QEII Times - Winter 2019 by SaltWire Network

S H I N I N G A L I G H T O N T H E Q E I I H E A LT H S C I E N C E S C E N T R E , I T S STA F F, V O LU N T E E R S A N D D O N O R S

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A QEII FOUNDATION PUBLICATION IN ASSOCIATION WITH THE CHRONICLE HERALD

YOUR QEII 3 Wishes Project

Making an impact

In the details

RESEARCH & INNOVATION Turning tragedy into life

Throat cancer rates climbing 12

Funded entirely by the QEII Foundation and its many donors, the QEII Health Sciences Centre recently opened its doors to a $1.8-million, state-of-the-art Simulation Bay where medical teams practise their skills in a low-stress, no-risk environment. Darren Hubley

Practising hands-on patient care QEII’s Simulation Bay provides state-of-the art training opportunity Virtual neighbourhoods

By Jon Tattrie

ALSO From ship to surgery QE11 team puts international patient at ease during a stressful time Page 2

Burn care specialist joins team Dr. Jack Rasmussen brings wealth of knowledge and skills to the operating table Page 10

Cannabis and the developing brain QE11 study examines the risks for cannabis use Page 13

When Dr. Brock Vair trained as a surgeon in the 1970s and 1980s, he relied on textbooks and the fruit stand. “Every technical skill that we acquired was learned and refined on real people. The only models we had in medical school were orange rinds for practising our suturing,” Dr. Vair says. As co-director of the QEII Health Sciences Centre’s Simulation Program, he’s celebrating the new Simulation Bay (Sim Bay). The fully functional simulated medical facility is located next to the QEII’s Emergency Department (ED) and comes complete with a high-fidelity patient simulator and an operating space for cadaveric skills training. “The simulation environment accurately recreates a clinical situation. Learners can learn and practise a wide variety of technical skills without the concern of causing patient harm,” Dr. Vair says. Just outside the Sim Bay, a sign on the wall pays tribute to Don Horne, who donated $100,000 to the QEII Foundation’s campaign to upgrade the space and required technology. As a pilot, Don knows the importance of being prepared for the unexpected and how critical simulation and training is to medical practitioners. Donna Warren, coordinator for the Sim Bay, says training starts in the Sim Bay’s debrief room.

Learner groups meet there to talk about the upcoming simulated scenario before heading into the simulation. These groups can include multiple healthcare staff — from first year students to experienced physicians — and they get to experience a range of scenarios, from fairly frequent medical events to rarely-seen medical traumas. “We try to recreate this simulation space as close as possible to a clinical setting,” Donna says. “So when the learner leading the simulation says ‘please start an IV,’ the other team members need to know that it’s going to actually take them three to four minutes to get an IV and set it up. We don’t want skills to happen in ‘simulation time.’ We want it to happen in real time.” During the simulation, Donna operates the patient simulator from the control room with the facilitator, adapting the scenario based on activities they see through the one-way glass or via the three camera views of the simulation space. If a learner makes a mistake, the patient simulator’s vital signs can be adjusted to reflect their actions and decisions. “Maybe the simulator patient was completely awake when they were talking to them two to three minutes ago, but the learners gave an abnormal amount of a certain medication that altered their level of consciousness, and now the patient doesn’t respond. “We can change all of those patient parameters and vital signs

“The simulation environment accurately recreates a clinical situation. Learners can learn and practise a wide variety of technical skills without the concern of causing patient harm.” Dr. Brock Vair

on the fly.” The learners have an opportunity to work through their decisions made during the simulation. The duration of a typical learning session is usually 10 to 20 minutes and is followed by a debrief session that lasts twice as long. The facilitator and learners can review a recording of the scenario, discuss the various treatments and refine interventions by clarifying anything that they may not have understood during the simulation.

“During simulation, making mistakes isn’t discouraged because mistakes are opportunities for learning,” Donna says. The Sim Bay’s second simulation room is used for cadaveric training. “There is no higher fidelity than practising your skills on a real person,” Donna says. “Rather than practise skills for the first time on a real patient, such as inserting a chest tube, the learner has the ability to practise that skill repeatedly, which helps to build muscle memory. It is important to practise high risk skills in this type of setting, where the completion of these skills is not time dependent, and using the cadaver allows us to facilitate this.” Dr. Vair says the $1.8-million project was entirely funded by the QEII Foundation and its many donors. “The QEII Foundation recognized that this is the future of medical education,” he says. Donna says the new Sim Bay will greatly improve training, which will lead to better results for patients. “The QEII Foundation has been an unbelievable champion for the QEII Simulation Program and this project. It doesn’t matter if you give $5 or $50, you can see it all adds up to an amazing end result,” Donna says. “It really does make a difference.” It’s a long way from putting sutures in an orange rind. For a virtual tour of the QEII’s Simulation Bay, visit bit.ly/QE2SimBay.

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QEII Times A QEII Foundation publication in association with The Chronicle Herald, QEII Times is designed to shine a light on the QEII Health Sciences Centre community. Editor & Project Manager Lindsey Bunin Communications, QEII Foundation Jenn Coleman-Ford Account Executive Tracy Skinner Contributors Jenna Conter Zack Metcalfe Melanie Jollymore Allison Lawlor Bill Bean Colleen Cosgrove David Pretty Jon Tattrie Cynthia McMurray Photographers QEII Foundation Darren Hubley NSHA Research Services

© The Chronicle Herald 2019 All rights reserved. No part of this publication may be reproduced, stored in retrieval systems or transmitted in any form or by any means without the prior written consent from the publisher. The Chronicle Herald 2717 Joseph Howe Drive PO Box 610, Halifax, N.S., B3J 2T2 902-426-2811 thechronicleherald.ca We want your feedback! Share your thoughts, comments and story ideas with us at: info@QE2Foundation.ca 902 334 1546 or toll-free at 1 888 428 0220. QEII Foundation 5657 Spring Garden Road, Park Lane Mall, Floor M3, Halifax, N.S., B3J 3R4

‘Hundreds of life-changing and life-saving moments’ A word from the QEII Foundation By Bill Bean, President & CEO, QEII Foundation “It takes a village.” This old adage is still relevant today and it couldn’t be more apparent than in health care. It takes a collective vision to transform health care and, thanks to donors from across Atlantic Canada, the QEII Foundation is able to do just that. From my neighbourhood to yours, thousands of donors have helped establish the QEII as a centre of excellence. And at the

QEII Foundation, changing lives is our measure of success. The QEII Foundation supports healthcare research by funding programs such as the QEII Foundation Translating Research Into Care (TRIC) grants. These grants bring teams of researchers and administrators together to fuel direct, positive change such as better patient outcomes, reduced wait times and improved access to care. To date, the QEII Foundation has invested $1,271,000 in TRIC grants to advance health care by closing the gap between evidence and current practice. We also fund new patient care technologies, ensuring QEII healthcare teams are better able to treat patients at the most critical times of their lives. The QEII’s Simulation Bay is one

example of this. The new Sim Bay, as it’s known, opened in December 2018, allowing healthcare teams to train and refine their skills through hands-on, real-life scenarios before they perform the same procedures on patients. This $1.8-million project was possible thanks to QEII Foundation donors who recognize the critical importance of advanced medical education. Hundreds of life-changing and life-saving moments are experienced by Atlantic Canadians every day at the QEII. From the operating room to the research lab, the most advanced care in our region is provided within the walls of the QEII. And while these walls are going to change as we move toward a new generation of the QEII, the

passion and commitment of our healthcare teams remains the same. Before research can find a cure, before technology can save lives, and before a patient’s journey home can begin, we need to come together to support the more than one-million patient visits each year at the QEII. For families from Clark’s Harbour to St. John’s, Halifax to Tignish and Gaspé, and everywhere in between, the QEII is here for you. With 10 buildings over two sites, the QEII is a vibrant and compassionate community with thousands of people delivering exceptional care, every day. We can all play a role in saving lives. We invite you to join us and help make patient care at the QEII even stronger.

From ship to surgery QEII team puts international patient at ease during a stressful time By David Pretty On September, 1, 2017, Silvia Graf began to experience intense chest pains while travelling from Sydney, N.S. to Halifax on a cruise ship. “I suddenly became very ill and everybody was very anxious,” she recalls. At first, the ship’s doctor told Silvia to remain calm and get some bed rest — assuring her that the pain was caused by too much stressful activity. But when tests revealed that Silvia was experiencing a significant heart event, the doctor realized her

condition was beyond his ability to treat. “The next morning, at about 8 a.m., we were in the harbour of Halifax,” Silvia remembers. “There was an ambulance waiting for me and I was taken from the ship to the hospital. And that was my good luck!” Silvia’s good fortune came in the form of the QEII Health Sciences Centre and Dr. Greg Hirsch, chief of cardiac surgery. Silvia was treated in the emergency department where she had a computerized tomography (CT) scan; the results confirmed Silvia’s life-threatening diagnosis.

“If Dr. Hirsch could not have done the surgery, I would not be alive.” Silvia Graf Dr. Hirsch used the detailed images of Silvia’s aorta to develop her care plan. “She had an intramural hematoma, which results from a split in the innermost layer of the aorta,” Dr. Hirsch explains. “The aorta is a multi-layer structure,

like a laminate tabletop, and the inner lamina had split and blood was entering the middle layers.” With the initial tear detected and the possibility that the condition might repair itself, Dr. Hirsch continued to observe Silvia over the next few days before repeating the scan. “Ultimately, we identified the likely entry site and replaced that segment of her aorta,” he says. “This required a major cardiac operation requiring the use of a heart-lung machine to support her circulation while the major blood

SURGERY - Page 6

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Dr. Sarah McMullen (left), Nancy Michalik (centre) and Dr. Jennifer Hancock (right) reconnect at the QEII’s Intensive Care Unit. Nancy lost her husband, Kevin MacKenzie, in June 2018, just hours after his final wish — to marry Nancy — was realized through the QEII’s 3 Wishes Project. QEII Foundation

3 Wishes Project provides sweet memories in difficult times By Colleen Cosgrove Nancy Michalik and Kevin MacKenzie were too busy enjoying the simple things in life — like regularly attending Saturday night dances in their hometown of Glace Bay — to think much about the details of their eventual wedding. Nancy, a semi-retired NICU nurse, and Kevin, a heavy-equipment operator, had been dating for more than seven years and marriage seemed inevitable — just not a priority. It wasn’t until an unexpected turn of events saw Kevin, a once-vibrant 55-year-old, lying motionless in the Intensive Care Unit of the QEII Health Sciences Centre that the worst news was delivered. An abscess had formed on his upper spine, and surgeries to remove and repair it were unsuccessful. Kevin now faced a future as a quadriplegic, and he would need a tracheostomy and ventilator to breathe.

It was not the quality of life he wanted, and Kevin decided his time on earth was over. The healthcare team in the QEII had done everything they could, and now their attention shifted to keeping the shocked couple comfortable as they navigated palliative care. “Kevin was very outgoing — a jokester and prankster,” Nancy says. “That wouldn’t have been his lifestyle, so we had to accept the facts. He wanted the decision made that he no longer wanted to live that way.” Knowing his time was limited, Kevin asked the nursing staff if they could help him propose to Nancy and marry her. It was his dying wish to marry the love of his life, even if it meant they could never again hit the dance floor together or raise a toast to their love. The couple was married in a patient room in the QEII’s Intensive Care Unit, just steps away from where doctors had tried everything they could to get Kevin a better outcome. He died just an hour after he and Nancy

“It was the most heartbreaking day of my life, but it was also beautiful.” Nancy Michalik said “I do.” “It was the most heartbreaking day of my life, but it was also beautiful,” Nancy says. “When I have dark days, I can look back and I can think of Kevin and all of our memories, including that special day.” A recent initiative called the 3 Wishes Project helped Kevin live out his last wishes. QEII staff dimmed the lights, moved any non-essential medical equipment out of the room, decorated the space and played music during the ceremony. The program, funded by the QEII Foundation and community donations – including the ICU team’s own fundraising efforts – is designed specifically for

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individuals at the end of their life. The endeavour was founded by Dr. Deborah Cook, an ICU doctor in Hamilton, Ontario in 2013, and was introduced to the QEII in May 2018. At publication, more than 160 wishes — things like visits from family pets, religious ceremonies, tea parties and family gatherings — have been granted to over 50 patients. Traditionally, healthcare professionals were instructed to keep patients at arm’s length, to “not get too close,” says Dr. Sarah McMullen, a physician in the department of Critical Care and assistant professor at Dalhousie University. But projects like 3 Wishes are challenging that approach, and the impact — for the dying, their families and hospital staff — has been resoundingly positive. “For staff, it’s a difficult and big change when you’ve spent the last few days trying to make someone better and then to change that conversation to focusing on how to make the dying process an important and meaningful experience for the

family,” says Dr. Jennifer Hancock, an ICU physician at the QEII. The 3 Wishes Project represents a timely transition in how patient care is approached and the team at the QEII is proud to offer it to patients and their families. “3 Wishes is a nice fit for any ICU, but we just felt it was time in this era of patient and family-centred care to really put the patient and their family at the centre of our care in a slightly different way,” Dr. McMullen says, who was present for Kevin and Nancy’s wedding. “Kevin knew the type of life he wanted and that it would no longer be possible. He also knew he loved Nancy and wanted to marry her. It was moving to see that much courage displayed at the end of life,” Dr. McMullen says. “There was no hesitation. It really was a special day for everyone.” To support the last wishes of QEII patients like Kevin, visit QE2Foundation.ca/donate-3 -wishes-project.

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Antoun (right), PET-chemist team lead, and Matt (left), Cyclotron engineer, work behind the scenes every day to produce isotopes, used for Positron Emission Tomography (PET) scans — a nuclear imaging test for diagnosing and monitoring cancer. Following six years of hard work and preparation, the QEII’s Cyclotron is the first in Atlantic Canada to receive a Health Canada Drug Establishment Licence — a proud moment for the Cyclotron team.

EMILY-ROSE TARASCO-McGRATH

“The role we play in the diagnosis and treatment of patients dealing with cancer is simply amazing.”

$QWRXQ 0DWW ANTOUN BOU LAOUZ & MATT SAWLER Cyclotron

Registered nurse Emily-Rose is a registered nurse at the QEII’s neurosugery care unit. As part of the team caring for patients with brain and spinal cord injuries, and progressive neurological disorders, Emily-Rose recognizes the lasting impact both she and her colleagues have on the lives of patients and their families. “I feel honoured to have witnessed amazing patient recoveries. To be part of their journey is very special.”

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Linen services With more than 4.6 million pounds of linens — including sheets, towels and hospital gowns — arriving at and leaving the QEII every year, Star is part of a team providing clean linens to all areas of the health centre. Attending to her assigned floors several times per day, Star is proud of her contribution to patient care and safety. Star cherishes the times when patients and their families recognize her as part of their care team.

BRANDON CAIRNS Medical device reprocessing

“Recently the daughter of a patient hugged me and told me how much they appreciate what I do. These are the moments that inspire me every day.”

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FACES OF THE QEII Whether you’ve seen their faces in a clinical setting or on a bus or billboard, they are all part of a compassionate community delivering exceptional care every day at the QEII Health Sciences Centre. Kristin, an occupational therapist at the QEII’s Rehabilitation and Arthritis Centre, helps people return to everyday activies following a life-changing event, such as stroke or amputation. Working together with patients, caregivers and the inpatient rehabilitiation team, Kristin helps patients improve their functional abilities.

As a medical device reprocessing (MDR) technician, Brandon is part of a team that upholds the highest standards of cleaning, disinfecting, packaging and sterilizing medical instruments and devices used during surgeries and procedures at the QEII. While most patients are unaware of the role the MDR team plays in their care, the team sees every patient as an extension of their own families, with patient safety top of mind. “When working in the OR, seeing the medical instruments I processed fills me with pride to know my work has helped improve or save someone’s life.”

“Whether it’s something small, like a patient re-learning to hold an object in their hand, or being able to live at home on their own when they never thought they could — these are the most rewarding parts of my job.”

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ADRIAN KERR Perfusionist Adrian has a crucial, though little-known role at the QEII. As a perfusionist, Adrian manages patients’ circulatory, respiratory and cardiac functions with the cardiopulmonary bypass, via the heart-lung machine, during open-heart surgery. Outside of the OR, Adrian provides cardiac support in areas such as the intensive care unit and cardiac catheterization lab. “The magnitude of my responsibility in patient care is top of mind during every surgery and procedure. I’m proud to be part of a team that has such an impact on patients’ lives.”

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As part of the QEII’s housekeeping team, Trevor works primarily on the fourth floor of the Halifax Infirmary building and is responsible for disinfecting and cleaning patient rooms and common areas. With his warm smile and kind conversation, Trevor builds a rapport with many patients. Along with his housekeeping duties, Trevor takes extra care to ensure patients and their families have everything they need. “Due to their surgery or illness, some patients may be here for weeks at a time. I enjoy getting to know them and their families, making them as comfortable as possible during some of the most challenging times of their lives.”

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EMILY-ROSE TARASCO-McGRATH

“The role we play in the diagnosis and treatment of patients dealing with cancer is simply amazing.”

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BRANDON CAIRNS Medical device reprocessing

“Recently the daughter of a patient hugged me and told me how much they appreciate what I do. These are the moments that inspire me every day.”

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Making an impact Garry Beattie’s Brain Cancer Bash raising funds for brain tumour research at the QEII By Allison Lawlor Fueled by his own experience, Garry Beattie is making an impact on brain cancer research with a recent $250,000 gift to the QEII Foundation’s Brain Tumour Research Fund. The former president of the Nova Scotia Golf Association, who has represented the province at national championships, has been fiercely fighting glioblastoma, a malignant brain tumour, since being diagnosed in 2015. Garry had just returned from a golf trip in the United States when he was rushed to the QEII Health Sciences Centre. He and his wife, Lori Duggan, thought he had suffered a stroke. A CT scan found a brain tumour and at 52 years old, Garry underwent his first brain surgery. The surgery was successful but he lost his ability to speak and walk. He had to learn to do both again but Garry continues to battle the same type of tumour that took the life of The Tragically Hip’s Gord Downie. Despite having undergone four brain surgeries so far, Garry hasn’t lost his infectious sense of humour, his skills on the golf course or his desire to help others. After his diagnosis and grateful for the care he received, Garry and Lori got creative and started raising money and awareness by hosting events to

support brain cancer research at the QEII. “Seeing there is a need, it made a lot of sense to do this,” says Garry. According to Garry’s neurosurgeon, Dr. Adrienne Weeks, research — and Garry’s donation and fundraising –— will have a significant impact on brain cancer in Nova Scotia and beyond. “Garry and Lori’s generous donation to the QEII Foundation’s Brain Tumour Research Fund will allow current research projects to move forward,” says Dr. Weeks. “Their fundraising efforts will help secure further necessary funds to aid in this critical research.” With numerous research projects underway, Dr. Weeks is exploring new therapies for patients with brain cancer, including collaborating with Dr. Jeremy Brown, a biomedical engineer, to develop novel ultrasound technology. Dr. Weeks’ work to advance patient care is critical for people like Garry. “My only chance is research,” says Garry. “I kept thinking, ‘What can Lori and I do to help?’” In 2017, Garry and Lori and the QEII’s Division of Neurosurgery put their ideas in motion and hosted the first ever Brain Cancer Bash, supporting brain cancer research at the QEII. The theme of their evening soiree is magic, and draws on inspiration from their experience at The

Garry Beattie has been fighting glioblastoma, a malignant brain tumour, since being diagnosed in 2015. Not letting it slow him down, Garry and his wife Lori Duggan, shown here during their 2017 trip to Peru, got creative and started raising money and awareness by hosting events to support brain cancer research at the QEII. Along with their event, the Brain Cancer Bash, Gary and Lori are making an impact with their own $250,000 gift to the QEII Foundation’s Brain Tumour Research Fund. Contributed

Magic Castle Hollywood. Last November, they held the second annual bash at the Lord Nelson Hotel in Halifax. It was a magical night, featuring several local magicians and a grand illusionist that delighted the crowd. A net total of $16,500 was raised for the QEII Foundation’s Brain Tumour Research Fund. The Brain Cancer Bash is one of several community-based fundraisers managed by individuals or groups. Differing in size and scope, they all raise thousands of dollars each year to help patients and their families at the QEII. Golf continues to play a central role in not only Garry’s recovery and positive attitude, but

Silvia Graf (left), her husband Ulrich (far right) and their friends had an unexpected adventure on their transatlantic cruise when Silvia had emergency surgery at the QEII Health Sciences Centre. Contributed

Surgery Continued from Page 2

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vessel exiting the heart was replaced. While this is a major intervention, our centre sees about 40 aortic emergencies a year, so it’s routine for us.” Grasping the details of a complicated medical diagnosis and procedure is challenging enough, but for the native of Berlin, Germany, the language barrier was particularly daunting. “My English isn’t strong, so when they were talking about my medical condition, it was problematic,” Silvia admits. “But they called Dr. Michael Vician, who spoke very good German. He translated everything and he was a big help.” Above and beyond facilitating clear communication through Dr. Vician, director of the QEII’s cardiac and vascular intensive care unit, Silvia’s stay was memorable thanks to several key staff members. “I had a visit from a volunteer,” Silvia recounts. “She’d had the same procedure so she could talk about the surgery, the recovery and how she was OK again. She calmed me down and gave me a lot of hope.” Silvia also fondly remembers a nurse named Heather who always made her comfort paramount. “I was always cold, so Heather had a wonderful idea to make me warmer with an intravenous drip and two warm hot

water bottles for my feet.” According to Dr. Hirsch, the QEII features a unique combination of top-tier staff and cutting-edge resources to help any visitor to Halifax deal with an unexpected health crisis. Dr. Hirsch is also quick to point out that the synergy between the cardiac division and other affiliated departments is key to this level of effectiveness. “We have a very close relationship with our cardiology and interventional radiology colleagues. Many situations require emergency interventions, including angioplasty and stent grafting, that avoid the need for open surgery. When open surgery is required, our radiology and cardiology colleagues provide quick access to the necessary diagnostic tests. “Working together, there isn’t a cardiac emergency that we can’t definitively handle,” says Dr. Hirsch. While Silvia’s vacation ended at the QEII, she’s grateful for the high level of quality care she received. “If Dr. Hirsch could not have done the surgery, I would not be alive,” she says. “It was very well done. Now, I have only to take some medicine every day and that’s all. I’m feeling totally fine!” “There’s not an emergency I can think of that we couldn’t effectively deal with beginning to end here at the QEII,” Dr. Hirsch confirms. “I’m very proud of the fact that we’re able to provide these services to Atlantic Canadians and to our Canadian and international visitors.”

“My only chance is research.” Garry Beattie

his ability to fundraise. In addition to his own events, Garry has put his support behind the Nova Scotia Golf Association’s senior men’s championship to create awareness and raise money for glioblastoma research in Nova Scotia. The event is now called the #GolfBeattieStrong Men’s Senior Championship. Garry and

Nova Scotia-based company, Dormie Workshop, collaborated on a special golf club head cover, with funds raised from these head covers going to brain cancer research at the QEII. Understanding firsthand the importance of continued research, Garry and Lori believe that money is only good if it is spread around and continue their quest to raise funds and awareness for brain cancer. “We focus on what we can do, not on what we can’t do,” says Lori. To support the QEII Foundation’s Brain Tumour Research Fund, visit QE2Foundation.ca/ garry-beattie-brain-tumour-fund.

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It’s all in the details

FAST FACTS ABOUT THE HOUSEKEEPING TEAM

Why housekeeping is the QEII’s best-kept secret

• They’re innovators — the team is constantly testing new products and equipment that can enhance cleaning to control and prevent outbreaks, along with new tools that could prevent sprain and strain injuries among staff. • They’re collaborators — involved in renovations and new construction to provide feedback on materials used. • They never stop learning — the team is trained on disease outbreak and crisis response, such as Ebola and SARS.

By Colleen Cosgrove An untucked bedsheet, an empty towel dispenser and full garbage may sound inconsequential to the overall operations of the 10 buildings of the QEII Health Sciences Centre, but the truth is, these everyday tasks are a crucial part of the system. For Shane Earle and his 200 colleagues on the housekeeping team, the details matter. “It’s everything,” Shane says. “As soon as they walk through the front door our patients are scanning, looking to make sure everything is clean. A bathroom and space that is clean shows that we care about them, so I think that plays a crucial role.” The happiness and contentment of patients and their families is paramount to an organization that welcomes feedback and makes strides to respond to complaints and suggestions and continuously get better, says Tracey Prescott, the QEII’s assistant manager for environmental support services. “We’re as open as we can be and we prefer it that way,” Tracey says. “It’s the appearance. If you’re coming into a room that looks well-made and well-attended and all the supplies are there, that gives some reassurances.” Housekeeping staff are dedicated to patient units and are responsible for all aspects of cleaning and disinfecting anything and everything visitors and staff touch, including daily service of all patient rooms and bathrooms, as well post-discharge cleaning. Other team members focus on prepping operating rooms or keeping communal areas in order. Shane, who spent most of his career in the hospitality industry, joined the QEII’s housekeeping crew in 2010 as a second income to support his daughter’s college education. Shane really enjoyed the role – he chose to stay and he quickly assumed a leadership role among staff. Today, his sustained enthusiasm and ability to look beyond his job description make him standout. “He helps us with all our recruiting,” Tracey says, smiling. Shane is an expert at his job and he says it all comes down to the details. He regularly befriends patients and, recently, bought a deck of cards and coloured pencils for a senior patient who felt isolated without family nearby. Shane asked her about her interests and began spending his lunch breaks playing cards at her bedside. “While they’re here, it’s their home,” Shane says. “It’s a critical role in their mindset and how their day goes and I want to treat that home environment with the utmost respect I can.” The warmth Shane exudes is a common thread among housekeeping staff, Tracey says, adding that stories of card games are not as infrequent as the general public may think. “They do it out of pure joy and in recognizing that the patients are human just like us,” she says. “We get to know them, learn from them, treat them like family. That goes a long way.” The housekeeping team is among the only staff who enter a patient’s room who don’t need to remind them they're unwell. No samples are needed, the conversation is light and there’s never a needle in sight. As a result, team members like Shane naturally strike up a conversation

The QEII’s housekeeping staff, like Shane Earle, are dedicated to patients and responsible for all aspects of cleaning and disinfecting anything and everything visitors and staff touch, including daily service of all patient rooms and bathrooms, as well post-discharge cleaning. QEII Foundation

and in some instances, they become attached. It’s not uncommon for a unit team to host a celebration of life for a deceased patient who touched staff and in other cases, staff attend funerals or seek grief support services offered internally. “I hope families know we do genuinely care,” Shane says. “We aim to provide comfort and it just comes naturally to us because, like that deck of cards, little things make a big impact on their day. I think it’s important and part of the culture that we try to provide.”

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Turning tragedy into life One donor can save eight lives By Cynthia McMurray It is often said that in all situations — no matter how bad they may seem — we need to find even a sliver of good if we are to be able to move forward. Dr. Robert Green, medical director of Trauma Nova Scotia, understands this all too well. As a trauma and critical care physician at the QEII Health Sciences Centre, Dr. Green sees both sides of a complicated and emotional subject — which usually only becomes relevant when people are at their most vulnerable. Dr. Green spends most of his waking moments thinking about — or working with — trauma and critical care patients, both of which come with high-risk outcomes. But it’s here that he’s able to bridge the gap between what is undoubtedly the worst and best outcomes for individuals and their families. “When trauma patients have terrible injuries that they are not going to survive, the only good thing that is going to come out of that totally horrific situation is to save another life,” says Dr. Green, adding that it can be a

TRAGEDY - Page 15

Dr. Robert Green, medical director of Trauma Nova Scotia and QEII critical care physician, is focused on finding ways to not only help every trauma patient, but also those in need of a life-saving organ donation. QEII Foundation

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YO U R Q E I I - W I N T E R 2 019

Burn care specialist joins QEII team Dr. Jack Rasmussen brings wealth of knowledge and skills to the operating table

“I feel lucky that I get to do what I have a passion for, and I get to do it here in Halifax.” Dr. Jack Rasmussen

By Allison Lawlor Dr. Jack Rasmussen knows he came to the QEII Health Sciences Centre at the right time, with the right skills. A specialist in burn care, Dr. Rasmussen has unique training as both a plastic surgeon and an intensivist or critical care doctor, allowing him to follow major burn patients from the time they enter hospital, through their reconstructive surgeries, all the way to their recovery — both in and out of hospital. “Dr. Rasmussen is our link between the intensive care unit and the plastic surgery team,” says Dr. Jason Williams, a QEII plastic surgeon. “We now look to him as the burn care leader in the institution.” Last July, Dr. Rasmussen became Canada’s first cross-appointed physician in plastic surgery and critical care. As the only adult health care centre in the Maritimes to house an inpatient burn care centre, this is an important step in improving how the QEII delivers care to burn patients. “We are able to deliver more comprehensive care to patients now,” says Dr. Williams. “Having a dedicated burn care specialist in this centre is something we have been hoping for.” Dr. Rasmussen was the type of physician the QEII was looking for. He had the right training and he had developed a keen interest in caring for burn patients — who are often some of the sickest in the hospital, and require years of follow-up, monitoring and care. “It is challenging work,” Dr. Rasmussen says. “Some of these people will become my patients for life.” Raised in Antigonish, Dr. Rasmussen went to St. Francis Xavier University, where he was taught anatomy and physiology by his father, Dr. Roy Rasmussen. He went on to pursue medical school and his plastic surgery residency at Dalhousie University. During his second year of residency, he did a rotation in the intensive care unit and helped care for several patients with severe burns. He liked the intensity and complexity of the work. After his residency, Dr. Rasmussen completed a two-year fellowship in critical care medicine, with a portion of his training devoted to burn care. He trained at the Ross Tilley Burn Centre, the country’s largest centre of its type, based in Toronto. One of the benefits of working in a major burn care centre is that he not only became part of a network of some of the best burn care specialists in the country, but also learned new techniques and technologies to improve the way care is delivered. One of the advances he brought back to Halifax was an innovative way to use a synthetic “skin substitute” product called Integra. The product helps patients rebuild the deep layer of their skin, leading to fewer surgeries, less scarring and less time in hospital. Dr. Rasmussen is also using a new skin grafting machine called the Meek mesher, acquired through the efforts of previous burn unit director Dr. John Stein, and funded by the QEII Foundation and the Nova Scotia Firefighters Burn Treatment Society. Using the machine, Dr. Rasmussen can take a relatively

Dr. Jack Rasmussen, a burn care specialist, arrived at the QEII in July 2018 with unique training as both a plastic surgeon and an intensivist or critical care doctor, allowing him to follow major burn patients from the time they enter hospital, through their reconstructive surgeries, all the way to their recovery. QEII Foundation

small amount of healthy skin from one part of a major burn patient’s body and spread it over a larger area of their body, helping the patient heal faster with fewer surgeries.

“I feel lucky that I get to do what I have a passion for, and I get to do it here in Halifax,” Dr. Rasmussen says. “I wanted to stay in my home province and help to modernize our burn care.”

Since July, Dr. Rasmussen has been involved in the care of all burn patients at the QEII. While the health centre typically sees as many as 15 major burn cases a year (patients who have more

than 20 per cent of their skin burned), he also sees between three and five new minor to moderate burn patients a week in his outpatient clinic. When he’s not busy treating burns, Dr. Rasmussen is taking a leadership role in delivering wound care at the health centre. Dr. Ward Patrick, senior medical director of the province’s critical care program, is certain his colleague’s arrival at the QEII will have a positive impact on patient care. Having worked in critical care in Halifax for the past 25 years, Dr. Patrick recognizes the need to remain current with burn care practices. “We’ve been lucky that Dr. Rasmussen has joined us,” says Dr. Patrick. “He is making a difference for patients at a critical time in their lives.”

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Throat cancer rates climbing The rise of HPV and its dangers for all sexes By Zack Metcalfe Human Papillomavirus, or HPV, has made alarming gains in the last several decades. Likely growing in prominence since the sexual revolution of the 1960s, it’s been on the radar of Canadian healthcare providers as a cause of cervical cancer in women. But as our understanding of this sexually transmitted infection catches up, we see that its consequences reach even further afield. “We’ve probably been dealing with HPV longer than we realize,” says Dr. Matthew Rigby, a head and neck oncology surgeon at the QEII Health Sciences Centre who spends much of his time removing cancers of the throat. For a very long time it’s been assumed that such cancers were exclusively the result of smoking and alcohol, and non-smokers who developed throat cancer anyway were dismissed as oddities. It’s now clear that, apart from cervical cancer, HPV also causes throat cancer in both sexes, and for reasons as yet unclear, men are particularly susceptible. “Since historically we’ve had high rates of smoking and drinking, and no testing for HPV, we’ve probably had this as an additional underlying factor in many of our head and neck cancer patients a long time without noticing.” By consulting banked tissues, researchers in the United States discovered that 16 per cent of tonsil cancers in the 1980s, for example, were HPV related and not the result of smoking, as was previously thought. Today it’s closer to 70-80 per cent. As rates of smoking decline across Canada

Dr. Matthew Rigby, head and neck oncology surgeon at the QEII, says research has shown that HPV is a common cause of throat cancer. While HPV-positive patients respond well to treatment, prevention is still the best option. QEII Foundation

and this virus becomes common, it’s expected that by 2030, half of all throat cancers will be a result of HPV. At the QEII, Dr. Rigby and his colleagues are applying these discoveries — combined with smaller studies of their own — to clinical practice to develop and communicate the best treatment plans for patients. “Patients who are HPV-positive are very responsive to treatment,” says Dr. Rigby. Generally affecting a younger population, and with a survival rate that can often be over 90 per cent, HPV-positive cancers allow for different treatment options. In many cases, this means

minimally-invasive trans-oral microsurgery, often followed by radiation treatment. Alternately patients can have radiation, which is often given with chemotherapy “We are trying to maximize the chance of cure and post-treatment quality of life, such as speech, breathing, swallowing and eating,” says Dr. Rigby. Dr. Rigby credits the QEII’s multidisciplinary team, including radiation oncologists, medical oncologists, and multiple other healthcare professionals working together to provide the best care possible for patients. But prevention is still the best option. In 2007, the HPV vaccine was

included in routine vaccinations for Nova Scotian girls in the seventh grade, an effort to quell rates of cervical cancer beyond 2030 (vaccines take time to affect population level change). Beginning in 2015, in response to the research, Nova Scotian boys were added to the HPV vaccine routine. Unfortunately, Dr. Rigby notes, this leaves nearly the entire adult population of Nova Scotia — particularly men — unvaccinated and vulnerable. As a sexually transmitted infection, HPV has some obvious risk factors which should be considered. Sexually active individuals in their 20s, 30s or 40s are encouraged to practise

safe sex, but ultimately vaccination is recommended, especially if they have multiple partners. Oral sex is also a factor. Those in older age groups without risk factors can probably skip the needle. Not all strains of HPV are harmful — there are hundreds of them — and not everyone who contracts it will develop cancer, but all the same, Dr. Rigby and his colleagues are bracing themselves for a significant rise in the rates of throat cancer across the Maritimes. This inevitable rise can only be softened by being proactive and perhaps a trip to your local pharmacy with a rolled up sleeve.

Life extended

The optimism of a battery-powered man inspires new web series By Jenna Conter It took Don Ingram’s family doctor no time to realize something was very wrong with his longtime patient. Don had just returned home from a trip to British Columbia where he had contracted pneumonia. Don was told to go directly to the emergency room. He was going into heart failure. Not five years prior, Don was fitted with an implantable cardioverter-defibrillator (ICD) as the left side of his heart was working inefficiently. However, it had been years since this incredibly active gentleman found himself benched from most of his activities. An avid hiker, swimmer and skier, Don was living the life until he was faced with the possibility of it ending abruptly. “The efficiency of the left side of my heart, which was the pump, was about 12 per cent so they said I had a choice to make,” Don remembers. “We can implant this device or you can start saying goodbye because you won’t be around much longer.” The device was a left ventricular assist device, more commonly known as an LVAD. This device is a mechanical pump that is implanted into a person’s chest that helps the heart to circulate blood throughout the body.

“It was a strange notion to have something implanted in me with a battery operated system and it was going to be the only thing keeping me going.” Where Don differs from most severe cardiac patients is that he rarely, through his own accounts, grew anxious at the prospect of his failing heart, the LVAD surgery or the possibility of dying. “For me it boils down to a faith issue,” Don admits. “I am a Christian and I believe that there is an afterlife so whether that was to be my last week on the earth or am I to carry on, I was basically ok with that.” Accepting of what this life or the next had to offer and with no expectation, Don went in for emergency surgery for his lifesaving LVAD. “I came out of the surgery and realized, well, ok, here I am, I’m still functional,” he remembers. Faith-based and spiritually inclined, Don took every day one step at a time. Willing himself to return to his once active lifestyle and let his latest life-saving accessory backpack be just that. It’s a rarity to have someone given such a grim diagnosis continue to look at life with such a positive spin. It is this positive attitude that inspired the idea for the web series, Life Extended. His story just had to be shared with the world. “A year-and-a-half ago, I met

Don Ingram lives with a battery-powered heart, meaning he relies on technology to keep him alive. He and his wife, Ethel are sharing their healthcare story through Life Extended, a web series by the QEII Foundation. QEII Foundation

this incredible patient and knew right away that he had a story to tell,” says Natalie Jarvis, a communications and marketing officer for the QEII Foundation. “The QEII Health Sciences Centre is an amazing place, changing and saving lives every day. We wanted to demonstrate the advanced health care that is happening in our community and that health care is often not a one-time transaction – it can impact a life over the long-term.” In fact, Don recalls the predicating factor that had led to him becoming involved in Life Extended. Having been well on his way through recovery and returning to his active lifestyle, VAD coordinator, Sonja Osmond, requested that he speak to a

fellow patient who was just beginning the process. “When I walked into the room I could see how anxious they were and people are inclined to imagine the worst,” Don remembers. The patient was a man in his late 40s. Surrounded by family, the idea of having a machine run his heart was undoubtedly terrifying. But Don was living proof that once given this device, patients are not confined to a life in a bed or made to rely on a wheelchair. It was this calming presence and soon to be developed friendship that Don created amongst other LVAD patients that helped to foster the need to share his story. On top of the personal

connections Don made with fellow patients, he continued to lend his experience to educate medical practitioners outside the cardiology department. “There aren’t that many LVAD patients around — about 20 today in Atlantic Canada — so when we show up in the emergency room, the pressure is on the medical practitioner to know what to do and what not to do,” he said. “If they did chest compressions that would be the end of us.” Taking common vitals on an LVAD patient, Don explains, is also complicated. For instance, LVAD patients do not have a pulse. An oddity, as episode seven addresses, that he is still getting used to. In short episodes, Don candidly shares his story. Drawing on his own experience, handling every moment with faith and positivity, his hope is to further lessen the anxiety around the topic of LVADs and eliminate any trepidation or worry to its efficacy in patients just starting on their journey. “I would hope that these patients would look at this series and understand that they can survive such a revision in their life,” Don says. “You wake up from the surgery and you continue to wake up every day after that and ask what is possible for that day and just go from there.”

YO U R Q E I I - W I N T E R 2 019

Cannabis and the developing brain QEII study examines the risks for cannabis use

“The use of cannabis in adolescence increases the risk of developing psychosis or schizophrenia.” Dr. Phil Tibbo

By Jon Tattrie A ground-breaking study underway at the QEII Health Sciences Centre will scan brains to see what effect cannabis has on the white matter — the tissue in the brain composed of nerve fibres - of young patients dealing with psychotic disorders. Dr. Phil Tibbo, QEII psychiatrist and the Dr. Paul Janssen Chair in Psychotic Disorders, wants to understand how cannabis — and THC in particular — affect neural connections in developing brains. Dr. Tibbo and his team, including Drs. Sherry Stewart, Candice Crocker, James Rioux and Jacob Cookey, think it may weaken the connections for younger and regular users of cannabis. “The use of cannabis in adolescence increases the risk of developing psychosis or schizophrenia,” he says. “The younger that you use, the higher that risk. The more that you use during adolescent years, the higher the risk.” The three-year study, funded by the Canadian Institutes of Health Research and Research Nova Scotia Trust, recently got underway and will compare people aged 18-30 in four groups of 90 people. One group will be people with early-phase psychosis who use cannabis, and one group will be those with early-phase psychosis who do not use cannabis. The other two groups will be people without those disorders — one group that uses cannabis and one that doesn’t. While Halifax is the primary site for this study, some of the participants will be recruited from London, Ontario with the help of co-investigators Drs. Lena Palaniyappan and Ali Khan. Dr. Sherry Stewart is a professor of psychiatry, psychology and neuroscience at Dalhousie University. She’s also a Canada Research Chair in addictions and mental health. She’ll help Dr. Tibbo’s team gauge usage levels. “I bring to the study some expertise in addictive behaviours and disorders,” she says. “I’m very interested in the co-occurrence of mental health and addictive disorders.” She’ll use a “timeline follow-back procedure” to help determine how much cannabis a participant uses. Dr. Stewart uses memory anchors to help people be more accurate in their estimates. A calendar helps participants link their use levels relative to any

QEII psychiatrist Dr. Phil Tibbo (centre) and his research team, including Dr. Sherry Stewart (left) and Dr. Candice Crocker (right), are working to understand how cannabis — and THC in particular — affect neural connections in developing brains. QEII Foundation

His research partner, Dr. Candice Crocker, says the prevailing theory for the causes of psychosis is that “the brain isn’t wired right.” “The connections aren’t made properly,” adds Dr. Crocker. “We have evidence that cannabis — particularly the THC in cannabis — acts on the connections themselves and makes the white matter thinner.” She compares white matter to the plastic coating on electrical wires; eroding the coating slows the system. She thinks that’s what happens when people who have psychosis use cannabis. To prove it, they need large, detailed studies like this one.

special events that help them remember their cannabis usage occasions more vividly. Participants in Dr. Tibbo’s study undergo clinical and cognitive testing and spend about an hour in an MRI machine. Dr. Tibbo says there is extensive literature about the connection between psychotic disorders and cannabis use, but little looking directly at its impact on brain white matter. “There’s a lot of really good things that can come out of this research. One is it may help us figure out how cannabis can affect white matter within the brain, leading us to further examine novel treatment options,” he says.

The MRI images will show the white matter at the start of the study and again at the end of the study. It might not show clear differences on an individual level, but it will give them a collective picture if the white matter is indeed affected. Research has also shown that the higher the THC level, the greater the impact. Dr. Tibbo says the recent legalization of cannabis will help the study, as cannabis sold in Nova Scotia tells you the THC level — something few users would have known when buying it illegally. The team is focusing on younger people because of the way brains develop. Humans have

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what’s called an endocannabinoid system and cannabinoid receptors in the brain. They help the brain develop and are very active from gestation to after adolescence and young adulthood. When you are 25 or older, that changes — the receptors decline and move more to grey matter, a major component of the central nervous system. “That’s why THC during those adolescent years will have a different effect than THC on the brain in someone who’s 30 or 40,” Dr. Tibbo says. If the results confirm their hypothesis, it could improve treatment for young people with psychotic disorders. For example, they could get help quitting cannabis early on so as to not make things worse for their psychosis. They could also use medications that help repair white matter and thus make their brain healthier.

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QEII gastroenterologists, Dr. Jennifer Jones (left) and Dr. Stacey Williams (right), recently received a QEII Foundation TRIC grant to help launch their pilot study, The Virtual Gastrointestinal Primary Health Medical Neighbourhood, aimed at strengthening gastrointestinal care for Nova Scotians. QEII Foundation

Virtual medical neighbourhoods QEII’s gastroenterology team working to improve care and decrease wait times By Cynthia McMurray It is often a daily challenge for the 20 million Canadians living with gastrointestinal (GI) conditions. Unfortunately, help can take years depending on the type and severity of their condition. But at the QEII Health Sciences Centre, two gastroenterologists recognize the challenges that Nova Scotians with GI conditions face and are determined to change the status quo when it comes to referrals, wait times and access to treatment options. Dr. Jennifer Jones recently received a QEII Foundation Translating Research Into Care (TRIC) grant to help launch their pilot study, The Virtual Gastrointestinal Primary Health Medical Neighbourhood. The Virtual Medical Neighbourhood (VMN) is a model for providing integrated healthcare delivery between primary healthcare providers and specialists through an online tool, allowing them to collaborate and implement evidence-based, best practices in more remote locations. Dr. Jones says the model is perfect for Nova Scotians. “One in 83 Nova Scotians have Inflammatory Bowel Disease (IBD) compared to one in 160 in the rest of Canada,” says Dr. Jones. The idea for the QEII’s study builds on a concept that initiated in the United States that has since provided useful data for how this program can successfully support access to care for patients. “In an area like Nova Scotia, where there is geographic variation in access to care and resources, the question is: ‘How are we able to integrate how we care for patients more, so we are changing the traditional referral routes and providing the right care for the right patient in the right place and at the right time?’” Currently, most referrals for GI conditions come from primary care physicians within Nova Scotia Health Authority’s Central Zone, explains Dr. Williams. She adds they do receive referrals for complex disease from across the province. “Over the last five years, we have seen the wait times for patients increase. We are doing our best to streamline the triage process so we make sure the referrals we are seeing are those who will benefit most,” says Dr. Williams.

As the provincial site for advanced endoscopy and the multi-disciplinary IBD team, she says there are certain patient populations that can only be cared for at the QEII, which means they not only see these patients, but also all of the referrals from primary care physicians. “It is estimated that as much as 20 per cent of primary care physicians’ practice may be comprised of GI conditions,” says Dr. Jones. The current referral model involves generating a paper-based referral to initiate the process, then waiting to receive a set of paper-based recommendations, which she says is not working for GI patients. With the support of NSHA’s Information Management & Technology team, the pilot will look at the feasibility of rolling out a VMN in which a gastroenterologist can directly connect with primary care physicians, nurse practitioners and other allied health professionals in real time, using special software, to implement more efficient diagnostic and management approaches. Dr. Jones says they chose the Westville Medical Clinic in New Glasgow as the trial clinic based on its documented need as an underserviced area for GI specialty services. Dr. Aaron Smith will head the trial clinic, which has four primary care physicians, two nurse practitioners and a clinic nurse. With more than 7,000 patients, it is expected to provide valuable data the team hopes will address some of the concerns and barriers physicians and patients face. “Involvement in this project is exciting for us at the Westville clinic, says Dr. Smith. “As a primarily rural clinic, our clinicians are often challenged to ensure that our patients’ medical needs are addressed effectively.” “GI issues are one of the main reasons we see a significant number of our patients,” he continues. “Our geographical area has had challenges in meeting our patients’ clinical needs in this regard.” Innovation in health service delivery and effective use of technological support, such as VMNs, are key factors in improving the health outcomes of Nova Scotians. Through the VMN, physicians can also access clinical-care algorithms for common, routine

GI conditions. “For example, if you had a patient with GI tract symptoms, there would be a standardized approach to diagnosing and treating them. By following the plan, the physician would be confident about the diagnosis and whether the patient should be coming to the QEII for treatment or if they can be treated locally,” says Dr. Jones, who adds

that a study in Calgary that returned routine GI referrals to primary care physicians with a set of comprehensive clinical care instructions reduced referral times for routine GI conditions by more than 80 per cent. Dr. Jones is hopeful the pilot will result in reduced wait times, decreased delays in diagnosis, improved access to therapy, and

ultimately, improved outcomes for various GI conditions, along with a reduced overall cost to the system. And if all goes well, Dr. Jones and her colleagues are confident this type of evidence-informed system transformation could eventually be customized and adopted by other chronic disease clinics.

YO U R Q E I I - W I N T E R 2 019

Virus research aims to prevent or reverse immune-system aging By Melanie Jollymore Infectious diseases specialist Dr. Lisa Barrett is studying the blood of patients with chronic viral infections to learn how the immune system becomes worn down. “It takes decades for the immune system to deteriorate in a healthy person—we need a model of accelerated aging,” explains Dr. Barrett, who divides her time between a busy infectious diseases clinic at the QEII Health Sciences Centre and her lab at Dalhousie Medical School. “Chronic viral infections, like HIV and hepatitis C, provide us with that model. They put so much wear and tear on the immune system, it ages prematurely.” Dr. Barrett and research scientist, Dr. Sharon Oldford, have found that the immune cells of patients with HIV and hepatitis C look and act a lot like those of much older people who are virus free. In particular, the killer T-cells of both groups of people are covered with molecules that inhibit immune response. As a result, vaccines aren’t able to stimulate adequate immunity and they fall prey to infections. The researchers want to find a way around this problem. Among many projects, they’re exploring immune exhaustion and poor vaccine response in HIV infection, with support from the NSHA Research Fund. “We’re assessing many types of immune cells in HIV-positive patients, assigning an immune

Tragedy Continued from Page 9 highly-charged subject for the family. For Dr. Green, organ donation has become an important focus. Since the QEII is the only hospital in Atlantic Canada that can perform these vital organ transplants, Dr. Green is focused on finding ways to not only help every trauma patient, but also those in need of a life-saving organ donation. He says the two are intrinsically intertwined, which is why he continues to research what is needed to improve organ donation and trauma medicine. “In Nova Scotia, 40 per cent of patients with trauma who died in hospital were potential organ donors, yet only 39 per cent of these patients were referred for donation,” Dr. Green explains. In 2018, he published a report in the Canadian Medical Association Journal (CMAJ) that examined the number of traumas in Nova Scotia, the types of traumatic injuries, the number of critically-injured people that were referred for organ donation and the number that ultimately went on to donate. Dr. Green and his colleagues were able to confirm what they already anticipated: more work is required to improve organ donation within the trauma population. The team is working with the Nova Scotia Legacy of Life program — the province’s organ and tissue donation program — to improve the organ donation system by developing a more focused plan with the transplantation team, establishing regionally based donation physicians and implementing a data management system so missed opportunities can be recognized and information fed back to healthcare teams on the front line in a timely fashion. Dr. Green’s first-of-its-kind study was critical for many reasons, but especially because there haven’t

QEII infectious diseases specialist, Dr. Lisa Barrett (left), and research scientist, Dr. Sharon Olford, are studying the blood of patients with chronic viral infections to learn how the immune system becomes worn down. NSHA Research Services

profile and ‘immune age’ to each individual, and tracking them over time,” says Dr. Barrett. “One of our goals is to learn which aspects of immune aging are associated with robust or weak responses to vaccines, so we can find a way to improve vaccine response.”

“There is not enough awareness about organ donations. It is a hard and uncomfortable discussion to have, but it is one we all need to have.” Dr. Robert Green been any similar studies in Canada to date. For those waiting for a transplant, this research is vital. At any given time in Atlantic Canada, there can be more than 300 people waiting for an organ transplant, according to the Multi-Organ Transplant Program (MOTP) Atlantic Canada at the QEII, which serves Nova Scotia, New Brunswick, Prince Edward Island and Newfoundland. In 2017, only 96 received a transplant. Dr. Green says part of the issue simply comes down to education. “There is not enough awareness about organ donations. It is a hard and uncomfortable discussion to have, but it is one we all need to have,” he says. Dr. Green says one of the biggest reasons why a particular donor is not accepted is because the family has refused — even in cases where the recipient themselves has already agreed to donate. Apart from physicians doing more to refer potential donors, Dr. Green says the bottom line is that the public needs to understand “just one organ donor can save eight lives.” According to the Legacy of Life, a single tissue donor can save or improve the lives 50-80 people. “Don’t ever exclude yourself as a potential donor,” Dr. Green says. “Even people with underlying conditions or those that are older may be able to donate in some capacity.”

The same mechanism could be harnessed to improve vaccine effectiveness in older patients. “Infections are a leading cause of hospitalization and death in older people,” notes Dr. Barrett. “If we can make vaccines work better for them, it would save

years of good-quality life and health system resources.” The researchers even aim to reverse immune-system aging. “We see that immune-aging is largely reversed when patients with chronic viral infections are treated with potent new

antivirals,” Dr. Barrett explains. “By tracing how this immune-age-reversal process unfolds in patients with chronic infections, we hope to learn how we can produce the same effect in the general population as people age.”

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