In Touch newsletter: Summer 2017

INTOUCH SUMMER 2017

A rendering of the entrance and ambulance bay of the new Slaight Family Emergency Department, which is currently under construction.

(Rendering by NORR Architects.)

ED renovation will open doors to better patient flow

By Kate Manicom

All patients arriving at St. Michael’s Emergency Department come through the same doors, whether they have a broken ankle or have been severely injured in a collision. When it’s busy, the current configuration is challenging for both patients and for staff.

“Patients who arrive on their own aren’t sure who to speak to or where to go, creating bottlenecks at the registration desk,” said Karin Wells, a registered nurse in St. Michael’s ED. “Patients on stretchers who are brought in by Toronto Paramedic Services can obstruct our view into the waiting area, making it tough to monitor those who are seated and may need to be seen quickly. It also presents privacy Printed on 100 per cent recycled paper

challenges to have our trauma patients transferred through the area, and can be upsetting for other patients and loved ones who are waiting in the same space.”

As part of the renovation and expansion of the ED, the ambulance bay, triage and patient waiting area will be reconfigured to create better flow for clinical staff and first responders, and a better experience for patients and their loved ones. A key change is creating two separate entrances for patients who are transported by Toronto Paramedic Services and for those who arrive on their own.

The new triage area will be larger, with better sightlines for staff. The registration desk will be positioned across from the door, making the triage process more clear

for patients. Outside, a new drop-off area for cars and taxis will be created on Shuter Street.

“The nature of the ED is very stressful to begin with, and triage is often a patient’s first impression of the hospital,” said Natasha Cummings, a registered nurse in the ED. “Having a welcoming space that is easier to navigate will help to put patients at ease.”

The ambulance bay, which now can accommodate only three to four vehicles, will also be expanded. Increasing dedicated parking for ambulances will help to ensure they do not impede traffic around the hospital and will bring patients closer to the Continued on page 2 SUMMER 2017 | IN TOUCH | 1

OPEN MIKE with Joseph Hall Feature Writer, The Toronto Star have often felt most welcome and the lost, most comforted.

And it’s here, too, that Canada’s medical community has turned time and again for guidance and discovery.

The term “Urban Angel” attached to St. Mike’s for decades had little of the celestial in its origins.

Quite the opposite, in fact. It was first used in a Toronto Star feature this author wrote to commemorate the hospital’s centennial and described its organic place in the city’s gritty urban core.

Here’s how it made its debut in that November 1992 article: Unlike the lofty, monumental medical plants that line stately University Ave. below Queen’s Park, St. Michael’s is a uniquely urban angel. Its red and brown brick walls are part of an ungainly, piecemeal edifice - dour and cold - and the grime of the downtown core clings to its mortar.

So it’s here, as if by nature, that the city’s poor have come; here that the immigrants

Urban Angel status for years -- is sadly gone as well. I often pointed with pride to that billboard when walking with friends and family downtown. My son was especially taken by it.

Star editors liked the phrase well enough to elevate it to the front page headline that accompanied the Sunday story.

And someone at the hospital -- who saw that headline --was taken with it as well.

The following Monday, I got a call from St. Mike’s media relations asking if the hospital could use it in a capital expansion campaign the board was planning.

The paper was happy to oblige, as was I, having been born at the hospital some 32 years earlier.

The place has changed in the ensuing 25 years, with gleaming glass structures like the Peter Gilgan Patient Care Tower and Li Ka Shing Knowledge Institute giving the hospital a more chic architectural profile.

And the large blue sign on the hospital’s southwest facing -- which proclaimed its

But at heart, the hospital’s urban mission remains -- both at the Bond Street site and in its scattered downtown clinics.

Just as the urban archangel, perhaps carved of the same Italian marble Michelangelo employed for his La Pietà, stands watch in the Bond Street lobby.

ED story continued from page 1

hospital doors. A garage door will be added to the bay to provide increased security when required.

The overall renovations to the ED will double its size and will include more patient treatment areas, including 24-7 diagnostic imaging inside the department and a larger ambulatory area. It will also include a fully renovated and enhanced trauma area and a new, dedicated mental health area, physically separated from the rest of the ED, staffed by specially educated crisis workers and health-care providers.

ED staff, like Cummings, say they are eager for the changes. “If only we had a magic wand to make it happen right away!”

SUMMER 2017 | IN TOUCH | 2

Follow St. Michael’s on Twitter: @StMikesHospital

Dr. Michelle Sholzberg, an adult hematologist, (left) and Dr. Filomena Meffe, an obstetrician/gynecologist, (right) are part of the all-female team that runs a clinic for women with bleeding disorders. (Photo by Katie Cooper, Medical Media Centre)

Clinic for women with bleeding disorders follows women through life cycles

By Leslie Shepherd

Many people associate bleeding disorders with hemophilia, the rare and potentially fatal genetic disorder that affects men predominantly, including about 3,100 in Canada.

But the most common bleeding disorders are von Willebrand disease and inherited platelet disorders, affecting one to per cent of the population, or 35,000 Canadians.

The people most commonly affected by those two conditions are women.

Because woman have more opportunity to bleed than men – during their menstrual periods and around childbirth – and because these conditions can be difficult to diagnose, even for hematologists, St. Michael’s Hospital has established a Multidisciplinary Clinic for Women with Bleeding Disorders. It’s only the fourth clinic of its kind in Canada.

“We follow our patients through their life cycle,” said Dr. Michelle Sholzberg, an adult hematologist and medical director of St. Michael’s coagulation lab. “We are available for management of heavy menstrual bleeding, surgery, antenatal consultation, labour and delivery and

postpartum care in the bleeding disorders population.”

The clinic, located in the Specialty Clinics on 4 Cardinal Carter, has registered about 200 patients and delivered more than 60 of their babies since opening in 2014.

The entire team is female: Dr. Sholzberg, obstetrician/gynecologist Dr. Filomena Meffe, pediatric hematologist Dr. Jillian Baker, anesthesiologist Dr. Rachel Martin, case manager Georgina Floros and clinic administrator Antonette Travas. This clinic has been supported since its inception by Dr. Jerry Teitel, founder of the hemophilia treatment centre at St. Michael’s.

“It’s a one-stop-shop,” said Dr. Meffe.

“Patients see us all in one clinic and it’s our team approach that makes a difference” Dr. Sholzberg said bleeding disorders are vastly underdiagnosed and under-reported among women. Women with inherited bleeding disorders may believe their heavy periods are “normal” because that’s what their mothers, grandmothers and other female relatives experienced, she said.

“Your personal interpretation of your

St. Michael’s is an RNAO Best Practice Spotlight Organization

bleeding pattern is coloured by your family history and your own history of bleeding.

If you have bled heavily since your menarche, that’s your benchmark.”

Heavy, chronic bleeding can cause iron deficiency and anemia, which can profoundly impact quality of life, she said. Iron deficiency lowers energy, mood, concentration, IQ, and can result in work/ school absences. Women with inherited bleeding disorders are at increased risk of needing transfusions during childbirth and there is a higher risk of them or their babies dying.

“Our goal is to diminish unnecessary harm from heavy bleeding,” Dr. Sholzberg said.

“We’re not going to cure them but we can help them manage so they can live healthy, productive lives.”

Dr. Sholzberg recently published a paper showing how questionnaires about bleeding can help health-care providers make better diagnoses and lead to better patient care. She said that since women with a family history of heavy bleeding may not recognize it as a health issue, practitioners have to ask.

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‘Supercharged’ stem cells expected to heal the heart

By James Wysotski

Drugs can halt the damage a heart attack causes to heart muscle, but they can’t reverse the harm already caused. A new regenerative therapy being tested

by St. Michael’s cardiologist Dr. Kim Connelly aims to do both.

To reverse damage to the heart, Dr. Connelly must modify scar tissue caused by the heart attack and the remaining functioning heart muscle. Dr. Connelly, director of the hospital’s Krembil Cell Facility, does this by harvesting bone marrow stem cells as they enter the blood stream of heart attack patients, and then growing them for six days in petri dishes. He “supercharges the cells” in the lab by adding the eNOS (endothelial nitric oxide synthase) enzyme, which helps regrow blood vessels and reduces the stress on remaining heart cells. Once the cells are supercharged, they are inserted back into the heart attack patient.

“We identified the problems that cause stem cells not to work properly, and we replace the factors we think are missing,” said Dr. Connelly. “Basically, we’re flipping the chemical switch that fixes damaged stem cells. This means they can functional normally again.”

Until the switch is “flipped,” scar tissue prevents the stem cells from working, and the heart muscle continues to fail.

Previous research by other teams failed because they did not recognize that the stem cell quality in heart attack patients, without “supercharging,” is often too poor to effectively turn off the scarring process and create new blood vessels.

Dr. Connelly’s clinical trials are part of the ENACT-AMI (ENhanced Angiogenic Cell Therapy-Acute Myocardial Infarction) study, the world’s first genetically modified stem-cell trial for the treatment of cardiac disease. The SUMMER 2017 | IN TOUCH | 4

Cardiologist Dr. Kim Connelly studies the effects of supercharged stem cells in his lab. (Photo

by Katie Cooper, Medical Media Centre)

study is led by Dr. Duncan Stewart, the former head of cardiology at St. Michael’s who now is CEO and scientific director of the Ottawa Hospital Research Institute,

didn’t supercharge stem cells showed modest benefits to heart function after two years, but Dr. Connelly said he expected benefits from his to last

Did you know?

Kidney disease accounts for half of all cases of heart failure in Canada. and locally by St. Michael’s cardiologist Dr. Michael Kutryk.

longer since they’re “more potent and make more scientific sense.”

One hundred patients who have had a heart attack that caused serious damage and but who have not responded sufficiently to other treatments are to get the supercharged stem cells before the trial concludes at the end of 2018. To date, 37 received treatment.

The long-term plan is to freeze some cells and implant a second dose a couple of years later because aging will eventually damage the cells again.

Patients get a single delivery of cells within 30 days of a heart attack. Other trials that

Dr. Connelly said he expects to know if the trials are successful by fall 2019. If they can reverse damage to the heart, he said it would be “forever a gamechanger in medicine.”

Patients form Ontario support network for inflammatory muscle diseases

By Skaidra Puodziunas

At age 41, Audrey Gouskos was at the peak of her career, working in the fast-paced world of media relations at Queen’s Park and raising her young son.

But over a matter of weeks, she started to lose energy and one afternoon could barely make it to the other side of the room without being overcome by exhaustion. Gouskos was rushed to St. Michael’s Hospital in critical condition.

“I couldn’t walk, talk or breathe independently,” she said. “It all happened so fast. I literally lived in the St. Michael’s ICU for three months, intubated. It’s a miracle I’m still alive.”

Gouskos was diagnosed with late-stage myositis, an umbrella term for a rare condition that causes muscle inflammation. Specifically, she had dermatomyositis, which she has been managing for 15 years.

Part of the challenge for patients with myositis is that it is a rare condition. Only 10 in every million Canadians are diagnosed with it.

Patients Paul Bond and Audrey Gouskos plan the first Ontario Myositis Network meeting in the office of Dr. Ophir Vinik, a rheumatologist at St. Michael’s. (Photo by Yuri Markarov, Medical Media Centre)

“This leads to a lack of awareness on how to appropriately identify and diagnose myositis within the medical community, and for patients, the resources available to manage its symptoms,” said Dr. Ophir Vinik, a rheumatologist at St. Michael’s. “Not every diagnosis of myositis leads to a near death experience as in Audrey’s case, and is often treatable, manageable and even reversible, if diagnosed early.”

Raising awareness and supporting and improving the lives of people affected by myositis are the reasons why patients Gouskos and Paul Bond partnered with Dr. Vinik and Dr. Rachel Shupak, a senior rheumatologist at St. Michael’s, to launch the Ontario Myositis Network.

“With any critical illness, it takes a network of medical, emotional and physical support to heal, and through the Ontario Myositis Network, we hope to address this,” said

Gouskos. “We want patients to realize they can still contribute meaningfully to society.”

All involved stressed the importance of this being a patient-led support group.

“Patients can best address the challenges they face in accessing myositis care in the health-care system through their lived experiences,” said Dr. Vinik. “We hope this initiative brings patients together and empowers them to advocate for improved awareness, education and resources to better manage these diseases.”

For more information, email OntarioMyositis@gmail.com or follow the Ontario Myositis Network page on Facebook.

The Ontario Myositis Network had its inaugural meeting on June 8, with more than 50 patients and relatives in attendance.

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An alternate reality

St. Michael’s Psychiatrist-in-Chief Dr. Tom Ungar (right) lays on a bed with two actors in a scene of his reality-TV-style web series, Think you can shrink? The series challenged people who think they’re good at giving advice to try addressing common issues that psychiatrists treat.

(Photo by Katherine Fibiger)

By Geoff Koehler

People may think they’re good at giving advice, but St. Michael’s new Psychiatristin-Chief Dr. Tom Ungar wanted to put that to the test while also improving the way people talk about mental health issues. So, naturally, he developed a realityTV-style web series called Think you can shrink?

“We have a bartender, hairdresser, grandmother or friend who we turn to for advice,” said Dr. Ungar, who joined St. Michael’s in June. “Think you can shrink? challenged similar everyday people to spend a day in my chair and demonstrate how they would help someone work through a challenging issue.”

The series’ concept was to educate people about mental health, reduce stigma and encourage people to seek professional help.

The wannabe shrinks were selected from a Facebook call for Ontarians who SUMMER 2017 | IN TOUCH | 6

wanted to try their hand at armchair psychiatry. Judges included a psychiatrist, an emergency room or family doctor and celebrity Rick Campanelli, co-host of ET Canada.

almost put me out of business. But some contestants also demonstrated what not to do, which gave our judges opportunities to help educate the audience.”

While the contestants were real, “patients” who portrayed mental health issues were trained actors.

The web series was supported by Movember Canada, through the North York General Hospital Foundation—the hospital where Dr. Ungar previously practiced.

“It was important that actors portrayed patients in the series because we never wanted to be exploitive of patients or their conditions,” said Dr. Ungar. “We styled the show like reality television but didn’t use their nasty and shaming aspects. Think you can shrink? is fun and we had fun with the contestants, but never at their expense nor the expense of the ‘patients’ or conditions.”

Dr. Ungar said he was amazed at a few of the contestants.

“One was just so Zen with the anger management actor. Another knew the condition he was working with and could

Dr. Ungar said the show’s success was proof men’s health has room for edutainment—a combination of education and entertainment. In published research on the series, Dr. Ungar said the feedback from viewers was that the show was entertaining and after watching, would be more comfortable supporting a friend with similar health issues and would themselves be more likely to seek professional help if needed.

Dr. Teodor Grantcharov is the creator of the OR black box. It records nearly everything in the OR, including video of the surgical procedure, conversations among health-care workers, room temperature and decibel levels. (Photo by Yuri Markarov, Medical Media Centre)

‘Black box’ founders using artificial intelligence and research collaborations to further improve surgical safety

By Kelly O’Brien

The team behind the operating room black box is working to incorporate artificial intelligence into its reporting on surgical safety.

Dr. Teodor Grantcharov, a surgeonscientist at St. Michael’s who specializes in advanced minimally invasive procedures such as gastric bypasses, is the leader of the OR black box research project.

St. Michael’s has one black box, used by Dr. Grantcharov. A second black box is at the Academic Medical Centre in Amsterdam.

What continues to be the key to the success of the black box project is the post-surgery data analysis, he said.

“The problems a black box detects in Amsterdam are going to be different from those problems detected in Toronto,” said Dr. Grantcharov. “That’s the advantage of expanding the project. We can make educational interventions benefitting a wide range of people.”

With interest in the black box increasing,

the team has begun using computer vision to improve the efficiency of its reporting and meet the growing demand.

Computer vision, a form of artificial intelligence, is a science concerned with the automatic extraction, analysis and understanding of useful information from a single image or a sequence of images.

Dr. Grantcharov said the team is “teaching” the computer to identify an adverse event by feeding it existing clips of events from procedures that a human has already analyzed.

Karthik Raj, Dr. Grantcharov’s research program manager, said each time the process is repeated, the accuracy of the computer report improves.

“The more parameters we bring in, such as error detection, bleeding detection, all of those things added together, the more accurate the computer analysis will be,” he said.

Until earlier this year, the team focused on improving safety by reporting on performance issues, communication

and team dynamics. But in May, Dr. Grantcharov and his team hosted a retreat for 17 principal investigators from across Ontario to begin examining the different ways in which the data they collect can be used to improve surgical safety.

By bringing in researchers with different backgrounds, the ways in which the team will be able to improve surgical safety will expand, said Dr. Grantcharov.

“Take OR design as an example. When we have researchers come in with an expertise in design, they are able to see the data we’ve collected in a whole new light,” he said.

Dr. Grantcharov said he hoped that by taking full advantage the data from the black box, he and his team would find new ways to improve surgical safety.

“As long as there are humans, there will be mistakes. But by learning from these mistakes, we will continue to make surgery safer.”

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Q&A

SARO GANESHAPILLAI, LACTATION CONSULTANT, OBSTETRICS

By Emily Holton (Photo by Katie Cooper, Medical Media Centre)

Q. Why did you choose to focus your career on promoting and supporting breastfeeding?

Saro Ganeshapillai is a board-certified lactation consultant in St. Michael’s postpartum unit as well as our new St. Michael’s Hospital/Toronto Public Health Breastfeeding Clinic.

Q. What is a lactation consultant? What do you do?

A lactation consultant is a trained professional who helps mothers understand the health benefits of breastfeeding, assists them with learning how, and supports them through any breastfeeding challenges and issues that may come up. When I work with moms and babies, I make sure the baby’s latch is OK and I watch to make sure they’re sucking and swallowing enough milk. I also teach moms how to check these things herself, at home. Sometimes a mom has an issue with her nipples or baby has sucking issues, and they need a different technique. A lot of my job is just helping moms believe that they can do it. However, if it turns out that a mom or baby can’t breastfeed, or it’s not right for mom, I respect that and we work together to come up with an alternative plan.

INTOUCH

SUMMER 2017

In Touch is an employee newsletter published by Communications and Public Affairs.

Please send story ideas to In Touch editor Leslie Shepherd at shepherdl@smh.ca.

Design by Andrew Tang, Medical Media Centre

I started out as a pediatric nurse and then started working with babies. Then I realized that breastfeeding is a preventative measure for families and for societies, in terms of public health. When I help moms with breastfeeding, I’m helping babies get a good start right from the beginning. Sometimes the mothers I see are really upset; their babies are losing weight and they come to the clinic crying – they don’t know what to do. So when I see them happy and doing better at the next visit, or they email me later to tell me how much I helped them, that really makes my day. This job is so rewarding.

Q. Tell us about the new breastfeeding clinic.

We opened the clinic on May 1, in partnership with Toronto Public Health. We’re open five days per week on the 4th floor of 61 Queen.

Mondays and Wednesdays are for walk-ins, and the rest are by appointment. We did a survey of our walk-in clinic patients and so far we have 99 per cent satisfaction! They’re so happy with our service.

Q. Do you have any summer vacation plans?

My brother lives in Europe, so I’m going to visit him in September.

I usually love a beach vacation, but this time I decided to go for a different experience: Switzerland and the Alps!