Only weeks ago, Health Minister Sylvia Jones claimed that Ontario’s health-care system is doing fine. The facts tell a different story. Hospital ERs are closing and patient wait times are ballooning, mainly because of a devastating nursing shortage made worse by the Ford government.
Confronted by the truth, the Health Minister shifted the blame to vulnerable seniors in hospital beds. Now she’s pitching for-profit health care as the government’s solution. Unbelievable.
Private health care will pull resources away from the public system. Money that could be used to increase staffing and benefit patients instead disappears in the form of profits. For-profit care undermines the fundamental Canadian value of equal access to quality health care. The size of someone’s paycheque should never be a factor in their access to care.
For years, the status quo in this province has been deliberate government underfunding and understaffing. Ontario deserves a government that proves it truly cares about patients, one that invests in nurses and health-care professionals to rebuild public health care for everyone.
The COVID-19 pandemic has amplified inefficiencies and lack of access to resources that have stressed Ontario’s healthcare system to the brink. Many Canadians have seen or heard about potential ICU closures, shuttering of emergency rooms, and cancelled elective surgeries.
There is growing concern from both providers and patients about the backlog of postponed surgeries, especially as hospitals struggle with daily operations due to enormous staffing challenges. In Ontario, a large part of the backlog in surgeries consists of patients awaiting hip and knee replacement operations. Ontario performs almost 50,000 hip and knee replacements each year, and the demand for these surgeries continues to rise.
With hospitals understaffed and overloaded with patients who are anxiously awaiting long-delayed surgeries, now is the time to ensure that all our processes are as efficient as possible.
As orthopaedic surgeons and pathologists, we see an opportunity for improvement that can help free up time and limited resources. In Ontario hospitals, there is a routine practice of sending the removed bone during hip and knee replacement surgery for pathology testing. This is based on an outdated practice that pathology testing may reveal a rare cancer that would alter a patient’s treatment plan. Yet several studies show this testing does
EDITORIAL: October 4
ADVERTISING:
Display – Oct. 21 | Material – Oct. 25
Monthly Focus: Technology and Innovation in Healthcare/ Artificial Intelligence (AI)/Patient Experience/ Health Promotion: New treatment approaches to mental health and addiction. An overview of current research initiatives Programs and initiatives focused on enhancing the patient experience and family centred care. Programs designed to promote wellness and prevent disease including public health initiatives, screening and hospital initiatives.
+ SPECIAL MEDTECH SUPPLEMENT
610 Applewood Crescent, Suite 401 Vaughan Ontario L4K 0E3 TEL. 905.532.2600|FAX 1.888.546.6189
www.hospitalnews.com
not improve or change patient care for those undergoing hip and knee surgeries.
In fact, in other provinces, there are major efforts underway to reduce this practice. Manitoba reduced pathology testing for hip and knee surgeries by 93% without negatively impacting patient care.
In Ontario, this routine practice remains entrenched due to many hospital legal department’s interpretation of Regulation 965 of the Public Hospitals Act, which mandates that such tissues removed during an operation be sent together with a short history of the case to a laboratory for examination and report.
Pathology testing requires time and effort from staff including technologists, pathologists’ assistants, and pathologists as well as the use of hazardous chemicals and storage space. It also diverts finite resources from patients who need timely diagnosis, such as those undergoing cancer treatment.
on page 6
accountingteam@mediaclassified.ca
info@hospitalnews.com
Lauren Reid-Sachs
Senior Graphic Designer Johannah Lorenzo
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:
EDITORIAL: November 8
ADVERTISING:
Display – Nov. 25 | Material – Nov. 29
Monthly Focus:
Medical Imaging/Year in Review/Future of Healthcare/Accreditation/Hospital Performance Indicators: Overview of advancements and trends in healthcare in 2021 and a look ahead at trends and advancements for 2022. An examination of how hospitals are improving the quality of services through accreditation. Overview of health system performance based on hospitals performance indicators. A look at medical imaging techniques for diagnosis, treatment and prevention of diseases.
+ SPECIAL FOCUS: ANNUAL RADIOLOGY SUPPLEMENT
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
THANKS TO
Hospital
at no cost in hospitals. When
ads in Hospital News.
Canadian Publications mail sales product agreement number 42578518.
team of researchers from Sunnybrook Health Sciences Centre and University Health Network (UHN) are the first in the world to demonstrate that focused ultrasound technology can safely be used to deliver a therapeutic to targeted brain regions in patients with Parkinson’s disease (PD).
The leading-edge study has been published in Movement Disorders.
“Our early findings are an exciting and critical first step in less invasive direct-to-brain delivery of therapeutics to key areas of the brain important in the development and progression of Parkinson’s disease,” says Dr. Nir Lipsman, the study’s co-principal investigator and director of Sunnybrook’s Harquail Centre for Neuromodulation. “Current management strategies for Parkinson’s include medications and more invasive neurosurgery. Focused ultrasound is a less invasive, targeted approach that could change the way brain disorders are treated in the future.”
Low intensity MRI-guided focused ultrasound technology uses ultrasound waves to breach the bloodbrain barrier, a layer of cells that protects the brain from toxins but can also block potentially helpful medications from getting where they need to go. The opening in the barrier, which closes within hours of the procedure, allows the therapy to pass and reach targeted brain region with millimetre accuracy.
Typically, treatments are unable to cross the blood-brain barrier because compounds are too large. In some cases, open brain surgery is required to help manage PD symptoms.
There is currently no cure for Parkinson’s, which is a common and progressive brain disorder that causes difficulties with movement and numerous disabling symptoms which dramatically impact a patient’s quality of life. Symptoms vary, and can progress at a different rate for each individual.
Study researchers investigated the delivery of an enzyme, glucocerebro-
sidase, to the putamen which is a key structure in the brain related to movement. Glucocerebrosidase may help to prevent buildup of the protein alpha-synuclein, a key indicator of PD that leads to unhealthy brain cells and neurodegeneration. In Parkinson’s, the enzyme can be defective and result in PD symptoms. Enzyme replacement therapy could be one approach to reduce or prevent neurodegeneration in PD.
The Phase I trial included four patients diagnosed with early-stage Parkinson’s disease with an average age of 54 years. Participants received three doses of the therapeutic and application of focused ultrasound every two weeks to the side of the brain most affected by the disease. They were followed for three and six months.
“The Phase I trial offered a hint of potential improvement in symptoms following treatment but this requires further study. Any side effects, such
as involuntary movements, were only temporary, and none were severe,” says Dr. Lorraine Kalia, co-principal
investigator and a neurologist and senior scientist at the Krembil Brain Institute, part of UHN. “It is still very early in the research, but with our firstin-the-world study findings, we are making much needed progress in the development of innovative treatments for people with Parkinson’s disease.”
The Sunnybrook and UHN researchers have launched a Phase I/ II clinical trial continuing the team’s investigation.
“The upcoming trial will further explore low intensity MRI-guided focused ultrasound and targeting enzyme replacement therapy to both sides of the brain. The ultimate goal is to improve the delivery of therapeutics to the brain with the hope of improved symptoms or slowed progression of Parkinson’s disease,” says Dr. Suneil Kalia, co-principal investigator and a neurosurgeon and scientist at UHN.
“There is robust data in both preclinical and clinical studies demonstrating that glucocerebrosidase replacement is a promising disease-modifying therapy in Parkinson’s disease. The next step is to better understand the biologic effects of the treatment with further research,” says Dr. Ying Meng, the study’s first author and neurosurgery resident at Sunnybrook. ■ H
“THERE IS ROBUST DATA IN BOTH PRECLINICAL AND CLINICAL STUDIES DEMONSTRATING THAT GLUCOCEREBROSIDASE REPLACEMENT IS A PROMISING DISEASE-MODIFYING THERAPY IN PARKINSON’S DISEASE.”
Comprehensive repairs to Ontario’s health-care system will not be quick or easy. The Ontario Medical Association has a detailed roadmap for what needs to be done over the next four years, Prescription for Ontario: Doctors’ 5-Point Plan for Better Health Care.
But there are some steps we can take now that will make a difference to patient care in the short-term, by dealing with the supply of health-care workers, shortening wait times and expanding access to palliative care.
from page 4
The OMA’s “three solutions” government could implement now are:
• Licensing more foreign-trained physicians, through increased residency spots and a government practice-ready assessment program
• Moving ahead urgently with the creation of Integrated Ambulatory Centres for less complicated outpatient surgeries and procedures to ease the burden on hospital and reduce wait times. The OMA is ready to work with the government now to create a centralized referral system so that patients, regardless of
Many groups including Choosing Wisely Canada, in collaboration with the Canadian Orthopaedic Association and the Canadian Arthroplasty Society, have recommended against the routine use of pathological examination for these surgeries. In fact, in July 2019, Choosing Wisely Canada and the Ontario Orthopedic Association sent a joint letter to the Ontario government requesting a simple amendment to the Act to remove the
requirement for hip and knee tissues to be sent to the pathology lab for routine testing. Unfortunately, as it currently stands, hospitals that choose to practice according to scientific evidence would be breaking the law.
We are seeing firsthand the cracks in our system unfold that have forced hospitals into crisis mode. Now is the time to find improvements and end redundant practices so Canadians can have timely access to the care they need. ■ H
Dr. Sarah Ward is an orthopaedic surgeon at St. Michael’s Hospital and Assistant Professor in the Department of Surgery at the University of Toronto. Dr. Jesse Wolfstadt is an orthopaedic surgeon at Mount Sinai Hospital and Assistant Professor in the Department of Surgery at the University of Toronto. Dr. Corwyn Rowsell is a Staff Pathologist at St. Michael’s Hospital and Associate Professor in the Department of Laboratory Medicine at the University of Toronto
where they live and those in most need of high-demand surgeries and procedures, are distributed among all available doctors
• Creating more hospice beds and palliative care services to improve the patient experience, support caregivers and reduce pressures on emergency departments
“These are solutions that can be implemented now and will have system-wide impact and improve patient care,” said OMA CEO Allan O’Dette. “Bigger reforms are needed and we have to start somewhere.”
The shortage of physicians and other health-care workers, many of whom are suffering from burnout after three years on the front lines of the pandemic, has contributed to long waits and closures of emergency departments this summer. In addition, too many Ontarians lack access to a family doctor.
The OMA supports measures to give temporary licences to physicians from other provinces. But more can be done. Mechanisms exist for licensing U.S.-trained family physicians and specialists who want to work in Canada and family physicians educated in countries such as Ireland, Britain, New Zealand and Australia, whose training is similar to Canada’s.
Ontario’s doctors say we must also reduce the backlog of care created during the pandemic and reduce wait times, many of which were too long even before COVID. Integrated Ambulatory Centres have been shown to
have faster recovery times, lower infection rates and efficiency gains ranging from 20 to 30 per cent compared with inpatient hospital care. These centres would operate on a not-for-profit basis within the Canada Health Act and provide publicly funded OHIP-insured surgeries and procedures.
The third OMA solution is to make palliative care available when it is needed by increasing the number of hospice beds and providing consistent funding to operate them. Of the more than 100,000 people who died in Ontario in 2017-18, only 61 per cent received palliative care in their final year. Ontario should have about 945 to 1,350 palliative-care beds province-wide, but there are only 271.
We also need to enhance supports to allow people to receive palliative care where they need it, including at home. That means having access to on-call palliative specialists who are available when patients most need them. And we need to integrate palliative care within long-term care homes. The OMA would also like to see more training to increase the number of palliative care health professionals and workers.
Ontario spends more than $208 million a year on dying inpatients who are waiting for a bed in a more appropriate care setting. Ontario’s doctors think this money could be better spent on the beds and resources these individuals were waiting for – beds in longterm care, hospices and hospital-based palliative care units, or home care. ■ H
date of receipt. Special offer applies to new or lapsed members
for 2022-2023
atients with chronic heart failure who received collaborative, home-based palliative care were less likely to die in hospital and more likely to die at home than people who received usual care, according to new research in CMAJ (Canadian Medical Association Journal)
In Ontario between 2010 and 2015, 75 per cent of people with heart failure died in hospital despite the majority preferring an out-of-hospital death.
The current CMAJ study included 245 people in Ontario with chronic
heart failure between 2013 and 2019 who were enrolled in the collaborative care model and 1172 who received usual care. The mean age was 88 years, and 55 per cent were female.
The collaborative model, which involved primary care providers, cardiologists and palliative care specialists, was associated with fewer visits to the emergency department, fewer admissions to hospital and intensive care near the end of life, and a lower likelihood of dying in hospital (41% v. 78%) than usual care. The model emphasized advance care planning;
home-based management of heart failure; standardized protocols for clinical care; education of patients, families and clinicians; and collaboration between health care professionals.
“The implementation and scalability of this model does not require major restructuring for providers,” says Dr. Kieran Quinn, a palliative care physician with Sinai Health and the University of Toronto, Toronto, Ontario. “However, scalability does require increased awareness on the part of all providers of the potential to provide integrated palliative and heart failure care.”
“This model coincided with a regional cultural shift among palliative care physicians, cardiologists and other health care providers, and people living with heart failure and their family caregivers,” says Dr. Sarina Isenberg, Bruyère Chair in Mixed Methods Palliative Care Research at Bruyère Research Institute and the University of Ottawa. “The clinical leads of the model worked tirelessly to affect these changes in skills, behaviours and attitudes, and champions are needed to expand to other regions.”
■ H
The Canadian Medical Protective Association (CMPA) announced the publication of Patterns and trends among physicians-in-training named in civil legal cases. The results of this study will help direct the Association’s future patient safety learning efforts for residents (physicians-in-training) to improve safe medical care.
Published in CMAJ Open, it is the first peer-reviewed research of its kind to explore the frequency and types of cases among physicians-in-training named in civil legal cases in Canada. The results of this research will help inform the CMPA’s efforts to promote patient safety through enhanced education, targeted at reducing the frequency and severity of medical liability issues for physicians-in-training.
Sharing these data may help physicians-in-training to anticipate and mitigate patient safety risks and to shape their expectations for medico-legal events during their years-long training. More specifically, awareness of medico-legal patterns across specialty areas can help stakeholders in postgraduate medical education to focus on areas of priority to address and mitigate medico-legal risk.
Civil legal cases take an emotional toll on any physician, but there are unique stressors and important considerations when a physician-in-training is named in a case. We know physicians-in-train-
ing sometimes worry about their medico-legal liability, but until now, information on how often and why they are sued hasn’t been available.
Significantly, the study reports that civil legal cases can last several years. Therefore, given 2- to 3-year residencies in Canadian
family medicine programs and 4- to 5-year training programs in other specialties, civil legal cases can persist through the entire duration of residency, and even beyond.
“The stress caused by a poor patient outcome, compounded with a medico-legal matter, can be agonizing for
physicians-in-training,” said Dr. Lisa Calder, Chief Executive Officer of the CMPA and the study’s senior author.
“It’s a difficult thing to go through –and this research helps shed light on an often undiscussed and misunderstood element of life as a resident.” ■ H
With the lingering effects of COVID-19 continuing to cause significant burnout and disrupting clinical learning, a new e-learning platform, created by award-winning health-care practitioners, is now launching with the support of the Canadian Nurses Association (CNA) to help nurses build their skills.
NursingSKL.com, created by a group of Canadian physicians and nurses, launches today to help nurses improve their clinical skills in seven clinical specialties. And with nearly 66 per cent of nurses suffering from burnout and nearly one-in-three contemplating leaving the profession, services to help with professional development could not have come at a better time.
“During the pandemic, the usual practicums and clerkships that nursing students and nurses rely on to learn shut down. So I started working with nurses
in my own clinics to teach them between patients. They really enjoyed it. Their confidence improved and the quality and efficiency of their work was noticeably better. When thinking about the project, we envisioned a collaboration whereby physicians and nurses worked together as a cohesive group to improve patient related outcomes to ensure the highest quality of care for patients,” said Dr. Sanjay Sharma, NursingSKL’s editor-in-chief and a professor of ophthalmology at Queen’s University.
NursingSKL.com launched its e-platform in seven different specialty areas, including mental health, oncology, and women’s health. Currently, the e-platform is offered in English only. With NursingSKL.com, nurses will also be able to learn important clinical skills from leading practitioners, earn continuing professional development (CPD) certificates and
participate in fun games to connect to colleagues around the country.
“We know that the pandemic has been unrelenting for nurses, and that the disruption of nursing education will have long-lasting impacts on the profession. That is why we are so excited to support the launch of NursingSKL, as it is fully aligned with CNA’s mission of strengthening nursing leadership and promoting nursing excellence. This innovative e-learning platform will help to support nurses with the training and education they need to be successful in their jobs,” said Tim Guest, chief executive officer of CNA. “At a time where much of the profession is experiencing symptoms of burnout, it is important that we do everything we can to retain and recruit nurses.”
Go to NursingSKL.com to find out more, meet the Faculty, and try its free practicum on diabetes mellitus.
AUnity Health Toronto team led by Dr. Andrew Brown has become one of the first groups in Canada to trial a new technology for treating deep vein thrombosis that allows doctors to remove even the most complicated clots without surgery or potentially dangerous medications.
“There is a lot of hope and optimism with the introduction of these new tools,” said Dr. Brown. “In our practice we see 20 or 30-year old patients who can no longer walk-up a flight of stairs because they are limited by pain or breathlessness. We now have a tool to treat these patients.”
Deep vein thrombosis (DVT) is one of the most common cardiovascular disorders in the world, effecting roughly 200,000 Canadian patients a year. Blood clots that form in deep veins in the body, often in the arms and legs, can lead to permanent damage in veins and other conditions like chronic pain, disability and post-thrombotic syndrome (PTS).
The St. Michael’s team recently became the first group in Canada to use the ClotTriever System to treat venous blood clots in the arms.
This device has the potential to limit long hospitalizations because it can be used in a single session. The device works for both acute and chronic
Dr. Andrew Brown
blood clots, making it unique among blood clot treatments.
Dr. Brown said he was aware of the technology from his literature reviews
and conversations with other experts in the field. When a patient came into the hospital one day with a blood clot, he thought it would be a good op-
portunity to try the device. He didn’t know at the time that it would be one of the first times a physician in Canada used it.
For Dr. Brown, these advancements in treatments for patients are promising and exciting, and the need for continued research and development is critical.
St. Michael’s Hospital employs a collaborative approach in treating patients with DVT and PTS. Dr. Brown and the Interventional Radiology team work closely with the Thrombosis Clinic at the hospital, led by Dr. Vera Dounaevskaia and Dr. Erin Tseng, to manage these often difficult cases.
“I’m saddened when I think of patients I have treated in the past who could have benefitted from this technology. But I believe these innovations will now give us an edge in these challenging cases.” said Dr. Brown.
“The vision is to not only perform a procedure but to provide comprehensive care for these patients and in turn, help them to live as full a life as possible.”
Dr. Brown and his team have several more ClotTriever procedures set up in the next few months, and the device is readily available to them when a patient with a blood clot comes into the Emergency Department. ■ H
The Master of Health Administration (Community Care) program prepares graduates to effectively manage and lead organizations in the dynamic and growing Community Care sector.
1st program of its kind in Canada
Located in Toronto’s epicentre
Modular format allows students to work full-time while completing the program in 16 months
Learn more at torontomu.ca/mhacc
Olivia Lavery is a communications advisor at Unity Health Toronto.
THE ST. MICHAEL’S TEAM RECENTLY BECAME THE FIRST GROUP IN CANADA TO USE THE CLOTTRIEVER SYSTEM TO TREAT VENOUS BLOOD CLOTS IN THE ARMS.
Home of your next customer.
Global growth isn’t painful when your tour guide is an international shipping expert. FedEx makes it easy to ship your products to more than 220 countries and territories around the world.
Visit fedex.ca/international
Where now meets next
While the grocer’s fridge is filled with different types of cow’s milk and plantbased beverages (PBBs), they do not have the same nutrient composition. Milk is known for containing 15 essential nutrients from vitamin A to zinc. The nutrient content of PBBs has a huge range – some are fortified, some are not, and they all have vastly different Nutrition Facts panels.
There are over 20 PBBs to choose from, which can be made from nuts (almonds, cashews), coconuts, grains (rice, oats), legumes (soy, peas), and seeds (flax, hemp).1 With a range of possible nutrients, the nutritional quality of PBBs is highly variable.2 Milk tends to have more protein and a wider variety of vitamins and minerals compared to PBB.
Since PBBs are often sold in the dairy case in similar packaging to milk, some consumers mistakenly think milk and PBB are interchangeable. That can be problematic if consumers choose a low-protein or unfortified PBB and get fewer nutrients without realizing it.
Choosing a lower-nutrient PBB can be a public health concern if it replaces milk, since milk is a main source of protein, calcium, potassium, and vitamin D in the diet.3 Here’s a guide to help your clients make informed choices.
Globally, dairy is an important contributor to population nutrition, providing 12 per cent of dietary protein.4
Milk has 9 grams of protein per cup – and the protein is particularly high quality, per the Digestible Indispensable Amino Acid Score (DIAAS). Milk protein concentrate has a
DIAAS score of 1.18, compared to 0.94–0.97 for soy protein isolate, 0.54 for oats, 0.4 for almonds, and 0.37 for rice protein.5
As shown in this chart comparing milk and PBBs, milk has the most protein, with 9 grams per cup. Soy beverages have the closest protein content to milk (6-8 grams per cup), while the other PBB groups contain about 1 gram of protein per cup.
Several studies have compared the protein in milk and PBBs. One study found that one cup of milk provides a greater contribution toward the recommended daily intake (RDI) of all amino acids considered (29–61 per cent contribution to each amino acid except histidine), while PBBs provide 11 per cent or less.6 In another study, researchers found that the protein content of PBBs ranged from 5 to 100 per cent (48 per cent when averaged) of the protein content of milk.7
That means it’s important for consumers to carefully read labels if they are looking for a protein-rich milk or
alternative. Milk comes out on top, both for protein quality and quantity.
Calcium in milk is naturally occurring, and milk provides 30 percent of the per cent Daily Value (DV). Calcium is added to PBBs via fortification, and the amount added can range from 23-38 per cent DV.
But there’s one hiccup with calcium in PBBs. Since it’s added as a fortifier, it’s not naturally part of the beverage. Studies show that the added calcium sinks to the bottom of the beverage container as sediment. So, the nutrient content of PBBs depends on whether the product has been shaken.8
In one study comparing the calcium content of PBBs based on shaking, researchers learned that unshaken almond and soy samples had 14 and 18 per cent lower calcium contents than their wellmixed samples. Even more troubling, unshaken rice and oat samples had 96 and 97 per cent lower calcium contents than the well-mixed samples.9
While there may be comparable amounts of calcium on Nutrition Facts panels, you get more calcium from milk because it doesn’t separate from the beverage and settle on the bottom of the container.10
Milk contains 14 different vitamins and minerals, including vitamin A, vitamin B12, potassium, magnesium and zinc. PBBs don’t have that variety; they range based on what’s naturally occurring and how much they are fortified.
Overall, milk contains more vitamins and minerals than PBBs, including more potassium, phosphorus and zinc. 11 Plus, studies show that the bioavailability of phosphorus and zinc is significantly lower in soy PBB products compared to milk. Phytate, an antinutrient found in plant-based foods and beverages, reduces mineral absorption from plant-based foods. 12
Lactose
Lactose
Lactose
1102.512910012301045
130512910012301045
160812910012301045
700796052311
902.5796052311 8
Almond (original) 602.5811501231110 42
Almond (unsweetened) 302.5111304231110 42
Cashew (original) 602.5911601231110 42 Cashew (unsweetened) 252111601231110 42
Soy (original) 10048690830104550
Soy (unsweetened) 803.548409301045 50
Oat (original) 803.51211004231110 42
Oat (unsweetened) 704.581904231110 42
Macadamia (original) 704.5711150352520N/A
Macadamia (unsweetened) 556111100382520N/A
Milk is considered a whole food. The only ingredients are milk and vitamins. Some PBBs are close to nature and the only ingredients they contain are water, vitamins and the plant they are named for (almond, soy, etc.).
But buyer beware. More often, PBBs are considered ultra-processed. Studies show that 90 per cent of PBBs meet the criteria for ultra-processed foods,
meaning they contain sweeteners, hydrogenated oils, hydrolyzed proteins, flavour enhancers, emulsifiers, thickeners, and/or bulking agents.13 Dietary guidelines recommend eating more whole foods and cutting back on ultra-processed foods to help lower the risk of chronic disease.14,15
When comparing milk and PBBs, milk comes in on top for protein, cal-
cium, vitamin and mineral content. Soy is the nearest substitute, with several caveats: fortification sediment at the bottom of the container, less calcium bioavailability, and slightly lower protein quality. Other PBBs don’t compare, so it’s important that consumers understand that most PBB should not be considered a nutritional substitute for milk.
For more information, visit Milk.org. H
Cara Rosenbloom
1. www.mdpi.com/2072-6643/13/3/842/htm 2. pubmed.ncbi.nlm.nih.gov/34746213/ 3. www.frontiersin.org/articles/10.3389/fnut.2021.761442/full 4. www.frontiersin. org/articles/10.3389/fnut.2022.957486/full 5. www.frontiersin.org/articles/10.3389/fnut.2021.761442/full 6. www.frontiersin.org/articles/10.3389/fnut.2022.957486/full 7. www.sciencedirect.com/science/article/abs/pii/S0958694618301900?via%3Dihub 8. www.frontiersin.org/articles/10.3389/fnut.2022.957486/full 9. www.frontiersin.org/ articles/10.3389/fnut.2022.957486/full 10. www.sciencedirect.com/science/article/abs/pii/S0958694618301900 11. www.frontiersin.org/articles/10.3389/fnut.2022.957486/ full 12. www.sciencedirect.com/science/article/pii/S1756464619306528?via%3Dihub 13. academic.oup.com/advances/article-abstract/12/6/2068/6325326?redirectedFrom=fullt ext&login=false 14. food-guide.canada.ca/en/healthy-eating-recommendations/limit-highly-processed-foods/ 15. food-guide.canada.ca/en/healthy-eating-recommendations/make-it-ahabit-to-eat-vegetables-fruit-whole-grains-and-protein-foods/
www.frontiersin.org/articles/10.3389/fnut.2022.957486/full 17. www.mdpi.com/2072-6643/13/3/842/htm
he drug toxicity crisis in British Columbia has claimed the lives of over 130 youth between January and May 2022. A new study led by Vancouver Coastal Health Research Institute researcher Dr. Danya Fast and published in the International Journal of Drug Policy highlights the importance of collaborating with youth who use drugs to find possible solutions to this crisis.
The study calls for improvements to treatment options, such as opioid agonist therapy (OAT), for young people who use illicit drugs.
“Youth use opioids for many different reasons,” explains Fast, who has over 15 years of experience working with young people. “They are consumed for pleasure and as part of socialising, but also to treat physical, emotional, psychological and even economic pain, such as the pain of crushing, entrenched poverty.”
Dr. Danya Fast is a research scientist with the British Columbia Centre on Substance Use, as well as an assistant professor in the Department of Medicine and associate member in the Department of Anthropology at the University of British Columbia.
“When I first started working in this field, I would say that there was a lot more hopefulness among youth who use drugs,” she says. “Since the beginning of the COVID-19 pandemic in 2020, I have seen a lot more cynicism and despair from these youth about their opportunities for housing, employment and education.”
According to BC Mental Health and Substance Use Services, OAT “is a safe and effective medication-based treatment for people who are dependent on opioid drugs,” including heroin, oxycodone and fentanyl, and is often combined with other supports, such as counselling.
OAT can help manage withdrawal symptoms and lower the risk of drug-related harms, such as fatal overdose and the transmission of hepatitis C or HIV, leading to improved treatment retention and outcomes.
Despite being recognized as a critical tool for the treatment of opioid use disorder and harm reduction among youth, previously published research has suggested that Canadian youth who use drugs are significantly less likely to access OAT than adults, notes Fast.
For her research, Fast interviewed 56 young people between the ages of 14 and 26 who reported using heroin or fentanyl two or more times per week and received some form of drug treatment therapy within the past six months. The research team used an interview guide developed in collaboration with a Youth Advisory Council of eight youth with lived experience of substance use and mental health concerns.
Interview topics included living conditions, drug use history, substance use treatment and service access across time, and also addressed how OAT impacted relationships with family, friends, health care professionals and romantic partners over time.
“A lot of the youth I have spoken with believed that OAT would enable the positive unfolding of their lives,” says Fast. “But, when that did not happen despite repeated attempts, it made it harder for them to imagine a different future via OAT. Many youth then concluded that OAT was irrelevant to their needs.”
The study team found that participants’ perceptions of OAT were often shaped by their peers, family members and romantic partners, some of whom raised concerns about such things as side effects and the potential efficacy and long-term health implications of the therapy.
Daily witnessed dosing at a pharmacy during limited hours of operation was also identified by youth as a significant barrier to accessing and sticking with OAT. Many juggled poverty, various health challenges and unstable housing or homelessness, along with work and family commitments, which
made the dispensing requirements unrealistic or burdensome, Fast explains.
One participant noted the challenges of OAT: “I’ve got, you know, doctor’s appointments. I’m homeless so I’ve gotta figure out food in a day. I’ve got to figure out... shelter. I’ve got to figure out how to help my partner.”
While take-home OAT was available to some participants, Fast’s study found that accessing these ‘carries’ was often difficult and out of reach for many youth.
“I tried to call my pharmacy to get more carries, and they were like, ‘No’,” recalled a study participant, who eventually found a pharmacy willing to offer OAT due to temporary access measures introduced during the pandemic. “If it wasn’t for COVID, I never would have been able to get my meds and I would have had to leave the job site and miss out on, like, another $1,000 worth of work.”
Developing treatment interventions that better align with and address the needs of youth who use opioids could help improve treatment retention and outcomes, says Fast.
“The challenge lies in the fact that many youth tell me that they live in supportive housing, are impoverished and have no fun or pleasure in their lives, so drugs may offer them a way into pleasure and fun in that context,” says Fast.
Along with OAT and other harm reduction measures, Fast believes that treatment interventions should focus on the full spectrum of livelihood needs among young people.
“This includes housing, employment, income support, opportunities for leisure and recreation, as well as cultural and spiritual practices,” she says. “Things that we all reach for in our lives.”
■
“WE NEED TO MAKE SURE THAT WE ARE LISTENING TO AND CONNECTING WITH YOUNG PEOPLE WHO USE DRUGS, AND THEN SEEING HOW WE CAN WORK WITH THEM AND NOT AGAINST THEM.”
No intervention seemed to be getting through. A patient was threatening to harm themselves on the neurosurgery unit, and Krystal Fox knew she had to act fast.
The nurse practitioner’s last resource would be calling a Code White, which involves security personnel. The experience could be distressing to the patient and staff. Instead, for the first time, Fox paged a service called BERT.
“It was surprisingly easy,” Fox says. “The lead, Jenna, came right away, and made a care plan to support the patient and the staff. It was very successful and we were able to avoid a Code White or having security involved in their care. It made a substantial difference in supporting the patient and staff.”
Jenna Richards is a clinical nurse specialist with the Consultation Liaison Psychiatry team at St. Michael’s Hospital, a site of Unity Health Toronto. Richards and her St. Joseph’s Health Centre counterpart, Glen D’Souza, make up Ontario’s first hospital mental health response team, formally called the Behavioural Escalation Response Team (BERT).
BERT responds to patients with escalating behaviours and intervenes before a Code White occurs. Their work follows the concept of a critical care response team, which is a team that responds to medical units to support patients who are medically decompensating prior to a Code Blue, when a patient experiences an urgent physical health event such as a cardiac arrest or losing consciousness.
The BERT service focuses on creating a safer environment for patients and staff, while improving patient outcomes.
When a patient begins to experience escalating behaviours, such as yelling, swearing, harming themselves or others, staff can page the BERT member at their acute care site, who will respond to help support the patient and staff.
“When you’re in a medical unit, you’ve got a lot of things on your mind, you’re really focused on your tasks at hand, and if a client is experiencing responsive behaviours, it’s really hard to take a step back,” says Richards.
“I try to figure out what’s the root of this issue, why are they experiencing responsive behaviours? I try to give another perspective to the situation on how we can address the unmet need and support the client while they’re here.”
Richards says the BERT service is an important way to acknowledge that the hospital can be an anxiety-provoking place, especially for patients who have experienced institutional and systemic oppression. There’s a misconception that people with responsive behaviours are dangerous, Richards says, but it is important to understand that they are often trying to communicate that they have an unmet need.
“The blame is not on the individual for their responsive behavior,” Rich-
ards says. “It’s really looking at what’s the big picture here, and what can we do better to support our clients while they’re in hospital.”
Stephanie Lucchese is the clinical nurse specialist for the Mental Health and Addictions Program at St. Michael’s Hospital. She also is behind the inception of BERT at Unity Health.
When she would respond to Code Whites at the hospital, she remembers staff would often have to use last-resort methods to de-escalate situations, with staff sometimes getting injured in the process. While debriefing with staff, Lucchese says they would always mention how the patient demonstrated warning signs before their behaviour escalated.
“That’s what got me thinking, how can we create a process that can begin right when the patient starts demonstrating these warning signs?”
Lucchese worked with her director, Janet Wilson, and the Mental Health Leadership team, to research possible
solutions. The BERT model appeared in their review as an option that had been implemented at hospitals in the United States. Lucchese says research showed the best practice for preventing behavioral escalation is early intervention. Studies also suggested the model reduced restraint use and increased staff satisfaction.
The BERT service at the St. Joseph’s and St. Michael’s sites at Unity Health started in the spring, with two nurses, D’Souza and Richards, providing support during daytime hours during the weekdays.
Richards says she has received positive feedback from staff. They often are relieved when she responds to a BERT call, she says, and they appreciate the extra support.
Katie McTaggart is a charge nurse on the general internal medicine unit at St. Joseph’s. She says the BERT implementation has been helpful.
“It’s a much easier and more familiar point of contact as the charge nurse to help patients they can support with,” she says.
BERT has helped her come up with care plans for patients as well, and McTaggart remarks on how the team will even help out with patient discharge.
Lucchese says other hospitals are contacting her to learn from the BERT implementation.
“They’re interested in the BERT, and I think that shows how needed, how important this program is,” she says.
Back at the St. Michael’s neurosurgery unit, Fox says avoiding Code Whites can prevent patients from experiencing the trauma associated with them and build trust between patients and care providers.
“If we can prevent Code Whites, it will build better relationships with patients, increase their trust in health care, and allow for safer discharges.”
H Talar Baboudjian Stockton is a communications intern at Unity Health Toronto. Glen D’Souza and Jenna Richards. Photo credit: Unity Health TorontoCanadian digital health leaders are joining clinicians and patients who say it’s vitally important to improve health system interoperability –the ability of health data to flow seamlessly across the care continuum and across different IT systems with different infrastructures. This will result in greater efficiencies for the system and for clinicians, and most importantly, better health care and better outcomes for patients.
In a recent article, I wrote about a new Canada Health Infoway (Infoway) survey of more than 800 Canadian clinicians that found they are overwhelmingly in favour of greater interoperability: 92 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 might not be familiar with the term “interoperability” but they understand the benefits of being able to access their personal health information (PHI) online in a timely manner and being able to share it with their circle of care. Our survey of Canadians found that, of those who are able to access their PHI 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.
We wanted to see if digital health leaders shared the sentiments of clinicians and patients, so we recently conducted in-depth interviews with 77 key digital health leaders from across the country. This group included clinicians who have been leading the way in the use of technology, primarily electronic medical records (EMRs), and connecting with systems outside their practices. It also included non-clinicians who are: CEOs of
ALL OF THESE DIGITAL HEALTH LEADERS WERE CONFIDENT THAT WE WILL BE ABLE TO ADVANCE INTEROPERABILITY BY WORKING TOGETHER, BUT THEY SAID IT WILL TAKE TIME AND FUNDING BECAUSE THE CHALLENGES ARE SIGNIFICANT AND COMPLEX.
Health, Chief Information Officers, Directors of Information Management and Digital Health Standards, program and regional managers, solution architects and digital health advisors. These leaders were in the public sector (governments, health organizations) and private sector (vendors).
They overwhelmingly told us interoperability is a high priority. They shared clinicians’ and patients’ understanding of interoperability and the many benefits that can result – more efficient and effective care, enhanced access to care, and greater collaboration among health care professionals. And they agreed that the current state of interoperability is far from ideal.
The clinicians we talked to had three main issues: incompatibility of their practice system with external systems; technical issues and malfunctions; and inability to connect seamlessly from their EMR to specialists and hospitals.
Administrators shared the clinicians’ views about lack of compatibility between systems, especially between hospitals, private practices and pharmacies whose systems don’t speak the same language. They also expressed frustration with lack of consistency across regions, provinces and organizations, and they said this lack of standardization makes any rollout of systems difficult.
Government representatives were similarly frustrated by this lack of standardization. While they expressed a desire for greater interoperability, they said they have to balance these larger system changes with more immediate priorities, such
Michael Green is President and CEO, Canada Health Infoway
as the COVID-19 pandemic and emergency room capacity.
Vendor representatives said a disjointed health system makes it more difficult for them to deliver systems, and that we need a “whole-system” approach to truly experience the positive impact of technology.
All of these digital health leaders were confident that we will be able to advance interoperability by working together, but they said it will take time and funding because the challenges are significant and complex.
They agreed that implementing standards-based solutions that allow systems across clinical settings to communicate is a central challenge. They also identified challenges with data privacy, funding and differing strategies among the provinces and territories. And they said it’s essential to focus on workflows and intuitive design, and to provide change management support and incentives for clinicians.
Most agreed that it is up to governments – federal and provincial/territorial –to provide the leadership to overcome these challenges and drive interoperability forward. They said governments have the ability to set policy and make
investments, two key drivers that are beyond the capabilities of other stakeholders. They also said Infoway is a trusted partner and thought leader who can play a key role.
While many of the digital health leaders said the ideal state for interoperability could be achieved within five years, nearly all agreed that it will take up to 10 years.
These valuable insights from Canada’s digital health leaders reinforce what we have heard from clinicians and patients, clearly showing that we are all on the same page about the benefits of interoperability and the challenges in achieving its ideal state. Now we need to move forward together to overcome these challenges so patients, clinicians and our health system can realize the benefits. H
The use of mobile technology in healthcare has been expanding in recent years. One of the common forms of mobile technology utilized in healthcare is mobile health applications (or mHealth apps). This growth is mainly driven by the increased adoption of smartphones and investment in the digital health market.
Recent advancements in technology facilitated application developers
to refine mHealth apps by integrating artificial intelligence to simulate human cognition in the interpretation of health data and provide users/ patients with personalized care recommendations. There is a growing body of evidence supporting the value of mHealth apps in improving the quality of care for patients when used in conjunction with traditional care. Many mHealth apps are now avail-
able to help users/patients manage their medical conditions, particularly, in cardiology, endocrinology, and mental health care.
Some of the reported benefits of using mHealth apps to manage medication conditions include improved medication adherence and better
1. Endorsement by a recognized association or health care organization
2. Usability
Recommend a mHealth app that has been endorsed or developed by a professional or recognized medical/health association or one that has been subject to a robust peer review process.
Learn about the patient’s level of computer literacy and recommend a mHealth app that matches their comfort level. You may also consider testing the mHealth apps prior to making a recommendation to patients.
3. Reliability of informationInformation presented/provided on mHealth apps should be referenced, evidence-based, and current (i.e., time-stamped with the most recent update indicated).
4. Privacy and securityPatients should be made aware of the potential security risks associated with use of mHealth apps and they should also be aware of existing security features on their mobile device. Refrain from recommending a mHealth app that lacks a clear privacy policy outlining how the data collected will be used.
5. Free of conflicts of interestPatients should be made aware of the company or the organization responsible for the development of the mHealth app and their mandate. Patients should be provided with resources to make informed decisions.
6. Avoid contribution to fragmentation of health information
7. Validated impact on patient health outcomes
Recommend mHealth apps that will contribute to existing data repositories that are standardized, linked, and/or cross-referenced, such as, existing electronic medical records.
Recommend mHealth apps that have been assessed and validated to demonstrate impact on patient health outcomes.
self-management behaviours. While mHealth apps are widely accessible and often cost-effective, it is currently challenging to fully assess the health claims or recommendations made by app developers. Moreover, there may be potential privacy and security risk implications when a consumer/patient enters personal and health related information into a mobile application. To minimize privacy risks and maximize health benefits, healthcare professionals are encouraged to educate/ support patients when they are seeking mHealth apps that will meet their health goals, but without jeopardizing their privacy and confidentiality.
In 2015, the Canadian Medical Association (CMA) released the “Guiding Principles for Physicians Recommending Mobile Health Applications to Patients” (https://policybase.cma. ca/link/policy11521) with information on how to assess the credibility and safety of a mHealth app. With the high adoption of smartphones, it is anticipated that more patients will inquire about mHealth apps from their healthcare providers. Therefore, we encourage all healthcare professionals to review these guiding principles (Table 1) and be ready to support patients in the management and monitoring of their health and medical conditions through the potential use of mHealth apps.
■ H
Tahani Dakkak is a PharmD Student 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.
n increasingly toxic drug supply combined with the effects of the COVID pandemic has led to a steep increase in the number of opioid-related deaths. Nationally, more than 7,500 deaths were recorded last year by The Public Health Agency of Canada.
As an Emergency and addictions physician, UHN’s Dr. Hasan Sheikh is on the frontlines of this public health crisis.
“Last month, there was another public health alert after a spike in overdoses,” he says, speaking in advance of International Overdose Awareness Day on Aug. 31. “I’ve had patients in tears because they’ve lost their partner and their closest friends.
“Seeing the impact on people is really hard to take.”
As UHN’s first Medical Lead for Substance Use Services, Dr. Sheikh is working to enhance and integrate services for patients who use substances, and raise awareness of the effective treatments available.
“Substance use disorder is an illness that’s been undertreated in the past,” says Dr. Josée Lynch, addiction psychiatrist at the UHN Centre for Mental Health. “A dedicated Medical Lead offers us the chance to formally advocate for this group of patients and find opportunities to improve their care.”
Educating colleagues to understand that substance use disorder is an illness, and not a matter of personal choice or moral failing, is a key priority for Dr. Sheikh.
Patients struggling with this disorder face discrimination and barriers to getting help. When perpetuated by healthcare workers, stigma can lead to ineffective treatment and drive patients to avoid care all together, extending substance use’s vicious cycle.
“People develop stigma towards a population when they feel like there is nothing they can do for them, that it’s just hopeless,” says Dr. Sheikh. “If you give people hope that we can make a difference in someone’s life it really breaks through that barrier.”
Dr. Sheikh is particularly focused on raising awareness in TeamUHN about the evidence-based tools available such as medications for opioid and alcohol use disorder.
“These interventions are very under prescribed,” he says. “It helps bring people along to say there’s a medical piece to addiction and we can provide the right treatments and people will get better.”
Another stigmatizing misconception to tackle: providing pain medication to patients with an existing opioid use disorder.
These patients are often more sensitive to pain and have a higher tolerance to pain medication. They need to have their pain treated more aggressively, says Dr. Sheikh, but are
This article was submitted by UHN News.
less likely than other patients to be prescribed pain relief.
“It comes from not wanting to make someone’s addiction worse, but it makes it hard for people to remain in hospital and get the care they need,” he says. “We can make the hospital a much less traumatizing, much more compassionate place for people who use drugs.”
A further complication for substance use disorder patients is the increased likelihood of co-occurring mental or physical health conditions that can be caused or worsened by their substance use.
In an effort to provide a holistic approach to treat both causes and symptoms, Dr. Sheikh has embarked on a mission to build capacity for more integrated care – in line with a UHN strategic priority.
“If you’re a plastic surgeon treating a patient abscess caused by frequent injections, the support you need to take care of a patient might differ from someone in internal medicine treating a patient experiencing alcohol withdrawal,” says Dr. Sheikh. “The formal structure of a Medical Lead provides a place to hear about various needs in different departments and figure out how to best support colleagues.”
Since he joined the Emergency Department (ED) in 2016, Dr. Sheikh has reached out to colleagues about substance use disorder interventions, and led similar initiatives with General Internal Medicine (GIM), Family Health Teams and other services.
He’s now overseeing the completion of a series of short modules on substance use disorder treatments being created with the Michener Institute of Education at UHN to better educate TeamUHN.
Dr. Sheikh’s interest in improving addictions care developed early in his time at UHN when he observed how
frequently substance use disorder patients revolved in and out of the ED.
“They had so many touch points with the healthcare system, but weren’t getting the help they needed,” he says. “I started to look at what models of care were out there and how we could provide something better.”
Along with Dr. Lynch, he co-founded in 2017 Toronto Western’s Rapid Access Addiction Medicine (RAAM) clinic, which provides low barrier access to medication and counselling as well as connecting patients to community services.
(Dr. Sheikh subsequently helped launch a RAAM clinic in Calgary while serving as Bloomberg Policy Fellow for the city.)
The RAAM clinic is often a patient’s entry point to care. They are seen on a drop-in basis and do not require a referral or appointment, which are often obstacles for patients that use substances.
Reflecting an increased patient volume, the RAAM clinic recently expanded its service hours and now operates five half-days a week (previously it was three). They also added social worker Ewa Konart to their interdisciplinary team.
“Expanded hours means we are more responsive to patients – able to see them that day to manage prescriptions or treat withdrawal – and this eases the burden on the ED,” says Dr. Sheikh.
UHN’s ED sees roughly 17 patients with substance use disorder daily.
Planning is also underway for a pilot project – an addictions consultation service that would support patients hospitalized at Toronto Western whose care can benefit from substance use disorder treatment. The pilot is scheduled to roll out in January 2023 ■ H
“We can make the hospital a much less traumatizing, much more compassionate place for people who use drugs,” says Dr. Hasan Sheikh, UHN Emergency and addictions physician.Photo credit: UHN
President, Medtronic Canada
Six powerful words that inspire us to engineer the extraordinary, innovate life-transforming technologies and create better outcomes in Canada and around the world.
Roxane Belanger
ow does a more expensive treatment help save healthcare dollars? In a socialized health system, the answer to this question must be supported by robust data. Researchers Derrick Y. Tam, MD, PhD, and Hamid Sadri, PharmD, MSc, MHSc have done just that with their recent study published in the Canadian Journal of Cardiology: Annual Budget Impact Analysis Comparing Self-Expanding Transcatheter and Surgical Aortic Valve Replacement in Low-Risk Aortic Stenosis Patients.
The authors set out to test a hypothesis regarding the affordability of a minimally invasive treatment with a higher up front procedure cost than its traditional surgical counterpart requiring longer in-hospital recovery. Transcatheter aortic valve replacement (TAVR, also known as TAVI) is a minimally invasive procedure that
replaces ailing cardiac valves via a keyhole incision. This contrasts with the less expensive, though more invasive surgical aortic valve replacement (SAVR) option. The latter requires open heart access, which requires longer in-hospital recovery time, and can lead to higher rates of complications.
TAVR, initially developed to treat frail, high- risk AS patients who were unsuitable for the invasiveness of open heart SAVR, has now been established as a safe and effective treatment across the risk spectrum for AS patients. However, the higher procedural cost of TAVR has led to a perception of unaffordability, which creates a barrier to access for low risk AS patients.
Since its 2012 launch in Canada, physicians have attested to the fact that TAVR delivers better outcomes for patients, while also using fewer hospital resources. Yet the actual cost difference in terms of the full suite of resources was unknown. Tam and Sadri measured as-
Roxane Belanger is a Communications specialist at Medtronic Canada.
sociated costs one year out from surgery for both treatments, concluding a total cost difference of approximately 2.8 per cent, feasibly small enough to warrant a shift in budget allocation for cardiac care. They determined that the key difference in cost lays in reduced length of hospital and ICU stay for TAVR, as well as a reduction in adverse events compared to SAVR.
“Rather than focus only on procedural cost, this model demonstrates the advantages of looking outside budget silos to optimize resources as well as patient outcomes,” says study coauthor Hamid Sadri, director of Health Outcomes Research at Medtronic Canada. “This is particularly important as our healthcare system is challenged with human resources constraints after the last few years of pandemic mobilization.”
Previous studies have demonstrated the effectiveness, and feasibility of TAVR, but this is the first to pro-
vide a costing model that can be used to show affordability on a global scale. “This cost model helps substantiate evidence-based decisions made at the healthcare management level whether here in Canada, Brazil, or Singapore,” says Sadri. “Health innovation can lead to increasingly complex budgetary decisions, but we now have a model that helps healthcare managers follow the relevant data.”
TAVR, initially developed to treat frail, high-risk AS patients who were unsuitable for the invasiveness of open heart SAVR, has been established as a safe and effective treatment across the risk spectrum for aortic stenosis patients. However, the higher procedural cost of TAVR has led to a perception of unaffordability, which led physicians to prioritize the minimally invasive procedure for higher risk patients. The hope is that this study will help make minimally invasive TAVR more accessible to more patients. ■ H
Dean Detlev Zwick of the Schulich School of Business and Joseph Mapa, Krembil Chair in Health Management and Leadership invite you to our third virtual Leadership Summit.
The third Krembil Summit will explore how AI-driven automation technologies can transform the health industry and discuss essential principles for responsible adoption of these technologies for better healthcare.
6:00 to 7:30 pmEDT via Zoom
REGISTER AT: schulich.yorku.ca/krembil-centre
KEYNOTE SPEAKERS
Dr. Leo Anthony Celi Clinical Research Director and Principal Research Scientist, MIT Laboratory for Computational Physiology and Staff Physician at Beth Israel Deaconess Medical Center (BIDMC)
Dr. Abi Sriharan Senior Krembil Fellow, Krembil Centre for Health Management and Leadership, Director of Leadership Wellness Lab MODERATOR
Dr. Amol Verma Clinician-Scientist at St. Michael’s Hospital and Assistant Professor at University of Toronto
By Colette Ouellet
Annually in October, we have an opportunity to recognize Infection Prevention and Control (IPAC) and the leadership role that IPAC professionals play across the country and across the spectrum of care. Infection Prevention and Control Canada (IPAC Canada), representing over 1700 of these specialized healthcare providers, works behind the scenes to ensure our members have a voice in key areas to promote our roles and to make a tangible positive difference in the healthcare system.
Each year, representatives from IPAC Canada are involved in advo-
cating for key infection control initiatives at the federal level through “Hill Day” which is a day (or sometimes several days) devoted to meeting Members of Parliament from across the country to promote our message and highlight our national priorities. We have spent several years focusing
on the critical need for a national surveillance system, using standardized case definitions, to allow data regarding Healthcare Associated Infection (HAI) from all levels of the healthcare system to be collected and analyzed. We were elated to see that the 2022 federal budget addressed this need by allocating over $437 million dollars to strengthen public health surveillance and risk assessment capabilities. This will help to realize our goal to have a robust database from which a clearer understanding of the impact of HAIs can be gleaned, and targeted recommendations can be developed. Clearly, to continue the important work of Infection Control and to have a structure that allows data collection and submission, we must ensure that there is succession planning and training of new talent in the infection control professional role. Last year, IPAC Canada’s Education arm developed an accelerated distance education program for new ICPs, providing training to 60 people who were then prepared to grow into this complex role with confidence. A slower stream, but
equally comprehensive program, was also made available to meet the needs of those who wished to develop their skills to step into the ICP role and/or for those with other life priorities that did not allow them to go through the concentrated accelerated program.
A new and exciting opportunity came to IPAC Canada when we were invited to join the membership of an exclusive Global IPAC Network through the World Health Organization. As a clear recognition of our country’s expertise in Infection Prevention and Control, we are now in the company of worldwide experts who are dedicated to ensuring Infection Prevention and Control is an international priority.
Locally, nationally and Internationally, IPAC Canada is supporting and representing our membership to be recognized as an effective and expert body of skilled healthcare specialists. Infection Control Week (October 1721, 2022) allows us to congratulate one another and celebrate the dedication of each member in our vast team. It is a time to be proud of our past accomplishments and excited for those to come. ■ H
Colette Ouellet RN BN MHA CIC is President-elect of IPAC Canada. She is Director, Infection Control, at the Queensway Carleton Hospital in Ottawa.CLEARLY, TO CONTINUE THE IMPORTANT WORK OF INFECTION CONTROL AND TO HAVE A STRUCTURE THAT ALLOWS DATA COLLECTION AND SUBMISSION, WE MUST ENSURE THAT THERE IS SUCCESSION PLANNING AND TRAINING OF NEW TALENT IN THE INFECTION CONTROL PROFESSIONAL ROLE.
Try it first on your unit. Visit www.scjp.com/en-ca/poc-trial to register for a free trial.
CloroxPro® provides trusted protocols, training and best-in-class products and technologies.
Let us help you keep environmental disinfection under control and prevent HAIs, so everyone can return home safely. Together, we’re ready for anything.
Learn more at CloroxPro.ca or contact CloroxProCanada@Clorox.com
In healthcare facilities, surfaces are susceptible to contamination with healthcare-associated infections (HAIs). Despite proac tive infection control measures, many of these pathogens can still survive on surfaces long enough to be transmitted to patients and healthcare workers.1
Proper cleaning and disinfection with the appropriate disinfectants are a vital component of infection prevention. 2
However, it’s important to ensure that the cleaning and disinfection products used in healthcare facilities are compatible with the material that the medical equipment is made of and won’t cause expensive damage to the surfaces or leave behind unsightly residue. 2
Surface residue: After a disinfectant applied to a surface has dried, some of the ingredients in the product will be left behind on the surface.
• On a smooth surface, the disinfectant may form small beads, which when dry may leave visible spots or circles.
• If the surface is textured, or if the disinfectant spreads out evenly on the surface, the residue may not be easy to see but may feel sticky or slippery to touch. 5
Surface damage: After cleaning and disinfecting a surface for an extended period, it may start to look dull or pitted, or you may see hairline cracks in the surface. 5
Plastic fatigue – Cracks/crazing usually caused by plasticizing ingredients in formula (usually solvents). E.g., unappealing cracks in hospital and clinic chairs, pillows or other plastic furniture in waiting rooms, patient rooms, dining halls.
Discolouration – Can occur when a protective coating is removed, and the surface is exposed to heat or sunlight. E.g., unattractive or alarming colour changes on side or dining tables, window ledges, washroom paper towel holders, etc.
Metal corrosion – Occurs when acidic or alkaline disinfectants damage metal surfaces, even those with protective paints or coatings. E.g., questionable differences in colour or texture on handrails, bars in elevators, door handles, etc.
• Select products that are compatible with most of the surfaces and materials in your healthcare facility.
• Follow instructions from manufacturers for cleaning and care of surfaces or medical equipment. Manufacturer
instructions may provide recommendations for the types of products that they know are safe to use on these surfaces.
• Wipe surfaces with a clean damp cloth to remove residue and reduce the risk of damage. Look at the star rating of the CloroxPro® disinfectant and the surface material to help you decide when to do this. As you continue to work hard to provide patients and healthcare workers with healthier and safer environments, consider the type of surface materials being cleaned and which disinfectant you want to use.
Following these tips to eliminate residue and help reduce the potential for surface and equipment damage will help keep your healthcare facility disinfected and looking good. 5
In 2015, Clorox launched the Healthcare Compatible™ program. Our scientists continue to develop industry best practices to help our customers feel confident about the performance of our products.
1. Soak test: Material submerged in disinfectant for 4 days.
2. Wipe test: Surface wiped and allowed to dry 180 times.
3. Stress test: Hole drilled in material near edge. Material submerged for up to 72 hours.
CloroxPro® uses a star rating system to account for the varying effects of cleaning and disinfecting products on surface materials. This system grades the compatibility of our products against a range of hard, nonporous materials such as plastics, metals, tile, quartz, marble and granite. This rating system helps users balance the benefits of cleaning and disinfecting against the risk of surface damage. It provides guidance on when you might need to wipe surfaces with a clean damp cloth to remove excess disinfectant to protect the surface.
For more information on disinfectant surface compatibility, and Health Canada approved disinfectants used on noncritical equipment and hard surfaces, visit CloroxPro.ca
References: 1. Kramer A, Schwebke I, Kampf G. How long do nosocomial pathogens persist on inanimate surfaces? A systematic review. BMC Infect Dis. 2006;6:130. 2. Surface Compatibility Resource Guide. Clorox Professional. Clorox Healthcare. 3. PHAC. Routine Practices and Additional Precautions for Preventing the Transmission of Infection in Healthcare Settings. (p31). http://publications.gc.ca/collections/collection_2013/aspc-phac/HP4083-2013-eng.pdf.
4. PIDAC. Best Practices for Environmental Cleaning for Prevention and Control of Infections in All Health Care Settings, 3rd Edition. (p31). https://www.publichealthontario.ca/-/media/Documents/B/2018/ bp-environmental-cleaning.pdf?sc_lang=en 5. CloroxPro®. Protecting surfaces while disinfecting. https://www.cloroxpro.com/resource-center/protecting-surfaces-while-disinf ecting/. Accessed June 16, 2022.
PHAC and PIDAC guidance highlight the importance of medical device disinfection. 3,4How can we better care for people living with HIV as they age? Antiretroviral therapies – treatments for people with HIV – are easier to access and more effective than ever before. This improvement in care means that people with HIV are living longer, and as they age, they face other chronic conditions associated with aging. People living with HIV also have an increased risk of complications with long-term antiretroviral therapies.
Currently, people living with HIV typically access care through HIV or infectious disease specialists, which are
usually located in larger urban centres. However, the number of HIV specialist physicians is declining, and fewer physicians are entering this specialty. There is a need, and in fact has been a recent shift, to caring for people with HIV through primary care. Is it possible for primary care physicians to balance HIV care with other chronic conditions? What are the outcomes for people living with HIV when they receive care from primary care physicians?
CADTH – an independent agency that finds, assesses, and summarizes the research on drugs, medical devices, tests, and procedures – recently published a report on the management of HIV care in primary care settings. The
report highlights current Canadian guidelines on HIV management and provides a summary of the relevant literature that describes the models for HIV management and the outcomes for people with HIV.
The CADTH report found 4 studies that identified patient outcomes associated with different HIV models of care. Based on the information in those studies, there was generally no difference in outcomes for people living with HIV whether they were seen by specialists or by primary care doctors. This is the case for most HIV-related outcomes as well as outcomes related to other chronic conditions. These studies looked at integrating
HIV-specific care within primary care, embedding primary care within HIV clinics, or delivering HIV care at the same location as other health care services. Overall, the frequency of screening for chronic diseases, like cancer or diabetes, was also similar, regardless of type of clinician seen.
There are some unique challenges facing people with HIV who also have other chronic health conditions. Medication fatigue, due to having to take numerous drugs, can make it difficult to be consistent and adhere to all the medications a person may need to take. Increased medical costs can also be stressful and impact daily life and relationships. There can also be increased
Posters are available in English and French through IPAC Canada. Shipping and delivery fees apply for orders over 25 posters.
IPAC Canada - The smart way to advance infection prevention and control.
stigma associated with having both HIV and a chronic condition, but positive coping strategies can help with the stress of having multiple chronic conditions.
There were some limitations and gaps in the literature. Most of these studies looked at urban centres, so it is uncertain how people living with HIV in rural areas experience care. This is particularly important for a geographically large country like Canada, where even primary care may be limited in rural or remote areas.
Primary care doctors may need training to increase their knowledge of HIV-specific care and to increase their confidence in providing care. A consult service – where primary care doctors can virtually connect with HIV specialists – may be an option for improving care and building capacity in the primary care setting. Clinicians providing care for people with HIV should familiarize themselves with current guidelines – this includes screening for chronic conditions like cancer and diabetes as well keeping up to date with vaccinations. Some routine
screening may be different compared with people without HIV, for example, current recommendations are to screen people with HIV for syphilis every 3 to 6 months.
As people living with HIV age, it is important to consider the range of care they
might need. Shifting to primary care, or more fully integrating primary care into HIV care settings, may ensure that people living with HIV receive care that is inclusive of other chronic conditions.
The full report on HIV management in primary care, can be found at
canjhealthtechnol.ca/index.php/cjht/ article/view/hc0028. To learn more about CADTH, visit us at www.cadth. ca, follow us on Twitter @CADTH_ ACMTS, or speak to a Liaison Officer in your region: cadth.ca/contact-us/ liaison-officers.
■ H
Zentek is an intellectual property development and commercialization company based in Guelph that uses expertise in nanomaterials to uncover new possibilities in healthcare and beyond.
Graphene – a single layer of graphite or carbon atoms arranged in a honeycomb lattice – present almost limitless potential to protect against pathogens, detect and treat disease, produce clean water, make building materials stronger, and generate cleaner energy.
Graphene can be added to plastics, metals and many other materials to make them stronger, lighter, disease resistant, more durable and more conductive of electricity.
During the pandemic, Zentek (Nasdaq: ZTEK; TSX-V: ZEN) worked with its partners at the University of British Columbia to develop ZenGUARD™, a proprietary, patent-pending technology that uses a graphene compound to produce an antimicrobial layer that transforms critical items like surgical
ZenGUARD™ has received authorization from Health Canada, with FDA approval underway. The product is a 2021 Mitacs Award winner for Commercialization in Canada.
ZenGUARD™ masks include four layers: a hydrophobic exterior that prevents infectious droplets from penetrating the mask; a ZenGUARD™-
dust and other particles; and a hydrophilic interior that traps droplets inside the mask to prevent transmission of disease.
The Zentek team is currently exploring additional uses for ZenGUARD™,
“In addition to masks, we are exploring ZenGUARD™ for use in supporting said Greg Fenton, CEO. “Our antimicrobial coating could be a game changer in the HVAC space. “
Zentek has recently expanded its operations in Guelph, opening a new
The company, which has partnerships with 100 researchers at universities scaleup facility in Guelph.
To learn more about ZENTEK Ltd. please email info@zentek.com or visit www.zenguard.com
Sarah Garland is a knowledge mobilization officer at CADTHFraser Health’s fleet of 16 Ultraviolet Germicidal Irradiation (UVGI) robots now have UVGI ‘helpers.’
Two new UVGI disinfection pods have joined the team.
The robots and pods are deployed at hospitals across the region to kill virus-
es and bacteria that linger on surfaces and can potentially cause infection.
The pods reflect and trap UV rays and are easily moveable and collapsible so disinfection can occur in small areas without the need to close entire rooms. Mobile pieces of equipment such as wheelchairs, incubators
and IV poles are placed in the tentlike pods so the robots can do their work.
The stars of the disinfection process remain Fraser Health’s germ-zapping robots, purchased in 2020 and funded through local hospital foundations. The entire UVGI fleet has logged thousands of hours and disinfected nearly 62,000 rooms in the past 21 months.
The UVGI robots emit short pulses of UV light, damaging the DNA and RNA of harmful pathogens, including severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), Clostridioides difficile (C. difficile), carbapenemase-producing organisms (CPO), Candida auris (C. auris), and methicillin-resistant Staphylococcus aureus (MRSA). The robots light up as they disinfect, removing viruses and bacteria from a patient room in as little as 20 minutes.
The robots keep an internal timesheet of where and when they work, and the data is sent to a server so we can monitor usage. If they need some “downtime,” a backup robot is brought in.
Each robot is controlled by an environmental services (EVS) operator, working with Infection Prevention and Control, housekeeping staff and health care aides using traditional and chemical cleaning methods.
“We must remain vigilant to keep all viruses and bacteria out of our acute and community facilities,” says Ruth Dueckman, executive director, Infection Prevention and Control. “UVGI robots and pods are one of the innovative tools to help keep our patients and staff safe. We have seen a reduction in some hospital-acquired infections such as C. difficile and MRSA since we first introduced UVGI disinfection into the region in 2016.”
By Samantha Sexton
Medical care requires clinicians to think through complex uncertainties, assess risks analytically, and guard against possible biases in human judgment.
A new study, published this week, from Sunnybrook senior scientist Dr. Donald Redelmeier explores how an available simple diagnosis can skew complex medical decision making.
“Occam’s razor is the traditional idea that simple explanations should be preferred over more convoluted theories,” says Dr. Redelmeier, who is also a Sunnybrook staff physician and Canada Research Chair in Medical Decision Making. “Yet this idea has rarely been subjected to experimental testing for evidence-based medicine.”
Dr. Redelmeier and his co-author Dr. Eldar Shafir from Princeton University were interested in testing the concept in the context of the COVID-19 pandemic. “We hypothesized that an available alternative explanation might lead individuals to underestimate the likelihood of a COVID-19 diagnosis,” says Dr. Redelmeier.
The study asked community members and health-care professionals to judge the chances of COVID-19 in a hypothetical patient through a set of different surveys. Each survey provided a succinct description of a hypothetical patient scenario, suggestive of COVID-19. Each scenario was formulated in two versions randomized to participants, differing only in whether an alternative diagnosis was present or absent.
“Through scenarios involving a spectrum of risk, we found that respondents judged the probability of COVID to be much lower in the presence of another diagnosis, such as influenza or strep throat, compared with when an alternative diagnosis was absent,” says Dr. Redelmeier. This contradicts available microbiological evidence.
“The bias can lead individuals to mistakenly lower their judged likelihood of COVID or another disease when an alternate diagnosis is present. In turn, underestimating the risk of COVID infection might reduce a patient’s willingness to seek care and a clinician’s willingness to investigate a medical diagnosis.”
Dr. Redelmeier adds that the results suggest an available simple diagnosis can lead to premature closure and a
Samantha Sexton is a communications advisory at Sunnybrook Health Sciences Centre.failure to fully consider additional serious diseases.
“This bias occurs because risk factors such as crowded living spaces, lapses in hand hygiene, and poverty are risk factors for COVID infection, as well as for other diseases such tuberculosis. After diagnosing a patient with COVID, for example, a clinician might pause and check – is that really everything?”
He adds that as patients are living longer with multiple diagnoses occurring together, an over-reliance on Occam’s razor can contribute to misplaced complacency and discourages the search for additional contributing factors.
“The bias may be important to recognize for the COVID-19 pandemic, other diseases, and for the next disease outbreak.”
This is why Sani Marc offers its Sani Marc eAcademy®, an online training platform that provides a wide range of interactive courses, video demonstrations, protocols, guides, certifications and more. This value-added service is offered exclusively to Sani Marc clients*.
*Certain conditions apply.
Learn more at: Sanimarc.com/eacademy
Best practices are just as important as having the best products.By Ana Gajic
pproaching research through an equitable lens is a core principle emerging at Unity Health Toronto. Vast inequities in healthcare experiences and outcomes surrounding who is cared for, how treatment is administered, and how illnesses are prevented are results that can emerge without this approach.
We engaged two members of the Research Equity, Diversity and Inclusion (REDI) Task Force, researchers shaping our strategy at Unity Health, to learn about their work and goals.
To get started, can you please share information about your social location? These reflect intersections of a person’s experience based on social characteristics such as (and not limited to) race, gender, and sexual orientation.
Galo F. Ginocchio, a research coordinator in the St. Michael’s Hospital Emergency Department and MAP Centre for Urban Health Solutions: I am an able-bodied, Queer, Latino, cisgender man, and a second generation Canadian graduate student.
Dr. Cheryl Pritlove, scientist at the Applied Health Research Centre: I am a young and healthy cisgender woman of European decent, born in Canada to a working class family. I am a feminist, I am left-leaning in my political views, and I am university-educated in a socio-cultural health sciences stream.
Why is it important for research to have a focused task force on equity, diversity and inclusion (EDI)?
Ginocchio: Equitable lenses and approaches can be powerful routes to identify and reduce inequities in healthcare experiences and outcomes. Our scientists aim to incorporate these responsibly, and a task force like ours empowers our network to identify opportunities to integrate emerging best practices, and directly apply the knowledge and research findings we produce locally.
Dr. Pritlove: Researchers are producers of scientific knowledge and we know that knowledge generated affects health outcomes and experiences. We are aware of the very real dangers when the power and privilege afforded to this position are predominated by a demographically homogeneous group.
It is important to have a task force committed to addressing EDI in research because if we fail to create more diverse, equitable, and inclusive spaces in the fields of medicine and health science, then the biology, lived experiences, needs, and preferences of many members of our society will continue to be inadequately and inappropriately represented in the science that ultimately informs healthcare and its delivery.
Ginocchio: One of the things I like about REDI is we’re always seeking views and experiences from racially, sexually, and gender-diverse staff, physicians, and learners to help us ensure that our academic environment is a place that everyone can participate and feel safe in, to learn and grow together.
What drove each of you to choose to participate in the task force?
Dr. Pritlove: My research is focused on critically interrogating issues of EDI in healthcare contexts, from both patient and staff perspectives. Through this work I’ve accrued knowledge about the complex contributors to the inequities
we’re seeing in research and medicine. It can be disheartening to sit with this information and not have an accessible path through which to affect change. I was driven to join REDI because I saw it as a potential pathway through which to translate knowledge to action.
Ginocchio: I’ve been involved with health equity and activism for much of my life, and my scholarly work focuses on public health for communities that struggle with mental health and addictions. I thought REDI could be a great route to support these groups. It had not occurred to me that I would work alongside colleagues with globally renowned expertise, informed by our own lived experiences, to create thoughtful solutions to longstanding inequities together. This is a space where we can hear each other, and discuss what community members are experiencing in an authentic, and honest way.
We’re doing equity, rather than just talking about it. It’s cool to see new international best practices being applied here – we’re effecting meaningful changes in our approach to health research and by extension, the healthcare system, starting at Unity Health. Examples of this are the new three-tiered Patient and Community Engagement in Research Guide developed at Unity Health, and the innovative work the Knowledge Translation Program creates, such as advancing gender equity in medicine.
What would you like to achieve through REDI?
Ginocchio: Employment equity is a topic that we are presently discussing. We are exploring approaches to integrate these ideas here at Unity Health. We have been examining these topics, and are navigating how we might apply our own findings on economic justice in the research institute. In this case, advocating for employment equity, and establishing a living wage across Research.
Dr. Pritlove: Big picture, I hope our work leads to greater representation in the research institute across all levels. I would love to see improved opportunity and equity in both position and pay for our people. I hope our work helps foster an environment where people feel safe, respected and valued. And, I hope we can contribute to the development of a suite of resources to better support individuals in adopting EDI principles in their research.
In order for these big picture changes to happen, we need to first disrupt and dismantle the very strong, political and historically charged foundations that contribute to the production and maintenance of the inequities that we see in medicine. In the immediate, I hope we can chip away at, unsettle, and start to rebuild this foundation in ways that will permit for a sustainable commitment to EDI within the institution.
What are some of the projects that REDI has taken on?
Ginocchio : The bulk of our work has been identifying barriers to health equity in Research, and developing collaborations across Unity Health to align our current internal practices with newly emerging global research standards. Like Cheryl said, the labour that we have put in is about chipping away at the foundations – it’s about scrutinizing things that haven’t been questioned before, and asking uncomfortable, unpopular questions and being bold in that exploration. In the setting of a pandemic, it’s been pretty remarkable how much we’ve accomplished in such a short time.
Galo F. Ginocchio and Dr. Cheryl Pritlove are members of Unity Health’s Research Equity, Diversity and Inclusion (REDI) Task Force.Dr. Pritlove: We’ve been consulting with different groups within the organization, like the Office of Research Administration, Human Resources, the MAP Centre for Urban Health Solutions and the Anti-Racism, Equity and Social Accountability Office to discuss issues like job description, compensation rates, community engagement, and our hiring practices.
We have provided feedback to the Grants and Awards Office for creating materials that will support researchers in thinking about and integrating EDI into their grant applications and research studies. We are also in the process of creating a Distinguished Lecture Series which will help with education and knowledge raising.
What do you hope the impact of the projects REDI takes on will be?
Ginocchio: We should begin to ask ourselves the perspective and the identity that we are approaching research questions from, and how historical lenses and routine practices can perpetuate injustices. Doing so will mean
that we can begin to decolonize healthcare research, and act upon the calls to action put forth by the Truth and Reconciliation Commission of Canada.
I hope we succeed in creating a space where everybody – regardless of who they are, where they come from, or what their identity is – feels that this is a welcome space that they can learn, grow, and conduct scientific activities in.
Dr. Pritlove: My hope is that the work that we are doing will promote better education and awareness. Inequities and -isms are often invisible, and that’s by design. The work we are doing will be critical to drawing these inequities out of the shadows. With education will come greater dialogue, and potentially discomfort. I hope we as an institution lean into, rather than
shy away from, this discomfort, as it is an essential building block of change, and in my view, a sign of progress.
What have you learned during your tenure with REDI so far?
Ginocchio: Decolonizing how I approach and see the world is a continual process that doesn’t happen overnight. You need to deliberately seek out knowledge about health equity, and not put the emotional labour on people from diverse communities to do the work for you. It’s about taking responsibility for your own education, and doing the hard work for yourself through reflection.
Part of that looks like speaking out when you hear that racist comment your colleague expresses, or recognizing when something you have said is op-
pressive to say and causes preventable harm. The good thing about equitable tools is that they allow you to scrutinize your behaviour so that you can be mindful of how to support and empower the communities you seek to support.
In the context of research, this is essential because it puts the integrity of the work at risk if you’re if you’re unwilling to empathize with populations under study in ways beyond the superficial.
Dr. Pritlove: Meaningful and sustained change doesn’t, can’t and probably shouldn’t happen overnight. It takes time, patience and resolve. While it is challenging to remain patient when change is long overdue, I’ve learned that meaningful change requires a great degree of critical thought and diverse wisdoms. It involves the dedication of many people and ongoing collaboration across diverse departments, committees and communities.
It is the undoing of a deep-seated history that continues to affect people differently; it is complex and it takes time.
This interview has been condensed and edited.
■
Ana Gajic is a senior communications advisor at Unity Health Toronto.
MY HOPE IS THAT THE WORK THAT WE ARE DOING WILL PROMOTE BETTER EDUCATION AND AWARENESS. INEQUITIES AND -ISMS ARE OFTEN INVISIBLE, AND THAT’S BY DESIGN.
Research out of the University of Southern California released on World Alzheimer’s Day, found that Ontario could save up to $9.9 billion in long-term care costs over 20 years with a disease-modifying treatment for Alzheimer’s disease – but that today, Ontario is poorly positioned to take advantage of any Health Canada-approved treatment.
“Our findings give cause for both hope and for concern,” said Dr. Soeren Mattke, an expert in innovative chronic illness care and lead researcher of the study. “Hope, because a therapy for Alzheimer’s disease has the potential to fundamentally alter how Ontario cares for older adults living with dementia. Yet concern, because the province clearly is behind its international peers in preparing for this breakthrough.”
There is no prevention, cure, or disease-slowing treatment for Alzheimer’s disease, the most common type of dementia in Ontario and around the world, that has been authorised for use in Canada. Currently, there are four medications approved by Health Canada: three are publicly funded in Ontario, however each of these target symptoms of Alzheimer’s disease at the dementia stage and do not treat the earliest symptoms nor slow progression
of the disease itself. While non-pharmacological approaches to dementia, such as exercise, cognitive engagement, and social interaction, may confer benefits to the brain, these do not replace the need for disease-modifying medications for Alzheimer’s disease.
In June, 2021 the United States became the first jurisdiction in the world to approve a disease-modifying pharmacological treatment for Alzheimer’s disease. Several disease-modifying medications are at varying stages of review in Canada, and Ontario is potentially years – not decades – away from its first ever disease-modifying therapy for Alzheimer’s disease.
“The over 260,000 Ontarians living with dementia today, and their families, are closely following news of a possible treatment,” said Cathy Barrick, CEO of the Alzheimer Society of Ontario. “There is an expectation among families that the provincial and federal governments work together to prepare for the approval and rollout of a disease-modifying therapy. Peo-
ple have hope, and if a treatment is approved and used elsewhere while Ontario struggles to catch up, that hope will quickly turn to despair, and anger.”
Research findings show that Ontario will spend $27.8 billion between 2023 and 2043 on alternate level of care (ALC) and long-term care (LTC) costs associated with people living with dementia. With the theoretical approval of a disease-modifying therapy for Alzheimer’s disease in 2023, these costs would decrease by $6.1 billion, a 22% reduction over 20 years. If, however, Ontario removes all constraints on detecting and diagnosing cases of dementia, the province will save an additional $3.8 billion over the same time frame for total savings of $9.9 billion.
“Treatments currently in late phase development, and for which approvals are anticipated, will need to be initiated when people are still at the early stages of Alzheimer’s disease,” explained Dr. Sharon Cohen, neurol-
ogist and Medical Director of Toronto Memory Program. “Capacity to detect and diagnose Alzheimer’s disease at its earliest stages is crucial in order to leverage the benefit of upcoming treatments. However, today, most Ontarians living with Alzheimer’s disease are diagnosed late – after several years of symptoms, imprecisely, or not at all. The status quo for diagnosis of this disease is neither timely nor accurate and will require substantial revision to allow the affected population to benefit from breakthrough therapies.”
According to findings* earlier this year Canada is projected to have the longest wait times for a dementia diagnosis of any G7 country. With the introduction of a disease-modifying therapy, wait times for a diagnosis will peak at over seven and a half years by 2029 – longer than the expected lifespan of many Ontarians who come forward with concerns about dementia today. This wait time would mean that the average Ontarian would not be able to access a treatment for Alzheimer’s disease. The harsh reality: by the time they receive a diagnosis, the disease will almost certainly have progressed to a point at which the treatment is no longer effective.
“This research is an early warning,” continued Ms. Barrick. “A treatment is coming. Ontario isn’t ready.”
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.
By Dr. David Attwood
No one thinks schizophrenia is their problem- until it is.
The numbers are difficult to hear. One out of every 100 people live with schizophrenia. In Ottawa alone, 200-300 people will develop this brain disease this year. Schizophrenia is a disorder of psychosis and cognition that can dramatically impact how a person perceives themselves and the world around them, yet despite that, most struggle to recognize the need for assistance.
The good news is that the first episode of psychosis is very treatable, and about 90 per cent of people who have experienced the first episode of psychosis will achieve remission within one year of treatment.
The bad news is that 85 per cent will have a serious relapse within five years.
When I was a younger doctor, I imagined genetics would become the
key to diagnosing and treating schizophrenia, but over the last 20 years, we have discovered more than 100 genes involved in this illness – all of them contributing a little bit, but not a single one of them diagnostic, or offering clear treatment directions.
The most remarkable thing about the genetics of schizophrenia is that we know family history is the largest factor in developing the illness, yet about 90 per cent of individuals do not have a parent with schizophrenia and over 60 per cent not even a first degree relative.
Allow that to sink in. For many families, this illness comes completely out of the blue.
Usually, by the time a person gets to The Royal’s Integrated Schizophrenia Recovery Program, they have seen several psychiatrists, acquired several diagnoses, and had a few efforts at treatment, perhaps even several hospitalizations. So when I see someone new, they are not new to this at all.
The statistics are sobering.
Around 20 per cent of our clients will get stable jobs, about 30 per cent will live independently, 35 per cent will ever get married, and only about 14 per cent will maintain a meaningful recovery. Yet, we remain devoted to creating that possibility.
It’s estimated that over 50 per cent of people who are unhoused have schizophrenia. Sadly, most people who have schizophrenia die about 20 years earlier than their peers, and often from treatable medical illnesses. Most tragically, while one per cent of people with schizophrenia die by suicide each year, this group accounts for 12 per cent of the annual total suicides in Ontario, with a lifetime risk of suicide just under 10 per cent – yet it is a constant struggle to access long term assistance.
As schizophrenia is a stigmatized, yet highly treatable, severe psychiatric disorder, it requires a robust and highly integrated continuum of care.
The Ottawa Regional Psychosis Clinic is a community-based model designed to bridge this gap in the continuum of care for clients and families experiencing severe and persistent psychotic disorders. The clinic will provide effective long-term therapies, including early and easy
Home care is about trust. It is feeling comfortable with a provider coming into the home of someone you care for and, possibly, Bayshore’s home care services are extensive, tasks or round-the-clock care, Bayshore’s caregivers can help your loved ones to live
Let’s talk.
AS SCHIZOPHRENIA IS A STIGMATIZED, YET HIGHLY TREATABLE, SEVERE PSYCHIATRIC DISORDER, IT REQUIRES A ROBUST AND HIGHLY INTEGRATED CONTINUUM OF CARE.
access to long-acting injections and clozapine, and can be integrated into existing community-based services, as well as cognitive behavioural therapy, family therapy, recovery and rehabilitation services. It is also exciting to note that all patients can volunteer to participate in cutting edge research, including fascinating studies in neuroimaging, electrophysiology, sleep, and cognition at The Royal.
Thanks to a transformational $2.5 million gift of philanthropic support from the Ozerdinc Grimes family, we are able to retain a team of experts supporting the newly established Ozerdinc Grimes Family Regional Psychosis Clinic, set to open this fall through 2025.
This gift will help an additional 1,000 people living with schizophrenia and their families to access quality standard-based care while connecting them to ground-breaking research. With rigorous education and evalu-
ation embedded in the clinic, we will make a case for sustainable ongoing funding from the government.
Schizophrenia is a life-long illness. We are committed to providing our
patients with the diagnostic and treatment tools they need while connecting them to a quality-based system of care, and staying with them for as long as they need us.
We also know we need to focus on families, because this is a family illness, and we want to reassure parents and loved ones that their person is getting the best care they can get, anywhere. ■ H
AVHAnursecanhelpyourchild:
staysafeathomeandoutofhospital participateinschoolandotheractivities
LearnmoreabouthowVHAcansupport childrenwithcomplexmedicalneedsand theirfamiliesat www.vha.ca/ccmn.
Dr. David Attwood, MD, FRCPC is Assistant Professor, University of Ottawa, and Clinical Director, Integrated Schizophrenia Recovery Program, The Royal.
Dr. David Attwood
ore patients now have access to electroconvulsive therapy (ECT) as Waypoint Centre for Mental Health Care expands the availability of this highly effective therapy from three days to five.
“ECT is part of Waypoint’s role as the specialty mental health hospital for our region and is central to our providing both acute inpatient mental health services and outpatient services with a goal to keeping people well in our community. We are committed to improving access to high quality care and this ECT expansion as well as the additional 14 acute mental health beds we are operating are priorities in these challenging times, with emergency departments overburdened from the pandemic impacts and staffing pressures,” notes Dr. Nadiya Sunderji, Waypoint’s CEO. “I want to share my appreciation
to our staff for making this happen for our patients and clients.”
Performed for over 80 years, the effectiveness of ECT is well documented in the medical literature but its uptake has been limited by stigma and fear. While this stigma persists, there have been many advances in the practice evolving it to a modern, safe and well-established medical procedure that can be live-saving and transforming for those who need it.
Recent research suggests that ECT works by stimulating brain cells (neu-
rons) to grow and develop healthy connections to each other. It works similar to how a defibrillator or pacemaker helps restore a normal rhythm to a person’s heart, the electrical stimulation can help restore proper function to the brain.
“ECT has long been used for treating severe and treatment-resistant cases of mood and psychotic illnesses,” says Dr. Plabon Ismail, Waypoint Medical Director of Regional Programs and ECT Lead Psychiatrist. “Because of its effectiveness and improved side
effect profile, we are seeing an overall trend where patients and physicians are opting for ECT early in the treatment course, especially in outpatient settings. Increasing our service from three to five days per week will allow us to meet these increasing demands while providing appropriate follow-up treatment promptly.”
Despite widespread staffing challenges throughout the pandemic, Waypoint was able to maintain ECT services during these times of critical need. The hospital has also been collaborating with the Ontario Health Mental Health and Addictions Centre of Excellence and other experts across the province to identify the need and are now at the forefront of developing standards for high quality delivery of ECT. Expanding access at Waypoint takes the pressure off acute care partners and allows them to focus on re-
storing surgical volumes and reducing wait times.
Waypoint’s ECT clinic is located at the hospital’s Penetanguishene campus and is available for both inpatients and outpatients. A team of trained medical professionals that includes psychiatrists, anesthesiologists, and nurses assess patients, educate patients and families, and administer the treatment.
Not sure if ECT is the right treatment for you or your loved one? “Our team is happy to speak with anyone, patients, families, healthcare providers and students who are looking for more information on ECT and the services we provide,” says Jackie Watt, Program Director. “Our Central Intake Office staff manage referrals and can assist in identifying the right supports.”
Waypoint is a recognized academic and teaching hospital providing specialty mental health and addiction ser-
vices for Simcoe County, Muskoka and central Ontario, as well as provincially as the province’s only high secure forensic mental health program. The hospital, which includes the Waypoint Research Institute, is located on the beautiful shores of Georgian Bay in the Town of Penetanguishene. Waypoint provides an extensive range of acute and longer-term psychiatric inpatient and outpatient services as well as the
North Simcoe/Muskoka Specialized Geriatrics Services program.
As part of our commitment to support the Ontario healthcare system, Waypoint is currently operating an additional 14 acute care mental health beds (for a total of 34 acute mental health beds); is a network lead organization for the Ontario Structured Psychotherapy Program; offers free, confidential
Kristi Lalonde is a Communications Officer at Waypoint Centre for Mental Health Care.
and low barrier access to individual counselling for healthcare workers, frontline workers and first responders through Frontline Wellness; and is a partner in the Ontario Health Team for Specialized Populations with a goal to bring expertise in specialized services through an individual’s lifespan with a focus on mental health and addictions, seniors and Indigenous populations. ■ H
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.
programs and services are available to Ontario caregivers:
and 1:1 Peer Support (online or
and 1:1