QEII Times – Summer 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 S TA 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 Shining a spotlight on thyroid cancer

Porters with purpose

Uncommon conditions: Cushing’s disease

RESEARCH & INNOVATION Accessing MRI when it matters most

QEII perfusionists Steve Morrison (left) and Roger Stanzel (right) demonstrate the use of the heart-lung machine in one of the QEII’s cardiac catheterization labs. During surgery, the QEII’s perfusion team takes over the heart and lung function of the patient, ultimately keeping them alive throughout the procedure. QEII Foundation

Retrain the brain

Guardians of the operating room The ultimate team sport: perfusion and cardiac surgery By Colleen Cosgrove

Transforming palliative care 14

ALSO Photo essay Residents at the QEII Pages 4 & 5

Banking blood QEII hematopathologists create world-leading blood bank algorithm Page 9

Exercise and cancer Research shows exercise improves overall well-being and quality of life for cancer survivors Page 10

Up to five times a day, a staff perfusionist like Roger Stanzel stands behind a control panel, busy with dials and digits, pumps and cords. Every second is occupied as he systematically glances at every monitor and every variable in the operating room, looking for signs of trouble. When the stakes are as high as they are during cardiac surgery, even the slightest non-verbal communication is intensely monitored. “You’re reading what the surgeon is doing and you’re in team mode,” says Roger. “I can tell based on the way the surgeon is standing or how they move what they’re going to need. Part of my job is trying to anticipate and get ahead of things.” Roger isn’t just tracking respiratory data or monitoring heart activity for the surgeon. Roger is a clinical cardiovascular perfusionist and he’s in full control of patient physiology during heart surgery. “For any sort of cardiac operation, perfusionists provide life support services,” Roger says. Perfusionists take over the heart and lung functions of the patient and ultimately keep them alive throughout surgery. They operate cardiopulmonary bypass, also known as a heart-lung machine, which maintains the circulation of blood and oxygen through the body. A still heart is required for a multitude of cardiac surgeries including

bypass grafts, replacing or repairing valves, fixing holes and heart transplants. “A perfusionist has more of a 30,000-foot view of things, so our role is to help guide the surgeon,” Roger explains. “Once the heart-lung machine is up and running, we’re checking levels and making sure everything is operating as it should. It’s very hands-on and very detailed.” At the QEII Health Sciences Centre alone, five cardiac surgeries are performed each day, both emergencies and planned operations. Each surgery requires a perfusionist. A unique profession, there are only about 300 perfusionists across Canada with 14 employed at the QEII, two of which are on call at all times. As the largest tertiary care centre in Atlantic Canada, the QEII is the only hospital performing heart transplants and insertions of long-term mechanical heart support (ventricular assist devices). Dr. Edgar Chedrawy, the head of cardiac surgery at the QEII, says the collaborative dynamic in the operating room is the “ultimate team sport.” “I don’t think there’s any other surgical specialty that really counts on the team as much as we do and I’m a firm believer it’s not just everyone doing their job. The team is more than the sum of the parts and this team makes it happen for us,” Dr. Chedrawy says. “There’s a lot of mutual respect and admiration for what they do.” Adam Gillis, the QEII’s manager for anesthesia and perfusion services, says

“For any sort of cardiac operation, perfusionists provide life support services.” Roger Stanzel

perfusion is not widely understood or discussed as much as traditional surgical, nursing and anesthesia roles. “The heart-lung machine is a very intense and intimidating machine,” Adam says. “It takes a wealth of knowledge and competency to do this profession. These men and women are in complete control of the heart and the lungs during these operations and they have to react quickly to emergency situations. They work closely with surgery, anesthesia and nursing, making them an integral part of the care team.” As Canadians live longer, medical teams at the QEII are adjusting to operating on and treating more elderly patients who are living with two or more chronic diseases or comorbidities. “We’re getting to the point where at age 70, we’re doing a very invasive surgery,” Roger says. “It’s a lot, but this patient population does do well.” The average age for a cardiac surgery requiring perfusion is around 74. “Compared to 20 years ago, patients on average are living longer but they tend to be sicker,” Dr. Chedrawy says. “There is more diabetes, more obesity and more renal failure and that makes the demands of our work even more challenging.” “The QEII’s perfusion team have really kept up with that demand and that complexity. And that’s a testament to how they’ve evolved, and keep evolving, as a profession.”

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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 Allison Lawlor Bill Bean Colleen Cosgrove Cynthia McMurray David Pretty Jenna Conter Jon Tattrie Nicole Topple Photographer QEII Foundation

© 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

A word from the QEII Foundation By Bill Bean President & CEO, QEII Foundation The QEII Foundation cares deeply about advancing health care. But we can’t do it alone. We all have a role to play in health care and we are grateful for donors — both individuals and organizations — who directly support change and provide solutions to some of health care’s biggest challenges. Take wait times as an example. By working closely with our partners at the QEII Health Sciences Centre, the QEII Foundation has been able to affect major impact in several key areas for timely diagnoses or life-changing treatment. As a result of QEII Foundation funding, the QEII’s new Epilepsy Monitoring Unit (EMU) opened, giving more Atlantic Canadians a chance at a new life, seizure free. The EMU is a specialized inpatient unit designed to evaluate, diagnose and treat seizures — identifying the source

of the seizures and determining if a patient can have surgery. Our $2.5-million Neuroscience Alliance campaign provided the EMU with two new inpatient beds. The QEII’s epilepsy team is now able to diagnose and treat more patients each year — an increase to 75 patients per year from 40-45 patients per year. The QEII’s new Joseph Shannon Family Cardiac Catheterization Suite sees about 5,800 patients per year. The original suite — one of four catheterization suites at the QEII — closed in 2016 when its aging equipment became unserviceable. The QEII Foundation’s $4.5-million From the Heart campaign re-opened this suite, making sure wait times did not increase and ensured the QEII’s heart health teams can deliver the best care during procedures like angiograms, angioplasties and pacemaker implantations, for patients from across the Maritimes. Thanks to donors to the original Cancer Never Waits

“As a result of QEII Foundation funding, the QEII’s new Epilepsy Monitoring Unit (EMU) opened, giving more Atlantic Canadians a chance at a new life, seizure free.”

campaign, which raised more than $4 million, the QEII Foundation celebrated the opening of The James and Edna Claydon Radiation Treatment Clinic. Aimed at reducing wait times and improving treatment options, the more than $20-million expansion

to the cancer centre — jointly funded by government and the QEII Foundation — transformed the care journey for patients receiving radiation therapy at the QEII. This transformation included establishing one of North America’s best and most innovative radiation treatment clinics and funding three new linear accelerators, reducing treatment times for patients and radiation wait times, overall. These linear accelerators provide unparalleled image guidance to target a patient’s tumour with the utmost precision and accuracy, avoiding harm to the surrounding healthy tissues. Philanthropy has a direct correlation to reducing wait times, improving accessibility and impacting care for Atlantic Canadians. When you give, patients are getting the care they need and deserve. For more information about the QEII Foundation, call 902 334 1546 or drop us a line at info@qe2foundation.ca.

Shining a spotlight on thyroid cancer Blue Butterfly Evening raises funds for vital research and thyroid cancer care By Cynthia McMurray According to the Canadian Cancer Society, cases of thyroid cancer are on the rise. In fact, the incidences of this cancer have been steadily growing, says Dr. Mal Rajaraman, radiation

oncologist at the QEII’s Interdisciplinary Thyroid Oncology Clinic (ITOC). “There are about 900 cases a year of lung cancer in Nova Scotia compared to about 125 cases of thyroid cancer. It’s a smaller number but the rate of increase is rising more rapidly than any other cancer and it happens in relatively younger people,” he says. “Most cases are in people between 20 and 55, but it is the number one cancer in those 15 to 29.” The thyroid is a small butterfly-shaped gland in your neck, measuring about four to six centimetres in diameter. While it may be small, the thyroid has a huge impact on your entire body.

It produces thyroid hormone, which regulates metabolism, heartbeat, temperature, mood and a slew of other vital processes. So, when something goes awry, it can wreak havoc on your body. Carol Dodds, a teacher and chair of the annual Blue Butterfly Evening fundraiser, knows this all too well. Carol was diagnosed with thyroid cancer in 2007, which is how she met Dr. Rajaraman. Like many thyroid cancer patients, Carol is a survivor and 11 years ago she became determined to raise awareness. Carol, along with a small committee of volunteers and in collaboration with the QEII

Foundation, has been hosting the Blue Butterfly Evening since 2009. This year’s event raised more than $31,000 net and counting, to support the development of the largest thyroid cancer database in the Maritimes, established 15 years ago. “We are not just leaders in Atlantic Canada, we are leaders in Canada,” says Dr. Rajaraman, who is also the co-chair for the Canadian Network for Cancer of the Thyroid (CANNECT) — a collaborative network of researchers and clinicians

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Kevin Crain (left), Sam Baker (centre left), Nnamdi Umahi (centre right) and Mish Manette (right) are part of the team of porters at the QEII. Porter Services — about 72 staff working on any given day – transfer items such as medical specimens, patient charts and blood samples, and more importantly, patients, throughout the QEII. QEII Foundation

Porters with purpose QEII porters play an important role in patient care By Jon Tattrie Kevin Crain speeds into the porters’ break room in the basement of the QEII’s Camp Hill Veterans Memorial Building to take a breath for a few minutes. It’s a rare sight: a quick check of his phone’s pedometer shows he’s already hit the 10,000-step mark and he’s only three hours into his shift. He averages 22,000 steps a day, or about 16 kilometres, and that’s up and down stairs, speeding along halls and quickly walking between 10 buildings of the QEII Health Science Centre in Halifax. “I don’t go home at night and go for a jog,” he says with a smile. He and the roughly 100 other porters are the blood pumping through the QEII’s veins. About 72 will be working on any given day. They take blood samples to the lab for testing, deliver organs for transplants and transfer medical specimens. But perhaps the most important work they do is helping patients get from one spot to the next, either walking alongside them for stability and guidance, or pushing their bed to the right place. Small talk makes a big difference. “We’re not moving boxes – we have people,” Kevin says. “You might have the same conversation 30 times a day, but that person might have only had that conversation once. People going to the operating room are nervous. You make small talk with them. I don’t know how many times I’ve had people say, ‘Oh! Are we here already?’ They don’t

have time to be nervous.” Kevin started when he was 24 and didn’t know what he wanted to do next in life. “I just came here and stayed,” he said. “I found my niche. I’m a people person and in this job, I make 30 new friends every day.” He spent this morning picking up patient charts and carrying them to health records. He then helped patients get to the operating room. It’s a tough job, as some people are “sick of being sick,” or just received devastating news from their doctor. “Obviously everything isn’t

peachy keen, because if it was, they wouldn’t be here,” Kevin says. “You just try and make their stay as good as it can be.” Tanya Godley, an assistant manager for Porter Services, says the porters use smartphones as a modern pager. A call comes in and a dispatcher sends a porter. “It could be a chart or specimen delivery, a call to the lab or pharmacy, or transferring patients to a clinic,” she says. Brant Johnson supervises Porter Services and has done the job himself for more than two decades. He knows that many

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patients are stuck staring at the ceiling most of the day. “Just that five-minute interaction of making sure that person knows you care about their well-being while they’re in here; to me that’s one of the most important parts of this job,” he says. “At some point in time, we’re either all going to be in here, or we will have loved ones in here.” Brant says working with very sick people takes its toll on the porters. And some patients don’t leave, but die in the hospital. The porters accompany them on their last journey, too.

The porters work – and walk – through sunshine, through rain storms and through blizzards. They develop a mental map of the quickest route between any two hospital sites. If you’re lost in the QEII, ask a porter for directions. Kevin says the best day is almost always the same one: discharge day. Walking with patients as they take those last steps back into their regular life brings joy to them – and to the porters. “Everybody’s glad to go. Nobody wants to see us again,” he laughs.

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At age 25, Amy Stracey was diagnosed with Cushing’s disease, a very serious but hard to diagnose disease. Following treatment and surgery from the QEII’s endocrinology care team, Amy returned to school and is now a registered nurse. QEII Foundation

Uncommon conditions QEII’s collaborative response to treating Cushing’s disease By Allison Lawlor Amy Stracey was a fit young woman in the Canadian Forces when a rare disease turned her life upside down. Thanks to her strong determination to recover, coupled with the expertise of her medical team at the QEII Health Sciences Centre, she not only made a full recovery, but also returned to school motivated to help others living with health conditions. Having successfully completed basic training and posted to CFB Shearwater, Amy started noticing she was losing significant muscle tone and gaining weight. “I thought I should be getting stronger, but I was getting weaker,” she says. Her muscles ached, she had swelling in her body and her face became moon-shaped. She went to see her doctor and he recommended a weight loss program. She persisted, knowing something wasn’t right in her body. She was eventually referred to Dr. Ali Imran, an endocrinologist at the QEII’s Halifax Neuropituitary Clinic. In 2010, at age 25, she was diagnosed with Cushing’s disease. She was 240 pounds, more than 100 pounds above her normal weight. Until now, she had always been healthy and fit. “Cushing’s is a very serious disease,” says Dr. Imran. “But in the early stages, it is hard to diagnose.” It is not a common disease. In Nova Scotia, QEII specialists see between three and five new cases each year. In people with Cushing’s disease, a non-cancerous tumour in the pituitary gland produces too much ACTH, a hormone that causes the adrenal glands to make cortisol. Cortisol is often called the body’s stress hormone. The disease can go undiagnosed for years and if left untreated, can lead to other health conditions such as bone fractures, diabetes, high blood pressure and even death. “There are people walking around with this condition who don’t even know they have it,” says Lisa Tramble, a registered nurse in the QEII’s Halifax Neuropituitary Clinic. Five days after Amy was diagnosed, she went in for surgery. Dr. David Clarke, the QEII’s chief of neurosurgery, and Dr. Emad Massoud, an otolaryngologist at the QEII, performed the surgery endoscopically with an illuminated optical, tubular instrument

used to look into the body. Accessing the tumour through the nose, no incisions were needed. During the surgery, a hole was drilled into the base of the skull to gain access to the pituitary gland. Using a small scalpel, Dr. Clarke removed the small tumour. Given the nature of Cushing’s, tumours can be as small as two millimetres in diameter and hard to detect. The surgery was a success. Two months later, Amy ran a five-kilometre race in the Scotiabank Blue Nose Marathon wearing a t-shirt with a photo of herself and the words, “Running for Cushing’s.” Amy was medically released from the military. She lost the weight she had gained and returned to school with the dream of becoming a nurse. “I knew I wanted a career where I could give back,” she says. Last year, Amy graduated from Dalhousie University and is now a registered nurse at the QEII’s hemodialysis unit. Grateful for the care she received from the endocrinology clinic, she thinks she might like to work there one day. “I know I would have to learn a lot,” she says. Close to 20 years ago, Drs. Imran and Clarke started working closely together, knowing that by combining their expertise they could better serve patients. “We wanted to provide them with one-stop care,” says Dr. Imran. Dr. Clarke agrees. Instead of having multiple appointments on various days to different specialists, patients, like Amy, have their diagnosis and medical care coordinated and streamlined to reduce the number of visits and tests required. As many as 1,800 pituitary patients are followed, providing the doctors with a valuable resource for their research and ability to continually improve the care they provide. “Our clinic really has become a model for other clinics across the country,” says Dr. Clarke, who co-chairs the Halifax Neuropituitary Program with Dr. Imran. “We have been a leading centre in pituitary disease in the country over the last decade.” Thankful for her recovery from Cushing’s disease, Amy is equally thankful for the care she continues to receive from the team at the QEII. “I feel like I am my old self,” she says.

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Spotlight on thyroid cancer Continued from Page 2 committed to improving patient care, research and advocacy of thyroid cancer across the country. Currently, CANNECT has 12 centres in eight provinces and they collect data on patients from across the country including 1,400 patients in Atlantic Canada, 3,000 in Winnipeg and another 3,000 in London, Ont., to create one large database that has become an invaluable resource. The Blue Butterfly Evening and Carol are a big part of that. “The event would not exist if it weren’t for Carol,” Dr. Rajaraman explains. Because thyroid cancer is not a high-profile cancer, and it is very survivable in most cases, it tends to be left behind when it comes to awareness and funding. Dr. Rajaraman says this is why the yearly event is so crucial. All of those funds stay within the community and go directly to helping Atlantic Canadians. Donations and sponsorship for the event are on the rise and include contributions from community members, local businesses, large corporations and Saint Mary’s University, who has donated the venue space since the event began. The Blue Butterfly Evening is much more than a fundraiser. It is one of the most unique wine tasting events in Atlantic Canada, according to Carol. And Dr. Rajaraman says the event and the ITOC team have become a family. “It is really an acknowledgement for the healthcare team and patients, all of whom rarely get acknowledged for the vital work they do to bring awareness to the issue and

Dr. Mal Rajaraman (left), QEII radiation oncologist, and Dr. Ali Imran (right), QEII endocrinologist, are part of the QEII’s Interdisciplinary Thyroid Oncology Clinic (ITOC). The ITOC partnered with Carol Dodds (centre), thyroid cancer survivor, to raise awareness and funds for vital research and thyroid cancer care at the QEII through the Blue Butterfly Evening event. QEII Foundation

improve care and treatment,” he adds. The ITOC, which has quickly become a recognized centre for excellence in thyroid cancer care and treatment, includes Dr. Rajaraman; Dr. Ali Imran, an endocrinologist; Dr. Steve Burrell,

a nuclear medicine physician and Dr. Jonathan Trites, a surgeon — each of whom are thyroid cancer clinical leads in their departments at the QEII. The ITOC also includes dedicated nurses, pathologists and other clinicians that create a

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one-of-a-kind clinic where patients can see all of the key team members in one visit instead of having to travel numerous times for appointments over what can be many months. Since it began, the Blue Butterfly Evening event has

helped raise $383,257 net. Apart from the database, plans for the funds include improving the reliability of ultrasound reports for thyroid nodule evaluation, as well as several smaller projects designed to advance thyroid cancer treatment and care.

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Banking blood QEII hematopathologists create world-leading blood bank algorithm By Allison Lawlor Dr. Calvino Cheng and Dr. Jason Quinn have developed an innovative method to dramatically reduce red blood cell product waste at the QEII Health Sciences Centre. Without an adequate supply of the precious resource, patients couldn’t receive surgeries, chemotherapy or blood transfusions. The QEII hematopathologists found a way to optimize blood ordering for the red blood cell inventory by using data from inpatients at the health centre in a more innovative way. “We wanted to find a way to help save blood,” says Dr. Cheng, the outgoing medical director of the blood transfusion services at the Nova Scotia Health Authority’s Central Zone in Halifax and medical director of the Pathology Informatics Group. After noticing that the blood bank was still expiring around two per cent of its red blood cell products, Dr. Cheng and his collaborators developed an algorithm that looks at hemoglobin levels of all admitted patients. It then determines the probability for transfusions in the centre within the next 48 hours, calculates what blood was historically used and then projects what will be needed. All of this

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Dr. Jason Quinn (left) and Dr. Calvino Cheng (right), QEII hematopathologists, have developed a way to optimize blood used for transfusions by using data from inpatients at the QEII in a more efficient way. QEII Foundation

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Exercise and cancer: a winning combination Research shows exercise improves overall well-being and quality of life for cancer survivors By Cynthia McMurray Decades of research show “taking it easy” is not always the best prescription for healing. While there are obvious contraindications, a new research study is looking at how exercise impacts the overall well-being of cancer patients and survivors. Activating Cancer Communities through an Exercise Strategy for Survivors (ACCESS) is a free exercise program designed to lessen the impact of a cancer diagnosis and its treatments on the health and well-being of individuals confronted with the disease. Launched in September 2018, ACCESS is already having a huge impact, according to Dr. Melanie Keats, a professor with the School of Health and Human Performance at Dalhousie University, affiliate scientist in the Department of Medical Oncology, and a three-time cancer survivor. As one of the principal investigators for ACCESS, Dr. Keats works closely with co-investigator, Dr. Scott Grandy, an associate professor at Dalhousie and affiliate scientist in the Department of Cardiology at the QEII Health Sciences Centre. Together they hope to not only support the current research that irrefutably shows regular exercise is a vital, yet often neglected, piece of the cancer treatment and care journey, but also how it can be feasibly implemented into real-world situations. “ACCESS will help us translate the exercise evidence into care to ensure exercise becomes part of the standard treatment for all cancer patients and survivors,” says Dr. Grandy. One of those patients is

“I may have no control over this cancer — it just does what it wants — but I can help fight it the stronger I am and exercise does that.” Andrea Davidson Andrea Davidson, a Halifax native originally diagnosed with colon cancer in July 2015. Referred by her oncologist, Andrea joined ACCESS in late October 2018. “In December 2017, I fell in the bathtub and broke my arm. That arm healed, but my other arm took up all the phantom pain,” she explains. Andrea also broke her pelvis. “I was in a lot of pain, but exercise got rid of it,” she says. Andrea’s results are not surprising according to both Dr. Keats and Dr. Grandy, which is why they are so passionate about ACCESS. The ACCESS program received funding from the QEII Foundation through Dragon’s Den, part of the Nova Scotia Health Authority Central Zone’s Perioperative Education Day. When the Dragon’s Den opportunity presented itself, they rose to the challenge much like contestants in the TV show. “There was a short proposal sent in advance that included a financial impact statement showing how this would affect cost and patient care and they selected the top four who were invited to pitch to the Dragons,”

Living with colon cancer since 2015, Andrea Davidson joined the new ACCESS program at the QEII in October 2018. ACCESS will help researchers translate exercise evidence into care to ensure physical activity becomes part of the standard treatment and care for all cancer patients and survivors. QEII Foundation

says Dr. Grandy. Ultimately ACCESS won first place, receiving $50,000 over two years. Since launching ACCESS, Dr. Keats says they have had more than 160 referrals — 78 per cent from clinicians with the remainder being self-referrals. Participants attend one of three locations: the QEII’s Victoria General site, the Rath Eastlink Community Centre in Truro, or the Canada Games site in Clayton Park, where they typically attend 24 free sessions over 12 weeks, most coming twice per week. “This trial is different than a standard clinical trial where you say, ‘here is an exercise program. Does it improve fitness markers in this patient population?’ We are still looking at patient outcomes, such as quality of life and reduced fatigue, but with a typical research study, everyone would get the same exercise regimen,” explains Dr. Keats. “Here, every individual works on the same components of the exercise program — cardiovascular fitness, strength, balance, flexibility — but one person might be running on the treadmill, whereas another may be on the bike pedalling slowly or

going for a short walk.” “They are at very different levels that depend on what they are able to do on any given day,” she says. Dr. Keats says participants use the Green-Yellow-Red Light Program. “Green light — great day — let’s go for it. Yellow light? Not quite as good as a green-light day, so we bring it back a bit. Red light doesn’t mean stop, it just means let’s move and do something but at a very low level,” she says. Andrea comes to the QEII at least once per week where she is guided through her personal fitness program that includes the treadmill, exercise bike, free weights, exercise tubing and core strength-building exercises. “I already have more energy. I don’t have hip or arm pain anymore and I can really tell if I haven’t been here. I get wobbly.” Andrea says. “It has given me a real sense of balance again — it makes me feel younger.” “We have 30 years of evidence that says exercise is safe, feasible and we should be doing it. Yet very few places offer exercise programs for cancer survivors,” Dr. Grandy explains. “We need to

make the leap between what we know and what we are doing, and this trial makes that leap.” Participants range from people who believe in exercise, to those that think it is a waste of time but their doctor told them to try it. Dr. Grandy says that no matter where you may fall on that spectrum, the bottom line is that doing anything is better than nothing. “The number of cancer diagnoses in the next 15 years is going to increase by 78 per cent, so the impact on the healthcare system will be astronomical,” says Dr. Keats. “If we can help patients better cope with their treatment, prevent or manage other health conditions, and reduce their time in the hospital, maybe we can help mitigate some of that burden for everyone.” “Exercise really is tremendous. I may have no control over this cancer — it just does what it wants — but I can help fight it the stronger I am and exercise does that,” says Andrea. For more information about ACCESS, look for them on Facebook, Instagram or Twitter @ACCESSforWellness, contact 902 473 2035 or access.wellness@nshealth.ca.

Accessing MRI when it matters most By David Pretty In March 2019, the QEII Health Sciences Centre received delivery of the Evry* MRI machine, a unique instrument designed to provide point-of-care diagnostic information for patients in the emergency department. Funding for this project includes $700,000 from Atlantic Canada Opportunities Agency, $1.26 million from the Research Nova Scotia Trust and $1.4 million of in-kind contributions from Synaptive Medical, Evry’s manufacturer. Currently, due to safety and design restrictions, MRIs are often housed far away from emergency departments. But according to Dr. Steven Beyea, scientific director for the Biomedical Translational Imaging Centre (BIOTIC) at the QEII, these same limitations are precisely what inspired Synaptive Medical to design the Evry device. “They’ve attempted to re-engineer what an MRI looks like,” he says. “For example, they’ve gotten rid of the requirement for thousands of litres of liquefied helium, a limitation requiring expensive and specialized building ventilation, improving the ability for the machine to sit within the point of care.” This collaborative research partnership with Synaptive Medical will allow Dr. Beyea’s

“Synaptive Medical is seeking a collaborative partnership with our healthcare system, and in doing so they’re investing in Nova Scotia.” Dr. Steven Beyea

A collaborative research partnership with Synaptive Medical, including Michelle MacPherson (left), director of MRI Product Development, Synaptive Medical, and Alex Panther (right), director of MRI Research & Development, Synaptive Medical, will allow Dr. Steven Beyea (centre) and his team at BIOTIC to be the first in the world to evaluate the potential impact this new technology could have on emergency medicine patients at the QEII, and beyond. Contributed

team to be the first in the world to evaluate the potential impact this new technology could have on emergency medicine patients at the QEII, and beyond. “This partnership is about being the first to access this technology,” he says. “Synaptive Medical is seeking a collaborative partnership with our healthcare system, and in doing so they’re investing in Nova Scotia.” While giving local healthcare professionals an opportunity to work hands-on with leading-edge technology, as well as the economic development opportunities, Dr. Beyea believes the province could see a broad spectrum of benefits. Evry is expected to be up and running by early fall. After the installation, BIOTIC will begin research to evaluate the value the instrument could have to physicians and patients at the

QEII’s Charles V. Keating Emergency and Trauma Centre, and to the healthcare system more broadly. “Given that this is a brand new form of MRI, the goal is to make evidence-informed decisions about whether this should or should not someday become a standard of care within the emergency medicine department,” Dr. Beyea says. This will involve working in close conjunction with Synaptive Medical. “We’ve worked with the company and various clinical partners to develop a four-year collaborative research program specifically aimed at evaluating whether, or if, this new technology provides value to the healthcare system in a variety of different ways,” Dr. Beyea explains. For Dr. Matthias Schmidt, a neuroradiologist at the QEII, the potential advancement of MRI technology is an exciting prospect.

“MRI gives me an opportunity to learn about tissue structure detail and function,” Dr. Schmidt says. “It’s a very versatile procedure that can get into anatomy, physiology and biochemistry and be very sensitive for subtle diseases.” This in turn, makes MRI an ideal point-of-care device.

“When a patient comes in with an acute neurological symptom the question is: Is this because of a stroke or an inner ear problem?” says Dr. Schmidt. “If it’s a stroke, the patient should be admitted and treated by neurology, but if it’s an inner ear problem then they can be treated

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‘What can we do better?’ Big data and artificial intelligence to drive health care forward By Cynthia McMurray When most people hear the term artificial intelligence (AI), they have a futuristic image ripped straight from the latest action/sci-fi movie in which robots take over the world. But nothing is farther from the truth, according to Dr. Leonard D’Avolio, an assistant professor at Brigham and Women’s Hospital at Harvard Medical School. Dr. D’Avolio was invited to be a keynote speaker at the Dalhousie Medical Research Day in April 2019 by Dr. Michael Dunbar, an orthopaedic surgeon at the QEII Health Sciences Centre, director of Dalhousie University’s Department of Surgery Research and QEII Foundation Endowed Chair in Arthroplasty Outcomes. Sponsored by the QEII Foundation, Dr. D’Avolio spoke about big data and building the machine learning system. Dr. D’Avolio is a software engineer and the co-founder of a performance improvement organization called Cyft, which uses data and AI to improve clinical care and operations. He says there is nothing to fear with AI and big data. In fact, if anything is to change and improve in today’s healthcare system, we will need to fully embrace this inevitable shift in technology. “Unfortunately, the way it is positioned now, it is sort of ‘robot versus man’ and the stage is set for AI to go to war against doctors to revolutionize health care,” he says. “But AI is neither artificial, nor is it intelligent. It’s just math.”

Dr. Leonard D’Avolio (left), an assistant professor at Brigham and Women’s Hospital at Harvard Medical School, was invited to be a keynote speaker at the Dalhousie Medical Research Day in April 2019 by Dr. Michael Dunbar, a QEII orthopaedic surgeon, director of Dalhousie University’s Department of Surgery Research, and QEII Foundation Endowed Chair in Arthroplasty Outcomes. Dr. D’Avolio spoke about big data and building the machine learning system. QEII Foundation

Dr. D’Avolio, who has family connections in Nova Scotia, offers the example of maps. “In the past, we had paper maps. You could pull it out of your pocket to understand the lay of the land,” he says. “Now we have Google Maps. We still have maps — the underlying data — but when AI and big data come together, they give us new abilities.” This data goes beyond simply

“What area of health care wouldn’t be affected by the opportunity to learn faster, better, in real time?” Dr. Leonard D’Avolio

allowing us to see which roads connect. We can now see what the traffic is like in real time and if you take route A versus route B, which route will you get there faster. “This is a really profound opportunity. It’s a new capability — not a new tool, not a new technology,” he explains. “The super power that we now have

access to, and we are now just beginning to scratch the surface of, is that we can learn in ways that were never before possible.” “What area of health care wouldn’t be affected by the opportunity to learn faster, better, in real time?” And that is really what it boils down to, according to Dr. Dunbar.

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QEII Foundation raises $4 million to bring Atlantic Canada’s first hybrid OR to the QEII Equipment and technology within surgical suite completely donor-funded By Nicole Topple Within one year, the QEII Foundation – in collaboration with the Maritime Heart Centre – has raised $4 million towards Atlantic Canada’s first hybrid operating room (OR) at the QEII Health Sciences Centre. The announcement, which was unveiled at the QEII Foundation’s Heart Heroes event on May 15, 2019, revealed that all of the technology and equipment within the new leading-edge operating suite will be completely donor-funded. At Heart Heroes, Danny Chedrawe, who is a longtime supporter of the QEII Foundation and Honorary Trustee, and Stewart E. Allen, who made a $1-million gift in support of the hybrid OR, were both honoured with Heart of Gold awards for their visionary support of heart health care. A hybrid OR is one of the most technologically-advanced operating suites available today – allowing surgical care teams to perform diagnostic imaging, minimally invasive procedures, and complex, open surgeries all in the same room, at the same time. This is especially important when treating trauma patients like car accident victims or if an emergency situation arises in the OR, as patients will no longer need to be transferred to other units or care teams for imaging procedures. “By establishing Atlantic’s Canada first hybrid operating room, the QEII will be a leader in eliminating the physical divide between the operating room and essential diagnostic imaging,” says Dr. Gerald MacKean, the QEII’s division head of vascular surgery. “The technology funded by QEII Foundation donors will be paramount to delivering the most innovative and effective care for patients.” Thanks to donors, the region’s first hybrid OR will be fully outfitted with state-of-the-art surgical and imaging technology, which will ultimately drive more complex and cutting-edge procedures, smaller incisions, less stress on the heart, and shorter recovery times for patients. “Ensuring Atlantic Canadians have the most innovative and advanced care in our region is what inspires our donors to support projects, like the hybrid OR,” says Lydia Bugden, vice chair of the QEII Foundation’s

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Stewart E. Allen, who made a $1-million gift in support of the QEII’s hybrid OR, was honoured at the QEII Foundation’s Heart Heroes event on May 15, 2019. The Heart of Gold award recognizes his visionary support of heart health care. QEII Foundation

Board of Trustees and chair of the heart campaign. The QEII is one of the top 20 health centres in Canada and one of 17 academic teaching hospitals across the country. According to Lydia, access to a hybrid OR will allow the QEII and its world-class teams to continue to elevate heart health care and help set standards from coast-to-coast. Government has approved $32.2 million for the construction and renovation of the third and fifth floors at the QEII’s Halifax Infirmary, which includes the addition of the new hybrid OR. With the QEII Foundation contributing $4 million to fund all of the advanced technology to bring the surgical suite to life, the impact for QEII patients and their families will be significant. Construction is currently underway on the new hybrid OR, which is slated to open and treat its first patients in fall 2020.

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Dr. Gail Eskes (centre), Dalhousie University professor and researcher, Dr. Richard Braha (left), program manager for the QEII’s Acquired Brain Injury program, and Dave Kay (right), QEII occupational therapy assistant, are collaborating to help stroke patients retrain their brains through a fun computer game called Peg-the-Mole. QEII Foundation

Retrain the brain How a computer game is helping stroke victims recover the left side of the world By Jon Tattrie Sometimes a strange thing happens to people after they’ve had a stroke: the left side of the world disappears. And stranger still, many people don’t even notice. “They may forget to put makeup on the left side of their face, or they may not see the left side of their plate when they’re trying to eat,” says Dr. Gail Eskes, a professor of psychiatry, psychology and neuroscience at Dalhousie University. “You can sometimes say, ‘you’ve missed something on the left,’ and then they’ll find them. That’s another way of seeing that it’s not a vision problem, it’s an attention problem.” Dr. Eskes has some good ideas about how to treat the condition. She’s collaborating with Dr. Richard Braha, program manager for Acquired Brain Injury, and occupational therapists on his team at the QEII’s Nova Scotia Rehabilitation and Arthritis Centre, to put them to the test. Dr. Eskes and Dr. Braha are using a 2015 QEII Foundation Translating Research Into Care (or TRIC) grant of $29,346.85 to conduct the Feasibility and Effectiveness Study of Implementing Prism Adaptation as a Treatment for Spatial Neglect After Right Hemisphere Stroke. The TRIC health care improvement research program supports research that will provide evidence and facilitate the translation of clinical science into improved healthcare policy, service delivery and patient care at the QEII. Dr. Braha’s team works directly with patients and stresses that the eye itself is not damaged. It’s as if a camera is filming, but nobody is watching the screen. “It’s not a problem with sensory visual input per se,” he says. He says some patients don’t

even realize they have a problem, while others are acutely aware of it. Either way, it can be incredibly frustrating. Untreated, it can reduce independence, especially if it happens to older people. Driving becomes a real problem, along with an increased risk of falls. The TRIC grant is bringing researchers and clinicians together to try and figure out exactly what works and on whom. To do that, they’re getting stroke patients to retrain their brains through a fun computer game called Peg-the-Mole. Sitting before a touch screen, patients wear a pair of goggles

containing prisms that shift the wearer’s world to the right of where it actually is. Rows of holes appear on the screen. The patient holds the space bar, a mole pops up in one of the holes and the patient has about a second to touch it. “Once they’ve put on the goggles, they reach too far to the right when they try to touch the mole. Gradually, the brain begins to learn to adapt leftward to the prisms,” Dr. Eskes says. “The more times they do it, their brain is going to retrain itself to know, ‘this is where I have to reach.’” When they take the goggles

off, their brain holds onto the leftward correction, drawing their attention to the left. In the study, patients play the game for about 10 minutes every weekday for two weeks. It makes a difference for a lot of people, but not all. “In this study we are also trying to get a better idea about who it helps,” Dr. Eskes says. “We’re taking advantage of the brain’s flexibility with these prisms.” A big problem today is that assessment practices and treatments vary across the country and around the world. That makes it hard to learn what

works and develop best practices. Their study aims to improve just that and help to establish what works for which type of patients. They hope to have 50 patients through the study by spring 2020. The results should help develop evidence-based treatments for the condition and bridge the gap between research and clinical care. Ultimately, they intend to make the Peg-the-Mole game available on computer tablets so they can give patients goggles and let them practice at home to “reset the brain leftward” when they notice their attention is drifting.

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Members of the Murphy family alongside palliative care champions at the QEII Foundationâ&#x20AC;&#x2122;s announcement event unveiling the familyâ&#x20AC;&#x2122;s $4-million gift to transform palliative care. Pictured â&#x20AC;&#x201C; back (left to right): Lisa Murphy (J & W Murphy Foundation), Julie MacKean (QEII Foundation), Karen Spaulding (J & W Murphy Foundation) and Dr. David Anderson. Front (left to right): Dr. Paul McIntyre, Holly Murphy (J & W Murphy Foundation) and Dr. Drew Bethune. QEII Foundation

The QEII Foundation celebrates a $4-million donation to transform palliative care A familyâ&#x20AC;&#x2122;s game-changing support of palliative care research and Hospice Halifax By Jenna Conter On February 26, the QEII Foundation announced that the Murphy family â&#x20AC;&#x201D; on behalf of the J & W Murphy Foundation â&#x20AC;&#x201D; made a $4-million donation to help transform palliative care in our region. $3 million will be the catalyst in creating an Endowed Chair in Palliative Care and $1 million will provide critical funding for Hospice Halifax. When people think of the terms â&#x20AC;&#x2DC;palliativeâ&#x20AC;&#x2122; care and â&#x20AC;&#x2DC;hospiceâ&#x20AC;&#x2122;, it is common to associate them with end-of-life care. However, although they are inextricably linked, Dr. Rob Horton believes that this generous gift from the Murphy family will help shatter some of the misconceptions surrounding palliative care and raise awareness of its importance for patients facing a life-limiting illness and their families. Dr. Horton, a palliative care physician at the QEII Health Sciences Centre, knows too well the assumption that hospice and palliative care is nothing more than an individualâ&#x20AC;&#x2122;s choice between spending their last moments in the hospital or at home. â&#x20AC;&#x153;Itâ&#x20AC;&#x2122;s a form of care that focuses on the patient, preparing them and their families for tasks associated with dying â&#x20AC;&#x201C; ranging from complex decision-making to bringing resources in the community together to try to make the best of one of the most profound times of our lives,â&#x20AC;? says Dr. Horton. According to Dr. Horton, palliative care can include managing pain and symptoms, planning for the future, and addressing the physical,

emotional, social, and spiritual needs of patients and their families. Dr. Horton is a longtime board member of Hospice Halifax, who got involved in the local non-profit after years of working in the system with a front row seat to where and how improvements can be made. â&#x20AC;&#x153;I think thatâ&#x20AC;&#x2122;s where the Murphys are coming from,â&#x20AC;? he says. â&#x20AC;&#x153;They have experienced palliative care from a personal standpoint more than once and theyâ&#x20AC;&#x2122;ve seen the good in the system â&#x20AC;&#x201D; what can be done well â&#x20AC;&#x201D; and theyâ&#x20AC;&#x2122;ve also experienced some of the gaps.â&#x20AC;? The Murphys lost three family members in painfully quick succession a few years previous to their monumental gift â&#x20AC;&#x201D; the largest one-time donation of its kind to the QEII Foundation to help ensure exceptional palliative care for all Nova Scotians. â&#x20AC;&#x153;To take that experience and step forward with a gift like this, is not only extremely generous, it carries with it a lot of foresight in terms of what can be done to make the system better. Itâ&#x20AC;&#x2122;s very much a community-minded gift and Iâ&#x20AC;&#x2122;m very excited to be part of the whole thing,â&#x20AC;? says Dr. Horton. With their transformational gift, the Murphy family funded the furniture, equipment, design and architecture needs within the new Hospice Halifax, which recently opened to its first patients. Hospice Halifax, like other hospices across the country, provides state-of-the-art palliative care and support services to individuals and their loved ones in a beautiful home-like setting. The 10-bed residence, located near the Northwest Arm in Halifax, features a family kitchen, outdoor

terraces and garden, overnight accommodation for families, and more. The new hospice will welcome about 150 patients a year, whose palliative care needs cannot be met at home and who do not require care in a hospital. In addition to their game-changing support of Hospice Halifax, the Murphys chose to invest in groundbreaking research by helping to establish an Endowed Chair in Palliative Care. Endowed research chairs at the QEII are world-renowned experts in their field who are cross-appointed at the QEII, Nova Scotia Health Authority (NSHA) and Dalhousie University. â&#x20AC;&#x153;When donors invest in the creation of an endowed chair position, they are doing so much more than supporting the role of an additional researcher in that field,â&#x20AC;? says Dr. David Anderson,

Dean of the Faculty School of Medicine at Dalhousie University. â&#x20AC;&#x153;They are ensuring that from this point forward, long-term, stable research funding for palliative care is available indefinitely.â&#x20AC;? At its heart, the Endowed Chair in Palliative Care will be dedicated to leading palliative care research at the QEII and, ultimately, translating evidence-based findings into best practices, policies and training that will be adopted here at home â&#x20AC;&#x201D; and both nationally and internationally. Research conducted around the globe has already demonstrated that quality palliative care improves patient and family quality of life and well-being, reduces healthcare costs and, in many instances, even prolongs life. â&#x20AC;&#x153;The Endowed Chair in

Palliative Care will build upon these findings and help establish the QEII as a true centre of excellence in this area,â&#x20AC;? says Bill Bean, president and CEO of the QEII Foundation. â&#x20AC;&#x153;On behalf of all Nova Scotians, weâ&#x20AC;&#x2122;re incredibly thankful to the J & W Murphy Foundation and the entire Murphy family for their visionary commitment to transform palliative care in our region.â&#x20AC;? Itâ&#x20AC;&#x2122;s a sentiment echoed by Dr. Anderson: â&#x20AC;&#x153;The importance of this cannot be overstated. Itâ&#x20AC;&#x2122;s really a transformational gift that will allow us to practice the kind of informed care that is necessary to meet the needs of patients in this province,â&#x20AC;? says Dr. Anderson. To learn more about the Murphy familyâ&#x20AC;&#x2122;s donation and the QEII Foundationâ&#x20AC;&#x2122;s vision for palliative care, visit QE2Foundation.ca/transform.

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Banking blood Continued from Page 9 happens before more red blood cell units are ordered from Canadian Blood Services. “It is the first time we have used real-time patient data,” says Dr. Cheng. “It is a much closer daily look at what is going on in the health centre.” Now the QEII’s blood bank can keep a correctly-sized inventory of red blood cell products, wasting much less blood. Just over eight units of red blood cells are not used each month because they are too old. This compared to just over 19 units before the algorithm was implemented, according to a recent paper published in Transfusion, the most widely-read journal in its field in the world. By significantly reducing its own inventory, more blood products are freed up and available for

other hospitals in the region. The blood used at the QEII is now also fresher. Blood has a shelf life of 42 days. “Blood is something we have to treat as a valuable asset,” says Dr. Quinn, the incoming medical director of the blood transfusion services. “It isn’t just a resource we make, like a drug. It is actually someone’s blood.” Dr. Cheng knew the blood bank had to become more efficient after he noticed too many red blood cell products were being thrown out because they were too old for use. Ordering red blood cells used to be done using a table that looked at average daily usage, explains Dr. Cheng. Technologists would be given a rough estimate of what was needed for a five-day inventory but often the inventory reached as high as a 10-day supply. Now with the algorithm, the estimating is gone and only

Doing better Continued from Page 11 “The department of surgery is moving forward to start looking at the data we have already collected and see if we can make better use of it.” In order to do this, Dr. D’Avolio says it is imperative to ask the right people the right questions. He acknowledges researchers are working on some very interesting problems, but it’s in their nature to frame those problems in terms of what matters to them. In order to make meaningful change, researchers need to frame problems in terms of what matters to those who

control access to the data needed. Dr. D’Avolio gives the example of accidental death due to medical error. “In the U.S. in 2015, researchers suggest on the lower end that number was 210,000 and on the higher end it was 400,000, but nowhere in the debate did anyone ask the question, ‘why don’t we know this number?’” In the airline industry, every near-miss between airplanes is tracked. “We pay really close attention when 100 people die in an airplane, yet we don’t count whether it was 210,000 or 400,000 when they die in health

“It is very novel. No one does anything like this.” Dr. Jason Quinn

care,” he said. Part of the issue is we live in a culture where we are programmed to protect patient privacy, but the question then becomes, at what cost? “Even if we go so far as to create registries, we go out of our way to de-identify them,” says Dr. D’Avolio. “So once we know something that can help you, we have no way to know if you are the person we can help.” The data is there and is readily available to start answering the three fundamental questions for improving anything: What are we doing? Is it working? What should we be doing? Dr. Dunbar adds that the QEII is ahead of other provinces in some ways because it is the leading hospital in Atlantic

the correct amount of blood is ordered. “The algorithm looks forward and backward,” says Dr. Cheng. “This forward-looking part is the unique part.” Developed in 2015, Dr. Quinn has played a crucial role since then in sharing information about the algorithm and getting studies published. “We are trying to disseminate this algorithm so that other centres can better use this system,” says Dr. Quinn. “It is very novel. No one does anything like this.” In 2018, close to 13,800 blood transfusions took place at the QEII thanks in large part to the blood bank’s adequate blood supply. The QEII’s hematopathologists are confident the algorithm will allow doctors and nurses to continue performing their life-saving work and prevent unnecessary waste. “The bottom line is, it gives us a better ability to deliver blood to patients,” says Dr. Cheng.

Canada, and as such is a “living health lab.” “I think there are some good things that can be done with respect to understanding some of the outcomes that are already in front of us,” says Dr. Dunbar. He says the QEII also has an amazing opportunity to potentially design products, specifically in analytics. “That takes longer, but I think we can and should start. We have already tested the water and the pathway but what I am interested in, as part of the department of surgery, is making this happen for all of the divisions.” Dr. Dunbar says ultimately, this data can answer the burning question on the minds of all Nova Scotians — what can we do better?

MRI Continued from Page 10

as an outpatient. A point-of-care MRI would allow us to diagnose on the day of presentation rather than after a night spent at the hospital.” Having an MRI that can safely image patients closer to the emergency department holds considerable appeal for Dr. Schmidt. “For the first time it makes it practical for really sick people,” he says. Not content to observe the machine’s effectiveness from a purely clinical perspective, Dr. Beyea will study the patient experience as well. “A stroke survivor is going to work with our research team to develop feedback questionnaires. It is not only about superior technology, as it is equally as critical for us to understand how this might have changed the patient’s perspective and experience,” explains Dr. Beyea. “Did they see it as something that provided a value or not to their healthcare journey?” For Dr. Schmidt, this new version of MRI offers a chance to add a valuable new diagnostic resource to his repertoire. “It’s scary for patients who develop acute neurological symptoms when they are either admitted or sent home without all the answers,” says Dr. Schmidt. “As a diagnostician, I think it would be wonderful if I had a tool that would allow me to make a subtle diagnosis more confidently at the time of presentation. An exciting new tool today may become the standard of care tomorrow.” * Not yet approved for sale in Canada as a medical device.

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QEII Times – Summer 2019

Articles inside

Retrain the brain

YOUR QEII

RESEARCH & INNOVATION

Transforming palliative care

Uncommon conditions: Cushing’s disease