Hospital News July 2022 Edition by Hospital News

Inside: From the CEO’s Desk | Evidence Matters | Safe Medication | Ethics

July 2022 Edition

www.hospitalnews.com

FEATURED

The next

cardiovascular

epidemic Page 14

Are You Protected From An Unexpected Loss of Income? Our Signature package (Life, LTD and ADD&D) is tailor-made for those who already KDYH KHDOWK EHQHȴWV WKURXJK D VSRXVH RU RWKHU JURXS SODQ CELEBRATING 25 YEARS 1997 - 2022

$VN XV DERXW RXU %2186 /7' R΍HU ZKHQ \RX FDOO 1-866-768-1477 | www.healthcareproviders.ca

keepnursingstrong.ca

The real emergency Every month in Ontario more than half a million people turn to hospital Emergency Departments for urgent medical care. But the system is overwhelmed. Patients are waiting hours to be assessed, and can wait days to get a bed in the right unit. It’s hallway medicine at its worst. This is a direct impact of a growing shortage of nurses and healthcare professionals. Emergency departments are working with 50-percent less staff at the same time as occupancy rates are up as much as 400 percent. One ER nurse might be caring for as many as 30 patients. In these situations, nurses simply don’t have time to provide the level of attention patients deserve. This can’t go on. The emergency is real, and it must be answered.

Contents July 2022 Edition

IN THIS ISSUE:

New tool shows promise in helping people manage traumatic brain injuries

▲ Cover story: The next cardiovascular epidemic

▲ The golden future of cardiac tissue repair

▲ Growing cardiovascular services to address high incidence of heart disease

COLUMNS Editor’s Note ....................4 In brief .............................6 Evidence matters ...........18

Safe medication ............20 From the CEO’s desk .....26 Ethics .............................28

▲ Major Canadianled trial finds vitamin C doesn’t help sepsis patients

▲ What a bariatric surgeon wishes you knew about obesity

www.hospitalnews.com

JULY 2022 HOSPITAL NEWS 3

‘Summer of Rage’ coming on abortion rights in the U.S. By Joanne H. Wright merican pro-choice advocates promised a “Summer of Rage” if the Supreme Court overturned Roe v. Wade – the landmark case that made women’s right to choose abortion legal in the United States. With the decision to overturn now officially announced, the protesters are making good on their promise. And why wouldn’t they? A constitutional right that women have enjoyed for almost fifty years is now gone. The impact of this decision is already spilling over into Canada. There are reasonable fears that anti-choice advocates and lawmakers here will be emboldened. It is a basic democratic principle that citizens have a role in shaping the laws that will govern them. But clearly, in lawmaking, the voices of women are too often missing. When U.S. Supreme Court Justice Samuel Alito wrote in the leaked decision that it’s time to return this issue to legislators, he completely ignored the history of the struggle to get abortion decriminalized in the first place. Challenging restrictive laws in the courts was often the only way to force change. Even in states where the majority of citizens support women’s right to choose, restrictive abortion laws get passed because there are not enough women and people who support reproductive justice elected to office. Consider the state of Texas where some of the most restrictive abortion laws have been passed – the vast majority of elected members are white men. Women

make up only 27 per cent of the Legislature, despite the population of Texas being 40 per cent Hispanic and 50 per cent women. If we really want to know what the impact on American women will be, we need only look to other countries where restrictive abortion laws persist: Poland, El Salvador, and, until recently, Mexico, Northern Ireland and the Republic of Ireland. In these states, women have had to travel to obtain a medical procedure that is, in many other places, legal and safe. Where there is no legal access to abortion, women have to carry unwanted pregnancies to term or risk their lives and health to take matters into their own hands. American women seeking an abortion will have no choice but to seek abortion services in Canada and elsewhere. Cross-border abortion traffic is not a new phenomenon, but it is likely to intensify as access is restricted under new state laws. Preparations are already underway in Canada and in US states where legal abortion will be protected. Around the world, if we want better, more equitable judicial decisions and better laws and policies, we need greater gender parity in our judicial and representative bodies. Only then will there be the critical mass necessary to get diverse women’s voices heard, and not just on abortion and reproductive justice. Greater representation of women and gender diverse people will increase the likelihood of developing better public policy all round. Continued on page 6

610 Applewood Crescent, Suite 401 Vaughan Ontario L4K 0E3 TEL. 905.532.2600|FAX 1.888.546.6189

www.hospitalnews.com Editor

Kristie Jones

editor@hospitalnews.com Advertising Representatives

Denise Hodgson

denise@hospitalnews.com Publisher

Stefan Dreesen

stefan@hospitalnews.com Accounting Inquiries

accountingteam@mediaclassified.ca Circulation Inquiries

info@hospitalnews.com Director of Print Media

Lauren Reid-Sachs

Senior Graphic Designer

Johannah Lorenzo

ADVISORY BOARD Barb Mildon,

RN, PHD, CHE VP Professional Practice & Research & CNE, Ontario Shores Centre for Mental Health Sciences

Helen Reilly,

Publicist Health-Care Communications

Jane Adams,

President Brainstorm Communications & Creations

Bobbi Greenberg,

Health care communications

Sarah Quadri Magnotta, Health care communications

Dr. Cory Ross,

B.A., MS.C., DC, CSM (OXON), MBA, CHE Vice President, Academic George Brown College, Toronto, ON ASSOCIATE PARTNERS:

UPCOMING DEADLINES AUGUST 2022 ISSUE

SEPTEMBER 2022 ISSUE

EDITORIAL: July 5 ADVERTISING: Display – July 22 | Material – July 26

EDITORIAL: August 9 ADVERTISING: Display – August 26 | Material – August 30

Monthly Focus: Paediatrics/Ambulatory Care/Neurology/ Hospital-based Social Work: Paediatric programs and developments in the treatment of paediatric disorders including autism. Specialized programs offered on an outpatient basis. Developments in the treatment of neurodegenerative disorders (Alzheimer’s, Parkinson’s etc.), traumatic brain injury and tumours. Social work programs helping patients and families address the impact of illness.

Monthly Focus: Programs and initiatives that Emergency Services/ Critical Care/Trauma/Emergency: Innovations in emergency and trauma delivery systems. Emergency preparedness issues facing hospitals and how they are addressing them. Advances in critical care medicine. + ONLINE EDUCATION SUPPLEMENT + SPECIAL FOCUS: EMERGENCY ROOM

THANKS TO OUR ADVERTISERS Hospital News is provided at no cost in hospitals. When you visit our advertisers, please mention you saw their ads in Hospital News. 4 HOSPITAL NEWS JULY 2022

Hospital News is published for hospital health-care professionals, patients, visitors and students. It is available free of charge from distribution racks in hospitals in Ontario. Bulk subscriptions are available for hospitals outside Ontario. The statements, opinions and viewpoints made or expressed by the writers do not necessarily represent the opinions and views of Hospital News, or the publishers. Hospital News and Members of the Advisory Board assume no responsibility or liability for claims, statements, opinions or views, written or reported by its contributing writers, including product or service information that is advertised. Changes of address, notices, subscriptions orders and undeliverable address notifications. Subscription rate in Canada for single copies is $29.40 per year. Send enquiries to: subscriptions@ hospitalnews.com Canadian Publications mail sales product agreement number 42578518.

www.hospitalnews.com

NEWS

Major Canadian-led trial finds vitamin C doesn’t help sepsis patients By Samantha Sexton he largest study of its kind investigating the use of high-dose vitamin C for the treatment of patients with sepsis has found this vitamin does not reduce the risk of death or organ dysfunction. Results of the multi-centre trial, called LOVIT (Lessening Organ Dysfunction with VITamin C), led by researchers at Centre de recherche du CHUS du CIUSSS de l’Estrie – CHUS and Sunnybrook Health Sciences Centre, were published in the New England Journal of Medicine and presented at the Critical Care Reviews meeting in Belfast, Ireland today. “Among adults with sepsis in the intensive care unit, high-dose intravenous vitamin C was found not to be a helpful treatment. Importantly, we also found that study participants in the treatment group had a higher risk of death or persistent organ dysfunction at 28 days, compared to those who did not receive the treatment,” say co-principal investigators of the study Dr. Neill Adhikari, critical care physician and associate scientist at Sunnybrook Health Sciences Centre, and Dr. François Lamontagne, full professor at Université de Sherbrooke and clinician-scientist at Centre de recherche du CHUS. Patients in the trial were randomized into a treatment or placebo group.

At day 28, 191 of 429 patients (44.5%) in the vitamin C group had died or had persistent organ dysfunction, as compared with 167 of 434 patients (38.5%) in the placebo group. “Given this, we advise against using high-dose vitamin C to treat sepsis patients, unless they are part of a clinical trial,” say the principal investigators. The results challenge a treatment that has been viewed as a promising treatment for sepsis, which occurs when the body develops organ dysfunction in response to an infection. Current treatment options for sepsis are focused on antimicrobials and supportive care, such as intravenous fluids, vasopressors, mechanical ventilation and renal replacement therapy. The authors say interest in intravenous vitamin C took off about three years ago, when a non-randomized American study found that a combination of vitamin C, steroids and thiamine, also known as vitamin B1, led to a dramatic drop in mortality among septic intensive care unit patients. Although other subsequent trials have looked at vitamin C alone, the LOVIT trial is the largest to date, enrolling 872 patients from 35 intensive care units in Canada, France and New Zealand between 2018 and 2021. “When we began the study, we were caught between two groups – pro-

ponents of the potential therapy and those who felt that it lacked evidence. With such strong opinions, we knew it needed to be studied further,” say the principal investigators. “Clinical trials like this are critical for examining currently used interventions and telling us what should be used, what should not be used, or what should be used differently.” The authors have also conducted an updated systematic review and meta-analysis, published today in NEJM Evidence. Overall, this review found no convincing evidence of a benefit of vitamin C in hospitalized patients with infection. Trials of vitamin C showed variable results, which may

in part be explained by differences in study methodologies. The authors also hypothesize that vitamin C may be effective in some but not all causes of sepsis, which is a syndrome caused by a variety of viral and bacterial infections. The researchers continue to study vitamin C in hospitalized patients with COVID-19 as part of two separate ongoing trials, which are being closely monitored. “Our results from LOVIT serve as another example of the importance of embedding research in clinical care,” say the investigators. “Treatments administered to our patients should be H examined in high-quality studies.” ■

Samantha Sexton is a Communications Advisor at Sunnybrook Health Sciences Centre.

We HEAR you. We STAND with you.

JOIN NOW! at join.RNAO.ca 800-268-7199 www.hospitalnews.com

J OIN NOW! It’s only

SO WE CAN STAND TOGETHER.

$50 + HST

with PLP included

$256.36 JULY 2022 HOSPITAL NEWS 5

IN BRIEF

Measures to reduce drug shortages in Canada during COVID-19 worked easures introduced to reduce shortages of prescription drugs in Canada during the pandemic in March 2020 appeared to be somewhat effective, according to new research published in CMAJ (Canadian Medical Association Journal). Drug shortages are an ongoing issue in Canada and other countries, with almost half of all drugs running short during the last five years. Amidst worries that the pandemic would exacerbate the situation because of supply chain disruptions and increased

DRUG SHORTAGES ARE AN ONGOING ISSUE IN CANADA AND OTHER COUNTRIES, WITH ALMOST HALF OF ALL DRUGS RUNNING SHORT DURING THE LAST FIVE YEARS. demand for some drugs used to treat patients with COVID-19, the federal Minister of Health issued an interim order that allowed certain key drugs at high risk of shortage to be imported and sold in Canada. Among other actions taken to address the issue, the federal government also amended the Patent

Continued from page 4

‘Summer of Rage’ Even a lone woman or a few women at the table can have an impact. The Right Honourable Kim Campbell, Canada’s first woman Prime Minister, tells the story of sitting at the cabinet table earlier in her political career listening to male colleagues discuss the need for women to learn more about birth control so they wouldn’t need an abortion. She seized the moment and began to list the number of fraught and flawed birth control methods she had had the misfortune of using in her time. As Minister of Justice, Campbell brought forward the no-means-no sexual assault law that contained a new rape-shield provision (protecting women making a sexual assault allegation from interrogation about their sexual past). This law was far from popular and received a lot of public ridicule for the emphasis it placed on consent. Another Canadian pioneer, Justice Bertha Wilson, the first woman on the Supreme Court, made the vital link between a woman’s ability to choose whether or not to reproduce and her basic liberty and human dignity. In the Mortgentaler decision that decriminalized abortion on the basis that aspects of the law violated a woman’s security of the person, Justice Wil-

Monkeypox virus: five things to know ith the recent rise in cases of monkeypox virus, clinicians may need guidance for diagnosing and treating the virus, which is new to Canada. An article published in CMAJ (Canadian Medical Association Journal) summarizes five things to know about the virus, which is endemic to West and Central Africa. 1. Monkeypox is a viral infection with person-to-person transmission through direct and close contact during the infectious stages. Airborne transmission is thought to be less common. 2. A rash with distinct skin lesions is typically preceded by symptoms such as fever, aches and swollen lymph nodes, but not always. Clinicians should also consider syphilis, chancroid, varicella zoster, herpes simplex, hand-footand-mouth disease, mulloscum contagiousum, and cryptococcus. Patients are likely to be infectious

Joanne H. Wright son offered her own concurring judgement. She argued that not having reproductive choice makes a woman a means to an end which is not her own. This would make her subject to the control of the state, a passive recipient of a fundamental decision about her own body. Justice Wilson asks “can we imagine anything that comports less with human dignity and respect?” The Summer of Rage is rightly focussed on abortion rights given what is unfolding in the United States. That rage should also be directed at the need for gender parity in all of our poH litical institutions – in Canada too. ■

Joanne H. Wright is a professor of Political Science at the University of New Brunswick. Her research examines gender and politics and the history of women’s citizenship rights. 6 HOSPITAL NEWS JULY 2022

Act on March 25, 2020, to allow manufacturers to make, use or sell versions of patented drugs without requiring negotiation with patent holders. To determine whether these policies were successful, researchers used a time series analysis to track drug shortage rates over time and found that rates of prescription drug shortages reduced markedly in the first year after new legal flexibilities were introduced and then plateaued. “The new measures to resolve and reduce shortages during the COVID-19 pandemic appeared to have had a substantial positive im-

pact,” writes Dr. Reed Beall, University of Calgary, Calgary, Alberta, with coauthors. “These measures should be maintained, sustained and built upon in the long term to minimize the harms caused to patient care and to professional practice.” The policies were made permanent in March 2022. “Our study adds to the literature on drug shortage tracking during the COVID-19 pandemic by observing that Canada’s high rates of drug shortages declined (especially among non-patented drugs) in the first year after the institution of interim shortage mitigation policies,” conclude the authors. “COVID-19 and the prevalence of drug shortages in Canada: a cross-sectional time series analysis from April 2017 to April 2022” was published H June 13, 2022. ■

from the start of symptoms until all scabs have resolved. 3. Health care providers should follow airborne, droplet and contact precautions and notify public health authorities when testing for monkeypox, including for sample collection. Diagnosis is made with real-time polymerase chain reaction (PCR) testing. Consultation with an infectious disease specialist or microbiologist is advised to support clinical assessment. 4. Most patients with monkeypox can be managed as outpatients. 5. Smallpox vaccination is effective for monkeypox, and vaccination of high-risk contacts (ring vaccination) and contact tracing may help contain spread. People with previous vaccination against smallpox (e.g., many born before 1970) have some cross-protective immunity to monkeypox. “The monkeypox virus” was pubH lished June 2, 2022 ■ www.hospitalnews.com

Wound Care Solutions

IN BRIEF

Life-support system reduced COVID-19 mortality by 7.1 per cent, study shows new study published in the British Medical Journal (BMJ), led by UHN researchers and the COVID-19 Critical Care Consortium (COVID Critical), showed that ECMO (extracorporeal membrane oxygenation), a life support system for patients with acute respiratory failure, was associated with a reduction in COVID mortality by 7.1 per cent when compared with mechanical ventilation alone. During the pandemic, ECMO has been used around the world as a last-resort intervention to save some of the sickest COVID-19 patients. This study is the first to demonstrate that it provides a significant benefit in acute respiratory failure due to COVID-19, particularly for patients with age less than 65 years with severely impaired gas exchange or exposure to higher intensities of mechanical ventilation in the early phase of the disease course.

This was the largest international, registry-based cohort study looking into ECMO effectiveness to treat acute respiratory failure caused by COVID-19. It compared outcomes of 7,345 adult patients admitted to intensive care units with clinically suspected or laboratory confirmed case of COVID in 30 countries. The senior author of the study is Dr. Eddy Fan, a scientist at the Toronto General Hospital Research Institute and Medical Director of the Extracorporeal Life Support Program (ECLS) at UHN. He says this high-impact study was made possible by the global alliance of healthcare professionals and researchers behind COVID Critical. “Less than two years ago, the world had no data, no information on how effective ECMO was in treating patients with COVID-related severe acute respiratory failure,” he says.

“With this study, we were able to take millions of datapoints, use the data to mimic a randomised controlled trial (RCT) and close this knowledge gap,” says Dr. Fan, who is also an Associate Professor of Medicine at the University of Toronto. Dr. Martin Urner, the study’s first author, and a clinical and research fellow in Critical Care Medicine at UHN, said by using advanced statistical methods to model a RCT, the team was able to quantify the effect of ECMO on outcomes of adult patients with COVID-19, compared to treatment with mechanical ventilation alone. “The findings provide evidence that ECMO is a highly effective and lifesaving therapy for well-selected patients with catastrophic forms of lung failure from COVID-19,” said Dr. Urner, who is also a PhD candidate in Clinical Epidemiology and Health Care Research at the Institute of Health Policy, Management and Evaluation at U of T.

According to COVID Critical Co-Founder John F. Fraser, Drs. Fan and Urner have taken “big data” and working with COVID Critical’s lead statisticians Drs. Adrian Barnett and Dr. Nicole White, have “cracked the code” to analyse observational data in a revolutionary way, mimicking a RCT, which could never be done in a clinical setting. “The way in which the data has been used is a world-first,” says Dr. Fraser. “We’ve taken the largest known resource of deidentified patient data and interrogated it to shed new light on COVID-19 and associated ARDS (Acute Respiratory Distress Syndrome) mortality and treatment options.” The COVID-19 Critical Care Consortium consists of more than 400 collaborating centres in 64 countries, contributing data to the world’s largest known database of COVID-19 ICU H patient information. ■

Innovative work underway and identifies improvements to boost cancer system capacity he Canadian Partnership Against Cancer (the Partnership) released a new report, The road to recovery: Cancer in the COVID-19 era, that urges policymakers and health system leaders to consider cancer a priority in the wake of the pandemic. Noting that time is of the essence, the report also shares innovative solutions already underway by partners in parts of Canada – which can be used as models for improvement by other communities across the country. “Canada must not forget cancer when allocating healthcare resources as we continue to deal with the impacts of the pandemic,” said Dr. Craig Earle, CEO of the Canadian Partnership Against Cancer. “The Partnership’s priority from the start of the pandemic was on meeting the needs of people with cancer whose disease did not stop, even as much of the world did, and our cancer system partners have done incredible work to deliver care during this challenging

8 HOSPITAL NEWS JULY 2022

time. As we shift to pandemic recovery, we’re keeping our focus on cancer and we urge others to do the same.” Lives are at stake. One study predicts the possibility of more than 20,000 additional cancer-related deaths over the next 10 years. However, that could be reduced by almost 16,000 if the cancer system’s diagnostic and treatment capacity is increased 10 per cent above pre-pandemic levels. Putting the focus on cancer in key areas “Strengthening Canada’s cancer system starts with getting a clear picture of what’s happening today, and what kinds of responses and investments will be needed for the future,” said Dr. Earle. “Policy-makers and cancer system leaders should take action now to focus on the key areas identified in The road to recovery, and can draw on the many examples of innovative, practical actions already underway across the country the report highlights.” These actions and solutions can be found here: https://www.partnershi-

pagainstcancer.ca/topics/cancer-incovid-19-era/actions-solutions/ The road to recovery: Cancer in the COVID-19 era identifies a number of challenges that arose during the pandemic, such as delays in cancer screening and diagnosis, disruption of cancer prevention services, treatment and care, and pressures on the healthcare workforce. This resulted in real impacts on real people, exacerbating health and social inequities, with a disproportionate effect on First Nations, Inuit and Métis. The report notes that, as COVID-19 continues to disrupt Canada’s cancer system, attention needs to be given to three key focus areas to boost system capacity and save lives: (1) solving the healthcare human resources crunch, (2) preparing for a surge in cases, and (3) leveraging the potential of new ways of delivering care including those supported by digital technologies. It also highlights the fact that, to improve care and outcomes for cancer

patients, health equity must be at the forefront of Canada’s pandemic response and recovery. The report brings together recent data and research from partners across Canada, and it also shares examples and stories of innovative approaches already underway to improve cancer care. “Throughout the pandemic, healthcare professionals and cancer system partners across Canada dedicated themselves to supporting patients and their families through a very difficult period,” said the Honourable JeanYves Duclos, Minister of Health. “Our government is committed to improving access to health care and supporting healthcare professionals to ensure Canadians have access to the care they deserve. This timely and insightful report provides examples and ideas to improve cancer care for patients everywhere.” Share your thoughts, actions and innovations on the road to recovery H using #FocusOnCancer. ■ www.hospitalnews.com

Virtual care for hospitals and health systems

Empowering health systems. Transforming healthcare delivery. Teladoc Health is enabling a new kind of healthcare experience with greater convenience, outcomes and value at unmatched quality and scale.

Canada's leader in virtual care, allowing you to: Free up nurse capacity to focus on the patient Improve access and care coordination ȶƺɨǉƃɰǉ ǉǹˎƺȈǉȶƺʰ ƃȶǁ ɥɨǉʤǉȶɽ ɨǉӸƃǁȴȈɰɰȈɁȶɰ Expand population health programs Deliver care conveniently and securely

Contact us today to learn more. Visit: teladochealth.com/en-CA/health-systems Contact: engage@teladochealth.com Whole person care for better health outcomes.

NEWS

New tool shows promise in helping people

manage traumatic brain injuries By Celine Zadorsky team at Lawson Health Research Institute and St. Joseph’s Health Care London, has created a new online tool called MyBrainPacer™ App to help assist people living with a mild traumatic brain injury (mTBI). mTBI’s, including concussions, may come with lasting effects that can alter a person’s life. Although a person with an mTBI may appear fine on the outside, many have to pace their day-today activities in order to allow the time needed for the brain to properly heal. That’s where the MyBrainPacer™ App can come into play as a helpful resource. “By documenting activity levels over time, patients and their clinicians can better understand what activities are linked to worsening symptoms, which they can therefore avoid,” explains Dr. Dalton Wolfe, Lawson Scientist. The online application is being used as a research tool, allowing Dr. Wolfe and his team to track its efficacy.

“BY DOCUMENTING ACTIVITY LEVELS OVER TIME, PATIENTS AND THEIR CLINICIANS CAN BETTER UNDERSTAND WHAT ACTIVITIES ARE LINKED TO WORSENING SYMPTOMS, WHICH THEY CAN THEREFORE AVOID.” Much like point tracking used by dieters to monitor food choices, through MyBrainPacer™ App, users can assign values to tasks like driving, grocery shopping, screen use and exercise so they can plan and pace their daily activity. Individual users are given a total number of points per day that will keep their persisting symptoms in the “safe range.” As users track their symptoms through the app, the app adjusts the daily point value to what is best for the user. The app is based on St. Joseph’s Pacing and Planning Program, which has helped hundreds of concussion patients achieve their recovery goals.

“By putting the app in the hands of patients and the clinicians who treat them, the app has the potential to give us data that traces the recovery patterns of patients and how that relates to the activities that they participate in over time,” adds Dr. Wolfe. “This will enable us to document safe levels of activity for persons with specific characteristics or symptom profiles, which could be the key to unravelling better treatment strategies.” After a number of concussions, study participant Cindy Vanderveen, has been using the app to manage her brain injury and has noticed a positive change.

“In the beginning I wasn’t able to drive farther than five minutes at a time,” remembers Cindy. “My care team at St. Joseph’s recommended MyBrainPacer™ App to help me plan and pace my day. Once I began to use the app to plan and track my activities, my symptoms dramatically decreased. I still have bad days and some tasks are harder than others, but through using MyBrainPacer™ App, I am able to do more activities independently and I am 90 per cent back to who I was.” Currently anyone with an mTBI can enroll as a study participant on the MyBrainPacer™ App by visiting mybrainpacer.ca. The research team is hoping to enroll approximately five-thousand users. The creation of the app has been made possible by funding provided by the Cowan Foundation and other community supporters through St. JoH seph’s Health Care Foundation. ■

Celine Zadorsky is a Communications Consultant at Lawson Health Research Institute. 10 HOSPITAL NEWS JULY 2022

www.hospitalnews.com

With diabetes on the rise, Time in Range is a powerful management tool By Dr. Bruce Perkins terns and fluctuations in blood glucose levels than the A1C test. Healthcare professionals have depended on the A1C blood test for close to three decades. It offers a great estimation of the average blood sugar levels over the past few months, but it doesn’t quite go as far as TIR. While A1C measures the average amount of glucose in the blood for two-to-threemonth periods, TIR captures the variation of blood glucose levels that occur both within a 24-hour period and over time. As a result, it’s a more immediate and more accurate summary of how an individual’s blood glucose levels may fluctuate on a daily basis. Think of it this way: two people with diabetes could appear to have the same blood glucose and A1C levels. However, one of them could have consistent levels, while the other might have levels that fluctuate dramatically from day to day, or hour to hour, over that same period of two to three months, with dangerous highs and lows. Identifying those fluctuations in real time can help reduce the risk of both short-term and long-term complications.

t’s no secret that the challenges for people living with chronic health conditions, including diabetes, have only worsened during the pandemic. And while more than five million Canadians live with diabetes now, this number is expected to rise over the next decade. As this number continues to grow, empowering patients with the tools to better monitor and live well with diabetes is becoming increasingly essential. To do this, one of the best tools at our disposal is monitoring their amount of time spent in their target range, or “Time in Range.”

WHAT IS “TIME IN RANGE” AND WHY IS IT IMPORTANT?

Time in Range (TIR), is a measure of the amount of time that a person with diabetes spends in their target blood glucose range. Wearing a continuous glucose monitor (CGM) can give a person this measure so that they have a better sense of when their blood glucose levels are fluctuating, how often and why. Managing blood glucose levels appropriately is a critical part of diabetes care, so monitoring TIR is a powerful tool. Spending as much TIR as possible can help prevent hypoglycaemia and hyperglycaemia, which we know can lead to serious complications, including damage to the blood vessels, neuropathy, retinopathy, nephropathy, heart attack and stroke, and even cancer. We also know that, even when individuals with diabetes are aware of these risks, daily diabetes management can be overwhelming. Monitoring TIR can help pinpoint fluctuations in blood glucose levels, empowering patients to review their patterns over the past weeks to plan better for the future, achieve consistent blood sugar

“DIABETES IS A LIFE-LONG, CHRONIC DISEASE THAT REQUIRES DAILY MANAGEMENT AND SPENDING TIME IN RANGE CAN SIGNIFICANTLY IMPROVE QUALITY OF LIFE FOR A PERSON LIVING WITH THE CONDITION.” goals, and prevent both the short- and long-term complications of this chronic disease. For physicians, using TIR as a metric helps determine what factors might cause a patient’s blood sugar levels to fluctuate – for example, lifestyle factors such as diet – and, in turn, enables

better and more personalized guidance on how to keep those levels in check.

HOW DOES TIME IN RANGE COMPARE TO THE A1C BLOOD TEST?

Recent evidence suggests that measuring TIR helps to better identify pat-

WHY IS LIVING “IN RANGE” HELPFUL FOR PEOPLE WITH DIABETES?

Diabetes is a life-long, chronic disease that requires daily management and spending TIR can significantly improve quality of life for a person living with the condition. While this constant management can be overwhelming at times, physicians can help by making sure their patients have the most up-to-date information and the best available tools. By taking a holistic and personalized approach to care, patients can be empowered to feel more in control and make the best decisions possible, so they can have optimal management of their condition H and truly live well with diabetes. Q

Dr. Bruce Perkins is an Endocrinologist and Director at the Diabetes Clinical Research Unit, Leadership Sinai Centre for Diabetes, Sinai Health System. www.hospitalnews.com

JULY 2022 HOSPITAL NEWS 11

NEWS

The golden future of cardiac tissue repair MEDICAL LAB ASSISTANT CERTIFICATION IS ALL YOU NEED!

Why get certified?

LOWEST PRICED MLA EXAM IN CANADA

PROVIDES PORTABILITY THROUGHOUT CANADA

PROFESSIONAL CREDENTIAL

NATIONAL RECOGNITION

MADE BY MLAS FOR MLAS

!³xn³ ǣɀ Ə ƬƺȸɎǣǔɵǣȇǕ ƫȒƳɵ ǔȒȸ ȅƺƳǣƬƏǼ ǼƏƫȒȸƏɎȒȸɵ ƏɀɀǣɀɎƏȇɎɀِ ɖȸ ƺɴƏȅ ɮƏǼǣƳƏɎƺɀ ɎǝƏɎ Əȇ ǣȇƳǣɮǣƳɖƏǼ ǝƏɀ ƏɎɎƏǣȇƺƳ Ə ƬƺȸɎƏǣȇ ǼƺɮƺǼ Ȓǔ ɀɎƏȇƳƏȸƳɀ ƏȇƳ ɎȸƏǣȇǣȇǕِ

&DQDGLDQ 6RFLHW\ IRU 0HGLFDO /DERUDWRU\ 6FLHQFH 6RFL©W© FDQDGLHQQH GH VFLHQFH GH ODERUDWRLUH P©GLFDO

nƺƏȸȇ ȅȒȸƺ ƏɎ ƬɀȅǼɀِȒȸǕٖȅǼƏ 12 HOSPITAL NEWS JULY 2022

esearchers at the University of Ottawa Heart Institute (UOHI) have discovered gold nanoparticles and synthesized peptides restore function, contractility, and electrical conductivity to damaged heart tissue – a scientific feat which may one day be applied to save human lives. The breakthrough research made the cover of the March issue of ACS Nano, a monthly, peer-reviewed, scientific journal of the American Chemical Society. Dr. Marcelo Muñoz, a chemist in the Bio-Engineering and Therapeutic Solutions (BEaTS) Laboratory at the UOHI, and the primary author of the study along with fellow researcher, scientist and PhD candidate Cagla Eren Cimenci, said heart attack survivors are increasing thanks to leaps in scientific innovation, technology, and patient care. On the other hand, many heart attack survivors go on to develop an often-fatal condition called heart failure, which results from injuries sustained during the attack. When a heart attack (myocardial infarction) occurs, one or more of the coronary arteries shut down, cutting off blood supply, nutrients, and oxygen to cells (cardiomyocytes) on the heart. Without rapid intervention, the affected tissue is lost and cannot be recovered. A scar forms on the heart and, over time, the muscle weakens, until ultimately, it fails. Patients with heart failure are no longer capable of pumping enough blood to meet their bodies’ demands. Paradoxically, as deaths from heart attacks drop off, deaths from heart failure are on the rise. In Canada, as many as 750,000 people live with heart failure and 100,000 are diagnosed with the condition each year. Such staggering figures present scientists like Dr. Muñoz with important questions: Is a therapeutic solution capable of recovering damaged heart tissue even possible, and if so, can scientists use one to prevent a heart attack patient from becoming a patient with heart failure? To date, no such therapy exists. However, early tests in mice are proving demonstratively positive. Gold nanoparticles – that is, tiny flecks of gold so small they are invisible to the

naked eye – have been of keen interest to scientists for years. Their properties make them ideal for use in a variety of applications, including in electronics, nanotechnology and biomedicine.

GOLD NANOPARTICLES AND SYNTHESIZED PEPTIDES RESTORE FUNCTION, CONTRACTILITY, AND ELECTRICAL CONDUCTIVITY TO DAMAGED HEART TISSUE. Muñoz and his colleagues encapsulated and stabilized these tiny golden nanoparticles with nanoengineered peptides (strings of amino acids). The peptides were fortified with spider-like branches that stem outward from their core. Then, by using a specially designed micro-nozzle (imagine a can of spray paint with a tip so fine it could deliver the application within micrometres), the nanoparticle and peptide solution was sprayed onto a localized area of the heart. “When applied to mouse hearts, one week after infarction, the spray-on treatment resulted in an increase in cardiac function (2.4-fold), muscle contractility, and myocardial electrical conductivity,” writes Dr. Muñoz and his colleagues. “Our cumulative data suggest that the therapeutic action of our spray-on nanotherapeutic is highly effective, and in practice, its application is simpler than other regenerative approaches for treating an infarcted heart.” Researchers have studied stem cell injections, cardiac patches, exosome delivery, and drugs, but these approaches to myocardial tissue regeneration have not yet translated into the clinic. Stem cell therapies offer great promise for new medical treatments; however, the process is costly and can take months. The gold nanotherapeutic system developed at the UOHI can be stored in the fridge, is ready to use when required, remains stable over H time, and is a fraction of the cost. ■ www.hospitalnews.com

SPONSORED CONTENT

The heart health benefits of milk

Studies show that milk is part of cardioprotective eating patterns By Cara Rosenbloom, RD ine out of 10 Canadians have at least one risk factor for heart disease, stroke, or vascular cognitive impairment,1 and 23 percent of adults report that they have been diagnosed with hypertension or take anti-hypertensive medication.2 In addition to drug treatment, there are also lifestyle interventions, such as changes in eating habits, that can help manage high blood pressure and other risk factors for heart disease.3 Research shows that both the Mediterranean and Dietary Approaches to Stop Hypertension (DASH) eating patterns can help reduce heart disease risk and manage high blood pressure levels.4,5 Milk and dairy foods play a role in both the Mediterranean and the DASH eating patterns. In the Mediterranean eating pattern, dairy foods are recommended in moderate portions and can be enjoyed daily.6 This includes milk and fresh (non-fermented) cheese, as well as fermented dairy foods such as cheese, yogurt and kefir. The whole Mediterranean eating pattern includes: Ý :KROH JUDLQV Ý )UXLWV DQG YHJHWDEOHV Ý %HDQV DQG QXWV Ý +HUEV DQG VSLFHV Ý +HDOWK\ IDWV VXFK DV ROLYH RLO Ý )LVK DQG VHDIRRG Ý 'DLU\ Ý (JJV DQG SRXOWU\ Ý 5HGXFHG LQWDNH RI PHDW DQG VZHHWV7 A study published in the American Journal of Clinical Nutrition looked at the effect of a Mediterranean eating pattern supplemented with additional dairy foods to see the impact on cardiovascular risk factors.8 The ran-

domized, controlled study compared a Mediterranean eating pattern with 3-4 daily servings of dairy to a low-fat diet for eight weeks. Researchers found that the Mediterranean eating pattern with dairy resulted in significantly lower blood pressure, higher HDL “good” cholesterol, and lower triglycerides compared to the low-fat diet. They concluded that the Mediterranean eating pattern with dairy was “appropriate for an improvement in cardiovascular risk factors in a population at risk of cardiovascular disease.” In addition to antihypertensive drug treatment, changes in dietary patterns can also help manage hypertension.9 The most well-researched eating pattern for preventing and controlling high blood pressure is DASH. The blood pressure-lowering effect of DASH was first documented in a clinical trial over 25 years ago, where a dietary pattern rich in fruits, vegetables, and low-fat dairy products was seen to reduce systolic and diastolic blood pressure more than a typical American diet.10 The experimental diet had reduced amounts of saturated fat, total fat, and cholesterol, but was rich in potassium, magnesium, calcium, fibre and protein. The synergy of these nutrients led to blood pressure reduction. Today’s DASH eating pattern is based on this original research. The DASH eating pattern includes: Ý VHUYLQJV RI PLON DQG PLON SURGucts daily Ý VHUYLQJV RI IUXLWV GDLO\ Ý VHUYLQJ RI YHJHWDEOHV GDLO\ Ý VHUYLQJV RI JUDLQV GDLO\ Ý VHUYLQJV RI SURWHLQ IURP EHDQV nuts and seeds weekly

Ý /HVV WKDQ VHUYLQJV RI ILVK SRXOWU\ and meat daily11 It’s also lower in salt, sugar, fat and red meat compared to the typical North American diet. The combination of foods in the DASH eating pattern can decrease systolic blood pressure by about six to 11 mm Hg in both hypertensive and normotensive people.12 Milk is an important part of DASH because it’s a source of protein, and contains minerals including calcium, potassium and magnesium, which help lower blood pressure levels. One serving of dairy is equal to a cup of milk or yogurt, or 1.5 ounces of cheese, and DASH recommends 2-3 servings daily.13 :KLOH WKH RULJLQDO '$6+ VWXGLHV focused on low-fat milk as part of the eating pattern, one study found that a higher-fat DASH eating pattern, which replaced low-fat milk products with full-fat milk products, was able to lower blood pressure as much as the standard DASH eating pattern.14 Using higher fat milk products also lowered triglyceride levels and did not adversely impact blood cholesterol levels. So, your patients can choose whichever dairy products they prefer.

Studies support the inclusion of dairy foods for cardiovascular health and lowering blood pressure levels, so you can feel confident making this recommendation to your patients. It’s definitely time to celebrate milk as part RI D EDODQFHG DQG QXWULWLRXV GLHW )RU H more information, visit Milk.org. Q

Milk is a convenient source of nutrition since it provides 15 essential nutrients in just one glass: 3URWHLQ 9LWDPLQ $ 9LWDPLQ % 9LWDPLQ % 5LERIODYLQ 1LDFLQ 7KLDPLQH 3DQWRWKHQLF DFLG 9LWDPLQ ' &DOFLXP 0DJQHVLXP 3KRVSKRUXV 3RWDVVLXP =LQF 6HOHQLXP

Cara Rosenbloom RD is a registered dietitian, journalist and author in Toronto. This is paid sponsored content for Dairy Farmers of Ontario. 1 Heart & Stroke. Connected by the Numbers. https://www.heartandstroke.ca/articles/connected-by-the-numbers 2 Statistics Canada. https://www150.statcan.gc.ca/n1/pub/82-625-x/2021001/article/00001-eng.htm 3 Filippou C et al. (2020). Advances in nutrition. 11(5), 1150–1160. doi.org/10.1093/advances/nmaa041 4 Mediterranean Diet. Oldways. https://oldwayspt.org/traditional-diets/mediterranean-diet 5 Filippou C et al. (2021). Clin Nutr. 2021;40(5):3191 doi: 10.1016/j.clnu.2021.01.030. 6,7 Mediterranean Diet Pyramid. Oldways. https://oldwayspt.org/resources/oldways-mediterranean-diet-pyramid 8 Wade A et al. (2018). Am J Clin Nutr. 108(6):1166–1182. doi.org/10.1093/ajcn/nqy207 9 Filippou C et al. (2020). Advances in nutrition. 11(5), 1150–1160. doi.org/10.1093/advances/nmaa041 10 Appel L et al. (1997). N Engl J Med. 336(16):1117-1124. doi: 10.1056/NEJM199704173361601 11 US National Heart, Lung and Blood Institute. DASH Eating Plan https://www.nhlbi.nih.gov/education/dash-eating-plan 12 Challa, H. DASH Diet to Stop Hypertension. May 2021. (book). https://www.ncbi.nlm.nih.gov/books/NBK482514/ 13 US National Heart, Lung and Blood Institute. Following the Dash Eating Plan. https://www.nhlbi.nih.gov/education/dash/following-dash 14 Chiu S et al. (2016). Am J Clin Nutr. 103:341-347. doi.10.3945/ajcn.115.123281

www.hospitalnews.com

JULY 2022 HOSPITAL NEWS 13

COVER

The next cardiovascular By Leigh Morris hierry Mesana, MD, is nearing the end of his second term as president and CEO of the University of Ottawa Heart Institute. The heart valve surgeon who revolutionized treatment of cardiovascular disease – Mesana literally wrote the book on advancing patient-centered cardiac care – has performed thousands of life-saving surgeries over his decades-long career. And while he said he remembers every case, he admitted there is a special spot in his heart for one patient in particular: John Bassi. This is the story of how one man’s gratitude for the surgeon who saved

epidemic DR. THIERRY MESANA HAS PERFORMED THOUSANDS OF HEART OF LIFE SAVING SURGERIES AND REVOLUTIONIZED THE TREATMENT OF HEART DISEASE. his life inspired a legacy fund in his name, paving the road for research, innovation, and better care for tens of thousands of heart patients.

JOHN BASSI

At 44, John Bassi was a successful businessman and community builder, happily married, and the father

of two boys. Still, something wasn’t right. Though he considered himself healthy and active for his age – fit enough to play pick-up soccer with friends – John felt exhausted every day. Long working hours and a demanding social schedule were catching up to him, he thought. His energy levels

were dipping, and friends and family were starting to notice. At the time, John was a member of the University of Ottawa Heart Institute Foundation’s board of directors. One morning, while attending a meeting, John revealed to his colleagues how tired he had been feeling. “John, when was the last time you had your health checked?” they asked. John hadn’t considered this. Confident his experiences were par for the course, and the exhaustion he lived with was indicative of his busy lifestyle, he made plans to meet with his doctor. Continued on page 16 SPONSORED CONTENT

The impact of pre-existing conditions on access to insurance By Sarah Kirshin-Neilans and Ashley Bowers uring the Obama administration, there was a lot of political buzz surrounding the term “pre-existing condition.” A pre-existing condition is generally defined as an illness or injury that has been diagnosed and/ or treated prior to an application for insurance. When the Affordable Care Act, often referred to as “Obamacare,” came into force in the U.S. in 2014, it made it illegal for health insurance companies to deny Americans medical coverage or raise premiums due to a pre-existing condition. As a result, the percentage of uninsured American adults decreased significantly. Fortunately, with universal healthcare being accessible to Canadians for more than 60 years, most Canadians alive today have never fathomed facing financial

ruin due to the fact that they or a family member have required medical care. However, pre-existing conditions are very much a part of the insurance vernacular in both countries. Due to limits in government-funded healthcare services in Canada, insurers offer many products to complement universal health care (OHIP in Ontario). While a pre-existing condition will generally not preclude a group insurance plan member from accessing extended health and dental coverage (including coverage for medications for chronic illnesses like diabetes and heart conditions), they are usually considered in the context of disability, critical illness and life insurance. The wording of the policy will govern whether a person (a) qualifies for coverage and (b) is entitled to a

benefit in the event of a claim, despite a pre-existing condition. When applying for such policies, consumers must truthfully disclose their medical history, including symptoms they have experienced, which is usually done in the form of a questionnaire. This allows the insurer to determine the risk and decide whether to insure the individual and what premium to charge. Failure to disclose a pre-existing condition could result in the insurer rescinding the contract and/or denying a claim. If this happens, it is important for the insured person or their family to consult with a lawyer experienced in this area of law to review and potentially dispute the denial. Pre-existing conditions are also relevant to assessing the value of personal injury claims based in negligence.

There are several heads of damages that a person may pursue, including general damages (meant to compensate a person for their pain and suffering), income losses, medical care and housekeeping/home maintenance assistance. An important consideration is whether the claimant had a pre-existing condition that predisposed them to a worse outcome from the injury or whether their condition would have worsened in any event of the injury. Pre-existing conditions that affect longevity and/or a person’s ability to work and live independently are particularly relevant in assessing a claimant’s future income loss and fuH ture care needs. Q

Sarah Kirshin-Neilans is a lawyer with the Personal Injury Team and Ashley Bowers is a Law Student at McKenzie Lake Lawyers LLP. 14 HOSPITAL NEWS JULY 2022

www.hospitalnews.com

COVER Continued from page 14

Epidemic He didn’t know it then, but that decision ultimately saved his life. John was diagnosed with a mitral valve prolapse, one of the most common types of valvular heart disease among men his age. He would need open-heart surgery to repair the defective valve that was leaking blood between the left chambers of his heart, forcing it to work double-time. “It was a shock to me and my family,” John recalled. “My whole world was suddenly changing. I kept thinking about what would happen if things didn’t work out.” Without treatment, John’s condition would continue to progress, increasing his risk of developing more serious complications – arrhythmia, heart failure, stroke, hypertension, and if left untreated long enough, even death.

THE NEXT EPIDEMIC OF HEART DISEASES

Cases like John’s are nothing new. Despite continuous improvements in the diagnosis, evaluation, and treatment of patients with valvular heart disease, cardiologists believe conditions like John’s represent the next epidemic of heart disease. David Messika-Zeitoun, MD, is a cardiologist and director of the Centre for Valvular Heart Disease (CVHD) at the University of Ottawa Heart Institute (UOHI). He said heart valve disease is all too common, affecting nearly 25% of patients admitted to hospital for cardiovascular reasons. “Patients with valvular heart disease are underdiagnosed, referred late in the course of the disease, and are often undertreated, leading to increased risk of complications and mortality,” said Messika-Zeitoun. “It’s awfully sad because we’re not talking about cancer. Most valvular heart diseases are treatable.” Whereas some heart conditions may be effectively managed with drugs, Messika-Zeitoun said there is no known medication that can cure valvular heart disease on its own. Without research, Messika-Zeitoun’s fear is a growing subset of the population 16 HOSPITAL NEWS JULY 2022

will develop severe progressions of the disease that will eventually need an intervention. Vincent Chan, MD, a cardiac surgeon at the UOHI, has operated on hundreds of patients with such progressions. Expert in valve repairs, replacements, and minimally invasive treatments, Dr. Chan said medical research has a crucial role to play in the operating room, in the catheterization lab, as well as in the examination room. “There are a number of techniques we use for which there is limited data available,” said Chan. “In addition to improving surgical techniques and outcomes, research helps care teams identify the ideal strategy to manage each pathology of disease. Researchers analyzing valve disease provide surgeons with nuanced guidance in the OR, as well as an indication of the outcome they may expect.” Since it opened in 2019, the CVHD has provided state-of-the-art evaluation, second opinions, and care to patients with heart valve disease. More than 20% of those referred to the clinic are passed onto Chan and his team for life-saving intervention, Messika-Zeitoun estimated. It’s a rate cardiologists, cardiac surgeons, nurses and research coordinators are working in tandem to study. To this effect, CVHD patients are offered to join the centre’s research registry, a database containing information about patients’ baseline characteristics and outcomes. Researchers consult the registry to better understand the mechanisms and natural history of valvular heart disease. Patients are also invited to participate in the CVHD “biobank,” where de-identified blood samples are collected and retained for future research. “Our main aim is to provide personalized care to patients with valvular heart disease and to perform timely interventions,” said Messika-Zeitoun. “At the same time, we are continuously exploring innovative ways to improve screening and detection, developing and testing medications, and simulating interventions to advance

Dr. Thierry Mesana revolutionized treatment of cardiovascular disease and performed thousands of life-saving surgeries over his decades-long career. care and improve outcomes. It’s about ensuring patients like John Bassi receive timely access to treatment that enhances their quality of life.”

ONE OF THE GREATS

John Bassi was referred into to the care of Thierry Mesana, MD, then the head of the UOHI’s Division of Cardiac Surgery, and currently the institute’s president and CEO. Mesana was a specialist in repairing failing heart valves, a surgeon world-renown as much for his technical skill and ability as his leadership in academia. Under Mesana’s tutelage, the UOHI’s surgical and valve repair program had expanded dramatically to become recognized as one of the best in the world. Mesana, too, was highly respected as “one of the greats” in the industry. His emphasis on repairing heart valves (rather than replacing them with artificial or biological alternatives) helped to establish this

approach as the gold standard for treatment. For John, who had been seeking a second opinion, this was all the reassurance he needed. “When the doctor found out Dr. Mesana was going to be my surgeon, he basically handed me back my file and told me to go home. He assured me I was in great hands,” John laughed. “It was just incredible. When you hear that, you realize you’re going to be okay.” Four months after his diagnosis, John underwent a successful openheart surgery. Mesana and his medical team were able to repair his prolapsed mitral valve. John said he noticed improvements in his health right away, his energy returning “almost immediately.” Within days of the operation, he was recovering at home. Four weeks later, he returned to work. More than a decade after the surgery, John was overcome with emotion www.hospitalnews.com

COVER when asked to reflect on his experience and the relationship he shares with the surgeon he affectionately calls “Superman.” “The care I received was a ten out of ten. Honestly, the staff and the nurses… I want to cry when I think about it,” he said. “Not only is Dr. Mesana a fantastic leader and businessman, but he’s also a fantastic person with outstanding bedside manners. He’s like a friend to me.”

THE LEGACY OF A HEART SURGEON, PRESIDENT AND CEO

Though no longer on the Heart Institute Foundation’s board of directors, John Bassi and Thierry Mesana keep in touch to this day. John and his wife Maria continue to financially support the institute that saved his life. They encourage their peers, business associates, and everyone they meet to donate generously. With the Bassis’ support, and with support from the community, the

DESPITE CONTINUOUS IMPROVEMENTS IN THE DIAGNOSIS, EVALUATION, AND TREATMENT OF PATIENTS WITH VALVULAR HEART DISEASE, CARDIOLOGISTS BELIEVE CONDITIONS LIKE JOHN’S REPRESENT THE NEXT EPIDEMIC OF HEART DISEASE. UOHI Foundation has established an endowment fund for heart valve research in Mesana’s name. With an initial amount of $4 million, the Dr. T. G. Mesana Endowed Team Chair in Heart Valve Disease is one of the largest – if not the largest – chairs dedicated to a cardiovascular research program in Canada. The team chair will be held and cochaired by one cardiologist and one cardiac surgeon: Drs. David Messika-Zeitoun and Vincent Chan are the first to serve five-year mandates. “Dr. Mesana has always said a world-class centre cannot be considered world-class without a strong

group in valvular heart disease,” said Messika-Zeitoun. “This was his vision from the beginning. When people think of heart valve disease in Canada, we want them to think of the University of Ottawa Heart Institute. This is Mesana’s legacy.” “Building on the shoulders of Dr. Wilbert J. Keon, Thierry Mesana has elevated the Heart Institute to be a global leader in team-based care,” said Chan. “I am humbled to be among the first to continue his important legacy.” Messika-Zeitoun and Chan will steer a wide range of research projects and provide academic leadership and direction in keeping with the vision

and objectives of the Division of Cardiac Surgery, the Division of Cardiology, and the UOHI. Their work will support the “heart team” concept Mesana established during his tenure as president and CEO, an approach which allows for interdisciplinary and personalized care for each patient. “An endowment such as this provides the essential framework to ensure funding for life-saving research in valvular heart disease exists now and for many more years to come,” said Mesana. “Knowing my legacy will have a positive impact on the culture of the Heart Institute, the community here in Ottawa, and for so many patients with valvular heart disease is truly special.” “I am eternally thankful and grateful to John Bassi and his wife Maria for all their efforts. John is a big supporter of the Ottawa community, a lover of our city, and we sincerely appreciate having people like him and Maria supH porting the Heart Institute.” ■

Leigh Morris is a communications officer at the University of Ottawa Heart Institute.

LESS transmission

MORE protection

than PCR We are committed to delivering a higher level of PCR excellence with unmatched testing that protects staff and patients, reduces HAI transmission, and enables appropriate bed management. Speed, plus Accuracy, plus Flexibility

Learn More

www.hospitalnews.com

JULY 2022 HOSPITAL NEWS 17

EVIDENCE MATTERS

Developments in Diabetes management:

What do we know about tirzepatide? By Barbara Greenwood Dufour pproximately three million people in Canada are living with diabetes. This includes one in 10 adults, the majority of whom have type 2 diabetes. It’s important that people with type 2 diabetes carefully manage their blood glucose levels because high blood glucose levels (hyperglycemia), when left untreated, can lead to various complications such as neuropathy, nephropathy, retinopathy, and cardiovascular disease. That’s why people with type 2 diabetes are at a heightened risk for major adverse cardiovascular events (e.g., stroke, heart attack, heart failure) and may have decreased life expectancy. If people with type 2 diabetes cannot manage their blood glucose levels through diet and exercise, an antihyperglycemia medication may need to be prescribed. Diabetes Canada’s clinical practice guidelines recommend that metformin be the first-line medication used. When metformin is no longer providing adequate blood glucose control, there are several other antihyperglycemia drugs currently available in Canada that can be used instead or added to metformin. These drugs include insulin secretagogues (meglitinides, sulfonylureas), slowand fast-acting insulin analogues, dipeptidyl peptidase-4 (DPP4) inhibitors, sodium glucose cotransporter 2 (SGLT2) inhibitors, thiazolidinediones, alpha-glucosidase inhibitors, and glucagon-like peptide-1 (GLP-1) receptor agonists. Even with all these medication options, some people with type 2 diabetes find it difficult to manage their high blood glucose levels. A new antidiabetes drug called tirzepatide is currently under development. It combines a GLP-1 receptor agonist with a glucose-dependent insulinotropic polypeptide (GIP) receptor agonist. It’s administered once a week by subcutaneous injection, and it would likely be given on its own or

along with another antidiabetes medication. It’s thought that, by activating both the GLP-1 and GIP receptors, tirzepatide could be more effective at managing blood glucose and obesity than GLP-1 agonists alone. So, what does the evidence say about this, and what’s the cardiovascular risk associated with this new drug? To find out, CADTH’s Horizon Scanning Service identified and summarized the available information on tirzepatide for the treatment of hyperglycemia in adults with type 2 diabetes. CADTH is an independent agency that finds, assesses, and summarizes the research on drugs, medical devices, tests, and procedures. Through its Horizon Scanning Service, CADTH gives Canadian health care decision-makers advance notice of emerging health technologies they may need to make decisions about in the near future. Because tirzepatide is an emerging drug, so far only phase III clinical trials have been completed (phase III clinical trials compare the safety and effectiveness of a new treatment

against standard treatment). CADTH reviewed the completed trial results, which show that tirzepatide appears to be effective for reducing hyperglycemia in adults with type 2 diabetes and might be more effective than semaglutide (another GLP-1 receptor agonist) and than insulin degludec and insulin glargine (both long-acting insulin analogues). Tirzepatide is intended to address cardiovascular risk associated with type 2 diabetes, such as reducing the risk of heart failure with preserved ejection fraction (when the heart pumps normally but isn’t able to relax enough to fill properly). The available studies suggest that tirzepatide doesn’t increase the risk of major adverse cardiovascular events, but the longer-term cardiovascular benefit or risk of tirzepatide is still not known. One study collecting longer-term data on cardiovascular outcomes is underway with results that should be available in 2024. Until this data are available, uptake of tirzepatide to address cardiovascular risk will likely be limited.

In addition to the trials currently in progress focused on people with type 2 diabetes, tirzepatide is also being investigated as a treatment for obesity in people with or without type 2 diabetes. Tirzepatide has not been approved by Health Canada and is not currently available in Canada. However, the US Food and Drug Administration (FDA) approved tirzepatide just last month (May 13, 2022). CADTH is, therefore, providing Canadian health care decision-makers with useful information and early evidence on tirzepatide to help them prepare for what might be coming up next in diabetes treatment. CADTH’s report on tirzepatide is freely available on the CADTH website at cadth.ca/tirzepatide-type-2-diabetes-mellitus. To learn more about our Horizon Scanning program, visit cadth.ca/horizon-scanning, or to suggest a new or emerging health technology for CADTH to review, email us at HorizonScanning@cadth.ca. You can also follow us on Twitter @CADTH_ ACMTS or speak to a Liaison Officer in your region: cadth.ca/contact-us/ H liaison-officers. ■

Barbara Greenwood Dufour is a knowledge mobilization officer at CADTH. 18 HOSPITAL NEWS JULY 2022

www.hospitalnews.com

TOGETHER IN CARE 2022 PROFESSIONAL CONFERENCE

REGISTRATION NOW OPEN! Join us in Calgary, November 9-12, 2022. Calgary | Virtual Telus Convention Centre & Online Use code DCPCHN10 and save an extra 10%. New this year: ȏ Attend conference in-person or virtually Selected sessions will be broadcast live.

ȏ Structured networking in the Braindate Lounge to help you connect with others on the ideas and issues you are most interested in ȏ Welcome & Awards Celebration reception on Thursday evening

SAFE MEDICATION

Towards a safer health system: Let’s start with patient safety culture By Wei Wei, Eulaine Ma, and Certina Ho atient safety is always a priority in health care. How can we ensure that patient safety is embraced in our everyday practice? Let’s start with the values and beliefs of individuals who work in health care. According to the Canadian Patient Safety Institute (CPSI),* patient safety culture is the shared values and beliefs in an organization where behaviours are aimed to maximize patient safety and minimize patient harm. Providing training and having ready references and resources for healthcare professionals to support a patient safety culture in practice would facilitate implementation of patient safety initiatives. In this article, we would like to propose a ready-to-use and easily translatable Patient Safety Culture Curriculum for Healthcare Professionals, which was recently shared and presented at the 2022 Society for Academic Continuing Medical Education (SACME) Conference. Using a systematic grey literature search, we sought patient safety guiding documents (Table 1)

that would help us identify the most important concepts for patient safety culture training. The four documents (Table 1) are diverse in both the sources that were consulted, and their aims and target audiences, ranging from health educators to institutional training of clinical and non-clinical staff, decision- and policy-makers who enable organizational support and provide oversight on promoting safe practices. Common themes were observed among all four documents.

A PATIENT SAFETY CULTURE CURRICULUM

To capitalize on the diversity and international nature of our findings, we compared the themes, competencies, and learning objectives across the four resources (Table 1) and consolidated into our proposed Patient Safety Culture Curriculum (link to https:// sacme.org/page-1859701#Developing), which consists of five key competencies (Figure 1) and 22 learning objectives.

Figure 1: Five Key Competencies of Patient Safety Culture Curriculum

Organizational culture enables staff and personnel to stay open and transparent in acknowledging and addressing human and environmental factors as potential barriers and/or facilitators to safe practices. Just culture emphasizes moving away from a blame-andshame approach, differentiates individual culpability from system failures as possible causes or contributors of safety events, and ensures psychological safety to care providers. Safety Improvement & Evaluation calls for the endorsement of continuous quality improvement, and the ongoing

Table 1: Patient Safety Culture Guiding Documents Resource

National Patient Safety Syllabus 1.0 1

The Safety Competencies 2

Implementation Resource Guide: A National Action Plan to Advance Patient Safety 3

Patient Safety Curriculum Guide: Multi-professional Edition 4

Country, Organization (Year of Publication)

United Kingdom (UK), National Health Service (NHS) (2020)

Canada, CPSI (2020)

United States (US), Institute for Healthcare Improvement (IHI) (2020)

World Health Organization (WHO) (2011)

Purpose

Patient safety training needs for all NHS clinical and non-clinical staff

Roadmap for educators to create patient safety curricula for educational and professional development programs

Strategies for leaders and organizations to achieve safer care and reduce risks of patient harm

Program for patient safety education in institutions where healthcare students are trained

Composition

Five domains with four key themes, one of which is Safety Culture

Six domains to enhance patient safety across professions, first of which is Patient Safety Culture

Four areas with 17 recommendations, with the first area being safety culture enabled by leadership and governance

11 topics spanning multiple areas of patient safety, many of which include concepts related to safety culture

evaluation of system and organizational safety. Information Sharing & Transparency promotes the sharing of safety events and lessons learned. Safety Leadership engages team members, ensures accountability, upholds patient safety as an organizational priority and core value, and commits resources to enable healthcare providers to practice and promote safety in partnership with patients, patient family and caregivers.

TOWARDS A SAFER HEALTH SYSTEM

Our proposed Patient Safety Culture Curriculum offers an integrative, multi-professional guide to interested groups who are seeking patient safety education materials for health profession students, healthcare staff, and/or leaders. Provincial regulatory authorities, safety advocacy groups, or healthcare facilities/institutions can adapt and operationalize this proposed curriculum into training courses, workshops, or webinars, etc., to meet their needs to foster, improve, and maintain H a safety culture. ■ *In March 2021, Healthcare Excellence Canada (HEC) brought together the Canadian Foundation for Healthcare Improvement and the Canadian Patient Safety Institute (CPSI). The authors also suggest readers to view the Patient Safety Culture “Bundle”, a resource that is available at the HEC website.

Wei Wei and Eulaine Ma are PharmD Students at the Leslie Dan Faculty of Pharmacy, University of Toronto; and Certina Ho is an Assistant Professor at the Department of Psychiatry and Leslie Dan Faculty of Pharmacy, University of Toronto. 20 HOSPITAL NEWS JULY 2022

www.hospitalnews.com

Infection Control Risk Assessment

ICRA

SMARTER TRAINING SAVES LIVES

The United Brotherhood of Carpenters’ Infection Control Risk Assessment (ICRA) training teaches healthcare construction protocols that save lives. Our training educates Healthcare Personnel, Construction Professionals and Architects in ICRA best practices that protect patients by working safely during all phases of healthcare facility renovations. Contaminants released during renovation projects

NIN RAI

can lead to deadly healthcare associated infections. This is why it’s critical for anyone working in a healthcare facility during renovation to have participated in ICRA Training.

TRAINED PROFESSIONALS PREVENT THE SPREAD OF DEADLY INFECTIONS With the UBC ICRA training, you’ll learn necessary safeguards to protect your patients from health hazards during construction.

1 in 25 hospital patients has at least one healthcare associated infection at any given moment

1.7 million patients suffer from healthcare associated infections every year nationwide

100,000 deaths resulting from healthcare associated infection occur each year

Safety is priceless. ICRA training is free.

Learn more at ubc-icra.org

@carpenters27

www.carpenterslocal27.ca 222 Rowntree Dairy Rd., Woodbridge, ON L4L 9T2 Telephone: 905-652-4140 Email: organizing@thecarpentersunion.ca

P R O G R A M

O F

T H E

NEWS

Growing cardiovascular services to address high incidence of heart disease By Catalina Guran hen Trevor Meynert began feeling chest discomfort in September 2019, he didn’t think it was anything serious. Two days later, an interventional cardiologist at William Osler Health System’s (Osler’s) Brampton Civic Hospital was inserting a stent into one of his heart’s major arteries to open a complete blockage. He had suffered an ST-elevation myocardial infarction (STEMI), a dangerous type of heart attack, and one that teams at Osler see all too often. “I walked into the Emergency Department not realizing I was having a heart attack,” said the now 67-year-old. “The emergency and cardiology teams were so efficient and worked like a well-oiled machine. Their timely actions saved my life.” In 2010, thanks to the generous, combined support of the Tour de Bleu annual cycling fundraiser, the Pe-

...

NEW

PACKAGE ...

IN RESPONSE TO THIS HIGH INCIDENCE OF HEART DISEASE, OSLER’S CARDIOVASCULAR PROGRAM IS NOT ONLY GROWING, IT HAS ATTRACTED A TEAM OF HIGHLY SKILLED CARDIOLOGISTS, MANY OF WHOM SPECIALIZE IN AREAS LIKE CARDIAC CATHETERIZATION, STRUCTURAL HEART DISEASE, ELECTROPHYSIOLOGY AND CARDIO-ONCOLOGY. ter Gilgan Foundation and Mattamy Homes, Osler was able to expand the range of cardiovascular services available at Brampton Civic Hospital. In 2013, the STEMI Program received significant additional support through a gift to William Osler Health System Foundation (Osler Foundation) from Ernest and Gladys Pitman after an excellent care experience. Today, Osler is home to one of the largest STEMI programs in Ontario,

Indocyanine Green for Injection USP

Tel: 905.673.5893 Fax: 905.673.5894 22 HOSPITAL NEWS JULY 2022

and is one of the top two hospitals in the province for patient outcomes following emergent and elective percutaneous coronary intervention (PCI), a non-surgical procedure that opens blocked arteries using a stent to help return blood flow to the heart. Osler also has one of the fastest “door to balloon” times in the province for what can often be life-saving care during a STEMI. “Osler sees some of the sickest patients in the province coming through our doors,” said Dr. Masud Khandaker, Osler’s Medical Director, Cardiovascular Health System. “The communities we serve are highly vulnerable to heart disease influenced by a high incidence of diabetes, hypertension, high cholesterol and genetic factors, so timely access to care is critical.” In response to this high incidence of heart disease, Osler’s cardiovascular program is not only growing, it has attracted a team of highly skilled cardiologists, many of whom specialize in areas like cardiac catheterization, structural heart disease, electrophysiology and cardio-oncology. Among them is Dr. Khandaker, a native Torontonian who received his cardiovascular training at the prestigious Mayo Clinic in Rochester, Minnesota. “Osler’s cardiovascular team of physicians, nurses, allied health professionals, kinesiologists, technicians, pharmacists and dieticians is second to none, and tremendously dedicated to our patients,” said Dr. Khandaker who is quick to praise his colleagues, Dr. Shy Amlani, Physician Lead, Cardiac Procedures Unit; Dr. Marc Allard, Physician Lead, Acute Cardiac Care Program; and Anne-Marie Graham,

Director, Cardiovascular and Chronic Disease, as instrumental leaders in helping to shape Osler’s cardiovascular program. “We all firmly believe in providing every patient with stellar care based on evidence-based best practices.” It’s that goal that led Dr. Khandaker to reach out to Unity Health’s St. Michael’s Hospital, a centre of excellence in valvular heart disease, to forge a collaborative relationship that enables patient-inspired health care without boundaries. He and a small team of Osler cardiologists perform a delicate diagnostic procedure, known as transesophageal echocardiography (TEE), which takes high definition images of the heart’s structure for patients suspected of having leaking or narrowed valves. These images are then shared virtually among a large team of cardiologists and cardiac surgeons at St. Michael’s Hospital and Osler to rapidly determine the best course of action for each patient. “We’re harnessing technology and clinical expertise at both hospitals to ensure Osler patients have timely access to the right care,” said Dr. Neil Fam, Director of Interventional Cardiology and Cardiac Catheterization Labs at St. Michael’s Hospital, who worked closely with Dr. Khandaker to develop the hospital collaboration. Dr. Khandaker notes that he looks forward to the day Osler is able to further grow its structural heart disease program, adding “The specialists at St. Michael’s Hospital have been fantastic collaborators.” Osler is also home to one of the few highly specialized cardio-oncology clinics in Ontario. Launched in the summer of 2021 at Osler’s Peel Memorial Centre for Integrated Health and Wellness, the outpatient clinic monitors cancer patients who are receiving chemotherapy and radiation treatments for any adverse reactions that have the potential to impact the heart. This specialty clinic connects cancer patients with a cardio-oncologist to assess them for any pre-existing heart disease, or risk factors for heart disease, prior to starting their treatwww.hospitalnews.com

NEWS ment. The clinic boasts cardiologists who have advanced training in cardio-oncology, are familiar with cancer therapies, and understand the best management strategies to be put in place should the need arise. “Osler’s cardiovascular program is robust, offering a comprehensive range of services, including cardiac procedures, cardiac diagnostic services, inpatient care and specialized rehabilitation and outpatient clinics,” said Dr. Khandaker. “With continued support from our health care and government partners, Osler Foundation and our community, we will continue to further advance these services. Everything we do is designed to achieve the best outcomes possible for patients.” Trevor Meynert, who recently completed his annual follow-up visit with Dr. Khandaker, couldn’t agree more. “The after-care is unbelievable. It brings all those stress and anxiety levels down to zero when you know you have someone you can depend on to look out for you year after year. We are so lucky to have this amazing expertise H so close to home.” ■

Front (L-R): Dr. Masud Khandaker, Medical Director, Cardiovascular Health System; Anne-Marie Graham, Director, Cardiovascular and Chronic Disease; and Dr. Shy Amlani, Physician Lead, Cardiac Procedures Unit. Back: Dr. Marc Allard, Physician Lead, Acute Cardiac Care Program.

Catalina Guran is Senior Manager, Public Relations at William Osler Health System.

Multivitamin and mineral supplement for the maintenance of good health. Available in bottle and single unit dose sachet. A convenient and economical alternative to a handful of multivitamin tablets Contains 14 essential vitamins and minerals in one convenient dose No abdominal discomfort, diabetes or toxicity concerns NO IRON NO SUGAR NO ALCOHOL To learn more or order, please contact: info@seaford.ca or tel:1-877-633-3987

Seaford Pharmaceuticals Inc. 1530 Drew Rd. Unit 29, Mississauga ON, L5S 1W8 Tel: 905.673.5893 Fax: 905.673.5894

NEWS

What a bariatric surgeon wishes you knew about obesity By Jennifer Stranges early 30 per cent of Canadian adults have obesity, yet despite its prevalence and association with serious chronic diseases like diabetes and hypertension, stigma remains a barrier to patients seeking proper treatment and care. Dr. James Jung is a bariatric surgeon at St. Michael’s Hospital, a site of Unity Health Toronto, and a scientist at Li Ka Shing Knowledge Institute. He completed a clinical fellowship at the Massachusetts General Hospital, Harvard Medical School and has research interests in using machine learning for early detection of clinical deterioration in surgical patients. We spoke with Dr. Jung about obesity, different treatment options and why he says obesity is a noun, not an adjective.

WHAT DO WE KNOW ABOUT OBESITY?

Obesity is a complex chronic disease in which abnormal or excess body fat impairs health, increases the risk of long-term medical complications and reduces lifespan. It’s recognized by the Canadian Medical Association as a chronic, progressive disease. Before that designation in 2015, it was not formally recognized as a disease, although many healthcare providers recognized it as such in their practices. However, without formal diagnosis of obesity as a medical disease, it was challenging for patients to get appropriate treatment. We still don’t know why some people develop obesity. We think that it’s multi-factorial and it’s a combination of genetic predisposition and behavioural or social factors.

WHAT ARE THE BARRIERS FOR PATIENTS WITH OBESITY TO ACCESSING CARE?

Obesity is a disease that has visible physical manifestations. There’s an increase in fatty tissue and body weight,

Dr. James Jung is a bariatric surgeon at St. Michael’s Hospital. so it’s subjective to everyone having some opinion and visually guessing or identifying someone as having this chronic disease – even if it’s true or not. The only way to actually diagnose someone with obesity is through the assessment of a physician and measuring BMI. There’s a lot of stigma for patients with obesity, and patients can feel embarrassment and shame or experience harassment. Some do not want to come forward to have the treatment they require because of this, and it’s an area we need to really work on. The other thing is most people are very quick to judge and think patients who have this disease have it because they have a problem with overeating or living too sedentary a lifestyle or not exercising enough. While behavioural factors like eating and exercise have a role in the development of obesity, it’s not all. There are a lot of studies that have shown that there are genetic components to obesity, and a lot of studies have demonstrated obesity is regulated by hormonal changes as well. Obesity is also a risk factor to access quality care – hospitals are designed for people with “normal” BMI, but more than half of our population is overweight or has obesity. What we call “normal” is actually the mi-

nority of the general population. It’s likely that there are shortages of ambulances or medical aircrafts suitable for transporting patients with higher BMI categories to be prepared for increasing prevalence of obesity. A lot of basic equipment like hospitals beds and chairs have specific weight-bearing statuses. For patients with a high BMI or weight class, they may need to wait for a specific bed or chair to be available. They’re likely to feel excluded from hospital setting and not feel included in the care system. From a care and personnel perspective as well, we need more education around how we label and discuss patients with obesity or severe obesity. I like to avoid terms like “you are” obese. I don’t use obesity as an adjective because it should be used as a noun – it’s a disease. I would not say to someone “you are obese” because that’s not who they are – they’re someone’s father, mother or sister, they just happen to have this disease, and that’s very important for our healthcare workers to understand.

WHAT ARE LIFESTYLE MODIFICATIONS THAT CAN TREAT OBESITY?

One is, of course, diet. This is a focus on the biochemical basis of obesity – if more energy is consumed (energy intake) than expanded (energy expenditure), the body will store that as fat and it’s a process that contributes to obesity. But we need to look at diet as not just “counting calories” but learning about food types that are more prone to generating fatty tissue per kilocalorie. Sleep is also a very important lifestyle factor that’s associated with obesity. There’s a lot of active research in this area – studies are showing patients who have obesity tend to have lower number of hours sleeping in a continuous cycle. One reason is chronic pain because of obesity – there’s stress on the spine so they adjust more during their sleep. They’re also more prone to needing to use the bathroom during sleep so they experience chronic sleep loss. There’s a recent randomized con-

trolled trial that showed that patients with obesity who received intervention to extend their sleep to 8.5 hours had lower energy intake, which resulted in a negative energy balance. Sleep hygiene is really an important part of a healthy lifestyle, which can be linked to weight loss. There are also very exciting developments in medications and very encouraging studies in this area. They studies showed a few medications that are effective in using excess body weight from five-15 per cent. That’s a great intervention.

WHAT ABOUT BARIATRIC SURGERY?

There are three things I want people to know about bariatric surgery – it’s safe, it’s effective and that there’s a lack of awareness about it. If a patient is at a BMI category of severe obesity (over 40 and above) or a BMI of 35 and above with one or more comorbidities, then the patient is eligible and should be encouraged to discuss bariatric surgery. It’s the most effective treatment for those patients. Over the last 30 years, there’s been a huge improvement in the safety of bariatric surgery. There’s been also been improvements in our understanding of patients with obesity, anesthesia care improvement, and more minimally invasive options. There is such a low risk of death and of severe complications. Bariatric surgery prolongs the lifespan and increases one’s quality of life. But there continues to be stigma towards patients who need to undergo active treatment for the disease they presume is a behavioural consequence. If you have a broken leg, you see an orthopedic surgeon. If you need braces, you go to an orthodontist. It should be the same way for patients who see professional help to treat their obesity. Yet, only 1 per cent of eligible patients based on BMI and comorbidities end up receiving bariatric surgical care, the most effective treatment for severe H obesity. ■

Jennifer Stranges is a senior communications advisor, Unity Health Toronto. 24 HOSPITAL NEWS JULY 2022

www.hospitalnews.com

NEWS

Canada’s COVID-19 response in first 2 years of pandemic compares well with other countries’ measures ompared with other G10 countries, Canada handled the first 2 years of the COVID-19 pandemic well by most measures, according to an analysis in CMAJ (Canadian Medical Association Journal). Canada had some of the most stringent policies to help contain the spread of SARS-CoV-2, such as restrictions on movement and public gatherings, workplace closures, event cancellations and international travel controls. “Keeping uncertainties about causation in mind, we can hypothesize that high vaccination percentages and good compliance with sustained public health restrictions explain at least part of Canada’s strong performance in limiting SARS-CoV-2–related health burdens,” writes Dr. Fahad Razak, Unity Health Toronto, and the University of Toronto, with coauthors.

The analysis looked at the response of 11 countries to the pandemic from February 2020 to February 2022: Belgium, Canada, France, Germany, Italy, Japan, the Netherlands, Sweden, Switzerland, the United Kingdom and the United States. The authors chose other G10 countries as a comparator group because of similarities in economic and political models, per-capita income and population size. Some highlights: • Japan was an outlier, with very low rates of SARS-CoV-2 infection and deaths from COVID-19, despite relatively low vaccination rates during the first half of the pandemic, the least stringent public health measures and an older population compared with peer countries. • Among the remaining countries, Canada’s rate of COVID-19–related deaths was the lowest (919/million),

with all other countries over 1000/ million. Canada also had the lowest excess mortality, a measure that includes all COVID-19 and nonCOVID-19 deaths. • Italy had the highest stringency measures in place, followed by Canada. • The US had the highest number of weeks of school closures, followed by Canada. • Canada was one of the slowest countries to introduce SARS-CoV-2 vaccination, but as of February 2022, it had the highest proportion of fully vaccinated people (as per the original 2-dose protocol). • Canada’s economy showed similar inflation and public indebtedness growth, but weaker gross domestic product growth compared with other countries. Comparison of Canada against countries with the highest burden of COVID-19 shows how different the

pandemic experience could have been for Canadians over the first two years: “If the US vaccination rate and COVID-19–related death rate occurred in Canada, about 5.9 million fewer Canadians would have been vaccinated, and about 68 800 more Canadians would have perished from COVID-19,” write the authors. Governments and the public may find lessons from the analysis helpful as the pandemic continues to unfold. “As the country continues through subsequent phases of the pandemic, careful collection and analysis of data are necessary, while acknowledging the limits of available indicators and comparisons. Leaders should share new findings with the public transparently and swiftly, and make strategic adjustments to reinforce measures that appear to be successful and to modify others as H appropriate,” the authors conclude. ■

“Canada’s response to the initial 2 years of the COVID-19 pandemic: a comparison with peer countries” was published June 27, 2022.

www.hospitalnews.com

JULY 2022 HOSPITAL NEWS 25

FROM THE CEO’S DESK

Challenging but exciting time as we reflect on what we have overcome and work together for the future By Dr. Nadiya Sunderji n any given year, one in five people in Canada will personally experience a mental health problem or illness and recent research from CMHA Ontario shows nearly half of Ontarians say their mental health has worsened since the pandemic began. As I begin my new role as President and CEO of Waypoint Centre for Mental Health Care in Penetanguishene, it is a time of extraordinary need and opportunity. I joined Waypoint in 2019 as Vice-President Medical Affairs and Chief of Staff after spending a number of years at St. Michael’s Hospital as a psychiatrist, clinical leader, and research scientist. Since coming to Waypoint and despite the pandemic, there have been successes to celebrate as we further the hospital’s journey to collaborate with patients, families, our expert team and community partners on quality improvement and more broadly on system transformation. The last two years of pandemic response has given us the opportunity to really work together as one health care system, furthering collaboration when critical service needs had to be addressed. Multiple partners including Waypoint worked with public health to open COVID-19 assessment centres and immunization clinics, and support long-term care partners. Waypoint took additional patients needing mental health care to free up inpatient and emergency department beds in acute care hospitals. Pressures for acute mental health beds and psychiatric intensive care services remain and we continue to operate 14 additional beds for patients from across the Ontario Health Central Region. Addressing gaps in services for families, children and youth has been a goal

regionally for many years, and the need has only grown during the pandemic. With support from the Ministry of Health, Waypoint expanded services in an innovative collaborative care model with primary care and community mental health partners across our region. Services cover the full spectrum of mental health conditions for infants to transitional age youth (youth who would be entering the adult system) in a trauma informed, family-focused setting. Our small but growing team of specialists recently launched urgent care services and a virtual on-call service to support the region. The pandemic taught us how to innovate quickly. Waypoint imple-

mented a virtual intensive day program for concurrent disorders to support people with addiction and mental health challenges when inpatient care was not available. We will continue to work with our patients, families and partners on innovation to achieve the best possible outcomes and experience. All hospitals are focused on employee wellness as serious concerns for burnout and staffing have worsened with the pandemic. Waypoint is one of five hospitals across Ontario offering the Frontline Wellness program, a service that connects all health care workers across the sector (including first responders and

those in residential settings such as long-term care) with supports and navigation to services to help manage mental health challenges. Frontline Wellness is part of Waypoint’s extensive employee wellness program. Thanks to an innovation grant, Waypoint’s wellness team has developed a toolkit for Central Ontario Region hospitals, which we hope to spread throughout the sector. It promotes a stepped care framework to support the health and wellbeing of all healthcare staff and connect those with more intensive needs to provincial mental health resources. There are still many gaps to fill and the Central Ontario Health Team (OHT) for Specialized Populations is focused on coordinated access and system integration. Waypoint is one of ten agencies working together to provide specialized services focusing on mental health and addictions including children, youth and adults, seniors and their caregivers, and Indigenous populations. Through collaboration with other OHTs serving local populations, the goal is to improve access and build capacity for better care. This innovative model builds on existing collaborations, avoids fragmentation of specialized services, ensures there is a critical mass needed to deliver specialized services, and supports the identification of service efficiencies so that resources can be re-allocated to address service gaps. We believe our OHT provides an exemplar for the future of specialized services in an increasingly integrated healthcare system. As we move towards pandemic recovery, I look forward to working with patients, families, staff, and local, regional and provincial partners to use new tools and partnerships to improve services for people who need mental health and addictions treatment and H care. ■

Dr. Nadiya Sunderji became Waypoint President and CEO on June 13, 2022. She is a psychiatrist with nearly 20 years of leadership experience. She is also an Associate Professor in the Division of Adult Psychiatry and Health Systems in the Department of Psychiatry at University of Toronto. 26 HOSPITAL NEWS JULY 2022

www.hospitalnews.com

A connected resident is a happy resident. Keep residents connected to the people and things they love the most. With Managed Wi-Fi, TELUS Business makes it easy to connect residents to their own personal area network. Our property-wide Wi-Fi is secure and reliable, our technology is easy to learn and use, and we offer bilingual 24/7 technical support for residents and employees.

telus.com/SeniorsLiving

ETHICS

Person-centered approach to dementia care: Applied behaviour analysis has a role to play By Jisan Phillips and Kristin Grant he prevalence of dementia is increasing across the globe, with projections of the diagnosis estimated to reach 115 million people by the year 2050. A dementia diagnosis encompasses a variety of incurable, neurodegenerative conditions (e.g., Alzheimer’s, vascular dementia) which influence a person’s cognitive functioning, language, self-help skills, and more. The impact of dementia can be exhibited in various ways, including the decline of a person’s cognitive, motor, and verbal skills, as well as an increase in challenging behaviours.

A dementia diagnosis is typically life altering for the person with dementia, as well as their loved ones. In response to this diagnosis, the Alzheimer’s Association in Canada and the United States endorse a philosophy of person-centred care, with the first guiding principle (in the Canadian division) being ‘personhood’. ‘Personhood’ is defined as “a standing or status that is bestowed upon one human being, by others, in the context of relationship and social being. Personhood implies recognition, respect, and trust.” Ultimately, a model of person-centred care recognizes all individuals as peo-

ple who extend beyond their disease or disability (i.e., a person with dementia is not exclusively a patient). This care philosophy also recognizes and values individuals’ preferences in relation to the type of care they do/do not receive. In order to manage many of the symptoms associated with dementia (including challenging behaviours), patients and families often reach out to trusted medical professionals, where evidence-based medical practices, including pharmacological interventions, may be proposed. The types of treatments proposed by clinicians sometimes align with the “medical

model” approach to care. A medical model of care prioritizes a patient’s pharmacological needs as the primary treatment approach, which frequently results in diminishing skills or ignoring the patient’s current level of abilities and challenges. Consequently, the autonomy of the person receiving care is not at the forefront. A medical model approach to care (e.g., responding to various symptoms via pharmacological intervention) is often essential to meeting the needs of and treating symptoms associated with dementia; pharmacological interventions should be proposed for patients and/or their

What is home care? Home care is about trust. It is feeling comfortable with a provider coming into the home of someone you care ĨŽƌ ĂŶĚ͕ ƉŽƐƐŝďůǇ͕ ĂƐƐŝƐƟŶŐ ǁŝƚŚ ƚŚĞ ŵŽƐƚ ŝŶƟŵĂƚĞ ĐĂƌĞ͘ Bayshore’s home care services are extensive, varied, ĂŶĚ ƉĞƌƐŽŶĂůŝǌĞĚ ĨŽƌ ĞĂĐŚ ŝŶĚŝǀŝĚƵĂů͘ tŚĞƚŚĞƌ ŝƚ͛Ɛ ũƵƐƚ Ă ůŝƩůĞ ĂƐƐŝƐƚĂŶĐĞ ĨŽƌ ĚĂŝůǇ ƚĂƐŬƐ Žƌ ƌŽƵŶĚͲƚŚĞͲĐůŽĐŬ ĐĂƌĞ͕ Bayshore’s caregivers can help your loved ones to live ƚŚĞŝƌ ďĞƐƚ ůŝĨĞ ǁŚŝůĞ ƌĞŵĂŝŶŝŶŐ Ăƚ ŚŽŵĞ͘

Let’s talk. 1.877.289.3997 bayshore.ca 28 HOSPITAL NEWS JULY 2022

PERSONAL CARE | HOME SUPPORT | NURSING www.hospitalnews.com

ETHICS substitute decision-makers if clinically indicated. However, an important part of providing person-centered care and enabling patients to make fully informed care decisions is to ensure that their values and preferences are considered, and that all available, evidence-based, and clinically indicated interventions are explored accordingly. Based on our experiences, a primary allied health approach to care, which involves various professional disciplines, such as occupational therapists and recreational therapists (who have fought to establish a foothold within gerontological care), can help to promote a person-centred approach to care, extending beyond an exclusive medical model. An allied health approach to caring for people with dementia provides patients and families with various options to explore for symptom management, which aligns with person-centredness. However, one evidence-based approach to the management of challenging behaviours (in particular) for people with dementia, which is seldom proposed, is that of applied behavioural analysis (ABA). Applied Behaviour

www.hospitalnews.com

Analysis (ABA) is the science of behaviour, which functions based on a person-centered approach to care and emphasizes the need to establish social validity and individualization to treatment. Social validity is at the heart of ABA. Social validity focuses on:

(1) the social significance of the goals of treatment; (2) the social appropriateness of the treatment procedures; and (3) the social importance of the effects of treatments. For example, suppose a dementia patient transitions into

a long-term care facility with their cognitive abilities very much intact, while their motor abilities have diminished and require support. This patient expresses a desire to have medications be a last resort. Continued on page 30

JULY 2022 HOSPITAL NEWS 29

ETHICS Continued from page 29

Dementia care In this case, a treatment approach that prioritizes minimal pharmacological treatment yields a socially valid approach to care. This example encompasses social validity from an ABA lens as it prioritizes the wishes of the patient, and appropriately supports their autonomy. When you consider that social validity to treatment is a core dimension of ABA practitioners, it is evident that ABA fits in with a person-centered approach to care; ABA provides an individual approach to treatment and care. In addition to establishing social validity as part of an individualized approach to treatment, learned dependency is one area where ABA has demonstrated effectiveness in reducing or minimizing acquired helpless and promoting person-centredness. Learned dependency is a challenge

faced by many seniors, with and without dementia, who transition from family or community dwellings into long-term care and nursing facilities. It occurs when skills that are still within their abilities are lost due to staff and caregivers doing tasks for them. For example, it can take less time for a staff member to complete daily hygiene than giving a patient the opportunity to complete their hygiene independently. This grows the problem of learned dependency as patients’ skills are lost and they become more dependent on having assistance provided. By developing individualized behavioural treatment goals, behaviour analysts aim to maintain a patient’s independence as long as possible with the systematic application or withdrawal of supports (primarily daily living and self-help skills)

to minimize the acquisition of learned dependency. Maintaining skills and/ or relearning skills (e.g. self-help and daily living skills), learning new skills (e.g. medication compliance) and reducing challenging behaviours (aggression to self or others) maintains a person with dementia’s autonomy and promotes person-centred care. Every patient with dementia has unique interests, passions, and personalities. And because every patient with dementia is uniquely affected by their diagnosis, each person requires treatment and care that is individualized according to their wants and needs, strengths, and challenges. Each of the allied health professionals in their discipline have the same goals - to maintain a patient’s independence, choices, and quality of life. Ultimately, dementia diagnoses are increasing, and responding to symptoms associated with dementia in a person-centered manner is essential.

Having a behaviour analyst as part of an allied health team can support other professional disciplines by individualizing treatment goals, collection of data, and graphing on progress of skills. Moreover, behaviour analysts have unique skill sets to develop behaviour specific supports to address challenging behaviour, verbal skills, motor skills and self-help skills. As advancements of evidence-based approaches are established as effective, including behaviour analysis, these options must be considered as part of a person-centred approach to dementia care. Reliance on a medical model approach to dementia treatment and care ignores the benefits of other available evidence-based treatment options for dementia patients, their families, and care team. Ensuring that dementia patients and their families have choices in treatment is a valued, ethical approach to care in any allied H health care team. ■

Jisan Phillips, M.ADS., BCBA is a Professor in the Honours Bachelor of Behaviour Analysis program at George Brown College and the Manager of Autism Services at Surrey Place. Kristin Grant recently completed her Honours Bachelor of Behaviour Analysis at George Brown College and is commencing her Masters in Disability Studies at Brock University in September 2022.

Supporting Clinicians with Virtual Care Tools and Training We’ve developed a new toolkit in collaboration with clinicians, virtual care experts and patient partners to give care providers the tools they need to provide safe, high quality virtual care to patients. Download the toolkit today: infoway-inforoute.ca/vc-toolkit

30 HOSPITAL NEWS JULY 2022

www.hospitalnews.com

Advancing interoperability together by Michael Green s a clinician, it’s no secret to you that Canada has an interoperability challenge. You likely encounter it every day, trying to access your patients’ vital health information from other care providers or repeating lab or diagnostic tests because you can’t locate your patients’ previous results. It’s frustrating for you and your patients, and it delays their care. That’s why we need to improve interoperability – the ability of different IT systems with different infrastructures to share data, like patient health information, in the context in which it was collected. This data needs to flow seamlessly across the care continuum, whether care is delivered in-person or virtually. It’s essential to the delivery of safe, effective health care. Despite huge progress in digital health in Canada over the past 20 years, issues with the exchange of patient health information persist, especially during transitions of care. For patients, gaps in their information can delay care and create safety issues that can have negative implications, such as adverse drug events or the need for hospital readmissions. Patients are also impacted by wait lists fueled by inefficiencies. For clinicians like you, these gaps take up precious time and contribute to burnout. Health systems are burdened as a result of poor information exchange, duplication of tests, unnecessary appointments and hospitalizations, and other inefficiencies. While electronic health records and related connected health information initiatives have led to significant improvements in these areas, Infoway estimates that $3 billion in potential benefits could be realized annually through greater interoperability. A recent Infoway survey of more than 800 Canadian clinicians (general practitioners and family physicians, specialists, nurses and allied health profes-

HEALTH SYSTEMS ARE BURDENED AS A RESULT OF POOR INFORMATION EXCHANGE, DUPLICATION OF TESTS, UNNECESSARY APPOINTMENTS AND HOSPITALIZATIONS, AND OTHER INEFFICIENCIES. sionals) found that, on average, about two-thirds of them can usually obtain patient information from outside their practice quickly and efficiently, and in a way that easily integrates with their system. However, they reported spending approximately 40 minutes a day beyond what should be spent searching for patient information. Not surprisingly, the clinicians surveyed are overwhelmingly in favour of greater interoperability. Ninety-two per cent said having more complete, timely and accurate information at their disposal would enable safer patient care; 88 per cent said it would improve their ability to collaborate and coordinate care with providers outside their practice; and 85 per cent said it would increase their productivity. Patients also want improved interoperability. Most have likely never heard that term, but they know they want to access health services, and their personal health information, online. They want the information all in one place, they want to access it quickly, and they want to share it with those in their circle of care. That requires better interoperability. According to Infoway surveys, 93 per cent of Canadians would like to receive their lab results immediately. Of those who are able to access their health information online, 88 per cent said they are more informed about their health, and 82 per cent said they are better able to manage their health. So what are Infoway and our partners doing to respond to the needs of clinicians, patients and the health system?

During the past year, Infoway established an active collaborative framework that engages jurisdictions, clinicians, other Pan-Canadian Health Organizations, industry and the broader health sector. We continued to publish and support data and terminology standards that are the foundation of digital health systems across Canada. We cultivated pan-Canadian governance with participating jurisdictions (Ontario, British Columbia, Alberta, Saskatchewan and Newfoundland and Labrador) for interoperability that supports and facilitates common goals. And we worked with stakeholders to develop an initial set of pan-Canadian technical requirements for a Patient Summary initiative that will enable different digital health solutions to exchange health data and enable health care providers to better support patients with integrated transitions of care.

We also hosted our first pan-Canadian Projectathon, where more than 40 representatives of vendors, jurisdictions and other stakeholders came together to test the first version of the pan-Canadian Patient Summary Interoperability Specifications. This is a significant milestone in Canada’s interoperability journey. However, end-to-end interoperability is a continuous, multi-year journey that will require coordinated effort and investment. We are on the right path, and Infoway and our partners are committed to this journey that will improve efficiencies for clinicians and our health system, and ensure safe, H effective health care for Canadians. Q

Michael Green is President and CEO, Canada Health Infoway www.hospitalnews.com

JULY 2022 HOSPITAL NEWS 31

The Pandemic Has Left Caregivers Burnt Out Health and service providers have felt the impact of Covid-19 on their mental health. The impact has been similar on family caregivers who support a family member, friend or neighbour. In fact, 58% say they feel burnt-out as a result of their caregiving role. The next time you meet a family caregiver, let them know the Ontario Caregiver Organization is here to help. Free programs and services are available to Ontario caregivers: 24/7 Helpline (1-833-416-2273)

Group and 1:1 Peer Support (online or by phone)

Helpful Webinars (Live and Recorded)

Group and 1:1 Counselling

e-Learning and Educational Resources

Toolkits for Caregivers (For New and Working Caregivers)

Dedicated Resource for Young Caregivers: youngcaregiversconnect.ca

Time to Talk Podcast

Learn more at ontariocaregiver.ca