“I hope there comes a day when I can actually spend the amount of time that I want to with each of my patients, and feel like I did the best I could with the best resources and support, and know that we’re giving care that is exceptional.
That’s really all I want.”
Ontario deserves better.
s Cover story: Mission critical: Maximizing safety in emergency departments
s All hands on deck: How St. Michael’s ED responded to a steamship fire 75 years ago
By Najeeb Ashraf
Iwas only a child when my life took a sharp turn. At around five or six years old, I started noticing odd changes in my body that I didn’t understand. The day I landed in the hospital was the day the word “diabetes” entered my life, even though I didn’t know what it meant.
I overheard my father telling my mother about my diagnosis, but all I could follow was that a few injections would make me feel better. I didn’t realize these injections would become a part of my daily routine for the rest of my life. The simplicity with which my condition was explained to me was a shield, protecting me from the gravity of what living with type 1 diabetes (T1D) would truly entail.
As I grew older, the impact of T1D on my daily life became more apparent. Living with this condition is a rollercoaster -- some days are good, others are a battle. In the early years, I grappled with feelings of negativity and depression. The constant question of “Why me?” weighed heavily on my mind, and the sense of guilt associated with my condition isolated me from others.
I felt alienated, like an outsider in my own life. But I was determined not to let this condition define me. Over time, I took mental control of my situation, transforming every roadblock into a new direction or a message from life.
Living with T1D has made me resilient, and I take pride in the strength it has forged within me over the
EDITORIAL: Nov. 8
ADVERTISING:
Display – Nov. 22 | Material – Nov. 26
Monthly Focus:
Medical Imaging /Year in Review/Future of Healthcare/Accreditation/Hospital Performance Indicators: Overview of advancements and trends in healthcare in 2023 and a look ahead at trends and advancements in healthcare for 2024. An examination of how hospitals are improving the quality of services through accreditation. Overview of health system performance based on hospitals performance indicators and successful initiatives hospitals have undertaken to measure and improve performance. A look at medical imaging techniques for diagnosis, treatment and prevention of diseases.
Annual Radiology Supplement
past three decades. It has also deepened my understanding of the importance of empathy. I’ve learned to give people the benefit of the doubt because I know firsthand how limiting assumptions can be.
This empathetic approach has been welcomed by my community and enriched my interactions with others. However, I recognize that awareness and understanding of chronic conditions like T1D are still lacking in many cultural communities. People often disregard issues that don’t affect them personally, and misconceptions about T1D are rampant.
The most common one I encounter is the belief that my diabetes was caused by overeating sugar. People assume that my insulin pump is a “pager” or some hightech gadget, or they think that managing T1D is easy and that I use the condition to garner attention. These misconceptions can be incredibly harmful, especially to young people with diabetes who are already struggling with their confidence and self-worth.
Stigma can lead to feeling isolated, depressed or believing you are fundamentally flawed.
Family, friends and community support are crucial in managing diabetes. It forms the bedrock of a patient’s ability to cope with the condition. A supportive environment can make the difference between despair and hope, between giving up and pushing forward.
My advice to families and friends is simple: Be open, seek knowledge and remain positive.
Continued on page 6
EDITORIAL: Dec. 6
ADVERTISING: Display – Dec. 13 | Material – Dec. 17
Monthly Focus:
Healthcare Human Resources/Continuing Medical Education (CME)/Staffing: Continuing Medical Education (CME) for healthcare professionals. The use of simulation in training.Human resource programs implemented to manage stress in the workplace and attract and retain healthcare staff. Health and safety issues for healthcare professionals. Quality work environment initiatives and outcomes.
+ PROFESSIONAL DEVELOPMENT SUPPLEMENT
THANKS TO OUR ADVERTISERS Hospital News is provided at no cost in hospitals. When you visit our advertisers, please mention you saw their ads in Hospital News.
610 Applewood Crescent, Suite 103 Vaughan Ontario L4K 0E3 TEL. 905.532.2600|FAX 1.888.546.6189 www.hospitalnews.com
Editor Kristie Jones editor@hospitalnews.com
Advertising Representatives
Denise Hodgson denise@hospitalnews.com
Publisher Stefan Dreesen stefan@hospitalnews.com
Accounting Inquiries
accountingteam@mediaclassified.ca
Circulation Inquiries info@hospitalnews.com
Director of Print Media
Lauren Reid-Sachs
Helen Reilly, Publicist Health-Care Communications
Bobbi Greenberg, Health care communications
Sarah Quadri Magnotta, Health care communications
Dr. Cory Ross, B.A., MS.C., DC, CSM (OXON), MBA, CHE Vice President, Academic George Brown College, Toronto, ON
ASSOCIATE PARTNERS:
Hospital News is published for hospital health-care professionals, patients, visitors and students. It is available free of charge from distribution racks in hospitals in Ontario. Bulk subscriptions are available for hospitals outside Ontario.
The statements, opinions and viewpoints made or expressed by the writers do not necessarily represent the opinions and views of Hospital News, or the publishers.
Hospital News and Members of the Advisory Board assume no responsibility or liability for claims, statements, opinions or views, written or reported by its contributing writers, including product or service information that is advertised.
Changes of address, notices, subscriptions orders and undeliverable address notifications. Subscription rate in Canada for single copies is $29.40 per year. Send enquiries to: subscriptions@ hospitalnews.com
Canadian Publications mail sales product agreement number 42578518.
esearchers at London Health Sciences Centre (LHSC) and Lawson Health Research Institute are using advanced technology and artificial intelligence (AI) to diagnose rare diseases and prenatal exposure-related birth abnormalities in two studies published today in American Journal of Human Genetics and Genetics in Medicine.
The research uses technology called EpiSign™, which was developed by Dr. Bekim Sadikovic, Lawson Scientist at LHSC. EpiSign leverages AI to measure a patient’s epigenome – a unique chemical fingerprint that every person has on top of their DNA that is responsible for turning genes on or off. EpiSign can currently be used to help diagnose more than 100 genetic diseases that were previously difficult to diagnose.
In one of two newly published studies, Dr. Sadikovic’s team has found that EpiSign can be used to accurately identify patients affected by birth disorders called recurrent constellation of embryonic malformations (RCEMs). Since their discovery more than 70 years ago, attempts to identify the cause and specific diagnostic markers for RCEMs have been unsuccessful, making it challenging to provide patients and families with accurate diagnoses. EpiSign can now be used to accurately identify RCEMs for the first time using a blood test.
“Reaching an early and accurate diagnosis can be lifechanging. This is a major breakthrough that allows physicians to provide earlier and more accurate diagnosis, resulting in improved disease management,” said Dr. Sadikovic, who is also Research Chair in Clinical Genomics and Epigenomics at the Archie and Irene Verspeeten Clinical Genome Centre at LHSC. “It also has the potential to lead to health system cost savings since many patients spend years and even decades being tested to rule out other potential diseases with similar symptoms.”
In a second study, Dr. Sadikovic’s team used EpiSign technology for
“THIS IS A MAJOR BREAKTHROUGH THAT ALLOWS PHYSICIANS TO PROVIDE EARLIER AND MORE ACCURATE DIAGNOSIS, RESULTING IN IMPROVED DISEASE MANAGEMENT.”
the first time to develop an accurate biomarker for a group of disorders called fetal valproate syndrome, which is caused by prenatal exposure to toxic levels of medication that may be used to treat bipolar disorder and migraines, or to control seizures in the treatment of epilepsy. It can result in neurodevelopmental disorders in infants, including learning, communication and motor disorders, autism, and intellectual disabilities.
“This is a significant breakthrough as it’s the first time the technology has been used to aid in diagnosis of a disease caused by environmental
factors rather than genetics,” explained Dr. Sadikovic. “It highlights how epigenetics can be influenced by environmental and lifestyle factors, including diet, exercise and exposure to toxins.”
The research is ongoing as Dr. Sadikovic and his team, in collaboration with the global EpiSign Discovery Research network, are currently studying and developing biomarkers for more than 700 rare disorders. He noted the potential of this research is endless, showing promise for use in the diagnosis, prognosis and treatment of many other diseases and disorders, including cancer.
“One in 20 people have a rare disease that could present at any point in their lives and can be caused by genes, environmental exposures, or their combined effects,” he noted. “We can help diagnose a growing number of genetic diseases and, now for the first time, we can look beyond the genome and accurately measure the impact of the environment.”
These studies are a collaborative effort involving multidisciplinary teams in Canada, the United States, the United Kingdom and Europe. The first study, titled “Identification of a DNA methylation episignature biomarker for recurrent constellations of embryonic malformations,” is published in American Journal of Human Genetics. The second study, titled “Discovery of DNA methylation signature of teratogenic exposure to valproic acid,” is published in Genetics in Medicine. Funding for the research was provided by Genome Canada and Ontario Genomics, as well as in-kind support from EpiSign Inc. n H
new study by Concordia researchers suggests that one-third of adult survivors of childhood cancer experience a fear of cancer recurrence so severe that it can seriously impact their daily lives. The cross-sectional investigation of 229 survivors of childhood cancer, published in JAMA Network Open Oncology, found that 16.6 per cent of long-term survivors reported clinically significant fear of cancer recurrence (FCR) and an additional 15.7 per cent reported high FCR.
While the numbers are believed to be similar to those seen in survivors of adult-onset cancer, this study highlights the general lack of scientific literature on adult survivors of childhood cancer, says lead author Alex Pizzo, a Clinical Psychology PhD student at the Behavioural Health Innovations Lab at Concordia.
“We have not seen the use of strong measures of FCR that have been validated or are reliable when it comes to studies with childhood cancer sur-
Continued from page 4
vivors, so it has been difficult to pin down prevalence estimates,” he says.
The researchers performed a detailed analysis of data from participants recruited from the Childhood Cancer Survivor Study, a retrospective cohort of survivors treated between 1970 and 1999 across North America. Most were decades past their last cancer treatment. The respondents’ fear levels were assessed following a series of questionnaires they completed via a study app that asked them to rate their symptoms of FCR, anxiety and depressive symptoms, self-perceived health, chronic pain and other measures. The total scores indicated whether they experienced minimal, high or clinically significant levels of FCR.
For demographic variables, survivors who were unemployed or had some college or an undergraduate degree were most likely to experience the highest levels of FCR. Additionally, survivors with a neurological condition, who underwent pelvic radiation treatment, limb amputation or
Understand that no one is at fault and be the pillar of strength your loved one needs.
Healthcare providers have an essential role for people living with diabetes. My own experience has been a mixed bag. Providers who took the time to engage in meaningful conversations and treated me as a person rather than a case number guided me without imposing. It allowed me to make informed decisions about my treatment. On the flip side, I’ve had healthcare professionals treat me as a “dummy” and rush me through appointments without listening or considering my lived experience. That those kinds of interactions continue today is disappointing. In the long run, they can also be harmful to a patient’s overall health and well-being.
Looking forward, I would encourage several changes in healthcare settings. We need continuous and integrated care, patient education, personalized treatment plans, quality patient-physician interaction and enhanced mental health support.
Greater access to telehealth services and diabetes technology, like continuous glucose monitors, would also make a significant difference.
Most importantly, there needs to be a shift toward empathy and understanding in patient care – a move away from treating patients as mere tools for promotional purposes and toward engaging them meaningfully in their healthcare journey.
In sharing my story, I want other people living with diabetes to feel less alone, be more understood, and better equipped to face their challenges –happily and strongly. n H
Najeeb Ashraf is CEO, SciVoc Consulting Inc. and is a passionate awareness advocate for Diabetes Canada, dedicated to empowering individuals with diabetes through education and peer support. Being a T1D, Najeeb strives to inspire and guide the community toward making healthier and informed choices.
limb-sparing surgery were most likely to experience FCR. Those with elevated levels of depression, anxiety or both, and who rated their health as poor or fair were also more likely to experience clinically significant FCR. The researchers say they hope the study stimulates a push to improve
treatment for adult survivors of childhood cancer, beginning with a brief screening of possible symptoms during medical consultations. “It could start with a few simple questions, which could indicate whether additional assessment is needed,” Alberts says. n H
Miscarriage, or early pregnancy loss, can have devastating emotional effects, but it is poorly managed in Canada. A review published in CMAJ (Canadian Medical Association Journal) provides guidance to physicians on how to diagnose and manage this condition and calls for referral to outpatient early pregnancy assessment clinics (EPACs) as well as a compassionate approach.
Data suggest that 15–20 per cent of all confirmed pregnancies result in miscarriage, with about half caused by chromosomal abnormalities, a risk that increases with age. These early losses, while common, can be devastating.
“[Providers] must bear in mind the considerable psychological effects of early pregnancy loss and not underestimate compassion as a cornerstone of assessment, management, and follow-up,” writes Dr. Modupe TundeByass, an obstetrician/gynecologist at North York General Hospital and associate professor at the University of Toronto, Toronto, Ontario, with coauthors.
Many pregnant people with bleeding and cramping seek care from the emergency department. However, for those without symptoms of a ruptured ectopic pregnancy or major uterine hemorrhage, seeking care in an overcrowded emergency department often means long delays, sitting in a waiting room chair, to see a health care provider.
“Although the emergency department is the safest and most expeditious place for a pregnant person to be treated for massive uterine hemorrhage or a suspected ruptured ectopic pregnancy, pregnant patients who are
not critically ill often receive suboptimal care in emergency settings,” writes Dr. Catherine Varner, an emergency physician and deputy editor, CMAJ in an editorial.
The authors of both articles recommend referral, where available, to an outpatient EPAC staffed by health care professionals skilled in delivering comprehensive, compassionate care for this specific patient cohort.
“Research from Ontario and British Columbia has shown that EPACs can ameliorate patient experience and have been shown to improve clinical outcomes, reduce repeat assessments in the emergency department, and lead to improved patient satisfaction,” writes Dr. Tunde-Byass.
However, these services are lagging.
“Given health systems’ current focus on health care innovations that seek to provide the right care, at the right time, by the right provider, in the right location, prioritization of patients experiencing early pregnancy loss would seem deserving of attention, given their risk for enduring physical and psychological effects related to existing models of care. It is time to invest in early pregnancy assessment clinics that are better equipped to provide a more tailored, patient-centred experience and greater understanding of early pregnancy complications and loss than can be found in an overcrowded emergency department,” concludes Dr. Varner.
“Diagnosis and management of early pregnancy loss” and “Investing in streamlined care for patients experiencing early pregnancy loss in Canada would reduce substantial suffering” were published October 15, 2024. n H
Anew study has revealed which Canadian region has the highest life expectancy – Ontario has some of the longest-living residents in the country.
The findings, compiled by Ontario personal injury lawyers Preszler Injury Lawyers, utilized life expectancy data from Statistics Canada, the national statistics office. The thirteen provinces and territories were ranked based on the average life expectancy from birth for both sexes, highlighting the regions where residents enjoy the longest lives.
THE STUDY IDENTIFIED QUEBEC AS THE CANADIAN REGION WITH THE HIGHEST LIFE EXPECTANCY AT BIRTH FOR BOTH SEXES, AVERAGING 82.48 YEARS – 1.14 YEARS ABOVE THE NATIONAL AVERAGE OF 81.34.
The study identified Quebec as the Canadian region with the highest life expectancy at birth for both sexes, averaging 82.48 years – 1.14 years above the national average of 81.34. This positions Quebec as the top province for longevity, with residents living considerably longer than in other regions.
Interestingly, Quebec offers the longest life expectancy for men in Canada at 80.78 years. Additionally, Quebec is the second-best place for women to live for a high life expectancy, with an average of 84.16 years. However, British Columbia is the region where wom-
Inuit children in Nunavut, Canada, are being overdiagnosed for macrocephaly and underdiagnosed for microcephaly, two neurological conditions measured by head size, because of reliance on World Health Organization (WHO) growth curves, according to new research in CMAJ (Canadian Medical Association Journal).
“Clinicians must be able to identify children with potential medical issues appropriately, without underdiagnosis or overdiagnosis at the extremes of head circumference measurements,” writes Dr. Kristina Joyal, a pediatric neurologist, University of Manitoba and University of Saskatchewan, with coauthors.
In a study that compared head circumferences of Inuit children in Nunavut with WHO head circumference charts, researchers used chart data on 1960 children born from 2010 to 2013. The study population represented 18 of 25 communities in the region. Most data were from children aged 0 to 36 months, and at all age points, head circumferences were significantly larger than the WHO comparators.
“We observed larger median head circumference values, distinct patterns of growth curves, higher rates of children with head circumferences greater
than the 97th percentile (macrocephaly), and lower rates of children with measurements below the 3rd percentile (microcephaly).”
This can result in higher diagnoses of macrocephaly, with resulting travel, treatment, and other stressors in otherwise healthy children, and underdiagnosis of microcephaly, which can mean delayed attention to a medical condition.
Variance from WHO reference charts has also been documented in other groups, including Turkish, South Asian, Australian Aboriginal, Canadian Cree, Japanese, and other populations.
“This unnecessary overinvestigation perpetuates a system that continues to bring harm to Inuit people, given the historical context of racism, mistreatment, and experimentation by settler health care workers,” write the authors.
They call for population-specific growth curves for Inuit children, developed in partnership with local communities.
“Our findings likely have implications for other Inuit populations in Canada and the circumpolar regions. The implementation of growth curves relevant to this population would necessitate ongoing discussion with Inuit
organizations, health care professionals, and public health officials in these regions,” the authors conclude.
“Head circumference values among Inuit children in Nunavut, Canada: a retrospective cohort study” was published October 21, 2024.n H
en live the longest, with an average life expectancy of 84.3 years.
Ontario follows in second place, with an average life expectancy of 81.82 years. Although slightly below Quebec, it remains above the national average, reflecting the region’s impressive healthcare system and the overall well-being of its residents.
Prince Edward Island ranks third in Canada for life expectancy, with residents living an average of 81.65 years. Despite being the smallest province in terms of size and population, the island clearly still offers a high quality of life, contributing to its residents’ longer-than-average lifespans.
In fourth place, British Columbia has an average life expectancy of 81.46 years. Interestingly, British Columbia’s women have the highest life expectancy in Canada at 84.3 years, five and a half years more than the men in the province. This represents the most significant disparity between male and female life expectancies nationwide.
Alberta rounds out the top five, with an average life expectancy of 80.22 years. On average, men in Alberta live to 77.91 years old, while women live to 82.64 years. n H
The College of Physicians and Surgeons of Ontario (CPSO) launched its redesigned Physician Register on October 16, 2024.This database houses public profiles of all licenced Ontario physicians and is a frequently used resource among health-sector professionals.
The redesigned register features numerous enhancements, including improved user-friendliness and strengthened cybersecurity. With feedback incorporated from hospital representatives during the re-design process, these new enhancements will make the credentialing process significantly easier. Visitors can search using a physician’s CPSO number or name, and each profile contains publicly available information about physicians, includ-
ing their registration history, specialties, hospital privileges, and any applicable practice restrictions or public notifications.
The new register organizes content on a physician’s profile using tabs to reduce the need for users to scroll for information. It has also changed its name, from “Doctor Search” to “Physician Register,” to reflect its function more accurately.
CPSO developed these and other improvements in consultation with several other stakeholders, including Ontario physicians, pharmacists, medical schools, and members of the public. To help with the transition, it has also published some resources on its website. Visitors to the register can also contact CPSO’s Patient and Public Help Centre with any questions. n H
new study, released by the University of Toronto’s Dalla Lana School of Public Health, finds that millions more Ontarians will be living with chronic illness in the next 20 years. The findings have sobering implications for Ontario’s health care system, which will face significant strain and rapidly rising pressure in the next two decades. The province will face a level of demand for health services like never before.
The study, Projected Patterns of Illness in Ontario, published in collaboration with the Ontario Hospital Association (OHA), represents the most recent comprehensive public report to quantify chronic disease and multimorbidity in the Ontario population. This study combined age and sex-specific demographic projections with historical chronic disease trends to model the burden of illness in the population in the future.
The authors of the study project that 3.1 million adults will be living with major illness in Ontario in 2040, up from 1.8 million in 2020. Approximately one in four adults over the age of 30 will live with a major illness in 2040, requiring significant hospital care, up from approximately one in eight individuals in 2002.
“Planning for sustainable and equitable health care that’s responsive to emerging trends requires projections of what chronic disease rates are likely to be in the future,” said Dr. Adalsteinn Brown, Dean of the Dalla Lana School of Public Health and co-author of the study. “Our projections suggest that more Ontarians will be living with major illness, and the number of cases will rise for many chronic conditions. Given these findings, it’s clear that new solutions are needed now, including significant efforts in chronic disease prevention and management.”
In addition to more people living with major illnesses, the number of illnesses any individual will be living with will also increase significantly. The conditions expected to increase the most in number are those that increase with age, including osteoarthritis, diabetes, and cancer. Multimorbidity is
“PLANNING FOR SUSTAINABLE AND EQUITABLE HEALTH CARE THAT’S RESPONSIVE TO EMERGING TRENDS REQUIRES PROJECTIONS OF WHAT CHRONIC DISEASE RATES ARE LIKELY TO BE IN THE FUTURE.”
also rising, which refers to the presence of two or more co-morbid chronic conditions. Multimorbidity is a major driver of demand for health services and costly for hospitals as people living with multimorbidity have unique and complex health care needs.
Canadians are living longer, with life expectancy growing to 81.5 years as of 2020-2022. An aging population contributes significantly to the estimated increases. Underlying structural and social determinants of health and an increase in chronic disease risk factors also contribute to these estimates.
“As we look to the future, it’s clear that Ontario’s reached a turning point,” said Anthony Dale, President and CEO of the Ontario Hospital As-
sociation (OHA). “Ontario’s health system is already grappling with rapid population growth, increasingly complex health needs and intense pressures on existing capacity. These findings confirm that maintaining the status quo is not an option. Health care in Ontario needs an innovation revolution. Without it, the system won’t be able to cope.”
Ontario’s health system must galvanize around the findings of this study and aggressively focus on prevention, early detection and effective treatment of chronic disease. Past successes, including reductions in chronic disease risk factors such as smoking and improved management of cardiovascular health at the population level, dramatically reduced the burden of chronic disease.
Ontario urgently needs a long-term health services capacity plan, so the province is truly ready to meet the
needs of its rapidly growing and aging population. Expanding services that support and encourage seniors to age at home, such as access to home and community support services, primary care and supportive housing, will also ensure that long-term care and hospital capacity are available for people with the most complex and serious needs.
“Over the past several decades it is biomedical and technological innovation that has driven clinical improvements, cost savings and improved access to care in hospital settings,” said Dale. And now, artificial intelligence, gene therapy and personalized medicine are demonstrating astonishing potential. Working together and embracing innovation in all its forms, we can create a future with less disease, better treatment and universal access to care. It’s within our reach.”
• The population will grow by 36 per cent in Ontario over the next 20 years, with the largest increase happening in the 65 and older age group.
• The number of people living in Ontario aged 65 or older will grow from 2.6 million in 2020 to 4.2 million in 2040, an expansion of over 60 per cent.
• The number of people living with chronic illnesses has nearly doubled over the past 20 years from approximately 960,000 in 2002 to 1.8 million in 2020. This trend is expected to continue, reaching approximately 3.1 million people living with major illness in 2040.
• Major illnesses are expected to increase substantially in the age 30 to 64 age group of the population – or working age population, from 5.7 per cent in 2002 and 9.2 per cent in 2020 to over 10 per cent in 2040.
• An additional 5.1 million people will be living with some illness in 2040, up from 2.9 million in 2002 and 3.9 million in 2020.
• Some of the conditions expected to experience large growth in the number of cases are those typically associated with aging, such as dementia, hearing loss and osteoarthritis. n H
For patients with metastatic cancer, individual tumours have different sensitivities to cancer therapies. A group of scientists from UHN’s Princess Margaret Cancer Centre has introduced a new computational method for predicting tumour-specific responses to treatments in patients experiencing metastasis.
“As cancer develops, subpopulations of cells arise with differences in their molecular characteristics and tumour microenvironment,” says Dr. Benjamin Haibe-Kains, Senior Scientist at the cancer centre and senior author of the study. “This can lead to a situation where there is a large amount of heterogeneity in cancer cells within an individual patient.
“Cancer heterogeneity is associated with poorer treatment outcomes, and must be addressed to improve precision oncology,” says Dr. Haibe-Kains, who is also a Tier 2 Canada Research Chair in Computational
Pharmacogenomics and professor in the Department of Medical Biophysics at the University of Toronto (U of T), and the Scientific Director at Cancer Digital Intelligence.
The differences in characteristics between metastatic sites in a patient create a situation where tumours have a varied response to treatment.
Recently, radiomics – a field of medical research that involves extracting and analyzing quantitative features from medical images such as CT scans –has emerged as a potential way to predict treatment outcomes.
“We investigated the use of radiomic biomarkers to predict tumour-specific treatment resistance in patients with leiomyosarcoma – a cancer that arises from smooth muscle cells – that has spread to multiple sites,” says Caryn Geady, doctorall student in Dr. Haibe-Kains’ lab and first author of the study.
“We looked at 202 lung metastases from 80 patients and examined both pre-treatment and treatment
follow-up CT scan features to use advanced machine learning techniques to develop a model to predict the progression of each metastasis.”
Assessments through medical imaging are a common aspect of cancer management. Using machine learning, medical images can help doctors predict tumour responses to treatments.
For each lesion, or tumour area, that was analyzed, the relative change in lesion volume from baseline was evaluated as a treatment response metric. Researchers then tested their models for their ability to accurately predict tumour response.
The team found that their model using radiomic biomarkers provided a
4.5-fold increase in predictive capability compared to a no-skill classifier – a model used as a baseline to compare the performance of more advanced models.
“This research shows that predicting individual tumour responses offers a novel strategy to manage metastasis,” says Dr. David Shultz, a clinician investigator at the Princess Margaret, co-senior author of the study and an associate professor of radiation oncology at U of T.
“It has the potential to guide selective targeting of treatment-resistant cells alongside systemic therapy.” This work was supported by the National Cancer Institute of the National Institutes of Health and The Princess Margaret Cancer Foundation. n H
In a significant step toward promoting public health and wellness, the North Western Toronto (NWT) Ontario Health Team (OHT) has celebrated the grand opening of The HUB@2115 at Humber River Health’s Finch Campus. This innovative community hub is designed to address longstanding barriers to healthcare access by integrating health and social services in one centralized location. Its goal is to improve access, coordination, wait times, and outcomes for residents of North Western Toronto, particularly those facing chronic health conditions and social inequities.
The HUB@2115 offers a comprehensive range of services aimed at addressing the full spectrum of health and social care needs. From mental health support to diabetes education, The HUB@2115 serves as a one-stop shop for the community, ensuring that critical resources are available to those who need them most.
“We have created a space where health and social care come together under one roof, providing a centralized point of access for those who need it most,” says Barb Collins, President and CEO of Humber River Health and Co-Chair of the Senior Executive Committee for the NWT OHT. “This hub is the embodiment of our shared mission to make healthcare more accessible, more equitable, and more responsive to the unique needs of our community.”
Compared to the rest of Ontario, The HUB@2115 serves a community with a greater prevalence of chronic conditions and a higher population of seniors aged 80 years and older, many of whom live alone. The community has poor access to mental healthcare, alongside having one of the highest needs for primary care in the province. By offering a centralized location for various equity-based health and social services, The HUB@2115 aims to improve accessibility for
residents who might otherwise face challenges in obtaining the care they need.
The launch of The HUB@2115 was made possible through the dedicated collaboration of Black Creek Community Health Centre serving as a lead agency, in addition to several key partners, including the Working Women Community Health Centre, COSTI, The Jane/Finch Centre, Across Boundaries, Reconnect, the Canadian Mental Health Association (CMHA) along with NWT OHT and Humber River Health.
Their collective efforts ensure that The HUB@2115 provides a wide range of services tailored to the diverse needs of the community, including settlement services, employment services, health and social care navigation, mental health and well-being supports, and diabetes education and counselling. Importantly, these services are available without the need for a valid health card, ensuring that support is acces-
sible to everyone in the community. By consolidating services in one location, The HUB@2115 is also able to reduce wait times and improve care outcomes for individuals who may have previously struggled to navigate a fragmented system.
“We know the population of North Western Toronto faces many barriers to health and social care,” says Cheryl Prescod, Executive Director of Black Creek Community Health Centre, and Co-Chair of the Senior Executive Committee for the NWT OHT. “The care navigators and providers working in this Hub, in close proximity to services across health and social sectors, are experts helping people get connected to the right services and supports, and reducing barriers.”
The launch event for The HUB@2115 included a tour of the facility, offering attendees an opportunity to connect with partners and learn more about the incredible programs and services that will be offered. This hands-on experience highlighted the commitment to addressing community needs through collaborative efforts and innovative solutions.
The opening of The HUB@2115 marks a major milestone in improving community health in North Western Toronto. With a strong focus on equity, The HUB@2115 aims to close the gaps in healthcare access that have disproportionately affected marginalized populations. Programs like mental health counseling and diabetes education are tailored to the unique needs of the community, empowering residents to take control of their health.
As The HUB@2115 continues to advance, it will remain responsive to community feedback, ensuring that its services meet the evolving needs of the population. This commitment to flexibility and continuous improvement is key to promoting long-term wellness across North Western Toronto.
The vision behind The HUB@2115 is simple yet powerful: to create a healthier community by addressing the social, mental, and physical factors that contribute to well-being. By doing so, this innovative hub sets a new standard for public health and wellness initiatives in Ontario, offering a blueprint for how healthcare can be reimagined to better serve the needs of all people. n H
By Brianne Tulk
In 2015, Sunnybrook Research Institute (SRI) scientists and clinicians performed a world-first: They successfully and non-invasively opened the blood-brain barrier to deliver chemotherapy into the brain tumour of a patient using MRI-guided focused ultrasound. The procedure – which was part of a clinical trial –hailed a new frontier in focused ultrasound that could transform the landscape of brain medicine.
Nearly 10 years later, the same group of researchers is once again approaching a new breakthrough, this time with the potential to bring the technology to more patients and more clinics, and to revolutionize the treatment options for many neurological and brain diseases.
The team, led by Dr. Kullervo Hynynen, vice president of research and innovation and senior scientist at SRI, has developed a powerful new ultrasound device specifically designed to open the blood-brain barrier to allow helpful agents – such as chemotherapy, antibodies, stem cells or gene therapy to reach the brain. However, unlike the current focused ultrasound device, the new technology operates without the need for real-time MR imaging – a costly hurdle for delivering focused ultrasound to the brain.
At Sunnybrook, focused ultrasound is most commonly used to treat essential tremor, a neurological disease that causes tremors which can severely affect a person’s quality of life. Dr. Nir Lipsman, chief of the Hurvitz Brain Sciences Program and senior scientist at SRI, explains that the technology used for this indication is called high-intensi-
ty focused ultrasound, which uses ultrasound waves to target tissue and create lesions deep within the brain, without the need for a scalpel or incisions.
The new technology in development, meanwhile, is low-intensity focused ultrasound, which Lipsman says, “is used to open the blood-brain barrier and deliver all kinds of therapeutics to the brain.”
The technology behind the low-intensity focused ultrasound is currently undergoing clinical trials at Sunnybrook’s Harquail Centre for Neuromodulation– to be housed within the new Garry Hurvitz Brain Science Centre – and has the potential to provide new treatments and therapies for brain cancers, Alzheimer’s disease, Parkinson’s disease and Amyotrophic Lateral Sclerosis (ALS).
Drs. Hynynen and Lipsman shared some of the latest developments
and most promising potential of the next-generation helmet.
Lipsman: One of the conditions we are most interested in is brain cancer. Currently, the entire procedure across all of our trials is done inside the MRI for real-time imaging. There are some indications where that’s very important, but there are other indications where real-time imaging may not be as critical. The next-generation helmet means we may be able to do the procedure outside of the MRI environment, saving time and money, and making the procedure more comfortable for
Using your mind to control machinery sounds like scifi to some, but for Tristin
Froma, it’s becoming reality. Tristin, who lives with restricted mobility, is one of several patients trialing a brain-computer interface (BCI) to drive his electric wheelchair at the Glenrose Rehabilitation Hospital.
“I love using BCI to move my wheelchair,” says the 19-year-old. “It makes me feel free.”
Tristin has cerebral palsy, a disorder that affects his ability to move freely. In his daily life, he can control his power wheelchair using sensors connected to his head rest. However, at the Glenrose, he now gets to convert his brain activity patterns into commands to control devices, including his wheelchair.
“Unlike switches or eye gaze, BCI does not rely on any physical movements,” says Corinne Tuck, an occupational therapist and clinical practice lead for assistive technology at the Glenrose.
“Patients wear a headset which can detect brain-activity patterns – and BCI converts these patterns into commands to control devices.”
Tuck is quick to point out that BCI cannot read anyone’s mind. It merely taps into the little electronic spikes in our brain that we all have every day to activate a computer signal.
Patients with restricted mobility use BCI at the Glenrose to play video games, move a robot covered in paint to create art, play music and, in Tristin’s case, to drive a wheelchair.
“When Tristin has been doing brain-computer interface driving, the main thing that we’re working on for him is to see if we can improve his endurance and the distance that he can go by himself safely,” says Tuck.
“BCI is an emerging technology. It’s exciting to see what research opportunities here could lead to real-world applications to help Tristin go farther, more independently and safely.”
The BCI program is a clinical and research program in partnership with the University of Alberta, with funding, thanks to donor support, from the Glenrose Hospital Foundation.
“Patients like Tristin have to rely on a lot of people to help them do things, but with BCI, he is doing things on
his own,” says Rennie Froma, Tristin’s mom.
“He gets so excited every time he has a BCI appointment. Just seeing the
smile on his face when he’s driving his wheelchair is incredible. I’m so grateful to the donors for giving him this opportunity.” n H
patients. The idea is over time to develop a safer, more streamlined, and effective procedures for accessing critical brain circuits, and that’s where the new technology will really shine.
Hynynen: Taking the procedure out of the MRI would make it a more accessible form of treatment. We would do an initial scan of the patient’s head to be able to create a rapid prototype of the helmet that is customized to the patient, and subsequent treatments could be done without real-time imaging. Being out of the MRI means no associated costs, and by bringing costs down it increases capacity significantly.
Hynynen: The current focused ultrasound technology works really well for precise single ‘dose’ treatments, like treating tremors or what you might think of as ‘surgery’ treatments. But for
Dr. Kullervo Hynynen is vice president of research and innovation and senior scientist at Sunnybrook Research Institute.
treating brain cancer or Alzheimer’s, which require multiple treatments, it becomes prohibitive in its current state using real-time MRI. By taking the treatment out of the MRI, we can perform any number of treatments. It’s taking it to the next level – it becomes a real treatment for things like brain cancer and Alzheimer’s.
Hynynen: The patient would get the initial MRI scan, and from that a customized helmet would be created. Then, the patient would come in for
Brianne Tulk is a Communications Advisor at Sunnybrook Health Sciences Centre.
treatment, get the helmet and transducers on. We would infuse drug and infuse the microbubbles that help us open the blood-brain barrier, and with very controlled modulation we would open the blood-brain barrier to deliver the therapy. The treatment can be precisely customized for each patient to the area of the disease while the intact blood-brain barrier is protecting the rest of the brain.
Lipsman: An aspirational goal would be to do with focused ultrasound what we do in a chemotherapy clinic or a dialysis centre. It would be an outpatient procedure where patients come in, get the procedure, and leave in a more streamlined, comfortable process. Ultimately, we hope to use focused ultrasound at every stage of the brain cancer treatment journey. This can include immediately after surgery, when patients undergo chemotherapy and radiation or it might be at the time of a recurrence, and in order to enhance the effect of other treatments. The idea is to match, as much as possible, novel treatments to our patient’s specific conditions. n H
Hoping to improve care for people with debilitating smell disorders, Dr. Leigh Sowerby, a surgeon with the Otolaryngology- Head and Neck Program at St. Joseph’s Health Care London, is recruiting patients for a novel trial testing a new treatment for parosmia – a disorder that causes a distorted sense of smell.
When Rebecca Bruzzese lost her sense of smell and taste after a bout of COVID-19, it was disconcerting. But when it returned a week later, it was downright debilitating.
For over a year, Rebecca experienced what is called parosmia – a disorder that causes a distorted sense of smell, turning normal odors into a repulsive stench, and often creating disturbing, even frightening, phantom smells.
“Coffee was the worst,” says Rebecca. “It smelled like hot garbage.”
FOR OVER A YEAR, REBECCA EXPERIENCED WHAT IS CALLED PAROSMIA – A DISORDER THAT CAUSES A DISTORTED SENSE OF SMELL, TURNING NORMAL ODORS INTO A REPULSIVE STENCH, AND OFTEN CREATING DISTURBING,
EVEN FRIGHTENING, PHANTOM SMELLS.
Ground beef frying on the stove smelled like “excrement in a pan” and tomatoes had a sharp acidic rancid smell.
condo and would contact the building manager to investigate. I was borderline neurotic for a couple of months.”
The 32-year-old was so repulsed by food she lost 30 pounds. Causing even more havoc were the phantom smells – cigarette smoke and natural gas – which triggered great anxiety. She refers to them as scent hallucinations.
“Not having a reliable sense of smell was very disorienting and anxiety provoking,” says Bruzzese. “The natural gas smell was the worst. I live in a
Today, a normal sense of smell has returned to a relieved Bruzzese – restored by novel treatment being trialed at St. Joseph’s Health Care London (St. Joseph’s) by Dr. Leigh Sowerby, a surgeon with the OtolaryngologyHead and Neck Program and scientist with Lawson Research Institute. He is working in collaboration with anesthesiologists Dr. Geoff Bellingham, Medical Director of St. Joseph’s Pain Management Program, and Dr. Mohammad Misurati.
The randomized controlled trial is testing stellate ganglion block (SGB) – a procedure involving injecting a local anesthetic into the stellate ganglion, a collection of nerves in the neck. The stellate ganglion controls sympathetic signals to the head, neck, arms and part of the chest.
In an earlier survey by the study team, patient reports of temporarily blocking these sympathetic signals through an anesthetic injection showed promise in alleviating the distorted sense of smell. This initial study, conducted online and published in The Journal of Laryngology & Otology, involved patients who had experienced various treatment options for post-COVID parosmia, including
SGB, to gather data about their experiences and outcomes.
The follow-up randomized clinical trial at St. Joseph’s with 44 patients is the next step and seeks to establish the efficacy of the SGB in treating postCOVID parosmia.
“The assumption for a lot of these patients is that there is nothing we can do,” explains Sowerby. “If the findings are positive, we’re hoping it will help advocate for more access to the procedure.”
It will also confirm the effect is not placebo, which will shed light on an intriguing neuronal pathway for olfaction (sense of smell), he adds.
“It’s an intriguing study because, based on our understanding of patho-
physiology, the stellate ganglion should have no effect on olfaction,” he says. “Initial reports of benefit were met with great skepticism. We hope to validate the benefit.”
Patients who fit the study criteria undergo full olfactory testing before and after receiving SGB. They are randomized to receive either saline (placebo) or lidocaine in a stellate ganglion block. It is a double-blind study, which means both the investigators and patients do not know what each individual receives.
Currently, 14 patients have been enrolled in the study with recruitment ongoing. Participants will be followed for up to one year.
Parosmia is an uncommon condition, but more prevalent since the arrival of COVID-19. It can be caused by bacterial or viral infections, head trauma, neurological conditions, surgeries, psychiatric conditions, toxic chemicals and medications.
Bruzzese, who came down with COVID-19 in February 2023, received her injection at the end of March 2024.
“Within two weeks I was mostly recovered. What Dr. Sowerby is doing
is incredibly important. Being able to recognize smells is something we take for granted, until you can’t.”
Sowerby agrees and sees the fallout for people daily. It’s why he has his nose to the ground to improve care for those with smell disorders.
“For vision and hearing, you can simulate the loss of those senses, but it’s very hard to get an idea what it’s like without smell until you experience it,” he says. “We live our lives with scents and smells always in the background. They evoke memories, are a significant source of joy and are signals to our surroundings. For some people I see in my practice, it’s also critical to their livelihoods – sommeliers, gas fitters, chefs. We need to do better in assessing and treating people, and this trial is part of that effort.”
Those experiencing distorted smell for more than six months after a COVID-19 infection may be eligible to take part in a study at St. Joseph’s Health Care London testing stellate ganglion blocks. For more information, email smell@sjhc.london.on.ca n H
SPONSORED CONTENT
Rapid innovations in technology, particularly AI, have many worried that machines will threaten their jobs. Yet there’s an optimism around the way technology could revolutionize the healthcare sector — particularly if, as these innovations develop, the next generation of healthcare workers develops with them. Emerging healthcare technologies are indicating an ideological shift could be coming. Clinicians are personalizing care with data from wearable technology, advancements in genomic testing are better predicting risks of disease, AI and machine learning algorithms are detecting fatal illnesses earlier — technology has the potential to change the main role of healthcare from treating sickness to preventing it.
Keeping the innovation momentum going strong will require a steady stream of highly trained healthcare
workers and researchers prepared to use, create and advance these technologies. And U of T Scarborough’s Arts and Science Co-op program is one way the vision of a high-tech healthcare system is getting the talent it needs.
Arts and Science Co-op students come from a range of programs across health, science and technology that give them the background to quickly begin using and helping develop the latest healthcare technologies, including custom and fledgeling ones. That was the case in a recent co-op placement that had students work with wet lab and computation scientists to develop a lab’s custom AI-based image analysis technology, which analyzes cellular phenotypes for early signs of cancer. Placements like these mean students will enter the workforce with the knowledge and experience needed to make these tools commonplace in medical settings.
Many Arts and Science Co-op students in computer science programs have similarly used their education in programming languages, web development and algorithms to develop technologies for healthcare and medical science. In another recent placement, students created and maintained code that uses machine learning to analyze big data, both physiological and genomic, to understand the relationship between sleep disruption and neurological disorders, namely Alzheimer’s.
Students in health sciences programs are having the same impact, drawing on their research training from top academics at U of T Scarborough. Another placement had students interact with patients, gain informed consent and use the latest in wearable sensor technologies to collect and interpret accelerometric, EEG and cardiopulmonary data.
These students offer a solution to labs and healthcare settings looking
for enthusiastic employees with highly technical skills and the disposition to quickly gain new ones. Employers can submit job descriptions (or upload them on the university’s Co-op portal), interview and choose students to be hired for four-, eight- or 12-month work terms. They can also hire co-op students from more than 100 disciplines across all three U of T campuses, all of them eager to start building the healthcare system of the future, today. To learn more about coop at U of T, reach out to the team at https://uoft.me/uoftcoop n H
t. Michael’s Hospital researcher is launching a first-of-its-kind global trial to test the impact of MDMA, commonly known as ecstasy, on chronic nerve pain compared with a placebo.
Pending regulatory approval, the St. Michael’s MDMA clinical trial will recruit 30 patients with chronic nerve pain from across Canada. These patients will be randomly assigned to receive either MDMA and psychotherapy or the active placebo methylphenidate, commonly known as Ritalin, and psychotherapy. The trial team, led by Anesthesiologist Dr. Akash Goel, is aiming to start recruitment in January 2025 and completion is scheduled for June 2026. It is the first active-placebo controlled trial of its kind, and Goel recently won $150,000 from the St. Michael’s Hospital Foundation Research Innovation Council to help launch the study.
“Currently, around one in five Canadians suffer from neuropathic pain, and many have no recourse for improvement,” said Goel, noting that common causes of neuropathic pain include diabetes, cancer, surgery and Multiple Sclerosis. “Of these patients, one in five rate their pain as worse than death, so there’s clearly an important need for innovation in this space.”
MDMA, which is short for methylenedioxymethamphetamine, is a synthetic psychoactive drug that works by affecting chemicals in the brain that play key roles in regulating mood, energy and social behavior. MDMA is known for altering mood and perception, and can cause increased feelings of happiness, empathy, energy and can heighten the user’s senses.
First created by Merck in the early 1900s, MDMA was used experimentally to enhance psychotherapy in the 1970s. In the 1990s it became associated with the underground rave scene and is now considered illegal in many jurisdictions, including Canada. Despite its illegal classification, Health Canada allowed limited distribution of MDMA for medical and research purposes in 2022.
In recent years, there’s been renewed interest in studying MDMA as a treatment for pain and mental health disorders, said Goel. The results from a 2023 clinical trial found that MDMA significantly improved symptoms of post-traumatic stress disorder (PTSD) in patients compared to placebo and psychotherapy. The trial also found that MDMA significantly improved pain-related disability for a sub-group of participants with chronic pain. However, the FDA raised concerns with the trial design, in particular, the lack of an appropriate active-placebo, as 90 per cent of patients correctly guessed if they had received MDMA or the placebo.
The St. Michael’s MDMA trial is the most recent study from the Pinnacle Research Group to investigate the effects of psychedelic drugs on chronic neuropathic pain. The Pinnacle Group is conducting similar trials testing the impact of ketamine and psilocybin.
Research suggests that MDMA creates feelings of empathy and openness, so that patients with trauma – and living with chronic nerve pain is trauma – can face it more openly, Goel said.
“This is called fear extinction. They’re able to revisit and explore that trauma in a way that helps them understand their experiences,” he said.
“This can help them adapt principles of psychotherapy into their daily lives in a more meaningful way and could leave a lasting positive impact on their life.”
There’s also mounting debate over whether MDMA improves neuroplasticity, which is the ability of neural networks in the brain to change through growth or reorganization, Goel adds. MDMA may create an opportunity for someone with chronic pain and unhealthy brain connections to lay down new, healthier neural frameworks, he said.
“I compare it to our aging highway system in Toronto. The highways were built decades ago, and they’re not really set up for the 2020s. What you need to do is lay down a completely new map.
“These are some of the reasons we believe MDMA could be a potential game changer in the area of pain medicine, as well as other mental health disorders.”
MDMA has side effects, including rapid heartbeat, dehydration, blurred vision, fatigue, depression and anxiety. As such, all participants will be doing psychotherapy while in the trial to ensure that they have stable and constant access to mental health supports, said Goel. The trial team will also touch base with participants regularly to see if they are experiencing prohibitive side effects. Patients who show active suicidality or have a history of psychosis will be excluded from the study to prevent serious adverse events, he said.
“Our research group has a solid infrastructure here at St. Michael’s to ensure that we have the right protocols in place, the right drug manufacturer and we develop our network to ensure that this clinical trial can be executed in a safe manner,” Goel said.
The St. Michael’s pain trials could bring relief to patients like Gabe Ramsay, who’s been suffering from debilitating chronic nerve pain after having elective laser eye surgery in 2018. Following his surgery, Ramsay developed dry eyes and inflammation of his corneas, which eventually developed into corneal neuropathic pain.
“I had a terrible time recovering from the surgery. I’ve had a constant, burning and stabbing pain in my eyes, that’s spread to parts of my face as well,” Ramsay said, noting that his pain drove him to leave work for a few months and even prompted him to decline entering a university Master’s program.
“It’s totally changed my life and everything I do. I’ve been battling it for six years.”
Ramsay had tried different treatments and procedures and even arranged to see a specialist in Boston. Because most of the treatments were not covered by OHIP, he paid for most of them out of pocket.
While he’s made some progress and has returned to work, Ramsay’s still dependent on a number of treatments, including eye drops and medications, which he says make him groggy and affect his short-term memory. He’s still looking for a more effective treatment.
“There’s a psychological aspect of chronic nerve pain, especially when there are no good treatment options,” he said. “The future is just so uncertain, and the pain can get worse. It can spread. This makes it hard psychologically to prepare for the future or think ahead.”
Goel says Ramsay’s experience is one he commonly sees in patients. “It’s not just the pain, it’s how the pain impacts relationships, careers, families,” he said. “It’s an experience.” n H
n a groundbreaking achievement, Scarborough Health Network (SHN) has become the first non-cardiac surgical centre in Ontario to successfully use an Impella pump – the world’s tiniest heart pump. The Impella pump greatly reduces the risk of complications and improves survival for patients with significant coronary artery disease requiring intervention or heart failure at risk of death. The Impella pump takes over the blood pumping duties of the heart while the cardiologist repairs blocked arteries. The use of this innovative technology, reduces patient mortality rates by 25 per cent, marking a significant milestone for SHN and the communities of Scarborough and Durham.
The journey to this historic moment began with extensive practice and expertise gained by SHN’s Dr. Mark Davis, who applied this novel technology while working at a hospital in the United States. Recognizing the potential of the Impella pump, the Interventional Cardiology team advocated for its adoption at SHN, with Dr. Davis stating, “We need this. It’s a complete game-changer.”
From the introduction of the concept to the first patient application, the process was completed in just 2.5 months, an incredible feat, involving
the development of entirely new orders and procedures in SHN’s Epic clinical information system. It was a collaboration across four programs: Lab, Pharmacy, ICU, and Interventional Cardiology. The team, supported by Dr. Amir Janmohamed, Chief and Medical Director of Cardiology as well as Dr. Martin Betts, Chief and Medical Director of ICU, worked tirelessly to ensure the success of the project. The dedication and teamwork paid off, with the first case carried out by Drs. Mark Davis, Chris Li, Shane Parfey and Jenny Namkoong being a tremendous success.
“This is a monumental step forward for SHN,” said Dr. Elaine Yeung, Chief of Staff and CMIO at SHN.
“The successful use of the Impella pump not only showcases our physicians and nurses’ commitment to innovation but also our dedication to providing the best possible care for our patients.”
SHN is already a leader in cardiac care, home to the designated cardiac centre for the Scarborough-Durham region. Offering the most comprehensive range of cardiac services to local and surrounding communities, SHN hosts a network of dedicated cardiologists who provide exceptional quality care. However, the absence of this
pump meant certain cases had to be sent to a cardiovascular surgical center rather than being treated locally here in Scarborough.
Now, SHN is able to perform more complex and “risky” procedures that were not previously available to the Scarborough and Durham areas. This technology stabilizes patients with or without the need to open arteries, enabling them to be treated locally with improved outcomes, or to be safely transferred to a cardiovascular surgical center if complications arise.
The availability of this technology and the enhanced expertise of the SHN
Cardiac team at a non-cardiovascular surgical site is more important than at other cardiac centers which may have alternative options with the support of their cardiovascular surgical teams.
The successful use of the Impella pump is a testament to the hospital’s commitment to innovation and excellence in patient care.
This first case provides a clear proofof-concept that the team will now use to expand SHN’s use of the Impella pump. Plans are in place to undertake more procedures as needed and grow the number of patients SHN is able to help. n H
By Olivia Lavery
ince its inception, the St. Michael’s Hospital emergency department has responded to many mass-casualty events – treating patients injured in tragic shootings, to massive parades, to highway car crashes.
This tradition of saving lives in the most challenging circumstances goes back decades, with one particular event standing out amongst the others.
On the night of Sept. 16, 1949, the Canadian steamship The S.S. Noronic was docked in Toronto Harbour as part of a seven-day pleasure cruise of Lake Ontario. But in the early morning hours of Sept. 17, a fire broke out on the steamship, spreading quickly and resulting in the deaths of roughly 120 passengers.
Injured and burned victims of the fire were sent to St. Michael’s Hospital and Toronto General Hospital, with between 70 and 80 patients arriving at St. Michael’s for treatment starting at around 3 a.m. The hospital called in doctors and nurses who worked overnight, and well into the next day, to treat the wounded. The Sisters of St. Joseph, who founded the hospital, set up a call centre to notify family
members of patients being treated and handed out blankets to people waiting. Lenore, who has asked to be referred to by first name only, was a nurse in the St. Michael’s Hospital emergency department at the time of the S.S. Noronic fire.
“It was a very quiet evening,” says Lenore, who was a graduate of the nursing school that used to operate out of St. Michael’s. “And then all of a sudden there were sirens from everywhere and patients from everywhere.”
The immediate treatment of patients from the fire included bandaging, anti-tetanus serum, morphine and penicillin, according to an article in Canadian Hospital from the time, with some requiring minor and major surgery. Large quantities of blood plasma were also needed throughout the course of the night and following day.
The night of the S.S. Noronic fire, a physician named Dr. Paul McGoey was on duty. McGoey was no stranger to a disastrous fire. As outlined in the St. Michael’s Nursing Alumnae News after the event, McGoey had been a part of the response to the Coconut Grove fire in Boston about five years earlier which resulted in more than
200 deaths. This experience may have helped him to guide the emergency department through the chaos of the S.S. Noronic disaster.
Lenore says the response to the disaster was inspiring. Clinical staff who were not on shift that night – and some doctors who did not work at the hospital at all – came in to assist with the influx of patients, and many others stayed well beyond the normal hours of their shifts. Patients, many of whom were badly burned, patiently waited for their turn to be treated – recognizing that those around them were in worse condition.
“Toronto responded 100 per cent to this tragedy,” Lenore says.
The fire and its aftermath were covered by major news outlets like the Toronto Star, and the City of Toronto even sent a letter of thanks to St. Michael’s for its quick and efficient response to the disaster. Many passengers of the S.S. Noronic were American, and their family members reached out to thank the Canadian hospitals that responded to the tragedy for their incredible care.
Dr. Carolyn Snider, an emergency physician and researcher at St. Michael’s, says the S.S. Noronic fire is a historical reminder of the need for constant learning and education about how to best respond to a crisis.
The emergency and trauma teams at St. Michael’s, which are made up of many departments and roles, regularly
practice for Code Orange mass casualty events, even bringing in simulated patients and partnering with Toronto Police Services to make the scenarios as realistic as possible.
Snider says that while no hospital wants to have to be good at handling a catastrophic event, the reality is that St. Michael’s is very good at it.
Lenore says she’s enjoyed reading about recent work being done at St.
Michael’s, particularly the work of the emergency department and trauma centre, in the years since she left.
When asked what she learned from the S.S. Noronic event, Lenore says that staying positive is key.
“I think we must not become a little discouraged. That old saying ‘better to light one little candle’ is true. Sometimes you can think it isn’t going to make any difference. But it does.” n H
By Melody Keshishian
Managing violent patients in hospitals is a growing concern, particularly in emergency departments where staff and physicians frequently encounter individuals in an agitated state or in distress due to medical, psychiatric or substance-related issues. The collaboration between hospitals, paramedics, and police is critical for safe transition of patients from pre-hospital settings to in-hospital care, knowing the receiving team is prepared for possible violence. Scarborough Health Network (SHN) is committed to a multi-disciplinary approach, where the hospital, paramedics, and police work together to ensure violent patients are managed safely in a controlled, secured environment.
In September 2024, a team including interprofessional staff and leadership from across SHN, Toronto Paramedic Services, and the Toronto Police Service, gathered at Birchmount Hospital for a Rapid Improvement Event (RIE). For SHN, it was all hands on deck, with representation from the Network’s emergency departments, admitting and registration, mental health, security, clinical informatics, professional practice, quality and patient safety, workplace health and safety, and senior leadership.
The team was asked to review and scrutinize root causes of violence in the emergency departments. Each key provider group often works in silos, which can lead to miscommunication and unsafe conditions. By adopting an integrated approach and collaborating more closely, hospitals can provide a safer environment for both staff, physicians, and patients.
“Coming to the emergency department is stressful for anyone. By enhancing communication, conducting joint training, and establishing clear protocols, healthcare settings can prevent and respond to violence more effectively, said Dr. Caroline Thompson, Interim Co-chief for SHN’s emergency departments.
“THE EVIDENCE SUGGESTS THAT THE BIGGEST IMPACT IN REDUCING VIOLENCE IN A HEALTHCARE SETTING IS TRAINING TO HELP IDENTIFY WHEN OUR PATIENTS ARE BECOMING FRUSTRATED OR ANGRY, AND HELPING OUR STAFF RESPOND IN A VALIDATING AND EMPATHIC WAY.”
“Exceptional quality care begins with maintaining a safe environment for patients and healthcare workers. Understanding and respecting each other’s perspectives can help create a safer and more compassionate environment.”
By collaborating with community partners and gleaning insights about workplace violence prevention ini-
tiatives at other institutions, this RIE focused on enhancing SHN’s current ED processes and building on existing action plans to adopt innovative strategies for managing and preventing violent incidents.
According to Dr. Ilan Fischler, Chief of Psychiatry at SHN, changing the culture to understand that violence occurs within a relationship
is the key to minimizing friction and ultimately decreasing violent incidents in the ED.
“The evidence suggests that the biggest impact in reducing violence in a healthcare setting is training to help identify when our patients are becoming frustrated or angry, and helping our staff respond in a validating and empathic way,” explained Dr. Fischler.
“Staff, patients, and families have an important role in helping to co-design a culture within hospitals that implements relationship-based care.”
Sergeant Giovanni Liggio from the Toronto Police Service agrees. His RIE presentation emphasized the powerful role of communication both between staff and patients, and between hospital staff and police officers.
“If a patient with a violent history is brought in, this needs to be communicated effectively,” explained Sergeant Liggio.
“When an officer escorts a patient to the hospital, it is important for the officer to stay with the patient until security arrives. This way they can prevent any incidents from occurring, and flag any previous incidents of violence to hospital staff before transferring responsibility for the patient to the hospital.”
Communication is also necessary in de-escalation training for better managing violent situations, along with understanding the cues for when someone may be prone to violence.
“Last year, there were 130 incidents of violence or threatened violence against paramedics at hospitals in Toronto,” stated Andrew Lock, Superintendent of Toronto Paramedic Services.
“In my experience, consistent language and assessment skills, communication pathways, inter-agency cooperation, and more training in de-escalation techniques are the most impactful in reducing violence in emergency departments.”
During the RIE, participants worked together in groups to:
epoc® Blood Analysis System
siemens-healthineers.ca/epoc-nxs
The epoc Blood Analysis System provides critical information that helps inform both the treatment path and transfer destination.
Test card features
Room-temperature storage
Bar-coded with lot and expiration for error-free test panel recognition
92 μL sample: arterial or venous whole-blood syringe 90 μL sample: whole-blood capillary
Results available in <1 minute from sample application
Simplified inventory management
Seamless, automatic critical result alerts and documentation reporting on the instrument.
Unity Health Toronto has received $200 thousand in funding from Toronto Innovation Acceleration Partners (TIAP) under its Critical Technologies Program, to scale homegrown AI tools that support workforce planning in health care. One of the tools, the Emergency Department (ED) Nurse Assignment tool, has reduced the time it takes to assign up to 27 nurses to their roles for each shift from three hours to 15 minutes or less per day.
“We know that AI can be harnessed to automate tasks and to make predictions based on patterns in data,” says Dr. Muhammad Mamdani, VP of Data Science and Advanced Analytics at Unity Health. “At Unity Health Toronto we are developing AI tools leveraging these capabilities not only to improve patient outcomes but also to help teams operate more efficiently and plan for the future.”
Administrative burden is a well-documented issue in health care, with staff and physicians often citing paperwork as a primary reason for burnout. By creating AI optimization models that find the best solution, time-consuming administrative tasks can be almost entirely automated. This contributes to better well-being at work and enables health care teams to focus on what matters most – patient care.
Continued from page 20
Healthcare systems in Canada and abroad have also faced significant staffing shortages in recent years. Using machine learning AI models to predict future health human resource needs helps ensure teams are properly resourced to provide excellent care. It can also decrease costs by reducing health care organizations’ reliance on overtime hours and private staffing agencies to fill in gaps.
Unity Health Toronto is the first hospital network in Canada to have an applied AI team, and the only health care organization in the country that has developed and deployed over 50 applied AI tools to support clinical practice and operational decision-making. These tools result from data scientists teaming up with clinical staff to tackle challenges and use the power of data and AI to reduce wait times, customize treatments, make medicine more precise and improve health outcomes – even save lives.
This funding will be used to help generalize AI models currently being used at Unity Health Toronto, including:
• The Emergency Department Nurse
Assignment Tool: This optimization tool helps nursing team leaders and administrative staff assign nurses to their role for each shift in the ED. It has reduced a daily task from three
• Examine real case studies involving violence in Ontario EDs, to identify process gaps that may have contributed to the escalation of violence;
• Discuss how systemic inequities and unconscious bias may impact a patient’s response to hospital staff and first responders;
• Explore how to improve communication between staff, security, and community partners; and
• Establish opportunities or interventions that could have been
Melody Keshishian
is
implemented to mitigate any escalation.
While SHN has robust workplace violence prevention training in place, and ED leaders continuously engage their teams and other hospital departments to identify gaps and make improvements, collaboration with community partners like police and paramedics is driven by SHN’s strategic vision for a more integrated healthcare system.
“Bringing in outside perspectives from our partners who are also grappling with
hours to 15 minutes or less. It has also reduced the ‘repeat rate’ – the number of times a nurse is assigned to the same role in back-to-back shifts – from 20+ per cent to 5 per cent. This helps to ensure nurses work in a variety of roles, creating more learning opportunities and job satisfaction.
• Interprofessional Resource Team planning: An interprofessional resource team (IRT) is a team of nurses and other health disciplines staff hired by a hospital to fill in for absences and leaves. This solution looks at historical data to predict the frequency of leaves and absences and helps leaders create IRTs with the right size and mixture of skills. “We are exceedingly lucky to have a Data Science and Advanced Analytics team at Unity Health Toronto that can build these tools to help improve our work environment,” says Manson
Locke, VP of Human Resources, Unity Health Toronto. “Many of the issues we face at Unity Health are being faced across the health system and this funding will help to ensure more healthcare organizations can benefit from the positive impact of these AI tools.”
As part of Ontario’s provincial Critical Technologies Initiative, TIAP has partnered with OBIO® to offer this new support to accelerate the health science industry’s use of 5G and advanced networks, blockchain, cybersecurity, ethical artificial intelligence (AI), quantum computing and/or robotics. If you are an innovator or entrepreneur with emerging life sciences technologies and/or an early-stage venture utilizing critical technologies and need support with IP management, company creation, and/or technology de-risking, access information on how TIAP may be able to help. n H
violence and harassment in their own roles is immensely helpful in thinking outside the box and exploring how we can adapt successful strategies inside the hospital,” said Morgan McNeil, Interim Director of Emergency Services at SHN.
“Our department is completing action planning and will regroup with the broader team in about six months to review accountabilities and fine tune any changes that may be necessary.”
The SHN team also looks forward to building new emergency depart-
a Communications Specialist, Scarborough Health Network
ments at Centenary and Birchmount in the next few years to address the increase in ED visits. Research shows that higher throughput in the ED and shorter lengths of stay can decrease violence.
With support from government partners and generous donors, SHN is well on the way to solving this piece of the puzzle. New infrastructure will help address the issue of overcrowding and lead to better patient experiences and outcomes. n H
Royal Victoria Regional Health Centre’s (RVH) Emergency Department (ED) is well prepared to serve the community ahead of this year’s respiratory season with its Minor Ailment Patient Pathway (MAPP) booking portal.
Pioneered here at RVH, the ED MAPP was designed to help decrease wait times and overcrowding by rerouting non-acute patients with cold, flu and other respiratory symptoms, along with minor limb injuries, lacerations, urinary tract infections and skin infections, out of the main ED into a designated treatment area called the Pink Zone. People presenting with any of these symptoms are encouraged to use the booking portal to determine eligibility and book a same or next-day arrival time.
“The ED MAPP enables us to provide improved access to care in our community, which is especially important during cold and flu respiratory season,” says Dr. Christopher Zanette, RVH Chief of Emergency Medicine. “We know for some, the ED is their only access point to a healthcare. We want to ensure that we are able to streamline our patients in the most efficient way possible to improve their care and experience.”
Since its successful launch in 2023, just over 5,000 patients have been seen and treated through the ED MAPP in the Pink Zone location. For most patients, the average time between being seen by the doctor and leaving the health centre is approximately 1.5 hours.
Dr. Christopher Zanette, RVH Chief of Emergency Medicine, treats a young patient booked through RVH’s Emergency Department Minor Ailment Patient Pathway.
“Staying up to date on vaccinations will help to keep everyone healthy this respiratory season,” says Sharon Ramagnano, RVH Operations Director, Emergency, Critical Care and Trauma. “If you do become sick and your symptoms require a higher level of care, please follow-up with your healthcare provider, access walk-in clinics within the area, or use our ED MAPP patient online booking system.”
RVH reminds residents to stay home when sick, wash your hands often, cover your mouth when you cough or sneeze, and clean high touch surfaces regularly to help keep everyone healthy.
Patients can book same- and nextday arrival times Monday to Friday from 9 a.m. to 5 p.m. The ED MAPP booking link can be found on the RVH website (rvh.on.ca) under Emergency Department. n H
The Peer Support and Trauma Response program at The Hospital for Sick Children (SickKids) is there for staff when they need it, and sometimes even before.
When the program began in 2018 –it was the first hospital-wide program of its kind in Canada – the goal was to provide confidential and individual support to any staff member experiencing personal or workplace stress. As the program evolved and matured, the pathways to support have broadened to include group support as well.
The SickKids Paediatric Nursing Orientation (PNO) program has embraced Peer Support to empower “our kind of nursing” at SickKids. By inviting Peers to be part of its Mental Health and Well-being Education Sessions, the partnership aims to help prepare new nurses for the challenges of working in health care and to set them up for success at SickKids. With four cohorts a year of around 100 nurses in each, it’s an opportune time to address aspects of the role not covered in a textbook.
“There’s strong evidence showing that the first year can be the most difficult for new nurses, and it’s during this critical time that they are most likely to leave the profession,” says Kelly McNaughton, Program Manager, Peer Support, SickKids. “This transition period can be extremely difficult for a variety of reasons, and so the goal of the Mental Health and Well-being Education sessions is to help nurses understand the demands of the job, how to get support and, most of all, that they’re not alone.”
At the heart of the well-being sessions is a panel of nurses who are also trained Peers. As an introduction to the Peer Support program, they hear from experienced nurses who speak about topics that aren’t typically spoken openly about. From working night shifts to adjusting to life in a new city, from conflicts with colleagues to mistakes they’ve made at work, the panelists show there’s strength in vulnerability.
Lisa Arce started working at SickKids 15 years ago as a nurse on the Haematology/Oncology unit, and now she’s an Interprofessional Education Specialist responsible for leading the PNO program. The comprehensive orientation lasts three months and takes nurses from the simulation environment to the clinical setting, learning alongside support nurses and preceptors. There’s a lot of ground to cover, with mental health and well-being a much larger component than when she went through the orientation herself.
“We want to create a safe work environment where we acknowledge the stress nursing can have on staff both professionally and personally, and we don’t expect people to deal with those stressors alone,” Arce says. “We are a community and we want to provide resources for our people to thrive and succeed.”
The Peers offer coping strategies that work for them, as well as addi-
tional resources to help them through their adjustment period. They also share key contacts who they can reach out to anytime they need to speak with someone who can relate to their situation.
“It’s such a relief when new nurses hear these stories because they realize their apprehensions are not unique. They gain confidence from their peers who have gone through it before,” Arce says.
Nicole Loureiro, who started at SickKids in 2012 and has spent most of her nursing career in the Emergency Department, is also a member of the Peer Support team and a panelist for the Mental Health and Well-being Education Sessions. She remembers what it feels like to start a new nursing job and makes a point of asking new colleagues how she can help to ease their transition.
Many arrive at SickKids with excellent credentials, but become over-
whelmed with feelings of self-doubt as they begin to question if they have what it takes for nursing, Loureiro says, adding that these feelings are natural and she lets them know it’s okay to feel this way.
“We take an ‘ask me anything’ approach and we are very honest with our answers about times we’ve struggled and how we worked through those struggles,” Loureiro says. “I am deeply proud we have this program and also of the work I’m doing to help bring new nurses aboard for the long term at SickKids.”
Looking back, McNaughton says the Peer Support program has come a long way since day one. “We put a program together but didn’t stop there,” McNaughton says. “We have great people to lead Peer Support, as well as great training, and the program will continue to build on its foundation and respond to the changing needs of the organization and our people.” n H
This year, Canada will celebrate Medical Radiation Technology Week from November 3-9. This week is a time to celebrate the essential role of Medical Radiation Technologists (MRTs) in the Canadian healthcare system.
MRTs play a critical role in Canada’s healthcare system. In total, there are more than 22,000 MRTs working in medical imaging and radiation therapy across the country in the specialty disciplines of radiologic technology, nuclear medicine technology, magnetic resonance imaging and radiation therapy. While many professionals in the hospital may not know their title, MRTs play vital roles in the lives of millions of Canadians receiving healthcare each year, whether in the hospital, imaging clinics or cancer centres.
Here are some things you may not know about your Medical Radiation Technologist colleagues ahead of MRT Week:
DID YOU KNOW YOU CAN SEE MRTS WORKING IN ALMOST EVERY AREA OF THE HOSPITAL?
• They work in oncology, gastroenterology, neurology, urology, cardiology, neonatology, orthopedics, pediatrics and radiology. They can be found in diagnostic imaging departments, cancer care clinics, operating rooms, emergency departments, intensive care units, and cardiology suites.
DID YOU KNOW MRTS DELIVER IN EXCESS OF 30 MILLION IMAGING EXAMS TO CANADIANS EVERY YEAR?
• Imaging is a vital part of modern medicine. Medical imaging such as x-rays, CT scans, MRI, PET scans, nuclear medicine, mammograms, and more are central to the proper diagnosis, care and management of millions of Canadians. MRTs
MRTS PLAY A CRITICAL ROLE IN CANADA’S HEALTHCARE SYSTEM. IN TOTAL, THERE ARE MORE THAN 22,000 MRTS WORKING IN MEDICAL IMAGING AND RADIATION THERAPY ACROSS THE COUNTRY.
in their many roles are essential to making sure this high technology is available to patients and their healthcare providers.
DID YOU KNOW 50 PER CENT OF CANCER PATIENTS REQUIRE RADIATION THERAPY AS PART OF THEIR TREATMENT PLAN?
• MRTs provide essential cancer care, treating hundreds of thousands of patients per year and are a key care taker in a cancer patient’s journey.
DID YOU KNOW MRTS WORK WITH LIVE SOURCES OF RADIATION?
• MRTs working in nuclear medicine use radioactive materials, known as radiopharmaceuticals, for im aging and cancer treatment. They are even considered nuclear energy workers for this reason!
DID YOU KNOW THERE ARE SUBSPECIALTIES IN THE PROFESSION THAT REQUIRE ADDITIONAL EDUCATION?
• MRTs working in radiologic tech nology can specialize in CT imaging, mammography, and interventional radiology. MRTs working in radi ation therapy can specialize to become dosimetrists. MRTs working in nuclear medicine can train to become radiation safety officers. As you can see, medical radiation technologists interact with almost every single patient in the hospital or clinic. Their unequalled contributions
to patient care, diagnostic imaging, and radiation therapy are the main reasons to celebrate this amazing profession!
If you work in a hospital or healthcare delivery in Canada, chances are you know and interact professionally with more than a few MRTs. These are your colleagues, more than 22,000 of them across the country, working in medical imaging and radiation therapy. If you come across one of your MRT colleagues the week of November 3-9, take a minute to wish them a Happy MRT Week. It will surely be appreciated. n H
Submitted by the Canadian Association of Medical Radiation Technologists (CAMRT). www.camrt.ca
Francine Pilon, whose husband Allan Bignell survived a hemorrhagic stroke, or brain bleed, in 2016 only to die two years later after a second stroke.
Hospital patients have long played a vital role in clinical trials by testing new medications and treatments aimed at advancing human health.
And now, more and more often, patients and their family members are finding themselves on the other side of cutting-edge research, as key advisors on research teams with the scientists, doctors and other health-care professionals leading trials.
Patient and family involvement is partly driven by funding agencies, which are increasingly making patient representation on research groups a requirement on grant applications. But the research community also recognizes the unique role that a patient or caregiver perspective brings to their
THE STUDY IS LOOKING AT WHETHER COLCHICINE COULD HELP PROTECT HEMORRHAGIC STROKE SURVIVORS FROM A SECOND STROKE OR A HEART ATTACK.
studies by sharing their unique insights and experiences.
“It’s not about ticking a box on a funding application,” says Dr. Aristeidis Katsanos, a Hamilton Health Sciences (HHS) neurologist and researcher with the Population Health Research Institute (PHRI), a joint institute of HHS and McMaster University.
“Instead, it’s a research partnership that lasts throughout a trial. After all, we’re doing this research to benefit patients so it makes sense to have their representation on our research teams.
Katsanos is co-principal investigator for the CoVasc-ICH stroke study with HHS neurologist and PHRI senior scientist Dr. Ashkan Shoamanesh. Their research team includes Ancaster resident Francine Pilon, whose husband Allan Bignell survived a hemorrhagic stroke, or brain bleed, in 2016 only to die two years later after a second stroke. Bignell was well known in the
business community as president of L3 Wescam, a world leader in electro-optic and infrared imaging technology.
The CoVasc-ICH study is evaluating the use of the drug colchicine in patients who experienced a hemorrhagic stroke by looking at whether this drug can help prevent a second, and potentially deadly stroke or heart attack from occurring.
“People with intracranial bleeds have a high risk of experiencing a heart attack or stroke related to clots in the weeks, months or years after their brain bleeds,” says Katsanos.
While patients who have a stroke due to a blood clot can take blood thinners to help prevent a second incident, those who experience strokes caused by bleeding can’t take blood thinners for long periods after the bleed.
“We know that patients who experience bleeding in the brain are at risk for both clotting and re-bleeding,” says Katsanos. “There’s currently no medication available to prevent clotting without increasing the bleeding risk in this patient population. We need to find another way to improve outcomes for these patients by reducing the risk of clotting without increasing the risk of bleeding.”
The study is looking at whether colchicine could help protect hemorrhagic stroke survivors from a second stroke or a heart attack. The well-established anti-inflammatory properties of colchicine may also provide additional benefit for these patients by protecting them against inflammation-related brain damage that results from bleeding in the brain.
The research team, including Pilon, has spent two years laying the groundwork for phase three of the study which is expected to launch by the end of this year, be international in scope and last for five years. The goal is to enroll approximately 1,200 patients across eight countries in North America, Asia and Europe including 40 to 50 HHS patients.
Pilon sits on the research team with Katsanos, Shoamanesh and other PHRI researchers. The PHRI, which celebrates its 25th anniversary in November, is among the largest and most reputable research groups worldwide.
Shoamanesh was Bignell’s neurologist, and invited Pilon to join their team. The Canadian Institutes of Health Research provided a $2 million grant in support of their phase three trial, with a condition that a patient representative be part of the team, and Shoamanesh thought that Pilon would be an excellent fit.
As well as being her husband’s main caregiver, she’s also a retired registered physiotherapist who taught physiotherapy and occupational therapy at McMaster University and the University of Guelph, and had participated in research through her work. While Pilon has a background in health care and research, her main role with the PHRI team has been to provide a patient and caregiver perspective.
DECEMBER FOCUS: Medical Imaging /Year in Review/Future of Healthcare/Accreditation/ Hospital Performance Indicators: Overview of advancements and trends in healthcare in 2024 and a look ahead healthcare for 2025. An examination of how hospitals are improving the quality of services through accreditation. Overview of health system performance based on hospitals performance indicators and successful initiatives hospitals have undertaken to measure and improve performance. A look at medical imaging techniques for diagnosis, treatment and prevention of diseases. + SPECIAL FOCUS: ANNUAL RADIOLOGY SUPPLEMENT
Advertising Booking Deadline November 22nd
Material Deadline November 26th
For more info email advertising@hospitalnews.com
“Having Francine on our team has been a great experience, and very eye-opening,” says Katsanos, adding that this is the first time he has been part of a research team that included patient representation. “When you work directly with patients and their families, it’s incredibly motivating because you’re reminded why you’re doing this research.”
Pilon says she feels genuinely valued by the team. “They have been amazing to work with, involving me in all the processes and meetings. I can see that they’re very compassionate, and really want the whole patient-family centered approach in their research.”
Study participants will be sent questionnaires to fill out and return, to give their perspective on their recovery journey so that researchers can build a scale to measure levels of disability after stroke and gauge colchicine’s effectiveness.
“Can this drug reduce clotting and improve patient outcomes after a brain bleed?” asks Katsanos. “When we’ve
finished phase three we’ll have the ultimate answer, and this could have huge worldwide implications.”
Pilon’s contributions include editing patient questionnaires, so they’re reader friendly and easy to complete.
“Researchers want to extrapolate a lot of data from questionnaires, but in order to receive that data the patients and their caregivers need to fill them out and return them,” says Pilon. “If I can make a difference by helping motivate people to complete our questionnaires, then the research data will be that much better.”
While this study is coming too late for her husband, Pilon is excited about the possibility of helping other patients and families living with the fear of a second stroke or a heart attack.
“It would be so exciting to be able to make a difference in an area that’s so dear to my heart,” she says, adding, “It has been an incredible experience and a privilege to be part of such a prestigious and important research team.” n H
JANUARY FOCUS: Healthcare Human Resources / Continuing Medical Education (CME)/ Staffing:
Continuing Medical Education (CME) for healthcare professionals. The use of simulation in training. Human resource programs implemented to manage stress in the workplace and attract and retain healthcare staff. Health and safety issues for healthcare professionals. Quality work environment initiatives and outcomes.
ANNUAL PROFESSIONAL DEVELOPMENT SUPPLEMENT
Advertising Booking Deadline December 13th, 2024
Material Deadline December 17th, 2024 For more info email advertising@hospitalnews.com
FEBRUARY FOCUS: Wound Care/ Gerontology/Public Health and Preventative Medicine/Rehabilitation:
Geriatric medicine, aging-related health issues and senior friendly strategies. Developments in rehabilitation techniques for a variet of injuries and diseases. Effective approaches for disease prevention and health promotion. Innovation and treatment and prevention of wounds.
WOUND CARE SUPPLEMENT
Advertising Booking Deadline January 24th
Material Deadline January 28th For more info email advertising@hospitalnews.com
s Canada’s health care landscape braces for another fall respiratory season, lessons learned from the COVID-19 pandemic remain top-of-mind. Humber River Health (Humber) has taken these lessons to heart, developing innovative strategies to meet potential growth in demand in the coming months. By addressing alternate-level-of-care (ALC) challenges and safeguarding the most vulnerable members of their community, Humber’s approach stands as a model for resilience in health care.
At the heart of Humber’s strategy is their Infection Prevention and Control (IPAC) Hub, developed in partnership with the Ontario Ministry of Health. The IPAC Hub plays a pivotal role in curbing infection rates and managing outbreaks within the Northwest Toronto community. By closely monitoring epidemiological trends, conducting risk assessments, and implementing comprehensive outbreak management practices, Humber’s IPAC Hub ensures the hospital’s readiness for future health crises while keeping health equity at the forefront.
Preparedness for the fall season at Humber includes maintaining an ample supply of hand sanitizer, personal protective equipment (PPE) and disinfectant wipes, which are critical in safeguarding both patients and staff. Regular risk assessments, particularly in the Emergency Department (ED), allow the organization to stay ahead of potential surges in patient volumes. Monthly meetings between the ED and Environmental Services (EVS) teams are held to evaluate the need for additional cleaning measures, ensuring that every step is taken to mitigate infection risks.
The IPAC Hub continues to work directly with long-term care (LTC) homes, retirement homes, and other
congregate living settings to provide guidance and support. On August 1, the IPAC Hub facilitated a Community of Practice/Networking day focused on Fall Preparedness, bringing together stakeholders to share insights and strategies. The Hub and Spoke Model, initiated during the peak of the COVID-19 pandemic, remains a critical component of Humber’s strategy, offering LTCs and other congregate living settings access to comprehensive IPAC expertise and support through infection prevention education and training.
“The COVID-19 pandemic underscored the importance of collective responsibility in infection control,” says Joan Osbourne-Townsend, Director of IPAC at Humber. “Our staff and stakeholders play crucial roles in ensuring that we are prepared and that our community remains protected.”
The annual rise in paediatric illnesses during the respiratory season has presented a significant challenge for Toronto hospitals, with occupancy levels reaching 124-150 per cent of normal capacity during peak winter months. In response, Humber is advancing several key initiatives to address the health care needs of its youngest community members.
To prepare for the Ministry of Health’s Fall/Winter Surge projections, Humber’s Maternal and Child Program has established a phased paediatric surge plan for September 2024 to April 2025. This plan ensures Humber can manage paediatric cases related to COVID-19, Influenza, and RSV by adjusting capacity and ensuring adequate resources are in place throughout the season.
“It’s not just about increasing beds and space,” says Mayura Kandasamy, Program Director of the Maternal and Child Program. “We want to ensure an optimal patient experience. We have to consider various elements – like
having an available team of nurses, specialists, social workers, and Child Life Specialists as well as having timely services including testing, imaging, cleaning, and medications – to ensure that we can provide wrap-around care to our patients.”
Humber’s patient-centric care extends well beyond hospital walls. When Ontario EDs observed a surge in respiratory illnesses among children after the pandemic, our Maternal and Child Program launched the Emergency Department Follow-Up Clinic to bridge gaps and provide timely care to our pediatric patients. This enables children to recover at home with physician follow-up within 24-48 hours, ensuring seamless continuity of their care. Physicians can monitor conditions, address issues, reduce readmissions, and improve patient experience.
As fall approaches, Humber’s long-standing community health programs are essential to addressing ALC challenges by meeting the health needs of their community members both within and outside the hospital. By reducing hospital admissions, these programs ensure that staff and physicians are better equipped to manage increased patient volumes during the respiratory season, all while ensuring that the diverse needs of their community are met.
The Community Care Hub exemplifies Humber’s proactive strategy, offering equity-based health and social services to the North Western Toronto community members. By improving access to preventative care, the Hub helps to reduce avoidable ED visits, ensuring resources are available for increased demand during the respiratory season.
From a clinical perspective, Humber’s Seamless Care Optimizing the Patient Experience (SCOPE) program further supports fall readiness by
streamlining care pathways and reducing the administrative load on primary care providers. This allows for better patient outcomes and less pressure on emergency services during peak illness periods. The Schulich Family Medicine Teaching Unit is also continuing to add much-needed primary care capacity, which is critical for managing community health during fall and winter.
Transitional programs like HEART@Home, and Hospice@ Home, as well as Humber’s Reactivation Care Centres (RCCs), facilitate smoother patient discharges, keeping acute hospital beds available for new admissions. Additionally, Humber’s LTC Remote Monitoring program helps prevent avoidable emergency visits by detecting early health issues in LTC residents, mitigating preventable ED visits via hospital pathways and resources and further strengthening the hospital’s ability to handle seasonal patient surges.
“As we approach the fall season, our strategy centres on fully utilizing the breadth of Humber’s resources and partnerships to bolster our community’s resilience,” says Beatrise Edelstein, Vice President, Post-Acute Care and Health System Partnerships. “By integrating our post-acute care and community health services, we ensure that our patients receive continuous support, whether in their homes, long-term care settings or through our expanded outpatient programs.”
Humber’s proactive and innovative approach to fall preparedness exemplifies the hospital’s commitment to patient-centric care and community health. By focusing on infection control, expanding paediatric care, and enhancing overall community health services, Humber is setting new benchmarks for health care delivery. As hospitals across Canada brace for the challenges of the upcoming respiratory season, Humber’s strategies offer a blueprint for building a resilient health care system that is well-equipped to meet the evolving needs of the communities it serves. n H
Imagine hearing your father singing the tunes of Jacques Brel, one of the most influential chanson singers and songwriters of the 20th century, after years of silence.
A virtual tour of Paris succeeded where other interventions had failed.
“His family was laughing so hard nurses stopped by the hospital room to see if everything was okay,” said Dr. Lora Appel, a KITE affiliate scientist, who leads UHN’s Prescribing Virtual Reality (VRx) Lab.
“It was beautiful seeing a phenomenon I know to be true in theory play out in real life. It’s one of the reasons why I love my job.”
Dr. Lora Appel is leading healthcare into an exciting new realm.
benefit caregivers. Earlier this year, Dr. Appel received a Canadian Institutes of Health Research Institute of Aging Mechanisms in Brain Aging and Dementia Operating Grant to explore using VR to provide respite to caregivers of people living with dementia.
In a six-week trial, people with dementia will engage in immersive VR simulations either by themselves or with someone else remotely while their caregivers take a break.
The project seeks to understand how caregivers could benefit from the respite VR provides.
The aforementioned patient was a participant in a study that investigated whether VR can help manage symptoms and behaviours, such as apathy and aggressiveness, in people living with dementia and who have been admitted to an acute care setting.
VRx Lab designs and evaluates therapeutic virtual reality (VR) interventions for diverse populations.
In addition to investigating how VR can support patients VRx Lab also investigates how the technology can
“Often caregivers feel guilty about not spending all their time with their loved ones,” said Dr. Appel, who also serves as an Associate Professor of Health Informatics at York University.
“With this intervention, they can take a much-needed break while their loved ones engage in an activity that has been proven to be beneficial.“
Continued on page 30
By Diane Peters
When Eduardo Jimenez, 52, comes into contact with the healthcare system, he often encounters providers who struggle to give him the best care. The Toronto father of two has paraplegia with no sensation or movement from the hips down due to a workplace accident 15 years ago – he was an arborist and fell from a tree.
“I’ve never had to deal with someone who’s paraplegic,” the doctor at a GTA fracture clinic told him when he sustained a spiral fracture of the tibia a decade ago. That injury happened from a fall while transferring himself to his van from his wheelchair. “He didn’t know what to do with me,” says Jimenez. The same thing happened during a routine screening colonoscopy last
Continued from page 29
AN SCI IS A COMPLEX CONDITION THAT AFFECTS MANY ASPECTS OF A PERSON’S LIFE AND HEALTH, AND THE IMPACTS CHANGE AS THEY AGE.
year – he had to do the procedure twice, as his bowels function differently. “There’s not enough of us out there,” says Jimenez about those with spinal cord injuries (SCI).
He’s right: there are about 3,600 new SCI cases in Canada every year, and just 86,000 Canadians live with the condition, which affects their mobility and sensation. SCIs can happen as a result of a car accident or fall but also from surgery (such as to remove a tumour near the spine),
Dr. Appel expects to launch this study in the fall.
VRx Lab partnered with the Epilepsy Monitoring Unit at Toronto Western Hospital this summer to investigate whether VR can reduce anxiety in people living with epilepsy.
As part of this work, people living with epilepsy will participate in VR exposure therapy that targets their epilepsy-specific anxieties twice a day for up to 10 days.
They will start with a scene that induces the least anxiety and progressively work up to more challenging situations, such as experiencing a seizure in VR from a first-person point of view.
The aim is to gradually increase their tolerance to anxiety-inducing situations in virtual reality so they are better equipped to handle them in real life.
“One participant from our pilot shared that after their VR training
when they experienced a seizure for the first time in a busy mall, they felt more prepared and less fearful,” said Dr. Appel. “This approach is truly making a difference in how individuals manage their situations.”
Preliminary results of this study will be presented at the Canadian League Against Epilepsy’s annual scientific meeting in October, 2024.
VRx Lab will collaborate with Krembil Research Institute Senior Scientist Dr. Michael Reber and KITE Senior Scientist Dr. Jennifer Campos to investigate the effectiveness of VRbased visual rehabilitation for stroke patients.
Some stroke patients suffer visual impairments that can lead to them losing the ability to drive and perform daily tasks safely.
In this study, stroke patients with visual impairments will use a VR headset for at-home visual rehabilitation to improve their driving abilities.
arthritis or inflammation of the spinal cord.
An SCI is a complex condition that affects many aspects of a person’s life and health, and the impacts change as they age, notes Dr. Cathy Craven, Medical Director of the Spinal Cord Rehabilitation Program at UHN and a Senior Scientist at the KITE Research Institute. “Living with it is as complicated or more than having an organ transplant or heart disease, but many people don’t recognize it.”
Most patients take roughly a dozen medications and see their healthcare team frequently – as often as 34 physician visits in the first year after injury. At the 10year mark, most of these patients are managing seven to eight different health conditions, some related to the injury and others due to being more sedentary and sitting in a chair for hours every day.
“It’s a challenge getting care outside the UHN network,” says Jimenez, because many medical professionals simply don’t have the knowledge or experience to address the myriad complications that accompany SCI. He sees Dr. Craven at the clinic for many of his chronic health conditions – back pain, Type 2 diabetes and low bone density –and finds his care there excellent.
As part of their rehabilitation, they will attempt to track a moving ball among distracting elements. The speed of the ball will increase or decrease based on their performance.
After six weeks, participants will test their progress in DriverLab –a state-ofthe-art driving simulator that allows researchers to recreate real-world driving situations in a safe environment.
“We hope this intervention will help stroke survivors improve their vision and potentially regain the ability to drive,” said Dr. Reber.
The study will begin this fall.
Through these groundbreaking studies, VRx Lab is leading healthcare into an exciting new realm.
“Virtual reality has the potential to improve the lives of many diverse patient populations,” said Dr. Appel.
“I’m dedicated to exploring its vast possibilities while staying rooted in evidence, hoping to bring comfort and joy to those in need while never forgetting the importance of care in the pursuit of cures.” n H
However, Dr. Craven knows her spinal cord rehab clinic and similar clinics nationwide could do better. Once patients are discharged from rehab after their injury – which can be lengthy, Jimenez was in Toronto Rehab’s Lyndhurst Centre for four months – it can be challenging to find comprehensive care as outpatients; often, they’re forced to piece that care together on their own.
“We haven’t set up a post-discharge care paradigm” the way the system has for other long-term complex conditions, says Dr. Craven. “Often, the rehab clinic ends up advocating for services for people. We need a better model to support these people over their lifetime.”
Dr. Craven is looking to fix the gaps at Toronto Rehab and across the country, plus collect more data on this poorly understood patient group. She is the Evaluation Lead of the Spinal Cord Injury Implementation and Evaluation Quality Care Consortium (SCI-IEQCC), a growing national network working to improve and measure the quality of care at spinal cord rehab facilities.
The consortium is comprised of 11 rehab sites nationwide, from Edmonton to P.E.I., with three more set to join soon. Its roots date back to 2015, when Dr. Craven led the SCI-High project to understand the priorities of both patients and healthcare providers regarding rehab after spinal cord injury.
The project prompted Dr. Craven and her collaborators to establish 11 priority goals and develop a set of quality indicators to allow centres to measure their success.
But change isn’t easy. “When someone knows what a best practice is, why don’t they do it? It’s not usually willful disobedience,” says Dr. Craven. “It’s usually that it’s complicated.” To help everyone in the rehab community get the right staff, equipment, care processes and outcomes to help patients, Dr. Craven and a group of colleagues were awarded an Ontario Ministry of Health Grant in 2019 to start the consortium. It has since expanded, becoming nationwide in 2022, and gained additional funding.
The consortium has a representative at each site – someone who already works there – who shares best practices, measures how well the site is doing and collects ideas from staff and patients. “We’ve got people who are creative problem solvers and expert clinicians who are local clinical champions whose job is to bring about change,” says Dr. Craven.
This relatively small group of patients has complex needs because of their condition, ranging from circulatory issues to pressure injuries to bladder and bowel control. However, with few formal studies of their health needs over their lifespans, there is limited evidence about what kinds of treatments and interventions help them live their best lives possible.
“We have very good data about pre-rehab admission and during rehab. But what happens to them after they’re discharged? There’s no uniform data set,” she says. To change that, the consortium collects information about patients and how they fare over the years.
“We need everybody to collect data and put it all together so we can tell this story,” explains Dr. Craven. Concrete numbers can help her and other professionals in the spinal cord injury rehab community explain their needs and attract better resources and funding. “We have to really push hard to get it on the agenda.”
A higher profile for spinal cord injuries will ensure people like Jimenez continue to get the help they need at Toronto Rehab and across the healthcare system – whether they’re dealing with a test, an injury or any other health condition.
A truly supportive system, like the one Dr. Craven is working hard to establish, can help people living with
spinal cord injuries have fulfilling lives. As for Jimenez, he makes sure he accomplishes something for his health and family every day. “Even
if it’s just getting up and walking the dog, I like to be productive. I don’t have to do it all, but I have to have some value.” 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
