Hospital News February 2023 Edition

WORTH MORE.

A crisis-level staffing shortage is redefining what it means to be a nurse. Unsafe staffing, impossible workloads - pushed beyond all reasonable limits, nurses have had to sacrifice their own wellbeing for the sake of their patients. It’s all become too much. And with the government’s deliberate and continuing disrespect, many are saying: it’s just not worth it.

Nurses are so done with the devaluing of their service. They’re done with being taken for granted by politicians who have no idea of what it actually takes to do the work. Retaining and recruiting nurses has become health care’s deepest need and most immediate challenge. It’s going to take far better compensation and a real commitment to safe staffing to address this crisis. Because here’s the final word: without nurses, the demands of health care can never be met.

It’s time Canada funded advanced diabetes treatment for everyone

By Dylan MacKay

It has been 101 years since the discovery of insulin made survival as a person with Type 1 diabetes possible. It is also the best time in history to be a person with Type 1 diabetes – but only if you can afford it. Few in Canada can or are covered for costs through public or private plans. I’m one of the lucky ones.

The technology available to help manage Type 1 diabetes is life changing. I use it every day.

Even before I wake up, my blood sugar is being measured while I sleep, and the results are sent to my phone where software can warn me if my blood sugar is out of range. But even better than alarms, the software, which is called a closed loop pump algorithm, can make changes to the amount of insulin I am getting automatically from my insulin pump, to prevent my blood sugars from going out of range.

The best part is I can sleep through the whole process and get up rested and well.

The ability to have this type of technology is made possible by the development of continuous glucose monitors (CGM). CGM is a wearable device that tracks your blood sugar every few minutes, day and night. This technology has changed my life and the lives of countless other people with Type 1 diabetes and their caregivers.

Before CGM, measuring blood sugar involved sticking your fingertips with a sharp piece of metal to get blood and putting the blood on a strip in a machine called a glucometer. It sucks, fingertips are sensitive, and you

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have sore fingertips all day, every day. Not to mention, you tend to only check your blood sugar before and/or after meals, so you are only seeing you blood sugar levels a few times a day.

Managing blood sugars for a person with Type 1 diabetes is a little like steering a big ship – you need to make changes in direction before they need to happen otherwise you crash into lots of things. Glucometers are like steering the ship with your eyes closed; CGM opens your eyes.

Knowing your blood sugar level and where it is going is very important, because while insulin is a wonder drug that keeps me alive, it is also incredibly dangerous.

Every time you take insulin, you put yourself at risk of low blood sugar, also known as hypoglycemia, which is a common cause of emergency room visits for people with Type 1 diabetes. If untreated, it can kill.

CGM use has been shown to be very effective at reducing time with low blood sugar. The flip side of low blood sugar is high blood sugar, which long-term is associated with poor outcomes such a heart attacks and kidney disease. The use of CGM helps with this as well, increasing the time that people with Type 1 diabetes have their blood sugars in a safe range.

Unfortunately, CGM costs between $3000 to $6000 dollars a year. Most provincial and territorial health and drug plans do not cover the expense. The few that do, often have age restrictions. For instance, Manitoba has coverage for CGM, but only to those under age 25.

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New study finds general pediatricians can accurately diagnose autism in children

By Suelan Toye

General pediatricians can accurately diagnose autism in some children, especially if they feel confident in the diagnosis, which can reduce long wait times for autism assessments, finds a new study led by Holland Bloorview Kids Rehabilitation Hospital.

The study was published inJournal of the American Medical Association.

“Many children and their families are waiting too long for autism (ASD) diagnostic assessments,” says Dr. Melanie Penner, the study’s lead author and a senior clinician scientist at Holland Bloorview’s Bloorview Research Institute. “We know from research that the earlier a diagnosis is given, the earlier the child can receive therapies to help improve their communication skills, as well as social and emotional learning. They can also have access to various services and government programs such as the province’s Ontario Autism Program.”

According to Autism Ontario, families in Ontario, on average, spend up to one year on a waitlist for an autism diagnosis. Even after the diagnosis, they can expect to wait from three months to two years to access services from various providers.

Traditionally kids suspected of having autism are often referred by their family pediatrician to a sub-specialist, such as a developmental pediatrician whose focus is autism. But because of the dearth of these sub-specialists and the prevalence of autism (1 in 66 children and youth diagnosed with ASD in Canada), the wait time to see a specialist can extend from months to years.

Dr. Penner’s study findings can be a game-changer in cutting down wait times and helping families get an autism diagnosis faster in their local community.

METHODOLOGY

Dr. Penner and her co-investigators enrolled 17 general pediatricians across Ontario and 106 children under five and a half years with developmental concerns, but who did not have an existing diagnosis.

Each pediatrician conducted an assessment of each child individually for any signs of autism by taking their medical history, observing their behaviour using diagnostic criteria outlined in the DSM-5, or the Diagnostic and Statistical Manual of Mental Disorders, an official guide for healthcare providers to diagnose mental health disorders.

The same group of 106 children were also assessed independently for autism by a specialist team within four weeks of the pediatricians’ assessments.

To ensure the utmost rigor in the study, the order of the assessments by both the general pediatricians and the specialist teams were evenly mixed randomly, so half of the children were first seen by the pediatrician while the other half were initially assessed by a specialist team.

The team also looked for features that were associated with getting an accurate general pediatrician diagnosis, including the child’s age, gender, racial/ethnic background, degree of autism features, and other developmental delays (ie language or cognition). In addition, the researchers looked at how confident general pediatricians felt about their autism assessment of the child.

RESULTS

When the general pediatricians felt confident that their autism diagnosis of the child was correct, they were right 90 per cent of the time.

However, when they ruled out autism as a diagnosis, they were right only 60 per cent of the time.

“If pediatricians in the community feel confident that autism is present, let’s support them in making this diagnosis so the family doesn’t have to wait for a sub-specialist. However, they need to be more cautious if they are ruling out autism in a child, particularly if a family has concerns,” says Dr. Penner, who holds the Bloorview Childrens Hospital Foundation Research Chair in Developmental Pediatrics.

In addition, when the children in the sample had other developmental delays, the general pediatricians were more likely to give an accurate autism diagnosis, a result which Dr. Penner found slightly surprising.

“Traditionally these cases tend to be more complex and would involve a sub specialist, but based on this finding, we might want to re-think this process now,” says Dr. Penner, who is part of the hospital’s Autism Research Centre and an associate professor at the

University of Toronto’s Department of Paediatrics.

KEY TAKE AWAYS

Dr. Penner encourages pediatricians to learn more about autism and feel more comfortable in providing an autism diagnosis to families. She is currently working with community-based pediatricians and other health care providers from across Ontario through a provincially-funded program called ECHO Autism to build capacity in the process of screening, diagnosing and managing autistic children and youth in Ontario.

As for parents who are noticing differences in their children’s development and think their child could be autistic, she says there are several paths to access an autism diagnosis.

“Think about going to your local pediatrician who may be able to provide an accurate diagnosis. This way, you can get access to services sooner at an earlier age, instead of waiting for a sub-specialist. Research has shown that earlier therapy leads to improved communication skills and better social and emotional learning. That said, in some cases, we do need sub specialists to help figure out the diagnosis. This research helps us to figure out which type of assessment might be right for a given child, in the hopes of making our whole system more efficient.”

The study’s co-authors are: Lili Senman, Holland Bloorview; Lana Andoni, University of Massachusetts; Annie Dupuis, University of Toronto; Dr. Evdokia Anagnostou, Holland Bloorview and University of Toronto; Dr. Shawn Kao, Pediatricians Alliance of Ontario; Abbie Solish, Holland Bloorview; Dr. Michelle Shouldice, University of Toronto and Hospital for Sick Children; Genevieve Ferguson, Holland Bloorview and Jessica Brian, Holland Bloorview and University of Toronto.

The study, Concordance of diagnosis of autism spectrum disorder made by pediatricians versus a multi-disciplinary specialist team, has been generously funded by the Canadian Institutes of Health Research and by Bloorview Research Institute. ■ H

Suelan Toye is the Senior Research Communications Specialist at Bloorview Research Institute Holland Bloorview Kids Rehabilitation Hospital.

Using machine learning to predict brain tumour progression

Researchers at the University of Waterloo have created a computational model to predict the growth of deadly brain tumours more accurately.

Glioblastoma multiforme (GBM) is a brain cancer with an average survival rate of only one year. It is difficult to treat due to its extremely dense core, rapid growth, and location in the brain. Estimating these tumours’ diffusivity and proliferation rate is useful for clinicians, but that information is hard to predict for an individual patient quickly and accurately.

Researchers at the University of Waterloo and the University of Toronto have partnered with St. Michael’s Hospital in Toronto to analyze MRI data from multiple GBM sufferers. They’re using machine learning to fully analyze a patient’s tumour, to better predict cancer progression.

Researchers analyzed two sets of MRIs from each of five anonymous

Continued from page 4

GLIOBLASTOMA MULTIFORME (GBM) IS A BRAIN CANCER WITH AN AVERAGE SURVIVAL RATE OF ONLY ONE YEAR.

patients suffering from GBM. The patients underwent extensive MRIs, waited several months, and then received a second set of MRIs. Because these patients, for undisclosed reasons, chose not to receive any treatment or intervention during this time, their MRIs provided the scientists with a unique opportunity to understand how GBM grows when left unchecked.

The researchers used a deep learning model to turn the MRI data into patient-specific parameter estimates that inform a predictive model for GBM growth. This technique was applied to patients’ and synthetic tumours, for which the true characteristics were known, enabling them to validate the model.

Diabetes treatment

But people with Type 1 diabetes get old too – so where does that leave them for the rest of their lives?

Many private insurance plans also do not cover CGM. I work full-time as a University professor and CGM is not covered by our plan. Fortunately, I am lucky enough to be able to afford the out-of-pocket costs.

Without coverage CGM simply costs too much for most Canadians with Type 1 diabetes.

Right now, the Yukon is the only place in Canada that gets the coverage right. They cover CGM for everyone with Type 1 diabetes, and I bet they will be rewarded for this with fewer

emergency room visits, lower longterm costs related to Type 1 diabetes care, and happier, healthier and more productive people with Type 1 diabetes and their families.

The federal government’s long promised pharmacare plan has so far amounted to words, words and more words, no action – and no guarantee CGM will be included should it ever materialize.

In the meantime, the other jurisdictions in Canada need to follow Yukon’s lead. If the provinces and territories all worked together, the costs for CGM would come down and everyone in Canada would benefit. ■ H

Dylan MacKay is person who lives with Type 1 diabetes and an Assistant Professor of Nutrition and Chronic Disease in the Department of Food and Human Nutritional Sciences and the Department of Internal Medicine Section Endocrinology at the University of Manitoba.

“We would have loved to do this analysis on a huge data set,” said Cameron Meaney, a PhD candidate in Applied Mathematics and the study’s lead researcher. “Based on the nature of the illness, however, that’s very challenging because there isn’t a long life expectancy, and people tend to start treatment. That’s why the opportunity to compare five untreated tumours was so rare – and valuable.”

Now that the scientists have a good model of how GBM grows untreated,

their next step is to expand the model to include the effect of treatment on the tumours. Then the data set would increase from a handful of MRIs to thousands.

Meaney emphasizes that access to MRI data – and partnership between mathematicians and clinicians – can have huge impacts on patients going forward.

“The integration of quantitative analysis into healthcare is the future,” Meaney said.

The study, Deep Learning Characterization of Brain Tumours With Diffusion Weighted Imaging, co-authored by Meaney, Sunit Das, Errol Colak, and Mohammad Kohandel, appears in the Journal of Theoretical Biology ■ H

CMA recognizes one year of federal law to protect health workers, more needs to be done

It has been nearly one year since a federal law came into force that made it illegal to use threats and bullying to stop a health worker from providing care to patients. It also prohibited actions that would prevent a person from obtaining health services or accessing health facilities.

This law became necessary following the escalation of harassment and threats of violence targeting health workers, along with protests at health facilities that prevented patients from accessing care.

The Canadian Medical Association (CMA) has long advocated for protection of health care workers and patients. Results from the CMA’s 2021 National Physician Health Survey found that eight in 10 physicians have experienced intimidation, bullying, harassment and/or microaggressions in the workplace at some point in their careers. Four in 10 physicians reported that these experiences happen “fre-

quently” or “often,” with women more likely to say they happen at least once a week.

The law protecting health care providers and patients is critically important and a welcomed measure. Now, let’s make sure the law is applied by law enforcement and that it helps protect our health workforce and patients seeking care. We still frequently hear stories of physicians and other health care workers facing threats, intimidation and other forms of abuse, especially online. This harm is unacceptable and must not be tolerated. We are pleased that the federal government has committed to establishing a transparent and accountable regulatory framework for online safety in Canada. We urge public safety officials and law enforcement agencies to enforce laws that prohibit the harassment and abuse of health care providers and patients. We all need to protect patients and those who provide them with care. ■ H

“Vaccination desserts” identified in northern, rural and French-speaking Ontario

ew research out of the University of Waterloo has identified “vaccination deserts” in parts of northern and rural Ontario and in locations where French is predominantly spoken. These areas have little to no access to pharmacist-administered vaccination sites for COVID vaccines or the flu shot.

Researchers used provincial and Statistics Canada data to determine where pharmacists are working in relation to where Ontarians live. They found that most community pharmacists authorized to administer injections work in the urban regions of southern Ontario, confirming a large geographic discrepancy.

“Our biggest realization is that there are many communities that do not have local access to a pharmacy at all,” said Dr. Sherilyn Houle, a professor at Waterloo’s School of Pharmacy and co-author of the study. “While medication can be delivered remotely and virtual care can be used for offsite counselling, access to vaccinations will need a more innovative approach.”

Lack of association between virtual care and ED visits among

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as the shift to virtual visits during the pandemic with primary care physicians associated with increased emergency department visits? A new study published in CMAJ (Canadian Medical Association Journal) found no evidence that patients with a primary care physician in Ontario visited the emergency department as a substitution for in-person physician visits.

Researchers looked at data from Ontario, Canada’s largest province, on patients enrolled with a physician, and a link to the number of emergency department visits and virtual visits between Apr. 1, 2020, and Mar. 31, 2021. They included 7936 physicians, including 2458 (31 per cent) in family health groups (enhanced fee-for-service) and 5478 (69 per cent) in family health organizations (blended capitation). At the start of the pandemic, emergency department visits and in-person primary care visits dropped sharply while virtual visits increased.

“We did not find evidence that enrolled patients substituted emergency department visits because of less availability of in-person care,” writes Dr. Jasmin Kantarevic, Department

of Economics, Research and Analytics and chief economist, Ontario Medical Association, with coauthors. “This finding is important given concerns about virtual care adversely affecting quality of care, leading to calls to substantially reduce care delivered virtually.”

The researchers controlled for monthly and regional variation, patient complexity and other factors. There was variability between practitioners, with fewer emergency department visits linked to patients with female physicians and in urban areas. More medically complex patients, those in rural regions and those of male gender had higher rates of emergency department visits.

“Virtual care is now being described as the new normal in Canadian health care. Future research should consider evaluating the long-term impact of virtual care, and whether it improves appropriate use of emergency departments,” they write.

“Association between virtual primary care and emergency department use during the first year of the COVID-19 pandemic in Ontario, Canada” was published January 23, 2023.

As community pharmacies are becoming the preferred locations for administering vaccinations, the ability for people in northern communities and rural areas to access pharmacies continues to be difficult.

“Reaching these communities of individuals will require innovative ideas, including mobile vaccination clinics and additional training for pharmacists located in these areas,” Houle said.

These findings have immediate and long-term applications for public health as the ongoing pandemic and influenza season mean vaccinations are more important than ever.

“We have to recognize where the gaps remain and plan accordingly to bring seasonal services to provide for hard-to-reach communities and hopefully encourage practicing pharmacists in those areas to become trained in vaccination, if they haven’t already,” Houle said.

There is an additional limitation for primarily French-speaking populations in Ontario. In areas where at

least 25 per cent of the population speaks French, there are not enough French-speaking pharmacists to service those areas.

Most French-speaking pharmacists practice in areas where the smallest French-speaking population resides, with many of the larger French-speaking populations located in “vaccination deserts”.

“The landscape has changed drastically in these past few years, and a shift has occurred where pharmacies are becoming more relied upon as vaccination providers. However, pharmacists alone can’t meet these needs for all communities. Without a pharmacy, many services cannot be provided,” Houle said.

Policymakers and health professionals need to be creative when addressing these issues since solutions that have been effective in urban centres do not necessarily work for all Ontarians, especially in rural and remote regions.

The study, Identifying vaccination deserts: The availability and distribution of pharmacists with authorization to administer injections in Ontario, co-authored by Houle, Patrick Timony, Nancy M. Waite and Alain Gauthier, was a collaboration between the University of Waterloo and Laurentian University. The study was recently published in the Canadian Pharmacists Journal. ■ H

enrolled patients during pandemic

“REACHING THESE COMMUNITIES OF INDIVIDUALS WILL REQUIRE INNOVATIVE IDEAS, INCLUDING MOBILE VACCINATION CLINICS AND ADDITIONAL TRAINING FOR PHARMACISTS LOCATED IN THESE AREAS.”

ew theory details how Alzheimer’s could be a chronic autoimmune condition that attacks the brain.

By 2030, nearly a million Canadians will be living with dementia. The vast majority will be diagnosed with Alzheimer’s disease, the most common form of dementia.

Alzheimer’s impacts more than 50 million people around the world, with a new person being diagnosed every three

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seconds. Yet, despite more than 200 clinical trials in the past 30 years, there are no disease modifying therapeutics to prevent, halt or treat Alzheimer’s.

“We need new ways of thinking about this disease, and we need them now,” says Dr. Donald Weaver, a Senior Scientist at the Krembil Brain Institute.

Dr. Weaver is the author of a recent paper detailing a new theory of Alzheimer’s – not as a brain disease, but as a chronic autoimmune condition that

attacks the brain. This novel research was recently published in the journal of the Alzheimer’s Association, Alzheimer’s & Dementia.

“We don’t think of Alzheimer’s as fundamentally a disease of the brain. We think of it as a disease of the immune system within the brain,” says Dr. Weaver.

“To date, most of the approaches in Alzheimer’s research have been based upon the theory that a protein called

beta-amyloid, which is supposedly abnormal in the brain, clumps up. And when it clumps up, it kills brain cells.”

“But we believe beta-amyloid is right where it should be. It acts as an immunopeptide – a messenger within our immune system – so that, if we have head trauma, beta-amyloid repairs it. If a virus or a bacteria comes along, beta-amyloid is there to fight it.”

And that’s where the problem occurs, says Dr. Weaver.

Could Alzheimer’s actually be an autoimmune condition? In defense of falling

t Toronto Rehab, embracing the risk of a fall may actually be part of a patient’s recovery journey.

That’s because experts are promoting the concept of therapeutic falls: a fall that takes place in the hospital –while a patient is practicing higher-risk activities they’ll need to perform at home – where the benefit of practicing outweighs the risk of falling.

In the journal Disability & Rehabilitation, Toronto Rehab experts argue that, unlike other falls prevention programs aiming to achieve zero falls, hospitals embracing the concept of therapeutic falls may better prepare patients for a safe transition home.

“We would rather patients take mediated risks in a rehab setting and let us teach them how to prevent the next fall than be discharged home and take a tumble there,” says Dr. Meiqi Guo, Medical Director of Toronto Rehab’s Brain Rehabilitation Program.

A CONCEPT BUILT ON TRUST AND SHARED DECISION-MAKING WITH PATIENTS

The concept of therapeutic falls was first piloted on Toronto Rehab’s Brain Injury Rehab Inpatient Service with patients who demonstrated a desire to push boundaries; were on the cusp of achieving a goal they’d need to

perform at home, such as transferring from bed to a wheelchair; and could understand and appreciate the risk of falling.

“They’re the ones who make our hearts beat a bit faster,” says Angie Andreoli, physiotherapist and Innovations Lead, Safety & Quality.

“They’re so close to achieving their goal, we can tell they’re itching to reach out and grab it … but they’re not quite there yet. We see it as our duty to meet them where they’re at, because patients shouldn’t be making decisions about risk-taking alone.”

Therapeutic falls is a concept built on trust and shared decision-making between patients and their care team.

It starts with engaging a patient, and exploring the risks and opportunities associated with practicing certain activities on their own related to mobility.

“I need to be able to look my patient in the eye and essentially say ‘we know you want to move on your own, so let’s go down this path together. Yes, you might fall. But here are all the ways we can prevent a fall together,’” says Angie.

Key to this work is the emphasis on education around falls prevention and mitigation. If a fall does happen, the patient knows what to do next to prevent further harm.

“This work is not so much a practice change, but a shift in philosophy about how we discuss, communicate and learn from falls,” says Angie.

IDENTIFYING APPROPRIATE TIMES TO PUSH BOUNDARIES

George Barrett isn’t the kind of patient to stay idle.

“I’m a fast-going person,” says the 75-year-old retired mechanic, who is recovering from a brain injury. “I don’t want to lay around, if I can be moving.”

Together with Angie, he’s been identifying appropriate times to push boundaries, as he prepares for discharge.

For George, that means walking independently for the first time since his injury and subsequent surgery, both with and without his gait aid.

To that end, he’s been taking short trips to the washroom on his own two feet, and using a rollator to move around the unit independently.

“The rollator won’t fit through the door of my washroom at home, and I can’t always rely on my family to help me get around,” says George. “I’ll need to do this on my own eventually.

“I also like to stay active and walk around, and I don’t like sitting in bed. If you don’t use it, you’ll lose it.”

ENCOURAGING ACTIVITY AND INDEPENDENCE

And that’s a challenge the concept of therapeutic falls helps solve.

“We all have a desire to protect patients as much as possible,” says Dr. Guo. “But in a rehab setting, that can lead to more time spent in bed, instead of participating in therapy.

“The risks associated with that can be further – or unnecessary – deconditioning, decreased activity levels, and there’s an emotional impact, too.”

While not appropriate for all patients, individuals who are willing to take on the risk of falling are more likely to practice higher-risk activities that may propel their recovery forward.

The concept of therapeutic falls is being spread across Toronto Rehab. The team urges other rehab centres to consider their own falls prevention approaches, and how they can promote safety while maximizing independence.

“Beta-amyloid gets confused and can’t tell the difference between a bacteria and a brain cell and so it inadvertently attacks our own brain cells. This, then, becomes what we call an autoimmune disease. The immune system is actually attacking the host, our brain.”

This new theory of Alzheimer’s as an autoimmune condition has been getting a lot of attention internationally.

Dr. Weaver was announced as one of the recipients of the coveted Oskar Fischer Prize, awarded to scientists worldwide who are investigating new theories of Alzheimer’s. His recent essay ‘Alzheimer’s might not be primarily a brain disease. A new theory suggests it’s an autoimmune condition’ in The Conversation – an independent source of news from the academic and

research community, has been viewed more than a million times and translated into several languages, including French, Spanish, Indonesian and Bulgarian.

“Tangible rethinking about Alzheimer’s disease as an autoimmune disease, and beta-amyloid as a normal

part of our immune system, opens the door to new avenues and approaches to develop innovative and much-needed new therapies,” says Dr. Weaver.

“I have spent the last 30 years trying to come up with new approaches and new drugs to treat Alzheimer’s disease.

We’re pretty excited in our lab. We think that this autoimmune theory is very sound. We think that it does represent a significant step forward and a new way of thinking and we’re excited about finding the molecules that hopefully, one day, leads up to a very useful drug.” ■ H

Krembil Brain Institute Senior Scientist Dr. Donald Weaver believes this theory could one day lead to new therapeutics for Alzheimer’s. “We need new approaches and we need them now.”

Photo credit: Krembil Brain Institute

“WE DON’T THINK OF ALZHEIMER’S AS FUNDAMENTALLY A DISEASE OF THE BRAIN. WE THINK OF IT AS A DISEASE OF THE IMMUNE SYSTEM WITHIN THE BRAIN.”

Everyone has a role to play in shaping the future of dementia in Canada

The Alzheimer Society of Canada recently released the first volume of its Landmark Study, forecasting dementia rates in Canada to 2050 – including ideas on how we can take action now to improve our collective brain-health future.

The latest Canadian dementia projections are staggering – but the study authors say if we act now, we can change them for the better.

• Over half a million Canadians are living with dementia today, and that number is expected to reach 1.7 million by 2050.

• Females continue to be affected by dementia at a rate that far outpaces males. The Landmark Study projects that more than 1 million Canadian females will be living with dementia by 2050, compared to more than 600,000 males.

• On average, caregivers (such as a family member or friend) to a per-

son living with dementia provide 26 hours of care per week. Compare this to 17 hours per week for older adults with other chronic health issues.

• If current trends continue, the number of care hours provided by family and friends could reach almost 1.4 billion hours annually by 2050.

More data is available at alzheimer. ca/landmarkstudy.

HOW ALZHEIMER SOCIETY TEAMS IN CANADA CAN HELP PEOPLE IMPACTED BY DEMENTIA TODAY

The new study outlines actions for health systems, governments, researchers and individuals to take.

One thing health-care workers can do now is connect people with dementia to regional Alzheimer Society teams. Each Alzheimer Society provides free support to people living with

dementia, and to their caregivers. Support is even available pre-diagnosis.

Free, no-stigma help like this is crucial. Because while it’s possible to live well with dementia, it’s nearly impossible to do so without support.

Alzheimer Society groups across Canada offer:

• Evidence-based resources and education to navigate a dementia diagnosis, learn about symptom management, enhance communication, begin conversations around Advance Care Planning, and more!

• Counselling, ongoing support, day programs.

• Connection to other people living with dementia and caregivers, to reduce isolation and build a sense of community.

To find your local Alzheimer Society, visit alzheimer.ca/find.

HEALTH-CARE

1. Be physically active each day. Reduce sedentary time and move more. This can include all types of physical activities, including walking, rolling, running, gardening, tai chi, swimming, dancing, biking, team sports and yard work.

2. Protect your heart. Monitor your blood pressure, cholesterol and diabetes. What’s good for the heart is good for the brain.

3. Stay socially active. Make sure to be engaged with friends and family. Maintain your social network and stay connected. Virtual visits count too!

4. Manage your medical conditions. Keep on top of your overall health. This is directly linked to your brain health and your ability to reduce dementia risk as you get older.

5. Challenge your thinking. Take on mental leisure activities that you enjoy. Always try to learn new things.

6. Get a good night’s sleep every night. Try to sleep 6 to 8 hours each night.

RATES IN FUTURE

With dementia rates rising, the health-care system impact over the coming years could be tremendous. But the Landmark Study reveals that:

• Delaying the onset of dementia by 1 year would avoid nearly 500,000 cases of dementia over the next 30 years in Canada.

• Delaying the onset by 10 years would effectively avoid more than 4 million cases.

• Delaying the onset of dementia may be possible through risk reduction.

While many risk factors for dementia cannot be changed (such as age, sex, genetics), there are 12 key actions that can improve overall brain health and reduce risk of developing dementia. The more of these actions a person takes, the better their brain health is protected.

To reduce your own risk of developing dementia, implement these actions. And to help lower national dementia rates in future, share these actions with your patients, too.

7. Seek support and treatment for depression. Remember that depression is more than just feeling down. Seek help.

8. Avoid excessive alcohol intake. Limit your intake of wine, beer and other alcoholic beverages.

9. Maintain your hearing. Use hearing aids if you need them. Protect your hearing from loud noises. Get your hearing tested.

10. Find meaning in life. Find a purpose to get out of bed each day. This is associated with better brain health.

11. Avoid all types of head injury. Steer clear of activities where you might put your brain at risk of harm. Wear certified safety helmets.

12. Adopt healthy behaviours. Make balanced food choices, reduce avoidable stress, quit or reduce smoking, and get regular checkups with your doctor.

Read more and share these actions anytime at alzheimer.ca/12actions. And for more dementia tools MDs use, visit alzheimer.ca/mdsuse.

HOW

WORKERS CAN REDUCE THEIR OWN RISKS OF DEVELOPING DEMENTIA – AND HELP PATIENTS TO LOWER NATIONAL DEMENTIA

Developing the Healthcare Managers, Leaders & Innovators of Tomorrow

Schulich’s New Master of Health Industry Administration

The 12-month Master of Health Industry Administration (MHIA)* is a full-time program designed to provide the in-depth knowledge and skills necessary to navigate and manage in a highly complex and competitive field that encompasses business, government, and not-for-profit organizations.

The MHIA combines Schulich’s strengths in leading-edge management education with its specialized expertise in the field of healthcare administration. The curriculum is

designed by faculty within the newly created Krembil Centre for Health Management and Leadership, a holistic hub designed to promote thought leadership through education, applied research and industry collaboration.

JOIN THE NEXT GENERATION OF HEALTHCARE LEADERS

The Schulich MHIA program launches this Fall. For details, visit schulich.yorku.ca/mhia.

*Pending Ministry approval. Driving Positive Change | schulich.yorku.ca

Research aspires to help employers and employees meet the challenges of mild cognitive impairment in the workplace

For 20 years, Rosemary Leslie suffered with an ever-deteriorating work life, without ever truly knowing the reason. A self-described Type A personality, with a master’s degree in engineering, she was having difficulty doing basic tasks in her job with the federal government. It became a struggle to work with spread sheets and data analysis. Her short term memory was slipping, causing her to re-do research that she had already done the previous day. And she had difficulty understanding what her supervisors were asking her.

“I was beating my head against the wall, wondering what’s wrong with me,” said Leslie in an interview from her Ottawa home.

She thought it might be an issue with the subject matter, so she changed to a different group. There was no improvement. She spoke to her family doctor and a psychiatrist, who focused on her struggles with anxiety, but nothing was working.

“I could scarcely function, I was so stressed,” she said.

Having received a couple of negative performance reviews, Leslie was on the verge of losing her job when a sympathetic representative of her union, someone with expertise in disability issues, suggested a neurological assessment.

The result was a revelation. After two decades of being misdiagnosed, Rosemary Leslie discovered she had mild cognitive impairment (MCI), a condition that causes problems with memory and thinking. The specialist who assessed her suspected that it may have been caused by a severe heart attack that Leslie suffered on her 32nd birthday in 1997.

Although some people with MCI may go on to develop Alzheimer’s disease or other forms of dementia, the symptoms are not as severe and people with the condition can continue to work, with appropriate accommodations.

That’s what happened for Leslie. She was switched into an administrative position that matched her capabilities and her life was changed for the better.

“The stress started melting off. Now I’m in a job that I really like where I feel like I’m contributing. It’s a total turnaround,” she said.

The risks of developing MCI increase as people age. It means that with an aging workforce and more of us choosing to stay on the job past the traditional retirement age, accommodating people with the condition is an emerging issue.

An AGE-WELL project titled Cog@Work aspires to help employers and employees adapt better to the challenges of MCI in the workplace.

“Ensuring that an organization is prepared for this is really important,” said Dr. Josephine McMurray, an Associate Professor at the Lazaridis School of Business & Economics at Wilfrid Laurier University who is the co-lead of Cog@Work and also an Associate Scientific Director at AGEWELL.

“As this is a non-visible disability, some employers don’t even know this is an issue,” she added.

Dr. McMurray is collaborating on Cog@Work with co-leads Dr. Arlene Astell, Director of the Dementia Aging Technology Engagement lab at the KITE Research Institute at University Health Network, and Dr. Jennifer Bo-

ger, Adjunct Assistant Professor at the University of Waterloo.

The project is raising awareness about MCI, compiling information about work-related best practices, and developing policies and advice for building more accessible workplaces. In line with AGE-WELL’s mission, it is also nurturing the development of technologies that can support people with MCI so that they can continue to work. The Cog@Work website brings together an array of resources for easy access.

Dr. McMurray says that there is very little data on the prevalence of MCI in the workplace, so the evidence to date is anecdotal. Few managers have any idea of how to handle these kinds of situations, and how to navigate sensitive conversations with workers whose performance has changed. As a result, people can be fired or decide to retire early, she says.

Instead, MCI needs to be treated as a disability where accommodations can often be made to allow the worker to continue and contribute. Managers should not be expected to diagnose MCI, but rather to encourage a worker to seek professional help when performance on the job is affected, added Dr. McMurray.

“It’s a tough place to be doing research because it can be a difficult topic of discussion with employers,” said Dr. McMurray.

Fortunately, the project is benefiting from collaborations with some large employers who share a desire to create inclusive, accessible work environments for employees who identify with mild cognitive impairment or dementia. The overall goal is to improve employee experiences and enhance workplace accommodations through creative strategies for employers.

“Leaders require knowledge and understanding in order to identify the signs of someone living with MCI or dementia and be aware of the benefits and supports available. Often, they can be confused with other things such as performance issues rather than connecting the employee to the right supports,” said Lindsey Simpson, Director of Ability Management at Alberta Health Services (AHS).

Her team is actively working on reviewing existing policies and processes related to workplace accommodation with MCI in mind to help evolve best practices by participating in research with Cog@Work. They are drawing inspiration from the story of Roger Marple, an AHS employee based in Medicine Hat who developed early onset Alzheimer’s and feared he would have to quit a job he loved. Instead, an enlightened supervisor worked with him to develop a series of techniques, like sticky notes, alarms and cell phone reminders to compensate for his failing memory. The accommodations allowed Marple (who recently passed away) to extend his work life by two years.

Getting the right diagnosis and the appropriate accommodations made a profound difference for Rosemary Leslie.

“I plan to keep working as long as I am able, as long as I enjoy it and feel like I’m contributing,” she said.

She is also using her life experiences to assist the Cog@Work team, supporting their goal to help all employers find those kinds of solutions as they strive for workplaces that are inclusive and accessible.

Language matters: The power of words

By Alekhya Johnson, Mary-Lynn Peters, Wendy Zeh, and Barbara Liu

What images come to mind when you see the word “aggressive” in a patient’s chart? What about “wandering” or “violent”?

An 85-year-old man with dementia is admitted to hospital. While being showered, he grabs the care provider. The following note is added to his chart: “patient is aggressive”. Weeks later, his application to long-term care is declined and his discharge is deferred. An assessment by a behavioural care specialist reveals no other documented behavioural incidents; and that the patient had grabbed the provider because he was startled by the shower.

An 82-year-old woman at a reactivation care centre walks around the unit for something to do. Her behaviour is documented as “wandering”

and this word is carried over into her long-term care application. Her application is declined due to concern she would require a secure unit, delaying

MORE than a test

Xpert®

Coverage,

That’s

her discharge. She did not require a secure unit.

A 75-year-old man with dementia is on an orthopedic surgery unit.

When being turned, he raises his fist and strikes his care provider. The word “violent” is added to his chart. He is referred to the geriatric team for recommendations to manage his behaviours. The team determines that he has poorly controlled pain. When this is addressed, his physical behaviours stop. These examples reveal how language can influence an older adult’s care, length of stay, and journey within the health system. Patients with dementia are especially vulnerable as behaviours may be one of the ways in which they communicate unmet need. When care providers use vague words and phrases without context it can provoke fears, negative stereotypes, implicit biases, and reactive decision-making for other care providers. In contrast, person-centred language, which is specif-

AN

ADULT’S CARE, LENGTH OF STAY, AND JOURNEY WITHIN THE HEALTH SYSTEM.

ic, objective, and respectful, gives care providers important clues about how to minimize responsive behaviours, resulting in better care, documentation, and outcomes.

Consider the difference between saying “uncooperative” versus “resists bath if left uncovered”. The former conjures up assumptions that the patient may be generally resistant to multiple activities for no discernable reason, while the latter offers a specific scenario where care strategies might be tested to minimize behavior (e.g., ensuring the patient is covered, considering room temperature, etc.).

The impact of language in healthcare has received a significant amount of attention worldwide in the last

decade, with guidelines and resources produced by Alzheimer Society Canada, Dementia Australia, NHS England, Obesity Canada, Diabetes Canada, Diabetes Australia, American Medical Association, Mental Health Commission of Canada, and others. In 2017 the Toronto Academic Health Sciences Network (TAHSN) published a person-centred language guideline for acute care settings that includes practical examples of how to accurately describe behaviours.

The Regional Geriatric Program (RGP) of Toronto, with funding from the Public Health Agency of Canada, has been supporting the implementation of this guideline at three healthcare organizations: Trillium Health

Partners, Sunnybrook Health Sciences Centre, and Unity Health Toronto. Point-of-care staff, managers, physicians, and administrators have responded positively to the concept of person-centred language:

“I wanted to write “patient is agitated” but then remembered. So, I wrote “patient is agitated-their voice increasingly louder and said “get out of here!””

“When you hear on report that the patient is very aggressive, I’m already thinking that my shift is going to be bad or I’m scared of the patient, so it’s important to know what they mean by aggressive”

The RGP of Toronto, in collaboration with the Behavioural Supports Ontario Provincial Coordinating Office, has produced a suite of educational tools with practical examples of how to use person-centred language in acute care settings including a pocket card, video reels, teaching aids, posters, huddle games, an e-course, and more. All of these resources are available for free download online. Join the movement to use person-centred language in your communication and patient documentation! ■ H

Alekhya Johnson, MPH, Mary-Lynn Peters, RN(EC), NP-Adult, MSc, Wendy Zeh, RN, and Barbara Liu, MD, FRCPC are part of the Regional Geriatric Program (RGP) of Toronto.

The

Michener Institute’s

FUNDAMENTALS OF HEALTH CARE DIPLOMA

Michener’s Fundamentals of Health Care program is specifically designed to help prepare learners of all academic backgrounds for meaningful new positions in health care, and provides foundational knowledge for further post-secondary education.

The deadline to register is May 31, 2023

LANGUAGE CAN INFLUENCE

OLDER

The status quo won’t clear the surgical backlog We must be willing to experiment

By Dr. Kevin Smith

While there is never a shortage of opinions when it comes to the cherished Canadian healthcare system, it is a nearly universally accepted belief that the status quo simply isn’t working – for patients, providers, policymakers, or funders.

With a significant surgical backlog in Ontario and other provinces and substantial health human resources (HHR) stresses and strains, we know that many citizens are waiting too long for procedures that stand to dramatically improve the quality of their lives. More than 200,000 people were estimated to be waiting for a surgical procedure last month, according to provincial figures.

Recently, Ontario Premier Doug Ford and Deputy Premier and Health Minister Sylvia Jones unveiled a threestep plan they say will improve wait times by using public money to expand the number and range of procedures. It appears they are open to receiving expressions of interest from not-forprofit as well as for-profit clinics – an idea that has caused consternation in some quarters.

Beginning with cataract operations, and later expanding to offer MRI and CT imaging, colonoscopies, endoscopies, and hip and knee replacements, the government appears to be leaning on solutions that leverage public-private partnerships.

While the provincial government has been unequivocal that all procedures will be covered for patients under the Ontario Health Insurance Plan (OHIP), the plan has raised earnest concerns about the potential privatization of our system and the fear of HHR bleeding to privately run clinics.

While much of the early reaction focused on the enhanced role of private clinics, the plan also includes non-profit surgical and diagnostics centres, with promised measures to require new facilities to give detailed staffing plans with their application

and to ensure several physicians at such centres have active privileges at their local hospital. There are approximately 900 Independent Health Facilities in Ontario–about 875 of which focus on imaging and about 25 community surgical and intervention centres which currently perform 26,000 OHIP-insured procedures and surgeries each year, mostly cataract surgery and endoscopy procedures.

While the devil is always in the details, this approach has signalled a willingness in government to explore innovative ways to better serve patients. With the correct safeguards in place we can build on the success of the existing centres and leverage our scarce –and tired – healthcare workers, as well as attract extenders who will see the denominator of care expand.

As the President and CEO of University Health Network, the only public hospital deemed to be among the top 5 best in the world by Newsweek maga-

zine, I am proud of how Canadians passionately defend the public system.

It is a sacrosanct principle that the money you have in the bank should not determine your health or the length and quality of your life in Canada. We must never lose that moral lodestar.

Yet if we accept that the current state of affairs is not good enough, we must also be willing to experiment with models that ensure timely care is available across the continuum of need.

I am confident that by focusing on day surgeries – low acuity procedures that can be cancelled in a hospital setting because of emergency clinical needs or staffing pressures – the system can help clear the surgical backlog, get people the procedures they need promptly, and protect universal access while easing the burden on hospitals and allowing them to focus on critical and complex procedures.

To address concerns, including the potential of upselling services at pri-

vate clinics, it is imperative the government work with system partners to develop a framework to safeguard and maintain the integrity of our public system, particularly regarding staffing and quality assurance.

To ensure the plan is successful, we must begin by identifying the risks and possible unintended consequences and put in place a policy and financial framework that mitigated these risks while leaving room for true innovation. Ideally, an Expert Panel should be established to provide advice and recommend the needed guardrails on how best to improve access, enhance quality, and control costs. We can create models that, for example, negate the possibility of large numbers of nurses leaving hospital environments for these centres, exacerbating HHR challenges. If that scenario were to come to pass, and sicker patients’ care put at risk, this should rightly be viewed as a failure.

Yet it is long past time for Ontario to have the same kinds of mature conversations about public-private partnerships that have been had in British Columbia, Alberta, Quebec, and Saskatchewan. But conversations alone won’t advance access to care. We must have the ability to experiment and soon.

It could be argued that the Canadian healthcare system has not done anything truly radical since the days of Tommy Douglas. Instead, we’ve tinkered around the edges with marginal changes, even as patients who deeply value a public healthcare system demand a more patient-centred culture than we have seen in the recent past. Providers are equally demanding change that gives them the tools and the capacity to meet the needs of those we serve.

If we can agree that the status quo is no longer tolerable, let us also agree we can change with the times–if those changes mitigate unintended consequences and raise all ships. It is said that fortune favours the bold and Canadians are rightly demanding timely access to high-quality care. ■ H

Dr. Kevin Smith is the President and CEO of University Health Network

Dr. Kevin Smith

Creating the “Sharing Circle” website:

Providing culturally safe information to support wound, ostomy and continence care in Indigenous communities

By Catherine Harley and Troy Curtis

Despite Canada’s commitment to primary health care and principles of social justice, health inequities remain a pressing national concern for Indigenous peoples. In Canada, healthcare for Indigenous peoples, which include First Nations, Inuit and Métis, is shared by the federal, provincial and territorial levels of government. With a complex mix of policies, legislation and relationships, the Canadian healthcare system includes Indigenous peoples in the per capita allocations of funding from the federal transfer and are entitled to access insured provincial and territorial health services as residents of a province or territory. Indigenous Services Canada funds or directly provides services for First Nations and Inuit that supplement those provided by provinces and territories, including primary health care, health promotion and supplementary health benefits.

A coordinated approach to address the health needs of First Nations, Inuit and Métis, and health care delivery remains an ongoing challenge. The inequities in access to healthcare and social determinants of health experienced by Indigenous peoples in Canada are known and documented, however, this relevant information and evidence has not been translated into improved health. The root causes of inequitable access to healthcare for Indigenous peoples are complex and need further assessment within the social, historical, and political context in order to develop solutions.

In support of Truth and Reconciliation, Nurses Specialized in Wound, Ostomy and Continence Canada (NSWOCC) launched the Indigenous Wound, Ostomy and Continence Health Core Program in June 2018, to address the inequity of healthcare deliv-

ery in the areas of wound, ostomy and continence across Canada. One area for imporvement that was identified by this Indigenous Wound, Ostomy and Continence Health Core program was the lack of a consistent process to deliver culturally safe information on the topic of wound, ostomy and continence to First Nations medical practitioners, nurses, family caregivers and patients. In January 2022, this core program met to set objectives in order to develop a national, culturally safe, communication tool in the form of a website which would be an online informational and educational resource hub. The goal was to enhance accessibility to relevant information and ultimately improve healthcare for Indigenous peoples.

A project team was established made up of individuals who work in the frontline with Indigenous, Metis, and Inuit people and included two Indigenous patients. Objectives were set to develop a culturally safe national communication tool in the form of a website which would be an online informational and a centralized educational resource hub. The aim of this website was to enhance accessibility to culturally safe wound, ostomy and continence information and resources to improve healthcare for Indigenous peoples.

The objectives for this website were as follows:

• Provide a single directory whereby hyperlinks to culturally safe Indigenous information and educational resources on wound, ostomy and continence care for patients, physicians, nurses and aligned healthcare professionals could be found;

• Display hyperlinks to Indigenous Wound, Ostomy and Continence

health resources broken down by Province/Territory to help patients and healthcare professionals disseminate pertinent information that exists elsewhere online for the respective region they live and work in;

• Share news related to Indigenous Wound, Ostomy and Continence health;

• Welcome visitor-submitted suggestions for new links to resources to be added to the website;

• Support website visitors to connect with an Nurse Specialized in Wound, Ostomy and Continence ( NSWOC) closest to their area using the Nurses Specialized in Wound, Ostomy and Continence Canada (NSWOCC) “Find an NSWOC” search engine;

• Provide information in multiple mediums including video, blog, external hyperlinks, and images;

• Establish a common language by providing a glossary defining key ostomy-related terms adapted from the 2022 NSWOCC Ostomy Patient Teaching Guides for Ileostomy, Ileal Conduit, and Colostomy as well as establishing a glossary of terms, in

the future, for wound care and continence.

The design, content, and navigation of the website were refined over a seven month period. The Project Team collectively came up with the name of the “Sharing Circle” for this website because healthcare for Indigenous peoples must be shared by everyone. Sharing circles provide opportunities for each voice to be heard, respected, and valued. They are a traditional practice in some Indigenous communities in North America and are designed to ensure everyone has an equal opportunity to share their opinions and ideas.

Launched on August 10, 2022, this new “Sharing Circle” website is helping patients, and healthcare professionals to access a directory of resources, education, training, and support related to Indigenous Wound, Ostomy and Continence Health. The “Sharing Circle” website continues to be implemented through electronic communications, a social media campaign, posting on the NSWOCC website and the websites of aligned organizations and through personal emails to colleagues. The Sharing Circle can be accessed online at www.sharingcircle. online.

In developing and launching the “Sharing Circle” website, we have supported an open, respectful way of communicating wound, ostomy and continence information and resources for healthcare providers and First Nations people in a culturally safe manner. By having access to this website, we strive to support better access to patient care in a more timely manner. This is one step towards supporting improved ostomy care for Indigenous peoples. ■ H

Catherine Harley, eMBA, RN, IIWCC, Nurses Specialized in Wound, Ostomy and Continence Canada, Ottawa, Ontario, Canada. Troy Curtis, BHum, Nurses Specialized in Wound, Ostomy and Continence Canada, Ottawa, Ontario, Canada.

Wound debridement

By Erin M. Rajhathy

W

ound debridement refers to the removal of necrotic tissue from the wound bed and is essential in the care and management of healable chronic wounds. Debridement also removes other contaminants from the wound surface including foreign debris, leftover dressing material, and single or complex networks of bacteria (e.g., biofilm) all of which can stall the normal wound healing trajectory. Wound cleansing is but one example of wound debridement, as the purpose of cleansing a wound is to eliminate necrotic tissue and the above mentioned contaminants from the surface of the wound bed. Therefore, wound cleansing by either swabbing the wound with saline soaked gauze or via irrigation with normal saline can be classified as mechanical debridement.

Regardless of debridement being such a critical component of wound management, knowledge and practice gaps continue to exist across the continuum of care and within all health disciplines despite the recent publication of Debridement: Canadian Best Practice Recommendations for Nurses (NSWOC, 2021). Although written for nurses by nurses, these best practice recommendations can apply to, and can be implemented by, all health professionals in any health sector (e.g., acute care, long-term care, homecare) and should be supported by all system levels to optimize wound related outcomes and drive down complication rate and overall health system costs.

KEY FINDINGS OF THE BEST PRACTICE RECOMMENDATIONS

The extensive scoping review conducted by the document’s task force resulted in the development of twelve national recommendations that were

then approved by a panel of key opinion leaders via Delphi technique. The final document was then reviewed by a total of 38 peer reviewers from across all health disciplines as the care and management of wounds is best delivered by an interprofessional team approach. Overall, 89 per cent of reviewers stated they would recommend this document to their colleagues both at the bedside and at administrative levels (Rajhathy, Chaplain, Hill, Woo & Parslow, 2021).

The recommendations focus on six key methods of debridement and place patient and health professional safety as top priorities. Three recommendations focus on the health system, four focus on the health professional, and five focus directly on patient care. The recommendations intensely focus on requirements for initiating and performing competent debridement and in fact, led to the association of Nurses Specialized in Wound, Ostomy and Continence (NSWOC) developing a post graduate practice enrichment series education program dedicated entirely to the topic of advanced wound debridement (Figure 2). The planning of care for any wound must begin with a comprehensive patient and wound assessment by a health professional with advanced education and training in the field of wound healing (Rajhathy, Parslow & Hill., 2021). One key factor identified from the scoping review was the important element of the health professional completing an additional education program specific to debridement.

The course is competency based and adheres to a standard of practice. It is online and currently available to health professionals across Canada and from any health sector. It offers six weeks of paced, interactive modules, a rolling start time, access to course

mentor with extensive experience in wound debridement methods, and a final examination. The flexibility in the start time, and online platform, make it optional for the working health professional. Although this program provides the theoretical requirements identified in the extensive scoping review, health professionals still require a practicum with a qualified health professional to become competent in advanced wound debridement. Hands-on debridement workshops are available to begin skills training during the NSWOC conference each year (Wound, Ostomy and Continence Institute, 2022).

PRACTICE IMPLICATIONS

Moist wound healing first took hold in the 1960’s when research showed wounds healed best with optimal moist conditions (Junker, Kamel, Caterson & Eriksson 2013). Moist wound healing is autolytic debridement; defined as the body’s natural process for healing. This means any health professional involved in the application of a moisture donating or retentive dressing (e.g., silicone bordered foam or impregnated petrolatum dressings) is engaging in the controlled/restricted act of debridement. Without advanced education and training in chronic wound

management and further education and training in debridement specifically, health professionals should not initiate dressing protocols that may facilitate debridement, as they may unintentionally place the patient at risk for potential harm. With additional risk in wound located on the lower limb and foot, this can lead to serious complications including infection, limb loss, and even death. Organizations lacking appropriate policies and procedures, or advanced directives, for debridement increase the risk of negative patient outcomes related to wound management and place their organization at risk of litigation.

SUMMARY

Health professionals and organizations that provide professional services for the care and management of patients with chronic wounds need to ensure evidence-based policy and procedures are available to guide practice to ensure all risks associated with unintentional patient harm are mitigated. This can be achieved by ensuring debridement is well defined and health professionals are working within their scope of practice and have the necessary requirements to obtain the knowledge, skill, and judgement to initiate or perform debridement competently.

Brainstorming ways

wound care directly

those in need

By Grace Jenkins

n event to dream up innovative approaches to wound care has prompted an idea to bring a pop-up wound clinic to underserved people, right in their communities.

Skunkworks: Hacking Wounds recently gathered diverse minds in Vancouver to come up with ideas to target this area. Providence Research organized the event.

GETTING OUT OF YOUR SANDBOX

The term ‘skunkworks’ originated in the 1940s as an alias for an American engineering lab that worked on top-secret and innovative programs at Lockheed Aircraft Corporation. Today, ‘skunkworks’ describes a proj-

ect developed by a loosely structured group of people who identify issues and pilot creative solutions.

The wound-clinic team included people from several disciplines, from Providence Health Care nurses to students from the University of British Columbia’s School of Biomedical Engineering.

“We kind of put a dream team together without knowing it,” says Lisa Maks, diabetes clinical nurse specialist with Providence Health.

“What really intrigued me about Skunkworks was bringing together people from different specialties and backgrounds, who shared the common goal of making a change,” says Theresa Khosrovi, a clinical nurse educator at Providence Health Care.

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EACH MEMBER BRINGS DIFFERENT SKILLS

Because they had unique experiences and skills, the participants learned from each other.

“My main takeaway is how helpful it is to step outside of your regular sandbox and to toss around ideas with other professions,” says Aggie Black, Director, Health Services and Clinical Research and Knowledge Translation at Providence Health.

The team took on the problem of how to help people underserved by the health care system to take care of their acute and chronic wounds.

Maks originally brought the problem pitch forward. She’s worked in diabetes care for 18 years, and has seen the impact that wounds have on patients’ quality of life. As soon as she heard about Skunkworks, which was an opportunity to work on ways to prevent wounds from escalating, she was in.

REPEAT VISITS FROM PATIENTS WHO LACK SUPPORT

Working in the acute medicine unit at St. Paul’s Hospital, Khosrovi would see patients returning with unhealed wounds due to a lack of support. “That made me think, what I could do to solve this never-ending cycle so that these people could actually fully heal and live their lives to the fullest?”

The team pitched a pop-up clinic that would bring wound care directly to underserved populations. It would offer to-go kits for those who can’t wait or would rather do the dressing themselves. The team would bring care where people already are by partnering with existing services like shelters and soup kitchens. During the event,

they received feedback from patient partners and mentors that this is an important and unmet need.

BENEFITS OF TREATING WOUNDS EARLY

By catching wounds in early stages, they would prevent hospital admissions, readmissions, and escalations of care like amputations. The pop-up clinic is not meant to be the ultimate solution, but to gradually get everyone in need connected with the health care system and to more permanent services.

“Ideally, the goal would be to work ourselves out of a job,” says Black. “Until we have a perfect health care system, where everyone feels welcome and respected, we sometimes need to take care to people where they are.”

CARING FOR PATIENTS “STILL FALLING THROUGH THE CRACKS”

“I felt like the judges really saw what we were trying to get them to see – that this is a gap, and that we can provide an innovative solution, evaluate, and see if it makes a difference,” says Black.

“Part of the social justice mission is taking a hard look at how we’re doing things, and how we could do them better. Who are the patients that are still falling through the cracks?”

LOOKING BACK AND LOOKING FORWARD

Skunkworks: Hacking Wounds is a unique way for people from across disciplines to put their heads together and come up with creative solutions to problems surrounding wounds.

“It was a fabulous experience that I would do again in a heartbeat,” says Maks. ■ H

Providing outstanding

in

We believe that innovative care should be available to all patients. That is why we have dedicated ourselves to developing the wound care technologies that are as kind to patients as they are the bottom line. By shaping innovations for all, we’re shaping what’s possible. 1-800-463-7439 | www.smith-nephew.com

Novel wound care training to support evolving role of community care paramedics

There is paradigm shift towards Paramedic Services providing improved and expansive prehospital care. Training and education for Paramedic’s has been structured to support emergency acute care, however; with this paradigm shift to an expanded role for community care paramedics, the paramedic education model has expended to include inhouse, community care education including wound management. Traditional perceptions of the Paramedic Service are gradually being replaced with the view that it is a mobile health resource, able to provide an increasing range of assessment, treatment and diagnostic services.

Paramedic Services are playing a vital role in Ontario’s healthcare system, not just by providing a rapid response to emergency 911 calls and transferring patients to hospital but by becoming a portable healthcare service within the community. According to the Ontario Paramedic Association, there are over 11,000 Paramedics, 1200 Communications Officers and more than 2000 Support Staff who handle 1.75 million emergency calls every year in Ontario. Paramedics provide a critical service to 14.8 million Ontario residents in 444 communities.

The highly trained Paramedic’s in Ontario, were faced with a shift to work in multiple contexts of health care throughout the COVID-19 pandemic such as :

1. Long Term Care settings (other provinces utilized the Canadian Armed Forces)

2. Community Paramedics (providing hospital-level treatments in private residences)

3. COVID swabbing and COVID vaccine teams

4. Operation Remote Immunity (vaccinating communities in the far north) and

5. Emergency Departments (due to staffing shortages in hospitals)

There is a need for Paramedics to take wound care education in order to develop knowledge, skills and an understanding of modern technology to provide healthcare to individuals inside of the community environ-

ment. Paramedics reach a wide range of patient groups including those patients who need an emergency response to individuals who do not have a life-threatening condition but are seeking urgent advice or treatment, and to those whose condition or location prevents them from travelling easily to access healthcare services such as the elderly.

Paramedics are not generally trained or educated in chronic wound management. With the paradigm shift towards Paramedic Services providing improved and expansive pre hospital care, knowledge about the principles of best practice in wound care for the paramedic on the scene to facilitate care delivery within the home environment can reduce the need for acute hospital care which places a heavier demand on the time and costs of all parties involved.

Wound care is an integral part of the role of the Paramedic and is a clinical skill supported by evidence-based knowledge that is acquired during an educational process. The overall aim of managing wounds is to promote healing and to achieve wound closure as quickly as possible. It is well documented that wound care has advanced significantly

within recent years and with the development of wound care specialists who are knowledgeable in research, policy and practice and are able to effectively bridge the gap across theory and practice. Other health professionals, such as paramedics, have the opportunity to learn skills and techniques in wound management by sharing best practice and being able to access wound focused educational programs that are specifically tailored to paramedics to develop clinical skills in wound care.

In response to the paramedics evolving role, Nurses Specialized in Wound, Ostomy and Continence Canada (NSWOCC) saw an opportunity to develop and provide a wound management educational program that was designed for Paramedics. The Practice Enrichment Series for Paramedics: Wound Management, is a state-of-the-art educational program, designed to provide community care paramedics with the ability to provide optimal wound care in collaboration with an interprofessional team.

This educational program, which is offered through the NSWOCC Wound, Ostomy and Continence Institute, is a competency-based, selfpaced, online foundational program

in wound management facilitated by a team of Nurses Specialized in Wound, Ostomy and Continence (NSWOCs) who are Canadian Nurses Association (CNA) certified ( WOCC (C )). While this educational program is delivered on-line to provide a convenient way of learning, an onsite Paramedic Wound Management education program delivered by NSWOCs is available.

The goal of the program is to provide paramedics with knowledge about timely and appropriate wound intervention to positively impact patient outcomes through minimizing patient transfers to hospital and improving communications with community nurses and primary care providers. There is a strong focus on paramedic – nurse collaborations and pathways to care.

Paramedics now have a way to become educated in wound management in order to provide an essential healthcare service in the community. This will provide Ontarians with a new way to receive wound management in the community and could reduce unnecessary patient transfers to the hospital if the wound can be managed in the home. For more information on the program please visit nswoc.ca or email programmanager@wocinstitute.ca.

How Toronto Rehab continues to enhance

Telerehabilitation at UHN and beyond

team of researchers and clinicians at Toronto Rehab has launched the second edition of their Telerehabilitation Toolkit, marking UHN’s continued dedication to enhancing virtual care worldwide.

Toronto Rehab’s Brain Rehab Program and UHN’s KITE Research Institute launched Version 2.0 of the toolkit last month after receiving feedback from users to help tailor the original version.

The new edition includes 12 new patient-facing and clinician-facing videos of different telerehab scenarios in action.

“We created these videos because we know that the present and future of rehabilitative care means that organizations and providers rely more heavily on technology to support their patients,” says Dr. Meiqi Guo, Medi-

cal Director, Brain Program, Toronto Rehab.

“These videos will help inform patients and clinicians more holistically about how to improve, evaluate and participate in telerehab, an area that has seen increased demand since the onset of COVID.”

The videos, which can be accessed on YouTube, include topics from assessing balance and mobility in telerehab, choosing in-person or hybrid approaches to rehab, and preparing for your first telerehab session as a patient.

The team launched the first edition of the Telerehabilitation Toolkit in the fall of 2020, shortly after the onset COVID-19 pandemic, and it was widely downloaded across Canada and around the world.

But the impact of the toolkit goes far beyond the pandemic, as telerehab

This article was submitted by UHN News.

has since become a staple in rehabilitative care.

The toolkit set itself apart from similar initiatives by also including handson resources such as telerehab patient safety checklists, measures of balance and mobility that can be administered virtually and patient handouts on preparing for telerehab. It is available to rehab centres worldwide at no cost.

“The Telerehabilitation Toolkit reflects our heartfelt intention to remove as many barriers as possible, to delivering safe, efficient, and patient-centred rehabilitation,” says Dr. McKyla McIntyre, physiatrist at Toronto Rehab and a member of the development team.

“We continue to welcome user feedback to better help rehabilitation organizations and providers implement, improve, and evaluate virtual rehabilitation worldwide.” ■ H

Toronto Rehab’s Telerehabilitation Toolkit was released in the fall of 2020 following the COVID-19 pandemic. After receiving positive feedback from patients and clinicians, the team has launched a second edition that includes more content and examples of telerehab in action.

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Home health monitoring: The future of senior continuity of care

By Jiang Li

Providing ongoing care to geriatric patients presents a number of challenges including ensuring they receive needed care outside traditional channels. Geriatric patients can be particularly vulnerable to inadequate access to appropriate care, but there are options available. Remote patient monitoring technology can facilitate continuity of care from inpatient treatment to at-home recovery.

In 2020, the Canadian Virtual Care Task Force (VCTF) announced that both patients and physicians would be required to engage virtual platforms as part of standard care supported by multiple medical organization initiatives. However, the VCTF continues to face obstacles to implementation including instituting a framework for virtual care governance, establishing standards for providing care, securing funding as part of the public health care system, promoting guidance, and urging local governments and medical associations to include virtual care in care agreements. Laying the groundwork provides a foundation to help combat the discontinuity of care that can result from health systems failing to fully embrace telehealth opportunities.

ACCESS TO DATA

For the senior population, it’s necessary to address both chronic conditions that require periodic check-ins as well

as acute conditions in which there’s a specific need for more diligent shortterm and proactive monitoring. In the past, it was the patient’s responsibility to report symptoms or to wait for a follow-up call from the provider. But there’s a better way. Patients outfitted with medical wearables before they are discharged from hospital can be continually monitored after leaving the medical facility using a biometric data platform to maintain continuity of care.

A recent study examined the impact of virtual care with remote monitoring technology and standard care of more than 900 participants averaging 63 years old who received non-elective surgery in eight acute care hospitals in Canada. The monitoring technology measured blood pressure, heart and respiratory rates, oxygen saturation, temperature, and body weight. Among the results, fewer patients with virtual care reported pain at periodic intervals, and drug errors were detected and corrected in more patients in the virtual care group. And, fewer patients in the virtual care group required acute hospital care. All this data supports the concept that ongoing remote monitoring enables interventions which can support improved outcomes once a patient is discharged to home.

The most recent data available from 2020 says heart disease is the second leading cause of death in Canada. Pro-

grams that incorporate forms of telemonitoring can improve heart failure outcomes according to a study that evaluated patients in an outpatient heart function clinic in Toronto. The Medly program is based on patients using a mobile phone app rather than a wearable device to record data, receive care messaging, and generate alerts for the care team. While not as comprehensive as a remote patient monitoring platform that continuously records and stores data, there was a significant decrease (50 per cent) in heart failure related hospitalizations in the six months after enrolling in the program. The ability to intervene and reduce the need for hospital admission significantly impacts both the patients and the providers who continually face a shortage of beds and provider care.

KEYS TO SUCCESS

Addressing cost is always a consideration in trying to drive procedural and behavioral changes for both providers and patients. The VCTF acknowledges the challenge and recommends permanent fee codes and remunerating providers equally whether the care is provided on-site or virtually. The Alberta Health Virtual Care is one example of a plan to implement virtual care technology to help patients and providers better manage healthcare needs, which can be especially important for seniors and those in rural areas

without proximate access to traditional care locations.

Access to telemonitoring and remote monitoring technologies is critical to help seniors who chose to age in place as well as those who are discharged from inpatient care to recuperate at home rather than another rehabilitation care facility. Affordable options can make it possible for patients to better manage chronic conditions while continuing to live at home. Having access to real-time data about their health empowers patients to feel more in control while providing physicians and other caregivers with the information needed to monitor both chronic and acute conditions as well as intervene when needed to prevent hospitalizations. Access to biometric data helps providers determine how to best manage a potential incident which in turn offers peace of mind for senior patients that they aren’t alone in their healthcare journey. Although there have been many innovative point solutions, such as bedsheet sensors, smart toilets, and AI enabled video surveillance that have emerged on the market, there is still a lack of comprehensive and user friendly systems that can address various needs from the seniors and service providers. The development and deployment of such turnkey solutions is a key success factor for the eventual adoption of home health monitoring technology for seniors. ■ H

Jiang Li is CEO of Vivalink.

New hospital bridges a health care gap in Southeastern Ontario

By Jonna Semple-Kloke

Southeastern Ontario resident, 82-year-old Ada Groves, was unsure what her future would look like when she fell and broke her wrist last year.

After receiving acute care in nearby Kingston hospital she arrived at the newly opened Providence Transitional Care Centre (PTCC), a 64-bed, specialized, inpatient hospital, to rebuild her strength before returning home.

“The care is excellent,” says Ada Groves. “I didn’t even know this place existed before I arrived. I’m so happy I came here.”

Open since October 2021, PTCC provides restorative care, cognitive behavioral support, short-stay respite and convalescent care; services all un-

der the umbrella of transitional care. The goal is to enhance the level of function in older, frail, adults while promoting and preserving wellness. All with a focus on transitioning patients home to the community when they are ready.

“Our goal is to help people remain in the community for as long as possible,” explains Darcy Woods-Fournier, Interim Vice President, Patient & Client Care and Chief Nursing Executive with Providence Care.

“When individuals come to PTCC for care, we develop a care plan based

on their specific needs and help them with their activities of daily living, all while supporting their return to wellness as quickly as possible,” she adds.

In just over one year, the hospital is already making a significant difference in health care delivery and improving the overall patient experience. More than 65 per cent or 120 of the 234 patients admitted have returned to their homes, while 10 per cent have gone to long-term care, and some of the remaining have transferred to Providence Care Hospital for higher-intensity rehabilitation.

“The services and level-of-care provided at PTCC specifically address an identified gap that we had in Southeastern Ontario,” further explains Woods-Fournier. “With 77 per cent of patients coming from our local acute care provider, Kingston Health Sciences Centre, we continue to work together to better coordinate care and improve outcomes for the people we serve.”

PTCC, with the help from its allied partners, is reducing the use and length of stay in regional hospitals and diverting admissions from the Emergency Department. The length of a patient’s stay varies depending on the type of care required, however on average last about 60 days.

“OUR GOAL IS TO HELP PEOPLE REMAIN IN THE COMMUNITY FOR AS LONG AS POSSIBLE.”

Are we ready for the tsunami of aging patients in the health care system?

By Roy Butler, PhD Roy Butler, PhD is the President and CEO at St. Joseph’s Health Care London

For decades we have been preparing for the wave of aging baby boomers expected to flood our health care system. We have built expertise in geriatrics and pathways to care for older adults that focus on their complex needs while enhancing quality of life. But now that the wave is upon us - at a time of great strain on our system - are we ready for the tsunami of patients yet to come?

According to the Canadian Institute for Health Information, Canada’s senior population has more than tripled in the last 40 years, a trajectory that continues. Today, one in five people is over age 65, with that number expected to grow to one in four over the next 25 years. Those over 75, a group at higher risk for frailty, is growing at an even faster pace.

Older adults with frailty are those over the age of 65 who are experiencing increased vulnerability from a combination of physical, cognitive, social

Continued from page 25

New hospital

For Ms. Groves, she says she is grateful for the compassionate staff, extra support and care she had while she recovered.

In most cases, upon discharge from PTCC patients receive community support and home-care once they return home, ensuring a successful transition. However now, the hospital has recently received additional Ministry of Health funding for a pilot program called the Providence Care Transitions Home Program, which will extend the PTCC allied health care team into the community, supporting the patient and caregiver from hospital to home.

“This new program means enhanced continuity of care,” says Woods-Fournier.

and emotional factors that influence their ability to withstand life stressors. These individuals have an increased

risk of hospitalization, longer hospital stays, hospital readmission, emergency department visits and in-hospital death. A staggering 340,000 seniors at risk of frailty are admitted to hospital each year.

Break down silos between sectors to help ensure that older adults with frailty receive the care they need –close to home – when they need it. This includes streamlining navigation through cross-sectoral partnerships, community-driven coordinated intake and access points and better mechanisms for information sharing.

Bring together providers from different health care organizations and sectors to wrap care around patients as a collective. This requires clarifying roles to understand which organization best serves which type of patient and creating formal communication opportunities, such as shared rounds.

Improve information access and knowledge sharing for older adults, caregivers and health care providers. Stakeholders need to be able to find reliable information to navigate the system and make sense of work happening both provincially and regionally.

“The patients’ skills and confidence they’ve built up at PTCC will continue once they are home with a team they are already familiar and comfortable with; a team who knows and supports their unique journey,” she adds.

“We are bridging the gap in healthcare, alleviating the strain on regional hospitals, while helping older adults age well at home.”

The PTCC inter-professional care team taking part in the new pilot-program includes occupational therapists and assistants, physiotherapists and assistants, recreational therapists and behavioural therapists.

More patients, just like Ms. Groves, will now be able to benefit from familiar, extended support in the comfort of their own homes with a team they know and trust. ■ H

Jonna Semple-Kloke is a Communications Officer at Providence Care.

St. Joseph’s Health Care London (St. Joseph’s) has been the regional lead in Southwestern Ontario for geriatric programs and services for more than 30 years. In 2017, with the support of Ontario Health West, St. Joseph’s set out under the Southwest Frail Senior Strategy to improve outcomes and experiences for older adults with frailty and their caregivers through creation of an integrated health care system in Southwestern Ontario. Through this work, and in consultation with patients, caregivers, providers and community partners, we learned key lessons in enhancing the quality of care for older adults, providing equitable access to services and improving the patient and caregiver experience. As a system, key steps are required now if we are to meet the looming challenges ahead. We must...

Advocate for government investment beyond long-term care. Investment is also needed in suitable housing options for older adults such as assisted living and improved home care and community services so individuals can continue to safely live at home.

Address the ageism that exists in our system and society.

In a recent St. Joseph’s DocTalks Podcast episode, Dr. Sheri-Lynn Kane, Chief of Geriatric Medicine at St. Joseph’s identifies a common misperception that, “…anyone with white hair and a blue gown is going to be a drain on the health care system.” The opposite is actually true, she says. Older adults are extremely resilient and resourceful and have a lifetime of experience, perspective, time and talent we should tap into and harness.

So, perhaps the question is not, “Are we ready?” It is, “Are we doing the work necessary to get there?” I’m optimistic that, together, we can face the wave and continue to provide older adults with the respect, care and compassion they deserve. ■ H

Roy Butler, PhD is the President and CEO at St. Joseph’s Health Care London.

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Five resources for people living with dementia and their caregivers

By Nicole Pacampara

Last month, Alzheimer’s Awareness Month drew attention to the impact Alzheimer’s disease and other forms of dementia have on individuals, families, and communities. With more than 55 million people living with dementia worldwide, and nearly 10 million new cases every year (World Health Organization), there is a pressing need for resources to inform and support those living with dementia and their caregivers.

The Centre for Aging + Brain Health Innovation (CABHI), powered by Baycrest, presents five CABHI-supported companies and projects providing these invaluable resources:

iGeriCare is an award-winning dementia education program developed by experts in geriatrics, mental health, and online learning. It offers valuable information to newly diagnosed individuals with dementia or mild cognitive disorder, their families, caregivers, and health care providers.

Trualta provides training and support tools, conveyed through bitesized video clips, to help family caregivers build the skills they need to assist loved ones in continuing to live at home safely. Video topics include managing challenging behaviours such as wandering and lowering the risk of falls, which can be especially dangerous for individuals living with dementia.

The Driving & Dementia Roadmap, a first-of-its-kind, free, online resource empowers older adults living with dementia to make informed decisions about when to stop driving. Researchers from Baycrest, Sunnybrook Health Sciences Centre, and the Canadian Consortium on Neurodegeneration in Aging (CCNA) developed the roadmap to bring together information, videos, worksheets, and other materials to help navigate the decision in a way that honours the individual while involving their family or close community.

PairingCare is a dementia homecare platform through which individuals living with dementia and their caregivers can connect directly with professional homecare providers. With

PairingCare, individuals can benefit from a wide selection of homecare providers and vice-versa. The platform can be used collaboratively to optimize the dementia journey in various healthcare settings.

Leap: Brain Talk with Dr. Larissa McKetton. Leap is CABHI’s virtual innovation community for older adults and caregivers. Each month, members can watch Brain Talk, a monthly webinar where Dr. Larissa McKetton (Director of Scientific and Clinical Development at Cogniciti) shares the latest research findings about ways to maintain and improve brain health. You can attend these webinars or watch previously recorded webinars by visiting Leap. ■ H

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, Bayshore’s home care services are extensive, tasks or round-the-clock care, Bayshore’s caregivers can help your loved ones to live

Let’s talk. 1.877.289.3997

Nicole Pacampara is a Digital Marketing and Communications Specialist at the Centre for Aging + Brain Health Innovation (CABHI)

Canadian front-line mental health professionals share timely insights on The stresses, scars and opportunities emerging from the pandemic

The people on the frontline of mental health care across Canada believe the pandemic has created an opportunity to look at care differently, however the financial realities of an economic downturn, and access to care, are significant barriers to positive change. This coming from a mid-January survey conducted by faculty in Yorkville University’s Master of Arts in Counselling Psychology (MACP) program. Yorkville University polled 2,200 members of their MACP community, and 7 Key Findings highlight challenges and opportunities emerging from the pandemic.

1. 92 per cent of the respondents agree that the pandemic left traumatic scars for individuals across Canada, more than half say the state of parents’ and caregivers’ mental health post-pandemic is somewhat or significantly deteriorating, citing eco-

nomic stresses, eroding resiliency, and fatigue as contributing factors.

2. 78 per cent say economic and financial hardships are the most pressing issues facing individuals suffering from mental illness. In addition, more than half of respondents ranked financial stress as a contributing factor impacting mental health in post-pandemic hybrid workplaces.

3. More than half of respondents ranked access to care as one of the most challenging barriers facing people suffering from mental illness.

4. 95 per cent believe strongly that the virtual mental healthcare services that accelerated expansion during the pandemic have been beneficial for Canadians.

5. 85 per cent believe that flexible and hybrid workplace policies are having a positive impact on people’s mental health.

6. 61 per cent of respondents also revealed trauma-informed practice as the top area of importance where more attention, training, and resources are required for psychotherapists dedicated to improving the mental health of Canadians.

7. 75 per cent believe trauma-informed and neuroscience and brain-based practices are the most important areas for mental health research, with the greatest potential to improve the lives of Canadians.

While the stigma of mental illness is reducing – and there’s always more we can do – the time is right for positive change.

“The last few years illuminated the importance of mental health as well as the fact that we are all connected, and all affected,” said Dr. Sarah Stewart-Spencer, Dean of Behavioral Sciences at Yorkville University, which provides Canada’s leading online

counsellor education graduate program. “There is no debating from this survey that Canadians are exhausted and struggling with the scars of the pandemic coupled with the economic realities they are now facing. However, with the stigma of mental health reducing, and the empathy and understanding of Canadians increasing, the time is right for the frontline to be heard and have access to the tools they need.”

“As leaders in the development of the next generation of mental health practitioners across Canada, we believe positive change can come from listening to those on the front line of care,” said, Julia Christensen Hughes, President of Yorkville University. “The response to this timely survey reaffirms that this is a community of empathetic change-makers who care deeply about having their voices heard as we all work together to support those suffering from mental illness.” ■ H

VHA Home HealthCare's THRU is a nursing & pharmacist-led team that: transitions client care between different settings and providers; supports Primary Care Providers with operational and clinical duties; operates COVID response and recovery clinics creates pop-up Wellness Clinics anywhere in the GTA; offers Remote Patient Monitoring expertise and virtual care for clients; and more!

Summer student research program helps improve patient care

When it comes to advancing cutting-edge medical care, William Osler Health System (Osler) often looks to its own team members, engaged partners, and an enthusiastic group of undergraduate students whose timely and practical research regularly leads to direct benefits to its community.

Faced with exponential growth in its research program and building on its longstanding commitment to learning and education, Osler launched its Summer Student Research Program (SSRP) in 2015, and invited applications from undergraduate students pursuing various fields of study across Ontario. The initiative opened the door for students to gain rare hands-on experience in practical short-term research, both clinical and non-clinical, within a community hospital setting.

“Osler is one of only a few community hospitals in Canada actively engaged in research, which includes Osler-initiated research projects, as well as partner-led clinical trials to test new medications and therapies,” said Patti Rempel, Director, Clinical Research, William Osler Health System. “We currently have close to 200 active research projects, all of which are dedicated to improving the quality of care we deliver to our patients every day, with students playing an important role in helping to advance our research.”

During the summer of 2022, 15 student research positions were funded by Employment and Social Development Canada’s Summer Jobs program, and four more by Toronto Metropolitan University, with whom Osler is currently partnering to help support the development of a School of Medicine in Brampton. Selected student applicants receive an enriching research experience.

“Given that many of the research projects are led by Osler clinicians who have daily clinical responsibilities in our hospitals, they keenly welcome student participation,” said Rempel, who notes that the SSRP matches

students to research projects based on their interests and areas of study. “It’s a win-win for researchers, students and, most importantly, for our patients.”

Among the many research projects benefiting from student involvement was one recently led by Osler renal pathologist, Dr. Shubha Bellur. Her study looked at the spectrum of renal diseases prevalent in Osler’s communities, and the benefit of providing in-house renal biopsy services to minimize wait times for results, leading to earlier medical treatment for patients and more efficient use of hospital resources.

Dr. Bellur’s small project team was supported by students Anika Sharma,

who is pursuing her Bachelor of Science degree at the University of Toronto, and Jessica Kaloti, who is pursuing a Bachelor of Science: Biology Research Specialization at McMaster University. “The Summer Student Research Program at Osler is an excellent opportunity for students like myself to gain firsthand research and clinical experience that supports our education and potential career goals. It has been an amazing experience to be part of Dr. Bellur’s research team,” said Sharma.

With the students’ support, the team conducted an audit of renal biopsies for 1,256 patients at Osler, with a focus on the turnaround time

for biopsies that were sent to outside laboratories to be read versus those read in-house. The team also recorded the spectrum of native renal diseases prevalent in the community, and any additional tests required to reach an accurate diagnosis.

What they discovered was that the turnaround time for results decreased by 25.8 per cent when renal biopsies were performed in-house, with physicians receiving a preliminary report on their patients’ results within one to two business days. This, most importantly, reduced the wait time for patients to begin medical treatment, which leads to better patient outcomes, and also led to greater efficiencies in the use of hospital resources.

“There’s no question that the impact of this research on our community will be near term and positive,” said Dr. Bellur, who was impressed with the work the two students contributed to advancing this research over the summer. “As we’re seeing a steady increase in renal biopsies in our community, Anika and Jessica’s meticulous and attentive efforts on this project will help shape the future efficiency of the renal biopsy process at Osler.”

Osler serves one of the fastest growing regions in Ontario, providing care for 1.3 million people in Brampton, Etobicoke and surrounding communities. Given the region’s multi-cultural and multi-generational population, Osler fosters a culture of research, innovation and learning by working together with team members, research partners, students and academic institutions to advance excellent, evidence-based care.

“We’re proud of the high calibre research and learning environment we have created at Osler and, as it continues to flourish, we are committed to sharing what we learn for the benefit of all patients both within and beyond Osler,” said Rempel.

Osler’s SSRP runs from May to August each year. For more information visit www.williamoslerhs.ca/SummerStudentResearchProgram.

Nika Sharma and Jessica Kaloti

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