Inside: From the CEO’s Desk | Evidence Matters | Nursing Pulse | Careers Long-Term Care
July 2018 Edition
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Contents July 2018 Edition
IN THIS ISSUE:
Innovative procurement at Southlake Regional Health Centre
▲ Cover story: Artificial intelligence
▲ Capnography moves beyond the OR
▲ New cardiac mapping
Editor’s Note ....................4 In brief ..............................6 From the CEO’s desk .....12 Nursing pulse ................22 Evidence matters ...........24 Careers ..........................30
▲ Stages of diabetes care
Ingenuity meets hearth health
Cheap, fast, good -- pick two?
How to shorten hospital wait times in Canada
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By David R. Urbach ong wait times are the vulnerable soft underbelly of the Canadian health system. Canadians treasure our single-payer, publicly funded program of physician and hospital care, virtually as a defining part of our national identity. And yet, increasing legal and political pressure over quick access to elective surgeries – cataract extraction and joint replacement, for example – threatens to undermine that support. The Commonwealth Fund 2017 report ranked Canada last among 11 countries in timeliness of care. A case currently before the British Columbia Supreme Court aims to topple provincial regulations that limit private payment for medically necessary services, claiming that surgical wait times for elective procedures such as arthroscopic knee surgery violate the Canadian Charter of Rights and Freedoms. The truth is that few people anywhere in the world are in love with their health care system – Canada is no exception. Why? Modern health care is expensive – so expensive, at $5,900CAD per person per year in Canada, $9,900USD in the U.S. and £2,900 in the U.K., that it costs more than many people are happy to pay for, whether through taxation, insurance premiums or out-of-pocket payments.
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Many Americans still lack health insurance, and even insured Americans may not be approved for every treatment they desire. Among developed countries, Germany has the highest public support for their health system, but even there – Germany – 40 per cent believe the system requires fundamental changes or a complete rebuild. Sound familiar? But this does not mean that Canadians are doomed to long waits for elective surgery forever. There is actually much that can be done fairly easily without resorting to private payment. We can address the supply of surgical procedures, the demand for surgery, and improve coordination within the system to gain significant improvements. Increasing the supply of surgery can be achieved by paying hospitals using “activity-based funding” payments for each procedure they do for surgeries like joint replacements, rather than receiving an annual global budget in the hope that they will meet the demand. Reimagining the way we use hospitals, incorporating new anesthesia techniques and virtual care to transform common procedures like joint replacement to day surgery, can reduce costs and free up hospital beds to further increase the supply of surgical procedures. Continued on page 7
David R. Urbach, MD is Surgeon-in-Chief at Women’s College Hospital, Toronto and Professor of Surgery and Health Policy at the University of Toronto and an expert advisor with EvidenceNetwork. ca which is based at the University of Winnipeg. He is also Senior Innovation Fellow, Women’s College Hospital Institute for Health System Solutions and Virtual Care (WIHV).
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Monthly Focus: Paediatrics/Ambulatory Care/Neurology/Hospital-based Social Work: Paediatric programs and developments in the treatment of paediatric disorders including autism. Specialized programs offered on an outpatient basis. Developments in the treatment of neurodegenerative disorders, traumatic brain injury and tumours. Social work programs helping patients and families address the impact of illness.
Monthly Focus: Emergency Services/Critical Care/Trauma/Infection Control: Innovations in emergency and trauma delivery systems. Emergency preparedness issues facing hospitals and how they are addressing them. Advances in critical care medicine. Programs implemented to reduce hospital acquired infections. Developments in the prevention and treatment of drug-resistant bacteria and control of infectious diseases.
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Minimally invasive procedure and medication benefits patients with stable coronary artery disease By Ana Gajic non-surgical procedure, called percutaneous coronary intervention (PCI), along with prescribed medication, is better than medication alone as initial treatment for people who have the most common form of heart disease, suggests an analysis of an international clinical trial co-led by St. Michael’s Hospital. Published recently in the New England Journal of Medicine and simultaneously presented at EuroPCR 2018 in Paris, France, the five-year analysis of the FAME 2 trial shows that initial PCI along with medication was associated with a significant reduction in urgent hospital admissions and revascularizations to restore blood flow in the blood vessels of the heart and a likely reduction in heart attacks as compared to medication as the only treatment. The medication used in the FAME 2 trial consisted of a combination of aspirin, cholesterol-lowering and blood pressure-lowering drugs as required by current treatment guidelines. PCI is a minimally-invasive procedure where modern stents – small tubular metal scaffolds coated with medication – are inserted into an artery using a small catheter to widen a narrowed blood vessel in the heart. PCI is commonly used to treat sudden blockages of a coronary artery that cause a heart attack. In situations where the heart’s arteries narrow less suddenly and do not cause a heart attack but induce chest pain during exercise – a condition known as stable coronary artery disease – it has remained unclear whether PCI in addition to medication was better than medication alone in preventing future heart attacks. “Currently, the standard practice in North America is to prescribe medication to patients with stable coronary artery disease and avoid PCI,” says Dr. Peter Jüni, Director of the Applied Health Research Centre (AHRC) at
the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, who is a senior author on the study. “Our results pose the question: Would a large portion of patients benefit from early PCI in addition to medication?” “We used pressure measurements inside the heart arteries to find coronary arteries that should be widened,” says Dr. Bernard De Bruyne, an interventional cardiologist at the Cardiovascular Center Aalst in Belgium and the Principal Investigator of the trial. “With these measurements we were able to identify patients who would benefit from PCI in addition to medication.” The World Health Organization reports that every year, 17.7 million people die from cardiovascular diseases, which is an estimated 31 per cent of all deaths worldwide. Coronary artery disease is the most common type of heart disease in North America and Europe, and is a serious health problem worldwide. It occurs when the coronary arteries become narrow and hardened due to the build-up of cholesterol rich
plaques in the blood vessels. While the FAME 2 trial showed that PCI reduced urgent hospital admissions and revascularizations and likely reduced
heart attacks, it did not provide evidence for a difference between PCI and medication alone in the prevention of deaths. The trial was initially sponsored by St. Jude Medical, a global medical device company, until the three-year follow-up. The subsequent two years of follow-up have been academically driven, organized the by the academic steering committee of the study. Nineteen sites across Europe and North America participated in the five-year follow-up. “Our trial over its entire follow-up shows us that the longer you observe these patients, the more pronounced the benefits of the initial PCI become,” says Dr. Jüni, who is also a Canada Research Chair and a Professor of Medicine at the University of Toronto. While Drs. Jüni and De Bruyne agree there is more research to be done using modern PCI technology, this five-year follow-up offers evidence that PCI has the potential to provide long-term benefits to patients with staH ble coronary artery disease. ■
Ana Gajic works in communications at St. Michael’s Hospital.
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Clostridium difficile infections
have decreased 36% in Canadian hospitals ates of C. difficile infections have decreased 36 per cent in hospitals across Canada, although the virulent NAP1 strain associated with severe illness and deaths is the most common strain, according to research published in CMAJ (Canadian Medical Association Journal). Clostridium difficile is the most common infectious cause of diarrhea in hospitalized patients in developed countries, causing severe illness and occasionally death. Seniors and people on antibiotic treatment are most vulnerable to infection. However, the NAP1 strain of C. difficile, which is most virulent and can be resistant to treatment with fluoroquinolone antibiotics, has emerged in healthy people and in the community, spreading after several epidemics in the early 2000s.
CLOSTRIDIUM DIFFICILE IS THE MOST COMMON INFECTIOUS CAUSE OF DIARRHEA IN HOSPITALIZED PATIENTS IN DEVELOPED COUNTRIES. A pan-Canadian team of researchers from the Canadian Nosocomial Infection Surveillance Program looked at data from 42–53 acute care hospitals over 7 years (2009– 2015) to understand patterns of NAP1 strain and effect of infection on patient outcomes. A total 20,623 cases of hospital-acquired C. difficile occurred, mostly in hospitals with more than 200 beds. Infection rates decreased 35.8 per cent across Canada by 2015, although the number of younger patients with the disease increased.
Improvements in infection-control measures (such as improved testing, more judicious use of antibiotics, frequent handwashing, and better and more frequent cleaning of facilities) begun after outbreaks 10–15 years ago may have contributed to the decrease in infection rates. The large study found an association between the NAP1 strain and death in patients aged 18 and older, not detected by earlier single-centre or provinciallevel studies. “Our findings suggest that, as the proportion of NAP1 strain isolates decreas-
es in relation to all circulating strains, both the rate of health care – associated C. difficile infection and the number of severe cases can be expected to decrease relative to a peer hospital with a higher proportion of NAP1 circulating isolates,” says Dr. Kevin Katz, North York General Hospital, Toronto, Ontario. The authors recommend continued vigilance to better contain infection. “Infection prevention and control practices, antimicrobial stewardship and environmental cleaning should continue to be strengthened at the local level, as these areas positively affect institutional rates of health care – associated C. difficile infection, regardless of circulating strain types.” “The evolving epidemiology of Clostridium difficile infection in Canadian hospitals during a postepidemic period (2009–2015)” was pubH lished June 25, 2018. ■
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6 HOSPITAL NEWS JULY 2018
Health Canada Nursing workforce experiences slowest growth proposes new regulations linked to Vanessa’s Law
dverse reactions to drugs and incidents involving medical devices account for many hospital admissions and emergency room visits in Canada every year. These serious adverse drug reactions and medical device incidents are significantly underreported by clinicians, which is a long-standing problem both in Canada and internationally. Recently Health Canada published proposed regulations in Canada Gazette, Part I to amend the Food and Drug Regulations and Medical Devices Regulations to require hospitals to report serious adverse drug reactions and medical device incidents. This regulatory proposal supports authorities gained through the Protecting Canadians from Unsafe Drugs Act (Vanessa’s Law). Under the proposed regulations, hospitals will be required to report to Health Canada all serious adverse drug reactions and medical device incidents, in writing, within 30 days of when the incident was first documented within the hospital. The proposed regulations aim to improve the quality and increase the quantity of serious adverse drug reaction and medical device incident reports provided to Health Canada. Such reports are important in managing the risks associated with the use of drugs and medical devices, and are often the first sign of emerging safety problems. This new reporting requirement will help Health Canada better understand the benefits and harms of marketed health products, which will contribute to improving the safety of drugs and medical devices used by Canadians. These new measures are part of the Government of Canada’s efforts to gather important safety information and to take necessary action, while minimizing impacts on hospitals and on the health care system. The proposed regulations are based on the feedback that Health Canada received during its consultations to date. Canadians and stakeholders are invited to provide comments on the regulatory proposal between June 16 and August H 29, 2018. ■
anada’s regulated nursing workforce continues to grow, but the annual growth rate from 2016 to 2017 was the slowest in 10 years. New information from the Canadian Institute for Health Information (CIHI) shows that Canada experienced 0.7% growth in the regulated nursing workforce last year, compared with an annual growth rate of 1.3% to 2.8% over the past decade. There was a net gain of 5,219 regulated nurses in 2017, following net gains of 6,059 in 2016 and 8,363 in 2015. The regulated nursing workforce – those nurses who indicated they were employed in their profession at the time of
registration – reached 398,845 in 2017. “Declining numbers of new nursing graduates, growing numbers leaving the profession late in their careers and an increase in part-time and casual positions are the trends we see impacting the nursing landscape in Canada today,” says Andrea Porter, manager of Health Workforce Information at CIHI.
FACTS ABOUT NURSES IN CANADA
• 72% of new graduates employed in regulated nursing in Canada in 2017 held part-time and casual positions – an increase of 19 percentage points since 2008 (53%).
Wait times in Canada The demand for surgery is also elastic. Removing people who are not in dire need of surgery from waiting lists improves access for those in greater need of services. It also prevents the overtreatment of healthy people which is rampant in many areas of medicine – 32 per cent of patients waiting for cataract surgery in BC had near-perfect vision, in just one example. Ironically, the current case before the B.C. Supreme Court – the most pressing legal challenge to the constitutionality of Canadian medicare – is in part about access to arthroscopic knee surgery, a procedure that might actually cause more harm than benefit in some patient groups. Wait times in Canada may be long on average, but they are not long everywhere. Take the example of knee replacement surgery in Ontario. At first glance, the waits certainly seem long: in 2017, only 78 per cent of people had their knee replacement within the recommended six months and 10 per cent waited longer than nine months. In spite of this, half of all people actually had their surgery within three months. Why is it that some people have surgery quickly and others wait? Mostly, because there is little coordination of surgical practices. Long ago, other industries adopted effective queue-management strategies
• 48% of health care professionals in Canada are regulated nurses. • 57% of regulated nurses in Canada were employed full-time in 2017. • 46% of regulated nurses who did not renew their licence to practise in Canada in 2017 were age 55 and older. Regulated nurses are • Registered nurses (RNs), including nurse practitioners (NPs) • Licensed practical nurses (LPNs), also called registered practical nurses in Ontario • Registered psychiatric nurses (RPNs), currently regulated in the 4 Western provinces (Manitoba, Saskatchewan, Alberta, British H Columbia) and Yukon. ■
Continued from page 4
that prevent situations where some people wait much longer than others. “Single-entry” models – where all people enter one queue and take the next available slot once they get to the front of the line – smooth out the waits and increase efficiency in banks, fast-food restaurants and at Disneyland. Centralized intake, triage and referral of patients to appropriate heath care providers – taking advantage of inter-disciplinary teams including nurses and physiotherapists – would go a long way to reducing variation
in wait times and improving access to surgery. Medicare is not perfect, but it is still very good at providing excellent quality care to all Canadians who become ill and require hospital and physician services. Decisive action to improve wait times is necessary to maintain the public confidence that is required to preserve our unique health care system for future generations. The good news is that this can be done, by fixing Medicare’s problems with surgical precision, without killing H the patient in the process. ■
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JULY 2018 HOSPITAL NEWS 7
Avoiding the travel hassles of initial respiratory assessments By Vince Rice magine struggling for each breath, but facing a lengthy and possibly costly journey just to get a quick assessment on your chances of relief. For patients with respiratory illness like Chronic Obstructive Pulmonary Disease (COPD), that initial assessment to see if you’re a candidate for rehab can bring a whole set of ordeals. For those living in isolated communities, it might mean taking a day or two off work to travel to where the rehab program is located. Add in the cost of travel, or headaches with parking or navigating unfamiliar territory, and the ordeal can be overwhelming. Wouldn’t it better if you could just stay within your own community and do a live assessment via the internet – allowing you to avoid all those travel hassles? That’s what West Park Healthcare Centre in west Toronto has been researching – using an initial teleconsultation for some respiratory patients who live outside the city. “It might be a plane ride to get here, and then you get a 45-minute consultation,” says Sachi O’Hoski, a West Park physiotherapist and one of the researchers involved in the study. “It’s the conversation that’s really important, and it can just as easily be completed with a teleconsultation.” The study, recently published in the Canadian Journal of Respiratory, Critical Care and Sleep Medicine, examined nearly 100 cases between 2012 and 2015 where the initial assessment was completed via the Ontario Telehealth Network (OTN). Nearly half the patients lived between 400 km and 800 km away from the hospital. A local coordinating healthcare professional (most commonly a nurse or respiratory therapist) joined the patient and any family members for the teleconsultation. The focus of the interview was the discussion of the
Photo credit: Lucas Oleniuk.
Respiratory patient Kim Verwaayen participating in pulmonary rehabilitation at West Park. functional and emotional impact of the disease, provision of information about what pulmonary rehabilitation entails and discussion of the patients’ motivation to improve. The study concluded that teleconsultation is an alternative to in-person clinic visits, and may be effective in reducing travel costs for patients and improving their access to specialty respiratory consultation. The Ontario patients involved in the study saved a total of 70,070 km in travel, which translates to a travel-only cost savings of $28,028. “The most important thing is this is a way we can get a good picture of the health challenges of the person, and it saves people a lot of travel and money,” says O’Hoski. One patient from Elliott Lake in Northern Ontario was the first teleconsultation. She was so happy with
the teleconsultation process that she recruited others with lung problems in her community to participate, says O’Hoski. The teleconsultation also gives the chance to explain the program, answer any questions, as well as make an informed assessment. “It doesn’t have to be in person,” she says. Dr. Roger Goldstein, who heads Respiratory Services at West Park, is optimistic about using live video consultations for both initial assessment as well as after-program follow-ups. “This approach is working well. It might also lead to an opportunity to promote education and exercise at a distance provided there are some locally trained staff at the satellite site,” says Dr. Goldstein. Respiratory patient Kim Verwaayen travelled for more than two hours from London to get to her initial assessment
at West Park. The anxiety could have been overwhelming, yet the prospect of finally qualifying for a respiratory rehabilitation program to get her life back made it all worthwhile, she says. A teleconsultation would have been a great way to ease into the pulmonary rehabilitation program, says Verwaayen. “For some folks, summoning up enough energy to travel on top of everything else you have to do, can be too much,” she says. “To be able to conserve that energy and to have that conversation in the easiest way possible is great for sick people.” Now that Verwaayen’s graduated from the inpatient program and has returned to London, she can see further benefits of staying in touch via teleconsultation as needed, without having to leave her own H community. ■
Vince Rice is Director of Public Relations at West Park Healthcare Centre. 8 HOSPITAL NEWS JULY 2018
Virtual care solutions make it possible for physicians to reach Canadians outside of the usual spaces
seniors • Indigenous communities • rural/remote patients • vulnerable populations
To learn how virtual care solutions provide quality care for all Canadians, visit:
JULY 2018 HOSPITAL NEWS 9
Where you live impacts heart health Where you live in Ontario can have a major impact on your heart health. The CANHEART research group wants to change that, and we need your help. ardiovascular events such as heart attacks or stroke remain a leading cause of disability and death in Canada. A recent Institute for Clinical Evaluative Sciences (ICES) study showed that where you live has a big effect on your risk of cardiovascular disease, also known as heart disease. In fact, the study showed that people living in some health regions of Ontario were twice as likely to experience a heart attack or stroke, or to die from heart disease, compared to those in other regions. The study team found that differences in heart risk were due to differences in cardiovascular-related health behaviours such as smoking, as well as to demographic characteristics like one’s ethnic background. In addition, people living in areas of Ontario with the highest risk of heart disease were actually less likely to receive certain preventive health services such as getting tested for high cholesterol. High cholesterol is known to be a very important risk factor for heart disease. Worryingly, some people in Ontario have not been tested for it and many people who are identified to be at high risk for heart disease are not receiving or taking the recommended treatment as outlined in Canadian guidelines. However, an exciting new initiative is working to change that. The research group spearheading the project is called the CArdiovascular HEalth in Ambulatory Care Research Team (CANHEART) (www.canheart.ca), a dedicated team of 30+ researchers, clinicians, policy makers and patients that was formed to help understand and improve the quality of cardiovascular care in Ontario. The team is based in Toronto, Ontario at Sunnybrook Hospital and ICES, with research affiliations with universities and hospitals throughout the province. In order to ensure better heart health for all Ontarians, the CANHEART team is now working to develop and test interventions that will
improve preventive care. Funded by a grant from the Canadian Institutes for Health Research (CIHR) and Strategy for Patient-Oriented Research (SPOR), the CANHEART team has launched an exciting new trial called CHOICES (Community Heart Outcomes Improvement and Cholesterol Education Study). CHOICES will target Ontario health regions with higher rates of heart disease, developing decision-support “tools” to inform and empower people when it comes to the appropriate management of their cholesterol and cardiovascular health. These tools, such as cholesterol tip sheets, educational videos and decision aids, will be widely distributed in the highrisk health regions, to allow people to work with their family physicians and share in the decision making process together. The team hopes to identify whether these tools will help improve cholesterol management and prevent heart disease. At the study’s conclusion, CANHEART will make any needed updates and then will work with their partners such as the Heart
& Stroke Foundation of Canada to have all of the tools publicly available for wide and ongoing use. Patient engagement is key to the CHOICES project. The unique and diverse perspectives that patients bring, based on their own treatment experiences in the healthcare system are of great value and help to ensure that research findings are relevant to patients and their families. In the spirit of patients as partners in the team’s research, a patient partner panel has been formed to help guide the project. The purpose of the panel is to provide the public an important seat at the research table to share their lived experiences with managing cholesterol, as well as to provide important feedback and actively contribute to the project such as helping the study team develop cholesterol educational material and to determine which outcomes are most important to patients’ heart care. To foster meaningful collaboration and dialogue, panel members will be invited to attend and participate in ongoing teleconferences, online chat
discussions with the project team, and in annual study investigator meetings. All partner panel members are provided an honorarium for their time. The CANHEART study team is continuing to look for people from a variety of backgrounds and experiences who are interested in joining the patient partner panel to improve cardiovascular health. They must be Ontario residents between 40-75 years of age who have at least one of the following qualifications: • One or more major cardiovascular risk factors (e.g., high blood pressure, high cholesterol, diabetes, or family history), • Have ever had a heart attack or stroke, • Have ever undergone a cardiac procedure (e.g., bypass surgery, angioplasty). If you would like to learn more about CHOICES or are interested in joining the patient partner panel to improve heart health in Ontario, please email our team at canheart@ices. on.ca or visit http://www.canheart.ca/ H clinicaltrials/. ■
This article was submitted on behalf of the CANHEART investigators. 10 HOSPITAL NEWS JULY 2018
Capnography moves beyond the OR
By Melicent Lavers-Sailly apnography, the measurement of carbon dioxide (CO2) in respiratory gases, has long been used to monitor the breathing of patients under anesthesia in the operating room. Now there is a growing recognition of its value as a reliable tool for monitoring patients under conscious sedation in ambulatory settings outside the OR. Minimally invasive procedures are becoming more common in areas such as endoscopy clinics, cardiac catheterization labs, and interventional radiology labs, where nurses rather than anesthetists are responsible for sedation. These nurses need to have the right tools to ensure that patients are breathing properly. In a recent Heart and Safety podcast focusing on the use of capnography outside the OR, Michael Wong of the Physician-Patient Alliance for Health and Safety interviewed Barbara McArthur, an advanced practice nurse at Sunnybrook Health Sciences Centre in Toronto with wide experience in the OR and ambulatory areas, including medical imaging, where she currently practices. “In my area, we don’t have anesthesiologists administering the sedation,” says Barbara McArthur, “We have nurses giving the sedation, so we have to be more diligent. We know sedation is a continuum, so patients can easily slip from moderate levels into deep levels very quickly.”
Traditionally nurses in ambulatory areas have relied on visual assessment of breathing rhythm, which can be difficult if the patient is prone during the procedure or if comorbidities such as COPD or apnea are present. Pulse oximetry may also be used to monitor the patient’s oxygenation (O2) levels. However, patients under sedation are often given oxygen during a procedure, so if they begin having trouble breathing there may be a delay of a minute or more before their O2 levels drop and the oximeter alerts the nurse. Since a capnography monitor measures ventilation rather than oxygenation, it provides an immediate alert if expiratory CO2 levels start falling, and thus an earlier indication of patient decline. “Having the monitor can let you know the patient’s status sooner,” says McArthur. “If the patient is getting into respiratory problems, the nurses can intervene much more quickly.” Capnography readings consist of a waveform graph showing expiratory CO2 plotted against time, and a number representing the partial pressure of CO2 at the end of the exhalation, which is known as end-tidal CO2. During a recent review of hospital policies at Sunnybrook, McArthur’s team reviewed the current literature on procedure sedation and found position statements or practice guidelines
in favour of end-tidal CO2 monitoring from clinical societies such as the Association for Radiologic and Imaging Nursing, the American Anesthesiology Society and the Association of periOperative Registered Nurses. As a result, capnography monitoring is now recommended for use at Sunnybrook in all units that have the equipment. Those that do not will acquire it at the next opportunity and incorporate it into their practice. Some hospitals may believe that the lack of a capnography port on their existing monitors may prohibit them from adopting capnography outside the OR as soon as they would like, says Cheryl Ha, Senior Marketing Manager, Respiratory and Monitoring Solutions, for Medtronic Canada, a supplier of both capnography and pulse oximetry equipment. “However, the availability of capnography modules that can be added to many multiparameter platforms has expanded dramatically, thus allowing most hospitals to add on the feature
without having to replace their existing fleet. “Another barrier to adoption may be the learning curve associated with reading and interpreting the capnography waveforms and then knowing how to properly intervene when appropriate.” Nevertheless, Ha adds, “With strong recommendations coming from bodies such as the Canadian Anesthesiologists’ Society and Le Collège des Médecins du Québec, the benefits of including end-tidal CO2 monitoring outside the OR are becoming better known in the clinical community — so much so that we’re seeing a growing interest for education and peer-topeer support to help move past some of the barriers. “We genuinely believe that down the road, capnography will be adopted as a standard of care in procedures requiring moderate to deep sedation outside the OR as a key measure for promoting increased patient safety H and monitoring vigilance.” ■
Melicent Lavers-Sailly is senior manager of corporate communications at Medtronic Canada.
JULY 2018 HOSPITAL NEWS 11
FROM THE CEO’S DESK
Changing the mental health landscape By Karim Mamdani he journey we have been on to increase awareness and eliminate the stigma associated with mental illness has been important, meaningful and, in many ways, essential to normalizing conversations around mental health. The progress we, as a society, have made over the last decade has been tangible. Media campaigns and corporate investment are now societal norms helping make discussions about mild and moderate mental health issues more prevalent than ever before. However, there is evidence that much more needs to be done. Recently, the spotlight has been on the suicide deaths of celebrity chef Anthony Bourdain and renowned designer Kate Spade. This tragic news shook many. Neither had been overtly public about their personal struggles until it was revealed through their cause of death. The loss of these two people is tragic and it has served as an igniter of conversations as many attempt to grieve the loss of two individuals whom they felt connected to. The shock and awe of a celebrity suicide is understandable. They are characters wearing masks and we are only privy to a small piece of their lives. When larger pieces are revealed it can be overwhelming and difficult to rationalize. These tragic events have re-energized calls for broader discussions about mental health and greater support for people who may be contemplating suicide. Both are important and should never be marginalized. However, it’s time to elevate our efforts. We need to shift the focus from discussion to action. We have the opportunity and ability to enact change that can improve the lives and prospects of the people who comprise our respective organizations. How do we change the world? We start in our own backyards.
AS LEADERS IN HEALTHCARE, WE NEED TO BE SETTING THE STANDARD FOR MENTAL HEALTH IN THE WORKPLACE. WE UNDERSTAND THE ISSUE BETTER THAN ANYONE.
As leaders and employers, we can set out to change the mental health landscape in our organizations through a commitment to wellness, safety and workplace mental health. Healthcare is not immune to societal taboos and stigma, although they have been reduced as part of the global movement to bring mental health into the mainstream. However, there is a tangible difference between acceptance and action.
Wellness cannot simply be a buzz word in any organization. It has to accompany legitimate programs and resources that encourage everyone, regardless of role, to prioritize their mental health in an environment that is accepting, understanding and empathic. This may sound like a monumental task to bring to life within an organizational structure.
However, resources such as Mental Health First Aid, The National Standard of Canada for Psychological Health and Safety in the Workplace, and employee and family assistance programs are among the notable resources available. They can help organizations begin the journey down the road to creating and maintaining a psychologically safe and healthy workplace. Equally important is dedication of leaders and employers to embed these resources along with themes of acceptance and understanding throughout your organizational culture. Building and sustaining a desirable workplace culture requires unwavering consistency, commitment and focus. It is a long-term project that can have long-lasting impact on the lives of the people you rely on each and every day. As leaders in healthcare, we need to be setting the standard for mental health in the workplace. We understand the issue better than anyone. We understand its devastating impact and know people, with the right treatment and support, can flourish despite being confronted by mental health challenges. We can guide the way for our partners in both the private and public sector. As we look at the broader issue of mental illness and mental health in society, we must challenge ourselves and our partners to do more and to be better. Public outrage and shock is understandable when a person’s struggles are revealed through tragedy. But it’s not enough and it doesn’t guarantee real, impactful change. If the desire is to change the manner in which mental illness, suicide and treatment is viewed on more rapid trajectory, we must strengthen the commitment of our respective organizations to creating safe and healthy workplaces that others can model and H replicate. ■
Karim Mamdani is President and CEO at Ontario Shores Centre for Mental Health Sciences. 12 HOSPITAL NEWS JULY 2018
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the path to tackle the challenges in cardiac health By Max Mohammadi he human body is like an automobile. Much like a car, the body is a complex “system” where issues can be diagnosed based on symptoms. However, unlike automobiles, we are not outfitted with sensors and warnings – meaning potentially fatal issues can go undetected for months, sometimes even years. In many heart-related cases there are no expressive symptoms, and most people are not aware they already have coronary artery disease. Unfortunately, this can result in premature death and in many cases costly and invasive procedures, such as angiography operation or coronary artery bypass surgery. Sadly, this was the case for my grandmother, who by all standards was a healthy woman. Unbeknownst to her and our family, her heart was a ticking time bomb which went off far too soon. Deeply saddened by this unexpected turn of events, my brother and I were determined to find a viable way to mitigate the impact of cardiac events. Early on in our research, we learned that doctors would need a tool to help them make more accurate diagnosis. Because unfortunately, the human brain can only correlate a few parameters before making a diagnostic decision, making the current “human approach” to diagnosis somewhat problematic, particularly when the symptoms can be related to other diseases. During our research, we found out that the main cause of death is the late detection of the disease. We also learned the major costs associated with traditional diagnosis procedures are unnecessary and could be brought down significantly with the right approach. In response to these findings, my brother and I invented HeartstringsTM,
Max Mohammadi (left) and his brother receiving the honor of European of the Year. a life-saving technology that leverages the power of artificial intelligence (AI) and our proprietary platform to create a non-invasive, and more importantly, accurate screening and pre-diagnostic tool. Heartstrings uses personal patient data to create a profile that accurately identifies the disease. Essentially, doctors input patient data to our system and the artificial intelligence looks at many parameters to provide an intelligent insight to the doctors and help them make an accurate diagnostic decision. Additionally, because of the nature of our machine-learning approach, Heartstrings becomes smarter over time, making it even more adept at determining the likelihood of the disease. As it learns from similar profiles, it has already achieved a level of accuracy that cannot be achieved by human analysis alone. In terms of cost, conventional screening methods such as angiog-
raphy, can be quite costly – ranging anywhere from $1,000 to $30,000 depending on the healthcare provider and where the patient is located. Heartstrings helps patients uncover their condition well before these procedures are necessary. The Heartstrings solution costs as low as $5 per patient and, based on results from two clinical trials of 46,700 patients, is already extremely accurate. While accuracy in diagnosis is crucial to catching heart disease early, doctors have a low chance of making an accurate diagnosis without extensive tests – which is why the implementation of instruments like Heartstrings is crucial. However, it is also important to note that Heartstrings is not a replacement for doctors; rather our goal is to provide practitioners with a reliable “decision-support” tool that will help them make more informed decisions, put an effective
treatment plan in place and ultimately save patients’ lives. Additionally, the technology will also save hospitals valuable time and reduce costs significantly during the diagnostic process. Disrupting an established industry is not an easy feat. Luckily, we’ve received support from various organizations during our journey and on the path to realize our vision of “saving at least one million lives each year”. An example is the Entrepreneurs Organization, where we recently won an award in their Global Student Entrepreneur Awards that was hosted in Toronto. Through organizations like this, my brother and I have been able to connect with likeminded individuals who will one day help usher the new age of medical innovation. Additionally, our success is proof that there is an appetite for innovation on a global scale, and that the healthcare field H is only going to continue to advance. ■
Max Mohammadi is a value-driven leader and visionary social change-maker who has been selected by the Forbes magazine as one of the most influential entrepreneurs and featured on the prestigious Forbes 30 Under 30 list. As an innovator, Max has been awarded more than 70 times and is the youngest ever candidate to receive “European of the Year” in the Innovator category. Some other examples include Leader of the Year Award, Alfred Nobel Diploma, European Youth Award, Entrepreneur of the Year Award, Gold Medal and Best Inventor Award. 14 HOSPITAL NEWS JULY 2018
Artificial intelligence Why healthcare needs to embrace it By Dr. Naila Kassam ealthcare innovation has traditionally been the cornerstone of improved patient care. The most significant advancements in medicine, for example, include the development of anesthesia, antibiotics and radiography. When future societies look back at our current era, artificial (or augmented) intelligence (AI) will find itself on a list of major technologies known to further medical care in its history. Artificial intelligence is the concept of machine learning that was popularized by Geoffrey Hinton, a computer scientist who is a professor at the University of Toronto, who is considered the godfather of deep-learning. By creating software that assembles computers in networks that mimic the archi-
16 HOSPITAL NEWS JULY 2018
tecture of the human brain, Dr. Hinton has been able to create environments for computers to learn in similar ways as humans do. Once a relatively obscure field of computing, AI is now being touted as the next big thing in many industries. AI has already made significant progress and attracted global attention in areas including autonomous driving, as well as face and voice recognition, which are currently being developed and perfected by companies like Tesla, Apple and Google. Governments also appear to be enthused on the economic future of computer learning, which was illustrated by the federal governmentâ€™s recent commitment of $125-million to the Pan-Canadian Artificial Intelligence Strategy. This is in addition to
the highly anticipated Vector Institute for Artificial Intelligence in Toronto, whose chief scientific advisor is Professor Hinton. As tech entrepreneurs continue to refine AI technology, healthcare leaders should consider developing strong partnerships with these experts. Indeed, the applications for AI in healthcare are numerous; what remains to be seen is whether the healthcare industry will be receptive to technological disruption despite its usual apprehension to change. What is clear is that AI technology has the potential to improve the three key pillars of comprehensive medical care: prevention, intervention, and rehabilitation. Prevention has become increasingly important over the last several decades
as healthcare providers and institutions have achieved improved patient outcomes as a result of an increase in focus on disease prevention. Chronic diseases such as heart disease and diabetes are also costly to manage as a health care system. Therefore, the combination of improved quality of life for patients and system efficiency has aligned physicians and policy experts with the mutual goal of building a robust healthcare prevention infrastructure. Artificial intelligence could be the perfect tool for this. As AI technology becomes more sophisticated, patients will be able to better predict what kinds of health care resources they will need to access. Aggregate population data can also be used to plan for the types of healthcare utilization that will occur in different
AS A S TECH TECH ENTREPRENEURS ENTREPRENEURS C CONTINUE ONTINUE REFINE AII TTECHNOLOGY, HEALTHCARE TTO OR EFINE A ECHNOLOGY, H EALTHCARE LEADERS SHOULD CONSIDER DEVELOPING STRONG PARTNERSHIPS WITH THESE EXPERTS.
neighbourhoods, thus allowing sustainable policy to make the proper investments for the future. More concretely, AI can help predict which patients are at risk for falls or hospitalizations based on their personalized healthcare data, allowing for early, effective, and less costly intervention. AI can also help to intervene by reminding patients to take medications or suggest alterations in medication dosages and schedules, such as hypertension or diabetic medications based on physiologic parameters that are captured using wearable technology. This would allow patients to be treated in real-time in a way that would prevent complications of interval medical changes before seeing a provider.
While prevention and intervention strategies in healthcare are crucial, there is also an acceptance that sickness and disease are not entirely preventable. The importance of rehabilitation is growing, especially in the context of an aging population whose disease burden and healthcare utilization will continue to grow. AI technology should be viewed as a tool to ease caregiver burden and assist in the burgeoning area of home and long-term care by preventing medication errors and alerting attendants to early changes in health status. Additionally, AI will be able to develop personalized rehabilitation strategies and therapies for those who need it.
Finally, AI will undoubtedly revolutionize the flow-through of patients within our healthcare system. Predictive models will be able to identify individuals with a higher likelihood of becoming ALC (alternative level of care), and thus help navigate them to streamline the interaction between health care system and patient. As AI technology continues to evolve and becomes increasingly more sophisticated, healthcare institutions will need to leverage these new opportunities to improve the delivery of care. This will mean that health care systems will need to build teams to support the implementation and progress of AI technology across health care spaces. While many organiza-
tions already have a chief technology or chief information officer, it is likely that an expansion of their domain will be needed including the possibility adopting chief AI officers. We will need our leadership to be nimble enough to react quickly to this changing landscape and to ensure that the safe-keeping and reliability of data are held to the highest standard. As healthcare professionals, we need to become central stakeholders in how this technology affects patient care. By engaging with the entrepreneurial and tech communities, we would be able to instruct how AI would positively benefit the lives of those we serve, while ensuring their H continued quality of care. â–
Dr. Naila Kassam, MD, CCFP is an Adjunct Professor in the Department of Family Medicine at Western University and an MBA Candidate at Ivey Business School. www.hospitalnews.com
JULY 2018 HOSPITAL NEWS 17
LONG-TERM CARE NEWS
Menu planning in long-term care By Dale Mayerson and Karen Thompson he menu planning process in long term care is a complex activity. Above all, the menu must meet the needs of residents in terms of taste, texture and quality. Added to that are the various medical requirements of many residents, and the overall nutritional value of the menu. This is all done while on a budget – the Ministry of Health and Long Term Care funds raw food at $9 per day for each resident in Ontario. This should be the minimum spent on food and beverages and homes strive to keep within this budget. Also, the Ministry sets out 16 different criteria in the provincial regulations that need to be considered in menu planning.
STEPS TO PLAN A LONGTERM CARE MENU
1. Determine what your residents like to eat: The first step is to collect information about what residents like to eat. This can be done informally by discussing menu items and food likes and dislikes with residents. Meals are a common topic at Residents Council meetings and provide very useful information. A Food Committee of residents can also be very helpful in determining menu expectations. Staff can keep track of which meals are well-liked through informal resident surveys, meal and plate waste audits. These are very valuable, since they immediately show which meals are not popular and should be improved.
More formal surveys can be done with residents and staff to highlight where improvements can be made. 2. Plan the menu cycle: In long term care, menus are planned to be between three and six weeks long. This means that the menu will repeat every 21 to 42 days. Normally, menus change once or twice a year, to take advantage of seasonal foods, with heartier meals in the winter and lighter foods and seasonal fruits and vegetables during the local growing season. 3. Allow for choice and variety: According to Ministry criteria, the menu must include a full breakfast, and two different choices for both lunch and supper (main course, vegetable and dessert). As well, there must be a mid-morning, mid-afternoon and evening beverage, and snacks in the afternoon and evening. There should be as much variety as possible, while providing choices that residents find acceptable and enjoyable. In a 28 day menu cycle, that means 56 lunch and 56 supper choices. Avoiding repetition of foods is a challenge but can make a big difference to those with dislikes
or intolerances. Consider yogurt for breakfast and again for lunch the next day, or coleslaw for lunch and cabbage rolls for supper. 4. Plan for therapeutic diets and food texture modifications: After the main menu is set, the different diets and textures are planned. What is needed varies from home to home, but homes typically consider the advantages of a liberalized diet that encourage residents to have better intake with fewer food restrictions. Four food textures are generally available: regular, soft, ground or minced and pureed. Thickened liquids may be required for certain residents with swallowing disorders. It is helpful to identify common allergens on the menu so staff can provide the safest possible service for residents with food allergies and intolerances. Even if a resident is receiving therapeutic and or texture modifications, there should always be at least
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two entrée choices available to them at every lunch and dinner meal. 5. Determine purchasing specifications and standardized recipes: After the menus are developed, for each menu item, determine if it will be produced in house or purchased as ready to serve. If lonterm care home staff is cooking some or most of the food, there can be many recipes every
day, including recipes needed for all textures. It is important that the final products have the same quality every time they are prepared; this should not depend on which cook is working on any given day. Food items that are purchased must be sampled and tested by running taste panels to ensure that the quality of the product being purchased is acceptable to the residents. Whether the food is made in-house or is purchased from outside, staff need instruction on cooking and plating the food. The final portioning is just as important as the preparation, to ensure that everyone gets the same serving size and nutrition. 6. Analyze nutrients and adherence to Canada’s Food Guide: An essential step in the menu planning process is to ensure that the menu provides adequate nutrition for each resident. Canada’s Food Guide has long been an accepted tool to ensure ade-
quate nutrition. Each day of the menu is compared to the Guide standards. Homes also complete a nutrient analysis of the menu, using a computerized program to ensure that the menu meets the Dietary Reference Intakes (DRIs). Ensuring that the menus are nutritionally sound is only one part of the process; there must also be a system in place to monitor that each resident is actually eating the food being offered.
It is challenging to ensure that all residents are eating well and maintaining a healthy weight while they are dealing with complex medical conditions. Residents with physical disabilities, visual and hearing loss, confusion and other health problems may not respond well to assistance and encouragement to eat. Some residents are receiving many medications for their various conditions and this may have an effect on their appetite
and interest in meals, or their ability to smell and taste the food. Homes assess each resident’s needs and work towards optimizing their nutritional status. Menu planning is the cornerstone of dietary services in long-term care. It requires considerable effort and skill to please all residents with the same meal; naturally people vary in their preference for portion size, temperature, use of spices and herbs in food, amount of salt (preferred or allowed) and many other factors. The privilege of simply opening a refrigerator and choosing a snack is not as available to long-term care residents as it is to people who live in their own homes. Nevertheless, Nutrition Managers, Dietitians, and all staff who prepare and serve food do their best to ensure that residents are provided with meals that are well-prepared, safe to eat, flavourful and nutritionally adequate, as well as comforting and individually H pleasing. ■
Dale Mayerson B Sc RD CDE, and Karen Thompson, B A Sc RD are Registered Dietitians with extensive experience in Long-term care. They are co-authors of “Menu Planning in Long Term Care and Retirement Homes: A Comprehensive Guide.”
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LONG-TERM CARE NEWS
Harnessing and honouring the collective wisdom of our elders By Kristian Partington on Schlegel is a humble philanthropist, an urban developer with a unique vision of community, a visionary in health and long-term care and a hard-working farmer all tied into one brilliant and cheerful package. He is an elder in society with a wealth of wisdom to impart but perhaps one of his greatest specialities is his understanding of elderhood. As a boy he would rush home from school to assist the residents who lived in the small nursing home his parents operated in London, Ont. When he finished clearing their plates after dinner, he would do his homework at their feet while they told him stories of the past. This was the era when the medicalization of aging was in its early stages
IT’S SAD TO SAY BUT AGEISM SEEMS TO BE THE LAST ACCEPTABLE FORM OF PREJUDICE IN OUR SOCIETY. and the warehousing of older adults in declining health was ramping up. As Ron aged, he knew there was a better way to support older adults and today, he is the founder of Schlegel Villages, a collection of 19 long-term care and retirement communities across southern Ontario that embraces basic values of family and community. Ron’s vision of social model of living to counter the institutionalization of long-term care continues to expand, and that vision is certainly inspired by the experiences he had as a child working with older adults in their final years.
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“The greatest untapped resource in Canada, if not the world,” Ron said in conversation a few years ago, “is the collective wisdom of our oldest generations.” It is this thought that grew into the #ElderWisdom campaign, which throughout Senior’s Month in June the past three years has reminded community members of the value that older adults have in lived experience. “The premise is quite simple,” says Ted Mahy, online engagement manager with Schlegel Villages. “In all the cities from Whitby to Windsor
where Schlegel Villages operates, a green bench will appear on a chosen day in June in a prominent location. An older resident will be sitting there and the community – from mayors to sports teams to everyday folks – is invited to sit and share conversation.” From there, photos and quotes are shared through platforms like Twitter, Instagram or Facebook, all using the hashtag #ElderWisdom. The inaugural campaign in 2016 was modestly successful and 2017 showed even greater attention. However, 2018 is when the scales tipped and the ever-sought-after viral attention a social media junkie craves has made #ElderWisdom a global conversation. People are calling Ted from Hong Kong to ask if they can get benches and a group in Ireland wants to mirror the campaign.
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LONG-TERM CARE NEWS Ron Schlegel sits on one of the green benches. Someone in Oconomowoc, Wisconsin, a town of 16,000 souls, asked if the #ElderWisdom tour to could stop there. News feeds are sharing widely and one video in particular had garnered more than 600,000 views by the middle of June, barely half way through the campaign. “It’s sad to say but ageism seems to be the last acceptable form of prejudice in our society,” Ted says, “but when younger people get past the stereotypes that come with getting older and just sit and talk with an elder, those ageist barriers break down so easy. That’s what makes the #ElderWisdom campaign so special and it’s amazing to see the conversation spread.” In early June, Ted had the opportunity to sit upon the green bench in Guelph with the Right Honourable David Johnston, a man whose wisdom was well placed in his role as Canada’s 28th Governor General.
He recalled the first speech he gave in 2010 after he was sworn in as the Queen’s representative as Canada’s head of state. “If you remember only three words of what I say today,” he said that auspicious day, “they are ‘cherish our teachers,’ and if we had a day or two that we could spend together I could tell you a hundred sto-
Kristian Partington is a freelance writer.
ries about teachers, mentors, advisors, councillors who have had an impact on my life.” “That’s what the wisdom of elders represents.” “We learn from the people who’ve gone down the path before and have made some stumbles along the path and have recovered,” Johnston continued.
The opportunity to sit with them for a little while during this specific campaign reminds us all of the value to be found in such depth of experience, and encourages people to see past the stereotypical views that follow aging to see that in the minds and hearts of seniors, much remains on H offer. ■
A struggle for care
Ontarians without access to health insurance rely on a unique clinic when they need it most, but nurses are advocating for a broader solution. By Daniel Punch n a gloomy February evening, the pink, yellow and blue walls of Toronto’s AccessPoint on Jane are lined with occupied chairs. Children of various ethnic backgrounds explore the small community health centre (CHC) waiting room. Three young men with Caribbean accents discuss the latest basketball news. And a diverse group of patients mull around the front desk. Mondays and Thursdays draw big crowds to this west-Toronto location of Access Alliance Multicultural Health and Community Services, tucked inside the second floor of an otherwise quiet plaza on Jane Street. RN Sideeka Narayan is behind the
desk helping the secretary check patients in during the 4 p.m. rush. At the front of the line is a middle-aged Afghan couple, whose young son is rifling through public health pamphlets in every language from French to Nepali. The couple arrived in Canada two days earlier with their four children, hoping to make a refugee claim. In the meantime, their kids need to see a health-care provider. Though they speak limited English, Narayan is able to ask them if they have a permanent address, a phone number, or health insurance. The answer to all three questions is no. “Okay, we’re still going to go ahead and see them,” Narayan tells the secretary, before asking her to ring up a Farsi interpreter.
That’s pretty much the ethos on Monday and Thursday evenings at AccessPoint on Jane, when Access Alliance runs the Non-Insured Walkin Clinic (NIWIC). Since 2012, the clinic has been offering primary health care to Ontario residents not covered by the Ontario Health Insurance Plan (OHIP). With an NP and RN on site, NIWIC works with more than 500 patients a year, providing episodic care, treating chronic illnesses, doing health promotion, and connecting people with other community resources. But Narayan says CHCs alone cannot meet the needs of Ontario’s uninsured population, especially in smaller communities across the province. NIWIC saw a 30 per cent increase in
patients in 2016-17, and with uncertainty surrounding immigration and refugee policy in the U.S., Narayan expects the patient roster to continue to grow. To find a more sustainable solution for uninsured Ontarians, she is part of a large network of nurses and other health professionals advocating to give everyone residing in Ontario access to health insurance. “This is a huge equity issue,” says Narayan, who manages the clinic. “Health care is a human right. So what are we going to do as a system to make sure everyone has a similar level of access?” Though Canadians pride themselves on having a universal health system, it is estimated as many as 500,000
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NURSING PULSE Ontario residents live without health insurance. There are various reasons people are not covered by OHIP. Many are newcomers to the country who don’t have immigration status because they overstayed their visa or had it taken away. Others have come to Ontario as immigrants or temporary workers and are in the three-month waiting period before OHIP kicks in. And many asylum seekers fall through the cracks of the refugee system, and thus don’t qualify for the Interim Federal Health Program (IFHP). NIWIC’s patients come from all corners of the world. Portugal, Brazil, Mexico, Nigeria and Jamaica (in that order) are their most common countries of origin. They’re a diverse group, and for the most part, Narayan says they came to Canada seeking a better life. “These are people who are escaping poverty, abuse, violence, and may not have access to the most basic necessities of life,” she explains. But without insurance in Ontario, their options for health care are limited and costly. If they’re forced to go to hospital to treat an acute illness or to deliver a baby, they will likely leave with a hefty bill. In Narayan’s experience, the cost can be as high as $10,000 – a huge barrier for NIWIC patients, 35 per cent of whom report having an annual household income under $20,000. By the time some uninsured people seek health care, what could have been a small, preventable issue might be a lot more complicated, says NIWIC RN Monika Dalmacio. To keep people healthy, Dalmacio and her colleagues promote preventive care and make sure they inform uninsured clients about their rights. She says many people aren’t even aware this population exists. “When I share information about the work that I do, the first question is often: ‘doesn’t everyone have health insurance?’” If RN Melanie Spence gets her wish, everyone will. Spence is a community health nurse in Toronto, where she regularly encounters people without OHIP. She moved back to Ontario from B.C. in 2012, the same year Stephen Harper’s Conservative government made cuts to IFHP that would
Community health RN Melanie Spence (at the mic) is one of the founding members of OHIP for All.
THOUGH CANADIANS PRIDE THEMSELVES ON HAVING A UNIVERSAL HEALTH SYSTEM, IT IS ESTIMATED AS MANY AS 500,000 ONTARIO RESIDENTS LIVE WITHOUT HEALTH INSURANCE. leave many refugee claimants without access to health care. In response, she became active in the grassroots organization, Health for All, which advocated reversing the cuts. RNAO was vocal on this issue as well, securing standing in court to fight against the cuts. When IFHP coverage was restored by the Liberal government in 2016, Health for All turned its sights on getting
health insurance for those without it. The resulting OHIP for All campaign is calling on government to eliminate the three-month OHIP waiting period, and to provide coverage to Ontarians who lack it due to their immigration status. “On one level, (the OHIP for All campaign) is about human dignity and deservedness,” Spence explains. “On
another level, it’s about recognizing the varied and valuable contributions that everyone makes when they make a home here. These are people who are building our buildings, who are looking after our children, and who are our coworkers, neighbours and friends.” The Registered Nurses’ Association of Ontario (RNAO) has been a strong supporter of OHIP for All since the campaign’s inception two years ago. RN Lynn Anne Mulrooney, the association’s senior policy analyst, led much of the work on this issue. Having spent two decades nursing and studying abroad in Africa and the U.S., where she saw people struggle to access health care, Mulrooney is disheartened to see the same struggles among newly landed immigrants in Canada. “Access to health care is...a duty we have to each other as human beings,” she says. “I feel ashamed that we know this and still are willing to gamble with people’s lives.” As nurses and other advocates continue to fight for expanded OHIP coverage, people like Alice* are left with few places to turn. A young woman in her 20s, she came to Canada from the Caribbean with her partner, who promised to sponsor her for a visa. The relationship turned abusive, and Alice’s partner took away her visa papers. She ended up living in a shelter without immigration status. When she came to NIWIC in 2014, Alice was pregnant in her third trimester. She was HIV-positive. “She had been off her cocktail of medications for quite some time since she had been living here,” Narayan recalls. The clinic was able to connect Alice with a program for pregnant, HIV-positive women at another health care organization. The OHIP costs were covered through NIWIC. Though Alice had complications with her pregnancy and during delivery, she was discharged with a healthy baby boy. “Had (NIWIC) not existed...she might have shown up in the emergency department and not disclosed her HIV status...and there would have been a high risk of transmission to that child,” Narayan says. “If we didn’t have the clinic, (people without insurance) H wouldn’t have access to much else.” ■
Daniel Punch is former communications officer for RNAO, the professional association representing registered nurses, nurse practitioners, and nursing students in Ontario. This article was originally published in the March/April 2018 issue of Registered Nurse Journal, the bi-monthly publication of the Registered Nurses’ Association of Ontario (RNAO). www.hospitalnews.com
JULY 2018 HOSPITAL NEWS 23
Alternative treatments for depression: Time-tested or too soon to know? By Barbara Greenwood Dufour he Canadian Mental Health Association estimates that, each year, one in five Canadians will experience a mental health issue. These conditions are often debilitating and can be associated with considerable personal, societal, and economic costs. However, there is a wide range of therapies available to treat mental health conditions. In addition to conventional treatments, such as medication and western psychotherapy, there are also several alternative treatment options for mental health conditions. These include natural health products – such as, vitamin, mineral, and herbal supplements – as well as alternative therapies such as reiki and acupuncture. Some see these alternative treatment methods as potential alternatives to conventional medicine or, at least, as a way to augment the effectiveness of conventional approaches when used along with them. CADTH – an independent agency that finds, assesses, and summarizes the research on drugs and medical devices – recently conducted a search for abstracts of the best, most recent evidence on alternative health care providers and natural health products for managing mental health conditions. CADTH then reviewed the outcomes and findings that are detailed in the abstracts of these studies and produced a Summary of Abstracts report on what was found. Although it isn’t a comprehensive review of the studies and CADTH hasn’t critically appraised the evidence, it gives us a broad sense of what the evidence is saying on the topic. CADTH found systematic reviews on several alternative treatments for
mental health conditions, the majority of which suggest that it’s still unclear if they truly work. There isn’t a lot of scientific evidence supporting these practices despite the fact that many have been in use for centuries. For example, CADTH identified reviews of acupuncture for the treatment of depression. Originating in China, acupuncture is a treatment with a long history of use for a wide range of ailments. But the evidence is unclear and conflicting. One review concludes that whether acupuncture is effective either on its own or if it enhances the effectiveness of pharmaceutical treatments is unknown given that the evidence is of such low quality. Similarly, a review of the evidence on acupuncture for post-partum depression is inconclusive. Only one review, which focused on depression and depression-related insomnia, comes to a stronger conclusion, finding no difference in the improvement of symptoms between individuals treated with acupuncture and those treated with Western medicine, adding that combining acupuncture with Western medicine seems to be more effective than treatment with Western medicine alone. CADTH uncovered several reviews on a variety of natural health products for mental health conditions. For example, five systematic reviews were found on St. John’s wort for treating depression – this herbal remedy has been used for hundreds of years to treat mental health issues. Three reviews look specifically at its use to treat mild to moderate depression, and two are focused on major depressive disorder. All the reviews appear to suggest that St. John’s wort might be effective for improving depressive
symptoms and may even be as effective as antidepressant medications. However, the two reviews that focus specifically the use of St. John’s wort to treat major depressive disorder note that the available evidence tends to be of low quality. Another ancient, plant-based treatment that has been studied is saffron. CADTH identified four studies that suggest it may have some effectiveness for depression. A review of herbal medicines for treating depression and another specifically on saffron for mild-to-moderate depression both found saffron to be as beneficial as antidepressant medications. Similarly two additional studies focused on major depressive disorder found that the clinical trials conducted so far suggest that saffron may improve symptoms in patients with this specific form of depression. The research on alternative treatments and natural health products for depression, and for other mental
health conditions, looks encouraging. But it’s generally conflicting and unclear. In addition, although CADTH’s high-level review of abstracts didn’t assess the level of bias in the studies it identified, in their abstracts, several of the systematic review authors noted that the individual studies had a high level of bias. Furthermore, despite the fact that many people seek out alternative treatments believing that they have a lower risk of side effects compared with conventional treatments, the evidence to support this is unclear. For all these reasons, these are therapies that should be used with caution. If you’d like to read CADTH’s full Summary of Abstracts on alternative practitioners and treatments for mental health conditions, it’s freely available at www.cadth.ca/reports. To learn more about CADTH, visit www.cadth.ca, follow us on Twitter: @CADTH_ACMTS, or talk to our Liaison Officer in your region: www. H cadth.ca/contact-us/liaison-officers. ■
Barbara Greenwood Dufour is a Knowledge Mobilization Officer at CADTH. 24 HOSPITAL NEWS JULY 2018
The stages of diabetes care By Selma Al-Samarrai ohn was first diagnosed with type 1 diabetes at the age of 33. “It was a bit of an ordeal getting me properly diagnosed,” says John, now 38. “It took about nine months before I was referred to a specialist at St. Michael’s Hospital, and she recognized the symptoms of Diabetic ketoacidosis and diagnosed me within one minute of walking into her office.” Since his diagnosis just over four years ago, John’s care team at St. Michael’s Centre for Diabetes and Endocrinology, under the hospital’s Diabetes Comprehensive Care Program, now includes an endocrinologist, a team of diabetes educators including a registered nurse and registered dietitian, and an ophthalmologist. He also saw a social worker when he was first diagnosed. The Centre follows individuals whose diabetes management requires insulin, multiple medications, or whose diabetes itself is complicated and requires more specialized, comprehensive and multidisciplinary care. “In our clinic, our goal is to aid individuals to achieve the best blood glucose possible to prevent acute and long term complications of diabetes and to help them live a full life,” says Dana Whitham, Clinical Leader Manager of the Centre Complications can be acute such as hypo (low) or hyper (high) glycemia, or chronic such as long term damage to the eyes, kidney or blood vessels. Diabetes requires daily management and monitoring. “Living with diabetes means you can never stop thinking about it. Little things like having a cold, going for a jog or drinking a glass of wine can really affect you. You have to be paying attention all the time,” says John. “I can ask very difficult, in-depth questions, so having an exceptional team available to answer my questions when I call or visit is very helpful. The St. Michael’s folks saved my life. I’m pretty grateful for that.”
DIABETES CARE IS A JOURNEY THAT CROSSES MANY STAGES FROM PREVENTION, MANAGEMENT TO COMPLEX CARE. GIVEN ITS CHRONIC NATURE, DIABETES REQUIRES CONSTANT DILIGENCE AND CARE, AND CAN PRESENT NUMEROUS ASSOCIATED COMPLICATIONS. IT’S ALSO AN AGELESS DISEASE. Living with diabetes for an extensive period of time can present several associated complications. Bryan Rickey was diagnosed with type 2 diabetes in 1998. In the last year, he had both of his feet amputated due to the progression of his diabetes. He rehabilitated in Providence Healthcare’s Amputee Rehab unit in June of 2017 after the amputation of his right foot, and again in February of 2018 after the amputation of his left foot. The Orthopedic and Amputee Rehab teams at Providence Healthcare see patients who are recovering from a recent amputation and require rehabilitation. The two multidisciplinary teams provide inpatient and outpatient consultation, assessment, and rehabilitation services to patients with musculoskeletal injuries and amputations. “Soon after the patient is admitted, we start to establish a safe discharge plan. This means we have to
get to know our patient’s capabilities, strengths and potential barriers in order to maximize their independence at the time of discharge,” says Sofia da Silva, patient care manager for the Orthopedic Unit. Rickey received a prosthetic to replace his right foot following the first amputation, and is now waiting to return to Providence to rehabilitate with a prosthetic for his left foot through the outpatient Mobility Clinic. “My experience at Providence was wonderful, the team was extremely great. They did everything they could to help get me rehabilitated. I’m waiting to go back to get the second artificial leg so that I can get rehab to learn to walk again,” says Rickey. To maximize recovery, the teams collaborate closely with other clinics in Providence including the Orthopedic and Amputee Outpatient Clinic, Falls Prevention Clinic, and the Frailty Intervention Team.
“Our primary focus is to identify what is meaningful to the patient and to learn what life looks like once they get home so they can return to their community as a functioning member of society,” says Caroline Monteiro-Pagliei, the patient care manager for the Amputee Rehab Unit. At St. Joseph’s Health Centre, the goal of the Diabetes Education Program (DEP) is to help patients manage their health and prevent further complications. The DEP’s team of certified diabetes educators screen newly referred patients. They advise patients on numerous areas concerning self-management of the chronic disease, including medication management and adjusting insulin doses. The use of technology in diabetes management has also become an integral part of every patient visit as it helps both patients and health care providers monitor and manage blood sugar levels. “My role comes in when we recognize that there’s something we need to address and correct in order to prevent the development and progression of long term complications,” explains Brenda Pozzebon, Nurse Counsellor on Diabetes Education, DEP. Depending on the patient’s health care needs, they also work with various care providers on the DEP’s multi-disciplinary team which includes nurses, registered dietitians, endocrinologists, a physiotherapist, and social worker. “Our clinicians work collaboratively with patients to form successful partnerships and develop individualized care plans to effectively manage their diabetes care needs,” says Jennifer Spencer, Patient Care Manager, Ambulatory Care Centre. With the DEP embedded in the hospital’s Ambulatory Care Centre, patients can be referred to multiple clinics should they need help managing concurrent diseases that are associated with diabetes such as nephrology, the wound clinic and cardiology. “Building partnerships with our patients and care providers across the continuum is fundamental in chronic H disease management,” says Spencer. ■
Selma Al-Samarrai is a Communications Associate for the Network of Providence Healthcare, St. Joseph Health Centre and St. Michael’s Hospital. www.hospitalnews.com
JULY 2018 HOSPITAL NEWS 25
Putting Diabetes Canada’s Clinical Practice Guidelines into practice By Noah Ivers and Catherine Yu he 2018 Diabetes Canada Clinical Practice Guidelines (Guidelines) represent a monumental accomplishment, involving tens of thousands of hours of volunteer work by 135 health professionals across the country. Importantly, the Guidelines were also developed with the participation of informed people with diabetes on the Expert Committee to ensure that their views and preferences inform the guideline development process and the recommendations, as well as development of key messages using lay terms directed at people living with diabetes. Thus, the Guidelines provide recommendations for management of diabetes that cover a broad range of situations, informed by rigorous review of the evidence.
BP targets Cholesterol targets Drugs for CVD risk reduction
Exercise goals and healthy Eating
Screening for complications
Smoking cessation Self-management, stress, other barriers
26 HOSPITAL NEWS JULY 2018
However, guidelines do not self-implement. The massive contributions by volunteer health professionals across the country will be for naught without a concerted effort toward dissemination and implementation. We now ask for your help, as members of the diabetes community, in this effort. Who are we and why are we bothering with all this? We are a family physician (Ivers) and endocrinologist (Yu) who act as co-chairs of the Diabetes Canada Guideline Dissemination and Implementation Committee. This committee has over 50 members representing the full range of relevant disciplines, as well as people living with or affected by diabetes, from across the country. We do this because we believe in the potential of all of us working together to find ways to deliver ev-
idence-based care in a patient-centred manner. We know that change is not easy. It’s not easy for our patients who live with diabetes and it’s not easy for us in our practice when we are used to managing patients in a certain way. It’s one thing to be aware of the Guidelines… it’s quite another to put them into practice. For Guidelines to lead to better outcomes for patients, we need to move from awareness, to agreement, and then on to adoption and adherence. But even the most well-intentioned people may struggle to turn their intentions into action. Can we help them (and each other) as we collectively aim to improve diabetes outcomes? In this article, we provide an overview of some of the Key Messages in
dissemination of the Guidelines. In future articles, we will expand upon this overview, zeroing in on each of the Key Messages and describing some of the relevant tools that we hope will help with implementation.
ABCDES3 OF DIABETES CARE
Providing care concordant with the Guidelines requires conversations about opportunities to: Key Message 1: reduce the risk of complications; Key Message 2: ensure safety; and Key Message 3: support selfmanagement. A revised acronym that incorporates the Key Messages above was developed as an aid to facilitate comprehensive assessment and action by
A1C ≤7%; if on insulin or insulin secretagogue, assess for hypoglycemia and ensure driving safety BP <130/80 mmHg; if on treatment, assess for risk of falls LDL-C <2.0 mmol/L ACEi/ARB (if CVD, age ≥55 with risk factors, OR diabetes complications) Statin (if CVD, age ≥40 for Type 2, OR diabetes complications) ASA (if CVD) SLGT2i/GLP1ra with demonstrated CV benefit (if have type 2 DM with CVD and A1C not at target) 150 minutes of moderate to vigorous aerobic activity/ week and resistance exercises 2-3 times/week Follow healthy dietary pattern (i.e. Mediterranean diet, low glycemic index) Cardiac: ECG every 3-5 years if age >40 OR diabetes complications Foot: Monofilament/Vibration yearly or more if abnormal Kidney: Test eGFR and ACR yearly, or more if abnormal Retinopathy: yearly dilated retinal exam If smoker: Ask permission to give advice, arrange therapy and provide support Set personalized goals Assess for stress, mental health, and financial or other concerns that might be barriers to achieving goals www.hospitalnews.com
FOR GUIDELINES TO LEAD TO BETTER OUTCOMES FOR PATIENTS, WE NEED TO MOVE FROM AWARENESS, TO AGREEMENT, AND THEN ON TO ADOPTION AND ADHERENCE.
any member of the healthcare team, “ABCDES3”: (See Chart)
SOME GUIDELINE TOOLS (A TEASER):
At the Guidelines website (http:// guidelines.diabetes.ca/) you can find educational slide kits videos and case studies, a quick reference guide, healthcare provider tools organized by Key Message, as well as resources for people with diabetes in a variety of languages. In addition, both IOS and Android apps are available.
Many healthcare provider tools are available on the Guidelines website and also on the app which offers ‘interactive’ clinical decision support. These help you identify ways to use the recommendations for particular patients. For example, the interactive tool entitled Reducing Vascular Risk asks you to input selected information about your patient and then indicates which medication the Guideline would recommend. This tool provides you with a way to implement the ‘D’ in the ABCDES3 above. For the ‘A’, the in-
teractive tool entitled Pharmacotherapy for Type 2 Diabetes provides clinical decision support regarding the Guideline recommendations when considering adding the next antihyperglycemic medication class. If people with diabetes are taking medications that can cause hypoglycemia (i.e., insulin or insulin secretagogues), the Guidelines recommend counselling regarding safe driving. Now available on the Guidelines website is a handout you can give to such patients to help implement this recommendation. People with diabetes
benefit when they include a range of health professionals in their care team. We need all team members, along with the person with diabetes themselves, to be working ‘on the same page’. This was the impetus for an ABCDES3 tool that we hope people will ‘share to improve their care’. We hope people with diabetes will take this tool with them when they visit their primary care clinicians, including their pharmacist, nurse, dietician, etcetera to help keep things on track and identify key action items. ■ H
Noah Ivers MD PhD CCFP and Catherine Yu FRCPC MHSc are Co-Chairs, 2018 Clinical Practice Guidelines Dissemination and Implementation Committee.
JULY 2018 HOSPITAL NEWS 27
Ingenuity meets heart health By Andre Bertram eart disease is the second leading cause of death in Canada. According to the Public Health Agency of Canada’s Canadian Chronic Disease Surveillance System, about one in 12 Canadians aged 20 or over live with a diagnosed heart disease. Meanwhile, the health care industry continues to use the same tools to diagnose, monitor and treat the affliction in Canadians with little advancement in the field. My colleague Frank Nguyen and I both attended Danforth Collegiate Institute in Toronto, when Frank arrived home from school one day to find his mother at the bottom of the stairs with a broken leg. Doctors determined a minor cardiac event had caused the fall, nevertheless there was little to no empirical information from the event to make a concrete diagnosis – which is often the case when Canadians experience cardiac issues. From this event, HeartWatch was born. HeartWatch is a clinical-quality ECG monitor which is worn on the wrist and a new way for doctors to monitor their patients. It is currently being developed and produced inhouse at the Biomedical Zone at Ryerson, in conjunction with St. Michael’s Hospital in Toronto, and uses printed circuit boards to offer healthcare practitioners high-fidelity data from the wrist or arm. It then uses complex data processing models to analyze the constant data to detect soft- and hardheart issues. In terms of medical technology, I believe there is nothing quite like HeartWatch. Generally, wearable heart monitoring technology is consumer-facing, and while it offers a sleek and comfortable interface, it only uses pulse light to give a rudimentary understanding of heart rate. Nevertheless, the matter of data fidelity remains. Alternatively, in the ECG space, holter monitors are designed to give the highest-grade data, but are extremely large, cumbersome and stigmatizing. Furthermore, the adhesive pads can cause issues for patients, such as skin irritation.
HEARTWATCH IS A CLINICAL-QUALITY ECG MONITOR WHICH IS WORN ON THE WRIST AND A NEW WAY FOR DOCTORS TO MONITOR THEIR PATIENTS. HeartWatch marries both technologies to help usher in the new wave of easy to use, safe and reliable heart monitoring technology. It can be worn as long as necessary, is easy to set up and manage and still provides a level of data which is reliable for health professionals – which we believe will be the way of the future. And while our device is currently in trials, we are expecting to have FDA approval in the coming year. The medical field is constantly advancing and evolving, and a major trend has emerged – bringing the ICU into the home. This means that over the next decade and beyond, data science and artificial intelligence (AI) will likely become major disruptors
in cardiology. It is important to note that technology like HeartWatch will not be implemented to take the place of Canadian doctors, instead, it will enhance their abilities. This technology will save doctors time and shift their role from insight development – reading, absorbing and analyzing numerous data points – to strictly developing individualized treatment plans for patients. As a young entrepreneur in the medtech space, I have had to traverse numerous hurdles, most obviously funding. Luckily, investors believe in the work that we’ve completed on HeartWatch and, to date, while the details of our first round of funding aren’t public, we are proud to have won more than
Andre Bertram $300,000 through various grants and awards. Most recently placing second in the Entrepreneurs’ Organization’s Global Student Entrepreneur Awards, which not only awarded us close to $20,000 USD but expanded our network and connected us with likeminded disruptors from across the globe. While HeartWatch is generally still a young medical technology, we are hoping that our work will eventually change the face of heart disease in Canada and across the globe. By working with health professionals, data scientists and leveraging the technology available to us, we believe that we can change the narrative around heart disease and help foster a healthier H Canada. ■
Andre Bertram is the CEO and Co-Founder of HelpWear Inc. As a young entrepreneur, Andre uses his background in science and systems engineering in tackling the issue of cardiovascular illness globally. 28 HOSPITAL NEWS JULY 2018
Innovative Procurement at Southlake Regional Health Centre: Heather’s Story By Jessie Boogaard and Melicent Lavers-Sailly eather Stevens has rarely gotten a good break when it comes to her health. Even as a child, she remembers fatigue as her constant companion. First diagnosed in her teens with a congenital heart problem – the need for a pacemaker finally became obvious. “I had two children and then, just before my 25th birthday, I started passing out,” she says. “I passed out at home one time with my daughter standing over me saying ‘Mommy, mommy, mommy, wake up.’” For 33 years, Heather’s pacemakers helped keep her healthy. She received new ones when necessary, earning a special nickname, “Ticker,” from her friends. But things didn’t go well in 2017, when a life-threatening infection developed after a pacemaker replacement procedure. “I kept getting sick and the pains in my chest were unreal. I was giving up and I didn’t think I was going to make it,” she says. Heather needed open heart surgery to remove the new pacemaker, its leads, and the infection. But what happened next was made possible because of a new approach to purchasing by Ontario hospitals called “innovative procurement.” In Canada’s single-payer health system, buying medical products or services has traditionally focused primarily on lowest price. But at Southlake Regional Health Centre in Newmarket, Ontario, the Regional Cardiac Care Program recently experimented with an approach that supporters say could revolutionize Canadian healthcare. “Traditional procurement strategies were trying to achieve the lowest price for the products,” says Janice Allen, director, Regional Cardiac Care Pro-
UNDER “INNOVATIVE PROCUREMENT,” SOUTHLAKE WAS ABLE TO CONSIDER THE VALUE OF A PRODUCT OR SERVICE, IN ADDITION TO ITS PRICE. gram at Southlake Regional Health Centre. “Whereas we were looking for a strategy that would not only achieve value for money but would also achieve our goal of adopting new innovation into our heart program.” Under “innovative procurement,” Southlake was able to consider the value of a product or service, in addition to its price. They could discuss whether a product improves outcomes for patients, helps them recover faster, go home sooner or reduce their risk of returning to the hospital. They could also consider whether a medical device lasts longer than others, or is more appropriate for a patient’s particular condition. In order to achieve innovative procurement, Southlake engaged in
“competitive dialogue,” which allowed it to partner with companies to find ways of improving operational efficiency or streamline medical procedures. The savings could then be used in several ways, including investing in new medical technologies. The experiment came with permission and a grant from the Ontario Ministry of Government and Consumer Services. “I think if any of us stood in front of a whiteboard and redesigned the delivery of healthcare in Ontario, we would focus on competitive dialogue and innovative procurement,” says Bill Charnetski, chief health innovation strategist for the province of Ontario. “These have the potential, if used across the system, to enhance the
focus on patient outcomes and come to the appropriate method of getting to those outcomes at the right cost, measured across the patient journey through the system.” Thanks to innovative procurement and competitive dialogue, Southlake’s Heart Rhythm team was able to implant a leadless pacemaker to help Heather. Because it’s implanted inside the heart without traditional surgery, and because it has no leads connecting it to the heart, the risk of infection for Heather was much lower. But under Ontario’s standard approach to procurement, she likely would have received another traditional pacemaker, or been forced to go to another hospital hours from home. “This whole process not only benefits our institution and the Ministry in terms of funding, but it also benefits the patients,” says Dr. Zaev Wulffhart, physician leader of the Regional Cardiac Care Program at Southlake. “Giving our patients the best advantage is the most significant thing we can achieve.” Dr. Wulffhart explains that partnerships with healthcare companies will be important to the success of such programs. “Our relationships with industry have to change. We have to stop thinking of them as vendors and more as partners in care. They all have a commitment to a better quality of life for their patients, just as we do,” he says. Heather is now back at work and back to enjoying life with her family and friends. She had never heard of innovative procurement, but she appreciates what it’s done for her. And she hopes other Canadians will soon benefit from it too. ”I feel great. Better than I have in a long time. To go from feeling poorly to feeling like a million dollars, is H priceless. That’s the only word.” ■
Jessie Boogaard is Manager, Business and Quality, Regional Cardiac Care Program at Southlake Regional Health Centre. Melicent Lavers-Sailly is Senior Manager, Communications & Corporate Marketing at Medtronic Canada and a Member of the TOHealth! Marketing Working Group. www.hospitalnews.com
JULY 2018 HOSPITAL NEWS 29
In a cardiac procedure mapping of the heart takes about sixty per cent of the surgery time, but with this new catheter that time can be cut in half, which means shorter procedures and less waiting time for patients.
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New cardiac mapping catheter cuts surgery time By John Pereira atients undergoing a cardiac procedure at Kingston Health Sciences Centre (KHSC) will now benefit from a new technology that will cut their surgery time in half and help them recover more quickly. Known as the Abbott Advisor™ HD Grid Mapping Catheter, Sensor Enabled™, this catheter is a first-of-its-kind technology that provides the latest in cardiac mapping for patients with cardiac arrhythmias. KHSC is the first in Canada to use this technology. “The use of this catheter means that we will be able to see a lot more data much more quickly, which will significantly help us map the heart,” says Dr. Benedict Glover a cardiologist at KHSC and assistant professor of cardiology at Queen’s University. “In a cardiac procedure mapping of the heart takes about sixty per cent of the surgery time, but with this catheter we can cut that time in half, which means shorter procedures and less waiting time for our patients.” For some patients with a cardiac arrhythmia, physicians may use cardiac ablation therapy to create scars or lesions on the tissue of the heart where the abnormal heartbeats originate. As a
result, this tissue is no longer capable of sustaining the arrhythmia. Mapping catheters are critical to helping physicians visualize and navigate the heart during an ablation procedure. The new mapping catheter is designed to record electrical information from the heart to create a highly detailed cardiac map that helps doctors find and diagnose cardiac arrhythmias in their patients. “There is huge potential for this catheter,” says Dr. Glover, who performed the first procedure using the technology at KHSC’s KGH site. “Its novel design means it can capture both the direction and speed of signals in much greater detail than current technology. It gives us a better understanding of the electrical properties of certain arrhythmias such as atrial fibrillation. We’re very lucky to be the first to use it.” This is the second time KHSC’s electrophysiology group has taken the lead in implementing new technology for arrhythmia surgery. In 2017 Dr. Glover was the first in North America to use an advanced mapping suite of technologies for cardiac ablation surgery. This latest tool enhances the capabilities of that H sophisticated platform. ■
John Pereira is the Strategic Communications Advisor at Kingston Health Sciences Centre. www.hospitalnews.com
UNDERSTANDING MENTAL DISORDERS: PERSONALITY DISORDERS, ANXIETY, & DEPRESSION A Seminar for Health Professionals TUITION $109.00 (CANADIAN)
Conference registration is from 7:45 AM to 8:15 AM. The conference will begin at 8:30 AM. A lunch break (on your own) will take place from approximately 11:30 AM to 12:20 PM. The course will adjourn at 30DWZKLFKWLPHFRXUVHFRPSOHWLRQFHUWLÂ¿FDWHVDUHGLVWULEXWHG
Registration: 7:45 AM â€“ 8:30 AM Morning Lecture: 8:30 AM â€“ 10:00 AM Â‡ (OHPHQWVRI3HUVRQDOLW\How We Become Who We Are. Â‡ Cognitive Appraisals: Do We Perceive Reality? Do We Feel the Way We Think? Â‡ *HQHVDQG0HQWDO'LVRUGHUVDo we Inherit Abnormal Behavior? Â‡ 3HUVRQDOLW\'LVRUGHUV Three Clusters of Relationship Killers. Â‡ :RUVKLS0HÂ²:KDW,:DQW:KDW,7KLQNDQG:KDW,)HHONarcissistic Personality Disorder. Mid-Morning Lecture: 10:00 AM â€“ 11:30 AM Â‡ :KDW-XVW+DSSHQHG+HUH"The Person with Borderline Personality Disorder. Â‡ &RSLQJ:LWK'LIÂ¿FXOW%HKDYLRUVAvoidant, Dependent, and Paranoid Personality Disorders. Â‡ 6HOI&HQWHUHGDQG*XLOWOHVVZLWK/RVVRI(PSDWK\Antisocial Personality Disorder. Â‡ &KURQLF6WUHVVDQGWKH%UDLQHow Self-Defense Turns Into Self-Destruction. Â‡ (DUO\/LIH7UDXPDWLF6WUHVVA Powerful Path to Mental Illness. Lunch: 11:30 AM â€“ 12:20 PM Afternoon Lecture: 12:20 PM â€“ 2:00 PM Â‡ $Q[LHW\'LVRUGHUVDiagnostic Pitfalls and Treatment Options for Fear Out of Control.
0HGLFDO&RQGLWLRQV7KDW&DQ&DXVHRU0LPLF$Q[LHW\Adverting Disaster. Dental Anxiety: Managing the Anxious Dental Patient. 2EVHVVLYH&RPSXOVLYH'LVRUGHUIs this Compulsive Gambling and Hoarding? 3RVWWUDXPDWLF6WUHVV'LVRUGHU The Unrelenting Power of Flashbacks; CPT, PET, and EMDR Treatments. Mid-Afternoon Lecture: 2:00 PM â€“ 3:20 PM Â‡ 0DMRU'HSUHVVLYH'LVRUGHUDSM-5 Criteria; Effects of Hormones, Insomnia, Stress, and Chronic Pain. Â‡ 1HZ7UHDWPHQW*XLGHOLQHVIRU'HSUHVVLRQMedication and Cognitive Therapy. Â‡ 'HSUHVVLRQDQG6XLFLGHMedication Risks; Postpartum Depression. Â‡ &RPSOHPHQWDU\0HDVXUHVWR7UHDW'HSUHVVLRQExercise, Dietary Strategies, Transcranial Magnetic Stimulation, Electroconvulsive Therapy (ECT), and Vagal Stimulation. Â‡ %LSRODU'LVRUGHUVAvoiding Diagnostic and Treatment Pitfalls; Medication and Compliance Problems. Â‡ %H\RQGÂ³(LWKHU2UÂ´7KLQNLQJLQ7UHDWPHQWMedications, Mindfulness, and Psychotherapy. Evaluation, Questions, and Answers: 3:20 PM â€“ 3:30 PM
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Thu., Oct. 18, 2018 8:30 AM to 3:30 PM &ODULRQ+RWHO &RQIHUHQFH&HQWHU 2120 - 16th Avenue Northeast Calgary, AB
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Dr. Michael E. Howard (Ph.D.) is a full-time psychologist-lecturer for INR. Dr. Howard is a boardFHUWLÂ¿HG FOLQLFDO QHXURSV\FKRORJLVW DQG KHDOWK SV\FKRORJLVW ZKR LV DQ LQWHUQDWLRQDOO\UHFRJQL]HG authority on brain-behavior relationships, traumatic brain injury, dementia, stroke, psychiatric disorders, aging, forensic neuro-psychology, and rehabilitation. During his 30-year career, Dr. Howard has been on the faculty of three medical schools, headed three neuro-psychology departments, and directed treatment programs for individuals with brain injury, dementia, addiction, chronic pain, psychiatric disorders, and other disabilities. Biomed reserves the right to change instructors without prior notice. Every instructor is either a compensated employee or independent contractor of Biomed.
FEE: CHEQUES: $109.00 (CANADIAN) per person with pre-registration or $134.00 (CANADIAN) at the door if space remains. CREDIT CARDS: Most credit-card charges will be processed in Canadian dollars. Some charges will be in U.S. dollars at the prevailing exchange rate. The tuition includes all applicable Canadian taxes. At the seminar, participants will receive a complete course syllabus. Tuition payment receipt will also be available at the seminar. ACCREDITATION INFORMATION NURSES (RNs, RPNs, & LPNs)
7KLVSURJUDPLVGHVLJQHGWRSURYLGHQXUVHVZLWKWKHODWHVWVFLHQWLÂ¿FDQGFOLQLFDOLQIRUPDWLRQDQG to upgrade their professional skills. Numerous registered nurses in Canada and the United States have completed these courses. This activity is co-provided with INR. Institute for Natural Resources (INR) is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.
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CPE Biomed, under Provider Number BI001, is a Continuing Professional Education (CPE) Accredited Accredited Provider with the Commission on Dietetic Registration (CDR). Registered dietitians Provider (RDâ€™s) and dietetic technicians, registered (DTRâ€™s) will receive 6 hours worth of continuing professional education units (CPEUâ€™s) for completion of this program/materials. Continuing Professional Education Provider Accreditation does not constitute endorsement by CDR of a provider, program, or materials. CDR is the credentialing agency for the Academy of Nutrition and Dietetics. This course has Activity Number 127843 and Suggested Learning Codes: 4090, 5180, and 5320.
6RFLDO:RUNHUVFRPSOHWLQJWKLVSURJUDPZLOOUHFHLYHFRXUVHFRPSOHWLRQFHUWLÂ¿FDWHV7KLVFRXUVH is cosponsored by the Institute for Natural Resources (INR). The Institute for Natural Resources, Provider #1356, is approved as a provider for social work education by the Association of Social Work Boards (ASWB) www.aswb.org, through the Approved Continuing Education (ACE) program. The Institute for Natural Resources maintains responsibility for the program. ASWB Approval Period: 02/28/2018 â€“ 02/28/2019. Social workers should contact their regulatory board to determine course approval. Social workers participating in this course will receive 6 clinical continuing education hours. This program is approved by the National Association of Social Workers (Provider #886502971-4984) for 6 Social Work continuing education contact hours.
Biomed General is approved by the Canadian Psychological Association to offer continuing education for psychologists. Biomed General maintains responsibility for the program.
For all inquiries, please contact customer service at 1-877-246-6336 or (925) 602-6140. Please return form to: Biomed General Box #622 Unit 235, 3545-32 Avenue NE Calgary, AB T1Y 6M6 TOLL-FREE: 1-877-246-6336 TEL: (925) 602-6140 ÂŠ FAX: (925) 687-0860
(This registration form may be copied.)
Thu., Oct. 18, 2018 (Calgary, AB) Fri., Oct. 19, 2018 (Edmonton, AB)
Thu., Nov. 1, 2018 (Edmonton, AB) Fri., Nov. 2, 2018 (Calgary, AB)
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Please enclose full payment with registration form. Check method of payment. Cheque for $109.00 (CANADIAN) (Make payable to Biomed General) Charge the equivalent of $109.00 (CANADIAN) to my Visa
Most credit-card charges will be processed in Canadian dollars. Some charges will be in U.S. dollars at the prevailing exchange rate.
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Fri., Nov. 2, 2018 8:30 AM to 3:30 PM &ODULRQ+RWHO &RQIHUHQFH&HQWHU 2120 - 16th Avenue Northeast Calgary, AB
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Please register early and arrive before the scheduled start time. Space is limited. Attendees requiring special accommodation must advise Biomed in writing at least 50 days in advance and provide proof of disability. Registrations are subject to cancellation after the scheduled start time. A transfer at no cost can be made from one seminar location to another if space is available. Registrants cancelling up to 72 hours before a seminar will receive a tuition refund less a $35.00 (CANADIAN) administrative fee or, if requested, a full-value voucher, good for one year, for a future seminar. Other cancellation requests will only be honored with a voucher. Cancellation or voucher requests must be made in writing. If a seminar cannot be held for reasons beyond the control of the sponsor (e.g., acts of God), the registrant will receive free admission to a rescheduled seminar or a full-value voucher, good for one year, for a future seminar. A $35.00 (CANADIAN) service charge applies to each returned cheque. A $15.00 fee ZLOOEHFKDUJHGIRUWKHLVVXDQFHRIDGXSOLFDWHFHUWLÂ¿FDWH)HHVDUH subject change without notice. The rate of exchange used will be the one prevailing at the time of the transaction.
Focused: Cardiovascular Care, Respirology, Diabetes and Complementary Health.