Hospital News October Edition 2023

Inside: Ethics | Long-term Care | Special Focus: Infection Control

October 2023 Edition

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Nurses talk truth.

Public health care is on the line.

No one knows the true state of health care in Ontario the way nurses do.

They deliver the majority of direct care to patients. It’s nurses who deal every day with the disruptions in our precarious, under-resourced system. They’re the ones who have to face the frustration that patients and their families express because of long wait times and staffing shortages. And it’s nurses who are told to do more with less.

NursesTalkTruth.ca

The days of nurses carrying the load and being disrespected are over.

They’re speaking out with an insider’s perspective on the collapse of public health care.

Contents October 2023 Edition

IN THIS ISSUE:

2023

Infection Control

Overdose crisis: Harm reduction programs are supporting those at risk

14

National Inf Infection Week Control W October 16-20 16-20, 2023

Canadian Society for Medical Laboratory Science Société canadienne de science de laboratoire médical

www.hospitalnews.com

▲ Cover story: Magic mushroom experiences among people with bipolar disorder

10

OCTOBER 2023 HOSPITAL NEWS 17

▲ Special Focus: Infection Control

17

COLUMNS Guest editorial ................4 In brief .............................6 Ethics .............................12 Long-term Care ...............28

▲ Accidental drug and alcohol-related deaths nearly doubled during pandemic

8

▲ UHN first hospital in Canada offering new treatment to replace diseased heart valve

▲ Improving mental health support to reduce risks of selfharm and suicide in autistic individuals

5

16

Supporting health workforce planning for physicians

27

COVID-19 unleashed an ongoing crisis of

delirium in hospitals

By Christina Reppas-Rindlisbacher, Nathan M. Stall and Paula A. Rochon lder adults have borne the brunt of the COVID-19 pandemic. While Canadians aged 60 years and older make up only 20 per cent of the population, they account for 69.5 per cent of all COVID-19 hospitalizations, and most – 91.7 per cent – of all COVID-19 deaths.

One aspect of healthcare during the pandemic that has received considerably less attention is the failure of effective delirium care.

Delirium is a sudden and distressing state of confusion that occurs in up to half of hospitalized older people. It is usually triggered by a change in health, such as an infection or surgery, and is often short-lived but can sometimes cause long-term cognitive impairment leading to an increased risk of dementia.

Fortunately, delirium can be prevented or minimized using simple strategies. Within our own health practices, we have seen the effectiveness of promoting family caregiver presence, encouraging mobility and minimizing disruptions to eating, drinking and sleeping.

In May of 2020, an opinion piece written by geriatrician Dr. Sharon Inouye in the New York Times, warned of an epidemic within the pandemic that was leaving many hospitalized older patients more vulnerable to delirium by abandoning many simple care approaches.

Unfortunately, she was right.

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Our study recently published in JAMA Network Open showed that the fear of a delirium epidemic was realized. We found that during the first two years of the COVID-19 pandemic, older adults admitted to Ontario hospitals experienced more delirium and were discharged home with more sedating medications compared to before the pandemic.

Disruptions to delirium prevention care caused by the pandemic are in part to blame. A shortage of staff and volunteers, visitor restrictions and infection control rules created the perfect storm of less interaction with patients and fewer opportunities to use non-drug approaches for preventing and managing delirium.

Our study results are particularly alarming because we have made so much progress in delirium care over the last 30 years. Initiatives such as Senior Friendly hospitals, acute care of the elderly units and hospital elder life programs have flourished across Canada. In the three years preceding the pandemic, our study shows a clear trend of declining prescriptions of harmful and addictive sleep medicines given to older people after they left the hospital.

COVID-19 disrupted this hard-fought progress. Even two years after the onset of the pandemic, the number of new sedative prescriptions being prescribed out in hospitals has not returned to pre-pandemic levels.

Continued on page 6

UPCOMING DEADLINES NOVEMBER 2023 ISSUE

DECEMBER 2023 ISSUE

EDITORIAL: Oct. 5 ADVERTISING: Display – Oct. 20 | Material – Oct. 24

EDITORIAL: Nov. 9 ADVERTISING: Display – Nov. 24 | Material – Nov. 28

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.

Monthly Focus: Medical Imaging/Year in Review/Future of Healthcare/Accreditation/Hospital Performance Indicators: Overview of advancements and trends in healthcare in 2023 and a look ahead at trends and advancements in healthcare for 2024. An examination of how hospitals are improving the quality of services through accreditation. Overview of health system performance based on hospitals performance indicators and successful initiatives hospitals have undertaken to measure and improve performance. A look at medical imaging techniques for diagnosis, treatment and prevention of diseases.

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4 HOSPITAL NEWS OCTOBER 2023

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NEWS

UHN first hospital in Canada offering new treatment to replace diseased heart valve HN is the first hospital in Canada to offer a new treatment for percutaneous pulmonary heart valve replacement, providing more minimally invasive options for pulmonary valve replacement than anywhere else in the country.

North America’s first percutaneous pulmonary valve replacement was performed at the Hospital for Sick Children (SickKids) in 2006 by Dr. Eric Horlick, interventional cardiologist and Peter Munk Chair in Structural Heart Disease at UHN, and Dr. Lee Benson, interventional cardiologist at SickKids.

The first adult percutaneous pulmonary valve replacement was performed at UHN’s Peter Munk Cardiac Centre the same year.

“It was a game-changer for adult congenital heart disease (ACHD) patients,” remembers Dr. Horlick. “We were able to help these patients – most of them in their 20s and 30s – avoid open-heart surgery.”

Individuals who undergo multiple sternotomies face increased risk during and after surgery. Patients born with congenital heart disease typically undergo open-heart surgery as children and will likely need another surgical intervention in early adulthood.

Patients with Tetralogy of Fallot – a congenital heart defect which occurs when a baby’s heart forms incorrectly in utero – are almost certain to require multiple heart valve repairs or replacements in their lifetime.

Since 2006, percutaneous pulmonary valve replacements have become commonplace at specialized centres such as the Peter Munk Cardiac Centre.

But not all ACHD patients are anatomically suitable. Up until recently, only 20 per cent of this population could undergo percutaneous pulmonary valve replacement.

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‘A REMARKABLE ACHIEVEMENT’ Today, Dr. Horlick and his team add another intervention to their arsenal, increasing suitability in the patient population to 80 per cent. www.hospitalnews.com

“Open-heart surgery in your 30s means you may not be able to work for three or four months,” says Dr. Horlick. “If you’re in your 20s, you could lose a semester or a year in school.

That’s a huge deal.

“With this procedure, patients have an average stay of one day, and they

leave with a fully competent valve.

That’s a remarkable achievement.”

Thanks to the pioneering efforts of Dr. Horlick, Dr. Lee, and Dr. Mark Osten, Toronto General Hospital is home to the first and largest ACHD program in the world. The program provides care to nearly 10,000 patients

and is a global hub for ACHD research and education.

With ACHD patients living longer than ever before, finding ways to ease disease burden and improve quality of life is at the forefront of Dr. Horlick’s mind.

“We follow these patients for life,” he says. “We see what they go through, and when we’re able to provide a solution that we didn’t have months, or even a year ago, it’s incredibly rewarding.”

Sept. 11 to 17 was Heart Valve Disease Awareness Week, an international campaign aimed at tackling what’s being called the next cardiac epidemic. More than one million Canadians are affected by heart valve disease, yet public awareness of the disease is shockingly low. Heart Valve Voice Canada and the Canadian Cardiovascular Society are joining forces to increase awareness and improve early detection by educating Canadians on heart valve disease and the H importance of stethoscope checks. ■

New service for patients with breast cancer

By Sheila Olley nyone who has battled cancer knows the physical and emotional impact of the disease is life changing.

For women who undergo mastectomy as part of their treatment for breast cancer, there is an added psychological toll because of the dramatic change in the look and feel of their bodies.

Regaining their sense of wholeness is an important aspect of the recovery process, and reconstructive surgery is an option that can help improve confidence and quality of life for patients.

Breast cancer surgery is performed at Halton Healthcare’s Oakville Trafalgar Memorial Hospital and Milton District Hospital sites. Breast reconstruction surgery is also offered to patients, when appropriate, and approximately 460 breast cancer surgery procedures with and without reconstruction are performed each year at Halton Healthcare.

This year, the hospital became the first in the region to also offer patients

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areola tattooing as a physician funded service. This is an innovative technique that uses pigment to simulate the physical dimension and depth of an areola after breast reconstruction.

To support women in their cancer journey, an impressive team of physicians created the website – www. restoremeabc.com – as a trustworthy resource for women who have battled breast cancer to find reputable information about breast reconstruction and survivorship. The team is based at the Oakville site and includes nurses as well as Dr. Lauren Willoughby and Dr. Christine Nicholas, Plastic Surgeons who specialize in breast reconstruction, Dr Nicole Callan, General Surgeon with a specialty in breast surgery, and Dr. Alexandra Ginty, Family Physician and Surgical Assistant.

Dr. Ginty is the Regional Primary Care Lead, Cancer Screening, for the Mississauga Halton Central West Regional Cancer Program. She is also a breast cancer survivor and an artist.

She recognized an opportunity to further support survivors with restorative areola tattooing, a highly specialized field that requires about 100 hours of training, which Dr. Ginty completed in 2023.

While breast reconstruction post-mastectomy is covered by OHIP, areola tattooing is only covered if performed by a physician. Dr. Ginty was the first physician in the region to become certified, and the Restore-Me Clinic at Halton Healthcare is the first to offer this option as a physicianfunded service.

“A lot of people know about surgery and chemo, but they don’t put breast reconstruction into the equation,” Dr. Ginty says. “Areola tattooing is not decorative, it’s the end of the restorative phase. Bringing this into the hospital as a funded service is about equity and telling people we feel this is part of the process of healing…the psychological part.”

Continued on page 8 OCTOBER 2023 HOSPITAL NEWS 5

IN BRIEF

New guideline to promote health equity in Canada comprehensive new guideline with 16 preventive care recommendations aims to promote health equity for people disadvantaged because of racism, sexism and other forms of discrimination.

The guideline, created by a diverse team of clinicians from across Canada with patient involvement, is published in CMAJ (Canadian Medical Association Journal).

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SOME KEY RECOMMENDATIONS: • Colorectal cancer – prioritize colorectal cancer screening for patients starting at age 45 years (rather than the current recommendation of 50 years) • Cervical cancer – offer self-testing to people eligible for cervical cancer screening • Tuberculosis – use a blood test to screen for latent tuberculosis (rather than a skin test that requires several visits) • Depression – screen for depression along with providing appropriate supports in adolescents and adults

• Poverty – in all families with children, screen for social risk factors, such as poverty or the ability to afford basic necessities, and connect with resources and supports • Primary care access – prioritize connection to primary care, with automatic enrolment in a primary care practice similar to the way children are automatically enrolled in local schools Preventive care includes screening for certain cancers and heart conditions, blood testing for tuberculosis, self-testing for diseases like HIV and other practices to detect a condition before it progresses. However, many people face barriers to accessing preventive care, such as Indigenous people, racialized people, people who identify as 2SLGBTQI+ (2-spirit, lesbian, gay, bisexual, transgender, queer or questioning and intersex), people with functional limitations and those with low incomes.

“Preventive care such as screening for certain cancers can save lives, but access to this care is not equitable for

Continued from page 4

Delirium in hospitals So how do we reverse these dangerous trends?

It is likely that the fall and winter will bring a seasonal wave of viral illness such as influenza, RSV – and COVID-19, among others. Hospital and healthcare systems will soon be faced with decisions about visitor and volunteer policies in the face of viral outbreaks.

We can minimize rates of delirium by: 1. Implementing policies centered on delivering dignified care, especially to older persons with cognitive impairment who cannot always advocate for themselves.

2. Renewing nationwide hospital efforts to mandate flexible hospital vis-

itation and implement the simple and evidence-based care strategies needed to prevent and manage delirium.

3. Addressing national staffing shortages plaguing healthcare facilities across the country and redoubling our efforts to build and sustain senior-friendly healthcare environments.

Never again should sick patients with delirium be isolated from their family caregivers.

We must return to providing the standard of care for older people that reduces delirium and minimizes sedating drugs. We owe it to our aging population to provide the kind of humanistic care that helps older adults leave hospitals with their independence and H cognition intact. ■

Dr. Reppas-Rindlisbacher is a geriatrician at Sinai Health and University Health Network and a PhD student at Women’s Age Lab at Women’s College Hospital. Dr. Nathan Stall is a geriatrician and clinician scientist at Sinai Health and Women’s Age Lab at Women’s College Hospital. Dr. Paula Rochon is a geriatrician and the founding director of Women’s Age Lab at Women’s College Hospital.

6 HOSPITAL NEWS OCTOBER 2023

many reasons, including poor connections with primary care, limited availability to attend appointments, mistrust of health care and discriminatory practices in the health system,” said guideline co-lead Dr. Nav Persaud, Canada Research Chair in Health Justice at the University of Toronto and a family physician at Unity Health Toronto, Toronto, Ontario. “Stigmatization related to mental health, substance use, HIV and other infectious diseases is a barrier to care, especially for people experiencing disadvantages.”

The authors make 15 screening and preventive care recommendations for primary care as well as one policy recommendation aimed at government to improve primary care for people experiencing disadvantages.

“By prioritizing people who are disadvantaged in the health care system for preventive care like cancer and heart disease screening, we can promote health and make health outcomes more equitable or fair,” said Dr. Aisha Lofters, a scientist and family physician at Women’s College Hospital and associate professor, University of Toronto, Toronto, Ontario.

The authors also recommend removing cost barriers, such as costs for

bowel preparations for colorectal cancer screening, tests for HPV, tuberculosis and other diseases, and costs for treatment, counselling and any other out-of-pocket health expenses.

“The 16 recommendations focused on health equity represent perhaps the largest change to preventive care in decades, including changes in the starting age for colorectal cancer screening, depression screening, how cervical cancer screening and tuberculosis testing is done,” said Dr. Lofters.

“As well, we recommend new screening aimed at providing evidence-based health care interventions to address serious threats to health such as intimate partner violence.”

A decision tool that can help primary care professionals prioritize people for preventive care is available at , http://www.screening.ca.

To ensure equitable implementation, government funding is needed.

“Some long overdue changes will require government action,” urges Dr. Persaud. “This includes publicly funding blood (IGRA) testing for tuberculosis, HPV self-testing as cervical cancer screening, and major investments to ensure everyone has a family doctor H (or primary care provider).” ■

“Less is better” is the best message when talking to patients about alcohol hat are safe alcohol consumption levels for Canadians? “Less is better,” write the authors of an editorial published in CMAJ (Canadian Medical Association Journal), referencing the alcohol consumption guideline published in early 2023 by the Canadian Centre on Substance Use and Addiction (CCSA).

The CCSA guideline, which recommends a much lower threshold of three drinks per week for safe consumption, compared with the previous guidance of 10 drinks for females and up to 15 for males, has sparked confusion and debate around safe thresholds for alcohol consumption.

“Ultimately, clinicians should communicate to patients that alcohol consumption, at even low levels, has adverse effects on health; many patients are likely unaware of the carcinogenic

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effects of alcohol,” write Drs. Savita Rani, outgoing CMAJ editorial fellow and a senior resident in public health, and Andreas Laupacis, CMAJ senior deputy editor.

As a carcinogen, alcohol is linked to many types of cancer. It can also increase the risk of liver disease, mental health disorders and other diseases.

“Patients who have alcohol-related diseases or risk factors for those diseases will benefit the most from a reduction in alcohol consumption.

Patients who do not should be counselled that less alcohol is better in terms of overall health and encouraged to balance any benefits they may derive from alcohol consumption with its negative health effects,” they conclude. “’Less is better’ is the best message when talking to patients about alcohol” was pubH lished September 18, 2023. ■ www.hospitalnews.com

IN BRIEF

Pediatric ED visits and hospitalizations for self-harm, suicidal thoughts increased he COVID-19 pandemic had an outsized impact on the mental health of adolescents, especially young adolescent females, with a higher-than-expected number of emergency department (ED) visits and hospitalizations for self-harm and suicidal ideation, according to two new research studies published in CMAJ (Canadian Medical Association Journal).

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PAN-CANADIAN STUDY Researchers from the Pediatric Emergency Research Canada (PERC) network, a network of health care researchers from 15 children’s hospitals, looked at emergency department visits and hospitalizations across Canada for adolescents aged 10–18 years to determine if visits and admissions increased during the pandemic.

“Hospital admissions for suicidal ideation, self-poisoning, and self-harm increased significantly in the first two years of the COVID-19 pandemic among adolescent females,” said Dr. Naveen Poonai, a scientist at Lawson Health Research Institute, a pediatric emergency medicine physician at Children’s Hospital at London Health Sciences Centre, and associate professor at Schulich School of Medicine & Dentistry, Western University, London, Ontario. “What came as a surprise to us is that the greatest increase was among younger adolescent females, a demographic that is often overlooked.”

The study included data from the Canadian Institute for Health Information (CIHI) from April 2015 to March 2022.

Some findings: • Emergency department visits for suicidal ideation, self-harm and self-poisoning increased 14.5 per cent, from 5293 visits per quarter in the prepandemic period to 6060 visits per quarter during the pandemic.

• All-cause ED visits decreased 25 per cent, from 230 080 visits in the prepandemic period to 172 180 visits during the pandemic.

• Hospital admissions for suicidal ideation, self-poisoning and self-harm increased 11 per cent, from 1590 admissions per quarter in the prepandemic period to 1770 per quarter during the pandemic. www.hospitalnews.com

ONTARIO STUDY

A large study on self-harm in Ontario during the first 28 months of the pandemic found similar results to the pan-Canadian study. Researchers from The Hospital for Sick Children (SickKids), ICES, Sunnybrook Health Sciences Centre and others found that the number of acute care visits for self-harm was higher than expected among 1.3 million adolescents aged 10–17 years, particularly in females, during the pandemic than during the pre-pandemic period.

The study included data from ICES and CIHI from January 2017 to June 2022.

Some findings: • Emergency department visits and hospital admissions for self-harm increased 29 per cent and 72 per cent, respectively, above expected levels during the pandemic.

• The increases were greatest among females, especially those aged 10–13 years, in whom ED visits increased 62 per cent above expected levels and hospitalizations were 3.5 times greater than expected levels.

• The increases in acute care visits for young females were observed in

both those who had never previously received physician-based mental health care and those who had recently received care from a physician.

Although neither study could determine what caused the increases in visits for self-harm in this vulnerable age group, the authors suggest the disruptions of the pandemic may have been a factor.

“Findings may reflect the prolonged and cumulative effects of pandemic-related stressors on this younger age group such as social isolation, loss of routines, missed milestones, changing learning environments, familial stress, inadequately treated psychiatric conditions, substance misuse or changing patterns of mental health service use at a critical point in their developmental trajectory,” writes Dr. Natasha Saunders, a pediatrician and clinician-investigator at SickKids and an adjunct scientist at ICES, Toronto, Ontario, with coauthors.

The authors of both studies urge action on this critical issue.

“Our findings underscore an urgent need for public health policies to mitigate the impact of the COVID-19

pandemic and future pandemics on the mental health of adolescents,” said Dr. Poonai, “including developmentally appropriate screening programs for suicide risk that include younger adolescents.”

“Beyond the pandemic, it will be important to understand the factors driving the observed upward trend in self-harm among youth,” said Dr. Saunders. “Long-term suicide prevention strategies among youth should be age-, sex- and gender-specific; include upstream interventions; and target pandemic-associated stressors. In the short term, accessible and intensive mental health supports are needed for this segment of the pediatric population.”

“Emergency department visits and hospital admissions for suicidal ideation, self-poisoning and selfharm among adolescents in Canada during the COVID-19 pandemic” is published September 18, 2023.

“Self-harm among youth during the first 28 months of the COVID-19 pandemic in Ontario, Canada: a population-based study” H was published September 18, 2023. ■

Hospital admissions for COPD increased substantially nnual hospital admissions for chronic obstructive pulmonary disease (COPD) in Canada increased 69% since 2002, especially in females and people under age 65, according to new research in CMAJ (Canadian Medical Association Journal).

COPD affects the lungs and progresses, resulting in frequent hospitalization, burdening patients, families and health care systems. It has been viewed as a condition usually associated with male smokers.

“With increasing pressure on Canada’s health systems, it is crucial to identify gaps in care that lead to higher utilization,” said Dr. Kate Johnson, assistant professor, Faculty of Medicine and Faculty of Pharmaceutical Sciences at the University of British Columbia (UBC).

“Hospital admissions for COPD may represent one such area for improvement as, in many instances, they could be avoided with proper preventive or early therapeutic interventions.”

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The researchers from UBC, Providence Health Care Research Institute and St. Paul’s Hospital, Vancouver, BC, looked at national data on hospital admissions in Canada to understand trends in admissions for COPD. They identified 1 134 359 admissions for COPD in patients aged 40 years and older between 2002 and 2017. Of the total admissions, 240 611 (21.2%) were for younger adults aged 40–64 years and more than half of admissions (127 514, 53.0%) in this age group were for females. Over the 16-year study period, the number of annual hospital admissions for COPD increased by 68.8%, from 52 937 to 89 384.

After adjusting for population growth, age and sex, the hospital admission rate for COPD increased almost 10% (from 437 to 479 per 100 000 people), even though admission rates for other health concerns decreased over the same period. The increase was most pronounced among younger females (12.2%), followed

by younger males (24.4%) and older females (29.8%), while admissions among older males declined (9.0%).

“The number of hospital admissions for COPD has rapidly increased since 2010 in Canada. Even after adjusting for population growth and aging, COPD admission rates have risen since 2010 in all groups except among older males. This is in contrast to declining all-cause admission rates over this period. Our findings call into question whether progress is being made in improving COPD care and outcomes,” conclude the authors.

The authors suggest that a number of factors could be driving the increase, including better treatments that are extending the lifespans of patients with COPD, changes in the rates of pneumonia and influenza, and changes to hospital admissions practices. Environmental factors, such as changes in exposure to air pollution, wildfire smoke or indoor toxic inhalants, may H also be contributing to the increase. ■ OCTOBER 2023 HOSPITAL NEWS 7

NEWS

Accidental drug and alcohol-related deaths nearly doubled in Ontario during pandemic

By Adam Miller new report from The Ontario Drug Policy Research Network and Public Health Ontario shows the number of accidental drug and alcohol toxicity-related deaths grew to alarmingly high levels in Ontario during the COVID-19 pandemic.

There were almost 9,000 accidental deaths from substance-related toxicities in the province from 2018-2021 – reaching an unprecedented rate that was five times higher than the number of deaths due to motor vehicle collisions in Ontario.

The report found that the annual number of substance toxicity deaths nearly doubled in Ontario during this time, reaching nearly 3,000 deaths in 2021, with an average of eight deaths occurring every day that year.

“This report shows the extent to which substance-related harms have worsened during the pandemic,” says senior author Dr. Tara Gomes, a scientist at the Li Ka Shing Knowledge Institute of St. Michael’s Hospital and ICES, and a principal investigator of the ODPRN.

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Dr. Tara Gomes “During the pandemic, for the first time, the number of deaths involving multiple substances surpassed deaths

Continued from page 5

Patients with breast cancer Sandy Garraway, Program Director, Cancer & Ambulatory Care, agrees.

“The Restore-Me clinic finishes the journey; it restores women to their full selves. One of the areas we try to focus on is survivorship or what happens after active treatment is over.”

The procedure involves a consult from the specialist, surgeon, oncologist or family physician. Then the patient is booked for bilateral tattooing, unilateral tattooing or follow-up appointments. The actual tattooing process takes place in a dedicated room in the outpatient medical-surgical clinic at the Oakville site, using state-of-the-art equipment and inks. Before the procedure, the patient is given full information about the process and about the underlying surgery and reconstruction and how 8 HOSPITAL NEWS OCTOBER 2023

that might affect the ink absorption.

Generally, there are two to three follow-up appointments within the first few months to touch up the inks.

For patients, it’s not only important to have this option available to them, but to have it done in a setting where they feel safe and are supported by a trustworthy clinical team.

One woman says she had not been able to look in the mirror for two years and was astounded at the results. And another says, “When you have breast cancer, every step of the way there are times when you are up and times when you are down. This made me so happy, and I was glad it was in the hospital setting. It was very emotional for me, fantastic. I felt like I was complete again, like I was H Wonder Woman!” ■

from one substance alone, highlighting the increasing complexity of this issue and the types of responses required to prevent these avoidable harms.”

DEATHS LINKED TO MULTIPLE SUBSTANCES The report found over 80 per cent of alcohol, stimulant, benzodiazepine deaths during this time also involved opioids, which can lead to higher fatality rates, suggesting the need for more responsive healthcare, community-based and harm reduction interventions that address the complex needs of people who use multiple substances.

Gomes says that many of these patterns are driven by the growing opioid overdose crisis that has worsened in the pandemic, but the rising trends aren’t restricted to opioids – with stimulant-related deaths rising and remaining elevated since 2020 as well.

Although much more uncommon than deaths from opioids and stimulants, the report also found there were

almost 300 deaths from alcohol toxicities in Ontario in 2021, the majority of which involved another substance. Only 25 of these deaths involved only alcohol.

“These patterns of alcohol-related toxicities in part reflect how risks of harms from alcohol use can be mitigated by the regulation of its sale, in contrast to illicit drugs where supplies are highly unpredictable which can increase the risk of unintentional, fatal overdoses,” Gomes says.

“What is clear across all four of the substances that we studied is that these accidental deaths are occurring across all ages, both men and women, and in all parts of the province, meaning that responses and services need to be made accessible and tailored to these various populations.”

The researchers analyzed data from ICES and the Drug and Drug/Alcohol Related Death Database (DDARD), which contains records from investigations completed by the Office of the Chief Coroner/Ontario Forensic H Pathology Service. ■

Adam Miller works in communications at Unity Health. www.hospitalnews.com

SPONSORED CONTENT

How milk nourishes the brain Unveiling the surprising ways dairy foods influence mental health

By Cara Rosenbloom, RD nxiety, depression and other forms of mental illness affect about half of all Canadians by the time they reach age 40. And it starts young -- Canadians aged 15 to 24 are more likely to experience mental illness than other age group. Researchers are increasingly looking at the impact of lifestyle factors – such as diet and physical activity – and their impact on mental health at all ages.

It has increasingly been shown that a nutritious dietary pattern can improve mental health. Studies show that ultra-processed foods are detrimental to mental health, due to their absence of beneficial nutrients and high amount of salt, sugar, additives or preservatives. Diets filled with whole or minimally processed foods show better health outcomes.

Researchers are interested in the link between mental health and dairy foods such as milk, cheese and yogurt.

As minimally processed, nutrient-rich foods, studies increasingly show the value of dairy foods in brain health and mood. Here’s why dairy should be on your patients’ menu.

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MILK IS A NUTRIENTRICH FOOD Milk is a powerhouse of nutrients, boasting nine grams of protein per cup, plus an array of brain-supporting vitamins and minerals. Studies show that a higher intake of dairy, calcium and vitamin D are associated with protective effects on mental health.

Studies show that getting enough calcium may help prevent depression.

Calcium is part of the pathway that leads to serotonin synthesis (serotonin plays a key role in regulating mood).

Low vitamin D has also been linked with depression. Vitamin D activates the gene expression of enzymes that

help produce neurotransmitters such as dopamine and noradrenaline. Low levels of these neurotransmitters have been linked to mood disorders, so getting enough vitamin D is important.

Milk also contains a variety of B-vitamins, including vitamins B1, B2, B3, B6 and B12, riboflavin and niacin, which are vital for mental health and cognitive function. B-vitamins act as co-factors in cellular processes related to regulating mood.

BENEFITS OF DAIRY FOODS FOR CHILDREN AND YOUNG ADULTS A recent study of children aged 7-17 years looked at associations between dairy foods, depression and anxiety. The researchers found that children who consumed dairy most often had lower scores for depression and anxiety.

Another recent study conducted among university-aged students found that those with a higher intake of dairy foods and calcium also had: • Lower perceived stress • Higher positive mood scores • Lower anxiety • Higher resilience Milk intake tends to decline after early childhood, but the nutrients are important for brain health and mood control at all ages. Dairy foods should be on the menu daily; one cup of milk contains 15 essential nutrients.

DAIRY AND THE GUTBRAIN AXIS Emerging research supports the notion that the gut microbiome influences brain health and mood. Known as the gut-brain axis, this communication system is important at all life stages. Changes in the microbiome

can affect mood, and the gut-brain axis has been proposed as a link between diet quality and depression.

Fermented dairy foods such as yogurt and cheese provide probiotics that enrich the microbiome. A recent meta-analysis of eight studies on fermented dairy foods and depression noted a decreased risk of depression in people with higher intake of fermented yogurt and cheese. Researchers speculate that probiotics in fermented dairy can modulate brain function via the gut-brain axis by influencing gut microbiota, decreasing inflammation, and influencing the production of neurochemicals.

Dairy foods such as milk, cheese and yogurt contain a host of beneficial nutrients that support brain health and combat anxiety and depression. Dairy is an important part of the diet for Canadians of all ages. For more information, visit www.milk.org

Cara Rosenbloom RD is a registered dietitian, journalist and author in Toronto.

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OCTOBER 2023 HOSPITAL NEWS 9

NEWS

Magic mushroom experiences among people with bipolar disorder

By Sarah Ripplinger esearch co-led by Vancouver Coastal Health Research Institute (VCHRI) researcher Dr. Emma Morton is the first to characterize psilocybin use and impacts among people with bipolar disorder (BD) – a brain condition that causes extreme mood swings and altered behaviour. Published in the Journal of Psychopharmacology, the findings from Morton’s research offer both a promising and cautionary tale of the potential therapeutic use of psychedelic mushrooms to treat BD. There are two main types of BD. Type 1 is often characterized in manic episodes that may require hospitalization and involve exceptionally high energy, feelings of euphoria, risky behaviour, restlessness and difficulties concentrating and getting restful sleep. People with BD Type 2 experience periods of extreme depression that last at least two weeks, along with at least one less severe hypomanic episode.

Apart from these distinctions, people with both types of BD tend to experience depressive symptoms for around half of the year, says Morton.

About one in 100 Canadians over 14 years of age are living with BD. Medications and therapy can help many cope with the mood disorder; however, the effectiveness of these treatments can be limited.

sleep difficulties, hallucinations and depressive symptoms.

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THE POTENTIAL FOR MAGIC MUSHROOMS AS A MOOD DISORDER TREATMENT Psilocybin – the hallucinogenic compound found in psychedelic fungi, aka magic mushrooms – has been tested as a potential treatment for other mood disorders, such as depression.

The illicit drug can produce effects such as hallucinations and other altered states of consciousness that can last up to six hours.

WEIGHING THE POSITIVES AND NEGATIVES OF HALLUCINOGENIC MUSHROOM USE

Human consumption of psychedelic mushrooms has roots as far back as 5.3 million years ago, when our prehistoric ancestors, the hominins, likely ingested them while foraging for food

WHILE CLINICAL REMISSION OF THE SYMPTOMS OF BD, OR THE ABSENCE OF SYMPTOMS, IS IMPORTANT, IT IS NOT NECESSARILY THE FULL STORY FROM THE INDIVIDUAL’S POINT OF VIEW. Prior studies estimated that almost 10 per cent of Americans have used magic mushrooms at least once, and a recent survey found that over 63 per cent of respondents used psychedelic mushrooms for general mental health and well-being.

Morton and her research collaborators examined experiences of wellness among 541 members of the general population surveyed about their uncontrolled use of psychedelic mushrooms.

All respondents included in the study had self-reported BD; had at least one psychedelic experience or trip using psilocybin; and completed a survey to share their intentions, practices, experiences and adverse events, including any worsening of BD symptoms and hospitalizations following psilocybin use.

Respondents reported a variety of reasons for their psilocybin use,

including helping their personal development or growth and escaping pain or discomfort. Over half of all respondents said their goal was to treat a mental health or substance use condition.

Negative or unwanted outcomes during or within two weeks after a psilocybin trip were reported by around 32 per cent of respondents, with new or increased manic symptoms identified as the most common side effect.

Other side effects included difficulties falling or staying asleep and symptoms of anxiety and/or depression.

Around three per cent of respondents reported using emergency services – such as visiting an emergency department, psychiatric ward or general admission hospital ward – due mostly to new or increasing manic symptoms, delusional beliefs, anxiety,

Similar to antidepressant and antipsychotic medications, psilocybin is theorized to encourage the action of serotonin 5-HT2A receptors in the brain’s central nervous system, particularly in regions responsible for learning and cognition.

“Certain antidepressants that act on serotonin receptors are associated with a risk of switching people with BD into a mild or extreme manic state,” notes Morton.

On average, respondents in Morton’s study gave their psilocybin trips a harmfulness rating of 1.6 out of five, with one being ‘not at all harmful’ and five being ‘extremely harmful’. Psilocybin was given a four out of five for helpfulness, and individuals who experienced side effects still, on average, said that they perceived psilocybin to be more helpful than harmful.

“Given that roughly one third of respondents reported adverse effects, there is a need to be cautious about the use of psychedelic mushrooms among people with BD,” says Morton. A potential future psilocybin treatment might need to be followed by a debriefing with a therapist to ensure safe and optimal outcomes, she adds.

“However, respondents also noted that it helped them work through symptomatic feelings associated with their BD, and some reported being able to better cope with the mood disorder – when not using psilocybin – as a result,” states Morton.

“Overall, I am hopeful that more research will be conducted on novel BD treatments, such as psilocybin, and that findings will help people understand the precautions needed when H using such substances.” ■

Sarah Ripplinger is a Communications Specialist at Vancouver Coastal Health Research Institute.

10 HOSPITAL NEWS OCTOBER 2023

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Recruiting the employees of the future – now

University of Toronto Scarborough’s Co-op program makes hiring students easy

By Diana Swift or healthcare organizations, filling temporary gaps in their workforce with the right student employees can be a fast and seamless process. The University of Toronto Scarborough Co-op program in Arts and Science connects employers with student talent in a few steps in work partnerships that benefit institutions and students alike.

UofT Scarborough’s program simplifies the recruitment of top talent for busy hospital teams and research labs.

It supports employers and connects them with the best candidates for the positions to be filled. It also offers flexible timelines and streamlined hiring processes and helps with logistical and administrative details. In addition, it provides advice on funding opportunities for employers.

F

“Meet the talent of the future: Natalie Tam, UofT Scarborough Neuroscience

DATE LAB’S EXPERIENCE One partner that has benefitted from working with the Co-op program is the University Health Network’s Dementia Ageing Technology Engagement (DATE) Lab. This is a research facility within the Toronto Rehabilitation Institute that promotes positive aging. “The hiring process has been very smooth in helping us find engaged and enthusiastic students, and we are excited to welcome our next two students for the fall semester,” said Dr. Arlene Astell, PhD, the laboratory’s Director.

In the past term, the lab had three students engaged in activities ranging from data cleaning and analysis to coding video data and drafting methods and results – as well as title and abstract screening. “They’ve also all worked on a project co-creating a multimedia conversation support for people living with dementia,” said Dr. Astell. This has involved finding and www.hospitalnews.com

“THE HIRING PROCESS HAS BEEN VERY SMOOTH IN HELPING US FIND ENGAGED AND ENTHUSIASTIC STUDENTS, AND WE ARE EXCITED TO WELCOME OUR NEXT TWO STUDENTS FOR THE FALL SEMESTER” sourcing multimedia contents, reviewing co-creation sessions, identifying copyright owners, doing videography, and creating story boards.

One recent hire was Natalie Tam, a UofT Scarborough neuroscience student who worked this year as a research assistant in the DATE Lab from May until September, when she returned to her studies. “One of my

projects was content analysis on videos in which people with dementia try out different ‘exergames’ like Xbox Kinect and Nintendo Switch Instant Sports,” she said. In another assignment she collected content from online archives for a multimedia scrapbook designed for people with dementia.

“This job allowed me to participate in actual research compared with the

’hard’ knowledge gained from academic learning,” Ms. Tam said. “I developed interpersonal skills as well as organizational and note-taking skills.

These skills are transferrable and will definitely help me as I return to my classes.” Most importantly, the DATE Lab experience allowed her to learn about dementia from a human perspective, which aligns with her professional interest in pursuing research in behavioural neuroscience.

Ms.Tam and her student colleagues have collaborated well, Dr. Astell said, working not just on their own primary projects but together as teams and with other members of the DATE Lab or external partners.

Their interest in the wider research process has been evident. “We’ve been able to make a range of opportunities available to them to gain different skills and experience, which the Co-op students have responded to really well,” Dr. Astell said. These have included training in completing a Research Ethics Board submission and using the data extraction platform Covidence for titles, abstracts, and full-text screening.

“We would definitely be interested in rehiring these students in the future,” she said.

As for the logistics of recruiting, Dr. Astell added, “We found the Co-op application and hiring program very accessible and easy to navigate. It makes it very straightforward to post the advert and find suitable candidates.”

Further details on hiring a UofT Scarborough Co-op program student can be found at: utsc.utoronto.ca/hirecoop. Learn more about the hiring process at: How to Hire Our Students | Hire Arts & Science Co-op Students (utoronto.ca) utsc.utoronto.ca/hirecoop/how-hire-our-students This site also provides an Employer Inquiry Form at: hirecoop.utsc.utoronH to.ca/employer-inquiry Q OCTOBER 2023 HOSPITAL NEWS 11

ETHICS

Is some medical terminology ethically futile?

By George Magafas lear communication is essential to any patient-clinician interaction, perhaps especially when discussing end-of-life care. Conversations in these circumstances often contain content that may be troubling or distressing for patients, as well as their family or substitute decision-maker(s). If this kind of information is incumbent on medical knowledge, then practitioners are not fulfilling their duty to patients to ensure they have the tools they need to make decisions that align with their best interests. Patients may not be able to grasp the meanings and implications of medical terminology, which may prevent them from fully understanding relevant social and clinical information about their condition. Misunderstandings are often avoidable, if the information is conveyed in a way that is both specific and accessible.

“Medical futility” is one such term that can cause these misunderstandings. Terms like this are often rife with scientific and sociocultural ambiguity, which can cause confusion in a clinical setting. I do not intend to say that healthcare practitioners have not come to a consensus on the meanings of these kinds of terms (though some may still be up for debate). Rather that, for most patients, the definitions are not obvious, nor do they necessarily align with their goals or expectations from clinical treatment. There are numerous considerations surrounding ethical clinician-patient communication. One such consideration is to promote informed decision-making and prevent harm, which involves being mindful of – and avoiding – the use of potentially ambiguous terms that may be interpreted differently by providers and patients. As mentioned, futility is an example of one term that may be misunderstood and cause entirely avoidable patient distress.

Futility is often defined in terms of actions; a futile action is one that cannot accomplish a useful result. “Useful” is, however, a relative judgement.

In a clinical setting, the term “futile” often extends to treatment that will

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IN CONSIDERING ETHICAL CLINICAL COMMUNICATION, WORDS MUST BE CLEAR AND EASILY INTERPRETED IN ORDER FOR HEALTHCARE PROVIDERS TO FULFIL THEIR DUTY OF CARE TO THE PATIENTS THAT THEY SERVE. not improve a patient’s condition.

“Futility” can apply to treatment in any stage of health, but the ambiguity becomes most obvious in end-of-life care circumstances, particularly with life-prolonging treatments in cases involving brain death. It may be important to note that medical futility applies to the clinical condition of the patient without necessarily taking into consideration other facets of the patient’s life.

Thus, this strictly clinical definition of futility can easily be misunderstood as the end of the line for patients when it comes to their end-of-life care. If patients believe that there is nothing to be done, since the treatment is not improving their condition, then they may feel as though they are being rushed to die without having the time to make plans or say goodbye to their loved ones. Alternatively, the patient or family may not believe that the treatment is futile based on their perception of what is “useful”, broadly speaking. Of course, this is not necessarily the case.

But for a patient to hear that their treatment is futile, especially when it is their last option, it can be incredibly distressing for many reasons. For example, consider the brief case below: Harriette is an 85-year-old woman who has multiple co-morbidities and recently had a stroke. Unfortunately, her wife, Bessie, was not home when

the stroke occurred. By the time Harriette got to the hospital, she had already suffered significant brain damage and was not expected to make a full, if any, recovery. Although Bessie (as Harriette’s substitute decision-maker) wanted “everything done” for Harriette, the physician confirmed after a few days that Harriette’s condition was not expected to improve and that further treatment would be futile. Based on Bessie’s cultural perspectives, however, further treatment was not at all futile, since Harriette’s heart was still beating. Bessie did not understand nor agree with the physician calling the treatment “futile” and hearing this term being used without further explanation caused her significant angst.

Bessie questioned the clinical team’s motives since her wife was still alive.

Why would the medical team say that treating her was futile? This idea simply didn’t make sense to Bessie, and her trust in the medical team waned as a consequence.

The case of Harriette and Bessie provides just one brief example of how, given clinical and sociocultural contexts, shorthand medical terminology can be misconstrued and cause avoidable distress. In this case, the ambiguity in – and the expected reception of – the term influenced Bessie to be skeptical and untrusting of the medical

team. Bessie’s perspective of “futility” was heavily influenced by her cultural upbringing and, consequently, the physician’s use of the term simply did resonate with her. As such, Bessie incurred a great deal of stress in this already emotional situation. However, if the clinical team had been clearer and more concise about Harriette’s condition, and about what they meant when they said that the treatment was “futile” then Bessie may have continued to trust the team. Additionally, having a conversation in which potentially ambiguous terminology is broken down allows conceptual clarity to be achieved and trust to be maintained. If a more fulsome conversation occurred, with Bessie and the medical team learning about their differing perspectives by explaining their rationale to a greater extent, clarity about the concepts and options could have been achieved. Perhaps then a description of “futility” may have allowed Bessie to align her options with her family’s values and goals, changing the outcome entirely.

Language matters when communicating in a clinical setting; only with clear and concise conversations can clinical discussions occur in an ethically defensible manner. It is the duty of healthcare practitioners to provide care and it is of the utmost importance to do no harm while providing it.

However, if ambiguous terms are used without clear context and supporting information, it is not clear whether no harm has been done. I do not intend to say that being clear in communication can solve all challenges that may occur amongst clinical teams and patients/ families. But by being unambiguous and striving for conceptual clarity, perhaps we can lessen the burden on all parties, prevent misunderstandings, gain insight into each other’s values and perspectives, and potentially prevent (non-physical) harm from being done. In considering ethical clinical communication, words must be clear and easily interpreted in order for healthcare providers to fulfil their duty of care to the patients that they serve.

Otherwise, communication is bound to cause distress and harm, underminH ing the goals of clinical practice. ■

George Magafas graduated from the University of Toronto with a BSc in Biochemistry and also majored in Bioethics. George has a continued interest in clinical and biomedical ethics with a specific focus on the ethics of medical education, patient-clinician interaction, gender-affirming care, and equitable access to care. The author would like to acknowledge Andria Bianchi for her editorial support.

12 HOSPITAL NEWS OCTOBER 2023

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NEWS

Leveraging artificial intelligence to make care safer for mental health patients

By Kristi Lalonde voiding patient harm is a fundamental element of quality patient care. Timely intervention is crucial in managing and treating mental health conditions effectively. In recent years, the application of artificial intelligence (AI) in healthcare has shown great promise, and one area where it holds significant potential is the development of an early warning score (EWS) system for mental health patients.

“Early warning scores are tools used by hospital care teams to recognize the early signs of clinical deterioration in order to initiate early intervention and management,” said Dr. Andrea Waddell, Medical Director Quality Standards and Clinical Informatics at Waypoint for Mental Health Care.

“Knowing ahead of time that a patient may be at risk of harm can help us develop intervention strategies such as increased nursing attention and adjustments to their plan of care.”

Data from the Canadian Institute for Health Information in 2021-22 revealed that 1 in 17 hospital stays involved unintended harm, with nearly 50 per cent of them being preventable.

Waypoint’s Dr. Waddell is also the Regional Clinical Co-Lead for Mental Health and Addictions at Ontario Health’s Mental Health and Addictions Centre of Excellence. She and her team of researchers are seeking to change this statistic to develop an ear-

Dr. Andrea Waddell and her team of researchers are leveraging artificial intelligence to make care safer for mental health patients.

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ly warning score to help stop the risk of harm before it occurs.

Artificial intelligence, incorporating machine learning algorithms and natural language processing, has revolutionized various sectors and mental health care is no exception. AI can analyze vast amounts of data, identify patterns, and generate valuable insights to improve patient outcomes. When applied to mental health, AI has the potential to enhance early detection, personalize treatment plans, and reduce the burden on healthcare providers.

Early warning scores have been widely adopted in many acute medical settings, but this methodology has not been applied in mental health settings.

The development of an EWS system

involves the continuous monitoring and analysis of various patient-specific factors to assess the risk of deterioration. By combining historical data, real-time monitoring, and AI algorithms, a predictive model can be created to identify subtle changes that may indicate an impending crisis. Ideally alerting care providers up to 72 hours in advance so meaningful interventions can be put in place.

Waypoint and its expert staff care for some of the province’s most severely ill patients. The hospital has a 20bed acute mental health program, has submitted a proposal to the Ministry of Health to add an additional 20-bed unit, and is shifting the culture intentionally to become a learning health

system; making the hospital uniquely positioned to build this early warning model. Leveraging existing frameworks, expert opinion, and literature, the hospital is proposing variables for an EWS and testing a machine-learning model on 2022 patient data. Frontline clinicians, patients, and families will provide input at every step to guide the selection of the final algorithm.

Once finalized, the EWS will be piloted in some Waypoint units using a rapid-cycle quality improvement model.

“Early Intervention and timely detection of deteriorating mental health conditions is really about advancing person-centred care,” said Dr. Nadiya Sunderji, President and CEO. “Artificial intelligence enables personalized care plans tailored to individual patients’ needs, taking into account their specific risk factors, treatment history, and response patterns.”

Artificial intelligence unlocks tremendous potential in developing Early Warning Score systems for mental health patients, providing healthcare professionals with tools to detect deteriorating conditions at an early stage.

By leveraging AI’s capabilities in data integration, predictive analytics, natural language processing, and remote monitoring, these systems can enhance patient care, improve outcomes, and reduce the burden on mental health services. AI-driven solutions hold the key to revolutionizing mental health care for a brighter and healthier H future. ■

Kristi Lalonde is a Communications Officer at Waypoint for Mental Health Care.

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OCTOBER 2023 HOSPITAL NEWS 13

NEWS

Overdose crisis: Harm reduction programs are supporting those at risk

By Adam Miller anada is facing a devastating overdose crisis that has been severely exacerbated by the COVID-19 pandemic, the rising cost of living and lack of affordable housing and the toxic unregulated drug supply.

In the past year alone, there were at least 7,328 suspected opioid overdose deaths across Canada, according to the latest federal government data.

That’s an average of 20 deaths per day, up from 10 in 2019, signalling a worsening crisis with no signs of slowing down.

August 31st marked International Overdose Awareness Day – the world’s largest annual campaign to help end overdose, remember loved ones lost and acknowledge the grief families and friends face in the wake of the crisis.

“It’s an important day to remind ourselves that overdose is one of the leading causes of death in Canada right now – particularly among people under 65,” said Dr. Irfan Dhalla, VP of Care Experience and Equity and a general internal medicine physician at Unity Health Toronto.

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“The resources we need still pale in comparison to the need for care.”

Dr. Dan Werb, the Director of the Centre on Drug Policy Evaluation at St. Michael’s Hospital, says he’s more worried about the future of the overdose crisis now than he’s ever been.

“In Ontario, the number of people who have died of an overdose is higher than the number of people who have died of COVID. The number of people who are dying of COVID is going down, the number of people who are dying of an overdose is going up,” he said.

“The average age of people who die of an overdose is half that of people who have died COVID-19. And so what that means is in accounting for the number of years of life lost, this is an epidemic that is twice that in terms of its magnitude.”

PROGRAMS Unity Health’s outreach programs have made a difference in the lives of those experiencing harms from substance use, and are focused on providing evidence-based health care within a harm reduction philosophy.

“At Unity Health, we’ve been real leaders in trying to improve treatment

for our patients who use substances,” said Anita Srivastava, Unity Health’s Medical Director of Addictions and a family physician at St. Joseph’s Health Centre.

“Obviously, we have more work to be done, but I’m proud of what Unity Health has accomplished to date. We have really worked hard.”

Srivastava says programs that provide naloxone kits to those at risk of overdose in withdrawal management centres, outpatient clinics and the emergency department, and upcoming e-modules for staff on harm reduction, are making a significant impact.

The My Baby and Me Clinic at St. Michael’s Hospital provides low-barrier support to mothers grappling with substance use and offering a judgment-free space with obstetrics, addictions support and counselling.

And the Toronto Centre for Substance Use in Pregnancy (T-CUP) program, part of the Family Medicine Centre, at St. Joseph’s Health Centre, also offers multidisciplinary addiction, obstetric and neonatal care to pregnant women in a non-judgmental environment.

“They might need additional services, they might need specific medi-

cations, they might need some counseling, and they might need some reassurance that although their baby might need to spend some more time in the hospital after they’re born they will likely do very well,” said Dhalla.

“And those are all things that we are able to do, often with the support of philanthropy, because the system isn’t set up to provide funding for these kinds of vital services.”

RESEARCH Dr. Tara Gomes, an epidemiologist at St. Michael’s Hospital and Principal Investigator of the Ontario Drug Policy Research Network, is on the cutting edge of research to help reveal the true scale of the crisis in Ontario and help find solutions.

“For more than a decade, we have been working closely with provincial and federal partners to generate evidence and improve the accessibility of data that can be used to monitor and report on drug toxicities across Ontario,” she said.

“Through this work, and strong partnerships with Public Health Ontario, the Ministry of Health, and the Office of the Chief Coroner, we have been fortunate to have incredibly rich, www.hospitalnews.com

NEWS

high quality data that helps shed light on the changing patterns of drug related harms in our province, and the shifting circumstances that underlie these harms.”

While Gomes and her team are “constantly working to improve the data and reporting” they can provide, the public reports and online dashboard of opioid-related indicators they have developed are important resources for policy-makers and local communities.

“Understanding the types of drugs that are contributing to serious opioid-related harms, changing patterns of drug use, and the opportunities and gaps in services provide to people who use drugs can have important implications on public policy,” she said.

“Similarly, this work can also help shape public opinion as it can help show the widespread impacts of opioid-related harms in all parts of the province while also sharing key information about how each of us can play a part in keeping each other safe.”

Dr. Ahmed Bayoumi, a Scientist at the MAP Centre for Urban Health Solutions at the Li Ka Shing Knowledge Institute of St. Michael’s and a general internal medicine physician, says Unity Health researchers have a strong community focus that sets them apart from other health networks in Canada.

“It is a critical time, because the crisis continues and people continue to die,” he said.

“But even people who survive overdose we know are at greater risk for repeat overdose, and so part of the

research that we’re doing is trying to identify patterns of care to help to prevent people from having repeat overdoses.”

MORE SUPPORT NEEDED Bayoumi said there is an urgent need to provide integrated care between both the hospital and the community to help those at higher risk of overdose navigate the healthcare system and get the support they need.

“The collaboration between hospital and community is so important,” said Kelly Sequeira, Manager of the Toronto Opioid Overdose Action Network, adding that if substance users feel safer with harm reduction workers in the community and not the hospital, “it doesn’t make sense to not work together.”

One way that is happening is a new partnership between the City of Toronto, Unity Health and University Health Network to expand frontline health care services in responding to the escalating toxic drug crisis in Toronto.

The partnership is the first time that acute care hospitals in Ontario and Public Health have worked together to offer supervised consumption services, adding a new way of providing essential harm reduction programming and care in the city.

Zoë Dodd, MAP’s inaugural Community Scholar, says the work she and other Unity Health researchers like Bayoumi are doing evaluating supervised consumption sites during the pandemic, as well as harm reduction in

Amber Fester (L) with her daughters and Jasmine Saleh, social worker at the My Baby and Me clinic at St. Michael’s Hospital. shelters and encampments is critical.

“All of that work is really important, because it’s helped us generate a lot of knowledge that we should be using to make policy changes and to make investments,” she said. “We are living in a time of anti-science and anti-evidence and that’s one of our biggest challenges.”

But despite the work being done at Unity Health to help those at risk of overdose, the worsening crisis highlights the need for more financial support in order to continue to help address the needs of those in the community.

“The fact is that these programs and these organizations are the one thing in a lot of ways that is holding the whole continuum of care for people who use drugs together,” says Werb.

“Harm reduction does not exacerbate substance use, it doesn’t make

people use longer. What it does is keep people alive and act as an entry point, the best entry point, the best door that we’ve got to get people connected to the kind of care that they need.”

Dhalla says that despite the hard work of many frontline healthcare workers and staff at Unity Health, the resources to provide care to people who use substances are “dramatically lower” than other areas of the healthcare system despite the significant loss of life.

“The crisis was bad, and it’s getting worse, and people are working really, really hard,” said Kelly Sequeira, Manager of the Toronto Opioid Overdose Action Network.

“Despite all the work that’s happening, it’s going to take a lot of effort on the part of a lot of people for a long time to really address those in a way H that makes them go away.” ■

Adam Miller works in communications at Unity Health.

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NEWS

Improving mental health support to

reduce risks of self-harm and suicide in autistic individuals utistic females (assigned sex at birth) have an 83 per cent increased risk of self-harm leading to emergency healthcare relative to non-autistic people, according to a new study from ICES and the Centre for Addiction and Mental Health (CAMH).

Autistic males also had a 47 per cent greater risk of self-harm events and had the highest incidence of suicide death compared to autistic females and non-autistic individuals.

The study, Self-Harm Events and Suicide Deaths Among Autistic Individuals in Ontario, Canada, was published today in JAMA Network Open and is the first in Canada to explore suicide rates and self-harm events in autistic versus non-autistic individuals

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factoring sex, sociodemographic and clinical risk factors.

“The presence of psychiatric illnesses substantially accounts for these increased risks,” says lead author Dr. Meng-Chuan Lai, staff psychiatrist and senior scientist at CAMH. “We know that many self-harm and suicide-related events could be prevented when people have access to tailored mental health supports and services, and this is crucial for autistic people.”

The study included cohorts of 379,630 and 334,690 individuals in Ontario, Canada to understand the incidence of self-harm events and suicide death, respectively. Autistic and non-autistic individuals were followed for self-harm events that resulted in emergency care (from 2005 to 2020)

and death by suicide (from 1993 to 2018).

Study findings show: • There were significantly more selfharm events leading to emergency healthcare in autistic compared to non-autistic people, across both males (47% increased risk) and females (83% increased risk), after adjusting for neighbourhood income and urban/rural status, intellectual disabilities, and psychiatric diagnoses.

• Although both autistic females and males showed higher incidence of suicide death than non-autistic females and males, these increased suicide death risks in both sexes were explained by the presence of psychiatric diagnoses.

“In my twenties, I accessed the emergency room a number of times seeking help for suicidal thoughts and ideations.

During that time, I struggled with accessing mental health counselling and support in my city that didn’t have at least a six-month-long waiting list or were affordable, and I waited a over a year to access a psychiatrist,” says Megan Pilatzke, an advocate and autistic woman.

“This is a wake-up call,” says Dr. Yona Lunsky, Adjunct Scientist at ICES and Director of the Azrieli Adult Neurodevelopmental Centre at CAMH. “As mental health providers, we need to do more in terms of mental health promotion, and we have to work together with autistic people and their families to make sure that timely mental health supports are accessible, and adapted to meet their needs.” ”Autistic people are continually forced to mask and hide who we are

to accommodate a world that generally does not accept our traits,” says Megan. “I want people to understand that autistic people are struggling because our needs are just not being met throughout society.”

“Our healthcare system should take a two-pronged approach to support autistic people,” says Lai: “Enhancing access to mental health services, and autism-informed accommodations for those services. For example, we can support autistic individuals who come into the healthcare settings by offering calming spaces, providing maximal predictability possible, understanding their communication styles and preferences, meeting their sensory needs, and supporting them if they wish to come accompanied by a person they trust.”

The CAMH Azrieli Adult Neurodevelopmental Centre offers resources and tools aimed at individuals, their families, and clinicians to support the mental health of autistic people.

One limitation of the study is that the number of autistic individuals may be underestimated, because individuals who had yet to receive a formal diagnosis, or whose diagnosis was made by private practice psychologists may not have been included. Autistic people could have been miscategorized in the non-autistic group, which would have underestimated suicide-related outcomes in the autistic group. Finally, many self-harm events are not captured by health records, as individuals may not visit the emergency department for health care in these H situations. ■ www.hospitalnews.com

2023 Infection Control National Infection Control Week October 16-20 16-20, 2023

Canadian Society for Medical Laboratory Science Société canadienne de science de laboratoire médical

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OCTOBER 2023 HOSPITAL NEWS 17

INFECTION CONTROL 2023

Transforming fever management of unlucky people for whom a fever is a harbinger of life-threatening disease.

This leaves us overtreating with antibiotics, worsening the global crisis of antimicrobial resistance, and over-admitting to hospitals, increasing the burden on already strained health care systems.

Beyond providing no benefit to most patients, our current approach may also cause harm by subjecting them to unnecessary diagnostic tests and treatments and putting them at risk of serious hospital-acquired infections.

“The key is to be able to determine who is at risk of severe and fatal disease, early in the course of their illness,” explains Dr. Kain, who is also Director of the Sandra A. Rotman Labs at the Sandra Rotman Centre for Global Health and Professor of Medicine at the University of Toronto.

“This will allow us to identify which patients need to be admitted and aggressively managed, versus the majority who would be better off recovering at home.”

very parent knows the sinking feeling that accompanies waking to find their child burning up with a fever. Uncertainty and anxiety loom as they grapple with the age-old question: is this a fleeting ailment or a cause for medical attention?

Fortunately, a revolutionary tool is on the horizon – one that, with the simplicity of a finger prick, could empower health care workers, and eventually parents alike, with a reliable means to predict the severity of fever-causing infections.

“Worldwide, approximately two billion cases of fever are recorded each year,” says Dr. Kevin Kain, a Senior Scientist at UHN’s Toronto General Hospital Research Institute and Scientific Director of the Tropical Disease Unit at Toronto General Hospital. “The vast majority of cases are mild and resolve on their own, but one or two per cent progress to severe or even fatal illnesses.”

The problem is that there are no good tools to identify the small group

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18 HOSPITAL NEWS OCTOBER 2023

Photo credit: Kevin Kain

Hospitals in sub-Saharan Africa, such as this one in Jinja, Uganda, can frequently be overwhelmed due to fever-related admissions.

This is a particularly difficult task in regions of the world that have limited diagnostic tools and health care resources, such as sub-Saharan Africa.

There, young children typically experience upwards of six episodes of fever every year, and up to 70 per cent of severe infections are missed, leading to high mortality rates.

To address this issue, Dr. Kain and his collaborators have developed an innovative finger-prick blood test that can help to predict a patient’s risk of severe outcomes, early in their illness, regardless of the type of infection they have.

Now, the research team is evaluating the test in the field through an international consortium of 13 academic and industry partners from North America, Europe and Africa, called EChiLiBRiST.

A FAR-FETCHED IDEA According to Dr. Kain, the world-spanning research project was born from a seemingly far-fetched idea: what if the microbe itself is not all that important for predicting patient outcomes?

Vastly different infections, from malaria to COVID-19, behave in similar ways. Many people get infected, but only a small proportion become critically ill. Among those who do, common physiological processes lead to serious complications or death, and these processes are accompanied by distinct molecular features in the blood.

“As a clinician, you often see the same infection play out very differently in different patients,” says Dr. Kain.

“Usually, most people recover quickly and come through unscathed, but a

few end up with sepsis and long-term complications.

“It all comes down to their response to the infection.”

When the immune system is overactivated by bacteria, viruses or other invading organisms, it releases inflammatory molecules that alter the stability of endothelial cells – the cells that line blood vessels. This process – called endothelial activation – weakens the vessels and causes them to become leaky, eventually leading to multi-organ damage, a process called sepsis.

In a series of studies conducted over the past 10 years, Dr. Kain and his team have discovered circulating proteins that signal vessel damage in people with malaria, pneumonia, dengue, COVID-19 and other causes of sepsis.

Across diseases, high levels of these proteins serve as early warning signs that a person is likely to experience sepsis.

The team’s findings have been published in numerous journals, including Clinical Infectious Diseases, Nature Communications and PLoS Medicine.

These studies, which took place in Uganda, Tanzania, Mozambique and several other countries, laid a strong foundation for developing a blood test that measures markers of endothelial activation to predict a patient’s risk of becoming seriously ill.

A HARD SELL “We got a lot of push back initially, to put it mildly!” says Dr. Kain.

“Most infectious disease researchers are focused on microorganisms, rather than the host response, so the idea of shifting the spotlight to immune and endothelial activation was a hard sell.” www.hospitalnews.com

INFECTION CONTROL 2023 The group’s initial funder for the research was the Defense Advanced Research Projects Agency (DARPA) – the research agency of the United States Department of Defense.

The military was interested in determining whether Dr. Kain’s approach could be used to address the threat of synthetic bioweapons.

“The fear at the time was that someone could insert genes for lethal microbial toxins into the genomes of bacteria that normally colonize us and do not make us sick, like a Trojan horse,” Dr. Kain explains. “If they set those altered bacteria loose in a public setting, our traditional diagnostics would be useless at detecting who was exposed to the toxin because we wouldn’t know what bug we’re looking for.

“They liked the idea of being able to test if someone had been exposed to a toxin without knowing which bacteria was responsible, just by looking for markers of endothelial activation.”

Despite the potential military applications of his research, Dr. Kain’s steadfast focus was helping to manage globally important infections, particularly those that afflict neglected populations in low-resource countries.

Fortunately, more groups eventually came around to the idea and the team secured funding from the Canadian Institutes of Health Research, the Tesari Foundation and other funding agencies to continue developing their biomarker screening strategy.

FROM UHN TO AFRICA With a recent grant of 8 million euros – more than $11.5 million – from Horizon Europe’s Research and Innovation Program, the EChiLiBRiST consortium is now evaluating the test in two multinational clinical trials in Africa.

“This five-year research project, which is being led by my long-time collaborator, Dr. Quique Bassat, is a major step forward for translating our research into a transformative clinical tool,” says Dr. Kain.

The first trial, taking place in Mozambique and Gabon, will determine whether the biomarker test can improve current triaging strategies for risk-stratifying patients. The second trial, in Mozambique and Ethiopia, will assess whether the biomarkers can also serve as targets for therapy in severely ill febrile children.

The consortium is also working with the biotech company BioEclosion to determine the cost-effectiveness, scalability and cultural acceptability of the technology. These studies are laying the foundation for translating the test into an easy-touse, rapid and inexpensive point-ofcare tool.

“It is really gratifying to see this test – which arose largely from research conducted at UHN and funded by Canadian sources – be evaluated in populations that have so much to gain from it,” says Dr. Bassat, an ICREA Research Professor at the Barcelona Institute of Global Health (ISGlobal) and a principal investigator for the EChiLiBRiST project.

Although the initial clinical trial sites are in Africa, Dr. Kain emphasizes that the test could have major health and economic impacts worldwide.

“As a general rule, if a clinical tool works in low-resource settings like this – it will work anywhere,” he says.

The test could be a game changer everywhere from the crowded Emergency Department at UHN to remote clinics serving Indigenous communities. Eventually, the test could also be

available to the public for home use, like rapid COVID tests.

FROM FIELD SIDE TO BENCH Dr. Kain and his team rarely follow the traditional “bench to bedside” approach to research. Instead, they describe their unique workflow as “field side to bench, and back to field side.”

“If you think a physiological process is important in a particular condition, first show a clear epidemiological link in real people with real disease, then confirm causality in preclinical studies and develop a test or intervention in the lab,” explains Dr. Kain.

“Once you’ve done that, you can go back to the field and evaluate your test or intervention in clinical trials in settings that have high disease burden. This is what we are doing now with EChiLiBRiST – closing the translational loop.”

After more than 15 years of research and international collaborations, Dr. Kain’s innovative test has the potential to transform the way we manage infections globally – reducing deaths, disability and wasted health care dollars.

And hopefully, one day, helping parents H sleep a little easier when a fever strikes.■

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INFECTION CONTROL 2023

COVID-infected adults with 4 or more underlying diseases or advanced age, face higher risk of ICU stay, death hether vaccinated or not, having at least four disease risk factors put adults hospitalized due to COVID-19 at higher risk for critical outcomes, according to a 10-state study from the Centers for Disease Control and Prevention’s (CDC’s) VISION Network. The study describes the characteristics of adults hospitalized with COVID-19 from June 2021 through March 2023 and enumerates their risk factors for critical outcomes, defined as intensive care unit (ICU) admission and/or in-hospital death.

It is not uncommon for older adults hospitalized for COVID-19 to have four or more of these disease risk factors. The study authors note that this suggests that overall frailty may play a large role in susceptibility to critical disease regardless of vaccine status.

The majority of hospitalizations which resulted in ICU admission or death, regardless of vaccination status, were among male or female patients

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Data from statewide immunization information systems, electronic health records and insurance claims of 60,488 individuals aged 18 or older from 10 states, who were hospitalized with COVID-19 across periods of Delta predominance to the post-BA.4/BA.5 period were analyzed.

THE STUDY AUTHORS NOTE THAT THIS SUGGESTS THAT OVERALL FRAILTY MAY PLAY A LARGE ROLE IN SUSCEPTIBILITY TO CRITICAL DISEASE REGARDLESS OF VACCINE STATUS. From summer 2021 to spring 2023, the epidemiology of COVID-19 changed markedly. The researchers determined that the proportion of adults hospitalized with COVID-19 who experienced critical outcomes decreased with time, as did their hospital lengths of stay. Over the same time period the median patient age increased from 60 to 75 years.

“This is one of the first studies to examine and describe how the characteristics of seriously ill COVID-19 patients and the risk factors associated with those hospitalizations changed

over time,” said study co-author Shaun Grannis, M.D., M.S., Regenstrief Institute vice president for data and analytics and a professor at Indiana University School of Medicine.

“Our findings provide insight into factors that influence outcomes for hospitalized patients and can help us be alerted to those potential risks, so we can pay special attention to the most at-risk individuals.”

Vaccinated individuals, age 65 or older or with four or more underlying chronic medical conditions, were 1.7 times as likely to have a critical outcome. Unvaccinated individuals, age 65 or older or with four or more underlying medical conditions, were 2.3 times as likely to have a critical outcome. Both tendencies are in comparison to younger individuals or those with fewer than four disease risk factors.

“The number of patients hospitalized due to COVID-19 infection has decreased over time for a variety of reasons, including vaccination and natural immunity acquired due to past infection, advances in medical care as well as the severity of variants. But the virus hasn’t gone away and it’s important to note that people are still being infected or reinfected and are being hospitalized,” said study co-author Brian Dixon, PhD, MPA, interim director of the Center for Biomedical Informatics at Regenstrief Institute and professor at Indiana University Richard M. Fairbanks School of Public Health.

“Our analysis shows that the people hospitalized for COVID who are at higher risk of an ICU stay or even an in-hospital death tend to be older and sicker with underlying conditions, some of which may be undiagnosed. If you are or have family members who are at higher risk, you and your family members should stay up to date on vaccinations and avoid spreading the disease with vulnerable members.”

“Clinical epidemiology and risk factors for critical outcomes among vaccinated and unvaccinated adults hospitalized with COVID-19 – VISION Network, 10 States, June 2021-March 2023” was published in Clinical Infectious Diseases, an official journal of the Infectious Diseases Society of H America. ■ www.hospitalnews.com

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Effectiveness of COVID-19 vaccination for babies and young children confirmed in multi-state study OVID-19 mRNA vaccination protects babies and young children against COVID-19-associated emergency department/urgent care visits, according to a multistate study from the Centers for Disease Control and Prevention’s VISION Network.

The study found that children, age five and younger, who received the original COVID-19 vaccine and the updated vaccine were protected against the need for medical care for COVID in an emergency department or urgent care facility.

Emergency department/urgent care visits are considered indicators of moderate disease. The small number of hospitalizations for children ages six months to five years old limited the assessment of vaccine effectiveness against more severe outcomes.

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The VISION Network study, one of the first to analyze vaccine effectiveness in babies and young children, was conducted both to determine how well the vaccines work and to help inform and guide development of future vaccine policy for this age group.

Data was collected in eight states – New York, Wisconsin, Minnesota, Colorado, Utah, Oregon, Washington and California.

“In most cases, we have seen throughout the pandemic that the prevalence of COVID among children has been lower than among adults. But there has been limited analysis of vaccine effectiveness in young children due to limited availability of data. A large research network like the VISION Network provides sufficient data,” said study co-author Shaun Grannis, M.D., M.S., vice president

“IN MOST CASES, WE HAVE SEEN THROUGHOUT THE PANDEMIC THAT THE PREVALENCE OF COVID AMONG CHILDREN HAS BEEN LOWER THAN AMONG ADULTS.”

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for data and analytics at Regenstrief Institute and a professor at Indiana University School of Medicine. “Based on our analysis we found that, for this age group – children five and younger, even one dose of the two-dose vaccine series provided some protection. Based on this data, parents should consider vaccinating their children for COVID and I further encourage parents to discuss vaccination with their child’s physician.”

As of June 2023, SARS-CoV-2 had resulted in more than two million COVID-19 cases and more than 400 deaths among U.S. children aged six months to four years.

The original monovalent mRNA vaccines were authorized in June of 2022 for children aged six months to four years (Pfizer-BioNTech) and six months to five years (Moderna) with recommendations expanded to include bivalent vaccines in December of 2022.

According to the CDC, for best protection the COVID-19 vaccine series should be started as soon as children are eligible (age six months) and completed within the recommended time.

The study found that protection provided to babies and young children waned in patterns similar to those seen in older children and adults.

A previous VISION Network multi-state study confirmed that the Pfizer-BioNTech mRNA COVID-19 vaccine provided older children and adolescents, ages 5-17, with protection against both moderate and severe COVID-19 outcomes.

“Effectiveness of Monovalent and Bivalent mRNA Vaccines in Preventing COVID-19–Associated Emergency Department and Urgent Care Encounters Among Children Aged 6 Months–5 Years – VISION Network, United States, July 2022– June 2023” is published in the CDC’s Morbidity and Mortality Weekly Report H (MMWR). ■ www.hospitalnews.com

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INFECTION CONTROL 2023

Poop! There it is n a lab on the 4th floor of Hamilton Health Sciences’ McMaster Children’s Hospital (MCH), there’s a very special freezer. Instead of food, it stores pediatric stool samples. That’s right: poop.

The healthy stool samples are used to create a treatment for the recurring gut infection Clostridium difficile, or C. diff, in children when antibiotics haven’t worked. This treatment has become a common procedure in adults but MCH is on the leading edge of using it for children.

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BAD BACTERIA TAKES OVER Our digestive systems are filled with healthy bacteria that help turn food into waste – also called poop, or stool.

But sometimes the healthy bacteria get

knocked out by antibiotic drugs used to treat an infection elsewhere in the body.

And then bad bacteria like C. diff can take over in the colon and cause diarrhea, fever and cramps. And it can be hard to get rid of.

That’s what happened to nine-yearold Kayleah, who lives in Millville, Nova Scotia with her family. She has a medical condition that can cause seizures and having C. diff only made them worse.

“Kayleah had been admitted to the hospital for another reason and had to be on IV antibiotics,” says her mom, Tanya. “After that, she was in constant discomfort and pain. Once tests showed that she had C. diff, her health care team tried getting rid of it using multiple different antibiotics with minimal success. She spent 14 months

Photo credit: Josh Carey, Hamilton Health Sciences

MCH opens first stool bank for kids in Canada

Dr. Nikhil Pai is a pediatric gastroenterologist at McMaster Children’s Hospital. with only a brief break in between suffering from the pain and discomfort of C. diff, which triggered her seizures.”

THE SCOOP ON POOP

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Dr. Nikhil Pai, pediatric gastroenterologist at MCH and his team have been studying a treatment method called fecal microbiota transplant (FMT), to treat other conditions that affect children, like ulcerative colitis and Crohn’s disease. But, this method has already been proven to effectively restore healthy bacteria in the digestive system and get rid of the C. diff.

“About a quarter of all kids who get C. difficile will develop recurrence and need multiple rounds of antibiotics,” he says. “Among these kids, the repeat antibiotics don’t necessarily work, are expensive, can be hard on their bodies or put them at risk for other problems. Many of these children would be candidates for FMT.” An FMT is just what it sounds like.

Doctors take good bacteria from another person’s healthy stool and use an enema or colonoscopy to insert a liquid containing the good bacteria into the infected person’s body.

While treating C. diff with an FMT is available to adults in Cana-

da, Pai says a barrier to making the treatment more widely available for children has been the lack of a dedicated pediatric program. “Up until now, the only way a child could access FMT in Canada was by finding an adult FMT program and asking an adult physician to perform the treatment. A lot of programs closed down during the COVID-19 pandemic and among those that continued, treating kids with adult donor’s stool became a greater risk.”

He says another barrier is having stool from healthy kids. “It’s never ideal treating children with adult stool due to risk factors that could potentially be transferred from an older donor,” says Pai. “However, up until now, adult donors was all that has been available.”

HELPING KIDS ACROSS THE COUNTRY Dr. Pai and his team recognized they had the skills and experience with FMT to help Canadian children struggling with reoccurring C. diff infections. So, with the support of MCH President, Bruce Squires, the Chief of Pediatrics at McMaster University, Dr. Angelo Mikrogianakis, and the Hamilwww.hospitalnews.com

INFECTION CONTROL 2023

THE SUCCESS OF THIS TREATMENT IS OUTSTANDING. A SINGLE TREATMENT IS 81 PER CENT EFFECTIVE AND TWO FMT TREATMENTS ARE 90 TO 97 PER CENT EFFECTIVE IN KIDS. ton Health Sciences Foundation, they made MCH the first hospital in Canada to offer this treatment exclusively to children. Additional expertise was provided by Drs. Jeff Pernica, Christine Lee, Paul Moayyedi, and research coordinator, Melanie Wolfe.

“Our stool bank is literally a collection of poop,” says Pai. “Once the waste is separated from the important bits, one bowel movement can make up to ten FMT treatments. The success of this treatment is outstanding.

A single treatment is 81 per cent effective and two FMT treatments are 90 to 97 per cent effective in kids. I can see a future where we won’t need to be constantly chasing C. diff with antibiotics anymore.”

In January 2023, Kayleah was the first pediatric patient to get treated at MCH with healthy bacteria from donor stool. She and her family arrived in Hamilton on a Sunday, she had two treatments on Monday and Wednesday, and they flew home to Nova Scotia that Friday.

The treatment was life-changing for Kayleah.

“Both my husband and myself were beyond impressed with Dr. Pai and the whole MCH team and how flawlessly everything went,” says Tanya. “It is absolutely amazing to see how this treatment has helped to give our daughter her health and happiness back. The procedure was quick and simple and I hope one day it could be made avail-

able at additional hospitals across the country. Overall, we as a family are extremely grateful that the treatment worked.”

Since then, MCH has continued to grow its stool bank and remains open to children seeking FMT across the country. Any child struggling with C. diff can be referred to Dr. Pai and his

team for consultation and treatment by their health-care provider.

If a health-care provider is looking to refer a patient, please contact Amber Kirk at 905-521-2100 x73587, or akirk@mcmaster.ca. Interested in becoming a pediatric stool donor? Please contact Fariha Chowdhury at 905-521H 2100 x73587 or pailab@mcmaster.ca. ■

Ellie Stutsman works in communications at Hamilton Health Sciences.

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NEWS

WRICC from left: Vincent Siriani, RN, BScN, BScKin; Shannon Hudson, BSc., Msc., ATC-BOC, OT Reg.; Tyler Harris, RP, MACAP; Darryl Langendoen, MSW, RSW; Addis Campbell, RN; Sue Veldman, RN; Milimol Lukose, MSW; Manju John, MSW.

Mental health programs gaining international recognition he Outpatient Mental Health and Addictions Rapid Response Service (RRS) is dedicated to making sure that not a single mental health patient falls through the cracks while moving between hospital and community care.

Meanwhile, the Wellness Recovery Integrated Comprehensive Care (WRICC) program supports adults living with complex mental health needs who find themselves repeatedly in hospital.

Both programs have been named Leading Practices by Accreditation Canada and the Health Standards Organization.

“I believe we gained these certifications due to the compassion, commitment and hard work of the program staff,” says Robin Crown, Outpatient Mental Health and Addictions Clinical Manager.

In order to receive the international certification, a program must demonstrate innovative and people-focused practices that lead to a positive change related to safe, reliable, accessible and integrated care.

Crown says the credit for receiving the latest recognition for the

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26 HOSPITAL NEWS OCTOBER 2023

Rapid Response Service (RRS) belongs to the two nurses operating it: Rozmeen Khowaja and Elisabeth (Lily) Mumford, who helped create the program.

The RRS was designed to bridge support between hospital and community for all clients discharged from the inpatient mental health units and psychiatric emergency services. This ensures that patients and their families and caregivers understand the next steps and available resources with the overall goal of improving the patient care experience.

A nurse will phone within 24 to 48 hours to connect, review the discharge, answer any questions and provide further resources to support the transition from the hospital.

“It’s a big transition when someone is discharging and it can be emotional,” Crown says. “Sometimes clients don’t hear everything, or absorb everything, or appreciate everything upon discharge, so what rapid response does is take it a little slower and help the client to digest what has happened.”

Khowaja and Mumford are involved in every step of the process, she adds.

“They are involved in providing feedback to ensure the efficiency and effectiveness of the program, and are dedicated to supporting clients after their discharge by providing all of the resources they need. Their efforts ensure that no clients fall through the cracks.

“Both of them are absolutely lovely, compassionate, hard-working and dedicated nurses.”

WELLNESS RECOVERY INTEGRATED COMPREHENSIVE CARE PROGRAM ACCOLADES The Wellness Recovery Integrated Comprehensive Care (WRICC) program meets the criteria for a Leading Practice due to the eight team members “thinking outside the box” to support clients, Crown explains.

The WRICC team supports adults living with complex mental health needs, who experience repeat Emergency Department visits and hospital re-admissions, and helps them along their journey. The WRICC team works with clients and community

partners to develop a collaborative care plan with the goal of improved wellness.

“This team is people-centred, bringing about positive results for client wellness,” Crown says. “The program is also accessible without a waitlist, and is integrated and collaborative with other outpatient Mental Health and Addictions programs, inpatient units and community partners.”

Providing high-quality, safe care is the No. 1 priority of Niagara Health.

Crown says the Leading Practice certification validates the hard work this team has invested into developing the program. That includes truly listening to clients to consider gaps in support and brainstorming new ideas to deliver quality care.

“It also recognizes that with committed, compassionate, adaptive and innovative staff, clients can achieve meaningful change in their lives and not have to attend the Emergency Department to get their needs met.

“Achieving Leading Practice status is significant because if our teams can offer such services and be successful, H so can others.” ■ www.hospitalnews.com

NEWS

Pan-Canadian collaboration to support health workforce planning for physicians in Canada n collaboration with the federal, provincial and territorial governments, the Canadian Institute for Health Information (CIHI) is building robust projection models around physician supply and demand. Factors impacting the number of physicians practising in Canada over 20 years – a summary look at various aspects of physician supply and demand – was released by CIHI today.

The work is part of a pan-Canadian project aiming to enhance the data and information available about health care professionals, with the goal of supporting decision-makers and planners as they determine what programs, policy options or regulatory shifts will help address health workforce challenges.

Projection models rely on a number of data sources and can be adjusted to measure the impact of different factors

I

on the supply of physicians across the country.

For example, if the number of spots available in Canadian medical schools increased by 10 per cent every year starting in 2019, then by 2030, those physicians would be starting to practise. In this scenario, from 2030 to 2039, the number of physicians would increase by an average of two per cent per year because of the earlier increase in medical school enrolment.

“It takes eight to 10 years to train a physician, so a long-range look at supply and demand can help decision-makers, but there are many impacts beyond medical school capacity,” says Deborah Cohen, director of Health Human Resources at CIHI. “We need to be able to model different scenarios to find the right mix of strategies to deploy. This, along with more comprehensive data about other health care providers, will allow for better planning and allocation of resources.”

Factors impacting physician supply and demand can include the number of physicians anticipated to retire, the number of graduates starting their

specialty training, health care worker distribution, population density, population health status and health system H use trends. ■

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JANUARY 2024

EKs D Z &K h^͗ dĞĐŚŶŽůŽŐLJ ĂŶĚ /ŶŶŽǀĂƟŽŶ ŝŶ ,ĞĂůƚŚĐĂƌĞ ͬ ƌƟĮĐŝĂů /ŶƚĞůůŝŐĞŶĐĞ ; /Ϳ ͬWĂƟĞŶƚ džƉĞƌŝĞŶĐĞͬ ,ĞĂůƚŚ WƌŽŵŽƟŽŶ͗ EĞǁ ƚƌĞĂƚŵĞŶƚ ĂƉƉƌŽĂĐŚĞƐ ƚŽ ŵĞŶƚĂů ŚĞĂůƚŚ ĂŶĚ ĂĚĚŝĐƟŽŶ͘ Ŷ ŽǀĞƌǀŝĞǁ ŽĨ ĐƵƌƌĞŶƚ ƌĞƐĞĂƌĐŚ ŝŶŝƟĂƟǀĞƐ WƌŽŐƌĂŵƐ ĂŶĚ ŝŶŝƟĂƟǀĞƐ ĨŽĐƵƐĞĚ ŽŶ ĞŶŚĂŶĐŝŶŐ ƚŚĞ ƉĂƟĞŶƚ ĞdžƉĞƌŝĞŶĐĞ ĂŶĚ ĨĂŵŝůLJ ĐĞŶƚƌĞĚ ĐĂƌĞ͘ WƌŽŐƌĂŵƐ ĚĞƐŝŐŶĞĚ ƚŽ ƉƌŽŵŽƚĞ ǁĞůůŶĞƐƐ ĂŶĚ ƉƌĞǀĞŶƚ ĚŝƐĞĂƐĞ ŝŶĐůƵĚŝŶŐ ƉƵďůŝĐ ŚĞĂůƚŚ ŝŶŝƟĂƟǀĞƐ͕ ƐĐƌĞĞŶŝŶŐ ĂŶĚ ŚŽƐƉŝƚĂů ŝŶŝƟĂƟǀĞƐ͘ н ^W / > &K h^͗ EEh > D d , ^hWW> D Ed

D Z &K h^͗ DĞĚŝĐĂů /ŵĂŐŝŶŐ ͬzĞĂƌ ŝŶ ZĞǀŝĞǁͬ &ƵƚƵƌĞ ŽĨ ,ĞĂůƚŚĐĂƌĞͬ ĐĐƌĞĚŝƚĂƟŽŶͬ,ŽƐƉŝƚĂů WĞƌĨŽƌŵĂŶĐĞ /ŶĚŝĐĂƚŽƌƐ͗ KǀĞƌǀŝĞǁ ŽĨ ĂĚǀĂŶĐĞŵĞŶƚƐ ĂŶĚ ƚƌĞŶĚƐ ŝŶ ŚĞĂůƚŚĐĂƌĞ ŝŶ ϮϬϮϯ ĂŶĚ Ă ůŽŽŬ ĂŚĞĂĚ Ăƚ ƚƌĞŶĚƐ ĂŶĚ ĂĚǀĂŶĐĞŵĞŶƚƐ ŝŶ ŚĞĂůƚŚĐĂƌĞ ĨŽƌ ϮϬϮϰ͘ Ŷ ĞdžĂŵŝŶĂƟŽŶ ŽĨ ŚŽǁ ŚŽƐƉŝƚĂůƐ ĂƌĞ ŝŵƉƌŽǀŝŶŐ ƚŚĞ ƋƵĂůŝƚLJ ŽĨ ƐĞƌǀŝĐĞƐ ƚŚƌŽƵŐŚ ĂĐĐƌĞĚŝƚĂƟŽŶ͘ KǀĞƌǀŝĞǁ ŽĨ ŚĞĂůƚŚ ƐLJƐƚĞŵ ƉĞƌĨŽƌŵĂŶĐĞ ďĂƐĞĚ ŽŶ ŚŽƐƉŝƚĂůƐ ƉĞƌĨŽƌŵĂŶĐĞ ŝŶĚŝĐĂƚŽƌƐ ĂŶĚ ƐƵĐĐĞƐƐĨƵů ŝŶŝƟĂƟǀĞƐ ŚŽƐƉŝƚĂůƐ ŚĂǀĞ ƵŶĚĞƌƚĂŬĞŶ ƚŽ ŵĞĂƐƵƌĞ ĂŶĚ ŝŵƉƌŽǀĞ ƉĞƌĨŽƌŵĂŶĐĞ͘ ůŽŽŬ Ăƚ ŵĞĚŝĐĂů ŝŵĂŐŝŶŐ ƚĞĐŚŶŝƋƵĞƐ ĨŽƌ ĚŝĂŐŶŽƐŝƐ͕ ƚƌĞĂƚŵĞŶƚ ĂŶĚ ƉƌĞǀĞŶƟŽŶ ŽĨ ĚŝƐĞĂƐĞƐ͘ н ^W / > &K h^͗ EEh > Z /K>K'z ^hWW> D Ed

JANUARY FOCUS: Professional Development/ ŽŶƟŶƵŝŶŐ DĞĚŝĐĂů ĚƵĐĂƟŽŶ ; D Ϳͬ ,ƵŵĂŶ ZĞƐŽƵƌĐĞƐ͗ ŽŶƟŶƵŝŶŐ DĞĚŝĐĂů ĚƵĐĂƟŽŶ ; D Ϳ ĨŽƌ ŚĞĂůƚŚĐĂƌĞ ƉƌŽĨĞƐƐŝŽŶĂůƐ͘ dŚĞ ƵƐĞ ŽĨ ƐŝŵƵůĂƟŽŶ ŝŶ ƚƌĂŝŶŝŶŐ͘ ,ƵŵĂŶ ƌĞƐŽƵƌĐĞ ƉƌŽŐƌĂŵƐ ŝŵƉůĞŵĞŶƚĞĚ ƚŽ ŵĂŶĂŐĞ ƐƚƌĞƐƐ ŝŶ ƚŚĞ ǁŽƌŬƉůĂĐĞ ĂŶĚ ĂƩƌĂĐƚ ĂŶĚ ƌĞƚĂŝŶ ŚĞĂůƚŚĐĂƌĞ ƐƚĂī͘ ,ĞĂůƚŚ ĂŶĚ ƐĂĨĞƚLJ ŝƐƐƵĞƐ ĨŽƌ ŚĞĂůƚŚĐĂƌĞ ƉƌŽĨĞƐƐŝŽŶĂůƐ͘ YƵĂůŝƚLJ ǁŽƌŬ ĞŶǀŝƌŽŶŵĞŶƚ ŝŶŝƟĂƟǀĞƐ ĂŶĚ ŽƵƚĐŽŵĞƐ͘ н WZK& ^^/KE > s >KWD Ed ^hWW> D Ed

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OCTOBER 2023 HOSPITAL NEWS 27

LONG-TERM CARE NEWS

Transitioning from hospital to long-term care

By Tini Le he decision to move into long-term care can bring mixed emotions; perhaps concern at leaving the familiar, alongside relief knowing 24/7 care will be on-hand. It’s the guidance and support of Home and Community Care Support Services care coordinators that help make this process less stressful for patients and families.

Long-term care admissions across Ontario are facilitated by Home and Community Care Support Services, and the care coordination team plays a key role in supporting patients with the application, waitlist management and placement process. Care coordinators assesses applicants for eligibility and work one-on-one with patients, or their substitute decision maker, to select homes that meet their needs and preferences and provide a personalized approach to care.

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One year ago, the Bill 7, More Beds, Better Care Act 2022 was implemented, and amendments were made to the Fixing the Long-Term Care Act, 2021, to facilitate the safe transition of patients who no longer require treatment in hospitals to care arrangements in a long-term care home, while they wait for their preferred long-term care home.

These changes shone a light on the dedicated and tireless work of Home and Community Care Support Services while bringing renewed attention to the patient-centred services and empathy care coordinators provide.

“Our goal is to support people to get to a place where they are thriving,” said Home and Community Care Support Services Krista Brock, a Hospital Care Coordinator. “We are continually engaging patients and their substitute decision maker to make the best care decisions for themselves or their loved ones.”

Brock said the first challenge of the new legislation was helping patients

and families understand what Bill 7 really entailed and helping them look beyond some of the media headlines.

“The legislation is not just about picking a home within a certain radius, it’s about an individual patient’s needs. And we will always strive to work with the patient or their substitute decision maker to obtain consent,” Brock said, adding one of her goals was removing fear from conversations and helping patients and families navigate information to make the best care decisions.

“A valuable part of patient counselling is sharing specific details – including shorter waitlists – on homes that the patient or their family may not even know about and making clear that the applicant can continue to wait for their preferred home if they accept one of the other homes,” she said.

To prepare for the new legislation, care coordinators received technical education as well as ethics training

and interactive scenario-based coaching, guiding them on how to continue a personalized approach to care as part of a larger health care system.

Abraham Balachandran, another Hospital Care Coordinator with Home and Community Care Support Services, said that the extensive technical and ethics-based training was instrumental in not just enabling him to explain the new procedures, but also having patients and families understand and trust the process.

“We play an important role in the long-term care admission process. Last year’s changes escalated and enhanced that role,” he said. “It’s important that we’re meeting individual health care needs and preferences along with professional responsibility and accountability to ensure the right care at the right place”.

Last year, Home and Community Care Support Services helped over 28,000 people transition to a longH term care home. ■

Tini Le is the Vice President, Patient Services, Home and Community Care Support Services Central and Toronto Central, Central Region Lead and Provincial Placement Lead.

$! $. // - / #*( Bayshore’s home care services are extensive, ǀĂƌŝĞĚ͕ ĂŶĚ ƉĞƌƐŽŶĂůŝnjĞĚ ĨŽƌ ĞĂĐŚ ŝŶĚŝǀŝĚƵĂů͘ tŚĞƚŚĞƌ ŝƚ͛Ɛ ũƵƐƚ Ă ůŝƚƚůĞ ĂƐƐŝƐƚĂŶĐĞ ǁŝƚŚ ĚĂŝůLJ tasks or round-the-clock ŚŽŵĞ care, Bayshore’s caregivers can help your loved ones to live ƚŚĞŝƌ ďĞƐƚ ůŝĨĞ ǁŚŝůĞ ƌĞŵĂŝŶŝŶŐ Ăƚ ŚŽŵĞ͘

Let’s talk.

1.877.289.3997 bayshore.ca 28 HOSPITAL NEWS OCTOBER 2023

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LONG-TERM CARE NEWS

Canada falls short when it comes to

seniors’ care anada and its provinces, specifically Newfoundland and Labrador and Quebec, can do more to improve access to seniors’ care and overall equity in the health system, a new E-Brief from the C.D Howe Institute shows.

In “Shortcomings in Seniors’ Care: How Canada Ranks Compared to its Peers and the Paths to Improvement,” authors Rosalie Wyonch and Tingting Zhang use data from the Commonwealth Fund, a major US Foundation, to better understand how Canada’s health system is doing in relation to seniors’ care, and what areas can be improved. They found that Canada currently ranks 8th out of 11 developed countries.

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The study shows that the top-performing countries overall are Germany, Australia and Switzerland, and that Canada falls below the international average due to poor access to care and equity but meets the international average for care processes.

While four provinces (PEI, Ontario, Manitoba and Alberta) score above the international average overall, improving equity and reducing wait times and cost barriers should be a priority across the country. Some provinces, particularly Newfoundland and Labrador and Quebec score below most international comparators and also need to prioritize improving care processes.

“We can see through an international comparison that top-performing

countries such as Germany and the Netherlands rely on things like universal coverage, which includes primary care and treatments for chronic conditions, and are achieving better and more equitable health outcomes,” the authors state, also pointing to the fact that high-value services are more equitably available in those countries than in Canada. “Germany and the

Netherlands also invest in home care, which encourages seniors to live independently for as long as possible.”

In Canada, most provinces exceed the international average in care process, which includes factors such as coordination across providers and patient engagement, but fall below average on access to care and equity.

Continued on page 30

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NEWS

Covid-19 testing, vaccination and community outreach program designated leading practice Practice from the Health Standards Organization (HSO).

At the beginning of the COVID-19 Pandemic, Ontario Health (OH) put out an urgent call to action seeking partners to help improve access to

he Hospital for Sick Children’s (SickKids) former COVID-19 Testing, Vaccination and Community Outreach Program’s legacy lives on with the awarding of a Leading

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Continued from page 29

seniors’ care Access to medical care is also an obstacle for low-income seniors. “We’re seeing that 15 per cent of seniors in Canada are not visiting a dentist, and 8 per cent are not receiving the home care they need due to cost. Addressing access gaps in home care and dental should be priorities for government,” Wyonch and Zhang conclude.

Among their policy recommendations, Wyonch and Zhang suggest improving overall access, timeliness of care and reducing cost barriers to prescriptions, dentistry and home care services.

“With improved access and timeliness to medical appointments, accompanied by reduced cost barriers for pharmaceutical, dental and homecare, Canada would rank above the

international average and place 3rd in the ranking.”

For more information, please contact Rosalie Wyonch, Senior Policy Analyst at the C.D. Howe Institute, Tingting Zhang, Junior Policy Analyst at the C.D. Howe Institute and Gillian Campbell, Communications Officer, at gcampbell@cdhowe.org.

The C.D. Howe Institute is an independent not-for-profit research institute whose mission is to raise living standards by fostering economically sound public policies. Widely considered to be Canada’s most influential think tank, the Institute is a trusted source of essential policy intelligence, distinguished by research that is nonpartisan, evidence-based and subject H to definitive expert review. ■

30 HOSPITAL NEWS OCTOBER 2023

COVID-19 testing as well as provide infection prevention and control (IPAC) supports in community settings. SickKids responded immediately, deploying a small mobile team of nurses to support COVID-19 testing and infection prevention and control consultation in shelters and congregate living centres.

SICKKIDS HAS BEEN AWARDED A TOTAL OF 37 LEADING PRACTICES THROUGH ACCREDITATION CYCLES SINCE 2007 From there, the team expanded substantially, and the community support strategy evolved into a comprehensive COVID-19 Testing, Vaccination and Community Outreach Program focused on facilitating access to COVID-19 related testing, care, and information.

HSO, along with its affiliate Accreditation Canada, have been identifying and publishing Leading Practices in the Leading Practices Library for more than

15 years. According to HSO, a Leading Practice is an innovative, people-centred, evidence-informed practice that has been implemented by teams in an organization, which has demonstrated a positive change related to care or service that is safe and reliable, accessible and appropriate, and/or integrated.

SickKids has been awarded a total of 37 Leading Practices through Accreditation cycles since 2007, including two since the most recent on-site visit (the Peer Support and Trauma Response Program being the other).

Although the program was discontinued, SickKids and its system partners continue to learn from the experience. Lessons learned from ongoing program evaluations will prove valuable in helping to inform any future program development that seeks to address access to health services and/or information for vulnerable communities. These evaluations have helped identify the need for ongoing partnerships with the shelter and congregate care sector.

For additional information, read the report titled: Answering the Call: SickKids COVID-19 Testing, Vaccination & Community Outreach Program Report H (November 2022). ■ www.hospitalnews.com

NEWS

Older Canadians left out of the opioid crisis conversation he rates of opioid prescriptions in Canada have steadily risen over the past 30 years, becoming extremely high. Canadians are one of the top consumers of prescription opioids in the world. Opioids, commonly referred to as ‘narcotics’, are potent medications widely used to treat pain – but they also have strong potential for misuse and addiction.

While much of the perception of the opioid crisis focuses on younger persons consuming often non-prescribed opioids and experiencing high rates of overdoses, many people are unaware that older Canadians actually bear the largest burden from opioids– mostly from prescription sources.

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Compared to all other age groups, older Canadians have the largest overall consumption rate of opioids, as well as the highest rates of side effects, overdoses, and mortality associated with prescription opioids. This is strongly related to the fact that older Canadians experience more chronic pain compared to any other age group, and opioids are very commonly used in this population to control pain symptoms.

The NIA’s new report Out of Sight, Out of Mind: Addressing the Invisible and Older Faces of Canada’s Opioid Crisis outlines how due to a number of factors including ageism, older Canadians have been failed across the board with respect to a widespread

Careers

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lack of research, awareness, policy and guidelines geared to understanding and curbing the opioids crisis.

“There is a need to re-examine pain management strategies taught to current and future prescribers that are commonly employed to treat older Canadians, considering the very high rates of prescription opioids used and negative outcomes occurring amongst them as a result,” says Dr. Samir Sinha, Director of Health Policy Research at the NIA and one of the report authors.

To address the opioid crisis in Canada and ensure older Canadians are rightfully centred in these approaches, the NIA’s report offers a series of six evidence-informed policy recommendations:

1. Apply an ageing-specific lens to opioid policies and practices 2. Increase the use of non-opioid therapies before climbing the opioid pain management ladder and expand access to multidisciplinary pain treatments 3. Increase awareness and understanding of opioid use disorder in older Canadians 4. Create guidelines on opioid use and pain management in Canadian long-term care settings 5. Enhance health care provider education and training around the use and effects of opioids in older Canadians 6. Conduct more research and collect more data on opioid use and harms H in older Canadians. ■

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OCTOBER 2023 HOSPITAL NEWS 31