Inside: Evidence Matters | Safe Medication | Long-term Care | Special Focus: Paediatrics
August 2022 Edition
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Canada’s first
total artificial heart implant
in child Page 22
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Sign of the times. Across Ontario, the shortage of nurses is now so extreme that Emergency Departments are failing, with patients waiting hours just to be assessed and often days to be admitted. In desperation, an increasing number of hospitals are reducing Emergency Department hours or closing ERs completely. This crisis proves that it’s long past time for the true value of nursing to be reaffirmed. Retaining and recruiting nurses is a clear priority, but that won’t be successful until there are significant improvements to working conditions and staffing levels, and a commitment to fair wages…not just in Emergency Departments, but in every part of the health-care system.
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Contents August 2022 Edition
IN THIS ISSUE:
New tool to help manage traumatic brain injuries
15
▲ Cover story: Canada’s first total artificial heart implant in child
22
▲ Special focus: Paediatrics
18
▲ Postpartum Village supports new parents and their baby
COLUMNS Guest Editorial .................4 In brief .............................6
▲ Choosing Wisely: Low-risk injuries can safely forego abdominal CT imaging
5 10
Safe medication ............14 Evidence matters ...........24 Long term care ..............26
▲ New heart mapping system
16
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AUGUST 2022 HOSPITAL NEWS 3
Why is no one talking about
for-profit homecare? T
www.hospitalnews.com Editor
Kristie Jones
editor@hospitalnews.com Advertising Representatives
Denise Hodgson
By Laura Funk and Cynthia Yamamoto he global pandemic drew attention to decades-long problems in long-term residential care in Canada – resulting in tragic loss of life for thousands, and loss of quality of life for the many more who experienced isolation and inadequate care during pandemic lockdowns. Research has demonstrated that COVID-19 related mortality and inadequate care during the pandemic was most pronounced within for-profit long-term care facilities. Unsurprisingly, political organizations and advocates have called for the elimination of for-profit provision of residential care across the country. Many of the same critics have called on increased provision of homecare as a solution. But there has been relative silence about the for-profit model in homecare too. Why is no one talking about for-profit homecare in Canada? Given the rise in demand for homecare, the acceleration of private homecare services, and our rapidly aging population, the role of profit in homecare should also be front and centre in our public discourse. In Canada, homecare involves a complex and often confusing mix of public, for-profit and not-for-profit organizations delivering services across the country, often, but not always using a kind of managed competition model. Although publicly funded to varying degrees by the provinces, many Canadians pay personally for services, either to top-up publicly funded services or replace them.
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Poorly funded public services can mean wealthier families turn more frequently towards for-profit agencies. Although there is heavy reliance on not-for-profit care providers in this sector, some regions (particularly Ontario) have seen expansion of for-profit homecare delivery. With colleagues, we conducted a review of mainstream media articles on homecare in Canada. We found that during the pandemic, articles addressing the issue of homecare emphasized the safety, desirability and comfort of homecare compared to residential care, but never questioned the profit-model in homecare the way they do in residential care. We also found overwhelmingly homecare agencies, often for-profit ones, were the ones interviewed and quoted in the articles. Frequently the articles were supplied by the for-profit agencies themselves. Problematically, we also found that despite the considerable variability in homecare across Canada, media articles conveyed a sense of homecare as a singular entity. The outlier was a newly released CBC Marketplace investigation which revealed disturbing concerns with homecare quality and accountability in Ontario (where for-profit companies play a significant role in delivery). Media is not the only place where the discussion has been largely ignored. Analyses of for-profit homecare in Canada are also largely ignored in academic research. In the 1990s, when Manitoba shifted a small portion of its homecare from public to for-profit delivery, it was found not only to be more expensive for government but had higher worker turnover. Continued on page 6
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Monthly Focus: Programs and initiatives that Emergency Services/ Critical Care/Trauma/Emergency: Innovations in emergency and trauma delivery systems. Emergency preparedness issues facing hospitals and how they are addressing them. Advances in critical care medicine.
Monthly Focus: Mental Health and Addiction /Patient Safety / Research /Infection control: New treatment approaches to mental health and addiction. Developments in patient-safety practices. An overview of current research initiatives. Developments in the prevention and treatment of drug-resistant bacteria and control of infectious (rare) diseases. Programs implemented to reduce hospital acquired infections (HAIs).
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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.
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NEWS
Postpartum Village supports new parents and their baby By: Melissa Londono he journey of becoming a parent can be overwhelming with so many changes in such little time. Although there are many books to read on what to expect, classes to attend to prepare for the welcoming of a new baby, nothing really prepares you for when your new bundle of joy arrives. This is where Oak Valley Health’s new Postpartum Village can help. Theresa, a first time parent, felt just that. She had many questions to ask after her baby was born and needed support with all of these new changes. “Stephanie, one of the midwives that works in the Family and Baby Clinic, helped me navigate through this process during my early postpartum period,” says Theresa. “The clinic has so many inclusive services all in one place which I found the most convenient. The staff go above and beyond to advocate and support their patients.” It has been said it takes a village to raise a child, and at Oak Valley Health, we are committed to being part of that village that will continue to support new parents and their family’s wellbeing long after their baby arrives. Oak Valley Health created Postpartum Village, an online ‘village’ of services for new parents and their baby, staffed by caregivers specializing in postpartum care including breastfeeding, newborn care, and mental health. “We created the Postpartum Village, an online space bringing together all of our clinics and resources where new parents can find programs, specific to their needs after having a baby,” says Silva Nercessian, Director of Childbirth and Children’s Services & Alongside Midwifery Unit at Oak Valley Health’s Markham Stouffville Hospital. “The team here wanted to ensure that new parents feel just as supported when they were expecting their baby, as they do in this new stage of their life.”
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Programs and clinics that are part of our Postpartum Village include a Breastfeeding Clinic staffed by a certified lactation consultants, a Family and Baby Clinic offering postpartum wellness checks for both parents and babies, jaundice follow-up, weight check and feeding support, and telephone advice seven days a week. Mental health services are supported by a Perinatal Social Work Care program providing support to managing issues that may arise as a result of stressful life events and transitions during pregnancy and postpartum, as well as the Women’s Wellness Services, that offers Postpartum Cognitive Behavioural Therapy Group sessions to those who are identified, or at risk of depression and/or anxiety pre/ postnatal. Postpartum Village services also includes an Obstetrical Postpartum Clinic that provides follow up care for birthing parents that are higher risk and need Obstetrician follow up. For babies who may be at higher risk and require a Paediatrician follow up, there is also our Paediatric Ambulatory Clinic.
All resources are available to parents who delivered at Markham Stouffville Hospital and most of them to new parents who live in the area but who may not have delivered at our hospital. “The Family and Baby Clinic is our newest addition to our program,” says Stephanie, Postpartum Primary Care Coordinator at Markham Stouffville Hospital. “It was created in the midst of the pandemic to support new parents who could not access in-person care. We were noticing that many new families had no access to a primary care provider, and as a team we got together and created this robust seamless model of care.” The Family and Baby Clinic provides a wide range of support. The clinic provides much needed services between the time of hospital discharge and the family seeing their own provider. For families who cannot access a primary care provider, the Family and Baby Clinic follows families up to one month after giving birth. This is part of delivering an extraordinary patient
experience. Oak Valley Health is supporting new parents not only within our organization, but providing care beyond our walls. “We have seen that by providing this service, patients feel more at ease especially during the first month of so many changes and adjustments to their new life as parents,” says Stephanie. “The clinic is midwifery led, sees both parent and baby and offers in-person support that really makes all the difference when you have so many questions after your new baby has arrived.” The Postpartum Village is a one stop shop for new families to navigate the multiple services available to them. The dedicated team of postpartum care providers includes nurses, midwives, physicians, social workers, and mental health experts. Together the team will assist new families in getting the support they need, as every families journey is unique. To learn more about our Postpartum Village or to access our services, H visit our website. ■
Melissa Londono is a Sr. Communications Specialist, Oak Valley Health. www.hospitalnews.com
AUGUST 2022 HOSPITAL NEWS 5
IN BRIEF
Canadian health research must clearly define Black communities or risk failing their needs he use of precise, accurate language in defining Black communities in health care research must improve in Canada, or there is a risk that health research will fail to meet the needs of Black people in Canada, argues a University of Ottawa professor in a commentary published in CMAJ (Canadian Medical Association Journal). In “Who is Black? The urgency of accurately defining the Black population when conducting health research in Canada,” Dr. Jude Mary Cénat, an associate professor in the School of Psychology, writes that definitions
T
of “who is Black” vary widely, which leads to broadly reported research results that may not align with the realities and needs of Black populations. “Accurate, reliable and unambiguous data should be used for research to inform public health policies, training policies for health care workers and culturally appropriate and antiracist health care practices for Black communities,” writes Dr. Cénat, who is also Director of uOttawa’s Interdisciplinary Centre for Black Health and V-TRaC Lab. “Inability to find a common term to describe Black people in health re-
search in Canada may perpetuate inequities and hamper useful research on Black health in Canada.” Use of vague terminology, including “African-Canadian,” “Caribbean,” “African” and others, constrains researchers’ ability to compare the findings of studies and may also lead to inclusion of people who do not identify as Black in studies. “Thus, the answer to the question “Who is Black?” in health research is nuanced: self-identifying Black people of diverse ethnic backgrounds (e.g., African, Caribbean, South American or Canadian),” writes Dr. Cénat,
who suggests using the phrase “Black individuals, peoples or communities” combined with asking participants to identify country of origin for their family and/or a subgroup with which they identify, such as generation status, among others. Addressing this can provide more clarity to ensure that health research tangibly affects public policies, health care programs, strategies and action plans for Black communities in Canada. “Who is Black? The urgency of accurately defining the Black population when conducting health research in Canada” is H published July 18, 2022. ■
Some antivirals used in nonsevere COVID-19 may reduce hospitalizations and deaths he antiviral drugs molnupiravir and nirmatrelvir–ritonavir (Paxlovid), when used to treat nonsevere COVID-19, most likely reduce the risk of subsequent progression to hospitalization and death, according to new research published in CMAJ (Canadian Medical Association Journal). As most trials have focused on patients with severe or critical COVID-19, researchers conducted
T
a systematic review and meta-analysis to understand the effectiveness of these drugs in treating nonsevere COVID-19. “Because antiviral drugs may be most useful in nonsevere disease, this review addresses an important gap in evidence,” says Dr. Tyler Pitre, Division of Internal Medicine, McMaster University, Hamilton, Ontario, with coauthors. The researchers identified 41 trials involving 18 568 patients with nonse-
Continued from page 4
For-profit homecare? Yet despite these findings, little academic research has been done on the for-profit model in homecare across Canada. There is also concern for potential conflicts of interest amidst the expansion of for-profit care delivery, especially given the lack of oversight of this sector. We should not give this sector a free pass – from media scrutiny or academic
research. It’s time the nation turned its eyes to for-profit homecare. Is this the path we want to traverse? As homecare is more and more frequently turned to as the fix for longterm residential care woes, we need to more carefully assess the profit-model of homecare. It appears we are rapidly heading in this direction – so, it’s long past time for a public H discussion. ■
Laura Funk is a Professor in the Department of Sociology and Criminology at the University of Manitoba. Cynthia Yamamoto is an occupational therapist and interdisciplinary studies doctoral student at the University of Manitoba. 6 HOSPITAL NEWS AUGUST 2022
vere COVID-19, most of whom were aged 36.5 to 65.5 years. Compared with standard care or placebo, nirmatrelvir–ritonavir likely reduced the risk of hospital admission (46.2 fewer admissions per 1000), and molnupiravir probably reduced the risk (16.3 fewer admissions per 1000). These findings have implications for health care systems and clinical guidelines. “Our findings suggest that nirmatrelvir–ritonavir may be superior to molnupiravir for some outcomes, which has implications for organizations, such as the [World Health Organization] WHO, that are in the process of developing recommendations addressing molnupiravir and nirmatrelvir–ritonavir,” write the authors. “Health care systems deciding on drug procurement and cost issues need to consider the relative efficacy of nirmatrelvir–ritonavir over molnupiravir.” In a related commentary, authors point out challenges in applying these findings to current patients with COVID-19. Several of the trials on which the study is based were conducted among unvaccinated patients who had been infected with the Delta variant. As a significant portion of Canada’s population is now vaccinated and many have been infected with
the Omicron variant, the medications may be less effective in a real-world setting. The commentary authors call for national and international approaches to rapidly generate evidence in a changing disease landscape. “As the virus and population dynamics evolve, ongoing research is required to inform clinical and policy decisions,” write Drs. Corinne Hohl, University of British Columbia and Vancouver Coastal Health Research Institute, Vancouver, BC, and Andrew McRae, University of Calgary, Calgary, Alberta. “Adaptive platform trials and large observational studies offer the best opportunities to generate timely evidence on the effectiveness of COVID-19 therapeutics.” The authors conclude, “These studies can be completed in Canada, but need to be supported by Canadian research funders, health care institutions, data custodians, health care providers and patients.” “Antiviral drug treatment for nonsevere COVID-19: a systematic review and network meta-analysis” is published July 25, 2022. “Antiviral treatment for COVID-19: ensuring evidence is applicable to current circumstances” is published July 25, H 2022. ■ www.hospitalnews.com
IN BRIEF
New guideline from the Canadian task force on preventive health care D
epression in pregnant and postpartum people is a serious problem. Rather than using a screening tool with a cut-off score to detect depression in every pregnant and postpartum patient, clinicians should ask patients about their well-being as part of usual care, recommends a new guideline from the Canadian Task Force on Preventive Health Care published in CMAJ (Canadian Medical Association Journal). “Depression in pregnant and postpartum people is devastating, with a massive burden for families, and it’s critical to detect it,” says Dr. Eddy Lang, an emergency physician and professor at the Cumming School of Medicine, University of Calgary and chair of the task force’s pregnancy and postpartum working group. However, there is little evidence that universal screening for depression using a standard questionnaire and cut-off score improves longer-term
outcomes for these patients, indicating more research is needed. “We were disappointed to find insufficient evidence of benefit to universal screening with a questionnaire and cut-off score; rather, it’s best for primary care clinicians to focus on asking patients about their well-being at visits,” says Dr. Lang. “The emphasis is on an individualized rather than one-size-fits-all approach.” In creating the guideline, the task force engaged patients to understand their values and preferences around screening to inform recommendations. Participants felt strongly that a discussion about depression with their health care provider during pregnancy and the postpartum period is critical. The guideline is aimed at health care providers in Canada, including physicians, nurses, midwives and other health care professionals who interface with pregnant and postpartum patients. It replaces the previous guideline from the task force, published in 2013.
The guideline applies to pregnant and postpartum people in the first year after delivery. It does not apply to pregnant or postpartum people with a history of depression or who are being assessed or treated for other mental disorders.
WHAT DOES THIS MEAN FOR CLINICIANS?
Clinicians should: • ask patients about their well-being as part of usual care, • consider not using a standardized tool with a cut-off score to screen every patient, • remain vigilant for depression, and • use clinical judgment to decide on further steps. “Given the health implications of depression during pregnancy and the postpartum period, it’s essential to check in with people about how they’re feeling,” says task force member Dr. Emily McDonald, associate professor, McGill University and a physician at
the McGill University Health Centre. “If clinicians are uncertain about how to start the conversation, they could refer to questionnaires for discussion prompts, which is different than formal screening that would use a cut-off score to determine next steps.” As the practice of screening varies in Canada, with several provinces and territories recommending screening using a standardized tool, updated guidance was needed. “Jurisdictions that employ formal screening may wish to reconsider this practice given the very uncertain evidence of benefit,” says task force member Dr. Brenda Wilson, a public health physician and professor at Memorial University, St. John’s, Newfoundland, and task force co-chair. “What’s essential is clinical vigilance for depression as part of usual care, as engaging in practices with no proven benefit can take away from other H health issues.” ■
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AUGUST 2022 HOSPITAL NEWS 7
NEWS
Prostate cancer imaging research could bring big benefits By Amanda Taccone ith newly announced studies, Lawson Health Research Institute continues to lead the way in advancing prostate cancer imaging. Scientists at Lawson are at the forefront of research that uses imaging agents that bind to a protein on the surface of prostate cancer cells called prostate specific membrane antigen (PSMA). Advanced imaging technology called PET/CT (positron emission tomography/computed tomography) and PET/MRI (magnetic resonance imaging) is then used to capture clear images of the location and extent of the cancer. The first scan of its kind in Canada was captured at St. Joseph’s Health Care London in 2016 by Dr. Glenn Bauman, a Radiation Oncologist at the London Regional Cancer Program at London Health Sciences Centre and Scientist with Lawson. “We started out with mainly MRI imaging but we’ve developed this very rigorous pipeline that allows us to put the imaging and digitized
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MRI and [18F]-DCFPyL PET images of six trial participants with prostate cancer. pathology together,” explains Dr. Bauman. Early evidence indicates that PSMA PET scans have changed how prostate cancer is being treated, but more work is underway to understand the impact of those treatment changes. Working with imaging specialists there is hope
that registries of these scans that are in development could even lead to automated detection of prostate cancer. The Canadian Cancer Society recently committed $125,000 in funding for the creation of a database of PET/CT prostate cancer scans. Led by Dr. Katherine Zukotynski, an Ad-
junct Scientist at Lawson, the idea is to make annotated findings accessible to a wider community of medical and research professionals. “If you have an idea of the amount of disease detected, correlated with what kind of prognosis, then this could be very helpful. It would allow oncologists to compare patients with similar cases, which may help determine the best therapies to try,” Dr. Zukotynski says. Lawson has also become the first in Canada to enter a sublicense agreement to produce a new PET imaging agent called PSMA-1007 - that may produce even clearer images, especially when there’s a recurrence of cancer. “PSMA-1007 allows us to detect where the cancer is a lot sooner and take action, whether that’s through surgery or delivering radiation to exactly where the cancer is located,” says Dr. Michael Kovacs, Director of the Lawson Cyclotron & PET Radiochemistry Facility. Clinical trials have already begun to test PSMA-1007’s efficacy with an ultimate goal of obtaining Health CanH ada approval. ■
Amanda Taccone is a Communications Consultant at Lawson Health Research Institute.
Researchers adapt MRI technology to image salt within the kidneys By Celine Zadorsky n a newly published study, scientists at Lawson Health Research Institute have adapted PET/MRI technology to accurately image salt within the kidneys of patients with kidney disease. “Salt is very difficult to image in an MRI because the signal is much weaker than water,” explains Dr. Christopher McIntyre, Lawson Scientist and Nephrologist at London Health Sciences Centre (LHSC). “We wanted to find a way to look at the fundamental role of the kidney in getting rid of salt and water by using a functional MRI.” Imaging salt within the kidneys has never been accurately accomplished
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in patients with kidney disease, but Dr. McIntyre and his team developed new technology and software that was adaptable to a PET/MRI machine at St. Joseph’s Health Care London. The new technology allowed the machine to image salt and water levels within the kidney. “Salt within the kidneys have only been imaged in pre-clinical models, and low weight, healthy volunteers,” says Dr. McIntyre. “Since the kidney is further away from the MRI coils, and the organ moves when a person breathes, it is definitely very hard to image.” This was the first study to use MRI to look at salt within the kidneys with a wide range of participant with different body types (10 healthy volun-
teers), as well as patients with kidney disease (five patients). The research team also imaged patients who had a combination of kidney disease and heart failure, because it is especially important for those patients specifically to be able to release salt and water as part of their treatments. Currently clinicians rely on kidney biopsies to measure salt levels, but Dr. McIntyre says that method isn’t as accurate or effective as it could be. “The problem is that the biopsies are painful, they have risks, and because it is a small sample of the kidney, we don’t get an accurate perspective of the kidney as a whole,” Dr. McIntyre explains. The study, which is published in Radiology has now opened the door to
new possibilities when it comes to clinical care for patients with kidney disease. “Salt is very toxic in patients with kidney failure,” adds Dr. McIntyre. “This will now allow us to diagnose and manage both chronic and acute kidney disease. It is a significant step forward.” The next steps for the research team will be to compare salt MRI’s to biopsies, while also examining potential new therapy developments. “We are hoping we will have a higher degree of certainty moving forward to predict what will happen within the kidneys of these patients, with the possibility of using new targeted and effective treatments in the future,” notes H Dr. McIntyre. ■
Celine Zadorsky is a Communications Consultant at Lawson Health Research Institute. 8 HOSPITAL NEWS AUGUST 2022
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SPONSORED CONTENT
The sustainable future of healthcare is a digital-physical hybrid model A
t eHealth22 in June, André Picard, Globe & Mail’s health columnist interviewed Teladoc Health’s Joby McKenzie, PhD., Managing Director in Canada, and Dan Trencher, SVP, Corporate Strategy, for a session titled “Virtual Care IS Care”. Teladoc Health is one of the largest and oldest global virtual healthcare companies. The following is an excerpt from their conversation. André: Joby, you have a personal experience with the health system and some frustrations, which have led you to reimagine the delivery of healthcare. Can you tell us how an integrated, interconnected system could have changed your family’s experience? Joby: My son Calvin was diagnosed with leukemia in 2017 at five years old, and he had chemotherapy every day for three and a half years. He spent about 20 percent of his life in hospital and missed half of his school from kindergarten to grade three. First and foremost, he is two years post his treatment and a thriving ten-year-old. My first observation is that every appointment happened in person, and Calvin missed school and we missed work. Secondly, every time he had a fever, we had to go into the ER. He had a VIP pass at the hospital, it’s a pass nobody wants, and with that pass it still took us five hours to get assessed and discharged. Those doctors and nurses were working so hard, yet I’m left wondering if there would have been other ways to work with those clinicians. Thirdly, I carried around a three-inch binder for years that had his labs, prescriptions, consultation notes and I always think about data and how important that is to help people live healthy. Point four, his GP called me often to check in to see how he was doing because the data didn’t flow from the hospital to the pediatrician, and lastly, through that journey, both Calvin and his two siblings and my husband and I required mental health support which was hard to find and make time for.
André: What I’m hearing from your story is something I hear from patients all the time. They want the right care at the right place at the right time. People are often frightened of digital healthcare if they think “we’re not going to get to see our doctor anymore.” Can you talk about getting that mix right and how important that is? Joby: Digital care isn’t “in place of” in person, it’s bringing care to where the patient is or needs to be, and that can mean physically and that can mean emotionally, and it comes in different forms. One of the big themes is bringing care into the home. Imagine if more of those specialist visits could have occurred by beaming in the specialist to observe and talk with Calvin and his dad and I, monitoring when there is a post-discharge situation and not having to go in to get checked. Finally, mental health care can happen at home where Calvin was most comfortable. André: Another big challenge I’ve found, especially in the Canadian
health system but we’re not unique, is that systems don’t talk to each other in Canada. We have a row of hospitals in downtown Toronto, some side by side physically, yet information doesn’t flow easily. How can that change? Dan: It is a critical point because a key factor in health outcomes is continuity of care and whether it’s a transition in care from a facility to the home or to another type of care setting, sharing of data is critical and I think it starts with, how are the systems built? Our approach is to build with openness and open architecture in mind and that’s how we built our Solo platform, so that data is interoperable and shareable with common legacy systems such as electronic health records or imaging or lab ordering systems, and also compatible with new solutions such as devices that might be put into place to allow for home monitoring as an example. André: What does virtual care mean to hospitals and health systems in the big picture?
Dan: Teladoc Health has a large and growing business providing virtual care platforms to enable healthcare providers and systems to manage their patients, extend provider capacity and expertise. A use case that’s gotten a lot of prominence recently is virtual nursing. We have a huge staffing challenge and we’re working on solutions that can allow nurses to cover a greater range of rooms in a hospital by putting in a virtual care endpoint in every room. So how can we use the monitors to have a quick chat from the nursing station about what the need is, whether it’s more medication, to speak to the doctor or a glass of water. Joby: Those types of tools are certainly important but the other thing that’s important in this vast country is how to use technology to bridge where specialists and physicians are versus where patients are, because everybody deserves access to the specialists, not just people who happen to live in downtown Vancouver or downtown H Toronto. Q
Watch the interview at www.youtube.com/watch?v=bXp-cK889Ag www.hospitalnews.com
AUGUST 2022 HOSPITAL NEWS 9
NEWS
Choosing Wisely: Research shows low-risk injuries can safely forego abdominal CT imaging he Hospital for Sick Children (SickKids) is expecting to see the typical rise in child and youth injuries from outdoor activities this summer. CT imaging is widely recognized as a valuable tool to help clinicians rapidly diagnose and manage the care of patients, and new research will help guide clinicians when it’s needed most. As described in a recently published article in the Canadian Journal of Emergency Medicine, authored by Dr. Suzanne Beno, Emergency Medicine Physician and Medical Co-Director of the Trauma Program at SickKids, robust clinical decision rules have been published on this topic. The literature indicates approximately one-quarter of paediatric patients receiving abdominal CT imaging after this type of trauma are actually at very low risk for intra-abdominal injury (IAI), which includes organs such as the liver and spleen, as well as intestinal injuries. Children are at higher radiation risk from CT imaging compared to adults given their developing organs and longer life expectancy. “Children may safely forego abdominal CT imaging based upon clinical variables readily available at the bedside,” Beno says. “When all variables are absent, there is a very low risk of an IAI or IAI requiring intervention, meaning there is little reason to subject patients to an unnecessary and potentially harmful test.” A 2015 registry and chart review by the Trauma Program at SickKids observed that rates of abdominal CT imaging had exceeded published norms, and a significant number of trauma patients imaged were at very low risk for an intra-abdominal IAI. The Trauma Program concluded that safely reducing abdominal/pelvic CT use in lowrisk patients was needed. Resource stewardship, or the safe reduction of tests and treatments that patients do not need, is the goal of Choosing Wisely Canada, an international campaign SickKids joined in 2016. It has been estimated that in health care as many as 30 per cent of
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10 HOSPITAL NEWS AUGUST 2022
all tests and treatments may be unnecessary, add no value, and in some cases can actually lead to harm. CT imaging, despite its many benefits in trauma cases, does result in ionizing radiation exposure and sometimes the need for procedural sedation, which are potential risks, especially to young children. Unnecessary testing utilizes resources that may be needed more by other patients and puts added pressure on the health-care system. “The Choosing Wisely working group at SickKids provided invaluable support in the preparation and implementation of this project,” Beno says. “The work we’re doing is not only preventing children from being exposed to unnecessary radiation but also optimizing the efficient use of resources.”
PUTTING RESEARCH INTO ACTION
In 2016, a team led by Beno undertook a quality improvement (QI) initiative at SickKids to reduce rates of CT imaging among paediatric assessments following trauma at very low risk of IAI by 20 per cent within a six-month period. A root-cause anal-
ysis to assess rising CT rates revealed several factors contributing to overuse, including low familiarity with current literature and clinical decision rules; a trauma culture not aligned with observation or delayed imaging in lowrisk patients; and the need for hospital-wide diagnostic imaging guidelines for trauma. These findings led to the development of a SickKids Trauma Diagnostic Imaging Algorithm and a dedicated CT trauma requisition incorporating the Choosing Wisely criteria for paediatric abdominal trauma imaging based upon robust evidence-based clinical decision rules from both Emergency Medicine and General Surgery. Audit and feedback to providers, along with regular educational sessions were also important in achieving results. Through this QI initiative, the rate of abdominal/ pelvic CT in patients at very low risk for IAI decreased from 26.8 per cent to 6.8 per cent. Balancing measures were collected to ensure children with IAI were not being missed, including monitoring for CT scans ordered within 24 hours of admission, return visits within 72 hours, and hospital admissions with
newly diagnosed IAI. No clinically significant IAIs were missed as a result of this intervention.
KEY TAKEAWAYS FOR CLINICIANS
• CT imaging is an important tool for paediatric trauma diagnoses, and when indicated should be performed; however, it is important to minimize the radiation exposure when robust evidence exists to help stratify when children are highly unlikely to have injuries. • The alternative of abdominal ultrasound has not been shown to have enough sensitivity to replace CT in this setting. Further investigation around contrast-enhanced ultrasound as an example of alternative strategies to CT scanning, is being done and used elsewhere, but is not our standard of care at the present time. • The results of this study mirror much of the quality improvement work and research that has been published in this field, which all strongly favour a thoughtful and tailored approach to H CT imaging in paediatric trauma. ■ www.hospitalnews.com
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NEWS
Origins of diabetes may be different in men and women, according to new research By Patrick Lejtenyi ver the past four decades, global cases of Type 2 diabetes mellitus have skyrocketed. According to the World Health Organization, the number of people estimated to have the disease jumped from 108 million in 1980 to 422 million in 2014, with the fastest growth observed in low- and middle-income countries. Although the disease is common, there is still much research left to be done to fully understand it. For instance, while diabetes is linked to obesity, researchers still do not know the exact reasons why obesity causes diabetes. In a new paper published in the journal Obesity Reviews, Concordia researchers Kerri Delaney and Sylvia Santosa look at how fat tissue from different parts of the body may lead to diabetes onset in men and women. They reviewed almost 200 hundred scientific papers looking for a deeper understanding of how fat operates at the surface and tissue level, and the mechanisms by which that tissue contributes to diabetes onset. “There are many different theories about how diabetes develops, and the one that we explore posits that different regions of fat tissue contributes to disease risk differently,” says Kerri Delaney, a PhD candidate at Concordia’s PERFORM Centre and the paper’s lead author. “So the big question is, how do the different depots uniquely contribute to its development, and is this contribution different in men and women?”
O
FROM SURFACE TO CELL LEVEL
Men and women store fat in different places. Diabetes, like many other diseases, is closely associated with abdominal fat. Women tend to store that fat just under the skin. This is known as subcutaneous fat. In men, abdominal fat is stored around the organs. This is visceral fat. Fat appears to exhibit different features in men and women. They grow differently, are dispersed differently and interact with the inflammatory 12 HOSPITAL NEWS AUGUST 2022
THOUGH MORE RESEARCH IS NEEDED, THERE WERE OVERALL DIFFERENCES OBSERVED IN THE IMMUNE CELL, HORMONE, AND CELL SIGNALLING LEVEL IN MEN AND WOMEN THAT SEEM TO SUPPORT DIFFERENT ORIGINS IN DIABETES BETWEEN THE SEXES. and immune system differently. For example, in men fat tissue expands because the fat cells grow in size; in women, fat cells multiply and increase in number. This changes with the loss of the protective hormone estrogen that disappears with menopause and may explain why men are more susceptible to diabetes earlier in life than women.
Working from the hypothesis that diabetes risk is driven by expansions of visceral fat in men and of subcutaneous fat in women, the researchers then looked through the papers to see what was happening in the cell-level microenvironments. Though more research is needed, there were overall differences observed
in the immune cell, hormone, and cell signalling level in men and women that seem to support different origins in diabetes between the sexes. Delaney and Santosa hope that by identifying how diabetes risks are different in men and women, clinical approaches to treatment of the disease can be better defined between the sexes. “Currently, the treatment of diabetes is similar for men and women,” says Santosa, an associate professor in the department of Health, Kinesiology and Applied Physiology. “If we understood the differences between them better, we could consider these mechanisms in recommending treatments to men and women based on how diabetes H medications work.” ■
Patrick Lejtenyi is the Advisor, Public Affairs at Concordia University.
MUHC designated first provincial establishment for islet cell transplants for patients with type 1 diabetes he McGill University Health Centre (MUHC) is proud to announce its official designation, by the Ministry of Health and Social Services (MSSS), as the first establishment in the province to offer islet cell transplants – a non-invasive procedure that is a significant advancement in the treatment of type 1 diabetes. The MUHC has been the leader in the development of this unique medical expertise in Quebec, thanks to the dedicated work of research and clinical teams. Type 1 diabetes results from the inability of the pancreas to produce enough insulin, which can lead to a significant disruption of blood sugar regulation in the body. The disease requires lifelong monitoring of blood sugar and daily insulin injections to prevent serious long-term complications, such as blindness, stroke, kidney failure and cardiovascular disease. The islet cell transplant corrects this condition in severely ill patients. An estimated 300,000 Canadians live with type 1 diabetes.
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In 2015, the MUHC conducted the first islet cell transplant in Quebec, a procedure in which islets of Langerhans – the clusters of pancreatic cells that produce insulin – are isolated from a donor’s pancreas and infused into a patient’s liver through a small catheter in the abdomen. After only a few weeks, the patient is able to produce insulin and eventually, becomes insulin independent. Dr. Steven Paraskevas, director of the MUHC Pancreas and Islet Transplantation Program, heads the MUHC Human Islet Transplantation Laboratory, where islets are isolated and evaluated. The knowledge and expertise developed in this laboratory pave the way for the work of other clinicians. “The growth and development of this program has been a success story of collaboration between many researchers and medical professionals, supported by the vision and leadership of the MUHC,” says Dr. Paraskevas. “We would also like to acknowledge the precious contribution of the MUHC Foundation and
the Montreal General Hospital Foundation, whose donations enabled us to develop this program and be officially designated as the hospital to offer this procedure for Quebec.”
AN EXPANSION OF CARE
Since the first procedure, the MUHC team led by Dr. Paraskevas continued to develop its medical expertise at the MUHC Human Islet Transplant Laboratory, located at McGill University. Ten transplants have been performed and their effects have been carefully studied. The new designation will allow the MUHC to improve access to this procedure and to be able to treat many more individuals. “We are so proud that after years of work and persistence, the MUHC will be able to continue providing this life-altering therapy,” says Dr. Liane Feldman, MUHC Surgeon-in-chief. “This procedure makes a significant difference in the lives of diabetic patients. Our goal is to grow the program so that more Quebecers can H benefit in the years to come.” ■ www.hospitalnews.com
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SAFE MEDICATION
Safe medication use in
stroke management and prevention By Victoria Ezekwemba, Paulina Kmiec, and Certina Ho ames is a 57-year-old male who works full-time as an accountant. James’ past medical history includes high blood pressure for eight years and type 2 diabetes for two years. James smokes one pack of cigarettes per day, has an elevated body mass index (BMI) of 28.4 kg/m2 but has been trying to increase his physical activity by going on walks with his spouse, Evelyn. On Friday night, James and Evelyn went out for dinner. While eating dinner, James experienced slurring of speech, facial drooping on his right-hand side and inability to raise his arms. Evelyn panicked and immediately called 911.
J
WHAT IS STROKE?
A stroke happens when there is a loss of or reduced blood flow to a part of the brain. In general, there are two types of strokes: ischemic and hemorrhagic stroke (Table 1). A stroke is a medical emergency and requires immediate attention and management. Different types of stroke will have different management strategies and medication therapy management.
FAST: SIGNS AND SYMPTOMS OF STROKE
To help recognize common signs and symptoms of stroke, an acronym known as FAST (https://www. heartandstroke.ca/stroke/signs-ofstroke) has been developed: • Face: Facial drooping • Arms: Failure to raise arms • Speech: Slurred/jumbled speech • Time: Call 911 right away Other signs of stroke may include severe headache, difficulty walking or seeing, confusion and numbness. You can learn more about stroke symptoms at the Heart and Stroke Foundation of Canada (https://www.heartandstroke. ca/stroke/signs-of-stroke/fast-signs-ofstroke-are-there-other-signs).
ABOUT 90 PER CENT OF CANADIANS HAVE AT LEAST ONE RISK FACTOR FOR STROKE, FOR INSTANCE, UNHEALTHY DIET, PHYSICAL INACTIVITY, UNHEALTHY WEIGHT, SMOKING, STRESS, ETC. MANAGEMENT OF STROKE
It is best to avoid giving someone with stroke symptoms (https://www. heartandstroke.ca/stroke/signs-ofstroke) any food or drinks as stroke may impair swallowing. The key to acute stroke treatment and recovery is getting to the hospital quickly. It is recommended to call 911 immediately as emergency responders can start therapy while on the way to the emergency room.
SAFE MEDICATION USE IN STROKE MANAGEMENT
Taking over-the-counter medications such as acetylsalicylic acid (or ASA) is not recommended during a stroke. ASA is a blood thinner, which can prevent further blood clot formation, but not all strokes are caused by blood clots (Table 1). Hemorrhagic strokes (Table 1) are caused by ruptured blood vessels and taking ASA could worsen bleeding and stroke severity. A CT scan of the brain will help diagnose the type of stroke and whether the use of ASA is an appropriate medication therapy or not.
Depending on the type of stroke (Table 1) as well as other patient-specific factors (e.g., pregnancy, breastfeeding, or other medical conditions, etc.), there are different types of treatment that may be needed. Common medications used to treat stroke include: • tPA (tissue plasminogen activator) is used to treat ischemic strokes via the breakdown of blood clots. • Blood thinners (e.g., antiplatelet drugs and anticoagulants) can help prevent new blood clots from forming. You can learn more about stroke medications at the Heart and Stroke Foundation of Canada (https://www. heartandstroke.ca/stroke/treatments/ medications).
CARING FOR JAMES
Back to the above case scenario, as James has high blood pressure and diabetes, in addition to stroke treatment, there are other management strategies that may be needed. These include: • Blood glucose monitoring: Hypoglycemia (i.e., low blood glucose, a blood glucose reading less than 4 mmol/L) or hyperglycemia (i.e., high blood glucose, a blood glucose read-
ing greater than 10 mmol/L) can lead to poorer outcomes for patients with stroke. Therefore, it is important to treat patients if their blood glucose is not controlled. • Blood pressure management: Treating blood pressure may be helpful for some patients by helping with blood flow or by reducing bleeding in the brain. It is important to note that the approach to treating blood pressure will depend on the type of stroke (Table 1) that the patient has. Note: Depending on the patient’s condition, there are other management strategies that can be used. Hence, the strategies mentioned above are not an exhaustive list.
HOW CAN WE PREVENT STROKE?
Stroke can happen to anyone. About 90 per cent of Canadians have at least one risk factor for stroke, for instance, unhealthy diet, physical inactivity, unhealthy weight, smoking, stress, etc. Lifestyle modifications can be helpful in reducing the risk of stroke. Medical conditions, such as, high blood pressure, diabetes, high cholesterol, and atrial fibrillation, etc., can also increase the risk of stroke. Therefore, it is important to address the lifestyle risk factors mentioned above and properly manage existing medical conditions to help reduce the risk of stroke. You can learn more about risk and prevention of stroke at the Heart and Stroke Foundation of Canada (https://www.heartandH stroke.ca/stroke/risk-and-prevention). ■
Table 1: Types of Strokes (Note: This is not a comprehensive list of the different types of strokes). General Types of Strokes
Why does it happen?
Ischemic Stroke (~ 85% stroke)
Insufficient blood flow to a part of the brain (e.g., due to a blood clot or clogged blood vessel)
Hemorrhagic Stroke (~ 15% stroke)
Excess blood fills the brain (e.g., due to a ruptured blood vessel from high blood pressure or head trauma), putting pressure on and causing loss of blow to part of the brain
Victoria Ezekwemba and Paulina Kmiec are PharmD Students at the Leslie Dan Faculty of Pharmacy, University of Toronto; and Certina Ho is an Assistant Professor at the Department of Psychiatry and Leslie Dan Faculty of Pharmacy, University of Toronto. 14 HOSPITAL NEWS AUGUST 2022
www.hospitalnews.com
NEWS
New tool shows promise in helping people manage traumatic brain injuries one pace at a time ild traumatic brain injuries (mTBI), including concussions, may come with lasting effects that can alter a person’s life. Although a person with a mTBI may appear fine on the outside, many have to pace their day-to-day activities in order to allow the time needed for the brain to properly heal. For 42-year-old Cindy Vanderveen who lives with post-concussion syndrome, every day tasks can become quite a challenge. Cindy who had multiple concussions over the years, experienced her mTBI symptoms in July of 2020 after an intense workout. Not knowing what was happening, she assumed she was having a stroke or seizure. “I had issues with my vision; everything looked distorted. I had problems speaking (aphasia) and couldn’t eat or drink without choking on my food,” explains Cindy. “Everything I used to enjoy doing, gardening, cycling, working, it just stopped and my entire life was put on hold.” Cindy was referred to the Acquired Brain Injury (ABI) program at St. Joseph’s Health Care London where she was encouraged to try a new research tool called MyBrainPacer™App, created to help those living with an mTBI. The app was created at Lawson Health Research Institute – the institute of St. Joseph’s Health Care London – a team looking to better assist and treat those living with a mTBI. It was made possible by funding provided by the Cowan Foundation and other community supporters through St. Joseph’s Health Care Foundation.
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“By documenting activity levels over time, patients and their clinicians can better understand what activities are linked to worsening symptoms, which they can therefore avoid,” explains Dr. Dalton Wolfe, Lawson Scientist. The online application is part of a study which allows Dr. Wolfe and his team to track the efficacy of the app. Much like point tracking used by dieters to monitor food choices, through MyBrainPacer™ App, users can assign values to tasks like driving, grocery shopping, screen use and exercise so they can plan and pace their daily activity. Individual users are given a total number of points per day that will keep their persisting symptoms in the ‘safe range’. As users track their symptoms through the app, the app adjusts the daily point value to what is best for the user. The app is based on St. Joseph’s
Pacing and Planning Program, which has helped hundreds of concussion patients achieve their recovery goals. “By putting the app in the hands of patients and the clinicians who treat them, the app has the potential to give us data that traces the recovery patterns of patients and how that relates to the activities that they participate in over time,” adds Dr. Wolfe. “This will enable us to document safe levels of activity for persons with specific characteristics or symptom profiles, which could be the key to unravelling better treatment strategies.” After using the app for some time, Cindy has noticed a positive change. “In the beginning I wasn’t able to drive farther than five minutes at a time,” remembers Cindy. “Once I began to use the app to plan and track my activities, my symptoms dramatically decreased.”
STRENGTH IN NUMBERS =
CHANGE
Currently anyone with a mTBI can enroll as a study participant on the MyBrainPacer™ App and use the tool. The research team is hoping to enroll approximately five-thousand users over time to allow for a large evaluation population. “Without the app, there is no way to keep track of the hundreds of trajectories of patient recoveries,” says Dr. Wolfe. “This information is vital to understand what is working in terms of future therapeutic approaches.” “I still have bad days, and some tasks are harder than others,” adds Cindy. “But through using the MyBrainPacer™ App I am able to do more activities independently and I’m 90 per cent back to who I was.” Anyone interested in enrolling to use the app can do so by visiting myH brainpacer.ca ■
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AUGUST 2022 HOSPITAL NEWS 15
NEWS
New heart mapping system Three-dimensional maps of the heart are helping physicians to better target areas where irregular heartbeats originate he maps Kingston Health Science Centre’s (KHSC) cardiologists make of patients’ hearts in order to find and treat faulty heart tissue, causing abnormal heart rhythms, are being made with more accuracy and speed using new and improved heart mapping technology. “We are happy to be the first site in Canada to incorporate Abbott’s new EnSite™ X EP System that allows us to more clearly understand what is going on in the heart and determine the best location to deploy therapy safely and effectively,” says Dr. Damian Redfearn, cardiologist and the arrhythmia clinical lead at KHSC.
T
“NOW, WITH AN INSTANT, HIGH-DETAILED VIEW OF EVERY SINGLE HEARTBEAT, WE ARE, IN A MATTER OF SECONDS INSTEAD OF SEVERAL MINUTES, ABLE TO MORE ACCURATELY FIND THE SOURCE OF THE ARRHYTHMIA AND TREAT IT WITH ABLATION.” By acquiring this new technology from Abbott, KHSC has once again vaulted itself to the front of the pack as a Canadian leader in cardiac care. KHSC has been at the forefront of heart mapping since 2017, when it was the first site in North America to use an advanced mapping suite of technologies for cardiac ablation surgery, a procedure
that uses heat or freezing to destroy the tissue that is initiating the electrical signal causing the heart rhythm problem, also known as arrhythmia. When the electrical signals that coordinate the heart’s beats don’t work properly, causing heart arrhythmias, some irregular rhythms can be associated with serious, life-threaten-
ing complications such as strokes and heart failure. “Now, with an instant, high-detailed view of every single heartbeat, we are, in a matter of seconds instead of several minutes, able to more accurately find the source of the arrhythmia and treat it with ablation,” says Dr. Redfearn. “This is especially good news for patients with complex heart arrhythmias that are difficult to locate.” Traditional mapping systems are time-consuming, involving cumulative images and measurements of electrical signal speed and direction taken over a period of time and from multiple locations that then need to be pieced together, deciphered and verified.
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NEWS
The new system, which includes Abbott’s EnSite Omnipolar Technology, generates three-dimensional maps in real-time and can map 1 million points in the heart. It enhances Abbott’s Advisor™ HD Grid Catheter to provide electrical recordings in 360 degrees regardless of how the catheter, a long flexible tool, is ori-
www.hospitalnews.com
ented within the heart. The innovative system provides timelier, more precise location of treatment areas. “It’s exciting to be able to better plan treatment strategies because now, very quickly, we will have a better understanding of how an individual patient’s arrhythmia is strucH tured,” says Dr. Redfearn. ■
AUGUST 2022 HOSPITAL NEWS 17
PAEDIATRICS
Our community is our strength – Taking action for child health By Emily Gruenwoldt hat has historically set child and youth healthcare apart from the adult sector is the ability to come together as a national collective to identify common system challenges and codesign solutions to implement in unique environments. There has never been a time where this community spirit was needed more. Canadian healthcare systems are in crisis, and this includes systems that serve children, youth, and families. If the diagnosis is overstretched, underfunded systems serving children and youth, the symptoms include challenges accessing primary care, long waits for community-based children’s rehabilitation services, emergency services, surgical interventions and diagnostics, an understaffed and burnt-out workforce, government apathy and public belief that “the kids are alright.”
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years, very little action has transpired to change the course of children’s health outcomes.
THE CURRENT SITUATION: CHILDREN’S HEALTHCARE SYSTEMS STRETCHED THIN
Canada is home to 16 tertiary/quaternary children’s hospitals, many of whom are seeing a sustained surge in referrals for specialized care, visits to emergency departments (ED) and associated admissions. There is both a lack of inpatient beds and healthcare professionals available to facilitate care – further exacerbating already lengthy ED wait times. Some centres are reporting that children are waiting between 24-48 hours before such a bed is available – waits described as unprecedented in children’s healthcare in Canada. Very recently, a children’s
THE TRUTH IS CANADA’S KIDS HAVE BEEN A LOW PRIORITY FOR DECISIONMAKERS FOR YEARS. While the pandemic very publicly highlighted how fragile children’s healthcare systems are, the truth is Canada’s kids have been a low priority for decision-makers for years. In 2020, UNICEF Canada reported that Canada now ranks 30th out of 38 OECD countries regarding children’s health and well-being outcomes – an alarming standing that should be of great concern to elected officials at every level of government, parents, and youth alike. While organizations like Children’s Healthcare Canada have been ringing alarm bells for 18 HOSPITAL NEWS AUGUST 2022
hospital in Quebec closed their emergency department to non-urgent care based on high volumes of patients requiring hospitalization or critical care. Long delays result in sub-optimal care and outcomes for sick children and their families and create moral distress for children’s healthcare providers unable to deliver care in a timely fashion. In addition to ED delays, some children in Canada are waiting longer for essential healthcare services than adults. In Spring 2022, Children’s Health Coalition in Ontario reported that at CHEO, in Ottawa, children
Emily Gruenwoldt is President & CEO, Children’s Healthcare Canada. wait three times longer for an MRI than do adults (18+). At Sick Kids, in Toronto, 61% of children are waiting longer than is recommended for
surgeries, affecting the time they may wait in severe pain, and resulting in developmental and other health impacts that may last a lifetime. For some www.hospitalnews.com
PAEDIATRICS children, this could mean lifelong disability, being dependent on technology to survive, or experiencing chronic pain into adulthood – all untenable outcomes with long-term health and economic impacts. More publicly reported, children and youth in Canada are waiting far too long for mental health services in community and hospital settings – in some instances, wait lists are as long as eighteen months for community based mental health services. According to UNICEF Canada Report Card 16, suicide was a leading cause of death among young people in Canada and one of the indicators in which Canada ranked most poorly prior to the pandemic. Since COVID hit, Canada’s children’s hospitals and regional community hospitals have experienced a sustained increase in mental health related visits, referrals, and admissions for children and youth. It has been reported that across 13 children’s hospitals, admissions for eating disorders have nearly tripled, visits for depres-
sional anxiety (especially among equity deserving populations and children with disabilities) nearly doubled. Beyond the children’s hospitals, many of Canada’s regional community hospitals serve children and their families through emergency departments, neonatal intensive care units, pediatric in-patient units, and outpatient services. To meet the needs of the sick adult population throughout COVID, many of these hospitals made significant changes, which included closing pediatric departments or redeploying specialised pediatric healthcare professionals. For some community hospitals, these wards remain closed (or significantly downsized), and staff have yet to be repatriated, resulting in reduced access to local, specialized healthcare services for children and families. Children’s homecare and respite care providers across the country are experiencing similar staffing challenges as their acute care colleagues, as the result of the pandemic. A shortage of specialized nurses and personal sup-
port workers to care for kids impacts families of children with medical complexity who require support at home, including respite, rendering parents and caregivers equally exhausted. Routine healthcare for children has also been disrupted. The pandemic contributed to decreases in primary care access for children under 17 (Saunders et al., 2021 – CMAJ), but even prior, Statistics Canada estimated that 15% of Canadian youth did not have a primary care provider. Primary care is a cornerstone for healthy growth and development for millions of Canadian children delivering programs and services such as well-baby care, the delivery of routine childhood vaccinations, and assessments and referrals to services for child development assessments, diagnosis, and rehabilitation. Canada’s 8 million children might be small in stature, but the challenges facing children’s healthcare systems are daunting, and the stakes are high. The path forward is complex, and there is no single solution or magic bullet that
will “cure” decades of underfunding. Pressures in one part of the children’s healthcare system inevitably create ripples across the broader system. Longterm thinking and planning, sustained investments across the continuum of care, and an openness to new collaborations – across sectors, across all levels and portfolios within government (including across jurisdictions), with patients and their families, and across civil-service organizations is required. In 2020, over 1,500 youth, parents, researchers, educators, advocates, policymakers, service providers, community and business leaders, and others came together to co-create a roadmap to measurably improve children’s health and wellbeing, called Inspiring Healthy Futures. Five interlinked priorities for action lay a foundation for leaders, organizations, and governments to create a healthier, stronger future for children, youth, and families in Canada. The path forward is clear, now is the time to put the plan into H action. ■
Emily Gruenwoldt is President & CEO, Children’s Healthcare Canada.
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www.hospitalnews.com
AUGUST 2022 HOSPITAL NEWS 19
PAEDIATRICS
Setting the stage for future vaccine experiences:
Helping families manage needle pain in infants and young children fear of needles is common in both children and adults. Needle fear and immunization pain can lead children and their families to hesitate or even delay childhood vaccinations. This past year saw the approval of the COVID-19 vaccine for children and youth aged five years and up and has positively impacted the prevention of serious illness. Parents and health professionals are now preparing for children under five years to receive their COVID-19 vaccination. Canadian health professionals supporting children and youth with vaccines should become familiar with the easy, science-backed strategies to effectively manage immunization pain and needle fear. Needle fear and needle pain contribute directly to vaccine hesitancy. Thankfully, there are simple, well-studied techniques that children, parents, and health professionals can use to ensure kids have a positive and calm immunization experience. Even young infants and preschoolers are beginning to develop their experiences with needles. Needle fears typically start in children as young as five years old. This means that managing needle pain and discomfort is critical in early life to prevent needle fears and continued engagement in healthcare later in life. Solutions for Kids in Pain (SKIP) is a knowledge mobilization network that aims to improve children’s pain management by mobilizing evidence-based solutions, including strategies to mitigate needle fear and pain as contributing factors to vaccine hesitancy. SKIP is co-led by Children’s Healthcare Canada.
A
INFANTS
Why is it essential to manage needle pain from vaccinations in infants? No parents or health professionals want to see a child in pain. How we manage pain from an early age can change how people feel about the pain later on. 20 HOSPITAL NEWS AUGUST 2022
“As a parent, my goal is to be relaxed, prepared, and not to make it scary,” says Nadia Shular, a parent to a toddler and a pediatric nurse. “My advice is for parents and providers to partner to discuss what will work for their child.” This can include applying a topical anesthetic or numbing cream to the injection site approximately 45 minutes ahead of time. “As a nurse, I call this magic cream, and it makes the needle hurt less,” adds Nadia. “I have used it for all our son’s immunization appointments since he was an infant, along with cuddling him in an upright position and distraction techniques like singing or watching a show.” Babies under 12 months can also benefit from breastfeeding or non-nutritive sucking before and during the procedure. In addition, mixing a sweet solution of 1 tsp sugar and 2 tsp water and giving this to the baby just before the needle by syringe or on a pacifier helps stimulate sucking and releases natural pain-reducing chemicals. Physical contact from the parent combined with the sucking action helps to manage pain.
TODDLERS & PRESCHOOLERS
Many young children know how they may feel about visiting a clinic or getting a needle. Parents can help prepare by sharing with their child about the needle, typically a few days beforehand, while also talking with their child about comfort strategies that they will use. Parents are encouraged to be honest and use positive, age-appropriate language if the child asks if it will hurt. “It is important as parents and providers that we talk directly to the child about the procedure,” says Nadia. “Now that my son is a toddler, distraction is key! I have a favourite show on my phone to help distract him. Bubbles also work great because they not only distract but also help the child to take deep breaths. Also, do not forget the magic numbing cream before your appointment”. After the needle, talking about what happened and creating positive memories is essential. This helps future vaccines to go well! Use words of encouragement and be sure to celebrate, saying things such as “You did
it. I liked how you took deep breaths. Let’s go get a treat”.
SEVERE NEEDLE FEARS AND SPECIAL ACCOMMODATION CLINICS
If a child has severe needle fear or additional sensory, behavioural, or other special needs, additional support may be needed. With the rollout of the COVID-19 vaccination for children over the age of five years, some communities now offer low-stimulus or special accommodation clinics. These are quieter spaces where children and adults can go, have reduced sensory input, and often provide more time and support during the vaccination appointment. In addition, families are encouraged to bring comfort items to help with distraction, and often there are staff and volunteers with special training in helping those with needle fears. SKIP brings together Canada’s world-renowned pediatric pain research community, front-line knowledge user organizations, and end beneficiaries. Visit www.kidsinpain.ca for more information H and resources or follow us @kidsinpain. ■ www.hospitalnews.com
pdp-Levetiracetam
Pr
ORAL SOLUTION/IV SOLUTION 100 mg/mL
pdp-levETIRAcetam
For home and hospital care THE ONLY LEVETIRACETAM FORMULATION AVAILABLE IN IV AND READY-TO-USE ORAL SOLUTIONS FOR TREATMENT CONTINUITY Key attributes: Levetiracetam is the #1 prescribed AED in Canada1
Broad-spectrum activity in a wide range of patient types
Hassle-free conversion for treatment continuity
• Favourable safety profile; generally well tolerated in adults and children2 • Minimal drug interactions with other AEDs2 • No need for therapeutic drug monitoring2
• Adjunctive therapy for multiple types of seizures2 • An AED with pediatric, adult, and geriatric indications2
• The IV solution is an effective alternative in patients unable to take oral medication2 • Conversion to or from IV and oral administration can be done directly without titration2 • The oral solution is ready to use2
INDICATIONS AND CLINICAL USE: Adults: pdp-levETIRAcetam is indicated as adjunctive therapy in the management of patients with epilepsy who are not satisfactorily controlled by conventional therapy.
MOST SERIOUS WARNINGS AND PRECAUTIONS: • Increase in blood pressure in patients < 4 years of age: In a randomized, placebo-controlled study in patients 1 month to < 4 years of age, a significantly higher risk of increased diastolic blood pressure was observed in levetiracetam-treated patients (17%), compared to the placebo-treated patients (2%). Monitor patients 1 month to < 4 years of age for increases in diastolic blood pressure. • Behavioural abnormalities and psychotic symptoms: pdp-levETIRAcetam may cause behavioural abnormalities and psychotic symptoms. Patients treated with pdp-levETIRAcetam should be monitored for psychiatric signs and symptoms. Behavioural and psychiatric adverse reactions were more common in children than in adults.
Pediatrics: pdp-levETIRAcetam is indicated as adjunctive therapy in the treatment of: • Partial-onset seizures with or without secondary generalization in adolescents, children, and infants from 1 month of age with epilepsy. • Myoclonic seizures in adolescents from 12 years of age with juvenile myoclonic epilepsy. • Primary generalized tonic-clonic seizures in adolescents from 12 years of age with idiopathic generalized epilepsy. Adults and Pediatrics: pdp-levETIRAcetam for Injection is for intravenous use only as an alternative for patients RELEVANT WARNINGS AND PRECAUTIONS: • Acute kidney injury when oral administration is temporarily not feasible. • Driving and operating machinery
IV: intravenous; AED: antiepileptic drug 1. IMS data on levetiracetam tablets. MAT 04/2021. 2. pdp-levETIRAcetam Product Monograph. Pendopharm, Division of Pharmascience Inc. July 11, 2019. © 2021 Pendopharm, Division of Pharmascience Inc. All rights reserved. Montréal, Québec H4P 2T4 Canada.
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Coordination difficulties Dependence/tolerance Hematologic abnormalities Skin and subcutaneous tissue disorders, including: - Stevens-Johnson syndrome, toxic epidermal necrolysis; - and drug reaction with eosinophilia and systemic symptoms Anaphylaxis and angioedema Seizure control during pregnancy Suicidal behaviour and ideation Reduced dosage with renal impairment
FOR MORE INFORMATION: Please consult the Product Monograph at https://health-products.canada.ca/dpd-bdpp/ info.do?lang=en&code=98048 for important information relating to adverse reactions, drug interactions, and dosing information that has not been discussed in this piece. The Product Monograph is also available by calling us at 1-888-550-6060.
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Canada’s first total artificial heart implant in child SickKids teams came together to urgently perform an innovative procedure to bridge
Mariam to a second heart transplant after she went into heart failure for a second time By Sarah Warr ast year, when Mariam Tannous’ first heart transplant started failing and other medical interventions were no longer working, her clinical team at The Hospital for Sick Children (SickKids) had to quickly think outside the box for an innovative treatment. With time ticking away and an urgent need to bridge Mariam to a second heart transplant, the team decided to try something that had never been done before at SickKids or in Canada – a total artificial heart implant for a paediatric patient. Mariam’s team at SickKids consulted with colleagues in the United States and received training on the technology, and within two weeks, 11-year-old Mariam became the first paediatric patient in Canada to receive a total artificial heart. She was also one of the smallest, and youngest, patients in the world to have the device implanted.
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FINDING AN URGENT SOLUTION TO MARIAM’S FAILING HEART TRANSPLANT
Mariam, now 12, was born with two forms of congenital heart disease, Epstein’s Anomaly and cardiomyopathy, which meant her right heart ventricle was not well-formed and the valve was leaking. In 2017, she successfully underwent her first heart transplant at SickKids, and was able to go home and resume her favourite activities like swimming and soccer. A few years later, Mariam unexpectedly started to go into heart failure again and was admitted to SickKids. Her doctors tried various heart failure medications but Mariam’s condition only got worse. She would need a second transplant and the clinical team had to buy her time until a heart became available. As both ventricles of Mariam’s transplanted heart were showing signs of failure, the only option was a total artificial heart – de22 HOSPITAL NEWS AUGUST 2022
vice that can effectively replace an entire human heart for a limited period of time to help bridge patients to a transplant. “Total artificial hearts are rarely used in paediatric patients due to their size and limitations,” explains Mariam’s cardiologist, Dr. Aamir Jeewa, Medical Director of the Ventricular Assist Device Program at SickKids. “The device, intended for larger adults, has a large set of mechanical pumps that are surgically connected to vessels inside the chest and are driven by connections, outside of the body, to a large controller unit that is almost as tall as Mariam herself and runs 24 hours a day.” The total artificial heart would provide Mariam with time until she could receive a second transplant, but she could not be connected to the device indefinitely. A number of factors such as potential infection risks, device failure and other health complications make the device a time-limited option, especially for a young person like Mariam. Since this was a first-of-its-kind procedure at SickKids, Mariam’s parents had a difficult decision to make. “We had a meeting and they told us about the total artificial heart. They explained to us all the risks and what would happen in the surgery and after,” says Linda Antouan Adwar, Mariam’s mom. “It was a hard decision, but SickKids saved her life in the beginning, so we believed they would save her life again.”
SICKKIDS TEAM EMBARKS ON INNOVATIVE SURGICAL PROCEDURE
Jeewa and Dr. Osami Honjo, Mariam’s cardiovascular surgeon and Surgical Director of Heart Transplantation and Mechanical Circulatory Support at SickKids, quickly started to collaborate with American colleagues to train
SickKids staff on the device, the surgical procedure and post-surgical care. “Although we often manage other types of assistive devices, everything about the total artificial heart was new for the team. The fact that Mariam was one of the smallest patients in the world to have this device also presented a significant technical challenge,” explains Honjo.
On July 8, 2021, the surgery was successfully completed and Mariam began her recovery. With the support of her multidisciplinary team, she had to relearn how to walk, drink and eat while being attached to a large machine and tubes that kept her artificial heart pumping. “Mariam always needs to do everything fast, and sometimes she would www.hospitalnews.com
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forget she has the machine attached to her. I would have to tell her ‘Wait, slow down, you have a machine with you’ and she just wanted to go,” recalls Linda. A couple months later, Mariam received her second heart transplant and third surgery with Honjo. He says, “Mariam and her family have gone through a lot and it’s been my honour to join them on this journey. I’m so happy to see her thrive and go back to her life once again. It’s fantastic.” While Mariam still faces ongoing challenges with her health, she is enjoying being at home, playing with her brother and returning to school with her friends. “I’m so happy and we are so proud of her,” says Linda. “Her journey is not easy, but day by day she shows us how strong she is now.” About The Hospital for Sick Children (SickKids) The Hospital for Sick Children (SickKids) is recognized as one of the world’s foremost paediatric health-
care institutions and is Canada’s leading centre dedicated to advancing children’s health through the integration of patient care, research and education. Founded in 1875 and affiliated with the University of Toronto, SickKids is one of Canada’s most research-intensive hospitals and has generated discoveries that have helped children globally. Its mission is to provide the best in complex and specialized family-centred care; pioneer scientific and clinical advancements; share expertise; foster an academic environment that nurtures health-care professionals; and champion an accessible, comprehensive and sustainable child health system. SickKids is a founding member of Kids Health Alliance, a network of partners working to create a high quality, consistent and coordinated approach to paediatric health care that is centred around children, youth and their families. SickKids is proud of its vision for H Healthier Children. A Better World. ■
Sarah Warr works in communications at The Hospital for Sick Children (SickKids).
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AUGUST 2022 HOSPITAL NEWS 23
EVIDENCE MATTERS
Unwinding the evidence on melatonin supplements for insomnia in young people By Barbara Greenwood Dufour lthough nighttime insomnia is more common in adults, it is also an issue for many young people. According to the most recent sleep data from the Canadian Health Measures Survey, in 2014 and 2015, 8.8 per cent of children aged six years to 13 years and 15.3 per cent of adolescents aged 14 to 17 years reported having trouble going to sleep or staying asleep. Poor nighttime sleep can lead to daytime sleepiness. In children and adolescents, this can affect learning, school performance, and psychological and development growth. Melatonin supplements are commonly used to treat insomnia. Melatonin is hormone naturally produced by the brain’s pineal gland. In the evening, when light decreases, our pineal gland produces and releases more melatonin. In the morning, when light increases, less melatonin is produced and released. This process regulates our sleep–wake cycle so our body knows when to go to sleep and when to wake up. Melatonin supplements, which are intended to re-set the body’s sleep– wake cycle and to reduce the time it takes to go to sleep, were licensed by Health Canada in 2005 for adults. Since 2011, melatonin-containing products have been licensed for use in Canada in children aged 12 years and older, but none has been authorized for children younger than that. But what do we know about how effective melatonin supplements are for children and adolescents? To find out, CADTH looked for the latest research evidence on this topic. CADTH is an independent agency that finds, assesses, and summarizes the research on drugs, medical devices, tests, and procedures. It turns out that not a lot is known about the effectiveness of melatonin to treat insomnia in the general population of children and adolescents. Almost all of the studies CADTH found were on young people with neurodevelopmental conditions such as attention-deficit/hyperactivity disorder
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(ADHD), autism spectrum disorder, developmental delay, cerebral palsy, and epilepsy. This may be because sleep problems are common in neurodiverse children and adolescents. Overall, the evidence suggests that, in neurodiverse children and adolescents, melatonin might be effective in the short term to decrease the time it takes to fall asleep and increase the time spent asleep. Studies suggest that the benefit of melatonin may be greatest for children with autism spectrum disorder. According to the American Academy of Neurology, sleep disturbances are common in people with autism spectrum disorder, with between 44% and 83% of children and adolescents with this condition reporting having sleep abnormalities. The results of the 1 study that didn’t focus on young people with neurodiversity found melatonin supplements improved sleep outcomes as well. Interestingly, some of the children in this study also happened to have either ADHD or autism spectrum disorder. It should be noted that, even though the studies showed that melatonin supplements could potentially improve the sleep of children and adolescents, it’s unclear if this improves other outcomes (e.g., learning, school performance, and psychological and development growth). But what about the safety of products containing melatonin? In 2015, there were incidents reported of melatonin supplements having neurological side effects in children and adolescents. This prompted Health Canada to release a statement encouraging parents and caregivers to consult with a health care professional before giving these products to young people. In the studies CADTH found that assessed safety, adverse side effects were reported as generally being mild to moderate, including tiredness, headache, gastrointestinal upset, and decreased mood. But because the studies were short – varying from one week to 13 weeks – and because most didn’t conduct any
IT SHOULD BE NOTED THAT, EVEN THOUGH THE STUDIES SHOWED THAT MELATONIN SUPPLEMENTS COULD POTENTIALLY IMPROVE THE SLEEP OF CHILDREN AND ADOLESCENTS, IT’S UNCLEAR IF THIS IMPROVES OTHER OUTCOMES (E.G., LEARNING, SCHOOL PERFORMANCE, AND PSYCHOLOGICAL AND DEVELOPMENT GROWTH). follow-up evaluations, we don’t know about the long-term safety of melatonin in children. The length of the studies means that we don’t know the long-term effectiveness either. CADTH’s review found one guideline on the use of melatonin to treat insomnia and disrupted sleep behaviour in children and adolescents. This guideline recommends that highgrade melatonin be used only after behavioural strategies for improving sleep habits have been tried first. The guideline recognized the limitations of the evidence including the lack of information about long-term adverse side effects. Another limitation of the evidence to date is that mainly involves children between six and 11 years of age who are neurodiverse. So, the findings may not be applicable to individuals out-
side this age range or to those without neurodevelopmental conditions. In addition, the available studies compare melatonin only with placebo. So, additional studies that compare the effectiveness of melatonin with other treatments, such as prescription sedatives, would be helpful. CADTH’s review of melatonin for treating insomnia in children and adolescents is freely available at cadth.ca/ melatonin-treatment-insomnia-children-and-adolescents. You may also be interested in CADTH’s report on melatonin for treating insomnia in adults, which you can find at cadth.ca/melatonin-treatment-insomnia-2022-update. If you’d like to learn more about CADTH, visit cadth.ca, follow us on Twitter @CADTH_ACMTS, or contact a Liaison Officer in your region: H cadth.ca/contact-liaison-officer.■
Barbara Greenwood Dufour is a knowledge mobilization officer at CADTH. 24 HOSPITAL NEWS AUGUST 2022
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NEWS
For cancer patients,
the pandemic is not over recent Canadian Cancer Survivor Network (CCSN) survey shows Canadian cancer patients and caregivers remain fearful and stressed by the COVID-19 pandemic. Most surveyed continue to take measures to protect themselves and those they care for even as governments across Canada lift public health restrictions. This is the fourth CCSN survey in a series conducted by Léger to determine how cancer patients and caregivers from coast-to-coast are coping with the pandemic as it enters its third year. “The survey results tell us that many cancer patients and caregivers still believe that COVID-19 poses a serious risk for them, and that they feel the weight of responsibility for keeping themselves and their loved ones safe,” says Jackie Manthorne, President and CEO of the Canadian Cancer Survivor Network.
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LIFTING OF PUBLIC HEALTH RESTRICTIONS MAKE SOME PATIENTS FEEL LESS SAFE
Half of the respondents to CCSN’s survey said they were uncomfortable with the lifting of public health restrictions where they live, and one in five said these changes would have a negative impact on their lives. Both patients and caregivers openly shared their concerns. ‘COVID still exists’, said one patient, while another stated that their provincial opening was ‘too fast and [did] not look at actual case numbers.’ “The restrictions being lifted scares me. It makes me feel less protected,” said a stage 1 patient with multiple cancers in Alberta. “I have [been] home and alone even more now than when there were restrictions.”
CONCERNS FOR PATIENTS
For immunocompromised cancer patients, the negative impact is even greater. “With my husband being immunocompromised, it is even more dangerous to leave the house,” wrote a caregiver for a patient in British Cowww.hospitalnews.com
lumbia. “Lifting the restrictions means we need to stay home even more.” Just over one in four patients in CCSN’s survey – 26 per cent – are immunocompromised, and 41 per cent of caregivers care for an immunocompromised patient.
MASKS AND OTHER PROTECTIVE MEASURES SEEN AS IMPORTANT
Most patients and caregivers feel the need to continue taking measures to protect themselves or those they care for from COVID-19. Four in five respondents said they planned to continue wearing masks. Many stressed the importance of masks as an easy and effective way to hinder the spread of COVID-19. Many respondents feel a greater burden of responsibility to take measures to protect themselves now that public health restrictions have been lifted. “I still do not go to many stores. And I am still wearing my mask. I still avoid crowds and I do not visit people – so I am basically still self-isolated,” said a breast cancer patient in Nova Scotia.
ACCESS TO CARE REMAINS A CONCERN
Availability of healthcare remains a prevalent area of concern: 55 per cent of respondents worry whether they will receive care in an emergency room, and 53 per cent have concerns about whether they will receive cancer treatment in a timely fashion. Half of all respondents said they are not comfortable visiting a hospital because they feel the risk of getting COVID-19 is too high. Cancer patients and caregivers are well-aware of the strain the pandemic has placed on the healthcare system and its effects on their access to care. “I worry that due to the sixth wave (which is a result of restrictions being lifted), hospitals will again be overrun,” said a thyroid cancer patient in Ontario. “As a result, surgeries will likely be postponed again, resulting in delayed diagnosis and worse prognosis for cancer patients.”
“THE SURVEY RESULTS TELL US THAT MANY CANCER PATIENTS AND CAREGIVERS STILL BELIEVE THAT COVID-19 POSES A SERIOUS RISK FOR THEM, AND THAT THEY FEEL THE WEIGHT OF RESPONSIBILITY FOR KEEPING THEMSELVES AND THEIR LOVED ONES SAFE.” DON’T LEAVE CANCER PATIENTS BEHIND!
“Cancer patients and caregivers should not need to choose between protecting themselves from COVID-19 and participating fully in society. They need to know that the healthcare they depend on will be there for them when they need it most. “When the next COVID-19 variant emerges or when the next wave arrives,
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governments and health institutions must be ready so that cancer care is never disrupted, and cancer patients are protected,” concludes Manthorne. The CCSN will continue to share data from this important fourth Léger survey – as well as the three surveys that precede it – informing Canadians and policy makers from across the country about the impact of the pandemic on cancer H patients and caregivers. ■
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AUGUST 2022 HOSPITAL NEWS 25
LONG-TERM CARE NEWS
Older Canadians lack guidance, tools to safely age-in-place ELUS Health, together with the National Institute on Ageing (NIA), recently released the findings from a new survey that sheds light on how older Canadians can be better supported to age well, safely and independently. The 2022 survey of Canadian healthcare practitioners (HCPs) demonstrates the need to prioritize conversations surrounding innovative solutions to enable ageing-in-place: 95 per cent of HCPs surveyed discussed emergency situations with patients at least once in a month; however only 11 per cent of those discussions included the use of Personal Emergency Response System (PERS) technology, which is known to provide added safety and support. “It’s estimated that one in three individuals aged 65 years and older experience a serious fall each year, so
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proactive discussions between healthcare providers and their patients about how to incorporate healthy ageing practices and tools like PERS – which we know is a beneficial technology to support people during emergencies – are so important as our population ages,” said Dr. Samir Sinha, Director of Health Policy Research at the NIA. The survey of 125 Canadian healthcare professionals, conducted by MD Analytics between December 2021 and January 2022, discovered that 89 per cent of general practitioners and nurses are unlikely to discuss PERS unprompted. In many cases, HCPs are unaware of the rapidly evolving technological solutions that can help better enable their patients to age-inplace, and which to recommend. Proactive discussions during in-person or virtual appointments, whether directly
with a patient and/or their caregiver, are key for ensuring ageing adults have the support they need to live in greater safety and independently for as long as possible. “It’s incredibly important as we age to have the proper resources and technological tools to live longer, healthier lives, without compromising dignity or independence,” says Juggy Sihota, Vice-president Consumer Health, TELUS Health. “This recent study underscores the critical need for discussions about innovative technologies that are affordable, reliable and offer peace of mind to older Canadians and our loved ones as they age.” This year’s survey findings also reaffirm previous research findings from TELUS Health and the NIA – 99 per cent of Canadian older adults plan to stay as active as they can to maintain their optimal health and
independence, but the lack of discussions about available innovative support signals further education is needed. TELUS Health continues to empower HCPs and other medical professionals to support their ageing patients with knowledge and resources about the latest innovations, such as PERS like LivingWell Companion and TELUS Health Companion on Apple Watch. The NIA leads cross-disciplinary research to better understand issues and develop insights that can meaningfully contribute to shaping innovative policies, practices and products to address challenges and opportunities for Canada’s ageing population. It is dedicated to enhancing successful ageing across the life course, considering a broad range of perspectives, including those of financial, physical, psychological, H and social wellness. ■
What is home care? Home care is about trust. It is feeling comfortable with a provider coming into the home of someone you care for and, possibly, ĂƐƐŝƐƟŶŐ ǁŝƚŚ ƚŚĞ ŵŽƐƚ ŝŶƟŵĂƚĞ ĐĂƌĞ͘ Bayshore’s home care services are extensive, ǀĂƌŝĞĚ͕ ĂŶĚ ƉĞƌƐŽŶĂůŝnjĞĚ ĨŽƌ ĞĂĐŚ ŝŶĚŝǀŝĚƵĂů͘ tŚĞƚŚĞƌ ŝƚ͛Ɛ ũƵƐƚ Ă ůŝƩůĞ ĂƐƐŝƐƚĂŶĐĞ ĨŽƌ ĚĂŝůLJ tasks or round-the-clock care, Bayshore’s caregivers can help your loved ones to live ƚŚĞŝƌ ďĞƐƚ ůŝĨĞ ǁŚŝůĞ ƌĞŵĂŝŶŝŶŐ Ăƚ ŚŽŵĞ͘
Let’s talk. 1.877.289.3997 bayshore.ca 26 HOSPITAL NEWS AUGUST 2022
PERSONAL CARE | HOME SUPPORT | NURSING
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LONG-TERM CARE NEWS
London researchers collaborating on national dementia prevention program By Amanda Taccone esearchers at Lawson Health Research Institute are collaborating with Canada’s largest dementia research initiative, the Canadian Consortium on Neurodegeneration in Aging (CCNA), to study an innovative online program that offers older adults the opportunity to increase their knowledge of dementia and improve lifestyle risk factors. The program, Brain Health PRO (BHPro), offers interactive digital educational modules to empower older adults to improve their physical and mental health, and modify their risk factors for dementia. “Using the BHPro modules participants will learn how to improve their physical and mental health and reduce
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their risk of cognitive impairment. It is particularly novel with the education modules being delivered remotely,” explains Dr. Michael Borrie, Scientist at Lawson and Medical Director for the Aging Brain and Memory Clinic at Parkwood Institute. The bilingual program focuses on seven different modifiable dementia risk domains: exercise, nutrition, sleep, psychological and social health, cognitive engagement, heart health, and vision and hearing. For each, the program includes 10-minute educational videos, as well as interactive activities for users to complete. Participants will also be sent portable EEG headsets to measure their brain activity during sleep, and accelerometers to
track their physical activity. With the rise of dementia anticipated to reach nearly one million Canadians over the next 12 years, dementia prevention is becoming an increasingly urgent national health priority. “The launch of BHPro is part of a significant research effort to find concrete means of preventing dementia, with the ultimate goal of having tremendous benefits for the aging experience,” says Dr. Howard Chertkow, Scientific Director of the CCNA and Director of the Kimel Family Centre for Brain Health and Wellness at Baycrest. “Alzheimer Society of Canada (ASC) is proud to support the launch of the BHPro through the CANTHUMBS UP program,” adds Dr.
Saskia Sivananthan, ASC’s Chief Research & KTE Officer. BHPro is funded by the Canadian Institutes of Health Research and the ASC, and was created through the Canadian Therapeutic Platform Trial for Multidomain Interventions to Prevent Dementia (CAN-THUMBS UP) program, which is part of the CCNA. The study will support 350 older adults across Canada who have at least one risk factor for dementia, including up to 60 participants through Lawson, with the goal of seeing participants’ dementia risk reduced throughout the year-long study. Please note, there is limited space for research participants. To learn more, please visit H canthumbsup.ca ■
Amanda Taccone is a Communications Consultant at Lawson Health Research Institute
VHA nurses support children with medical complexities. A VHA nurse can help your child: > stay safe at home and out of hospital participate in school and other activities Learn more about how VHA can support children with complex medical needs and their families at www.vha.ca/ccmn.
28 HOSPITAL NEWS AUGUST 2022
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NEWS
Timing is right for
expanding mental health services for families, children and youth By Laurene Hilderley illing the gaps in children and youth mental health services has been a long standing shared goal for Waypoint Centre for Mental Health Care and regional partners in the Simcoe County and Muskoka region of Ontario, and the need has only been exacerbated by the pandemic. With support from the Ministry of Health, Waypoint expanded these services in March 2021 to provide additional community-based mental health care in a unique collaborative care model. Under the leadership of Dr. Rob Meeder, Medical Director for Family, Child and Youth Mental Health and a mental health pediatrician, Waypoint has welcomed an additional child/ youth psychiatrist and a mental health
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“WITH THIS MODEL WE NOT ONLY PROVIDE DIRECT PATIENT CARE BUT ARE ALSO BUILDING CAPACITY IN THE SYSTEM BY WORKING WITH AND PROVIDING EDUCATION TO LEAD MENTAL HEALTH AGENCIES AND FAMILY HEALTH TEAMS IN THE REGION.” pediatrician who are providing much needed direct services to children, youth, and their families, The team also includes an RN, social worker and two administrative staff who support both in person and virtual services. This service is located in the Community Health Hub in Midland Ontario, a collaborative state-of-art medical centre that is a partnership between
SEPTEMBER
SEPTEMBER FOCUS: ŵĞƌŐĞŶĐLJ ^ĞƌǀŝĐĞƐͬ ƌŝƟĐĂů ĂƌĞͬ dƌĂƵŵĂͬ ŵĞƌŐĞŶĐLJͬKŶůŝŶĞ ĚƵĐĂƟŽŶ͗ /ŶŶŽǀĂƟŽŶƐ ŝŶ ĞŵĞƌŐĞŶĐLJ ĂŶĚ ƚƌĂƵŵĂ ĚĞůŝǀĞƌLJ ƐLJƐƚĞŵƐ͘ ŵĞƌŐĞŶĐLJ ƉƌĞƉĂƌĞĚŶĞƐƐ ŝƐƐƵĞƐ ĨĂĐŝŶŐ ŚŽƐͲ ƉŝƚĂůƐ ĂŶĚ ŚŽǁ ƚŚĞLJ ĂƌĞ ĂĚĚƌĞƐƐŝŶŐ ƚŚĞŵ͘ ĚǀĂŶĐĞƐ ŝŶ ĐƌŝƟĐĂů ĐĂƌĞ ŵĞĚŝĐŝŶĞ͘ н KE>/E h d/KE ^hWW> D Ed н ^W / > &K h^͗ D Z' E z ZKKD
Waypoint and CHIGAMIK Community Health Centre. The North Simcoe Youth Wellness Hub also operates from the Health Hub and is a complimentary resource. “With this model we not only provide direct patient care but are also building capacity in the system by working with and providing education to lead mental health agencies and
UPCOMING EDITIONS NOVEMBER OCTOBER
OCTOBER FOCUS: DĞŶƚĂů ,ĞĂůƚŚ ĂŶĚ ĚĚŝĐƟŽŶ ͬ WĂƟĞŶƚ ^ĂĨĞƚLJ ͬ ZĞƐĞĂƌĐŚ ͬ/ŶĨĞĐƟŽŶ ĐŽŶƚƌŽů͗ New treatment approaches to mental health and ĂĚĚŝĐƟŽŶ͘ ĞǀĞůŽƉŵĞŶƚƐ ŝŶ ƉĂƟĞŶƚͲƐĂĨĞƚLJ ƉƌĂĐƟĐĞƐ͘ Ŷ ŽǀĞƌǀŝĞǁ ŽĨ ĐƵƌƌĞŶƚ ƌĞƐĞĂƌĐŚ ŝŶŝƟĂƟǀĞƐ͘ ĞǀĞůŽƉŵĞŶƚƐ ŝŶ ƚŚĞ ƉƌĞǀĞŶƟŽŶ ĂŶĚ ƚƌĞĂƚŵĞŶƚ ŽĨ ĚƌƵŐͲƌĞƐŝƐƚĂŶƚ ďĂĐƚĞƌŝĂ ĂŶĚ ĐŽŶƚƌŽů ŽĨ ŝŶĨĞĐƟŽƵƐ ;ƌĂƌĞͿ ĚŝƐĞĂƐĞƐ͘ WƌŽŐƌĂŵƐ ŝŵƉůĞŵĞŶƚĞĚ ƚŽ ƌĞĚƵĐĞ ŚŽƐƉŝƚĂů ĂĐƋƵŝƌĞĚ ŝŶĨĞĐƟŽŶƐ ;, /ƐͿ͘ EEh > /W /E& d/KE KEdZK> ^hWW> D Ed
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Family Health Teams in the region,” notes Dr. Meeder. “This significantly increases the number of families we are able to help and is also consistent with the priorities of the collaborative Central Ontario Health Team for Specialized Populations that includes 10 partner organizations in Ontario Health Central Region.” This expansion is in addition to the region’a existing pediatric mental health services and already has 1,137 registered clients which continues to grow. Services cover the full spectrum of mental health conditions for toddlers to transitional age youth (youth who would be entering the adult system) in a trauma informed, family-focused setting. Care is provided both virtually and in-person at the Commu-
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NOVEMBER FOCUS: dĞĐŚŶŽůŽŐLJ ĂŶĚ /ŶŶŽǀĂƟŽŶ ŝŶ ,ĞĂůƚŚĐĂƌĞ ͬ ƌƟĮĐŝĂů /ŶƚĞůůŝŐĞŶĐĞ ; /Ϳ ͬWĂƟĞŶƚ džƉĞƌŝĞŶĐĞͬ ,ĞĂůƚŚ WƌŽŵŽƟŽŶ͗ New treatment approaches to mental health and ĂĚĚŝĐƟŽŶ͘ Ŷ ŽǀĞƌǀŝĞǁ ŽĨ ĐƵƌƌĞŶƚ ƌĞƐĞĂƌĐŚ ŝŶŝƟĂƟǀĞƐ WƌŽŐƌĂŵƐ ĂŶĚ ŝŶŝƟĂƟǀĞƐ ĨŽĐƵƐĞĚ ŽŶ ĞŶŚĂŶĐŝŶŐ ƚŚĞ ƉĂƟĞŶƚ ĞdžƉĞƌŝĞŶĐĞ ĂŶĚ ĨĂŵŝůLJ ĐĞŶƚƌĞĚ ĐĂƌĞ͘ WƌŽŐƌĂŵƐ ĚĞƐŝŐŶĞĚ ƚŽ ƉƌŽŵŽƚĞ ǁĞůůŶĞƐƐ ĂŶĚ ƉƌĞǀĞŶƚ ĚŝƐĞĂƐĞ ŝŶĐůƵĚŝŶŐ ƉƵďůŝĐ ŚĞĂůƚŚ ŝŶŝƟĂƟǀĞƐ͕ ƐĐƌĞĞŶŝŶŐ ĂŶĚ ŚŽƐƉŝƚĂů ŝŶŝƟĂƟǀĞƐ͘ EEh > D d , d ,EK>K'z ^hWW> D Ed Advertising Booking Deadline October 21st Material Deadline October 25th For more info email advertising@hospitalnews.com
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nity Health Hub or at regional affiliated primary care settings, and is part of Waypoint’s outpatient and community programs. Last October, the team launched both an urgent care clinic which has operated virtually with the pandemic and an on-call support service for family doctors and emergency departments in the Simcoe Muskoka region. The on-call service provides support to primary care providers and Level 1 emergency physicians from Collingwood, Midland, Bracebridge/Huntsville, Alliston and West Parry Sound hospitals ranging from advice on diagnosis to medical management for patients under 18 year of age. The timing to launch these new services supports concerning data and statistics related to an increase in men-
Dr. Rob Meeder, Medical Director, Family, Child and Youth Mental Health at Waypoint Centre for Mental Health Care tal health challenges amongst children and youth from the pandemic. The oncall support service is part of the col-
tions to provide comprehensive and integrated care for children and youth, H and support to their families. ■
laborative stepped care program and shared goals with the Central Ontario Health Team for Specialized Popula-
Laurene Hilderley is the Director, Communications and Fund Development at Waypoint Centre for Mental Health Care.
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AUGUST 2022 HOSPITAL NEWS 31
The Pandemic Has Left Caregivers Burnt Out Health and service providers have felt the impact of Covid-19 on their mental health. The impact has been similar on family caregivers who support a family member, friend or neighbour. In fact, 58% say they feel burnt-out as a result of their caregiving role. The next time you meet a family caregiver, let them know the Ontario Caregiver Organization is here to help. Free programs and services are available to Ontario caregivers: 24/7 Helpline (1-833-416-2273)
Group and 1:1 Peer Support (online or by phone)
Helpful Webinars (Live and Recorded)
Group and 1:1 Counselling
e-Learning and Educational Resources
Toolkits for Caregivers (For New and Working Caregivers)
Dedicated Resource for Young Caregivers: youngcaregiversconnect.ca
Time to Talk Podcast
Learn more at ontariocaregiver.ca