Hospital News October 2013 Edition by Hospital News

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AMBULATORY CARE/NEUROLOGY/ MENTAL HEALTH AND ADDICTION

Canada's Health Care Newspaper OCT. 2013 | VOLUME 26 ISSUE 10 | www.hospitalnews.com

Specialized programs offered on an outpatient basis such as Speech-Language Clinic, Footcare Services, Eye Clinic, Family Practice etc. Developments in the treatment of neurodegenerative disorders, traumatic brain injury and tumours, and new treatment approaches to mental health and addiction.

This is the future of healthcare

INSIDE Evidence Matters ................................. 7 From the CEO's desk..........................15 Ethics ..................................................25

Why share my darkness? The face of mental healthcare

By Brett Charles Batten started thinking about all the labels I have had; insane, criminal, crazy, mentally ill, manic depressive, I could name a few more. Labels are basically stereotypes; mental molds that we cast for people so we feel separate and safe from them. With stereotypes comes stigma and with stigma comes isolation. This isolation helps protect the strong and healthy but it drives those who are different underground and often in the case of mental illness â&#x20AC;&#x201C; people donâ&#x20AC;&#x2122;t seek help. I have spent 20 years as a mental health care consumer, my journey began when I was 15 years old. I have been in several hospitals for varying lengths of time. I have been arrested, incarcerated, judged, found guilty and found Not Criminally Responsible (NCR). My circumstances have always been different but my mental illness has been a constant. At times I have had some extreme symptoms of mental illness; they have taken me down roads I would normally have avoided.

Continued on page 18

Brett Batten shares his journey in hopes of decreasing the stigma associated with mental illness.

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App helps youth tap into effective strategies to manage anxiety By Terry Foster

t’s that time of year when many households around the country are adjusting from summer to fall schedules. Often for young people and families that means a faster pace with increasingly more demands on our time; and with that sometimes the unwanted stress and anxiety of trying to keep up with all the changes.

MindShift is designed to help youth learn how to relax, develop more helpful ways of thinking, and identify active steps that will help them take charge of their anxiety. Now there’s a new free, easy-to-use App to help young people cope with feelings of anxiety. The “MindShift” app is the result of a joint collaboration between BC Mental Health & Addiction Services (BCMHAS), an agency of BC’s Provincial Health Services Authority (PHSA), and AnxietyBC. Anxiety is a natural, adaptive response when people feel unsafe or threatened. Everyone feels nervous and worried at times, but anxiety can be a problem when it is persistent, intense, and stops people

HOSPITAL NEWS OCTOBER 2013

from doing fun and important things they want or need to do. MindShift is designed to help youth learn how to relax, develop more helpful ways of thinking, and identify active steps that will help them take charge of their anxiety. This app includes strategies to deal with everyday anxiety, as well as specific tools to tackle: •test anxiety •perfectionism •social anxiety •performance anxiety •worry, panic and conﬂict. MindShift is free and is available through the iTunes app store and Google Play. It works on both iOS and Android devices. “Young people today are connected and mobile; it is important for us to provide resources that are relevant to them, says Dr. Connie Coniglio, Provincial Executive Director, Children and Women's Mental Health and Substance Use Programs, BC Mental Health & Addiction Services. “The MindShift app is like a portable coach, confidentially giving you tips, whenever and wherever you need them, to help you face your anxiety and take control in challenging situations.” BC Mental Health & Addiction Services (BCMHAS), an agency of BC’s Provincial Health Services Authority, provides

specialized tertiary mental health and substance use services for children, adolescents and adults across BC. Together, BCMHAS and PHSA are transforming healthcare through innovation. As communities across the country mark Mental Illness Awareness Week (612 Oct 2013) this October, BCMHAS is encouraging people to be part of the open discussion on mental health and reminding people to check with their community health care providers for more information on resources in their community. BCMHAS resources include: The Kelty Mental Health Resource Centre providing mental health and substance use resources and information for children, youth and families, and Mindcheck.ca: Information, resources and interactive quizzes designed specifically for youth and young adults to help them identify and understand mental distress they may be experiencing, including anxiety and depression, and link them H to sources of help. ■ Terry D. Foster is Manager, Communications at BC Mental Health & Addiction Services Provincial Health Services Authority.

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In Brief

First time in Alberta:

health groups launch anticoal campaign Leading health organizations launched a campaign urging the Alberta government to phase-out coalfired power, citing the grave health consequences of burning the dirty fossil fuel. The Canadian Association of Physicians for the Environment (CAPE), the Asthma Society of Canada, and The Lung Association began running advertisements in leading newspapers featuring a girl with an asthma puffer and the headline, “Coal makes her sick”. It is the first time in the province’s history health groups have launched such a campaign. The ads cite a report published by the groups showing Alberta coal causes over 4,800 “asthma symptom days” annually – days on which asthma patients miss work or school because of H their illness. ■

Innovative arthritis screening program Pharmacists at more than 1,200 Shoppers Drug Mart stores across Canada will be providing arthritis screening and information to Canadians as part of a three-year partnership between Shoppers Drug Mart/Pharmaprix, Arthritis Consumer Experts and the Arthritis Research Centre of Canada. The Shoppers Drug Mart Arthritis Screening is the first and only program in Canada designed with women in mind because the disease affects two out of three or 2.8 million Canadian women. To help detect the disease at an early stage, the program includes a self-administered joint exam and questionnaire. It also helps Canadians with arthritis work with a pharmacist to monitor their symptoms and medication over time to prevent the disease from worsening. The program was developed from research carried out at the Arthritis Research Centre of Canada with funding provided from the Government of Canada through the Canadian Institutes of Health Research. It shows how researchers, patients and the private sector can work together to provide inH novative health solutions to Canadians. ■

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Scientists discover genetic changes that may contribute to the onset of schizophrenia Scientists from the Centre for Addiction and Mental Health (CAMH) have discovered rare genetic changes that may be responsible for the onset of schizophrenia. Several of these same genetic lesions had previously been found to have causal links to autism spectrum disorder (ASD). This discovery gives new support to the notion that multiple rare genetic changes may contribute to schizophrenia and other brain disorders. This discovery also suggests that clinical DNA (genomewide microarray) testing may be useful in demystifying one of the most complex and stigmatized human diseases. The study is

published in the current issue of Human Molecular Genetics, and was funded by the Canadian Institutes of Health Research (CIHR). In the first study of its kind, scientists at CAMH and The Centre for Applied Genomics (TCAG) at The Hospital for Sick Children analyzed the DNA of 459 Canadian adults with schizophrenia to detect rare genetic changes of potential clinical significance "We found a significant number of large rare changes in the chromosome structure that we then reported back to the patients and their families," said Dr. Anne Bassett, Director of CAMH's Clinical Genetics Research

Program and Canada Research Chair in Schizophrenia Genetics and Genomic Disorders at the University of Toronto. "In total, we expect that up to eight per cent of schizophrenia may be caused in part by such genetic changes – this translates to roughly one in every 13 people with the illness." These include several new discoveries for schizophrenia, including lesions on chromosome 2. The research team also developed a systematic approach to the discovery and analysis of new, smaller rare genetic changes leading to schizophrenia, which provides dozens of new leads for H scientists studying the illness. ■

Alzheimer Society of Canada calls for Canadian Alzheimer's disease and dementia partnership The Alzheimer Society of Canada has called on the Federal Government to immediately establish a Canadian Alzheimer's disease and dementia partnership to lead and facilitate the development and implementation of a national dementia strategy. Mimi Lowi-Young, CEO at the Economic Club of Canada, says "Dementia is a huge threat to our public health

Community hospitals

threatened by secretive attempt to expand private surgical clinics Ontario's provincial government is making a substantive change to how some surgeries, procedures and other ambulatory

system and to our nation's productivity." "By 2040, Canada will spend $293 billion a year on this disease alone. We have the best minds and the best of intentions, yet what is missing is a fully coordinated response to curb costs and meet the crushing needs of families and those living with this profoundly life-altering and ultimately, fatal disease." Modeled after the Canadian

health services now available through public hospitals will be provided in the future. There is even a rapidly approaching deadline of October 11, 2013 for comments from the public on this significant change to health service delivery that would expand Ontario's reliance on private clinics and threaten the viability of community hospitals. "Yet few Ontarians are even aware that this is happening" says Michael Hurley president of the Ontario Council of Hospital Unions (OCHU) in calling for an open province-wide consultation on the regulatory changes. "It appears that the province is purposely doing very little to ensure the public is aware of the regulatory

Partnership Against Cancer and the Mental Health Commission of Canada, the Society is asking the Federal Government to bring together a partnership of dementia experts, government officials, health care providers, researchers and Canadians impacted by the disease to establish and implement an integrated, comprehensive H national strategic plan. ■

changes that will expand the use of private clinics to deliver publicly-funded health services. In fact the consultation process is so low-key and under the radar that it seems like the province really doesn't want public scrutiny." The changes to health service delivery that include the expansion of privatized primary care are so significant, says Hurley, that the little-known October deadline for comments should be scrapped in order to give "people all over Ontario from Thunder Bay to Windsor and Cornwall a chance to give meaningful input to the provincial government through well – publicized pubH lic hearings." ■

OCTOBER 2013 HOSPITAL NEWS

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The stigma of

mental illness While researching for this column, I came across a story about two British supermarket chains selling Halloween costumes that make “insensitive references to mental health issues.” Insensitive is not the word I would use to describe the costumes in question – I think abhorrent is much more appropriate. I won’t go into detail because the nature of these costumes is unspeakable. Fortunately, mental health advocates took swift action and the costumes have been removed from the shelves. That’s well and good, but the damage has been done – the stigma associated with mental illness is alive and well. Can you imagine a major retailer selling a costume depicting a patient with cancer? Everyone would be outraged. For the one in five Canadians living with mental illness, the stigma associated with their illness can often be more difficult to manage than their symptoms. Many (49 per cent) won’t even seek treatment because their fear of being judged outweighs their need for treatment. Perhaps what is even more disheartening is that often, when they do seek treatment they can be subjected to discrimination from the very people they have turned to for help. “The stigma associated with mental illness can be a killer. In many instances health care professionals have no idea as to the impact of stigma and discrimination. As a result, people report that once they express they have a mental illness, their legitimate physical health concerns are often disregarded,” notes Richard Chenier, Senior Project Manager at the Mood Disorders Society of Canada. Aren’t health care professionals trained to provide care to people living with mental illness? Shouldn’t they be the exceptions to stigma? Surprisingly, that’s not always the case. Hospital News’ monthly poll asked health care professionals if they felt their training had pre-

pared them to care for people living with mental illness. Nearly half of respondents (47 per cent)said they had received very little training and did not feel prepared. Only 16 per cent of respondents felt confident their training had prepared to provide adequate care to this patient group. “We hear from health professionals that they don’t receive enough training in dealing with people living with mental illness,” says Romie Christie, Manager, Opening Minds, Mental Health Commission of Canada. “Some of our recent research shows when health care providers have increased confidence in their skill level and feel they have the tools and wherewithal to help these patients they feel empowered and it reduces stigma,” she adds.

Mental illness is not a choice. It is a diagnosis, just like cancer or diabetes. So education is part of the answer. Several professional associations have partnered with national mental health organizations to create online education courses designed to break down the stigma and provide health care professionals with the tools they need. Christie adds, “When doctors, nurses and mental health workers in emergency rooms see patients with mental illness, they are at their most acute stage, when they aren’t doing their best. We have found another key ingredient to reducing stigma is when health professionals see people with lived experience of mental illness when they are in recovery, managing their illness and contributing to their communities.” Dr. Tyler Black, Medical Director of Child & Adolescent Psychiatry Emergency Unit, BC Mental Health and Ad-

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diction Services explains, “There is often a sense of hopelessness or this idea that mental health care is too complex, it’s a black hole, when in fact we are learning more and more and have some excellent treatments available.” This is why Brett Batten has courageously decided to abandon his anonymity and share his story with our readers. Having lived with mental illness for 20 years, he is in recovery and thriving. It is his hope that with this month’s cover story he can dispel some of the myths and change some of the negative perceptions of mental illness. Brett’s story is moving and powerful. He is living proof that health care professionals can make a difference in the lives of people living with mental illness. He has experienced discrimination from some health care professionals but also credits the ones who were able to see him as a person with saving his life. If that’s not enough reason to arm yourself with the education and tools you need to provide care to those living with mental illness, I don’t know what is. Mental illness is not a choice. It is a diagnosis, just like cancer or diabetes. We have come a long way. Up until recently, Canada was the only industrialized nation in the world without a national mental health strategy. That has changed with the advent of the Mental Health Commission of Canada. “Without a doubt, mental healthcare is improving in Canada. Hospitals need to take a proactive approach and collaborate with community-based organizations which represent the voice of the consumer. Consumers with lived experience (of a mental illness) need to be listened to,” adds Chenier. Until we arrive at a place where a costume depicting a ‘mental health patient’ evokes the same outrage as a costume of a ‘cancer patient’, there is much work to H be done. ■

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New report calls for expanding evidencebased treatment for opioid dependence By Kevin Hollett ccess to heroin and opioid medical treatment should be expanded to reduce the harms associated with addiction, according to a new report from researchers at the BC Centre for Excellence in HIV/ AIDS (BC-CfE). The report, published in the August issue of Health Affairs, highlights increases in the prevalence and hazards related to the use of opioids, such as heroin and prescription opioids like oxycodone, in the United States and Canada, and the gap in treatment availability in both countries.

Evidence shows appropriate treatment for opioid dependence is effective in reducing overdose deaths, lowering the risk of illicit drug abuse, and retaining clients on therapy “Access to proven and effective opioid addiction treatment has been severely limited in the United States and Canada,” says Dr. Bohdan Nosyk, lead author, health economist at the BC-CfE and associate professor of Health Sciences at Simon Fraser University. “We should be looking

at mechanisms that will expand access to treatment and discourage the use of ineffective and potentially harmful short-term (one to three month) detoxification treatment.” Evidence shows that methadone and buprenorphine, two forms of opioid substitution therapy, are effective at retaining clients in treatment. Prolonged retention in treatment can lead to reductions in illicit drug use, overdoses, behaviors that increase the risk of contracting HIV, and criminal activity. As a result, treatment has been shown to be highly cost-effective. The authors make several recommendations to expand access to evidence-based medical treatment, including: •eliminating restrictions on methadone prescribing •reducing ﬁnancial barriers to treatment •reducing reliance on opioid detoxiﬁcation treatment •integrating emerging treatments In the U.S., there are approximately 2.3 million people with opioid dependence, and opioid overdose is now the second leading cause of accidental death. As a result of a limited number of substance abuse facilities, fewer than 10 per cent of people addicted to heroin or opioids receive treatment. In Canada, there are an estimated 75,000-125,000 injection drug users (the majority of whom inject opioids) and an additional 200,000 people with prescrip-

Dr. Bohdan Nosyk, lead author of the report, health economist at the BCCfE and associate professor of Health Sciences at Simon Fraser University. tion opioid dependence. The availability of methadone maintenance treatment, where methadone is prescribed and dispensed as an opioid substitute in approved clinical settings, is limited in many provinces, resulting in long waiting lists for addiction treatment. “The abuse of opioids is pervasive around the world, however access to lifesaving treatment is limited in the United

States,” says Dr. Nosyk. “Further efforts are necessary to make treatment more readily available, particularly by eliminating the financial barriers faced by disadvantaged people, who are often the most complex to treat.” The authors propose changes to federal and state laws to adopt methadone maintenance treatment in office-based settings such as private doctor’s offices, as well as policies to mandate addiction education in medical schools to ensure treatment is administered safely and effectively. In addition, they recommend public and private insurers provide universal coverage for opioid substitution treatment. “There are serious medical harms associated with heroin and opioid injection, including the transmission of HIV and hepatitis C,” says Dr. Julio Montaner, senior author and director of the BC-CfE. “This research underscores the urgent need for scientific, evidence-based interventions to address these individual and public health harms.” A copy of the report, titled “A Call For Evidence-Based Medical Treatment Of Opioid Dependence In The United States And Canada,” is available on Health H Affairs' website. ■ Kevin Hollett works in communications at the BC Centre for Excellence in HIV/ AIDS (BC-CfE).

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Drug use in hospitals: Is there a role for harm reduction? By Thomas Kerr & Lianping Ti rug use remains a cause of significant health and social harm for individuals, communities and the health care system. High rates of infectious diseases, overdose and traumas among intravenous drug users (IDU) result in much preventable human suffering and present challenges for the health care system. Despite these challenges, recent evidence from Vancouver gives reason for hope. A report released this year by the Urban Health Research Initiative of the British Columbia Centre for Excellence in HIV/ AIDS, Drug Situation in Vancouver, indicates that much has improved for IDU in Vancouver. Rates of HIV infection and other indicators of drug-related harm have plummeted. This is very good news given that in the late 1990s the Vancouver/ Richmond Health Board declared a public health emergency in response to soaring rates of HIV infection and overdose among local IDU. The improvement in the health of IDU in Vancouver can largely be attributed to increasing access to addiction treatment, HIV treatment, but also the implementation of a range of harm reduction programs. Harm reduction programs seek to reduce the harms of drug use without requiring abstinence from drugs. Such programs place very few requirements or conditions on IDU and are considered to be “low-threshold” interventions. This approach is consistent with growing awareness among experts that addiction is often a chronic relapsing condition, with periods of active use occurring in between periods of abstinence. Examples

HOSPITAL NEWS OCTOBER 2013

Insite – a supervised injection facility located in Vancouver has shown positive results including an increase in access to addiction treatment. include syringe and crack pipe distribution programs, and supervised injection sites where IDU can inject drugs under the supervision of health care professionals. The positive impact of harm reduction

Although progress in reducing the harms of illicit drug use can be seen in community settings throughout Canada, the same cannot be said about hospitals.

in Vancouver is not surprising given that the World Health Organization and the United Nations’ Joint Program on AIDS recommend harm reduction programs as best practices. Although progress in reducing the harms of illicit drug use can be seen in community settings throughout Canada, the same cannot be said about hospitals. It is well known that many IDU avoid primary care and often overrely on emergency departments for care. As a result, many IDU show up late in the course of illness and require admission to a hospital bed. Sadly, research undertaken in Canada shows that far too many IDU leave hospital long before they should. A study undertaken in Vancouver showed that one quarter of all IDU admissions resulted in a patient leaving hospital against medical advice (AMA), and others have shown that IDU are about four times more than likely than their non-IDU counterparts to leave hospital AMA. Leaving hospital AMA often results in more serious illness and greater health care costs. The more commonly reported causes of AMA among IDU include active addiction, withdrawal, and untreated pain. Not surprisingly, research has also shown that many IDU inject drugs in hospital to deal with their withdrawal and pain. However, when faced with abstinence-based policies and the associated sanctions for drug use in hospital, many IDU simply leave. So what could hospitals do to address the problem of AMA among IDU? One approach would be to implement and evaluate hospital-based harm reduction programs. Past research has shown improvements in retention in primary care when harm reduction approaches were implemented. Likewise, the use of substitution therapies for opiate addiction, such as methadone and buprenorphine, has been associated with improved hospital care, including reduced AMA. Providing opiates or benzodiazepines to patients experienc-

ing withdrawal can also reduce the likelihood of premature discharge. A further innovation would be the inclusion of drug consumption facilities within hospitals. Recent evaluations of Vancouver’s supervised injection facility, known as Insite, have shown positive results in terms of reductions in infectious disease transmission, overdose, and disorder arising from use of drugs in public spaces. The evaluation also showed increases in access to addiction treatment and no negative impacts, such as increased crime or drug use. A supervised consumption room has also been implemented in the Dr. Peter Centre Day Health Program, which serves individuals living with HIV/AIDS and was at one time located in St. Paul’s Hospital. An evaluation of this program revealed that staff at the Centre found that the drug consumption room helped facilitate care and reduce overdose risk by reducing the need to punitively manage drug use onsite. Active illicit drug use continues to present challenges within health care settings throughout Canada. However, there is growing consensus that harm reduction programs can play an important role in mitigating the health and social harms of drug use, and can also promote more effective engagement in care and treatment. Given the significant problem of AMA among IDU, and given that harm reduction programs have become key features within community settings, it seems that the time has come for a new agenda of harm reduction program development and H evaluation for hospitals in Canada. ■ Thomas Kerr is the co-Director of the Urban Health Research Initiative of the British Columbia Centre for Excellence in HIV/AIDS, and an Associate Professor in the Department of Medicine at the University of British Columbia. Lianping Ti is a doctoral student at the School of Population and Public Health at the University of British Columbia. www.hospitalnews.com

Evidence Matters

Treating Schizophrenia:

What's the evidence By Sarah Berglas

chizophrenia is a chronic mental illness that requires lifelong treatment. Symptoms can be highly disruptive to a patient’s life and include hallucinations, delusions, cognitive impairment, disorganized thoughts, social withdrawal, and lack of motivation. The worldwide prevalence of schizophrenia is 0.5 to 1.5 per cent — with about 1 per cent of the Canadian population affected. Antipsychotic medications are the cornerstone of treatment for schizophrenia. Most of these fall into one of two classes: first generation or typical antipsychotics, and second generation or atypical antipsychotics (AAPs). Around one-third of patients with schizophrenia have a poor response to treatment with an antipsychotic. Although not recommended in most clinical practice guidelines, other strategies may be tried in an attempt to improve response to treatment. These may include prescribing an atypical antipsychotic at a dose higher than recommended (high-dose therapy) or prescribing an atypical antipsychotic in combination with another antipsychotic medication (combination therapy). But are these strategies safe and effective?

Olanzapine (Zyprexa), quetiapine (Seroquel), and risperidone (Risperdal) are the most widely used atypical antipsychotics prescribed at doses higher than their product monograph specifies. “If the patient is still responding to the medication, but hasn’t quite got to where I want him or her to be, then I would still continue to increase the dose….past the maximum recommended dose” Psychiatrist, Alberta. www.hospitalnews.com

Around one-third of patients with schizophrenia have a poor response to treatiment with an antipsychotic “With [olanzapine], I’ve patients above the recommended dose, because there isn’t as much of an issue with akathisia and extrapyramidal symptoms.” Psychiatrist, Quebec. When it comes to combining antipsychotic therapies, the most frequently prescribed combinations included risperidone, quetiapine, and/or olanzapine. “If the medication is not sufficiently effective, and a higher dose won’t be tolerated, I’m hoping that a second medication will be tolerated.” Psychiatrist, Ontario. “I might add a second antipsychotic that’s more sedating to help with sleep at night” Psychiatrist, Ontario. However, clinicians may be very surprised to learn how little evidence exists as to the safety and efficacy of these practices in treating schizophrenia. The Canadian Agency for Drugs and Technologies in Health (CADTH) – an independent, not-for-profit producer and broker of health technology assessments – recently completed a comprehensive study, with recommendations, examining the high-dose or combination AAP therapy, to treat schizophrenia in patients who had an inadequate response to initial therapy. In none of the 10 randomized controlled trials analyzed did high-dose atypical antipsychotics work better than standard dose atypical antipsychotics. There was a similar lack of evidence on prescribing two antipsychotics simultaneously. No clinically important benefits were seen with other antipsychotic combinations, and there may be an increase in serious adverse effects. What are the best options when schizophrenia symptoms are not being controlled? Exploring adherence to treatment and ruling out substance use are good places to start. Then both CADTH and the Canadian Psychiatric Association Clinical Practice Guidelines recommend either increasing the dose – but within the recommended dose range – or switching to a different antipsychotic drug, rather than combining antipsychotics or going beyond the maximum recommended dose. Another option when patients are not responding well to therapy is switching to

clozapine. Some clinicians may be reluctant to do so because of the risk of serious side effects and the need for blood monitoring. “The disadvantages are…the weekly blood monitoring, there’s the agranulocytosis, there’s seizures. I mean, it’s hard to get patients on it because you worry they will not be compliant with the weekly blood monitoring.” Psychiatrist, Ontario. “I wouldn’t [prescribe clozapine]. I would send a patient to someone who is more specialized if I was going to do that.” Psychiatrist, Quebec But others recognize clozapine as an important and potentially underutilized treatment option. “I have [prescribed clozapine] from the day it became available in Canada. I would say

less than 10 per cent [of my patients are taking clozapine]. And I should also say that I’m probably underutilizing the drug. It is a very effective drug.” Psychiatrist, Ontario To read more on atypical antipsychotic high and combination strategies in schizoH phrenia, visit www.cadth.ca/aaps. ■ The Canadian Agency for Drugs and Technologies in Health (CADTH) is an independent, not-for-profit producer and broker of health technology assessments. Federal, provincial, and territorial health care decision-makers rely on our evidence-based information to make informed decisions about the effectiveness and efficiency of drugs and other health technologies.

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Research network to investigate the mental health of fathers By Lauren Pelley s a child psychiatrist at St. Joseph’s Health Centre, Dr. Andrew Howlett has seen firsthand the powerful role fathers play in a child’s development – and the issues that can arise when dads don’t manage their own mental health concerns. “I wondered about how much we do to engage fathers in child care,” Howlett says. “And what’s the impact on the outcomes for children when their fathers are more involved?” With that motivation in mind, Howlett set out to research how men – and fathers in particular – handle their own mental health needs, and how this can impact their children. His research planning initiative has received full approval and funding, worth nearly $24,000 from the Canadian Institutes of Health Research. Howlett says this planning grant will support the development of a Fathers Mental Health Research Network (FMHRN) and enable the University of Toronto to host a meeting of international researchers in the area of fathers' mental health later this year. Dr. Jerry Maniate, Chief of Medical Education & Scholarship at St. Joseph’s Health Centre, says this is an exciting opportunity for St. Joe’s to be part of some important research. “St. Joe’s is a community academic hospital, and this is a great chance for us to contribute to a project that’s of national and international interest and impact,” he explains. Howlett’s research, alongside his coinvestigator, Dr. Robert Maunder, Head of Research in the Department of Psychiatry at Mount Sinai Hospital, will be building upon some already-established findings. Previous research has shown men are more likely to develop certain mental health and substance use conditions, Howlett notes. “There’s no question that (men) are less aware of their mental health and are less likely to use mental health services,” he adds. This, in turn, increases men’s risk of impairment or death. These issues carry over into fatherhood and can have a negative impact on children, as Howlett has observed working

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with young patients and their families at St. Joe’s. “Dr. Howlett's research speaks to the comprehensive mental health and addictions care and treatment we provide for both children and adults here at St. Joe's,” notes Paula Podolski, Administrative Program Director for the Mental Health and Addictions Program. “Our goal is to meet the needs of our community, and the mental health of fathers is clearly an area that requires attention.” Helping patients is the ultimate goal of Howlett’s research, and he says he hopes to begin developing clinical programs and public awareness initiatives based on men’s mental health once the research network is in place.

“There’s a growing concern over the fact that health care organizations need to better engage men – particularly fathers – and offer a service that would be exclusive to them, and attractive to the most reluctant dad,” Howlett says. Gender-specific treatment has moved forward in recent years for women, he notes, but services geared towards men are lagging behind. “I think being able to involve fathers and help them better understand their difficulties – and find ways to manage them – will better enable them to improve their H role as dads,” Howlett says. ■ Lauren Pelley is a Junior Associate, at St. Joseph’s Health Centre, Toronto.

Dr. Andrew Howlett at the Just for Kids clinic at St. Joseph’s Health Centre, Toronto.

Helping patients butt out gets results By Dahlia Reich

t’s one of the hardest habits to break but with just a little help at the right time, patients about to undergo surgery can be successfully convinced to butt out, a research study at St. Joseph’s Hospital in London has shown. The study, published in the September issue of the prestigious journal Anesthesia and Analgesia, tested the effectiveness of a smoking cessation program offered to surgical patients attending the Preadmission Clinic at St. Joseph’s. It compared a control group of pre-surgical patients who were simply advised to stop smoking at least three weeks prior to surgery and provided with a pamphlet, to a treatment group that received a structured interview with a nurse trained to counsel patients on smoking cessation, brochures on the advantages of stopping smoking before surgery, a referral to Ontario's ‘Smokers Helpline’, and a six-week supply of nicotine patches. On the day of surgery, 14.3 per cent of patients in the treatment group had stopped smoking compared to 3.6 per cent in the control group, explains St. Joseph’s anesthesiologist Dr. Pat Morley-Forster. At the 30-day follow-up, the difference had increased further to 28.6 per cent in the treatment group and 11 per cent in the control group. As well, the treatment group

was ready to be discharged earlier from the Post-Anesthesia Care Unit (PACU) after surgery. “These differences were statistically significant,” says Dr. Morley-Forster, who is also an associate scientist at Lawson Health Research Institute. “Surgery is a teachable moment for patients and this shows that we can have a significant impact on motivating people to stop smoking at this critical time if they are given the right support.”

Surgery is a teachable moment for patients and this shows that we can have a significant impact on motivating people to stop smoking at this critical time if they are given the right support Smoking by surgical patients is associated with increased complications, particularly perioperative respiratory problems and poor wound healing. The purpose of the study was to determine if pre-surgery smoking cessation intervention designed for a busy preadmission clinic would be successful in reducing smoking rates and the complications associated with it. Tracey Newman-Marshall was one of

the first patients to take part in the study and has now been smoke free for nearly three years. She had tried to quit smoking several times without long-term success. “It was like a rope was thrown out to me at exactly the right time,” says NewmanMarshall, who received knee surgery. “I was at a point where I wanted to make changes. The support provided to help me quit was phenomenal. Now I’m pain free and smoke free.” Dr. Morley Forster collaborated with Dr. Philip Jones on the project. Both are faculty members of Western University’s Department of Anesthesia and Perioperative Medicine. The study took place at St. Joseph’s Hospital between October 2010 and April 2012 with 168 patients participating. Dr. Susan Lee and Dr. Jen Landry, both anesthesiology residents at the time of the study, were the primary investigators and first authors of the paper. Follow up at the one year mark to see how many of the study patients continued to refrain from smoking is currently being compiled. Findings of the study are being shared with various hospital departments in the city with a goal of working towards making smoking cessation a priority for all H patients. ■ Dahlia Reich works in Communication & Public Affairs at St. Joseph's Health Care, London. www.hospitalnews.com

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AMBULATORY CARE/NEUROLOGY/MENTAL HEALTH AND ADDICTION

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AMBULATORY CARE/NEUROLOGY/MENTAL HEALTH AND ADDICTION

This is the future of healthcare By Patricia Nicholson

n first glance, it might seem like Women’s College Hospital’s (WCH) new building is missing one or two things. You’ll definitely find state-of-the-art operating rooms, specialized treatment areas designed around coordinated care, and unique programs that aim to improve the way healthcare is delivered and advance the health of women. But if you’re looking for an emergency room, or a maternity unit, or even patient beds, you won’t find them here. That’s because WCH is a different kind of hospital: one designed to keep people out of hospital. The new facility is purposebuilt to lead and evolve the field of ambulatory care. Phase one of this new hospital was completed last spring, and opened its doors to patients in June, 2013. “We call it the hospital of the future,” says Marilyn Emery, CEO of WCH. “And it’s about our innovative ambulatory model of care, which allows us to provide treatments, diagnostic and complex surgeries all

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without requiring overnight stays. It’s how we are developing programs and partnerships that enable us to offer our patients quality care with the best treatment outcomes and highest patient satisfaction.” To build the hospital of the future, WCH looked at the realities of the present, and what health care trends will mean in the coming decades. At a time when healthcare is facing challenges such as the increasing prevalence of multiple chronic conditions, an aging population and limited health care resources, WCH is focused on delivering tangible solutions for the health system. Keeping people out of hospital means creating programs and models of care that reduce emergency room visits and hospital admissions. It means tackling issues like care transitions and health system gaps, and improving care for patients in marginalized and hard to reach populations. And it means providing sophisticated procedures that yield the best possible results. One such procedure is Mohs micro-

Women’s College Hospital physician Dr. Christian Murray sees a patient with skin cancer for a follow-up visit at the hospital’s Mohs clinic. graphic surgery. Used to treat aggressive, non-melanoma skin cancer, Mohs is a meticulous surgical process that removes as much cancerous tissue as possible while preserving unaffected tissue. That means it provides both the highest possible cure rate and the best opportunity to minimize scarring. The Mohs surgeon microscopically maps the edges of the tumour to provide the most accurate and detailed excision guide. This complex procedure is reserved for more challenging tumours, often on the face and neck. In the Greater Toronto Area, the only specially trained physicians performing this groundbreaking procedure are at WCH, where more Mohs surgery is performed than in any other hospital in Canada. Two ﬂoors above the Mohs clinic in Phase 1 of the new hospital, Emery’s office overlooks the construction site of Phase 2. The second phase is scheduled to open in 2015 complete with an iconic pink glass cube that will serve as the new conference centre where new ideas and research come together to spark groundbreaking innovations. When joined together, the two phases will form a 400,000-square-foot facility that will have the capacity to welcome patient volumes 70 per cent higher than the previous WCH building that stood on the same spot. “Our new building, will integrate treatment, education and research to provide fully coordinated care,” Emery says. “We know that patients often require care from more than one health care professional. So we’ve set up clinical areas to provide patients with fast and efficient access to all aspects of the treatment they require.” For example, the Breast Centre – which is the only program of its kind in Toronto – is set up to provide a one-stop shop for breast care. It has mammography and ultrasound located in the same place as the physicians, nurses and therapists that

would be involved in the patient’s care. So patients don’t need to move around the hospital between different rooms and ﬂoors to see their various providers. Instead, the providers come to them. It’s all part of the patient-centred design of the new facility, which contributes to more efficient care delivery and a more comforting and welcoming environment for patients.

Women’s College Hospital is a different kind of hospital: one designed to keep people out of hospital. The new facility is purpose-built to lead and evolve the field of ambulatory care. The Breast Centre is only one of WCH’s innovative programs – such as the unique Young Women’s Gynecology Clinic and the new Toronto Birthing Centre – that continue the hospital’s longstanding commitment to advancing the health of women. Championing women’s health is one of the most celebrated aspects of WCH’s rich past, and it’s a past the hospital takes great pride in. And, outside Emery’s window, the future is taking shape on the busy construction site, where the old brick building that housed the hospital for much of its 102 years is making way for the new modern facility. “This is such an exciting time for Women’s College Hospital. Designing an exclusively ambulatory hospital is an opportunity to create new models of care that address the most pressing needs of our health system,” Emery says. “It’s not just about building a new hospital. It’s about H building the future of healthcare.” ■ Patricia Nicholson is a writer at Women's College Hospital. www.hospitalnews.com

Focus 11

AMBULATORY CARE/NEUROLOGY/MENTAL HEALTH AND ADDICTION

Easing the transition from an adolescent day hospital program to high school By Alannah Nesci magine you are a 16 year old student struggling with mental illness – the thought of going to school every morning is something you dread. Your school has tried to help, but ultimately, it lacks the resources to provide you with what you need. This scenario is faced by a number of youth on a daily basis and the reality is that some of them stop attending school altogether. In response to the need for a better way to help serve this patient population, the child and adolescent services team at Markham Stouffville Hospital (MSH) developed the A.T.L.A.S program (Adolescent Treatment and Learning Alternative Service) to meet the unique needs of these patients.

A.T.L.A.S integrates group therapy, academics and physical education. The ultimate goal of the program is to help patients learn to manage their symptoms and return to their schools. A.T.L.A.S is an adolescent day hospital program that runs during school hours from 9 a.m. to 3:15 p.m. for youth with severe anxiety and/or depression. The program is set to open this fall and will provide patients with a positive academic experience together with therapeutic support to help them work to overcome their emotional difficulties. The program is geared towards patients between the ages of 12 and 19 who have been referred by a doctor. The hospital has a number of community partners contributing to the comprehensive program being offered. The program’s main partner is York Region District School Board (YRDSB). MSH is also fortunate to have access to resources at the Cornell Community Centre, including a library and a gym, through a linked walkway. A.T.L.A.S integrates group therapy, academics and physical education. The ultimate goal of the program is to help patients learn to manage their symptoms, return to their schools, and cope with the daily demands of their academic, social, and family lives. There are a number of day hospital programs within the Greater Toronto Area and York Region. What are the strengths of the A.T.L.A.S program at MSH and what makes it different? Firstly, the program offers a graduated approach to transitioning patients back to the regular school system. The strategy focuses on starting the integration into the community from the beginning of a patient’s experience. Each day begins at the Cornell Community Centre where patients will work to complete a physical education credit by participating in activities in the centre’s gym and a weekly yoga class in the sensory room. Patients will also have the opportunity to attend youth groups open to all www.hospitalnews.com

A.T.L.A.S Program team members gather at the Cornell Community Centre and Library to discuss the fall 2013 program start Markham teens at the Cornell Community Centre Library. The groups will focus on topics of interest to teens such as the real deal on going to university, saving up for your first car, and cooking quick and easy meals. This aspect of the program helps reorient patients to the kind of group discussion experienced in school classrooms and provides an opportunity for informal communication with peers. “Having patients participate in youth group activities as well as gym in the community centre increases the likelihood that they will carry on these activities once they

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have returned to life beyond day hospital,” says Dr. Jessica Cooperman, psychologist with the program. “And by also focusing on the link between mind and body, we can achieve greater results through physical education and yoga, ultimately helping our patients achieve better overall health – both mental and physical.” Secondly, the program has a strong partnership with YRDSB in which the school board provides two dedicated teachers who will work with patients to help them achieve school credits while they are in the A.T.L.A.S program.

Patients will have the opportunity to achieve a physical education credit through the partnership with Cornell Community Centre and other credits through use of the A.T.L.A.S computer lab and classroom. Thirdly, there is a focus on working not only with patients, but also with patients’ parents. The A.T.L.A.S program includes family therapy as well as a mandatory weekly counseling group for parents to help equip them with the skills to best support their teens in transitioning back to school. Finally, the program goes beyond the transition back to school. The A.T.L.A.S program doesn’t simply end when patients transition back to their regular schools. Patients are integrated into the student volunteer program at the hospital during their time in the A.T.L.A.S program, enabling them to earn volunteer hours towards their school requirements. Further, once patients transition back to school, they will be encouraged to continue participating in the volunteer program as well as the other after-school activities coordinated by program staff. “This program is very important for our community,” says Dr. Cooperman. “Until now, we haven’t had the in-house resources to fully address the needs of youth with this level of severity of symptoms. Having the A.T.L.A.S program right here at the hospital is going to make integrating these youth back to the outpatient program and ultimately, back into the community, a more seamless process.” For more information about the A.T.L.A.S program at MSH, please contact Dr. Jessica Cooperman at JCooperman@ H msh.on.ca. ■ Alannah Nesci is a Public Relations Associate at Markham Stouffville Hospital.

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OCTOBER 2013 HOSPITAL NEWS

12 Focus

AMBULATORY CARE/NEUROLOGY/MENTAL HEALTH AND ADDICTION

Intraoperative MRI leading to reduced patient re-surgery rates E

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arlier this year Stollery Children’s Hospital and the University of Alberta Hospital in Edmonton opened The Dan and Bunny Widney Intraoperative Magnetic Resonance Imaging (iMRI) Surgical Suite to give Albertans who need complicated neurosurgery access to a sophisticated surgical suite. Surgery is the primary treatment option for patients with brain tumours. The goal of surgery is to remove the entire, or as much of, the tumour whenever possible as any remaining tumour cells may grow back. Studies show that the extent of tumour resection is directly correlated with improved outcomes in both children and adults with brain tumours. However, the complete removal of a brain tumour remains a challenge depending on its size, shape and location. There are risks and possible complications every time brain surgery is performed. The ideal situation is performing the procedure once and to do it right. Installed by IMRIS, Inc. of Winnipeg, the VISIUS® Surgical Theatre with iMRI puts at our fingertips the tools needed to perform the most complicated neurosurgeries, as well as complex surgeries for patients with epilepsy, or head, neck and vascular issues. This state-of-the-art IMRIS iMRI suite provides the team of neurosurgeons and radiologists unprecedented precision and finely detailed images of the surgical progress in real-time during a procedure. Surgeons use this imagery, along with powerful new microscopes specifically designed for neurosurgery, to confirm they have completely removed as much brain tumour tissue as possible, potentially preventing the need for follow-up surgeries.

Neurosciences hospitals around the world with multi-year experience with iMRI have reported significant reductions in re-operation rates. The VISIUS iMRI suite includes a sixtonne, 3-Tesla MRI, that moves between two rooms – one for surgeries and one for diagnostic use – on rails mounted on the ceiling which eliminates having to transport or reposition the patient for imaging. Unlike other iMRI systems which require moving the patient from the surgical position and into the scanner, the IMRIS surgical suite limits risks associated with patient movement such as brain shift and monitoring equipment issues. Because the naked eye is insufficient for confirming that the entire tumour has been removed during surgery, a follow-up MRI is required to confirm the extent of resection. Before the iMRI, patients may have waited months to have a scan to see if the entire tumour was removed. For pediatric patients, identification of residual tumor may mean the need and risk for a second surgery. With the new technology, on-site radiologists who can take multiple images during the surgery can immediately give surgeons exact directions to where any remaining tumour is located. In a way we can call this

The intraoperative MRI within The Dan and Bunny Widney Intraoperative Magnetic Resonance Imaging (iMRI) Surgical Suite a GPS for the brain because of it’s ability to find and localize residual tumour material. Neurosciences hospitals around the world with multi-year experience with iMRI have reported significant reductions in re-operation rates. During the last 20 years, iMRI has been used to assist neurosurgeons in surgical planning and decision making on how to approach assessing tumour removal. In the last few years, the imaging quality has improved by bringing high-resolution (high-field) scanners into the operating space. The higher-field MR provides a high contrast equivalent to diagnostic imaging, allowing the detection of residual tumours and viewing eloquent structures. These intraoperative images provide neurosurgeons the ability to evaluate anatomical and pathological structures and overcome inaccuracies due to brain shift and updating neuronavigational data. Implementing the new iMRI involved new workﬂow training and safety checks. Surgery can be performed as usual with standard instruments. Acquisition of the images takes place in a control room adjacent to the OR and takes 15-30 minutes, depending on the MR sequences (series of images with adjustments within software applications). Analysis of this data is performed by an experienced neuroradiologist who discusses the case and possible continuation or other next steps with the neurosurgeons. When not needed during the procedure, the magnet moves out of the way and back into a parking bay so the surgery can either continue or be completed using normal workﬂow. The main indications for the using iMRI are the resection of gliomas and other types of tumours, but eventually will expand to help other patients for complicated tumours or disorders of the tongue, mouth, pituitary and other skullH based applications. ■ This article was submitted by the Pediatric Neurosurgery Department at Stollery Children's Hospital, Edmonton, AB. www.hospitalnews.com

Focus 13

AMBULATORY CARE/NEUROLOGY/MENTAL HEALTH AND ADDICTION

Online interactive story aims to help children understand emotions By Megan Tilley

hen it comes to mental health, The Hospital for Sick Children (SickKids) is breaking the barriers in an unconventional

way. This September marked the 11th anniversary of World Suicide Prevention Day, an initiative to raise awareness that suicide is preventable, improve education and share information to decrease the stigma that surrounds mental health. To recognize this day, SickKids launched a new interactive online story, Monarchâ&#x20AC;&#x2122;s Mission, designed to help children ages 12 and under, understand emotions.

It is estimated that two out of three students between grades 8 to 12 will think seriously of suicide at some time and that children as young as seven, often express thoughts of suicide. â&#x20AC;&#x153;Educational gaming is a big wave of the future,â&#x20AC;? says Dr. Johanne Roberge, director of psychiatry emergency and crisis service at SickKids. â&#x20AC;&#x153;Everybody has feelings and responds to things that go on in their life. Helping to understand those feelings and what those choices are makes our lives easier and helps us to get to happier places faster.â&#x20AC;? Suicide is the second leading cause of death for youth in Canada, and third in the industrial world. It is estimated that two out of three students between grades eight to 12 will think seriously of suicide at some time and that children as young as seven, often express thoughts of suicide. In most cases, health care professionals recognize children who have a hard time coping with emotions when they end up in

emergency rooms, mental health clinics, child protection agencies or if they have academic difficulties in school. â&#x20AC;&#x153;Some kids, when theyâ&#x20AC;&#x2122;re having difficulties coping with things, express it internally with physical feelings, medical complaints, crying or avoiding school, not socializing with peers or not wanting to leave the house,â&#x20AC;? says Dr. Roberge. â&#x20AC;&#x153;Or it can be directed outwards where you get kids who are in fights or stealing things because theyâ&#x20AC;&#x2122;re trying to satisfy emotional needs.â&#x20AC;? However, the younger you can educate children and the more skills you can give them, the better it is in the long run. â&#x20AC;&#x153;Children who have coping strategies when confronted with conďŹ&#x201A;icts, actually do better,â&#x20AC;? says Dr. Roberge. â&#x20AC;&#x153;They have the ability to self-soothe, which translates into what they will have later on in life in terms of their health, well-being, academic successes and level of criminality.â&#x20AC;? The idea is that the earlier you start to talk to children about their emotions, the more open they will be to guidance; as opposed to starting at a later age, where they may have had a number of years struggling with how to cope and be less inclined to want advice. Monarchâ&#x20AC;&#x2122;s Mission, developed by the AboutKidsHealth team at SickKids, is an interactive space odyssey that provides children with opportunities to broaden their understanding of the concepts of empathy, honesty and emotional awareness. Players assume the role of Hero â&#x20AC;&#x201C; a brave adventurer from Planet Terra who has been chosen to collect artifacts from an uncharted region of our galaxy. Along

the way, Hero and his/her trusty sidekick, Monarch, encounter aliens who are caught in the grip of an emotional crisis. It is here that Heroâ&#x20AC;&#x2122;s role changes from collector to confidant. By encouraging the aliens to recognize the emotions theyâ&#x20AC;&#x2122;re experiencing, Hero is able to help them identify the triggers of these emotions and equip them with the necessary coping strategies. AboutKidsHealth collaborated with Dr. Roberge and her crisis team to tackle this project. Its inception began when SickKids Foundation donors Fran and Dan Brown provided the seed funding for the game, on behalf of the Lisa Brown Foundation. The Browns lost their daughter to suicide. â&#x20AC;&#x153;When the Browns came forward with this vision for a tool that would help younger children understand emotions and learn to talk about their feelings, we were really inspired,â&#x20AC;? says GeneviĂ¨ve Metropolis, manager of web

design and graphics at AboutKidsHealth. Their focus, says GeneviĂ¨ve, was based on the learning objectives and any key messages identified by Dr. Roberge, who provided input on specific aspects of the game, such as gender neutrality. â&#x20AC;&#x153;We wanted this game to appeal to both girls and boys,â&#x20AC;? says Dr. Roberge. â&#x20AC;&#x153;And it was important that it be cross-cultural so that it would make the game as universal as possible.â&#x20AC;? According to Dr. Roberge, 90 per cent of completed adolescent suicides had a diagnosable psychiatric disorder, primarily: mood disorder, substance abuse and conduct disorder. â&#x20AC;&#x153;Most of therapy is about constructing a narrative to help children understand the story behind what theyâ&#x20AC;&#x2122;re feeling and what theyâ&#x20AC;&#x2122;re doing, as well as to get a perspective to make different, healthier choices when experiencing those things,â&#x20AC;? she says. â&#x20AC;&#x153;This is how therapy and the game complement one another. If we can help children talk more about their emotions now, then it will give them the skills they need to translate into their adolescent years.â&#x20AC;? Monarchâ&#x20AC;&#x2122;s Mission can be accessed H through the AboutKidsHealth.ca website. â&#x2013; Megan Tilley is a communications coordinator for SickKids Foundation.

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OCTOBER 2013 HOSPITAL NEWS

14 Focus

AMBULATORY CARE/NEUROLOGY/MENTAL HEALTH AND ADDICTION

Connecting patients with the right level of care By Heather Brown

hen Charlene Crews comes to work at St. Michael’s Hospital she’s never entirely sure how her day will unfold. As one of three transitional case managers for the Coordinated Access to Care from Hospital (CATCH) Homeless program, Charlene is responsible for working with homeless patients who have been referred by their acute care physician and linking them to vital support services within the community, following their discharge from hospital. “I feel very fortunate to be part of this program,” says Crews. “Before this initiative vulnerable patients would be discharged from hospital without any direct support in place for additional care.” CATCH-Homeless offers multidisciplinary transitional support, including case management, peer support, nursing, and primary and psychiatric care. The team identifies client needs, offers treatment of an acute episode of illness and initiates referral to the appropriate level of long-term support. In addition, case managers help clients meet their immediate basic needs by helping them access the Ontario Disability Support Program, showing them where they can find food and clothing banks and assisting them in establishing roots in the community. CATCH is the first program of its kind in Canada. A partnership between St. Michael’s Hospital, Toronto North Support Services and Inner City Health Associates, it was set up to help people who tend to rely on the emergency department for their healthcare to find the right level of care in the community. In addition to St. Michael’s, the program serves homeless people presenting to St. Joseph’s Hospital and the Centre for Addiction and Mental Health and hopes

By Michael Torres

YOU

Centre for Addiction and Mental Health (CAMH) led study of a cross-section of youth services across Canada has found that two in five young people receiving services are experiencing significant concurrent mental health and substance use problems. The project also shows that increased collaboration between youth service providers can enhance services for youth. Building on similar pilot projects conducted by CAMH in Ontario, the National Youth Screening Project involved 10 service networks in five provinces and two territories across Canada, and examined the service needs of youth between the ages of 12 and 24. The networks included service providers who work with youth from across sectors, for example mental health, substance abuse treatment, child welfare, education, family services, justice, and social services. Staff at these agencies implemented a standard screening tool that quickly and reliably identifies youth who may have one or more mental health or addiction problems.

Charlene Crews talks to Bill Hordij, St. Michael's Hospital patient, about community supports available through CATCH.

The success of CATCHHomeless has a lot to do with its model of care. The only rule is that a client cannot have any form of stable housing and is not connected to supports. to expand to other settings serving homeless people with unmet health needs. CATCH Homeless, which began in 2010, just accepted its 1,000th referral and has received positive feedback from clients and system stakeholders. “This program and Charlene in particular are the reason I am where I am today,” says a CATCH client who asked that his name not be used. “Before I met her my life was spinning out of control. She has been my sounding board and has pushed through barriers and opened doors in the community that I never could

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have done on my own. Falling to addiction and recently a separation, I truly believe the CATCH program and Charlene in particular has been the building block I needed to refocus my life.” Vicky Stergiopoulos, psychiatrist-in-chief at St. Michael’s Hospital, was the driving force behind the program. “There was a huge gap in our health care system around access to follow up care in the community for our marginalized patients,” Dr. Stergiopoulos explains. “Through the creation of CATCH-Homeless we eliminated the numerous barriers that existed and created a central hub for patients to be referred to where they have access to both medical and non-medical community support before their discharge from an acute care facility.” The success of CATCH-Homeless has a lot to do with its model of care. The only rule is that a client cannot have any form of stable housing and is not connected to supports. Should a client stray from the program for a short time, which sometimes happens, he or she can return without having to be referred again. All he or she has to do is reconnect with his or her transitional case manager. This sets CATCH apart from other agencies that assist vulnerable patients. Crews says she believes that although access to a long-term case manager is an important aspect of this program, sometimes all the client really needs is a friendly voice on the other end of the phone. She worked closely with one client who she felt would benefit from stable housing. No matter how hard she tried to convince the client that stable housing would increase his quality of life, he was adamant that staying outside was safer for him. She respected his decision but brought him a sleeping bag so he would have somewhere warm to sleep. It wasn’t permanent housing but it did make a difference in his world. The program team consists of a project coordinator, three transitional case managers who are provided to St. Michael’s, St. Joseph’s and CAMH by Toronto North Support Services, one St. Michael’s family physician and two St. Michael’s psychiatrists, including Dr. Stergiopoulos. Physician funding comes through Inner City Health AssoH ciates. ■ Heather Brown is a senior communications adviser at St. Michael’s Hospital.

HOSPITAL NEWS OCTOBER 2013

CAMH national report paves the way for improved access to youth services

We know that youth with mental health and substance use issues would benefit greatly from early intervention and specialized care, but most are likely to remain undetected, some well into adulthood “We know that youth with mental health and substance use issues would benefit greatly from early intervention and specialized care, but most are likely to remain undetected, some well into adulthood,” says Dr. Joanna Henderson, Head of Research in CAMH’s Child, Youth & Family Program and Project Co-Lead. “We found that when service providers use a standardized screening tool it gives them another strategy for understanding a youth’s needs and ensures that when different services work together, they are speaking a common language.” Statistics uncovered during the study further illustrated the need for better pathways to care: •Two in ﬁve youth screened positive for concurrent disorders (i.e. both mental health and substance use disorders). Continued on page 17 www.hospitalnews.com

November 4, 5, 6, 2013 Metro Convention Centre Toronto, Ontario

2013

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2013

Changing the future By Heather McPherson hospital designed to keep people out of hospital.â&#x20AC;? It is a simple, revolutionary, yet humble idea that defines the relationship between Womenâ&#x20AC;&#x2122;s College Hospital and our patients precisely as it should be: With them, not us, at the epicentre. Literally. It is a model in which clinicians of different specialty backgrounds are located in the same area, hubbed around the patient. This is in contrast to the traditional way, in which patients go from specialist to specialist, accumulating different â&#x20AC;&#x201C; and disintegrated â&#x20AC;&#x201C; medications and treatment plans. Simply put, the new Womenâ&#x20AC;&#x2122;s College Hospital is a purpose-built, â&#x20AC;&#x153;one-stop shopâ&#x20AC;? model with an ambulatory surgery process that enables patients to go home within 18 hours of their surgery. It is an outpatient model â&#x20AC;&#x201C; even for patients with complex chronic diseases, for example, who benefit from clinics, centres and interprofessional teams of care providers coming together in a single location and creating a joint treatment plan that gets the patient home quickly. And able, with the assistance of a caregiver and related home supports, to take care of themselvesâ&#x20AC;&#x2122; and enjoy a quality of life we all know isnâ&#x20AC;&#x2122;t possible anywhere else.

of womenâ&#x20AC;&#x2122;s health

And indeed it would be impossible to release patients so quickly without some exciting technological advances. Take, for instance, the case of reconstructive breast surgery post-mastectomy. Previously, the patient stayed with us for a full five days. Now, with the help of new categories of anesthetics and minimally invasive surgical techniques â&#x20AC;&#x201C; and with the ubiquitous smartphone, which allows monitoring of the patient in the home â&#x20AC;&#x201C; it is under that

Simply put, the new Womenâ&#x20AC;&#x2122;s College Hospital is a purpose-built, â&#x20AC;&#x153;onestop shopâ&#x20AC;? model with an ambulatory surgery process that enables patients to go home within 18 hours of their surgery magic mark of 18 hours. Yet much of what makes the model possible is decidedly low-tech. With an initiative we called A Thousand Voices For Womensâ&#x20AC;&#x2122; Health, we asked women of all ages, demographics and health conditions what they wanted in the health care facility of

the future. We heard that they wanted coordinated care â&#x20AC;&#x201C; the one-stop-shop. We also heard that they didn't want a hospital that felt too clinical, which registered with them as intimidating. Instead, they wanted a warm, welcoming, human space. These themes were brought out in the new building through a wide range of design choices: Comfortable, non-traditional furniture including wingback chairs and loveseats; waiting rooms with big windows and lots of light; a genuinely intuitive flow to the floorplan that significantly

overcomes the hospital wayfinding that is so often confusing; colours that create a pleasing aesthetic environment and actually decrease anxiety. Itâ&#x20AC;&#x2122;s all about putting patients at the centre of everything we do. So we can change the future of womenâ&#x20AC;&#x2122;s health â&#x20AC;&#x201C; together. A model of the Womenâ&#x20AC;&#x2122;s College Hospital redevelopment will be featured in a H special exhibit at HealthAchieve. â&#x2013; Heather McPherson is Vice-President, Patient Care & Ambulatory Innovation at Women's College Hospital.

Mental health documentary connects with youth By Karim Mamdani

f I were to ask what percentage of people living in our communities are affected by mental illness I am sure I would get a wide and varied response. The truth is we are all affected by mental illness. One in five people will experience a mental illness at some point in their lifetime. But the effects of mental illness are shared among families and friends. The same is true for those young people who are struggling with a mental health disorder. The adolescent mental health journey is at the heart of our documentary film Three Voices: Discovery, Recovery, Hope. The film tells the powerful and moving real-life stories of three young people â&#x20AC;&#x201C; Stella, Alyshia and Asante. Each talks openly about their mental health struggles, their discovery and recovery journey, offering hope to others. Having held many screenings of the film at schools, private events and film festivals in both Canada and the United States, I can tell you that the message resonates with the audience regardless of age. Students connect with the three people in the film, who attend many of these screenings to answer questions. Students can see themselves and relate to their stories even in small ways. When the lights go up, they surround our three subjects buzzing with questions and looking for insight into things they may be experiencing. The film helps them understand and see the real face of mental illness and not just the ficti-

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tious stereotype they are used to seeing in TV and movies. Three Voices was created to help build awareness, reduce stigma and support our Adolescent Mental Health Literacy Program which trains teachers to deliver mental health curriculum at the high school level. We are pleased to see the tremendous uptake of this program. To date we have trained almost 1,000 teachers representing 12 school boards and private schools in Ontario. As with any illness, education is imperative to help with early identification. But for people suffering with mental illness and their families, stigma can be one of the biggest challenges to overcome. Young people with mental illness can be confused and unsure why they may be feeling sad or emotional. They may be afraid to speak for fear of being judged or labeled. In some cases they may have made an attempt to reach out for help only to have their concerns dismissed. The film is a great tool to reach young people and serves as a catalyst for dialogue and making that first step to ask for help. So far this year, Three Voices has been seen by more than 5,000 people through school events, private screenings and film festivals, including the New York City Mental Health Film Festival. The film and curriculum deliver the message that help is available if you are struggling with a mental health issue. We want to show young people that despite what they may be feeling they are not H alone. â&#x2013;

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OCTOBER 2013 HOSPITAL NEWS

2013 HealthAchieve 2013

Conference: November 4–6 Exhibition: November 4–5 Metro Toronto Convention Centre healthachieve.com

Exhibit Floor Highlights If you’re planning to attend HealthAchieve this year, make sure you schedule ample time to visit the award-winning exhibit ﬂoor – featuring close to 300 exhibitors and special attractions – the HealthAchieve experience just isn’t complete without a visit to the exhibit hall. Hundreds of exhibitors, showcasing the latest and greatest products and services extend a warm welcome to you – inviting you to visit their exhibit spaces for a chance to not only learn about the latest innovations in health care but also win some great prizes! New Product Showcase

Marketplace

Prepare to see the latest innovations in health care at this year’s HealthAchieve. The New Product Showcase is a dedicated area on the exhibit ﬂoor where exhibitors will showcase their latest products and services that ﬁt with HealthAchieve’s theme of Inspiring Ideas and Innovations. Don’t miss this opportunity to see some of the latest and greatest products that are sure to transform the delivery of health care.

The Marketplace is an interactive area on the exhibit ﬂoor where delegates can post their comments, network and share ideas and points of view. A collection of graphic illustrations and knowledge walls will make this a mustvisit location ﬁlled with attendee thoughts and perspectives on health care and beyond.

GE Healthcare

Meet and Mingle Hour

Come see how GE Healthcare is providing solutions that could change your care model for patients living with chronic disease. Remote Care Management is not just a technology solution, but a solution that can provide deeper, more personalized health care, while empowering patients with a tool that can access information to provide relevant and timely health care support.

A special one hour of the event will be dedicated to networking. This “meet and mingle” hour is yet another opportunity for you to network with health care professionals and business leaders in the industry. It’s one hour dedicated just for you – giving you the opportunity to take a break, see some of the latest innovations in health care, share your ideas and points of view with colleagues in the Marketplace, enter draws for your chance to win some incredible prizes and enjoy complimentary beverages courtesy of Booster Juice!

New Exhibitors Lane We welcome exhibitors who are new to HealthAchieve and give delegates the opportunity to find them easily. While on the exhibit floor, visit aisle 2000 to meet these first-time exhibitors – it is your chance to see their latest products and services and learn about what they can offer you and your organization.

Green Lane Green Lane is a dedicated area of the exhibit ﬂoor where organizations providing environmentally friendly products and services gather together to showcase innovative ways to help facilities save energy, reduce pollution and make healthier, greener choices.

Isabella’s Café This is a lounge area on the exhibit ﬂoor where you can relax, network with colleagues, and make use of free charging stations. While you’re in this area, be sure to try the complimentary hot beverages offer by Mars Drinks Canada.

HOSPITAL NEWS OCTOBER 2013

NEW

Health Care Community y Capital Project Display NEW With all the incredible capital initiatives taking place in Ontario health care facilities, HealthAchieve Show Management has reached out to these organizations inviting them to showcase their innovative new building design concepts. Come and see these state-of-the-art health care facilities that will be on display on the exhibit ﬂoor.

Book Store

NEW

Many of HealthAchieve’s keynote speakers are published authors. Purchase a copy of their latest book at the HealthAchieve Bookstore located on the exhibit ﬂoor.

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2013

Help us save more lives! • • • • •

Ontario’s organ and tissue donation registration rate is 23%. In 2012, 1053 lives were saved through organ and tissue donation. A signed donor card is not enough. Register today. All eligible Ontarians aged 16 years or older can register their consent to donate. Speak to your family about your decision. Register at beadonor.ca/healthachieve. You can use your Smartphone.

beadonor.ca Visit the Trillium Gift of Life Network booth (#1633) at HealthAchieve.

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OCTOBER 2013 HOSPITAL NEWS

2013

Canadaâ&#x20AC;&#x2122;s healthcare architect

Parkin Architects Limited sets the healthcare planning and design standards for others to follow. This is achieved by active participation in provincial and national associations, (such as the CSA), independent research and robust practical experience. Parkin is also an Evidence-Based 'HVLJQ $FFUHGLWDWLRQ DQG &HUWLĂ&#x20AC;FDWLRQ 3URJUDP ('$& $GYRFDWH Ă&#x20AC;UP

An award-winning leader in institutional planning and design, with a history dating from the 1940s, Parkin provides professional services to clients across Canada and internationally. A large number of the accomplished staff of over 120 architects, planners, designers, project managers and LEED accredited professionals are dedicated on a full-time basis to hospital projects. Parkin clients include some of the foremost institutions in Canada, many of which have relied upon Parkin people for over 20 years. ,Q DGGLWLRQ WR WUDGLWLRQDO DUFKLWHFWXUDO VHUYLFHV 3DUNLQ SOD\V D VLJQLĂ&#x20AC;FDQW OHDGLQJ UROH LQ VWUDWHJLF DQG RSHUDWLRQDO SODQQLQJ ZLWK PDQ\ RI LWV FOLHQWV 3DUNLQÂˇV FOLQLFDO SODQQLQJ DQG GHVLJQ LQĂ XHQFH can be found in hundreds of new, renovation and expansion projects, ranging from individual hospital departments to some of the largest institutions in eight of Canadaâ&#x20AC;&#x2122;s provinces and Nunavut. ,Q WKH HDUO\ V 3DUNLQ ZDV WKH OHDG DUFKLWHFW IRU &DQDGDÂˇV Ă&#x20AC;UVW WZR KRVSLWDO 3 SXEOLF SULvate partnership) projects â&#x20AC;&#x201C; Brampton Civic Hospital and the Royal Ottawa Hospital. Since then, 3DUNLQ KDV FRPSHWHG LQ WKH 5)3 VWDJHV RQ GR]HQV RI 3 $)3 SURMHFWV ZLWK FRQVRUWLD LQFOXGLQJ Â&#x2021; $FFLRQD Â&#x2021; %LOĂ&#x20AC;QJHU %HUJHU %27 ,QF Â&#x2021; %RX\JXHV Â&#x2021; 'UDJDGRV Â&#x2021; (OOLV'RQ &RUSRUDWLRQ Â&#x2021; /DLQJ 2Âˇ5RXUNH Â&#x2021; 2+/ *URXS Â&#x2021; 3&/ &RQVWUXFWLRQ 6HUYLFHV ,QF Â&#x2021; 3RPHUOHDX ,QF Â&#x2021; 61& /DYDOLQ ,QF Long-term hospital clients include: Â&#x2021; &KLOGUHQÂˇV +RVSLWDO RI (DVWHUQ 2QWDULR Ottawa, ON Â&#x2021; *UDQG 5LYHU +RVSLWDO .LWFKHQHU 21 Â&#x2021; WRQ 21 Â&#x2021; +RWHO 'LHX *UDFH +RVSLWDO :LQGVRU 21 Â&#x2021; 2ULOOLD 6ROGLHUVÂˇ 0HPRULDO +RVSLWDO 2ULOOLD ON Â&#x2021; 4XHHQVZD\ &DUOHWRQ +RVSLWDO 1HSHDQ 21 Â&#x2021; 5RVV 0HPRULDO +RVSLWDO /LQGVD\ 21 Â&#x2021; 6W 0DU\ÂˇV +RVSLWDO .LWFKHQHU 21 Â&#x2021; 6LFN .LGV +RVSLWDO 7RURQWR 21 Â&#x2021; 6RXWKODNH 5HJLRQDO +HDOWK &HQWUH Newmarket, ON Â&#x2021; 7LPPLQV DQG 'LVWULFW +RVSLWDO 21 Â&#x2021; 7ULOOLXP +HDOWK &HQWUH 0LVVLVVDXJD 21

P3/AFP projects built or under construction include: Â&#x2021; %UDPSWRQ &LYLF +RVSLWDO %UDPSWRQ 21 Â&#x2021; 1HZ 2DNYLOOH +RVSLWDO 2DNYLOOH 21 Â&#x2021; 5HVWLJRXFKH +HDOWK &HQWUH &DPSEHOOWRQ 1% Â&#x2021; 6W -RVHSKÂˇV +HDOWKFDUH /RQGRQ 21 Â&#x2021; 6W -RVHSKÂˇV +HDOWKFDUH 6W 7KRPDV 21 Â&#x2021; 6XUUH\ 0HPRULDO +RVSLWDO 6XUUH\ % & Â&#x2021; 7KH 5R\DO 2WWDZD +RVSLWDO 2WWDZD 21 Â&#x2021; :RRGVWRFN *HQHUDO +RVSLWDO :RRGVWRFN 21 Â&#x2021; 8QLYHUVLW\ RI 0RQWUHDO +RVSLWDO 5HVHDUFK &HQWUH 0RQWUHDO 4&

Canadian Coalition for Green Health Care: 13 years down the road to sustainable health

Canadaâ&#x20AC;&#x2122;s premier green health care resource network, the Canadian Coalition for Green Health Care, has been a national voice and catalyst for environmental change within the health care sector for thirteen years. 7KH &RDOLWLRQ D QDWLRQDO QRW IRU SURĂ&#x20AC;W HQcourages the adoption of resource conservation, pollution prevention principles and effective environmental management systems to reduce the Canadian health care systemâ&#x20AC;&#x2122;s ecological impact while protecting human health.

Collaborating with health care organisations, and a multiplicity of other health care stakeholders in the private and public sectors, the Coalition works to raise awareness and increase the capacity of organisations to embrace environmental issues. 0HPEHUVKLS EHQHĂ&#x20AC;WV LQFOXGH RSSRUWXQLWLHV WR engage in and support Canadaâ&#x20AC;&#x2122;s green health care movement and be part of a relevant and meaningful process to meet greening health care needs, collaboration with like-minded individuals and groups, access to educational collateral, and opportunities to advise/mentor those taking on greening initiatives.

incentives, and helping implement a culture of conservation. www.greenhealthcare.ca/HELO

EcoAction GHG Emissions Reduction In partnership with the Canadian Healthcare Engineering Society (CHES) and Synergie Sante Environnement (SSE), the Coalition is embarking on a three-year GHG and water reduction initiative across Canada with targeted outreach and education collateral, and training modules to incite organisations to adopt sustainable environmental practices.

Climate Change Resiliency Toolkit With research and technical support from Health Canada, the Health Care Facility Climate Change Resiliency Toolkit helps organisations improve their ability to withstand the negative impacts of climate change. www. greenhealthcare.ca/climateresilienthealthcare/

Green Revolving Fund for Health Care EnHUJ\ (IĂ&#x20AC;FLHQF\ The Coalition recently launched a Green Revolving Fund pilot project, to research and test a new funding model for energy projects. Implementation is under development and the Coalition is actively looking for funding partners. www.greenhealthcare.ca/projects enerCoalition initiatives with a focus on sustaingy/greenrevolvingfund able energy management include: Achieving environmentally-responsible health Healthcare Energy Leaders Ontario (HELO) service delivery requires a collaborative apWhen fully operational, the HELO project proach, clearly articulated in the Joint Position team will be providing free onsite assistance to Statement â&#x20AC;&#x201C; toward an Environmentally Refacilities with activities such as energy assesssponsible Canadian Health Sector available at: ments, developing business cases, applying for www.greenhealthcare.ca/images/pdf/jps.pdf

As one of the few, remaining, independent, Canadian healthcare architects, and an employeeowned company, Parkin owners personally invest in every project, providing a hands-on approach and customized design experience.

HOSPITAL NEWS OCTOBER 2013

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2013

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OCTOBER 2013 HOSPITAL NEWS

2013

SickKids Manufacturing improvement By John Toussaint, Jeff Mainland and Gordon Burrill

eople are not cars. Hospitals are not manufacturing plants. Yet the methodologies of Lean manufacturing â&#x20AC;&#x201C; legendary for reducing errors, increasing quality and shortening lead times at companies like Toyota â&#x20AC;&#x201C; have proven tremendously effective on a range of issues in the hospital context, including staff engagement, meds reconciliation, hand hygiene and others.

Because continuous improvement in hospitals tends to be approached on a project basis, most organizations do not have a methodology in place to improve care day-today. They especially do not have a system in place to then sustain that improvement. Because continuous improvement in hospitals tends to be approached on a project basis, most organizations do not have a methodology in place to improve care day-to-day. They especially do not have a system in place to then sustain that improvement.

Yet each day on the frontlines, clinicians face a myriad of problems, big and small, that impact quality of care. These professionals are ultimately the people who can best solve these challenges â&#x20AC;&#x201C; but given the demands of their day-to-day roles, they report problems to managers, who are themselves overwhelmed and unable to tackle all but a small percentage of issues. At a number of Ontario hospitals including The Hospital for Sick Children (SickKids) in Toronto, the management principles of Lean have been an integral part of the answer in addressing these challenges. To implement an approach for ongoing daily improvement, the hospital initially focused, in collaboration with ThedaCare and KPMGâ&#x20AC;&#x2122;s Lean coaches, on two SickKids units. The hospital is now rolling out their Lean management system, called â&#x20AC;&#x153;daily CIPâ&#x20AC;? (Continuous Improvement Program) to all 20 clinical units of the building. Some frontline leaders have described the effects of the program as transformational. It has driven a culture of staff who feel empowered to maximize quality and value for the patients and families they care for. Clinicians were selected to work on improvement teams and design a new process of care, focused on removing errors and creating a safer patient experience. They examined every step in the process of care, in cases ranging the gamut, from elective

Relevant. Respected. The Diploma in Health Care Management.

On the initial units that have implemented CIP, the improvements have been nothing short of remarkable: Hand hygiene compliance: 17 per cent improvement for moments 1 and 4 (in four units) Medication reconciliation: 16 per cent improvement year over year in medication reconciliation on transfer (in one unit) Chemotherapy start time: 54 per cent improvement in the number of planned chemotherapy treatments before 5:00pm for admitted patients Falls compliance: 71 per cent improvement in compliance to protocols to reduce falls (in one unit) Staff Engagement: Average of 20.4 per cent increase (in the first five units in the program) surgeries to patients presenting in the emergency department with a headache. At every step in the process, the question was asked: â&#x20AC;&#x153;Is this step necessary to deliver a perfect outcome?â&#x20AC;? If the answer was no, the step was removed as non val-

ue-added. Only those steps in the patient experience that added to the outcome â&#x20AC;&#x201C; the steps that were value-added â&#x20AC;&#x201C; were retained. SickKids is providing in-house Lean training for all types of clinicians to receive their Yellow and Green Belts. To lead the effort, they hired â&#x20AC;&#x201C; full time â&#x20AC;&#x201C; three Master Black Belts with experience in Lean transformations. In the process, clinicians have been given the skills and support they need to take increased ownership for local improvement efforts. One could say that instead of the old model of fighting fires, they are predicting fires before they start. And then, if they do their jobs right, the extinguisher need never be used. The authors are taking part in the HealthAchieve Panel Discussion, Leveraging Lean Management â&#x20AC;&#x201C; Breaking Through the Sustainability Barrier and Creating a Culture of Continuous Improvement, on Monday November 4 at 3:30pm. Learn H more at www.healthachieve.com. â&#x2013; Dr. John Toussaint is Chief Executive Officer, ThedaCare Center for Healthcare Value. Jeff Mainland is Executive Vice President Strategy, Quality, Performance and Communications at The Hospital for Sick Children and Gordon Burrill is Partner at KPMG.

eLearning allows learners to receive training at their own pace

PSHSAâ&#x20AC;&#x2122;s extensive health and safety knowledge base serves as the basis for each eLearning offering we develop.

ELearning and other forms of digital education provide opportunities for self-paced learning seldom found inside a classroom and can serve as â&#x20AC;&#x153;just-in-timeâ&#x20AC;? training, allowing learners to revisit course material wherever and whenever they need it most. Its consistent delivery and rising retention levels also play important roles in why organizations are investing more money into eLearning each year. PSHSA offers a variety of eLearning services, including: â&#x20AC;˘ Content creation â&#x20AC;˘ Development â&#x20AC;˘ Learning management â&#x20AC;˘ Hosting

Bridging the gap between clinical training and executive development (MHA and MBA programs), the Ontario Hospital Associationâ&#x20AC;&#x2122;s Diploma in Health Care Management recognizes the completion of a broad spectrum of practical and relevant programs of study in leadership and management. Prepare yourself with the skills necessary to thrive in todayâ&#x20AC;&#x2122;s rapidly changing health care climate. Learn more at www.oha.com/diploma

Content Creation &DSLWDOL]LQJ RQ GHFDGHV RI VHFWRU VSHFLĂ&#x20AC;F H[SHULHQFH RXU WHDP RI RYHU FRQVXOWDQWV provides the subject matter expertise required to create invaluable learning experiences. Development Our team of instructional designers, graphic designers, photographers/videographers DQG H/HDUQLQJ GHYHORSHUV FROOHFWLYHO\ FRQWULEXWH RYHU \HDUV RI H[SHULHQFH WR HDFK eLearning development project. Whether you have your own content or need ours, our creative and innovative development team will bring it to life. Learning Management PSHSA provides clients with the ability to track eLearning course completions, print FHUWLĂ&#x20AC;FDWHV WDNH RQOLQH TXL]]HV DQG JHQHUDWH UHSRUWV DOO RQ RQH XVHU IULHQGO\ V\VWHP Hosting PSHSA.ca offers countless options for online eLearning hosting when a learning management system is not required. Custom server space and customized landing/ launch pages help tailor your hosting solution to your needs.

HOSPITAL NEWS OCTOBER 2013

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2013

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rubber duck

Slow death by By Bruce Lourie

hatâ&#x20AC;&#x2122;s more relatable than a rubber duck? Thatâ&#x20AC;&#x2122;s the question co-author Rick Smith and I asked ourselves when writing Slow Death By Rubber Duck, our response to the confounding reality that humans have a hard time relating environmental issues to their daily lives. People know that smog exists, and most will agree that climate change exists, but they still find it a challenge to articulate how it affects them directly. So they have a difficult time marshaling themselves to take action. But pollution isnâ&#x20AC;&#x2122;t just something â&#x20AC;&#x153;out there.â&#x20AC;? Itâ&#x20AC;&#x2122;s something â&#x20AC;&#x153;in here,â&#x20AC;? literally. Because we now know that all humans â&#x20AC;&#x201C; even unborn fetuses â&#x20AC;&#x201C; have measurable levels of toxic chemicals in their bodies. These toxins are in our homes, our carpeting, our shampoo, our plastic bottles â&#x20AC;&#x201C; including those from which we feed formula to our babies. Amazingly, most of these chemicals have never been tested for their affects on human health. Very little thought has gone into what the implications are of using these chemicals pervasively. And so in the early 90s we tried to change the conversation from one of abstractions to one of public health. One of the first links we made was between health and coal-fired power plants, which were proven to be the source of a multitude of

health problems, notably respiratory illness from fine particulate matter. Our work with the Ontario Medical Association led to regulating the shut down of all coal plants in Ontario. It was unprecedented at the time and is still the largest single climate change action in Canadian history. To make the issue as real as possible for people, we made not rubber ducks of ourselves, but guinea pigs. We did a series of experiments on ourselves, self-exposing to products believed toxic and then measuring whether the level of chemicals in our bodies increased. The results were dramatic. I ate, for example, several meals of tuna, measuring the mercury in my body before and after. My mercury levels shotup nearly three times, putting me over the limit of what is considered safe. In reality, there is no safe limit, especially for pregnant women. In a second experiment, the amount of Triclosan in Rickâ&#x20AC;&#x2122;s body increased by 2,900 per cent over our 48-hour test period. And that was from the simple act of using everyday personal care products, as directed. These included anti-bacterial soaps, deodorants and toothpaste that all listed Triclosan (a regulated pesticide) as an ingredient. Another part of the reality check was showing that the claims of industry â&#x20AC;&#x201C; namely, that these chemicals were inert, and would never get into your body â&#x20AC;&#x201C; were false. Industry responded with the admission that sure, these chemicals get into

Emergency Management for Health Care CertiďŹ cate

your body â&#x20AC;&#x201C; but at levels so low, they wonâ&#x20AC;&#x2122;t cause any harm. It has been demonstrated very clearly that industry is wrong again. In fact it is not so much the quantity of the toxic chemical, but the timing of the exposure that is pivotal. For example, a very minute quantity can enter a woman and cause

Along with cancer, many studies have now linked chemical exposure to autism, thyroid issues, childhood obesity, reproductive system disorders and many other serious or life-threatening conditions. significant harm to her fetus, whereas at a later date the same exposure causes no harm at all. The modus operandi of toxic chemicals is insidious indeed. They confuse the body into thinking they are a natural hormone; hormones of course send out messages that signal how brains and bodies should develop. For example, a female body will interpret a very small amount of Bispehnol A (BPA) as estrogen. Elevated levels of estrogen are of course linked to breast cancer. Along with cancer, many studies have now linked chemical exposure to autism,

thyroid issues, childhood obesity, reproductive system disorders and many other serious or life-threatening conditions. Fortunately, in recent years there has been great progress. We are starting to see governments and corporations take action. Canada was the first country to ban BPA in childrensâ&#x20AC;&#x2122; products. There are bans in the United States on flame retardants. Very recently, Walmart announced it would evaluate all of its products against a list of chemicals and refuse to carry goods that contain them. Johnson & Johnson announced it is removing many toxic chemicals from shampoo and other personal care products, which Aveda had already done. In a relatively short period of time, we have seen a sizable shift in the way the public looks at this issue. Yet scientists are still left to wonder why we deal with chemicals the way that we do. We have tough regulations on sewers and smokestacks. Why not the same for shampoo, baby bottles and rubber duckies? Rick and I will answer these questions and more in our next book, to be released at the end of this year: Toxin, Toxout: Getting Harmful Chemicals Out of Our BodH ies and Our World. â&#x2013; Bruce Lourie is President of the Ivey Foundation. He will be speaking at the Green Health Care Session at HealthAchieve this November 4 at the Metro Toronto Convention Centre. Learn more at www.healthachieve.com

RPNs: Advance and enhance your career through RPNAO

Are you an Ontario RPN whoâ&#x20AC;&#x2122;s interested in taking your nursing career or professional development to the next level but youâ&#x20AC;&#x2122;re not sure where to turn for guidance? Are you intrigued by the idea of enhancing your leadership skills but youâ&#x20AC;&#x2122;re not sure where to start? Do you have questions about a workplace harassment situation but you donâ&#x20AC;&#x2122;t know who you should trust? Are you ready to embark on that fellowship or similar career advancement opportunity but feel like youâ&#x20AC;&#x2122;d have a better chance with professional support? We can help The Registered Practical Nurses Association of Ontario (RPNAO) is the professional association for Ontario RPNs. And for the past 55 years, weâ&#x20AC;&#x2122;ve been providing our members with access to the experts, programs, resources and solutions they need to advance and enhance their nursing careers and to help create a healthier Ontario.

Focused speciďŹ cally on emergency planning and preparedness for hospitals and health care institutions, the Ontario Hospital Associationâ&#x20AC;&#x2122;s new Emergency Management for Health Care CertiďŹ cate is an emergency management credential recognized in health care settings in both Ontario and beyond. www.oha.com/EmergencyManagement

The best investment in your profession Your RPNAO membership provides the broadest, most complete package of protection, tools, UHVRXUFHV VXSSRUWV GLVFRXQWV DQG RWKHU EHQHĂ&#x20AC;WV DYDLODEOH WR 531V LQ WKH SURYLQFH RI 2QWDULR 7DNH advantage of: Â&#x2021; 3URIHVVLRQDO 3URWHFWLRQ Â˛ <RXU PHPEHUVKLS LQFOXGHV SURIHVVLRQDO OLDELOLW\ LQVXUDQFH FRYHUDJH that goes above and beyond the requirements that come into effect March 31, 2014. Â&#x2021; 1HWZRUNLQJ Â˛ 0HHW FROOHDJXHV DQG KHDOWK FDUH OHDGHUV IURP DURXQG WKH SURYLQFH Â&#x2021; 6DYLQJV Â˛ 6DYH PRQH\ RQ ZRUNVKRSV VHPLQDUV DQG SXEOLFDWLRQV Â&#x2021; 4XDUWHUO\ 0DJD]LQH Â˛ 5HFHLYH 7KH 5HJLVWHUHG 3UDFWLFDO 1XUVLQJ -RXUQDO IRXU WLPHV HDFK \HDU Â&#x2021; 'LVFRXQWV RQ +RPH $XWR ,QVXUDQFH Â˛ 6DYH ZLWK VSHFLDO JURXS UDWHV Â&#x2021; &DUHHU 'HYHORSPHQW Â˛ 7DNH DGYDQWDJH RI DPD]LQJ FDUHHU GHYHORSPHQW VXSSRUWV DW HYHU\ career stage. Â&#x2021; $GYRFDF\ Â˛ :H DUH VWURQJ DGYRFDWHV IRU 531V WR WKH JRYHUQPHQW KHDOWK FDUH RUJDQL]DWLRQV and the public.

Come visit us Please visit the friendly RPNAO staff at booth 1821 to learn more about our continuing education programs, career directions supports, mentorship program and much more. 531$2 2SWLPL]LQJ 531VÂˇ SURIHVVLRQDO SUDFWLFH IRU D KHDOWKLHU 2QWDULR

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Influenza vaccination:

Our patients are counting on us By Dr. Allison McGeer re health care workers (HCW) who are not immunized against influenza failing their patients? The Canadian National Advisory Committee on Immunization (NACI) says yes: “In the absence of contraindications, refusal of HCWs… to be immunized against influenza implies failure in their duty of care to patients.” Indeed NACI, along with the US Centers for Disease Control and Prevention (CDC), has been recommending influenza vaccination for health care workers for more than 30 years. Yet worker influenza vaccination rates remain below 60 per cent in the great majority of Ontario hospitals whose members will be attending HealthAchieve. This, despite the fact that influenza vaccination in Ontario is provided free of charge to all eligible residents, and that all hospitals in this province have programs to offer influenza vaccination to their workers. In 2012, the Ontario Provincial Infectious Diseases Advisory Committee suggested that scientific evidence now supports the need to make a fundamental change to our vaccination programs – annual influenza vaccination should be a condition of service for all Ontario health care workers.

What is that evidence? A careful review is in order. Requiring any behaviour on the part of an individual for the benefit of public health must meet three criteria: first, the behaviour must confer benefit on the individual who undertakes it, second, there must be sufficient benefit to the public health, and third, there must be no other means of achieving the public health benefit.

The risk of serious or fatal disease due to influenza and its complications is significantly higher than the risk of serious adverse events due to influenza vaccination For healthy, young adults, the serious risks associated with both influenza and influenza vaccination are very small. Nonetheless, influenza infection is common, and the risk of serious or fatal disease due to influenza and its complications is significantly higher than the risk of serious adverse events due to influenza vaccination. It is for this reason that the CDC and NACI encourage annual influenza vaccination for all adults, whether or not they are health care workers.

The benefit of health care worker influenza vaccination to patient safety has been clearly demonstrated in four randomized controlled trials. In these trials, conducted in chronic care hospitals and nursing homes, patients/residents were 44 per cent less likely to die during the influenza season if they lived in facilities randomized to influenza vaccination of health care workers – a result that is both striking and consistent across all the trials. Logistical challenges mean that similar studies have not been performed in acute care hospitals; however, both modelling and observational studies in acute care suggest that the benefits of health care worker vaccination are similar in this setting. So it is clear that our current voluntary vaccination policies are failing our patients – what evidence is there that condition of service policies are the answer? In hospitals, such policies fall into one of two groups: either health care workers must be vaccinated unless they have a medical contraindication or religious exemption, or health care workers who choose to remain unvaccinated are required to wear a mask in patient care areas during the winter season. These policies have been uniformly successful in substantially increasing influenza vaccination rates without significant adverse conse-

quences, and the majority of health care workers affected support or strongly support the policies. In Canada, the legality of these policies has not been completely tested. However, the great majority of arbitrators in relevant cases to date have considered both the rights of employees and the risks to patient health and safety – and have struck the balance in favour of patients. And so the evidence and need is clear. It’s up to Ontario hospitals to make that H need a reality. ■

Dr. Allison McGeer is Director, Infection Control at Mount Sinai Hospital. Dr. McGeer, a member of the Provincial Infectious Diseases Advisory Committee (PIDAC), will take part in a Panel Presentation – The Pros & Cons of Influenza Vaccination – at HealthAchieve on Monday, November 4 from 3:30–5:00pm.

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Purchase your HMM license through the OHA and get 65% off the regular rate. You can get 50 subscriptions for 50 employees for only $5,000 – an extraordinary savings of $10,000.

MAKING THE CONNECTION. In the clinical environment, it’s all connected. From clinical equipment, to employee retention, to patient care and satisfaction — everything has an impact on everything else. That’s why hospitals and care facilities can no longer compete on clinical excellence alone. Through the collaboration of our food, facility and clinical technology services, ARAMARK Healthcare works behind the scenes to help our clients make the connection to better outcomes, elevating every aspect of their organization and creating the optimal healthcare experience for patients, physicians and employees alike. Because it’s all connected.

To learn more, go (where else?) online: to www.oha.com/trainyourstaff

HOSPITAL NEWS OCTOBER 2013

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ARAMARK Healthcare proudly supports

HealthAchieve Join us for the Financial Management Breakfast on November 5, 2013 – 7:30 a.m., Room 206 BDF, MTCC Visit us at the HealthAchieve Exhibition– Booth #803

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ATTENTION Exhibitors Connect with delegates on the tradeshow floor Don’t miss this opportunity to showcase your product or service to the delegates in the EŽǀĞŵďĞƌ ŝƐƐƵĞ ŽĨ ,ŽƐƉŝƚĂů EĞǁƐ͕ ǁŚŝĐŚ ǁŝůů ĂůƐŽ ďĞ ĚŝƐƚƌŝďƵƚĞĚ ŽŶ ƚŚĞ ƚƌĂĚĞƐŚŽǁ Ň ŽŽƌ͘

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HealthAchieve Heads North After 80+ years in Toronto, we think it’s high time we take our show on the road. Introducing HealthAchieve North – HealthAchieve’s ﬁrst-ever satellite location, coming to Thunder Bay this November 4 and 5. Register now for this one-of-a-kind version of health care’s must-attend event. HealthAchieve North will feature keynote sessions broadcast live from Toronto’s HealthAchieve, along with additional in-person educational sessions and events.

Your Chance to Win a Free Pass! HIROC is the proud sponsor of registration for HealthAchieve North and are offering you the chance to win one of ten free passes to attend this year’s event. Simply register before October 31 and all paying registrants will be entered into a draw to win a free pass!

HOSPITAL NEWS OCTOBER 2013

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Focus 15

One hospital’s redevelopment

journey By Rosie Jacuzzi nyone following the news knows many hospitals across the country are in varying stages of redevelopment. It’s no different in Winnipeg, with many hospitals renewing buildings and QuickCare clinics springing up. Here at Misericordia Health Centre we’re in the midst of creating a new health complex in the heart of our city. Every capital redevelopment project has its own challenges and triumphs. CEOs and project managers always have to battle budget uncertainties and deadlines. Misericordia’s story isn’t about budget or timing: it’s about surviving and thriving in the everchanging world of healthcare.

The redevelopment of Misericordia has been a long and winding journey with many twists, turns and setbacks in over 30 years In the not too distant past, the early 1990s, the Manitoba government began changing its health care strategy from a multiple-site acute-care focus to centres of excellence with more community-based health services. Misericordia, sitting on a 400-bed upgrade plan, needed to evolve or face the possibility of permanent closure due to redundant acute-care programming and aging buildings – some dating back to the early 1900s. Misericordia responded by doing what it does best: coming up with innovative, invaluable health programs to meet the needs of the communities we serve – while remaining faithful to the Mission of our founding Misericordia Sisters. We developed a business proposal to consolidate all ophthalmology services in the city from four sites to a one-site program at Misericordia, creating an Eye Care Centre of Excellence. Today, close to 11,000 eye surgeries are performed annually and more than 25,000 are assessed and treated. We converted from an emergency department to an Urgent Care Centre – the first in Canada. Visits today exceed 43,000 annually. We created Health Links-Info Santé, the first provincial telephone nursebased triage system in Canada. This one program evolved into the Provincial Health Contact Centre, with 30 calling programs and upwards of 600,000 calls annually. Community support over the years has also been invaluable, demonstrating how Misericordia is a critical health care provider not just in the larger health system, but in its own neighbourhood. The redevelopment of Misericordia has been a long and winding journey with many www.hospitalnews.com

twists, turns and setbacks in over 30 years. I think I have enough historical redevelopment plans to wallpaper all of Misericordia. It’s all history now as cranes and construction crews are on site and our new Maryland health complex is taking shape! As much as we were excited about having a new building, it was incredibly difficult to close the carved wooden doors of our historical St. Luke’s Chapel after 94 years. A formal transfer ceremony – from St. Luke’s to our interim chapel – was celebrated with staff and community members. We did salvage frescos and stained glass windows with the hopes of incorporating them into our new permanent chapel. One unique aspect of our redevelopment project is the rooftop garden and solarium we built on top of one of our existing buildings. It’s the first rooftop garden at a hospital in Winnipeg, and maybe farther afield! We knew with our redevelopment project that the green space our long-term care residents enjoy would be engulfed with construction equipment. Creating a 7th-ﬂoor rooftop garden meant we’d still have a peaceful area for residents with access to fresh air. The panoramic views of the city and the Assiniboine River are a bonus. Our new Maryland building is on time for substantial completion this winter, with occupancy in the spring. Misericordia is a leader in healthy aging through compassion, innovation and excellence. That’s our Mission. And the programs in our new building reﬂect our Mission! We’re creating a new purpose-built home for our Buhler Eye Care Centre and introducing PRIME – a health centre for seniors. PRIME is designed to keep an aging population healthy and in their own homes. Available to seniors over the age of 65, PRIME’s range of health care professionals – doctor and nurse practitioner, therapists, nursing staff, social workers, pharmacist, recreation facilitators and more – means seniors will have all their health care needs addressed under one roof. Our new Maryland building and the rooftop garden are Phase 1 of Misericordia’s redevelopment. Phase 2 includes demolishing a 107-year-old building to create a spacious atrium and a new chapel to rival our former St. Luke’s Chapel. As a faith-based health centre, a chapel is a strong symbol of our compassionate Mission and an essential icon of who we are and what we do. We’re working on finalizing funding for Phase 2. But that’s another redevelopment H story. ■

Rosie Jacuzzi

Rosie Jacuzzi is the President and Chief Executive Officer of Misericordia Health Centre and the Winnipeg Health Region’s Rehabilitation & Geriatrics and Spiritual Care lead. OCTOBER 2013 HOSPITAL NEWS

16 Focus

AMBULATORY CARE/NEUROLOGY/MENTAL HEALTH AND ADDICTION

Skill building program for people who care for family members with dementia By Jyll Weinberg-Martin ount Sinai Hospital was recently awarded a five-year, $2.84 million grant from the Government of Canada’s Social Development Partnerships Program to develop a Working CARERS (Coaching, Advocacy, Respite, Education, Relationship, Simulation) Program, the first comprehensive program of its kind in Canada devoted to supporting caregivers in the workplace. Based on the model and success of Cyril & Dorothy, Joel & Jill Reitman Centre for Alzheimer's Support and Training CARERS Program, offered at the hospital, the Working CARERS Program will provide working professionals who care for family members living with dementia at home an opportunity to benefit from the much needed support and skills training offered at the hospital but in their workplace. The first company to introduce the Reitman Centre Working CARERS program is BMO Financial Group in partnership with Ceridian and Lifeworks, and is planned to roll out this fall. Half of Canada’s informal caregivers are between ages 45-54, balancing jobs with family responsibilities. Family caregivers also have a higher risk for stress-related illnesses, experience burnout and loss of productivity in their jobs and demonstrate a rate of depression that is much

Heather, who cares for two parents with dementia, together with Dr. Joel Sadavoy at Mount Sinai Hospital. higher than in the general population – up to 40 per cent. “With an aging population comes many demands on family members, many of them who are working,” says Dr. Joel Sada-

voy, Director of the Cyril & Dorothy Joel & Jill Reitman Centre for Alzheimer's Support and Training and Head of the Community and Geriatric Psychiatry Services at Mount Sinai Hospital. “These individuals are very vulnerable — they’re trying to juggle demands at work and demands at home.” The Reitman Centre Working CARERS Program will be led by Dr. Sadavoy and Dr. Virginia Wesson at Mount Sinai and will be developed through an innovative partnership between the federal government, Mount Sinai Hospital and private-sector partners.

Approximately 750,000 Canadians currently live with cognitive impairments including dementia and this number is expected to nearly double by 2031.

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Delivered to employees and their dependents by trained Employee Assistance professionals, this program will be grounded in therapeutic principles and offer group workshops, hands-on simulationbased caregiver training and individual attention, with a goal to relieve the intense pressure and impact that caring for a loved one with dementia has on their lives. One of the most innovative features of the program’s design is the use of standardized patients — actors trained to simulate real-life situations — so that caregivers, guided by expert clinical coaches, can learn how to deal with common challenging situations that arise. For Heather, a caregiver to two parents with Alzheimer’s disease, who participated in the 10-week CARERS Program offered at Mount Sinai Hospital, says the program was nothing short of a life saver. She had been caring for her parents for years when

a sudden change in her mother’s physical condition coupled with the emergence of her father’s full-blown outbursts made the situation unmanageable. “They honed in on exactly what I needed emotionally at one of my most difficult and vulnerable times. My life has been monumentally changed because of Mount Sinai,” says Heather. Approximately 750,000 Canadians currently live with cognitive impairments including dementia and this number is expected to nearly double by 2031. “To be able to have this level of expertise in the workplace from Reitman Centre staff, coupled with an employer who is willing to put resources into supporting employees in this way – this program will be revolutionary,” says Heather. As the only centre of its kind in Canada, the Reitman Centre at Mount Sinai Hospital is breaking new ground on the creation of an evidence-based, effective therapy based skills training method for family caregivers – a model that is poised to be replicated in various settings across Canada. In addition to the workplace, pick up has already happened by the Chinese Community in Scarborough at the Yee Hong Centre for Geriatric Care and the Mount Sinai Wellness Centre. The program has also expanded into Calgary through a partnership with Chinese Geriatric Community Services of Calgary and has been carried out in unexpected places like Holly Blossom Temple in Toronto. Satellite programs are possible in a number of different kinds of settings, including other hospitals and in places like the Alzheimer’s society or even through family health teams. For more information, or to learn how your workplace or organization can get involved, visit www.mountsinai.on.ca/reitman or call 416-586-4800 H ext. 5192. ■ Jyll Weinberg-Martin is a Communications Specialist at the Mount Sinai Hospital Foundation. www.hospitalnews.com

AMBULATORY CARE/NEUROLOGY/MENTAL HEALTH AND ADDICTION

Focus 17

CAMH national report Continued from page 14 •52 per cent of male youth and 39 per cent of female youth across all age groups reported significant substance use concerns. •73 per cent of female youth and 58 per cent of male youth reported significant mental health concerns such as depression and anxiety. •69 per cent of male youth and 56 per cent of female youth aged 12 to 15 reported behavioural concerns such as difficulties with impulsivity and inattention. •47 per cent of youth indicated suicide-related concerns at some point in their lifetime, with one in seven youth reporting they had thought about suicide in the past month. •60 per cent of female youth and 41 per cent of male youth reported trauma-related distress. Two in five young people receiving services are experiencing significant concurrent mental health and substance use problems. “These numbers are significant and give us a better understanding of the challenges our youth are facing,” says Gloria Chaim, Deputy Clinical Director of CAMH’s Child, Youth and Family Program and Project Co-Lead. “What we learned gave us a better understanding of the gaps that exist in youth services and how we can better address them. We hope the use of a common screening tool across sectors will assist in the development of collaborative models of service delivery systems across the country.” Several system improvement recommendations were made based on the report’s findings, including: •Support for gender-sensitive approaches to care to address the different service experiences of male and female youth. •Developmentally-informed services that reﬂect the differing needs of younger and older youth. •Suicide-related services, including early identification of concerns and high intensity mental health services. •Improved capacity to address cooccurring substance use and mental health problems. •Implementation of a consistent screening process for mental health and substance use problems across sectors, given the high rate of substance use and mental health concerns in youth. •Increased capacity for trauma-informed and trauma-specific care. The National Youth Screening Project was funded under Health Canada’s Drug Treatment Funding Program to foster collaborative work between youth-serving agencies in H communities across Canada. ■ Michael Torres is the Senior Media Relations Specialist at The Centre for Addiction and Mental Health. www.hospitalnews.com

A view of the kitchen in the newly renovated Moonlight Avenue residence.

Unlocking the door to better housing for people with mental illness By Renée Baker ou wouldn’t know it driving down residential Moonlight Avenue, in Sudbury, Ontario, that there are people living in a group home setting with mental illness. This recovery housing initiative resulted in a beautiful house that anyone would be proud to call home. “Like any new surroundings, it will take some time to adjust, but I am very happy here,” says Christine, one of six tenants in the home. This newly adopted concept has taken one large step forward leaving behind the stigmatized antiquated system of mental health housing most of us are familiar with. The project took close to 18 months to complete, but in June 2013, the Moonlight Avenue residence unlocked its doors to its first two tenants. The house can accommodate up to eight tenants, with full occupancy expected to be achieved within the next month as tenants and staff get familiar with the newly renovated home and housing model. This transformational housing project provides supported group living for eight individuals. The home utilizes a peer support staffing model. Peer Support Workers are those who have experienced mental illness and who offer recovery-based support using their own experience to provide one-to-one aid. Ten years ago, Christine, originally from Sudbury, was a full-time midwife, living in Cornwall. She was newly separated and was caring for her two boys, she pictured working very hard for the next 30 years as a midwife, a profession she adored, when suddenly, everything changed; Christine lost everything.

This was the beginning of a long eight year journey to a final diagnosis of schizophrenia with bi-polar tendencies. For years, Christine had lived a very productive life with no indication that she would one day live with a mental illness. She spent close to a year in hospital receiving treatment for her mental illness in North Bay and Sudbury. This home for Christine is the beginning

of a new chapter. “I have to appreciate what I have right now, and learn how to live this new life.” While in hospital, the ability to be independent is not as easy as you might think. Many things are scheduled such as meals, outings, activities and appointments, often times leaving the decision making and critical thinking involved with planning a day to others. This home, leaves Christine to make decisions when it comes to personal healthcare, budget, meal preparation, and recreation. Although independent in many aspects of her daily living, there is always support available. “The dream of having your own means never goes away, no matter how sick you are.” “My hope is always to live on my own, but in the meantime, this home makes me feel proud to say I live here.” Something she thought she would never say. Christine see’s this as an opportunity to let others know that a mental illness is not something to be ashamed of. Statistics prove that one in four people in northern Ontario will experience mental illness at one point in their lives. Her family visits her regularly in her new surroundings and take comfort in knowing she is in a beautiful home, with the support she needs and a model of care that will contribute to building her life over again.

“No one can reassure me that I will not lose everything again. I will always be sick.” People living with a mental illness need to manage this fear every day of their lives. A diagnosis that is sometimes hard to deal with. “A mental illness does not declare its arrival, it has no warning signs, and for those reasons, I can’t see myself practicing midwifery and putting others at risk.” For now, Christine is taking everyday as it comes. Her priority for today is becoming the healthiest person she can be. The North Bay Regional Health Centre partners with the Centre for Mental Health and Addiction – Sudbury/Manitoulin and Northern Initiative for Social Action in providing new and sustainable housing to mental health consumers. The hope is to be able to bring this new model of housing to other areas within the northeast region so that everyone in the communities we serve can benefit from this new innovative way of caring for those with a mental illness who are ready to live independently with the H support of peers. ■ Renée Baker is a Public Relations Officer at North Bay Regional Health Centre.

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18 Focus

AMBULATORY CARE/NEUROLOGY/MENTAL HEALTH AND ADDICTION

Brett Batten addresses the audience of community, patients, politicians, mental health partner organizations and St. Joseph's Health Care London staff at the opening of St. Joseph's Southwest Centre for Forensic Mental Health Care.

Mental healthcare

Continued from cover Psychosis can be frightening. I have personally experienced hallucinations, which I was unable to recognize as outside of reality. But even when I was most ill, I was always Brett Charles Batten. I always carried the same person inside me. I have abandoned my anonymity in the hope that I might change peopleâ&#x20AC;&#x2122;s perception of mental illness even when it intersects with the law. As humans we make mistakes, some more serious than others, but everyone has the right to learn from that mistake, grow from it and change. Seven years ago, I was in hospital, now I am in the early stages of publishing a book about my experiences. My story is one many share but few talk about. I have chosen to reveal myself because we need to talk about mental illness. There are too many misconceptions tattooed on our psyches. The images from headlines and HOSPITAL NEWS OCTOBER 2013

movies sit next to mental illness every day. Mental illness is in our neighbourhoods, workplaces and schools. We are surrounded every day. Statistics show that one in five Canadians suffer from a mental illness and the World Health Organization says by the year 2020 depression will be the single biggest medical burden on health. When we see a person with a cast on a broken bone we can understand it. The majority of mental illness is invisible to the eye. You will usually have no clue the person at the table next to you has depression, schizophrenia or bipolar disorder. The stigma associated with mental illness is simply fear. People fear the unknown and most know little about mental illness. And one of the reasons stigma is a continuing battle is because it is so widespread. I have encountered it among family, neighbours and in the talk and gestures of strangers. If Iâ&#x20AC;&#x2122;m honest, I am at times guilty of it as well. I was a forensic mental health care patient, that means, I live with a mental illness and have also been accused of a crime. Continued on page 19 www.hospitalnews.com

AMBULATORY CARE/NEUROLOGY/MENTAL HEALTH AND ADDICTION

Continued from page 18 People in my circumstance are often the victim of a `double stigma,’ which sheds a further negative shadow on those seeking treatment. And too often media focuses on high profile cases which paints an inaccurate picture of the relationship between violence and mental illness. For me stigma is subtle in a profound way. One word or one joke can eliminate dignity for an entire group. Stigma is such a battle because we condone it. Whether it is a news story or a movie, we are not yet outraged when we see mental illness portrayed with the darkest lenses. Stigma is a part of popular culture. Only when we stop to realize we are perpetuating misconceptions and making light of the suffering of others can we eliminate mental health stigma. We assume health care workers and those who are in the helping professions are the exceptions to stigma. Sometimes that too can be a misconception. I have had both negative and positive experiences among health care workers, the justice system and emergency services. And I literally would not be alive today were it not for the care and respect I received from many. I suppose best practices in mental health would be to diagnose, observe and treat the illness; but too often a patient’s identity is their diagnosis. I believe the main misconception among health care professionals and the justice system is that we are the words you see in a file. I am not a number, a dosage or diagnosis. I am a son, an uncle, a best man, a friend. If my problems make me less, help me to stand taller.

I use the term darkness as a representation of my mental health journey. Others may not see their illness as darkness, but for me that’s an accurate metaphor. To live with mental illness is to live with a series of abandonments. Our minds and emotions leave us for periods. Our behaviour associated with our diagnosis causes people in our lives to leave. Sometimes we abandon ourselves. As our world shrinks, as our support and friends pull away, we suffer. At times our care providers are all we have. To health care providers, whether in the mental health care field or outside of it, and in celebration of Mental Illness Awareness Week, I would like to share with you what I feel everyone needs to know in caring for someone with mental illness, from my first-hand experience. •Our illnesses could be shorter and our prognosis better if there were more good people in our lives. You can’t change that for many of us but for some of us you can be a substitute. You can be that one person for now, for today. •Learn to separate me from my illness; the majority of your treatment of me will be therapeutic to my rehabilitation. If you see me as a person and recognize our common humanity hopefully you will treat me as you do most people in your life. •There will often be people who misunderstand and therefore mistreat me. Often this will be as a result of the stigma that acwww.hospitalnews.com

companies my diagnosis. If you do not separate me from those ideas and thoughts, you will be nothing more than a stranger in my treatment. If you can’t separate me from my illness I can’t separate you from the rest. •Trust in the fact that although I may be symptomatic I can see, hear and feel. What you say, do or do not, impacts me in the same way it would if I was well. •At times your words and actions are all the hope I have. •You or someone you love could easily be where I find myself. Whatever the differences between us, we can share in the fact that mental illness is indiscriminate. I may get healthy again and be where you are or someone you love could be right where I am. •I have questions and fears about my diagnosis just like society. Share with me what you know clinically but also share with society the things you know about me as a person. •Please attach to me words that will help my family, peers and society recognize me as I was and hopefully can be. •If you are going to help me as a team, include me as a member if I am able and willing. If I am not a member of my treatment team I feel I am not a part of my treatment. •Help me ﬁnd my passion. My passion might be as simple as eating ice cream or as complicated as classical guitar. If you have listened to me or watched close enough you may even know my passion when I don’t. Encourage me to pursue my passion it can help build meaning and bring me moments of happiness. •To be listened to is empowerment. Even if what I say makes no sense, I will feel like a human if I know I have been heard. My voice may be the only shred of control I have. •I will see you as an equal who is a professional with skills that are meant to help me. If you treat me with respect you will not be that nurse or that doctor you will be someone who I can trust. •If I have the impression that you are here for more than a paycheque but that you have my interests at heart I can learn to trust you. •If you listen to what I express and attempt to help me express what I am unable to, you will be better equipped to assist in my recovery. •Please encourage me to see and dream beyond where I am. •Do not point out too much good when I feel bad, respect where I am at in my journey. My tears and frustrations are real to me so respect them. •I need to see and interact with the world as much as possible. How can I learn to live with my illness if I have not practised? How can I learn to interact with people if I see no one? •I may not be co-operative because of my illness. If you have to treat me against my will in any way remind me that you have my best interests at heart. I may not be able to see how it is best but if you have gained my trust I will be more willing to listen. •You may be the only one who can comfort me, so try. If I am in hospital, I have lost much of what I recognize. Explain to me why I don’t have certain freedoms. If I can understand why I must live with certain conditions I may be more accepting of them.

Focus 19

It’s ironic, the brain is located on top of our bodies but we hold mental illness below all else.

•If I have no family or friends you may be my only substitute. You have the ability to be my support when we interact. •You may have the ability to see obstacles I cannot, but I have the ability to overcome them. I may need your help in this or at least some encouragement. •I don’t need your sympathy but empathy helps. Just once in a while think about what it might be like to be where I find myself. •When you do things with me it makes me feel more human. I could think that I am not only a diagnosis to be treated but a person worth meeting and sharing time with. My self-worth may not be what it should be and in spending time with me you help to build it back. •If I say or do things in my illness, forgive me. I can’t always express what I need to or want to. Like you, I am doing my best to navigate my world. •There may be lost causes or individuals that will need constant assistance. They are still deserving of your respect and assistance. •I may not want to talk but that doesn't mean you can't speak to me. When I hear my name I can recognize that I am somebody. •Encourage me in my spirituality. It may not help you but it may be what carries me forward. •If I can say I got help and the experience was less traumatic more people would be willing to seek out your skills. •If you give me your best I will know I have your respect and I can only have respect for you. •I will not forget how you treated me. You can be a part of my memories; many psychiatric patients have their share of bad ones so make it a good one. •Being mentally ill carries many disadvantages. I hide from many activities and people because I don’t want them to know my history. This is the result of stigma. When you can be the one contact I know is on my side, my world expands. •If you let us into your hearts and minds maybe it will help us regain ours. •If you can’t share your happiness with me why should I share my darkness? Mental illness is not a choice. Most would be terrified by the prospect of losing control of their minds or emotions. Most

people pride themselves on being rational and in control. What could be worse than losing control of your mind, your sense and will, your emotions and desires; And to have it happen against your will? We become more human when we can view the individual living with a severe mental illness as unlucky, like we would for a physical illness, and share with them understanding and compassion for a diagnosis that was thrust upon them without their choice or option. It’s ironic, the brain is located on top of our bodies but we hold mental illness H below all else. ■ * I use the term darkness as a representation of my mental health journey. Others may not see their illness as darkness, but for me that’s an accurate metaphor. Brett Batten has been thriving in the community for seven years, was presented the Champion of Mental Health Award in 2012 and continues to educate, advocate and write about his experiences. Amanda Jackman is a Communication Consultant at St. Joseph’s Health Care London and edited the piece.

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AMBULATORY CARE/NEUROLOGY/MENTAL HEALTH AND ADDICTION

Patient and family advisors use own experiences to enhance mental healthcare By Owen Shaw n 2005, Margret Hajdinjak’s son (Steven Hajdinjak) took his own life after suffering with depression. He had visited the hospital for treatment for mental health issues three weeks earlier. Margret believes her son’s care could have been different, and now volunteers can help to improve experiences for others. Margret has been involved with several community groups related to the understanding and treatment of mental health issues, including Our Kids Count, an agency which promotes children's health and development, and Roots of Empathy, whose mission is to build caring, peaceful, and civil societies. She also developed Out of the Darkness, a community action project that includes an annual walk for suicide awareness. It was at the Out of the Darkness walk four years ago that Margret first learned about the opportunity to become a Patient and Family Advisor (PFA) at Thunder Bay Regional Health Sciences Centre (TBRHSC). Fern Mental Margret Hajdinjak Tarzia, Health Case Management Intake Coordinator at TBRHSC, suggested Margret apply her opinions and experiences to help make changes within the hospital. Since becoming a PFA, Margret has participated in several TBRHSC committees and councils, particularly those related to mental health issues and the emergency department. She is also a member of the Patient Family Centered Care Leadership Council that develops and supports processes to advance the practice of Patient Family Centered Care throughout the whole organization. She is currently part of a group that is working on a plan that will focus on respect, immediate care and continual attention. Margaret and three other PFAs from TBRHSC, recently travelled to Toronto by the request of the President of the Patients Association of Canada to help other hospitals learn how to involve their PFAs like Thunder Bay Regional Health Sciences Centre has done so well. Margret understands firsthand the impact and importance of taking the patient’s and family’s perspective into consideration. Patients and their families share a unique perspective. That’s why PFAs are integral to advancing patient and family centered care. Margret looks forward to continuing her contributions as a PFA, providing insights and personal experiences that will lead to improvements in the patient H care approach to mental health. ■

Dr. Michelle Keightley going through physical tests with Sean Killin.

Holland Bloorview’s groundbreaking research in youth concussion By Claire Florentin

ixteen-year-old Sean Killin remembers his first concussion, sort of. He was chasing a hockey puck when two opposing players body checked him, sending him headfirst into the boards. What followed was a blur, ending with Sean sustaining a significant concussion at just 12 years old. Holland Bloorview Kids Rehabilitation Hospital is widening the lens on concussion research to include children and youth. Despite the frequency of youth sports-related concussion in Canada and around the world, very little is known about its impact on young brains. Dr. Michelle Keightley, senior scientist at the Bloorview Research Institute’s Centre for Concussion Research is striving to fill that knowledge gap by researching how the youth brain recovers following mild traumatic brain injury. Using that information, she and her team are developing an evidence-based recovery process that includes more accurate and cost-effective assessment and rehabilitation protocols. “Until now, concussion research has largely focused on the adult population, but we know that the brains and bodies of youth and children are continually developing, which appears to make them more vulnerable to the effects of a concussion,” says Dr. Keightley. The Concussion Research Centre estimates that minor hockey players in Ontario alone experience approximately 36,000 concussions every year, which translates into two to three hockey players per team. And while it is known that concussions can impact daily life in the short and long term, HOSPITAL NEWS OCTOBER 2013

research from Dr. Keightley’s lab sheds additional light on the consequences of concussions for children and youth. She and her team have found that concussed youth hockey players may experience reduced upper and lower body strength, contributing to repeat injuries and future concussions. The Concussion Research Centre also found that post-concussed youth, even those no longer experiencing outward concussion symptoms, still showed poorer mental performance compared to their non-concussed peers in real world multi-tasking tests.

The Concussion Research Centre estimates that minor hockey players in Ontario alone experience approximately 36,000 concussions every year Dr. Nicholas Reed, a clinician scientist in the Concussion Research Centre, explains that scientists have developed “return-toactivity” guidelines for adults with mild traumatic brain injury, but that there are no such evidence-based guidelines for children and youth. “Without specific research support for the pediatric population, current recommendations for rest alone may be doing kids more harm than good,” says Dr. Reed. Dr. Keightley and Dr. Reed have embarked on a long-term project, “NeuroCare,” which focuses on three crucial paths to improving concussion treatment: identification, assessment, and management. This year, the Canadian Institutes of Health Research (CIHR), the Ontario Brain Institute (OBI) and the Ontario Neurotrauma

Foundation (ONF) have all lent support to NeuroCare’s concussion research through grants totaling $1.2 million dollars over the next five years. The NeuroCare project is among the first in the world to study the inﬂuence of pediatric concussion on thinking, balance and strength over a multi-year period, with the aim of reducing future injury. It is also one of the first studies to use brain imaging to determine how a young brain responds to concussion, and to bring concussion testing into the real world (like hockey arenas). Sean Killin, the youth hockey player who suffered his first concussion at 12, was lucky that his hockey team had previously partnered with the Concussion Research Centre at the Bloorview Research Institute to conduct baseline studies on young hockey players who had not experienced concussions. Following his injury, Sean repeated the tests and not surprisingly, did not perform as well as he had on the baseline testing. After four months of strength, balance and cognitive exercises, Sean was ready for supervised hockey practice. He encourages other young athletes to take concussions seriously. “It’s your brain,” says Sean. “What do you value more, the rest of your life or the next three weeks in playoffs?” To learn more about the concussion research happening at the Bloorview Research Institute at Holland Bloorview Kids Rehabilitation Hospital, contact Dr. Nicholas H Reed at NReed@hollandbloorview.ca. ■ Claire Florentin is a Communications Associate at the Bloorview Research Institute.

Owen Shaw is a Communications and Engagement Intern at Thunder Bay Regional Health Sciences Centre. www.hospitalnews.com

Focus 21

AMBULATORY CARE/NEUROLOGY/MENTAL HEALTH AND ADDICTION

Making the link between

mind and body health By Emily Baynes

he facts show that good mental health is directly tied to overall physical health and vice versa,” says Dr. Joseph Ferencz, Interim Chief of Psychiatry at St. Joseph’s Healthcare Hamilton. “There is no separation between mind and body health, and now is the time to break down those barriers and transform the way we think about delivering mental health and addiction care in Canada.” When St. Joseph’s new building, the Margaret & Charles Juravinski Centre for Integrated Healthcare, opens in February 2014 at the hospital’s West 5th Campus, it will replace the existing facilities on the site. The new hospital will fully embody the organization’s vision of integration by providing diagnostic and medical outpatient programs in harmony with the regional program for mental health and addiction care.

“

There is no separation between mind and body health, and now is the time to break down those barriers and transform the way we think about delivering mental health and addiction care in Canada “Whether you’re living with a chronic illness like diabetes, require an x-ray, or need support managing your anxiety disorder, you’ll find the resources and care you need at the West 5th Campus,” explains Dr. Ferencz. “Our facility reflects our vision to change the way that mental health and addiction are perceived, prevented, and treated. It’s not just about bricks and mortar. It’s a whole new approach to healthcare.” This philosophy of care is reflected in the new building in a number of ways. The modern design is inspired by healing, openness and accessibility. The therapeutic environment includes private patient rooms with ensuite washrooms to foster greater independence, privacy and safety for clients. Each unit also boasts a beautiful courtyard which will provide clients with access to the outdoors. Hundreds of windows look out onto stunning views of the natural surroundings and escarpment to promote comfort and wellness. This new centre also acknowledges St. Joseph’s commitment to innovation through the inclusion of research and academic spaces, integrated with clinical care. The West 5th Campus will be a full-fledged academic health sciences centre, and the home of McMaster University’s Department of Psychiatry and Behavioural Neurosciences. Here, groundbreaking research into the causes of and treatments for mental health and addiction will take place. With an embedded research and education program, St. Joseph’s will create an environment that not only fosters innovation in research, but also advances the way knowledge is translated to patients and clinicians at St. Joseph’s. On a cultural level, St. Joseph’s is working to eliminate stigma from the inside, out. Health care providers have an important www.hospitalnews.com

The new hospital at the West 5th Campus of St. Joseph’s Healthcare Hamilton will bridge medical and mental healthcare to break down barriers, improve access and reduce the stigma associated with mental illness. role to play in eliminating the stigma experienced by people living with mental illness. Within its 850,000 square foot centre, St. Joseph’s dedicated team of health care professionals – along with learners, researchers, and volunteers – will contribute to an atmo-

sphere where individuals and their families feel comfortable asking for the help they need. Through education and advocacy efforts targeting staff and the greater Hamilton community, St. Joseph’s is driving awareness

and acceptance so that individuals living with mental illness are treated with the respect, dignity and compassion they deserve. “This is all part of the recovery-focused model of care that we are privileged to provide to our clients,” adds Dr. Ferencz. “We’re developing a system where clients are empowered to help establish their own recovery goals,” says Dr. Ferencz. “And where they are provided with the treatment, support, and resources they need to transition successfully back into the community.” St. Joseph’s is shaping a future where clinical care, research and education are fully integrated; where patients are treated in comprehensive clinics, and where new models of care are created and shared. The new West 5th Campus will enhance St. Joseph’s Healthcare Hamilton’s role as the regional leader in providing care for those living with H mental illness and addiction. ■

Emily Baynes is a Communications Coordinator at St. Joseph’s Healthcare Hamilton

High performance computing advances neuroscience research

By Allen Lalonde

round the world, researchers and medical professionals are hard at work developing methods and processes to find cures, improve diagnoses and develop cost-effective treatments for the diseases and disorders that plague our population. Closer to home, in Ontar-

io, academic and industry researchers are working to improve the quality of life for those living with ailments, creating better patient experiences and aiming to reduce spending within the health care system by working with a set of technology-leading tools. These tools focus on making sense of the mountains of “big data” that have already been collected to make

At some point, everyone can use a hand.

advances that were not previously possible. For example, Dr. Mark Daley, an associate professor of Computer Science and Biology at Western University, is using high performance computing (HPC) at the IBM Canada Research and Development Centre (CRDC) to further his research in neuroscience and modeling the brain. Continued on page 24

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OCTOBER 2013 HOSPITAL NEWS

22 Focus

AMBULATORY CARE/NEUROLOGY/MENTAL HEALTH AND ADDICTION

Patients with head injuries get faster,

streamlined care By Evelyne Jhung

raumatic brain injuries (TBI) are often difficult to diagnose and can take a long time. Opened in September 2013, St. Michael’s Hospital’s new urgent care concussion clinic could have sped up the assessment and treatment of 28-year-old Sarah Jayne Benedict. An avid equestrian, Benedict fell off her horse and hit her head slightly in April 2012. After waiting eight hours at a hospital without being seen, she gave up and returned home believing she felt fine. For months afterwards, Benedict experienced sensitivity to noise, dizziness and headaches that kept her from classes at Wilfrid Laurier University, where she was in her third year. Unable to cope, she eventually had to drop out and moved back home to Collingwood. “This is a classic case of a concussion,” says Dr. Donna Ouchterlony, director of the Head Injury Clinic at St. Michael’s Hospital in downtown Toronto. “Up to 90 per cent of people with mild traumatic brain injury get headaches and experience dizziness – more frequently than people with severe TBI – and the nausea and sensitivity to light and stimulation at school are also common symptoms. Unfortunately, there aren’t any universally agreed upon tools to assess head injuries, so diagnosis can be delayed.” In Collingwood, Benedict had difficulty finding someone to see other than her family doctor to get specialized treatment. “I developed a lot of anxiety, I had trouble focusing and balancing and I had zero concentration,” Benedict says. “I’m normally a big reader, but at the time, I could only read for five minutes. I fell into a depression because I couldn’t figure this out.”

Mild traumatic brain injuries and concussions are a major cause of injury and the most resource intensive, nonacute medical issue these days St. Michael’s new urgent care concussion clinic facilitates quicker and more streamlined treatment. “Mild traumatic brain injuries and concussions are a major cause of injury and the most resource intensive, non-acute medical issue these days,” says Dr. Ouchterlony. “If this patient had come to us right away, she could have avoided months of pain and uncertainty.” Within a month of meeting with Dr. Ouchterlony and the Head Injury Clinic team in January 2013, Benedict’s health improved “more in that month than in the past eight combined. They made me feel confident in their care.” Dr. Ouchterlony is also co-chair of an Ontario Neurotrauma Foundation working group to develop standard guidelines for the assessment of brain injuries. “We’re HOSPITAL NEWS OCTOBER 2013

essentially trying to get everyone – military physicians, sports and rehab physicians and family docs – on the same page in terms of assessing and treating traumatic brain injuries.” Another component of the new urgent care concussion clinic is the opportunity for patients to get involved in research. Dr. Cindy Hunt, a research associate with the Head Injury Clinic, is working on developing a standardized data set. In addition, the team is developing a screening tool that will be a resource for health care providers to help triage and direct treatment. For example, at St. Michael’s, when patients contact the Head Injury Clinic, they are interviewed over the phone and asked a number of questions. The “score” they are assigned,

based on their answers, determines their treatment, which can range from receiving an information booklet to getting referred to the Head Injury Clinic. “We’ve created a new model of patient care with this urgent care clinic,” says Dr. Andrew Baker, the medical director of the Trauma and Neurosurgery Program and chief of the Department of Critical Care at St. Michael’s Hospital. “Patients who have experienced a mild traumatic brain injury or concussion will benefit from rapid referral as our clinic fills the gap between an emergency department, where patients are seen right away, and going to your family doctor, which can sometimes take up to six weeks to get an appointment. The system will benefit because patients will get the most ap-

Dr. Donna Ouchterlony, director of the Head Injury Clinic at St. Michael’s Hospital in downtown Toronto. propriate care by the most appropriate care provider at the most appropriate time.” A year and a half after falling off her horse, Benedict was able to return to school in September on a gradual back-to-school H program. ■ Evelyne Jhung is a Senior Communications Adviser at St. Michael’s Hospital.

Measurement and teamwork matter – wait times drop for mental health patients By David Brazeau f you don’t track it as a team, you don’t know what could be done better for patients. That’s what staff and psychiatrists learned in mental health outpatient services at Rouge Valley Centenary. Prior to getting coordinated numbers, and reviewing wait times to see one of Rouge Valley’s 11 psychiatrists, patients were waiting up to eight months to a year for an appointment. Patients referred by family physicians to Rouge Valley’s crisis clinic were, however, seen the same day or the next day. “Our process wasn’t working well for patients. Our patients were either going somewhere else or coming in to emergency when things had reached a crisis point for them,” says Julie Kish, manager of mental health. “We knew we had a problem. Some people were waiting far too long. It was unacceptable. We were unable to determine the exact wait times because of a disjointed referral system. We needed a process where no one could fall through the cracks.” Kish explains, “Our psychiatrists each had their own intake and referral process. They were doing it their own way, which worked in their practices, but it didn’t work for the tracking of all patients.” The hospital did not have a central coordinated tracking method for mental health patients waiting to see a psychiatrist. Mental health manager Laura Boyko says, “We needed a central registry so we could track all of our patients, see how long they were waiting, and see how many patients we were getting each month. Without a central registry, we simply didn’t know.”

So Boyko organized a Kaizen event (a Lean improvement set of team meetings) in July of 2012 with the psychiatrists, who were initially hesitant to change as things were working for them individually. Hospital staff members were also apprehensive, at first, about changing their processes.

Now, there are fewer noshows for psychiatrists’ appointments, and that’s simply because patients aren’t waiting a year to get them.

“Once three different referral approaches were exposed in our Kaizen event, staff and psychiatrists realized the inefficiencies and soon recognized how one approach could benefit everyone; staff, physicians and patients,” says Boyko. “The light bulb went off. They saw that an improvement was needed and one system would be best for the patients,” she adds. The three-day Kaizen event brought together psychiatrists, secretarial staff, information technology staff, managers, acute and mental health vice-president Cheryl Williams, and chief of psychiatry Dr. Steve Fishman. “The volume of referrals seen highlighted the lack of alternate resources in Scarborough and necessitated changes to streamline access for patients in our communities,” says Dr. Fishman. Kish says she knows this new process is working for patients. “Now, there are fewer no-shows for psychiatrists’ appointments, and that’s simply because patients aren’t waiting a year to get them. The appointment wait time has moved from a high of 12 months, a year ago,

down to two months in April 2013.” Having one coordinated list in a computer system tracking the patients has made a big difference. However, it was the work of the psychiatrists in agreeing to pick up patients, who were not specifically referred to them, that also made a big impact. Kish says, “It’s the difference between having a bunch of private practice doctors working independently and having one central clinic for mental health patients with everyone working together. The team engagement from our psychiatrists has been great and really made this work for patients.” She adds, “It was also great teamwork for everyone. Now our secretaries work as a team, rather than for a specific psychiatrist.” Here are the improvements from last summer’s Kaizen event: •Wait times have gone from one year, to 111 days in October 2012, to 64 days in April 2013; •Patients are happier because they are being seen more quickly; •There are fewer patient no-shows for psychiatrists’ appointments; •There are fewer preventable visits to the emergency department by mental health patients; •Each appropriate referral is given an appointment and no one gets missed; • It’s a more efﬁcient use of staff and physician resources. Ultimately, the entire mental health team at Rouge Valley has put the patient H first in this process. ■ David Brazeau is the Director of Public Affairs, Community Relations, and Telecommunications at Rouge Valley Health System. www.hospitalnews.com

AMBULATORY CARE/NEUROLOGY/MENTAL HEALTH AND ADDICTION

Focus 23

Outpatient treatment key to addiction recovery By Linda Rosenbaum

ince her early teens, Felicia* used alcohol to cope with her anxiety, depression and trauma from childhood abuse. At 28, the single mother was admitted to North York General (NYGH) after a suicide attempt involving prescription drugs and alcohol. As an inpatient, Felicia met with the hospitalâ&#x20AC;&#x2122;s addiction consultant, and within a few days had physically recovered from her overdose, was alcohol-free and no longer suicidal. With the consultantâ&#x20AC;&#x2122;s help, Felicia realized that alcohol dependency was keeping her from addressing mental health issues. She was discharged to the hospitalâ&#x20AC;&#x2122;s outpatient Addiction Program, and within a week, began a daily 10-week intensive outpatient treatment program. After successfully completing the treatment, Felicia followed up with six months in the once-weekly Aftercare Group, supplemented by one-to-one consultations with the programâ&#x20AC;&#x2122;s multidisciplinary team. Felicia is sustaining her abstinence from alcohol, and with help from medication and counselling, feels hopeful about her future. â&#x20AC;&#x153;Felicia was grateful she didnâ&#x20AC;&#x2122;t have to be separated from her school-age child while in treatment,â&#x20AC;? says Genevieve McMath, the Programâ&#x20AC;&#x2122;s Team Leader. According to Mc-

Math, outpatient delivery works because patients can integrate reality and relationships of everyday life into their new lifestyle of abstinence and recovery. â&#x20AC;&#x153;If something happens during the week to trigger a desire to â&#x20AC;&#x2DC;useâ&#x20AC;&#x2122;,â&#x20AC;? she says, they come and talk to us in the next day or two, explore the problem, and look at strategies to implement the next time a similar situation arises.â&#x20AC;? Since opening in 1968, NYGH has maintained a substance abuse program which has evolved and grown to meet the needs of patients. Today, as many as 125 people each week receive treatment through the Addiction Program, which provides outpatient treatment for people facing problems with alcohol, street or prescription drugs, as well as addictive behaviours such as gambling, compulsive overeating, shopping and internet/video game addiction. Addiction Medicine specialist Dr. Bonnie Madonik is Medical Director of the Addiction Program. Other team members include the program manager, a nurse with expertise in addiction, a psychologist, an occupational therapist, two social workers, and consultant psychiatrists. The programâ&#x20AC;&#x2122;s various components include assessments, consultation and referrals; daytime, three times weekly group sessions in an outpatient Harm Reduction program; a 10-week half-day Abstinence-

Based outpatient program; and an Aftercare program for people who have completed the Abstinence-Based program. The team also offers support for family members and significant others, is open to people with mental health as well as addiction problems, and accepts self-referrals. While individual recovery goals may range from total abstinence to harm reduction, addiction is a chronic brain disease, says McMath, and most people need total abstinence to achieve health â&#x20AC;&#x201C; whether physical, emotional, mental or spiritual. â&#x20AC;&#x153;That said, we want to meet people â&#x20AC;&#x2DC;where they areâ&#x20AC;&#x2122;,â&#x20AC;? she adds, acknowledging that a very small percentage of people, who come to addiction treatment, may be capable of keeping to the low risk drinking guidelines, or to have the odd joint per year. Rubin*, a 45-year old patient, came to the Addiction Program because of problems with alcohol and cocaine. â&#x20AC;&#x153;My wife said my use has to stop or sheâ&#x20AC;&#x2122;s taking the kids and leaving.â&#x20AC;? Rubin thought he could quit on his own and drink the occasional beer, but after unsuccessfully trying for a couple of weeks, he agreed to attend the program for four weeks to satisfy his wife. With encouragement from staff and copatients, he achieved complete abstinence from all mood-altering substances and behaviours for 10 consecutive weeks. He felt

better physically and was enjoying improved family relationships. Proud for the first time in years, Rubin agreed to continue his abstinence and attend Aftercare. Like Felicia, outpatient treatment was key for Rubin, who continued to operate his business and support his family while in the Program. â&#x20AC;&#x153;When patients are cocooned in residential treatment settings,â&#x20AC;? says McMath, â&#x20AC;&#x153;they live and breathe recovery but donâ&#x20AC;&#x2122;t have opportunities to practice what theyâ&#x20AC;&#x2122;re learning.â&#x20AC;? During treatment, Rubin wasnâ&#x20AC;&#x2122;t completely able to avoid people with whom he formerly drank and used cocaine. But each time he encountered a trigger, whether a person, place or stressor, â&#x20AC;&#x153;he returned to the program to strategize about what he could do to prevent relapse.â&#x20AC;? McMath admits that it can take months or years to achieve abstinence, noting that some patients have been connected to the program, in one way or another, for over 10 years. â&#x20AC;&#x153;Relapse is about learning. It may take a long time to sustain recovery. We encourage patients to come back, no matter how many times. The next try may be the one that works.â&#x20AC;? * not his/her real name *with notes from Genevieve McMath, H Dr. Bonnie Madonik â&#x2013;

Linda Rosenbaum is a Health and Medical Writer.

â&#x20AC;&#x153;Itâ&#x20AC;&#x2122;s my pleasure to say â&#x20AC;&#x2DC;thank you.â&#x20AC;&#x2122; Your knowledge DQG FRQĂ&#x20AC;GHQFH JXLGHG XV WKURXJK DOO WKH WLPH <RX ZHUH OLNH WKH OLJKW DQG WKH KRSH LQ WKH GDUN HVSHFLDOO\ LQ WKH Ă&#x20AC;UVW FRXSOH RI \HDUV , DP JODG LW LV RYHU VXFFHVVIXOO\ 7KDQN \RX Âľ â&#x20AC;&#x201C; A.W.

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OCTOBER 2013 HOSPITAL NEWS

24 Focus

AMBULATORY CARE/NEUROLOGY/MENTAL HEALTH AND ADDICTION

Families find support to navigate the mental health system By Charles Senior

ometimes it’s not just patients who need help to understand the health system; families and friends doing their best to support loved ones need help too. This was the case for the Holland family when their daughter’s mental illness brought the family in contact with the mental health care system. In their daughter’s second year of university, they had to bring her home. She was no longer able to function, no longer able to mask what they now know to be a serious mental illness. She entered hospital fully psychotic and afraid – afraid to talk about what she was experiencing – the voices, the hallucinations; afraid and denying her need for help; afraid of what her family and friends, would think; afraid of what this would mean in her life. What she didn’t know was that the family was also scared, afraid and in need of help. “We had no idea what questions to ask or where to go for answers,” says Christine Holland. “We needed help navigating the complex and disjointed mental health system so she could access the care she so desperately needed, while at the same time struggling to provide care for ourselves and our other children.” “After numerous years in the system, we arrived at Ontario Shores exhausted, frustrated, angry; uncertain of what was to come. We had a gut wrenching fear that our love and quickly eroding resilience might not be enough. Our hope was ﬂoundering,” says Holland. Holland found her family’s experience was not unique as she became acquainted with other parents and family members struggling to come to grips with their loved ones’ mental illness while trying to find support in the role of caregiver. Out of this experience and that of many

others, Ontario Shores initiated a Family Council in 2009 in response to requests from families for a support mechanism that could address their needs and help answer their questions. Ontario Shores recruited family members to establish a Family Council in May 2010 and the Council officially launched. The role of Family Council is to be a voice for all families and to help make the journey to recovery as positive as possible for all involved. When the idea for a visiting room for families within the hospital was advanced, Ontario Shores and Ontario Shores Foundation were wholly supportive. It soon became apparent that a visiting room alone would not meet the needs of families. The family council members knew from personal experience that families of patients feel acutely isolated and are often afraid to speak out in their community and workplace due to the stigma associated with mental illness. Together, the Ontario Shores Family Council, Social Workers Council and families researched and reported the need for system navigation tools, access to timely and accurate information and education. They revealed there were few services and supports available to families in the region, and that mental health system navigation tools as well as education on topics such as diagnosis, medication and side effects, therapy options and crisis management were badly needed. A Family Resource Centre was the answer. It would provide families with a warm, welcoming place to receive support from one another, learn together, and develop strengths and coping skills in order to sustain hope, wellness and recovery for their loved ones and themselves. In September, Ontario Shores opened its new Family Resource Centre designed around programs and services to enable families and friends to deliver the best possible support with access to the staff, volunteers,

the latest research, educational programs, groups and one-on-one counselling within a safe and supportive environment. The new space includes private office space, a common area for families, children’s play area and a room for teens equipped for wireless connectivity and music. A “family room” within the Family Resource Centre includes an eating area and a kitchenette, where families can visit with their loved ones in a less institutional and more relaxed setting. Ontario Shores realizes families play an important role in their loved one’s journey of recovery. “We have identified the pivotal role of loved ones and have integrated them into the recovery process. We believe the opening of our new Family Resource Centre will help manage the challenges of this journey for families and enhance their quality of life,” explains Karim Mamdani, President and CEO at Ontario Shores. “The Family Resource Centre will provide families a space to help other families through programs that foster family-to-family networking and support. Families who have lived the difficult journey have the unique perspective to offer emotional sup-

advances neuroscience research Continued from page 21 “To have this leg-up at this critical juncture is really exciting,” says Dr. Daley, “this will help to make [Canadians] world leaders in many disciplines by enabling us to make sense of the vast amounts of data we are generating.” The CRDC is offering Canadian researchers such as Dr. Daley the opportunity to access an advanced HPC infrastructure that includes the most powerful supercomputer in Canada and some of the most advanced analytics software available today. Dr. Daley’s brain research is one of fifteen health care projects using The Southern Ontario Smart Computing Innovation Platform (SOSCIP) capabilities.

Real-time analysis of human brain networks

An important tool in the diagnosis of neurological disorders is functional magnetic resonance imaging, or fMRI. The challenge with this process is that the current fMRI results often take more than a week to be analyzed and can require additional tests, which incur further expenses to the health care provider. Dr. Daley and his research team believe there are better methods to the review process and as such, have developed a working prototype that could enable faster, more accurate diagnoses in near-real time. In addition, the working prototype uses dynamically adapted brain scanning. This allows the test to be stopped, tuned and adjusted while it’s underway. This allows for review of neural functional conHOSPITAL NEWS OCTOBER 2013

The new Family Resource Centre at Ontario Shores for Mental Health Sciences. port and knowledge to other families who are also navigating the system,” says Holland. The Family Resource Centre is located at Ontario Shores and is open five days and one evening weekly. For more information, contact Ontario Shores Family Resource H Centre at 905.430.4055 ext.6970. ■ Charles Senior is a Communications Officer at Ontario Shores for Mental Health Sciences. nectivity networks. What’s more, these neural functional connectivity networks have shown potential as diagnostic indicators for several brain disorders including autism, schizophrenia, Alzheimer’s and ADHD. Dr. Daley and his colleague Rhodri Cusack are also looking at neonates ﬂagged as having potential neurological problems. Dr. Daley explains: “With premature babies it’s very difficult to do behavioral testing. For example you can’t say ‘how many fingers am I holding up?’ In this case we need some sort of quantitative metric such as brain scanning. In the case of infants who are at high risk, we’re hoping that we can identify simple metrics where the graph theory tool can tell us if an infant is at risk and needs to see a pediatric neurologist straight away.” “The tools IBM is providing allow us to take these colossal data sets and make sense of them in an automated way,” Dr. Daley notes. “In neuroscience, we can often generate terabytes of data from images detailing both the structure and the function of the brain. The new computational resources will allow us to automate that analysis so we can boil that down into simple models.” From a real-world application and commercialization perspective, this tool Dr. Daley and his team have developed is expected to create a product that would be installable with existing MR facilities so that a doctor would then have access to a stock tool set. The SOSCIP project portfolio includes close to 40 projects and the results of these projects are expected to hold much potential and deliver significant advancements in their respecH tive fields. ■ Allen Lalonde is the Senior Executive responsible for IBM Canada’s Research & Development Centre. www.hospitalnews.com

Ethics 25

Should oral feeding be considered â&#x20AC;&#x153;healthcareâ&#x20AC;? or a â&#x20AC;&#x153;necessity of lifeâ&#x20AC;?? By Jonathan Breslin bout a month ago the case of Margot Bentley hit the national news. Ms. Bentley is an 82 year-old former nurse, whose work with dementia patients inďŹ&#x201A;uenced her own decision to complete an advance directive in 1991. According to news reports, her advance directive included the following wishes: â&#x20AC;&#x153;If at such a time the situation should arise that there is no reasonable expectation of my recovery from extreme physical or mental disability, I direct that I be allowed to die and not be kept alive by artificial means or â&#x20AC;&#x2DC;heroic measuresâ&#x20AC;&#x2122;. â&#x20AC;? In addition, her advance directive explicitly stated, â&#x20AC;&#x153;No nourishment or liquids.â&#x20AC;? Eight years later, in 1999, Ms. Bentley was diagnosed with Alzheimerâ&#x20AC;&#x2122;s Disease. In late 2011 her family decided that she had reached the point at which her quality of life would no longer be acceptable to her, so they asked the long term care facility where she is living in British Columbia to respect her wishes and stop providing pureed spoon-feeding. The facility refused the request, stating that they are obligated to provide the â&#x20AC;&#x153;necessities of life,â&#x20AC;? includ-

ing food and ďŹ&#x201A;uids. The family is taking the facility to court and the hearing should take place this fall. Like in Ontario, patients in British Columbia do have the legal right to express wishes in an advance directive, including the refusal of healthcare. So the legal battle will focus on whether oral feeds qualify as â&#x20AC;&#x153;healthcareâ&#x20AC;? and, therefore, can legally be refused by Ms. Bentley. Part of that analysis will no doubt be a discussion about whether there is a legal distinction between refusing oral feeds and suicide, and whether honouring Ms. Bentleyâ&#x20AC;&#x2122;s refusal would be considered assisted suicide. The long term care facilityâ&#x20AC;&#x2122;s position is that oral feeds are necessities of life, not healthcare, which would make Ms. Bentleyâ&#x20AC;&#x2122;s request in her advance directive a request for assisted suicide (which they are not legally obligated to honour). Personally I would be surprised if the BC court sided with the long term care facility in this case because there are solid ethical reasons for honouring a patientâ&#x20AC;&#x2122;s advance directive in a situation like this. The reason why patients have the legal right to refuse treatment in Canada is because personal autonomy is one of our most cherished societal values, and an im-

portant part of exercising oneâ&#x20AC;&#x2122;s autonomy is having control over what is done to oneâ&#x20AC;&#x2122;s body. This is the source of the distinction between suicide and refusing life-saving or life-sustaining treatment; the former is an act undertaken for the purpose of ending oneâ&#x20AC;&#x2122;s life, while the latter involves a decision to remove or refuse unwanted intrusion into oneâ&#x20AC;&#x2122;s body.

Like in Ontario, patients in British Columbia do have the legal right to express wishes in an advance directive, including the refusal of healthcare In some contexts, voluntarily stopping eating and drinking (VSED) could be considered suicide â&#x20AC;&#x201C; for example, in a patient who has the ability to eat and drink but chooses not to in order to hasten death. What is different about Ms. Bentleyâ&#x20AC;&#x2122;s case, however, is that her advanced Alzheimerâ&#x20AC;&#x2122;s Disease has rendered her unable to maintain her own oral intake. A decline in both physical ability and interest in eating and drinking is a natu-

ral part of the progression of Alzheimerâ&#x20AC;&#x2122;s Disease and other dementias. Because she has reached the point at which she relies on others to feed her, feeding her against her wishes (as expressed in her advance directive) now represents an unwanted intrusion into her body. Thus, her refusal of that unwanted intrusion should be honoured as it would with any other unwanted intrusion. In my experience, many health care providers struggle ethically with decisions to withdraw/withhold nutrition and hydration more than any other clinical decision. This likely has to do with various social and cultural meanings attributed to eating, as well as the association people draw between feeding patients and feeding infants. However, it is important to recognize that refusing oral feeding may be the only way for some patients to exercise what little autonomy they have at the end of life and to die with what they perceive dignity to be. Under the right circumstances, honouring H this request can be the right thing to do.â&#x2013; Jonathan Breslin is an independent ethics consultant and educator and an Assistant Professor in the Institute of Health Policy, Management and Evaluation at The University of Toronto.

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â&#x20AC;&#x153;Canadians deserve the best legal representation and highest standard of healthcare available to them. $W +LPHOIDUE 3URV]DQVNL //3 ZH Ă&#x20AC;JKW IRU \RXU ULJKWV WR VHFXUH WKH SURIHVVLRQDO FDUH DQG IXOO FRPSHQVDWLRQ \RX GHVHUYH â&#x20AC;? David Himelfarb

Over 100 years of experience specializing in all areas of personal law Motor Vehicle Accidents Slip & Fall Accidents

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Contact us for a FREE consultation from anywhere in Ontario Tel: 416-599-8080 Toll Free: 1-855-446-7765 Email: david@himprolaw www.personalinjurylawyersintoronto.ca 480 University Avenue, Suite 1401, Toronto, Ontario M5G 1V2 www.hospitalnews.com

OCTOBER 2013 HOSPITAL NEWS

26 Focus

AMBULATORY CARE/NEUROLOGY/MENTAL HEALTH AND ADDICTION

A primer on Educational & Industry Events progressive To list your event, send information to “events@hospitalnews.com”.

We try to list all events and information but due to space constraints and demand, we cannot guarantee it. To promote your event in a larger, customized format please send enquiries to “advertising@hospitalnews.com” Q Oct 7-10, 2013 Canadian interRAI Conference The Westin, Ottawa Website: www.canadianinterrai.org Q Oct 17-19, 2013 &$* $JLQJ IURP &HOOV WR 6RFLHW\ QG $QQXDO 6FLHQWLÀF DQG Educational Meeting Canadian Association on Gerontology Halifax, Nova Scotia Website: www.cagacg.ca Q Oct 27-29, 2013 20th Canadian Conference on Global Health The Westin Hotel, Ottawa Website: www.csih.org Q Oct 28-29, 2013 National Reducing Hospital Readmissions & Discharge Planning Conference, Hyatt Regency, Vancouver Website: www.healthcareconferences.ca Q Nov 3-6, 2013 FutureMed San Diego, California Website: www.futuremed2020.com Q Nov 4-6, 2013 OHA HealthAchieve 2013 Metro Toronto Convention Centre, Toronto Website: www.healthachieve.com Q Nov 13-14, 2013 New Dynamics in Health/Health Innovation Forum MaRS Discovery District, Toronto Website: www.healthinnovationforum.com Q Nov 28-29, 2013 National Correctional Services Healthcare Conference Ottawa Convention Centre Website: www.healthcareconferences.ca Q Dec 2-3, 2013 National Operating Room Management Conference Hyatt Regency, Vancouver Website: www.healthcareconferences.ca Q Dec 3-4, 2013 Data Analytics for Healthcare The Old Mill Inn, Toronto Website: www.healthdatasummit.com Q Jan 28-29, 2014 10th Annual Mobile Healthcare Eaton Chelsea Hotel, Toronto Website: www.mobilehealthsummit.ca Q Jan 29-30, 2014 Activity Based Funding Conference Metro Toronto Convention Centre, Toronto Website: www.healthcareconferences.ca Q Jan 30-Feb 1, 2014 2014 Better Breathing Conference Toronto Marriott Downtown Eaton Centre Website: www.on.lung.ca Q Feb 1-5, 2014 CSHP 45th Professional Practice Conference Sheraton Centre Toronto Hotel Website: www.cshp.ca

To see even more healthcare industry events, please visit our website www.hospitalnews.com/events HOSPITAL NEWS OCTOBER 2013

supranuclear palsy By Dr. Lawrence I. Golbe

rogressive supranuclear palsy (PSP) is a brain disease similar to Parkinson’s disease in its outward appearance but to Alzheimer’s disease under the microscope. It has no known effective treatment or cure. PSP affects brain cells that control walking, balance, mobility, vision, speech, swallowing, thinking and behavior. Symptoms begin, on average, at age 63 but in a few cases as early as the 40s. It is slightly more common in men than women and slightly more common in those with lesser education. Five to six people per 100,000 have PSP, similar to the figure for Lou Gehrig’s disease but only about three per cent of the figure for Parkinson’s disease. Only a third of those with PSP have received the correct diagnosis. The most common first symptom, occurring on average in the 60's, is loss of balance while walking, usually with unexplained falls. A sizable minority will start with a milder gait problem that resembles the stiff, slow walk of Parkinson’s. Sometimes the falls are described as attacks of “dizziness,” prompting testing for problems of the inner ear, the heart or the blood vessels of the brain.

A real prevention or halting of the progression of PSP will require more knowledge about its real cause. Other common early symptoms are forgetfulness and changes in personality. The latter can take the form of a loss of interest in ordinary pleasurable activities or increased irritability. Less common early symptoms are general slowing, trouble with eyesight, slurring of speech, and mild shaking of the hands. Difficulty driving a car is common early in the course of PSP. The term "progressive" was included in the name of the disease because, unfortunately, the early symptoms worsen and new ones develop sooner or later. After five to six years, on average, the imbalance and stiffness make walking very difficult or impossible. The difficulty with organizing thoughts and speech makes communication difficult. If trouble with eyesight was not present early on, it eventually develops in almost all cases and can sometimes be as disabling as the movement difficulty. Difficulty with swallowing develops eventually in most patients. Usually, trouble with thin liquids precedes difficulty with solid food. This is because in PSP, the swallowing muscles have difficulty creating

a watertight seal separating th the path to the stomach from the path to the lungs. Repeated subtle aspiration can cause pneumonia and ‘aspiration pneumonia,’ in fact, is the most common cause of death in PSP. Neurologists manage the symptoms of PSP in a superficial way with drugs for Parkinson’s disease and other PSP symptoms such as insomnia, impaired memory, depression and bladder urgency. Physical therapy for gait and swallowing therapy are also useful. Sometimes special glasses called prisms can help the eye movement problem to a degree and botulinum toxin (“Botox”) injections can help the abnormal eyelid closure that affects a few PSP sufferers. But a real prevention or halting of the progression of PSP will require more knowledge about its real cause. The degenerating brain cells have an abnormal accumulation of a normal protein called “tau.” These clumps of tau are called “neurofibrillary tangles.” We don’t know whether the problem is that the tau is defective from the time of its manufacture, or if it is damaged later, or if it is merely produced in excess. It is increasingly likely that at least one important part of the cause of the misbehavior of the tau protein is some combination of genetic defects that alter the manufacture of tau or control its degradation by the brain cell’s “garbage disposal” machinery. Another important factor is the unfortunate ability of damaged tau protein to produce identical damage in previously normal copies of the tau protein in a chain reaction spreading the tau abnormality through the brain. All of these abnormal processes in the brain cells in PSP offer opportunities to scientists to develop drugs or other therapies that can act as a “monkey wrench” to disrupt one of the many vulnerable points in this complicated disease process. In fact, several such treatments have been tested recently and several others are near the stage of human trials. CurePSP’s research program is aimed at developing such treatments. Fortunately, the similarity of the tau protein problem in PSP to that in Alzheimer’s disease means that the huge worldwide research effort to eradicate AD could provide the same benefit to people with PSP. This is what we’re hoping for – as CurePSP’s motto says, “Because Hope H Matters.” ■ Lawrence I. Golbe, MD is the Director ofResearch and Clinical Affairs for CurePSP (www.curepsp.org). He is a Professor of Neurology at Rutgers Robert Wood Johnson Medical School in New Brunswick, New Jersey. www.hospitalnews.com

AMBULATORY CARE/NEUROLOGY/MENTAL HEALTH AND ADDICTION

Focus 27

Neurologist pilots program that treats patients at home By Alexa Giorgi

times for IVIG in day units are becoming increasingly long. Katzberg hopes to show his colleagues that Canada can learn from the U.S. and European model, which redirects stable patient care out of acute-care hospitals. “Our goal is really two-fold,” says Katzberg. “We need to free up resources in the hospital for those who need it and also find ways of providing the same quality care to patients– who might not necessarily need to be physically here at the hospital.”

eborah Farquhar doesn’t always look forward to her monthly visits to the Toronto General Hospital, where she goes for her IVIG (intravenous immunoglobulin) treatment. Each appointment involves travelling an hour each way from her home, arranging childcare, losing a full day to tend to household chores, and the feeling of loneliness that comes from being at a hospital all day alone. It’s why she agreed to be part of a study looking at whether it was safe and feasible to treat patients with her condition in their homes.

First Canadian study

Dr. Hans Katzberg, a neurologist at the University Health Network, has conducted the first Canadian study on home-based IVIG treatment for chronic inﬂammatory demyelinating polyradiculoneuropathy (CIDP), with the assistance of Vilija Rasutis, RN. Results were published in the Canadian Journal of Neurological Sciences in May 2013. CIDP is an auto-immune disorder that involves swelling and inﬂammation of the nerves, which leads to loss of strength and sensation, mostly in the arms and legs. It can strike at any age and affects both men and women.

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At-home treatment favoured

At home treatments for IVIG would be easier for patient Deborah Farquhar, who travels an hour each way from Richmond Hill to Toronto General Hospital for her monthly appointment. If left untreated CIDP could potentially lead to paralysis. “Working in a busy acute care setting like Toronto General, you can see the need for hospital care is outpacing our ability to see patients,” Katzberg says. “In healthcare, you are always looking for ways to deliver patient-centered care as efficiently as possible, and sometimes this requires adapting a model that has already been proven to work elsewhere.”

Learning from U.S., European models

IVIG is a blood product and the standard therapy that is given to patients with CIDP to help decrease the severity of their autoimmune disorder. Available in Europe and the U.S. in home and nursing-centre based settings for the last 20 years, IVIG is only administered in a hospital setting in Canada. Patients who currently require IVIG must come to the hospital once a month for 3-6 hours at a time. In addition, wait

The pilot study involved 10 patients, who were treated for six months. The objective was to determine the safety and feasibility of out-of-hospital IVIG for maintenance therapy in patients with CIDP. The study found that home IVIG treatment for maintenance therapy in patients with CIDP was well-tolerated, and almost all of the patients preferred home infusion to hospital based treatment. With these results in hand, the next step will be to determine how a program like this would work on a larger scale and to engage with partners, such as Ontario Home Care services and Canadian Blood H Services. ■ Alexa Giorgi is the Senior Public Affairs Advisor for the Krembil Neuroscience Centre of Toronto Western Hospital.

OCTOBER 2013 HOSPITAL NEWS

28 Focus

AMBULATORY CARE/NEUROLOGY/MENTAL HEALTH AND ADDICTION

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*Clostridium difficile spores. **Based on Health Canada master label and in-market labels of leading brands. **Use as directed on hard non-porous surfaces. See product label for complete list of organisms. ©2013 Clorox Professional Products Company.

HOSPITAL NEWS OCTOBER 2013