type 1 diabetes, new research offers promising insights.
A new study shows that semaglutide can improve glucose levels for people with type 1 diabetes who use automated pumps, without increasing hypoglycemia. In this double-blinded randomized trial conducted at the Centre for Innovative Medicine of the Research Institute of the McGill University Health Centre (The Institute), participants using semaglutide alongside automated insulin therapy were able to maintain safe glucose levels for longer periods. The results of the study were recently published in the journal Nature Medicine.
“WE KNOW THAT OFF-LABEL USE OF SEMAGLUTIDE IS RISING IN PEOPLE WITH TYPE 1 DIABETES, DESPITE A LACK OF INFORMATION TO GUIDE PATIENTS AND HEALTHCARE PROVIDERS ON THE BENEFITS AND RISKS ASSOCIATED WITH IT,”
glutide can help them better manage the disease.”
In type 1 diabetes, the pancreas is unable to produce insulin, a hormone that regulates glucose levels. As a result, people with diabetes must continuously monitor their blood glucose levels and provide their bodies with the amount of insulin they need to avoid complications. Achieving this goal can be facilitated by the use of an automated insulin delivery (AID) system, commonly known as an insulin pump, which allows for the automated administration of insulin doses that are adjusted in real time thanks to a glucose sensor and an algorithm that performs the necessary calculations.
A NEW STUDY SHOWS THAT SEMAGLUTIDE CAN IMPROVE GLUCOSE LEVELS FOR PEOPLE WITH TYPE 1 DIABETES WHO USE AUTOMATED PUMPS.
“The typical goal for patients with type 1 diabetes is to maintain a glycated hemoglobin (HbA1c) level of less than seven per cent, and to remain within the target glycemic range for 70 per cent or more of the time, in order to reduce the risk of microvascular and macrovascular complications. However, studies suggest that almost half of all people using automatic insulin pumps fail to achieve this,” explains Dr. Michael Tsoukas, principal investigator of the study, Investigator in the Metabolic Disorders and Complications Program at The Institute and Associate Professor in the Division of Endocrinology, McGill University Health Centre (MUHC). “Our study shows that the addition of sema-
The trial lasted a total of 32 weeks and included 28 adult participants. During the first 15 weeks, half of the participants injected themselves with a weekly dose of semaglutide, and the other half with a placebo, while continuing their own insulin therapy (22 of the 28 were using an insulin pump at the start of the trial). The dose of semaglutide was gradually increased up to 1 mg or the maximum tolerated dose. During the last 4 weeks of the 15, participants used a research-created automated insulin pump. After this intervention, participants took a two-week break and switched groups, so that those who had started on semaglutide took a placebo, and vice versa, for another 15 weeks.
In the clinical trial, semaglutide use led to lower insulin requirements and increased weight loss. It showed greater benefits in participants with a higher body mass index, as they lost more weight and achieved greater glycemic benefits. This has important implications, since the prevalence of obesity in people with type 1 diabetes is increasing and is associated with the risk of cardiovascular disease and complications.
While no diabetic ketoacidosis – a life-threatening complication of diabetes – or severe hypoglycemia occurred
during the trial, there were two episodes of recurrent high ketone levels without high blood sugars or acidosis that occurred while participants were using semaglutide. High ketone levels can occur in people with type 1 diabetes when there is not enough insulin for the body to absorb sugar, so the body breaks down fat instead; at very high levels, this can make blood acidic and cause severe illness. Gastro-intestinal side effects were also associated with semaglutide.
“We know that off-label use of semaglutide is rising in people with type 1 diabetes, despite a lack of information to guide patients and healthcare providers on the benefits and risks associated with it,” says Dr. Melissa-Rosina Pasqua, the study’s first author, endocrinologist at the MUHC and doctoral student at The Institute, who coordinated the study. “This study addresses a current treatment gap and is an important stepping stone in demonstrating the benefits of this drug, as well as the ongoing need to educate patients about the risks of high ketone levels.” n H
mid a global surge in measles cases, new research suggests that undernutrition may be exacerbating outbreaks in areas suffering from food insecurity.
A study involving over 600 fully vaccinated children in South Africa found those who were undernourished had substantially lower levels of antibodies against measles.
Researchers from McGill University, UC Berkeley School of Public Health and the University of Pretoria tracked the children’s growth over time as an indicator of undernutrition and measured their antibody levels through blood tests. Children
who were stunted around age three had an average of 24-per-cent-lower measles antibody levels by age five compared to their typical-sized peers.
The findings, published in Vaccine, suggest that undernutrition may affect the duration of vaccine protection. This indicates that addressing child hunger could be a key piece of the puzzle in preventing viral outbreaks, said senior author Jonathan Chevrier, an Associate Professor in McGill’s Department of Epidemiology, Biostatistics and Occupational Health and Canada Research Chair in Global Environmental Health and Epidemiology. n H
The worst days of the pandemic may be behind us, but research into the virus that brought the world to a halt continues at Sinai Health.
Now a new study, published in the journal Nature Communications, has mapped how the different Sars-CoV-2 variants evolved as they spread in Toronto from 2020 to 2023, revealing insights that could help fight future outbreaks.
“When the variants started arising in late 2020, there was a lot of interest about the dynamics of the variants, to find out how they spread and evolve within the population,” said senior author, Dr. Wrana, a Senior Investigator at the Lunenfeld-Tanenbaum Research Institute (LTRI), part of Sinai Health.
“There was also a notion that variants could be very dangerous and that maybe they could be controlled through public health measures.”
Dr. Wrana along with Dr. Laurence Pelletier, also a Senior Investigator at LTRI, had already adapted a tool called SPAR-Seq to enable rapid detection of Sars-CoV-2 that they then employed for variant tracking.
Before COVID-19, SPAR-Seq had been developed as a screening tool, in collaboration with Dr. Ben Blencowe’s group at the University of Toronto, and its implementation during the pandemic enabled automated screening and sequencing of thousands of COVID-19 samples at once by focusing on specific, functionally relevant regions of the virus. The sites selected by the team incorporated the region essential for binding to the ACE2 receptor as well as the so-called furin cleavage site necessary for viral infection and transmission. The choice of these regions also allowed for targeted tracking of mutations that could influence the virus’s ability to spread and cause disease.
Working closely with Dr. Tony Mazzulli, Microbiologist-in-Chief for
“Together, our findings show that the emergence of dangerous variants could be predicted. Through systematic screening of key domains in viruses, coupled with functional studies in the laboratory, it would be possible to identify variants with high risk for human transmission. This could be powerful tool to predict and manage future pandemics,” said Dr. Wrana.
This video summarizes their research:
Sinai Health and University Health Network (UHN), the researchers monitored over 70,000 samples from the Greater Toronto Area from June 2020 to March 2023. Because the samples were collected and tested daily, this allowed an unprecedented window into how the virus was evolving in real time.
Their findings indicated not only the rise and fall of major variants like Alpha, Beta and Omicron, but also the emergence of numerous sub-variants. Interestingly, many mutations detected in these early sub-variants mirrored those found in later dominant strains such as Omicron, suggesting an ongoing, natural exploration of mutation space by the virus.
“We found Omicron-like mutations in the original Wuhan strain in early samples taken in 2020, indicating that the virus is exploring wide evolutionary space. And that suggests, should a pandemic like this happen again, that you could predict potential evolutionary trajectories of a virus and future harmful variants before they arise,” said Wrana. Such advance knowledge could help inform vaccine and treat-
ment design and other public health measures.
Although the researchers detected numerous sub-variants, none were able to replace the main virus variants, all of which were imported into Canada, the study also found.
The SPAR-seq data also revealed complex patterns of viral transmission within the city, characterized by phases of acceleration and deceleration. This wave-like movement suggested that the spread of variants could be influenced by localized social interactions and the structure of community networks. This nuanced understanding challenges simpler models of viral spread and has implications for public health responses.
Finally, thanks to the depth of coverage of SPAR-Seq, the team was able to detect quasi-species – minor variants within an infected individual – providing insights into the virus’s evolution during infection. Again, the virus acquired changes that foreshadowed future changes seen in major variants in the population, a sign of extensive evolution within an individual.
Trainees Dr. Marie-Ming Aynaud in the Pelletier lab and Dr. Khalid Al-Zahrani in the Schramek and Wrana labs, along with bioinformatician Lauren Caldwell in Dr. Wrana’s group, played pivotal roles in the development and application of SPAR-Seq. While Dr. Aynaud was instrumental for the development of SPAR-Seq, Caldwell created the bioinformatics analysis pipeline and Dr. Al-Zahrani helped with data analysis. They had joined the LTRI teams, globally known for their cancer research, to fight one disease, only to rise to the challenge posed by another. Because the samples had to be processed within a day to provide results to public health agencies to help curb the spread of COVID-19, the Wrana and Mazzulli’s teams were working around the clock. The development of SPAR-Seq greatly enhanced diagnostic insight into variant strains at Sinai Health, where more than 2.7 million samples were processed between March 2020 and March 2023.
Dr. Anne-Claude Gingras, Director of LTRI and Vice President, Research, for Sinai Health, said, “This work exemplifies collaborative research that we value and foster at Sinai Health. Through the joint efforts of Drs. Wrana, Pelletier and Mazzulli’s teams, not only have we delivered crucial, timely data on COVID-19 for public health agencies during the pandemic, but we have also gained insights into how the virus evolves to enhance public health strategies.” n H
Stroke patient Leanne Mork is learning to walk again with the assistance of a dedicated care team and a Lokomat – a robotic assisted walking system now available to rehab patients at Queen’s Park Care Centre in New Westminster.
The Lokomat helps patients like Leanne regain their balance and mobility after a stroke. It’s helpful for other injuries and neurological disorders such as Multiple Sclerosis.
For the workout, Leanne is fitted into an exoskeleton (harness system) suspended over a treadmill. Robotic sensors help move her legs with the pace and settings constantly monitored by a physiotherapist. The Lokomat provides real-time biofeedback and incorporates game-like exercises during the training session to make it more challenging and fun.
“This technology is a game-changer in rehabilitation, benefiting both our patients and the therapists who are re-
ceiving specialized training,” says Saba Hena, Project Leader at Queen’s Park Care Centre. “With more advanced care options, we can provide a higher quality of care and improve patient outcomes.”
The Lokomat and a second device –the ArmeoPower – were donated to the Royal Columbian Hospital Foun-
dation by Vancouver resident Toan Nguyen. “I wanted this technology to be available to more people. After suffering a massive stroke, I saw the benefits, and now I’m walking and working again.”
“We’re incredibly grateful to be able to bring this technology to patients in the Fraser Health region,” says Jeff
Norris, President and CEO of Royal Columbian Hospital Foundation. “As the organization responsible for fundraising for Queen’s Park Care Centre, we’re proud that our generous donors continue to step up to provide life-changing care to patients throughout B.C. and support this important facility.”
While the Lokomat focusses on leg movement, the ArmeoPower helps improve upper limb function through functional training. Both devices incorporate virtual reality exercises based on real-life scenarios like fishing to stimulate the brain to learn and retain motor skills.
“It is our hope that this new robotic-assisted technology will help improve our patients’ overall strength, range of motion, and coordination thus, allowing them to get back to everyday life and being able to care for themselves,” says Melanie Mayede, Occupational Therapist, Queen’s Park Care Centre. n H
Researchers and physicians at Sunnybrook Health Sciences Centre and The Hospital for Sick Children (SickKids) are the first in the world to use MRI-guided focused ultrasound to open the blood-brain barrier and deliver chemotherapy in Diffuse Intrinsic Pontine Glioma (DIPG), an aggressive and terminal paediatric brain tumour.
The procedure was done as a safety and feasibility clinical trial in children with this tumour. The first three paediatric patients successfully underwent the procedure as part of a safety and feasibility clinical trial in children with this tumour. The trial is open to enrolling more patient participants from across Canada.
A challenge for treatment of DIPG is the blood-brain barrier, a protective network of cells, which can prevent therapeutics from reaching areas in the brain. In this Phase I clinical trial, low-intensity focused ultrasound technology is used to temporarily open the blood-brain barrier with the power of soundwaves, allowing drug treatment to cross and treat the brain tumour.
“DIPG is a devastating paediatric brain tumour which is inoperable due to its location in the brainstem,” says Dr. Nir Lipsman, study co-principal investigator, neurosurgeon, and director of Sunnybrook’s Harquail Centre for Neuromodulation. “Focused ultrasound is an innovative and non-invasive approach to more effectively
delivering chemotherapy directly to the tumour. Our hope is that this continued research will bring us closer to enhancing treatments to help change the course of the disease.”
“Current treatment for DIPG is limited to radiation, which can slow progression of the tumour for a period of time, but does not have longer-term effects,” says Dr. James Rutka, study co-principal investigator and director of the Arthur and Sonia Labatt Brain Tumour Research Centre.
“Focused ultrasound technology is a promising drug-delivery strategy that is helping us penetrate the blood-brain barrier in a novel way. Conducting this trial will help us build new and innovative treatment pathways for children with DIPG.”
DIPG tumours are the most common form of brain tumour in children under the age of 15 and make up nearly 10 to 15 per cent of all childhood brain tumours. It affects the region of the brainstem known as the pons which regulates the body’s involuntary activities such as breathing, heart rate and important functions such as swallowing. DIPG is considered a terminal cancer.
Clinical and research teams from Sunnybrook and SickKids are collaborating on the clinical trial which will investigate the safety and feasibility of breaching the blood-brain barrier using MRI-guided focused ultrasound in combination with the delivery of chemotherapy in paediatric patients with DIPG.
The study will include 10 patients between five and 18 years old who have been diagnosed with DIPG. Study participants receive general anesthesia ahead of focused ultrasound treatment at Sunnybrook, which will involve three cycles of chemotherapy about four to six weeks apart. A specialized helmet is used to deliver ultrasound energy to brain targets without requiring scalpels or incisions. SickKids physicians and nurses will assist with the treatment procedure at Sunnybrook, and the children will receive post-operative care at SickKids.
Low-intensity ultrasound interacts with microscopic bubbles which vi-
brate causing a temporary opening in the blood-brain barrier that enables therapies to pass and reach a targeted area. The blood brain barrier closes within hours of the procedure.
Sunnybrook is a global leader in focused ultrasound research and is the only Canadian Focused Ultrasound Centre of Excellence as designated by the Focused Ultrasound Foundation.
In 2015, Sunnybrook researchers were the first in the world to investigate low-intensity focused ultrasound in the opening of the blood-brain barrier and delivery of chemotherapy in adult brain cancer, and have safe-
ly demonstrated in a global first trial that chemotherapy can be delivered across the blood brain barrier in brain metastases.
Sunnybrook has also continued this leading-edge focused ultrasound research in other debilitating brain disease including Parkinson’s disease, Alzheimer’s disease, Amyotophic Lateral Sclerosis, major depression, and other disorders.
A key driver of this research is philanthropic investment. This study is funded and supported by The Harquail Family through the Harquail Centre for Neuromodulation at Sunnybrook, the Focused Ultrasound Founda-
Health care facilities (HCFs) play an important role in communities, providing a safe, secure, accessible, and inclusive space for patients, staff, and visitors. To fulfill this role, they must be designed and built for efficient operation and to respond to the evolving needs of the communities they serve.
The standard CSA Z8000, Canadian health care facilities, has been providing evidence-based guidance to support the key objectives of HCFs through design for more than ten years. The 2024 edition of the standard builds on this legacy, helping design HCFs for the future, including:
• Improving the quality of life in long-term care
CSA Z8000:24 recommends designing long-term care (LTC) homes with consideration for the programs and services they provide.
LTC home design should support residents in living to their full capa-
bilities while incorporating the necessary safety and security features.
It should promote a home-like, residential-style environment rather than an institutional setting, for example, by creating spaces where residents can congregate, prepare food together, or enjoy a private dinner with their families.
• Strengthening the climate resilience of health care infrastructure
CSA Z8000 highlights the importance of integrating climate change resilience in the planning, design, construction, and operation of HCFs to help ensure they can provide continuous service during and after extreme weather events. The standard requires developing and implementing a Climate Resilience Plan, assessing climate-related risks, and adopting climate-resilience measures and strategies, such as using heat pumps, renewable energy sources, or contingency planning
for extreme weather and supply shortages, to name a few.
• Reducing the environmental impacts of HCFs
CSA Z8000 provides guidance on developing a structured, performance-based sustainability program that integrates health care, energy efficiency, and climate change policies and actions in a holistic and coherent manner. By applying sustainability principles, including responsible use of water, energy, and other resources, business continuity, and adaptive capacity, HCFs can have a positive environmental impact.
• Balancing design approaches with practical realities of northern, small, and remote communities Logistical challenges, the harsh climate, building on permafrost, and access to material may make it difficult and expensive for some communities to comply with the requirements of CSA standards.
tion, and INSIGHTEC as well as by its lead donor at SickKids, Jordana’s Rainbows Foundation and the Fiorini Family, Meagan’s Hug, Nelina’s Hope and The Wiley Family who supported pre-clinical trial work.
SickKids Foundation also acknowledges the generosity of its donors who have supported DIPG research, including: AIan J. Power and Molly Fitzpatrick, ChadTough Defeat DIPG Foundation, Marita Simbul-Lezon and Ron Lezon, Ryan Chisim Charity Golf Tournament, Skate with Daniel, and We Love You Connie Foundation and Guglietti Family, and W. Robert Keyes and Barbara Jackson. n H
CSA Z8000 recommends using an ethical design framework to engage the community, understand how the HCF can best serve the community, and asses if modifications or adaptations of CSA Z8000 are necessary.
CSA Z8000:24 aims to lead the health care sector toward sustainability and climate resilience and contribute to better health outcomes and the well-being of patients and health care workers. Visit CSA Group’s website to learn more about CSA Z8000 and other standards and research for HCFs and the complex systems and processes within them. n H
By Samir Kanji, Huy Pham, and Certina Ho
Ablood clot is an accumulation of blood that has thickened and clumped together. The body creates clots to stop bleeding after a cut or an injury. While this process is important to prevent excessive blood loss, clots can sometimes form when they are not needed. In such cases, they can block blood flow and prevent oxygen from reaching vital parts of the body, leading to serious complications.
VTE is a condition that affects approximately 10 million people globally every year). VTE occurs when a blood clot forms in a vein, which is a blood vessel that carries blood back to the heart. This condition includes both deep vein thrombosis (DVT) and pulmonary embolism (PE). DVT occurs when a clot forms in a deep vein, usually in the legs. Symptoms of DVT may include leg pain, localized tenderness when touching the area, swelling, and redness. PE occurs when part of a clot breaks off and travels to the lungs. Symptoms of PE may include difficulty breathing, a fast heartbeat, chest pain, etc. Risk factors of VTE may include prolonged immobility (e.g., bedridden), major trauma or fractures, surgeries, active cancer, etc. Experiencing any of these symptoms should prompt immediate medical attention, as early treatment of VTE can help prevent complications.
Blood thinners are medications used to treat and prevent VTE. These include heparins (e.g., enoxaparin), warfarin, and direct oral anticoagulants (or DOACs e.g., apixaban). An
important consideration with heparin, warfarin, and DOACs is their interaction with other blood thinners, such as aspirin and clopidogrel. Using more than one blood thinner at the same time can increase the risk of bleeding. This is particularly relevant for patients who use blood thinners to prevent heart attacks or strokes. (Readers can refer to the American Society of Hematology Guidelines for Management of VTE for further information on the treatment of DVT and PE.)
Warfarin interacts with many other medications. For instance, some antibiotics (e.g., clarithromycin), heart medications (e.g., amiodarone), and other medications (e.g., phenytoin) may increase the effects of warfarin, raising the risk of bleeding. Speak to your pharmacist to learn more about interactions with warfarin if you are taking this medication.
DOACs, particularly apixaban, edoxaban, and rivaroxaban, could be influenced by certain enzymes (e.g.,
CYP3A4) and/or proteins (e.g., P-glycoprotein) in your body. It is important to note that some medications may affect how CYP3A4 and/or P-glycoprotein work, resulting in potential drug-drug interactions with DOACs. For example, certain antifungals (e.g., ketoconazole), antibiotics (e.g., rifampin), seizure medications (e.g., carbamazepine), and HIV medications (e.g., ritonavir), etc., may need to be avoided due to their effects on CYP3A4 and/or P-glycoprotein. In some cases, your doctor may need to adjust the dose of your blood thinner, change the timing of your medications, or monitor you more closely.
After experiencing a VTE, treatment usually lasts at least three to six months. In some cases, ongoing treatment, referred to as secondary prevention, may be needed for several years or for a lifetime. For patients taking apixaban or rivaroxaban as part of secondary prevention, a lower dose might be used. It is also important to
consider other health related conditions, such as kidney function, liver function, pregnancy, breastfeeding, etc., when taking blood thinning medications. For example, DOACs are not recommended for patients with severe kidney or liver dysfunction.
Blood thinning medications should always be taken exactly as directed. It is also important to let your pharmacist or doctor know about the use of any over-the-counter medications, vitamins, minerals, or supplements, and if there is a change in your diet. This allows them to monitor for any drug-drug or drug-food interactions that could potentially increase the risk of bleeding or the formation of blood clots. Having an open dialogue with your healthcare team can help manage potential side effects and ensure your medications are safe and effective. n H
As a former school principal, Jim has always looked at each day as an opportunity to learn something new. He still does. Now, as part of the Christie Gardens community, Jim is in a unique community that respects his passion for learning and invites him to share it with others.
early 20 years ago, Audrey Gouskos came through the St. Michael’s Hospital Emergency Department unable to walk. She had trouble breathing and would be intubated for six weeks. At 41 years old, with a busy career and a three-year-old son at home, Gouskos recalls having her last rites read as clinicians worked to determine what was going on.
This was the beginning of her journey with a rare disease known as dermatomyositis.
“St. Michael’s has really kept me alive,” says Gouskos.
Through the years, she has had flare ups that continue to require steroids to manage, been intubated twice, and now has a port for immunotherapy treatment. She has nine specialists at St. Michael’s and visits the hospital five to six times per month because her disease impacts so many different organs.
Myositis is an umbrella term for a rare autoimmune disease that makes your immune system attack your muscles. The skin, joints, lungs and heart can also be impacted. Affecting approximately one in 100,000 people, it causes muscle inflammation that leads to progressive weakness and functional limitations.
Unity Health Toronto is home to a first-of-its-kind rehabilitation pathway in Ontario where a team of clinicians in rheumatology and neurology at St. Michael’s and in rehabilitation at Providence Healthcare are working together to support patients with myositis to receive treatment and rehabilitation to manage their symptoms. There is no cure for myositis, but there are effective treatments to control the condition together with physical rehabilitation.
When St. Michael’s, a globally recognized fully affiliated academic health sciences centre, and Providence, a regional leader in rehabilitation, older adults and long-term care, became part of the Unity Health network, the Myositis Clinic team at St. Michael’s
saw an opportunity to collaborate and leverage the rehabilitation expertise at Providence to care for myositis patients.
“The early stages of the expertise in myositis at St. Michael’s began with my colleague Dr. Rachel Shupak,” says Dr. Ophir Vinik, a rheumatology physician. “When I joined the hospital about 10 years ago and slowly developed expertise on this condition, what was striking to me was how these patients again and again fall between the cracks – they go for months or years sometimes with the wrong diagnosis, inadequate treatment, and they have nowhere to go because it’s rare and many clinicians don’t have experience with it.”
Vinik said that physiotherapy is a fundamental part of the recovery process for myositis patients, but many don’t get it because it’s a rare disease and these patients don’t fall perfectly into any [rehab] category.
“That’s what led to this Unity Health pathway,” Vinik says.
Over at Providence, clinical educators Shelan McCreery and Lisa Azuma support the rehab needs of myositis patients in both inpatient and outpatient settings. McCreery, an occupational therapist, and Azuma, a physiotherapist, say the rehab for this patient population is often exercise-based and can also address cognitive concerns depending on the needs of the patient.
“It’s an interdisciplinary team, so we’ll do a joint assessment to see where the patient is at and then tailor treatments based on each individual patient,” says Azuma.
Some patients may come in unable to lift their arms or with difficulty taking a step. Azuma says it’s rewarding to see how the rehabilitation can result in significant improvements in patients’ quality of life.
Azuma and McCreery say the new pathway has also highlighted how far patients travel to receive care for this rare disease.
“We’re here in Scarborough, but the Myositis Clinic gets patients from
a wide area and from quite a distance sometimes, as well as in some cases younger patients who are working or have young families,” says McCreery. “So figuring out modifications or adaptations they need is something we really try to do, like offering the flexibility of virtual visits if that’s beneficial to them.”
The team has also collaborated with Arthritis Society Canada to share their expertise and to integrate myositis care into the Arthritis Society province-wide.
“So no matter where the patient is, the goal is they will have access to a clinician or allied health professional that at least has some experience or expertise that they can receive locally, and they don’t all have to travel to big centres, like in Toronto or London,” says Vinik.
Gouskos says she can’t stress enough the importance of physio and occupational therapy in helping her to continue to have independence in her life.
She recalls a few months back beginning to feel unsteady on her feet and having falls while at home. She began to worry about being able to get
on a flight to make it to her son’s university graduation in Florida. Working with physiotherapists Gareth Sneath, and Angelo Papachristos at St. Michael’s, helped Gouskos to set goals.
“It might be getting on a flight, it might be how you can maneuver your body to get help if you fall, they help me know what to avoid having in my house to prevent falls, and give you exercises to take home. It’s been really instrumental in my progress.”
Gouskos was able to make it to Florida to see her son cross the stage and she continues to encourage him as he pursues an MBA and his passion for lacrosse. She also fills her time as a Patient and Family Partner with Unity Health and as a volunteer supporting a clinical trial at St. Michael’s.
“For me it’s been about not letting the disease take over and showing my son that with the right attitude you can’t always beat things, but you can cope,” she says. “I had a high profile career and I did want to go back to work, but I couldn’t, and so being involved with the hospital is my way of giving back.” n H
Two recent studies from UHN’s Toronto General Hospital Research Institute (TGHRI) have advanced the understanding of best practices in care. These studies examined whether health outcomes, such as stroke recurrence, disease burden and quality of life differ between men and women.
In one of the studies, a research team led by Dr. Eric Horlick, Peter Munk Chair in Structural Heart Disease at Toronto General Hospital’s Peter Munk Cardiac Centre and investigator at TGHRI, and Dr. Lusine Abrahamyan, a scientist at TGHRI, investigated whether there were sexbased differences in stroke recurrence following patent foramen ovale (PFO) closure for stroke.
Limited clinical data had suggested men were more likely than women to benefit from the procedure.
A PFO is a small congenital hole in the heart – present in 25 per cent of the population – that is a recognized risk factor for stroke. Evidence from trials suggests that an outpatient, catheter-based procedure under local anesthesia, which is called PFO closure, yields better outcomes than medical therapy alone.
However, real-world data on longterm differences in outcomes for men and women after PFO closure is not available.
To determine whether outcomes differ, Dr. Horlick’s team analyzed the long-term results of PFO closure in men and women. They reviewed the detailed medical charts of patients from their practice who had undergone the PFO procedure at the Peter Munk Cardiac Centre, one of the largest programs internationally in the region.
Out of 783 patients in the study, 349 or 44.5 per cent, were women, and 434, or 55.5 per cent, were men.
Results showed that women were generally younger and more likely to experience migraines, while men had more risk factors for heart disease. There were no differences between men and women in the success of the procedure or outcomes within 30 days and over a median follow-up period of 14 years in areas such as repeat stroke risk, survival and atrial fibrillation.
These results underscore the importance of updating clinical trial data with robust longitudinal data disaggregated by sex, and demonstrate how sex-based analyses can enable more personalized, evidence-based care decisions.
The researchers recommend further studies include sex-based analyses to further advance care, which will enhance the reproducibility of findings, benefit women’s health and help support guideline development.
Many future trials will be designed from the outset focussing on the relative benefits of new and existing therapies for men and women.
In another study from TGHRI, a North American team led by affiliate scientist Dr. Florence Wong looked at sex differences in how patients perceive the burden of ascites from cirrhosis of the liver – fluid collecting in spaces of the abdomen – and how it impacts their quality of life.
Ascites develops in about 31 per cent of patients within the first year after being diagnosed with cirrhosis –scarring of the liver. As cirrhosis progresses, the ascites become increasingly difficult to control and treat.
Response to treatment can vary by sex, and men’s and women’s experience of disease can impact factors such as disease burden and quality of life. Understanding these differences is critical to developing personalized treatment plans that address the unique needs of men and women.
Due to factors such as physical discomfort, changes in body appearance, dietary restrictions and increased stress, patients typically experience a reduced quality of life.
Research suggests that women with liver disease may experience a poorer quality of life, possibly due to a greater disease burden or a stronger impact from the same disease severity.
As individualized care is becoming increasingly important in cirrhosis, this study aimed to explore whether men and women with advanced liver disease and ascites experience differences in quality of life, what factors contribute to these differences and how they affect daily functioning.
Researchers studied 392 men and 184 women with cirrhosis and severe ascites, comparing symptoms, mental health, physical activity and overall quality of life between men and women using various tests and questionnaires.
Results showed that women with cirrhosis and ascites had more severe symptoms than men at the same stage of the disease, which affected their quality of life, even though their physical functioning remained similar.
Women reported lower mental well-being, than men. Despite the negative emotional impact, women were able to conduct their daily activities as adequately as men.
Interestingly, women who were referred for transplants exhibited reduced physical function compared to men. This difference was not present in the patients not referred for transplant.
This study highlights the differences in the lived experience of women and men and the importance of using both clinical and patient-reported data to provide better, more personalized care.
By examining whether certain conditions, treatments and disease burdens affect men and women in distinct ways, both studies contribute to a more nuanced body of knowledge that promotes better outcomes for all patients.
UHN is committed to producing high-quality research that reports on sex and gender in treatment efficacy, health outcomes and experience of disease. Research that addresses these knowledge gaps illuminates the path to reducing health disparities based on sex and gender. n H
By Dr Michael Stacey
Yhis Consensus Statement was developed with the objective of creating a concise document that incorporates new clinical and research findings, and that Health Care Providers can use in the clinic. Nineteen Health Care Providers from across Canada were involved in the process. Their backgrounds included physicians, nurses, Nurses Specializing in Wound Ostomy and Continence (NSWOCs) and therapists.
An initial draft document was reviewed by the panel on multiple occasions for feedback, modification and determination of the level of consensus. The Consensus Statement was divided into 23 sections and the panel achieved full consensus on 20 sections and greater than 85% consensus on the remaining 3 sections. This was developed inde-
pendent of input from any wound care companies.
The Consensus Statement reiterates the foundational principles of managing venous leg ulcers (VLUs), including improving calf muscle pump function1 and the principles of Wound Bed Preparation2. It incorporates new research findings in two key areas –
• The use of the muscle pump activation device (MPA – geko™, Firstkind Ltd, United Kingdom) that has been shown to improve the function of the calf muscle pump in patients with VLUs3. The standard way of improving calf muscle pump function is with compression therapy on the lower leg and new research has shown that when MPA is added to compression therapy, VLUs heal at a faster rate4. MPA is recommended for patients who cannot tolerate optimal compression therapy; or for
patients whose ulcers are not healing or are slow to heal with the use of optimal compression therapy.
Supporting wound care education for clinicians is in line with our commitment to the patient. We are pleased to offer webinar sessions that focus on Lower Limb Assessment, Diagnosis, Treatment and Management of Lower Limb Wounds. Multiple series have been developed and will be moderated by leading Internationally recognized speakers Dr. Michael Stacey, Dr. R. Gary Sibbald, and Dr. Robyn Evans. Perfuse Medtec Inc. has partnered with Nurses Specialized in Wound, Ostomy, Continence Canada (NSWOCC), Nurse Practitioners Association of Ontario (NPAO), the Canadian Home Care Association (CHCA) and St. Joseph’s Care Group within Canada to deliver these educational opportunities.
Sessions can be accessed for free*. You just need to register for each session.
To explore the various webinar series go to: www.gekodevices.com/canadian-webinar-series/ *NPAO sessions are free of charge to their members.
• An algorithm for the use of new and advanced wound therapies that can enhance the healing process of VLUs once the underlying cause of the impaired calf muscle pump has been optimally treated5. These advanced wound therapies are recommended to be used in a stepwise fashion, the key categories are –
– Eradication of biofilm and bacteria
– Reduction of increased protease levels
– Improvement in the wound base by Negative Pressure Wound Therapy or by adding matrix substitutes
– Addition of growth promoting factors to the wound bed
– Addition of healthy cells to the wound such as skin grafts, cultured cells or stem cells
The Consensus Statement also provides guidance to Health Care Providers on the steps to take if VLUs do not enter a healing phase or if the rate of healing is very slow.
The key components of the Consensus Statement are –
• Clinical assessment
• Investigations
• Diagnosis
• Treatment of the underlying cause which is impaired calf muscle pump function
• Management of the ulcer
• Options when not entering a healing trajectory
• Management post ulcer healing
The Consensus Statement has been presented at a number of national annual conferences including Nurses Specialized in Wound Ostomy and Continence Canada, Wounds Canada and the Canadian Society of Vascular Surgery. To date it has received the following endorsements: Endorsed by Nurses Specialized in Wound, Ostomy and Continence Canada, 2024
The Canadian Home Care Association (CHCA) endorses the Canadian Consensus Statement on the Treatment of Venous Leg Ulcers as an essential resource for standardized care, complemented by CHCA’s Project ECHO: Home and Community Care, to enhance providers’ capacity through training and networking. (Nadine Henningsen, CHCA CEO). n H
Dr Michael Stacey is a Vascular Surgeon, Hamilton Health Sciences and Professor, Department of Surgery, McMaster University
A panel of 19 Physicians, NSWOCCs, Wound Specialists, and Therapists with experience in treating VLUs, using the Muscle Pump Activator device, and advanced wound treatments.
This panel agreed that the geko™ device (Muscle Pump Activator) should be added to the treatment plan when:
◦ A patient cannot tolerate compression
◦ A patient is not in optimal compression
◦ No progress is seen in a wound after 2-4 weeks
◦ A wound has not healed 30% in 30 days
◦ Dr Asem Saleh
◦ Dr John Hwang
◦ Rosemary Hill
◦ Josee Senechal
◦ Michele Langille
Read the VLU consensus here: https://sites.google.com/view/VLUconsensus or scan the QR code below
The geko™ device demonstrated greater than two-fold increase in wound healing rate1 and a reported reduction of pain2 in venous leg ulcers vs compression alone. Harding et al, 2023
By Dr. R. Gary Sibbald and Catherine Harley
To support Truth and Reconciliation and the wound, ostomy and continence health of Indigenous People, Nurses Specialized in Wound, Ostomy and Continence Canada (NSWOCC) launched an Indigenous Sharing Circle in June 2018. The members were interprofessional healthcare providers working with Indigenous people in communities across Canada. The members made a commitment to improved patient care delivery with access to skin and wound education. The process involved examining unique Indigenous community perspectives in rural, remote, and urban areas.
The NSWOCC Indigenous Sharing Circle members work in the frontline
with Indigenous, Metis, and Inuit people. They conducted a Strengths, Opportunities, Aspirations and Results (SOAR) analysis that identified the gaps in the system and where they could make a positive impact. Collectively the circle explored possible solutions to common health challenges faced by First Nations and Indigenous Groups
One of the areas identified requiring a change in process and improvement, was inequitable skin and wound care education provided to healthcare professionals working in Indigenous Communities. To provide equitable and sustainable skin and wound education, it was essential that NSWOCC partner with another organization. This culturally sensitive, skin and
At Molnlycke, we are driven by a commitment to revolutionize care for both people and the planet. This starts with creating lasting change that enhances the quality of life for patients and healthcare providers alike.
Our mission is to relieve patients, caregivers, and healthcare systems from the burden of wounds. We achieve this by offering products that not only support prevention but also promote faster healing. This ensures patients receive the care they need while empowering healthcare professionals with solutions that reduce treatment times, lower costs, and accelerate recovery.
Our innovative prophylactic dressings and positioning products are specifically designed to prevent hospital-acquired pressure injuries. These solutions help to reduce patient suffering, minimize staff hours, and shorten hospital stays.
Molnlycke has been at the forefront of pressure injury prevention, continuously developing and improving solutions helping healthcare providers deliver safer, more effective care. Our dedication to preventing these injuries and advancing patient care drives everything we do. By empowering healthcare systems with the knowledge, tools, and resources to reduce pressure injuries, we are improving patient outcomes and helping build a more sustainable future for healthcare. Find out more at Molnlycke.ca
wound education program needed to reach Indigenous communities across Canada.
Indigenous peoples in Canada face a disproportionate burden of diabetes-related foot complications including foot ulcers, lower extremity amputations, and peripheral arterial disease. WoundPedia led by Dr. Gary Sibbald, was identified as the right partner. Dr Sibbald and his partners had already successfully launched ECHO (Extension for Community Healthcare Outcomes) Ontario over the past 7 years. This program reached a wide variety of healthcare professionals across Ontario through a virtual platform. The education process focused on interprofessional collaboration, early screening for the high-risk diabetic foot and patient education with a strong focus on the lower limb. Using a hub and spoke model, there was an emphasis on educating healthcare professionals in practice. A key element was the development of interprofessional teams (doctor, nurse and allied health professionals) through the use of multimodal interactive didactic methods . Educational activities included case-based interactive learning and virtual skills training, leading to evidence-based care management with outcome evaluation. The Ontario ECHO Skin and Wound had already trained more than 600 healthcare professionals in 120 health care organisations and provided team consultations to more than 240 complex patients. More than 90 per cent of participants said the learning met their needs and 87 per cent changed their practice. The ECHO project focuses on treating patients in their communities, by ‘moving knowledge, not patients’.
NSWOCC linked with WoundPedia and their Ontario ECHO Skin and Wound experience with Queen’s University who provide accreditation and outcomes analysis. Indigenous Services Canada has supported initial funding and dissemination to create the Indigenous ECHO Canada Skin
and Wound program. Eight education sessions will be provided virtually. The educational materials were reviewed by an Indigenous healthcare professional for cultural safety. A lower extremity “Tool Kit” was developed by Dr Sibbald and the ECHO Ontario team. This kit will support improved community lower limb management capacity. This will improve care and healthcare equity in rural and remote Indigenous communities. A launch meeting was held January 13, 2025 (119 participants) and the first Indigenous ECHO Canada Skin and Wound session will start February 10, 2025.
The NSWOCC Indigenous Sharing Circle will provide Nurses Specialized in Wound, Ostomy and Continence (NSWOC) mentors across Canada to support building the knowledge of healthcare professionals who take this education program. This will help to support the student’s success and sustainability of this education program. Healthcare professionals from Indigenous communities can access this program from their own community and have been registering for this educational skin and wound care program. An evaluation of outcomes will be conducted after the completion of the eighth session May 26, 2025.
The sessions will be broadcast Monday evenings twice monthly from 7 to 8:30 pm Eastern time from February through May. The 8 sessions will cover 4 wound topics: Wound Bed Preparation 2024 as a process for wholistic patient wound care, vascular assessment, Infection and Plantar pressure redistribution. An indigenous dermatologist from Saskatchewan, .Dr. Rachel Asiniwasis performed a dermatology needs assessment for the indigenous communities. The assessment identified general skin care along with atopic dermatitis, skin infections and bites, stings and infestations.
The best way to free patients from the burden of pressure injuries is to prevent them.
Pressure injuries have long been a challenge for patients and healthcare providers. When traditional methods fall short, it’s time to rethink your approach.
By Dr. Michael C Stacey and Dr. R Gary Sibbald
Chronic wounds on the lower leg and foot have multiple etiologies that include vascular disease: venous leg ulcers (VLU), diabetic with neurotropic and/or ischemic foot ulcers (DFUs) along with ulcers due to peripheral artery disease (PAD). Although the underlying causes of the ulcers differ, the result of the underlying problems in each case is an impact on the microcirculation in the lower leg and in the region of the ulcers. The pathway to the altered microcirculation is different with each type of ulcer:
• PAD ulcers – reduced blood flow due to arterial stenoses or occlusions in the arteries taking blood to the leg, and changes in the small vessels
• DFU – increased pressure on the skin and compression of the blood vessels in the skin due to the underlying neuropathy, the inability to feel pain from the sustained pressure,
and the inability to subconsciously make adjustments to relieve the pressure. The microcirculation can also be impacted by changes in the small vessels in the skin or the larger vessels in the leg due to the impacts of diabetes on the blood vessels
• VLU – ambulatory venous hypertension due to an inefficient calf muscle pump that results from changes in the veins. This alters the microcirculation in the ulcers and the surrounding skin
Treatment of these types of lower limb ulcers focusses on treating the underlying cause which has the goal if improving the microcirculation of the ulcers and in the skin around the ulcers. The standard treatment methods are:
• PAD ulcers – reconstruction of the occluded or stenosed arteries to improve circulation to the limb and microcirculation to the ulcers including surrounding tissue
• DFU – pressure offloading to reduce pressure on the skin and its microcirculation to allow increased blood flow. Where appropriate, vascular reconstruction to correct arterial stenosis or occlusion
• VLU – compression therapy on the lower leg to reduce ambulatory venous hypertension and improve microcirculation of the tissue in and around the ulcer
In each of these forms of ulceration, treating the underlying cause improves the microcirculation, however, there are frequently still residual impairments in the circulation that are not fully improved. This adds to the challenges of healing in some of these chronic wounds. In addition, some patients are not able to undergo optimal treatment due to the extent of their underlying disease, difficulty tolerating the optimal treatment, or lack of access or delays in receiving appropriate care. For this reason, there is a need for other ways to improve the microcirculation in and around their chronic wounds.
The Muscle Pump Activation device (MPA – geko, Firstkind, United Kingdom) is an innovative device that has improved both venous blood flow in the lower limb, and the microcirculation in healthy volunteer. In addition, similar improvements have been documented in patients with chronic leg ulcers that include VLU, DFU and PAD ulcers. There is also a growing body of evidence documenting MPA benefits accelerating the healing of other chronic wounds.
With the growing evidence for the use of this innovative treatment, there is good reason for clinicians to use this device for managing their patients. Some of the current indications include:
• VLUs – patients who are unable to tolerate optimal compression or whose ulcers are not reducing in size or are not achieving the expected size reduction of 30 per cent after 4 weeks with optimal compression
• DFUs – patients whose ulcers are not reducing in size or are not achieving the expected size reduction of 30 per cent after 4 weeks with appropriate pressure off-loading, treatment of secondary infection and optimization of arterial blood supply
• PAD ulcers – patients whose arterial disease is not amenable to vascular reconstruction (exhausted all vascular reconstruction options, unable to receive vascular reconstruction due to other medical conditions or problems with access to care). This treatment would be applicable to patients who have significant delays in treatment due to remote locations The MPA device is an innovative technology that provides health care providers with a validated patient management option with chronic lower limb ulcers. It stimulates the peroneal nerve with an ankle twitch response associated with local increased perfusion. This is a tool that clinicians should incorporate into their management strategies for patients with VLUs, DFUs and PAD ulcers. n H
Dr. Michael C Stacey is a Vascular Surgeon at Hamilton Health Sciences, McMaster University and Dr. R Gary Sibbald is a Dermatologist at Women’s College Hospital, University of Toronto.
Continued from page 18
Each 60-minute session will be accompanied by 30 minutes of skills with short assignments to practice the skills and complete the requirements for a toolkit.
The vision for the development of the Indigenous ECHO Canada Skin and Wound Care will fuel equitable ac-
cess to skin and wound care education. The development of this program will improve the healthcare of Indigenous people from coast to coast. Healthcare Professionals can enroll in the program by contacting Linda@WoundPedia. com. Further information can be obtained at office@nswoc.ca. n H
Dr. R Gary Sibbald is a Vascular Surgeon at Hamilton Health Sciences, McMaster University and and Catherine Harley is Chief Executive Officer, Nurses Specialized in Wound, Ostomy and Continence Canada (NSWOCC).
Left: The HHS Centre for Burn Research team focuses on three areas of cutting-edge research: stem cell use in skin regeneration, skin printing for grafting wounds, and metabolism in burn recovery. Right: McMaster University masters student Fadi Khalaf operates the QIAsymphony, a robotic system that automates the purification of DNA and RNA. This allows researchers to analyze how burn injuries and age-related genetic changes impact the genome, helping to uncover why older adults experience higher mortality and identifying potential therapeutic strategies to mitigate these effects
Revving up older patients’ metabolism could be the key to healing from severe
Older patients suffering a severe burn are at a much higher risk of dying than younger patients with the same type of injury. Researchers at Hamilton Health Sciences (HHS)’ Centre for Burn Research are exploring ways to improve outcomes for older burn patients by closing that gap.
“Where a young adult or middle-aged patient might have a 20 per cent chance of dying from a severe burn injury, a patient aged 60 or older would have a 70 or 80 per cent chance of dying with the same burn size and injury severity,” says Dr. Marc Jeschke, a globally recognized researcher and burn surgeon at HHS.
Jeschke is also medical director of the Regional Burn Program at HHS Hamilton General Hospital (HGH). It’s one of two burn units in the province caring for patients with burns ranging from small but severe to full body. He’s also vice president of research and chief scientific officer for HHS, a top 10 Canadian research hospital.
Jeschke and his research team at the HHS Centre for Burn Research, located within the Thrombosis and Atherosclerosis Research Institute (TaARI), focus on developing cutting-edge treatments and therapies to improve outcomes in people with severe burn injuries locally and globally. Their main areas of re-
“OUR GOAL, THROUGH THIS RESEARCH, IS TO NARROW THE GAP SO THAT OLDER BURN PATIENTS SURVIVE THEIR INJURIES, AND HEAL IN A WAY THAT ALLOWS THEM TO ENJOY A GOOD QUALITY OF LIFE.”
search are stem cell use in skin regeneration, skin printing for grafting wounds, and metabolism in burn recovery. Metabolism is the process of using energy, or calories, for the body to maintain itself. It also aids in healing. As people age, their metabolism slows.
“Metabolism and aging are interconnected in our research work,” says Jeschke, adding, “It’s a very important area of study for our team.”
Older adults are more susceptible to burn injuries for reasons including thinning skin, decreased sensation and deterioration of judgement and coordination. Scalding is the most common type of burn injury in older patients, affecting more women than men.
Burn research aimed at improving survival rates for older adults is vital, given Canada’s aging demographic. Over the next 20 years, Canada’s se-
nior population is expected to grow by almost 70 per cent, according to the Canadian Institute for Health Information.
The HHS burn team’s cutting-edge research into the link between metabolism and aging could help narrow the gap in survival rates between older patients and their younger counterparts.
When a person suffers a severe burn, their body becomes hyper metabolic. Hyper metabolism, or metabolic stress, is the direct response to a burn injury, with the amount of stress increasing based on the extent of the injury. The body’s healing system is kicked into high gear, as the stress reaction fuels recovery.
But metabolism slows with age, and studies have found that older patients don’t respond with stress as younger people do, so they aren’t able to shift to that higher gear for healing. As a result, older burn patients experience
much poorer outcomes because their cells rejuvenate more slowly which can mean they don’t heal completely.
“Our research is looking at how we can restore this function in older adults, so they can respond to stress like a younger patient would,” says Jeschke, whose team is exploring this at the cellular level. “For example, we know that the mitochondria aren’t working as hard in older patients. But we don’t understand the entire ‘how or why’ of this.” Mitochondria are energy factories in cells that process oxygen and convert food and drinks into energy that promotes recovery.
Jeschke’s lab is exploring the use of biologic medicines to induce certain rejuvenating cells and organs into promote the energy needed for healing after a burn injury. Biologics contain substances that were created using living cells or organisms and are often used to treat severe, life-threatening illnesses.
“We’re one of the few labs in the world focused on this mechanism works in older adult patients,” says Jeschke. “Through our research, we’re exploring how to rejuvenate cells and organs so they’re able to respond better to healing. Our goal, through this research, is to narrow the gap so that older burn patients survive their injuries, and heal in a way that allows them to enjoy a good quality of life.” n H
As people grow older, their risk of developing cancer increases. So does their risk of becoming frail – a medical condition involving reduced function and health. It’s a dangerous combination, given that frailty affects up to 40 per cent of patients living with cancer, increasing their risk of both short and long-term side effects, and even death, following treatment.
When a person is frail, their body has less resilience to tolerate treatments and recover, says Dr. Julie Nguyen, a gynecologic oncologist at Hamilton Health Sciences (HHS), a top 10 Canadian research hospital. Nguyen cares for patients at HHS Juravinski Hospital and Cancer Centre (JHCC), and is also a clinician-researcher who studies frailty in patients with gynecological cancers, such as cancers of the uterus, cervix and ovaries.
“Research shows that frail patients have shorter survival rates after being diagnosed with cancer and going through treatment,” says Nguyen. “This is why it’s so important for cancer researchers to better understand frailty, and how to best measure it, so that we can tailor treatments to a patients’ individual needs, and develop interventions to help them grow stronger and live longer with the best possible quality of life.”
The FARGO (Frailty Assessment for Risk prediction in Gynecologic Oncology) study, co-led by Nguyen and senior researcher Dr. Maura Marcucci at the Population Health Research Institute (PHRI) – a joint institute of HHS and McMaster University – aims to find better, more practical ways to assess frailty in patients with cancer as they go through treatment and recovery.
Nguyen and Marcucci are both researchers with PHRI and the McMaster Institute for Research on Aging.
Dr. Julie Nguyen is a gynecologic oncologist at HHS Juravinski Hospital and Cancer Centre and a researcher who studies frailty in patients with gynecological cancers. The FARGO study she’s co-leading aims to find better, more practical ways to assess frailty in patients with cancer as they go through treatment and recovery.
They are working on the study in collaboration with leading experts from PHRI; the HHS Clinical Research Laboratory and Biobank – Genetic and Molecular Epidemiology Laboratory (CRLB-GMEL); and the gynecologic oncology and internal medicine teams at JHCC, Sunnybrook Health Sciences Centre, University Health Network and Credit Valley Hospital. The FARGO study is supported with funding from the HHS Foundation, among other funding sources.
It will follow 280 patients having surgery and treatment for gynecologic cancers to discover the most effective methods for measuring frailty and risk of complications. To date, more than 50 per cent of participants have been enrolled. All are 55 years of age or older whose treatment will include a laparotomy – a major surgery to help diagnose and treat gynecological cancers – and chemotherapy.
“FARGO is one of the first studies to measure frailty at several time points in a patient’s treatment jour-
ney, and perhaps the first that seeks to find new blood tests for frailty in patients with gynecologic cancers,” says Nguyen.
“In the future, we hope to develop interventions to help frail patients become stronger before, during and after their treatments. Studies show that patients value their quality of life just as much as length of life after cancer. The goal would be to preserve or even improve quality of life and functional status throughout treatment.”
Gynecologic cancers are often treated with surgery and chemotherapy which can be intensive and lead to short and long-term complications. Study participants will take a frailty assessment before and after surgery, as well as six months and one year after surgery, when treatments are completed. “Frail patients are known to have greater complication rates after sur-
gery, and are also less likely to tolerate regular doses of chemotherapy,” says Nguyen.
Testing for frailty isn’t part of daily medical care, and as a result this condition is often overlooked. Obstacles to frailty screening include time and resource limitations of the health-care system.
Meanwhile, the burden of frailty on the health-care system is increasing as our population ages and cancer rates among older adults rise. “Unfortunately, frailty remains greatly under-diagnosed,” says Nguyen.
Developing blood tests to measure frailty through blood biomarkers could help increase screening rates, because it could be faster, more efficient, and potentially more reliable. The FARGO study will innovate to find new blood tests in partnership with the CRLB-GMEL lab.
“Early detection of frailty through new blood tests could lead to proactive interventions, allowing us to strengthen patients before, during, and after their treatment, ultimately enhancing their outcomes and decreasing complications,” says Nguyen. “Developing more convenient and accurate methods for measuring frailty is crucial to improve patient care.”
For this study, Nguyen has been recognized with several awards including the Early Career Research Award and the New Investigator Fund from HHS, the Transforming Tomorrow Today grant from the PHRI, as well as the Most Promising Research Award from the Department of Obstetrics and Gynecology at McMaster University. Nguyen and Marcucci, with their research team, were also awarded the Hamilton Academic Health Sciences Organization Innovation Fund in 2020 as well as the HHS Foundation Research Thematic Grant. n H
By Shahana Gaur
The growing senior population in Ontario poses unique challenges to the healthcare system. By 2046, the province will see 1.7 million more seniors, with a significant proportion affected by dementia. In anticipation of this demographic shift, Humber River Health (Humber) has taken proactive steps to innovate and implement patient-centered strategies that address the complex needs of aging adults. Central to these efforts is the comprehensive Dementia and Responsive Behaviours Capacity Building initiative, a program that has transformed care across the organization.
At Humber, nearly 73 per cent of admitted patients are over the age of 65. This population is at an increased risk for comorbidities, including cognitive impairment such as dementia, with the risk of dementia doubling every five years between the ages of 65 to 84 years. Patients with dementia exhibit expressive behaviours – such as anxiety, agitation, wandering, or withdrawal – frequently creating barriers to discharge to the next care destination and extended hospital stays. These behaviours are manifestations of unmet needs, making early identification and intervention critical for improving outcomes.
Recognizing this, Humber launched the Dementia and Responsive Behaviours Capacity Building initiative. Over two years, this pioneering initiative focused on staff capacity building and achieving measurable resident-level outcomes, with the digitization of the paper-based tool Behavioural Supports Ontario - Dementia Observation System (BSO-DOS©), serving as one of its key enablers. Humber became the first acute care hospital in Ontario to do this, underscoring the hospital’s commitment to innovation and patient-centered care, even during the pressures of the COVID-19 pandemic. Permission was obtained from the Behavioural Supports Ontario (BSO)
THIS POPULATION IS AT AN INCREASED RISK FOR COMORBIDITIES, INCLUDING COGNITIVE IMPAIRMENT SUCH AS DEMENTIA, WITH THE RISK OF DEMENTIA DOUBLING EVERY FIVE YEARS BETWEEN THE AGES OF 65 TO 84 YEARS.
head office, and the integration into Humber’s electronic medical record (EMR) was overseen by this office to ensure compliance with the intent of the tool.
The initiative began with a pilot project on the Acute Care of the Elderly (ACE) inpatient unit in 2021, informed by stakeholder consultation and staff knowledge survey results.
This immersive program combined advanced staff training with the rollout of the electronic BSO-DOS© (eBSO-DOS©), which was completed within one quarter of 2021/2022 and went live in March 2021. Nurse practitioners and clinical practice leaders partnered with LOFT’s Behavioural Support Transition Resource Team (BSTR), the Regional Geriatric Program (RGP) Toronto, and the Alzheimer Society to deliver in-depth education on dementia care and responsive behaviour management to clinical teams. Additionally,
nurse champions across the hospital were supported to complete Gentle Persuasive Approach (GPA) training, led by LOFT, to further enhance their ability to care for this patient population.
The digitization of the BSO-DOS© integrated the tool into Humber’s EMR system, Meditech. This enabled real-time documentation, data analysis, and the creation of individualized behavioural support plans. In addition, BSTR team was provided view access to support and expedite their assessment across clinical areas, thus increasing team’s capacity. Over two years, the initiative expanded to 15 medical and surgical units and two Reactivation Care Centre (RCC) units, eventually covering all medical, surgical and RCC units at Humber.
The program unfolded during the height of the pandemic, yet the Humber team remained steadfast in its mission. “Expanding our team’s skills and
capacity during these unprecedented times showcased the resilience and dedication of our staff,” said Kathleen Kirk, Manager of Family Medicine Teaching Unit and Integrated Care Services. “Despite the difficulties, staff engagement and competency in managing dementia-related behaviours saw tremendous improvement.”
Between April 2022 and October 2024, daily compliance for completing the Behavioural Assessment and Care (BAC) Intervention, a crucial tool to support documentation, averaged 88 per cent. Within 24 hours of admission, these compliance rates reached 99 per cent. Feedback from over 300 trained staff indicated a significant increase in their knowledge and confidence in managing responsive behaviours.
Humber’s efforts align with the newly introduced Support for Seniors and Caregivers Act, 2024. This legislation dedicates $114 million to improving dementia care, caregiver support, and social connection opportunities for seniors. With $80 million earmarked specifically for dementia care over the next three years, Humber’s comprehensive program positions the hospital as a leader in addressing this growing crisis.
“This initiative reflects our dedication to safe, compassionate, and individualized care for seniors,” said Beatrise Edelstein, Vice President of Post-Acute Care and Health System Partnerships. “By combining technology, robust education, training, and interdisciplinary collaboration, we are creating a model to scale and spread.”
Humber’s approach has delivered several key outcomes. Enhanced staff capacity to assess and manage responsive behaviours has been a cornerstone of the initiative. This capability has led to the develop-
ment of individualized behavioural support plans, which in turn have improved patient outcomes and facilitated smoother transitions to community or long-term care settings. Additionally, the reduction in restraint use and incidents related to responsive behaviours has demonstrated the effectiveness of Humber’s strategies. Positive feedback from patients and caregivers further underscores the program’s impact.
Looking ahead, Humber has already initiated the sustainability phase of the initiative through several targeted actions. Audits on BAC and eBSO-DOS© compliance will continue to ensure consistency and identify areas for improvement. Long-term indicators such as alternate level of care (ALC) days and post-discharge hospitalizations will be closely monitored to assess the broader impact of the program. Recognizing the importance of staff training, Humber, in partnership with LOFT, is refreshing its education initiatives to address turnover and maintain high levels of competency through a train-the-trainer and unit huddles approach. The integration of new resources from the Toronto Academic Health Science Network (TAHSN) and RGP into staff training will further enhance the program’s sustainability and effectiveness.
At its core, Humber River Health’s Dementia and Responsive Behaviours Capacity Building initiative exemplifies the hospital’s identity as an innovator. In a society where the demands of aging populations are ever-growing, Humber demonstrates that innovation is not a choice but a necessity. By leveraging digital tools, fostering interdisciplinary collaboration, and prioritizing patient-centered care, Humber is lighting new ways in geriatric medicine. n H
Shahana Gaur is a Senior Writer/Communications Specialist at
Sunnybrook Health Sciences Centre is proud to announce a first-in-Canada recognition, as we received not only the Level 1 Age-Friendly Health System Participant designation, but also the prestigious Level 2 Age-Friendly Health System Committed to Care Excellence designation from the Institute for Healthcare Improvement (IHI). This milestone reaffirms our leadership in providing safe, high-quality and individualized care for older adults across all settings.
Sunnybrook’s journey toward achieving Level 2 status builds on the foundation of its commitment to the IHI’s 4Ms Framework:
1. What Matters: Empowering patients by understanding their personal goals and preferences through enhanced training on person-centered care practices.
2. Medication: Strengthening senior-friendly prescribing with updated Order Set Guidelines, incorporating antipsychotic stewardship and medication safety best practices.
3. Mentation: Expanding delirium reduction efforts by leveraging data insights from GEMINI and engaging interprofessional teams in targeted improvement initiatives.
4. Mobility: Increasing patient mobility through robust audit-feedback mechanisms and quality improvement huddles focused on daily mobilization.
Sunnybrook’s achievement of Level 2 status demonstrates its ability to sustain these practices while introducing innovative strategies to improve outcomes for older adults.
Sunnybrook’s recognition reflects the collective efforts of interdisciplinary teams working across the organization. Notable highlights include:
• Senior Friendly & Behaviour Support Specialists: Supporting clinical teams in advancing harm prevention strategies and embedding age-friendly practices into everyday care.
• Research and Quality Improvement (QI) Projects:
– Pharmacy Leadership: Residents have led impactful studies, such as reducing inappropriate antipsychotic and sedative prescribing.
– Delirium Management Enhancements: New interventions, such as communication tools and targeted rounds, have significantly improved the identification and treatment of delirium.
– Recreation Therapy Programs: Providing meaningful activities to enhance mobility, reduce delirium, and improve mental well-being.
• Patient and Family Portal: A comprehensive resource to empower patients and caregivers with tools to prevent physical and mental decline during hospital stays.
With the recognition of Level 2 designation, Sunnybrook is setting the standard for age-friendly health care in Canada. The achievement reflects the hospital’s unwavering commitment to continuously improving care for a rapidly growing senior population.
“We are honored to be the first Canadian hospital to achieve this milestone,” said Leanne Hughes, Manager, Senior Friendly & Best Practices at Sunnybrook, “and we are committed to leading the way in providing exceptional, age-friendly health care. This designation is not just a recognition of our efforts but also a call to continue innovating and collaborating to ensure older adults receive the care they deserve.”
Sunnybrook’s leadership in this space underscores the importance of prioritizing the needs and values of older adults, ensuring care is delivered reliably and equitably in every setting. n H
On a sunny fall day in Toronto, Sandesh Basnet is in the St. Lawrence neighbourhood for a meet-up. The bubbly, young, Nepali-Canadian knocks on the door and is greeted by a surprising companion: Edith Endrenyi, a stoic, 95-year-old Hungarian-Canadian woman who welcomes him into her home for the friendly visit.
The unlikely duo don’t have overlapping circles nor are they neighbours; Basnet is Endrenyi’s link worker through Support, Equity, Engagement and Dignity – or SEED – a new program at St. Michael’s Hospital that received $2.1 million in donor funding last year to launch and support the program for five years.
Developed by St. Michael’s Hospital’s Academic Family Health Team (SMHAFHT), SEED uses social prescribing – an approach to care that attends to social needs rather than medical – to address social isolation among lonely and often marginalized older adults.
“We’ve been at the forefront of developing programs for social interventions for decades,” says Dr. Gary Bloch, a family physician at St. Michael’s and the medical leader of SEED. “These programs are deeply embedded in our team and were developed ad hoc. But with this funding, we’ve been able to start SEED and really address the social needs of the older adults in our catchment area.”
Nearly 30 per cent of seniors in Canada are at risk of social isolation, an issue that can lead to further consequences including increased risk of falls, reduced quality of life, and premature death.
To help prevent these outcomes, any health-care provider at SMHAFHT can refer their 55+ patients to SEED – patients like Endrenyi, who was referred by her family doctor.
“About seven years ago, my husband died,” says Endrenyi. At her advanced age, many of her friends have passed as well. “I have nobody. I am alone.”
“You have a link worker!” interjects Basnet, forcing her to laugh and agree.
When patients like Endrenyiare are referred to SEED, they begin by meeting with one of the two link workers, Basnet or Murshida Samsun Mueen.
During that initial meeting and in the meetings that follow, the link workers get to know the clients, help to determine what their social needs are, and connect them to resources and programs that help meet those needs.
In the short time that SEED has been active, Basnet and Samsun Mueen have helped clients with a wide variety of interventions, from bringing clients to seniors programs so they can make new friends, to teaching them how to use a smartphone so they can connect with their loved ones more easily, to getting them cleaning services, to helping low-income seniors access affordable food, to simply joining them for a regularly-scheduled coffee.
“I feel like understanding people is like solving a puzzle,” says Basnet, talking about how he figures out what interventions a client needs.
“You have to listen to them and what they’re dealing with. Then you have to connect all the dots.”
He recalls one client who barely left her house when he first met her. After getting to know her, Basnet learned that she loved art, so he decided to accompany her to a jewelry-making class at a local seniors’ centre. She was apprehensive at first, but after having so much fun making bracelets – including one for Basnet – the client gained the confidence to go to the seniors’ centre regularly on her own.
When clients meet their link worker for the first time, they often express that they’re depressed and don’t have many plans to look forward to. Samsun Mueen says changing that is one of the best parts of her job.
“When you see the smile and they tell you that they’re looking forward to seeing you next time, it’s very rewarding,” says Samsun Mueen.
“It has been very beautiful so far,” agrees Basnet.
In addition to the work being done by the link workers, the SEED team has a community health worker, Orit Adose, who is building relationships with services in the local community. She is working on building an asset map that shows where clients can access nearby programs and resources. From libraries to ethnic cooking classes to exercise programs, the map will help link workers and clients to find services that fit their personal interests.
This tool, along with how the SEED program functions and what it will turn into, are guided by older adults in the community who are regularly welcomed to share candidly about their social needs.
Nassim Vahidi-Williams, the manager of community engagement for SEED, says it’s so important that the team “engages in community spaces to share the story of what we do and to
hear the stories of what the community feels is needed.”
Amplifying community voices helps clients know that their opinions matter and helps the SEED team ensure programming is centred on those they are serving.
In the less than a year since SEED has been up and running, 96 clients have been referred to the program, and demand is not slowing down.
Bloch says the SMHAFHT serves 17,000 elderly patients who would benefit from programs like SEED. He hopes the program will grow so more of them can be supported. Further, the SEED team also plans to expand to accept community members who are not SMHAFHT patients.
In the meantime, clients like Endrenyiare enjoying their time with the link workers and the resources they’ve been connected with.
Looking at Basnet warmly, Endrenyisays, “You are an interesting figure for me. When you are here, it’s good.”
This project receives philanthropic funding from Waltons Trust and other anonymous donors. n H
Over the past decade, longterm care (LTC) homes across Canada have made important progress in reducing inappropriate antipsychotic use. By focusing on person-centred care strategies to address dementia-related behaviours, these efforts achieved meaningful improvements in quality of care, benefiting residents, care partners and care providers. Between 2014-2015 and 2019-2020, the rate of potentially inappropriate antipsychotic use dropped from 27.2 to 20.2 per cent. Unfortunately, the COVID-19 pandemic brought new challenges. Staffing shortages and high turnover made it difficult to sustain progress and rates of inappropriate use have risen in many areas. Healthcare Excellence Canada’s (HEC) newest program, the Sparking Change in the Appropriate Use of Antipsychotics (AUA) Awards Program, aims to support LTC homes to use person-centred care approaches, build upon the previous success and bring teams across Canada together to improve care
The AUA approach focuses on person-centred care by tailoring strategies to meet the unique needs of each resident. Responsive behaviours are often a result of unmet needs, confusion or frustration due to changes residents are experiencing. By understanding the resident and their family and creating a care plan centred on their specific needs, it’s often possible to reduce or stop using unnecessary antipsychotic medications. The AUA approach is a full team approach and is most successful when all members of the resident’s care team have a common goal, share and review data and support and reinforce each other’s work. By collaborating, teams can improve residents’ quality of life, foster a positive staff culture and strengthen family involvement.
Hundreds of long-term care homes across Canada have made significant progress in reducing inappropriate an-
tipsychotic use through the Appropriate Use of Antipsychotics (AUA) approach. In New Brunswick, 52 per cent of participating residents had their antipsychotic doses reduced or discontinued by 2018. By 2019, over half of participants in Newfoundland and PEI achieved similar outcomes. In Quebec, the OPUS-AP – PEPS initiative now includes all 313 publicly funded long-term care and alternative homes. Recent efforts in British Columbia have expanded this success, with 59
per cent of participating care homes reporting a reduction in antipsychotic use – highlighting the transformative impact of person-centred care.
The Sparking Change in AUA Awards Program provides LTC teams with tailored support to reduce inappropriate antipsychotic use and improve person-centred care. Each team is assigned a coach, has access to a comprehensive toolbox of resources and
can participate in monthly learning and networking events. The program fosters collaboration, offering opportunities to learn from their peers, share strategies and build on proven approaches. Designed with flexibility and minimal reporting requirements, it equips teams to achieve meaningful improvements in resident care and quality of life.
Furthermore, all teams participating in the Sparking Change in the Appropriate Use of Antipsychotics Awards Program have the opportunity to win financial prizes. Some of the awards will be evaluation-based, while others will be chosen through random draws. Once teams register for the program, they will receive an information package with more details on each award opportunity and related scoring criteria, where applicable.
Whether teams are just starting or already have an initiative in place, this program provides resources to build on their work and drive meaningful change in resident care. Are you ready to spark change?
Learn more and register at healthcareexcellence.ca/sparkingchange n H
‘Healthy aging’: Education empowers patients when it comes to preventing falls
pilot program at Providence Healthcare hopes to empower patients to be more active in their own care, especially when it comes to preventing falls.
Nicola Bell, a Physiotherapist, and Peggy So, an Occupational Therapist, are bringing a small group of patients together in Providence’s Falls Prevention Clinic for the pilot phase of a program that offers education on topics ranging from physical activity to preventing falls and the importance of brain health.
The program’s content was created by surveying patients to find out what would benefit them most.
The creation and evaluation of the pilot program is supported by the Bellamy Manucha Rehabilitation Applied Research Fellowship, which offers clinicians and trainees a chance to complete a research project under the supervision
of one Applied Education Research Operatives (AERO) scientist.
“We’ve wanted to do this for a really long time,” says Bell. “The funding that we received through the fellowship allowed us to have dedicated time each week to work solely on this project.”
The Falls Prevention Clinic aims to maximize safety in the community, promote healthy aging and reduce the risk of a patient sustaining a fall. Patients attending the clinic engage in a one-to-one, tailored, exercise-based treatment program.
Falls can be detrimental to both physical and mental health, particularly for older adults. The new education program offers patients a space to share their own stories, and engage more actively in managing their own care while learning about healthy aging.
Throughout the three sessions, patients have an opportunity to interact and build connections while learning
from each other’s personal experiences and accessing peer support.
The program also focuses on recognizing early signs of decline that might lead to a fall or accident.
“Things like attention, judgement and insight can also have an impact on falls risk,” says Bell. “It’s really about healthy aging overall which is why we included the session on cognition and strategies to try and keep the aging brain sharp.”
While the program is currently in its pilot phase, the team already has hopes for the future. They are gathering feedback from the pilot group to make improvements to the content and mode of delivery for future sessions. The team also recognizes the need to consider how this information could be adapted for patients with varying levels of cognition and those who do not speak English. n H
By Katie Cooper
Most people view their time in the hospital as a brief interruption from home, expecting to return to their regular lives with little disruption. However, for some patients, this isn’t the case. They may be unable to return to their previous residence due to new medical conditions or specific accommodation needs. In some instances, they never had a home to return to at all.
For this population, leaving the hospital can be a daunting experience, marked by significant life changes and uncertainty – especially when they lack a support system of family or friends. This is where Community Resource Worker Cristina Pascual steps in. Her work at Unity Health Toronto begins when patients are ready to move beyond the hospital and re-enter the community.
“Social Workers are the primary discharge planners, but when an alternate discharge location needs to be explored they get me involved,” she says of her position at Providence Healthcare, where they specialize in senior’s care, rehabilitation, palliative and long-term care.
The majority of Pascual’s patients are identified from social workers directly on the units – stroke/neurology, geriatric, orthopedic/amputee, transitional care, or palliative care. She also works closely with the Alternate Level of Care (ALC) team to facilitate transition plans for patients occupying a bed that no longer need the level of care the hospital provides.
“You’ve got patients who may have been living on their own and now they’re not able to either because it’s no longer an accessible unit for them or their care needs are fairly high and they can’t live independently,” Pascual says, adding she helps those patients navigate a variety of housing options including group and boarding homes, supportive housing, retirement homes and long-term care facilities.
For the patients that Pascual assists, there are often several barriers to finding them housing. Some have no IDs or expired health cards, and proof of status in Canada is required to apply for subsidized or government funded housing.
“They need a bank card to provide proof of bank statements and they need their income tax done because they are always asked for a notice of assessment,” she says. “A lot of these folks don’t have any of those documents.”
While three quarters of her role focuses on helping patients secure appropriate housing after leaving the hospital, the other part is dedicated to ensuring they have access to vital community resources and stable sources of income – as a roof over their head is just the beginning of what they need to flourish.
Doug, in his 70s, has spent the last year in and out of hospitals, currently receiving care at Providence. He was previously in the shelter system for over a decade. Pascual first crossed paths with him when he needed assistance obtaining a photo ID and bank
account while waiting for a spot in long-term care.
“When I came to Providence, I couldn’t even get out of bed. I got that weak,” he says. Among other serious health issues, Doug shared that he has a shattered hip and chronic obstructive pulmonary disease (COPD). “They thought I would need oxygen 24/7,” he says.
‘I would be lost without her. It takes a lot off my mind knowing that somebody actually cares.’
Through regular exercises with an occupational therapist and physiotherapist, Doug’s physical strength improved to the point where he was able to get out of bed and use the bathroom unassisted. He also weaned himself off the oxygen tank.
“They’ve always been good to me,” he says about the staff. “It’s a good place with good people. They gave me a chance.”
As Doug’s condition improved and he became more independent, the Ontario Health At Home care coordinator, along with the hospital team, reassessed his situation and determined that community living would be a better fit. Pascual’s initial search
for housing proved difficult, as options that met Doug’s needs – wheelchair accessible and affordable for a fixed income – were scarce.
Then an opportunity popped up in a senior’s affordable housing building that was barrier-free and offered recreational programming. Pascual accompanied him to view the accessible unit and he was accepted.
“I would say it’s a nice place,” says Doug. “There are things to do and the stores are close by.”
When it came time to sign the lease, Unity Health Toronto Occupational Therapist Cheryl Tanaka took the opportunity to have Doug practice using Wheel-Trans, the city’s paratransit service for people with disabilities. Pascual joined Doug on the journey to review the kitchen setup and ensure he could access the stove from his wheelchair. Although the unit is accessible, there are additional aides Doug will need – like bed rails and a shower chair – that Tanaka is helping to source.
“Everything that I own or will own has to have a purpose. And it’s gotta be in a spot where it’s functional,” says
Doug. “And being in a wheelchair, to make my bed, I gotta be able to go around all sides.”
Besides securing the apartment, Pascual collaborates with social worker Celia Schwartz in setting up a Personal Support Worker (PSW), case management, and connecting Doug with a family doctor nearby. “With my health, I have to worry about medical stuff like my meds,” says Doug. “They’re setting all of that up, otherwise I’d be screwed. I would have to go to the hospital to get my prescriptions filled.” Pascual will also check in with Doug a few days after he moves in to ensure that the community supports and services the team has put in place are connecting with him directly.
“He’s not going to be alone,” she says. “But I’m not going to have that comfort until I know that he’s settled in his new home and that he’s thriving.”
When asked if he is looking forward to some privacy in his own place, Doug says “You know what, I’m going to say something really silly. I’m going to miss the people at Providence, the nurses.
Outside of an occasional visitor, that’s who I talk to everyday.”
Pascual’s work in supporting individuals who are underhoused or experiencing homelessness is embedded in a broader network of 164 Social Workers across Unity Health. When asked if there should be more roles like hers, Doug replies without hesitation.
“Yes, absolutely. What she does is very important. When you leave a hospital there’s so much to set up and Cristina knows how to access programs that we don’t.” Doug mentions that he is old fashioned and not very good with technology.
“The population is aging. Us old folks aren’t going anywhere, we’re going to keep coming,” he adds. “I would be lost without her. It takes a lot off my mind knowing that somebody actually cares.”
Pascual has been at Providence Healthcare for the past six years. She has a background in gerontology and sociology and formerly worked in the community for 19 years in assisted living management. In that role, she was no stranger to the health centre. “I
Katie Cooper works in communicatinos at Unity Health.
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was sort of the middle person with my previous organization and Providence, helping to move some of their ALC patients back to the community.”
Despite the challenges with the health care system and not being able to support everyone in need of appropriate housing, Pascual says that sometimes it’s all about timing. “I will hear from one of my external partners that they have a vacancy and I jump on it right away, I’m like, ‘Yes! I have someone for you!’”
Among the cards and photos displayed along the window ledge of Pascul’s office sits a marble-carved walrus, a souvenir from Nunavut given to her by a patient she helped secure housing for. “Every time I see that I’m reminded of her, she’s just a lovely lady,” she says. “It really warms my heart every time she reaches out to tell me that she is doing really well. To me that’s a success. That’s why I love my job.” n H
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The Bariatric Centre of Excellence at London Health Sciences Centre (LHSC) introduced a new medical stream for patients this past March as an additional patient care offering to complement its full-service bariatric surgery program. This expansion, supported through the Ontario Bariatric Network, is the result of several years of dedicated effort from the team’s co-medical leads, Drs. Jaclyn Ernst and Tayyab Khan, who worked tirelessly to spearhead the approval process. The medical bariatric program allows for a whole person non-surgical approach to care that targets not only weight loss but also broader lifestyle improvements.
Health discipline colleagues Lena Khalil, registered dietitian, Kim Dales, social worker, and Spencer Raposo, kinesiologist, work alongside program physicians Dr. Ernst, Dr. Khan, and Dr. Rasha Abdul-Karim to deliver this new service. Their multidisciplinary approach ensures that patients receive comprehensive support, addressing not just the physical aspects of weight loss, but also the emotional and psychological factors that play a critical role in sustainable health changes.
The medical stream consists of two distinct phases designed to help patients achieve sustainable lifestyle changes.
The first phase, which lasts six months, is an intensive treatment period where patients attend weekly group sessions as well as monthly checkins with their physician. The weekly sessions cover a variety of topics, including nutrition, diet and lifestyle education, physical education, and emotional well-being, helping patients understand the complex and often intertwined series of factors contributing to weight and offering strategies for lasting change. During this initial phase, patients also follow a meal replacement regimen, with the option of incorporating pharmacotherapy to support weight loss where appropriate.
The second phase focuses on maintenance. During this six-month period, patients meet monthly for group sessions and continue to have regular follow-up appointments with their physicians. This phase is designed to ensure that the improvements made during the treatment phase are sustained over time, reinforcing new habits and behaviours.
Although the program is primarily focused on group support, health discipline members are also available for personalized support as needed.
The new program adds more options for patients requiring bariatric services as it fills an important non-surgical gap that was previously missing in our region, and helps to ensure appropriate care based on an individual’s needs is available closer to home. Referrals for the program come from a range of health-care providers, including primary care providers and specialists.
For some patients, the medical stream serves as an initial step before surgery, especially for those with a higher BMI who may not yet qualify for bariatric surgery. For others, the
medical pathway is preferred as the only course of treatment.
“We designed the program based on best practices and clinical evidence, but also from a place of understanding that success will look a bit different for everyone,” says Spencer Raposo, Kinesiologist at LHSC. “What helps to make the offering resonate for patients is that the format and breadth of the education and supports we provide gives patients the flexibility to practice the learnings in ways that best align to their own individual goals and needs.”
The inaugural cohort completed phase one back in September, with all 30 patients achieving positive health outcomes.
Beyond the individual perseverance of patients giving their all as they take on the intensive work, collaboration has been a key driver of the program’s success – not only among the program’s team members, but also between patients. The members of the cohort groups have really come together, and patients have formed strong bonds, leaning on each other as they work through the program.
“We are seeing patients opt to expand their journey beyond the hospital’s walls,” says Lena Khalil, Registered Dietitian at LHSC. “They have created their own independent Facebook groups and other online chats to support each other through their dayto-day challenges, root each other on, and celebrate individual wins. They’re also applying their learnings about nutrition, emotional wellbeing, and physical activity within their homes where they are serving as a living example for their families and friends. This is creating a cascade of positive influence beyond the individual, which is leading to a much broader of an impact than we could have initially imagined.”
The goal of the medical stream is not simply weight loss, but the improvement of overall health and quality of life. While weight loss is an important measure of progress for patients, much of the success that feels the most impactful is seen in outcomes like improved self-confidence, increased physical activity, reduced reliance on medications for other weight-influenced medical conditions, and the ability to enjoy life’s simple pleasures –whether that’s walking further, playing with grandchildren, or simply feeling more energized.
“This has proven to be an efficient, effective, and powerful way to help people,” says Kim Dales, Social Worker at LHSC. “One of the most rewarding aspects has been seeing patients develop healthier relationships with themselves, as that kind of self-reflection and self-acceptance is what can often drive the life-long changes that go well beyond weight loss. We set out to make this type of comprehensive, non-surgical care available to patients in our region, and in working with our first cohort, have truly exceeded all our initial expectations of what success would look like as we not only see our patients realizing their health goals, they are also starting to live the rest of their lives to the fullest.” n H
We sat down with Dr. Matthew Muller, infectious diseases physician at St. Michael’s Hospital, to talk about how to protect yourself this viral season. Check out the full interview here.
A lot of people are wondering what the difference is between all of the respiratory viruses we’re hearing about such as COVID-19, RSV and influenza. These are all respiratory viruses which means that they can cause an upper respiratory tract infection where you might have symptoms like a runny nose or sore throat, but they can also cause more severe infections, particularly pneumonia. And so they’re lumped together as respiratory viruses.
But obviously, there are differences with respect to the three viruses. I think the most notable difference is that influenza and RSV have been around for a long time. We’ve known a lot about them. Whereas with COVID-19, the virus that causes it recently caused a large pandemic and we’re still recovering from that. As a result, immunity to COVID-19 is different from immunity to flu and RSV and we don’t have as defined a season for COVID-19.
We see waves or times when there’s high COVID-19 activity and low activity, but there’s always COVID-19 out there. On the other hand, influenza is much more of a virus that comes in the fall and winter and is largely gone in the summer except in rare instances. The symptoms of these three viruses really overlap and it’s not always possible in mild cases to distinguish between them.
As we know, we always have a seasonal influenza outbreak or epidemic in the fall and winter and I would expect that to be no different than in pre-
vious years. We also tend to have RSV incidents increase at some point over those same months, so we’re going to see both of those viruses circulating widely in the community and in hospitalized patients over that time period. With COVID-19, the epidemiology has been changing over time. Based on what we saw last year, we also expect that as we get into the cooler months the amount of COVID that’s in the community will be quite high.
A lot of people want to know if they’re at risk for these viruses and particularly if they’re at risk for severe disease or being hospitalized because of an infection with RSV, influenza or COVID-19. The risk factors for these three viruses are also similar, but not identical. We know with COVID-19 that the single biggest risk factor is age and the older you are, the higher your risk of severe infection.
But there are many other factors that can increase your risk. Many different medical conditions that people may have, such as cancer, kidney disease, liver disease or lung diseases, such as obstructive lung disease, all can increase your risk of getting severe COVID-19. And for all three viruses, there’s particular concerns about, getting them in pregnancy. For RSV, this is a disease that in most adults is fairly mild. In the very young, especially infants, there’s a significant risk of getting more severe disease and it’s one of the most common reasons for hospitalization.
In the elderly, RSV can cause severe disease that results in hospitalization. It can effect immunocompromised populations. Flu is quite similar to those things.
For the COVID 19 vaccine, this vaccine is recommended for all Canadians six months and older. And I would strongly encourage everyone to get this particular vaccine. It will reduce your risk of getting COVID-19
over the winter season and will also reduce your risk of getting severe COVID-19. It’s important to recognize with COVID-19 that your immunity, whether it’s from prior vaccinations or previously having COVID-19 or both, does decrease over time. Unless you’ve recently had a confirmed episode of COVID-19, I would strongly encourage everyone to get that vaccination. Similarly, the flu vaccine is available once a year and is updated to target the strains of flu that are circulating. And again, I would recommend that all adult and most kids in Ontario get their flu vaccine, as it can reduce their risk of infection and disease over the over the winter months and over the flu season.
One of the things that’s terrific about the RSV vaccine is it seems to confer long term immunity. So it’s not a vaccine that you need to get every year. So if you’ve never had it before, this is a great year to get it if you fit in one of the eligible groups. We believe it will protect you for several years into the future. You may need a booster dose at some point, but right now we’re not sure when that might happen. So you get several years of protection. This is the first season that we have really broad access to three vaccines for three important viruses and we hope that that will make a big difference as we go into what could otherwise be a little bit of a difficult fall and winter season. n H
In April 2024, Quebec surgeons Dr. Jean-Martin Laberge and Dr. Louise Caouette-Laberge volunteered on the Global Mercy in Freetown, Sierra Leone, to offer free surgery to the population.
As President Julius Maada Bio of Sierra Leone stated just prior to Mercy Ships’ field service, “Mercy Ships, provides a continuous humanitarian and medical support towards providing treatment to people with various medical conditions worldwide”. At the time if the announcement, the partnership agreement included a 10-month deployment of the Global Mercy, offering free surgical care in and training healthcare professionals to build capacity within Sierra Leone’s national health system.
As she prepared to come aboard, Dr. Caouette-Laberge shared her excitement at being able to work aboard the Global Mercy. “The advantage of having a state-of-the-art hospital like this is that it has international standards. It allows us to perform complex surgeries that we wouldn’t be able to do in an African country because they don’t have the necessary infrastructure.”
The couple was recognized for their humanitarian work by the Collège des Médecins du Québec, which jointly awarded them the Prix d’humanisme in 2013. As for Dr. Laberge, in addition to participating in missions with his wife, he has contributed to the training of pediatric surgeons in Kigali, Rwanda. Through their respective work in pediatric surgery, they have between them changed countless lives of children both in Canada as well as Africa.
“We receive much more than we give! The people we operate on for free are so pleased, they thank us and are happy. We take for granted the training we receive and how lucky we are to be able to study. There are no teachers there. You don’t realize it until you leave home and see the reality of others,” says Dr. Louise Caouette-Laberge. After all
these years in the field, they are now part of an international team of medical specialists that serve onboard Mercy Ships.
The Global Mercy’s volunteer crew of nearly 600, both short- and longterm, works with dedication and excellence to welcome patients for life-changing surgeries. Darryl Anderson, Executive Director of Mercy Ships Canada, stated, “We are grateful for medical staff and all hospital volunteers who, like Dr. Laberge and Dr. Caouette-Laberge, share a passion for our mission of Hope and Healing.” Anderson also announced, “We are excited that the President of Sierra Leone has extended our partnership for another field service into 2024.”
Mercy Ships Canada is one of 16 National Offices dedicated to raising funds, building awareness, recruiting volunteers, and supporting impactful projects for Mercy Ships’ global programs. Mercy Ships operates the world’s two largest civilian hospital ships, delivering free, life-changing surgeries and healthcare, along with training and mentoring for local healthcare professionals, ensuring communities have sustainable healthcare long after the ships depart.
Mercy Ships believes that everyone deserves a life full of promise and potential. That every mother deserves to see her child grow healthy and thrive. We believe that healthcare is a human right, and we are committed to reaching children and families in need of safe surgical care with state-of-the-art hospital ships filled with compassionate volunteer healthcare providers.
Dr. Louise Caouette-Laberge, conducting a surgery with her husband Dr. Jean-Martin Laberge, onboard the Global Mercy
To learn more on volunteering visit mercyships.ca/en/get-involved/volunteer WITH VOLUNTEERS
