Lightening the load of chemotherapy for teens, one backpack at a time
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ONCOLOGY/ MEDICAL IMAGING/PEDIATRICS:
Canada's Health Care Newspaper
Approaches to cancer treatment, diagnosis and prevention. A look at medical imaging techniques for diagnosis, treatment and prevention of diseases. Pediatric programs and developments in the treatment of pediatric disorders including autism.
JUNE 2013 | VOLUME 26 ISSUE 6 | www.hospitalnews.com
Improving the paediatric day surgery patient experience
INSIDE Legal ....................................................15 Ethics ...................................................21 Caregiver ..............................................24 From the CEO's desk........................... 26 Careers ................................................ 31
Smiles prescribed PRHCâ€™s Paediatric Outpatient Clinic By Amanda Roffey
hildren laughing, playing and running around are the first sounds and sights that greet you as you walk through the doors of Peterborough Regional Health Centreâ€™s (PRHC) Paediatric Outpatient clinic. Upon arrival, you are welcomed by a warm, friendly smile (or hug if you are a regular visitor) from Nurse Practitioner Jodi Hazell and Registered Nurse Shay Cannon that puts children and parents instantly at ease. The Regional Centreâ€™s Paediatric Outpatient (POP) clinic is creating new â€œexpress lanesâ€? for our youngest patients and their families to receive access to high quality patient care. Nurse Practitioner Hazell leads the specialized inter-professional paediatric team that includes herself and RN Cannon with ready access to Pediatricians, Dietitians, Respiratory Therapists, Social Workers, Physiotherapists, Occupational Therapists, Speech Language Pathologists, Paediatric Diabetes Educators, Fitness trainers, Psychology Associates, Pharmacists and a Lactation Consultant as required. â€œWe care for children as young as infants to 18 years old,â€? says Sheri Ferkl, Director of PRHCâ€™s Womenâ€™s and Childrenâ€™s pro-
Left to right: Nurse Practitioner, Jodi Hazell, Tyler Kelly RN, Patient Ethan Howcroft with RN Shay Cannon and Child Life Specialist Lois Scott celebrate Ethanâ€™s last treatment at Peterborough Regional Health Centreâ€™s Peadiatric Outpatient Clinic. gram. â€œThe Paediatric Outpatient clinic provides regional care and service to young people from Peterborough, Lindsay, Haliburton, Campbellford and Cobourg.â€?
â€œSince opening in April 2012, weâ€™ve developed partnerships with Tertiary Paediatric Speciality teams at The Hospital for Sick Children, so we can offer some components
of specialized care for children closer to home,â€? added Jodi Hazell, Nurse Practitioner, PRHCâ€™s Paediatric Outpatient clinic. Continued on page 6
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Harper government invests in eHealth innovation
World leaders: "the time is " now to confront cervical cancer
During a keynote speech at the 2013 e-Health: Accelerating Change conference, the Honourable Leona Aglukkaq, Minister of Health, announced funding from the Harper government to support research projects focused on developing innovative new electronic health (eHealth) technologies. These technologies will capitalize on advances in electronic patient records, internet technology and mobile devices. eHealth is an essential enabler of health care in Canada. Through its investment of $2.1 billion, the Harper government is supporting Canada Health Infoway in its work with the provinces and territories and many other stakeholders to increase the availability of electronic health records and other eHealth technologies that benefit Canadians through improvements in patient access to service, the quality of health care and the efficiency of the system. The funding will support 16 new research projects through the eHealth Innovation Catalyst Grant program, led by the CIHR Institute of Health Services and Policy Research. The program focuses on promoting the development of innovative technologies that enable patients to selfmanage their conditions via eHealth applications, support health professional decision-making and enable enhanced population health moniH toring. ■
Every year, 275,000 women die of cervical cancer. India alone accounts for 72,000 deaths – more than any other country – while the top ten highest mortality rates for cervical cancer are all in Africa. With global attention focused on cervical cancer, key stakeholders from more than 70 countries came together as an urgent 'Call to Action' was released at the Global Forum on Cervical Cancer Prevention. It called for universal access to cervical cancer prevention, which would rewrite the future for millions of girls and women living in some of the poorest countries in the world.
Leaders commended South Africa, which is not eligible for GAVI funding, for taking the bold step of announcing that in
February 2014, they too will roll out the vaccine to girls aged nine to ten. "We welcome the South African Government's new commitment to vaccinate girls against this deadly disease, which kills more than 3000 women every year and is a leading opportunistic infection for people with HIV," said Portia Serote of Treatment Action Campaign. International agencies have a key role to play to ensure that the world moves toward the World Health Organisation commitment that by 2015, 50 per cent of the 75 focus countdown countries will H have introduced the HPV vaccine. ■
Queen's University scientist wins top national award for spinal cord research A scientist from Queen's University has received the 2012 Barbara Turnbull Award for Spinal Cord Research, an annual prize supported through a partnership between the Barbara Turnbull Foundation for Spinal Cord Research, Brain Canada, and the CIHR Institute of Neurosciences, Mental Health and Addiction. Dr. Stephen Scott, a Professor in the Department of Biomedical and Molecular Sciences at Queen's University, received this honour in recognition of his outstanding research focused on helping Canadians who suffer the effects of spinal cord trauma and stroke. Dr. Scott and his research team focus on how feedback to the primary motor cortex, which is a key region in the brain for voluntary control, interacts with spinal activity.
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This will enable them to understand how sensory feedback from the limb (and vision) is essential while performing voluntary motor skills, such as reaching and grasping a cup or other objects in the world. This knowledge will also bring insights into the impact of neurological disorders, such as stroke, on brain function and motor performance. Barbara Turnbull is a well-known Toronto journalist and research activist who was shot and paralyzed from the neck down during a convenience store robbery when she was 18. The Barbara Turnbull Award for Spinal Cord Research was established in 2001 to support research and raise awareness of the more than 86,000 Canadians who are living with a spinal cord injury, with
Dr. Scott and his research team focus on how feedback to the primary motor cortex, which is a key region in the brain for voluntary control, interacts with spinal activity. 4,300 new cases each year. The prize is presented annually to the researcher who scores the highest ranking in the Canadian Institutes of Health Research Operating Grants competition for research in the field of spinal cord injuries. This award is H for $50,000. ■
Health care reforms not keeping pace with needs of Canadians, says report
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HOSPITAL NEWS JUNE 2013
"We welcome the South African Government's new commitment to vaccinate girls against this deadly disease, which kills more than 3000 women every year and is a leading opportunistic infection for people with HIV."
The Health Council of Canada recently released Progress Report 2013: Health care renewal in Canada, highlighting the progress achieved by governments in five key areas: wait times, primary health care and electronic health records, pharmaceuticals management, disease prevention/health promotion and Aboriginal health. The report finds that, overall, efforts at reform are not keeping pace with the changing health care needs of Canadians. There is variability of access to services across the country. To achieve better health care for all Canadians, the report calls for governments to set clear policy goals with clear lines of responsibility, to continue the spread of innovative practices, and to support collaborative efforts across all jurisdictions, including the federal government. The report points out that Canadian premiers have begun working together
on select initiatives, such as the joint pricing of prescription drugs, which saves significant health care dollars. The Health Council recommends this continue, because when governments work together with common goals, the quality of health care and access to it improve for all Canadians. Along with the need for accountability and collaboration, the report also calls for the sharing of innovative practices. An example of an innovative practice highlighted in the report is the First Nations Health Authority in British Columbia, which was established in 2012 and puts health care delivery and decision-making in the hands of First Nations people. This shift is the result of several agreements made between BC First Nations and the provincial and federal governments, in efforts to close gaps in health status between First Nations people and other residents of BritH ish Columbia. ■ www.hospitalnews.com
Lightening the load of chemotherapy for teens, one backpack at a time By Caitlin McNamee-Lamb
ntil now, treatment for paediatric sarcoma (bone and/or muscle tumour) in Canada has been done in the hospital. Typically, patients check in for a few days or up to a week at a time to receive their chemotherapy treatment. A new pilot project at The Hospital for Sick Children (SickKids) aims to deliver treatment at home and dramatically reduce time spent in hospital. For 16-year-old soccer player, Yusuf Hirji, the time spent in hospital was one of the most dreaded parts of his treatment. “Being in the hospital is a constant reminder that I’m sick. My spirits aren’t the best, I feel glued to my bed, and am constantly watching the clock,” says Yusuf, who was diagnosed with osteosarcoma, a bone tumour that develops in adolescence, in July 2012.
It is work to manage this at home, but when I see Yusuf at home with the family, happy and feeling healthy, it’s totally worth it. On the first day of treatment, patients with osteosarcoma receive about four hours of a common chemotherapy drug called methotrexate. They must stay in hospital for an additional three to four days until the drug has cleared from their body. Yusuf, and other teens with cancer, have asked if it was possible to do some of this treatment at home. In hopes of addressing this question, a team at SickKids started a pilot research project to deliver outpatient methotrexate treatment that allowed patients to go home every day. This is the first time aggressive chemotherapy (high dose methotrexate) has been given as an outpatient treatment to paediatric patients in Canada. A blue backpack filled with three litres of fluid gives Yusuf the freedom to leave the hospital each day after chemotherapy.
“I can continue my driving lessons, go out with friends, have dinner with my family, sleep in my own bed and I’ve even started learning to play the guitar,” says Yusuf. Eleanor Hendershot, Nurse Practitioner in Oncology at SickKids, was at a conference in Brazil in 2009 when she first saw this model of outpatient cancer care. “I thought, if they can do this in Brazil with limited resources, then we must be able to do it at SickKids,” she says. This type of treatment is offered at several centres in the United States but nowhere in Canada. It took a multidisciplinary team of nurses, doctors, pharmacists, researchers, patients and their families to get the project up and running. “We needed to make sure that the outpatient treatment would not only be safe and effective for patients, but also be feasible for the medical team and the family.” Eleanor explains that in order to give methotrexate safely, the patient must receive a lot of fluid, which is given through an IV. Eleanor worked with the Department of Pharmacy at SickKids to ensure that the hydration could be delivered through this backpack and that other medications required for care could be given orally. This had never been done in Canada before, so Eleanor and her team also needed to educate the staff at SickKids about this new concept of outpatient methotrexate treatment. Yusuf’s mom also needed to be trained on how to check the acid levels in her son’s urine and give medications that are typically given through IV, orally instead. “It is work to manage this at home, but when I see Yusuf at home with the family, happy and feeling healthy, it’s totally worth it,” says Yusuf’s mother, Shyrin Hirji. “He’s engaged and empowered to pursue new things and continue living his regular life. Once you understand the process and see how much your child is benefitting, there’s no turning back. I wouldn’t have it any other way.” Patients who are receiving this outpatient cancer treatment must still return to SickKids daily for continued monitoring of urine, kidney function, drug levels and potential side effects. More importantly however, is the number of hours spent in hospital is significantly reduced with this method of treatment. Yusuf went from
Yusuf Hirji is able to have more time for things that he enjoys while maintaining his chemotherapy treatment. spending approximately 96 hours (four days) in hospital to just 22 hours, a reduction of 75 per cent less time in the hospital. This project has had a huge impact on the quality of life of the patients. “It is so rewarding to hear about all the great things they’re able to do in their ‘free’ time,” she says. The project also results in significant savings to the health care system, as the outpatient care provided for this treatment is much less expensive than the several days of hospitalization that it replaces. Since using the outpatient hydration backpack, Yusuf has had a bigger appetite, better sleep, better mood, and overall has
felt much healthier. “With my backpack, I don’t feel like cancer is taking over my life. Whether it’s driving, participating at a Terry Fox event, or just playing video games with my brother; I can do it. I’m just a kid with a backpack, like so many others my age.” The pilot project was supported by The Garron Family Cancer Centre and the team plans to expand the project so they can treat teens with Ewing’s sarcoma as an H outpatient soon too. ■ Caitlin McNamee-Lamb is a Communications Specialist at The Hospital for Sick Children.
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UPCOMING DEADLINES JULY 2013 ISSUE EDITORIAL JUNE 7 ADVERTISING: DISPLAY JUNE 27 CAREER JULY 2 MONTHLY FOCUS: Cardiovascular Care/Respirology/ Diabetes/Gastroenterology: Developments in the prevention and treatment of vascular disease including cardiac surgery, diagnostic and interventional procedures. Advances in treatment for various respiratory disorders including asthma, allergies. Prevention, treatment and long term management of diabetes and other endocrine disorders. Advances in diagnosis and treatment of diseases of the gastrointestinal tract.
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Getting the facts on genetic testing Angelina Jolie’s recent editorial in the New York Times resulted in a whirlwind of discussion. Her announcement to decide to undergo a double mastectomy was based on genetic testing that revealed she carried a “faulty” BRCA1 gene that significantly increases her chances of developing breast and ovarian cancer. Jolie had witnessed the devastating effects of cancer and lost her own mother to the disease several years ago. The mother of six admitted that the decision was difficult to make but foremost in her mind was living a long and healthy life and being there for her children. Prophylactic mastectomy, or surgical removal of the breasts and/or oophorectomy, removal of the ovaries as a preventative measure is not a new procedure, but Jolie has brought a great deal of attention to it due to her celebrity status. No doubt this was her intention – to raise awareness about genetic testing and the options available. But what are the facts around this testing and who should be tested? BRCA1 stands for breast cancer susceptibility gene 1. Both BRCA1 and BRCA2 are genes known as tumour suppressors, which normally prevent cancer from developing. Women found to have mutations in the genes have a very high risk of developing breast and ovarian cancers. Only one in 500 to one in 1,000 individuals will carry a mutation or a gene change in one or another of these genes so the risk factor, while serious, is not common. According to the Cancer Society, the chance of breast and ovarian cancers being linked to the mutated genes are highest among the following families: • Those with a family history of breast or ovarian cancer;
• Early onset of breast cancer in one or more female relatives before age 50; • Breast and ovarian cancer in a single relative; • Family members developing cancer in both breasts; • A male relative with breast cancer. A family history of breast cancer, while a serious risk factor, is not necessarily an indicator of a known genetic link. No doubt further research and investigation will reveal other “faulty” genes in the future.
On the positive side, regular breast screening can be beneficial to all women, regardless of their risk factors. A genetic test for cancer predisposition is a blood test that shows whether an individual has inherited a gene mutation that increases the risk for certain cancers. Individuals with a personal or family history of breast, ovarian or colon cancer may see a genetic counsellor to discuss cancer risks and clarify eligibility for genetic testing. Genetic counselling and testing is paid for by the Ontario Health Insurance Plan. There are certain criteria an individual must meet to be eligible for genetic testing, including a strong family history of cancer, young ages of onset of cancer within the family and being a member of ethnic groups known to be affected. If you are worried that you might be at risk, your first step is to discuss your
concerns with your family doctor. If necessary, they will refer you to a familial cancer clinic, part of the Predictive Cancer Genetics Program funded by the Ministry of Health and Long-Term Care. A full list of these sites is available on the Cancer Care Ontario website: https://www.cancercare.on.ca/ Not every woman may choose to follow in Jolie’s footsteps. Making a decision to have any healthy body part removed is a radical move and every surgery has some accompanying risks and side-effects. Emotional and psychological effects of surgery are also an important factor and well worth considering. Some radical opinions even suggest that genetic testing is just a form of “medical hexing” and that if you believe that you are predestined to become ill you will. On the positive side, regular breast screening can be beneficial to all women, regardless of their risk factors. The Ontario government recently announced that it has decided to replace nearly a quarter of the mammography machines in the province because a new study has revealed that they are 20 per cent less effective in detecting breast cancers than other devices. Ontario women will be able to take advantage of the higher accuracy rate of digital technology or direct radiography machines which will replace the CR devices which are also being used in the province. Also helpful are lifestyle factors such as limiting consumption of alcohol, eating a low-fat diet and engaging in regular exercise. Getting informed about breast cancer is an important step towards prevention and hats off to Jolie for having the courage and conviction to bring atH tention to this sensitive subject. ■ Julie Abelsohn Acting Editor
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Marnie Loeb, a Paediatric Speech Language Pathologist at St. Joe's, uses play-based therapy techniques to help her young patients with language difficulties.
St. Joe’s makes speech-language therapy fun for our youngest patients By Lauren Pelley
oes your toddler seem tonguetied? Don’t worry – they’re not alone. Speech and language delays are a common issue for many Canadian kids, and one in ten children with these delays will need some help to ensure their speech is on the right track. Here at St. Joseph’s Health Centre, we work with children with all sorts of language difficulties in our outpatient Paediatric Speech-Language Pathology clinic.
"It’s all very play-based, so it’s not stressful for kids at all,” Loeb says. “They think they’re coming in to see the toy doctor." “I work with kids under the age of six who’ve been identified as having some sort of speech or language or developmental difficulty,” says Marnie Loeb, a Paediatric Speech Language Pathologist here at St. Joe’s. “So this may be something like they have trouble finding their words, or using words, or understanding.” Kids might also stutter or have trouble pronouncing words, she adds. For some children, the problem is strictly a speech issue, while for others it could point to a learning disability or autism. www.hospitalnews.com
“Parents often start to notice that their child is not talking as much as their peers around 12 to 18 months, (and) definitely by 24 months,” explains Dr. Janine Flanagan, Developmental Paediatrician. Dr. Flanagan says children should have between 10 to 20 single words or word approximations between 12 and 18 months. By the age of two, kids should be capable of putting two words together, such as saying “mommy come”. By three, they should be capable of short phrases like “I want juice”, and should be saying longer sentences by the age of four. Kids arrive at the St. Joe’s clinic once their parents or family doctor realizes they’re lagging behind, and the speechlanguage therapy they will do here takes a variety of forms, says Loeb. “Some people come in every couple months, sometimes we see kids on a weekly basis – either by themselves or in a group with other kids,” she explains, adding the group sessions are often the most enjoyable for the young participants. “It’s all very play-based, so it’s not stressful for kids at all,” Loeb says. “They think they’re coming in to see the toy doctor.” From the outside, the sessions definitely look like playtime, with books and toys used in each visit. But what’s actually happening is interactive therapy that encourages the kids to identify different words and form sentences – all while having fun. While these sessions are geared towards the kids, parents are key players as well. “The main goals of therapy (are) to help parents learn how to effectively communicate with their child and help their child communicate with them,” says Dr. Flanagan.
Loeb says a once-a-week therapy session won’t be as effective without additional parental involvement. “But once you have parents following up at home, we see huge gains and it happens very, very quickly.” “The earlier the intervention, the better the outcome,” adds Dr. Flanagan.
Watch our Speech Language Therapy in Paediatrics video, featuring Marnie working a young patient, by visiting our St. Joe’s YouTube channel at www.youtube.com/stH joeshealthcentre. ■ Lauren Pelley is a Junior Associate at St. Joseph's Health Centre, Toronto.
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Caring for our smallest patients NICU at North Bay Regional Hospital By Lindsay Smylie Smith
hen Kristen Roy’s water broke at 34 weeks, she didn’t quite believe it. “I didn’t know what to do. I didn’t even think that was really what was happening. It was too early!” Kristen, a supply teacher, immediately tried to get a hold of her husband Louis who was getting ready to go out of town for a night shift. Kristen says she didn’t realize the urgency of the situation. “I told Louis to go ahead to work, that I would go to the hospital and get checked out. I thought it was too soon to have the baby, and was sure they would just send me home.” Their son Nolan was born just over three hours later.
Baby makes three Kristen and Louis met through friends in university, when she was in North Bay and he was in Toronto. After a few years of a long distance relationship, they decided to move in together in North Bay. Louis proposed in the fall of 2008 and they were married the following July. When they decided to start a family, Kristen said it happened almost right away and she enjoyed a very healthy pregnancy. The day she delivered, she said she woke up and wasn’t feeling great. After work she still was feeling ‘off’, and then later that evening her water broke. Not convinced it was actually her water breaking, Kristen didn’t think there was a rush to get to the hospital. “I wanted to brush my teeth, change, have a shower,” she laughs now. Once at Labour and Delivery the nurses confirmed Kristen’s water had broken – Nolan was on his way, exactly six weeks early.
“What do you say to the nurses who kept your first born alive for the first month of his life?” NICU – Going above and beyond for our smallest patients At 10:58 p.m., Nolan Edward Maurice Roy was born at 4 lbs 12 oz and 47 cm long. “The total time from my water breaking to delivery was about three hours and 13 minutes,” Kristen explains.
Caring for our smallest patients Kristen says she held Nolan briefly before he was brought to the Neo-Natal Intensive Care Unit (NICU). Shortly after, she was able to go see him. “It was very surreal because everything happened so fast and he was so early – it was amazing that he was here, that he was mine.” After the shock wears off reality sets in. “Soon you realize you’re not going home tomorrow with a 7 lb baby.”
The North Bay Regional Health Centre provides an Intensive Care Nursery setting for newborns as early as 30 weeks gestation. Five Pediatricians and 15 skilled nurses with specialty Neonatal Intensive Care Nursing education provide intensive nursing for critically ill babies and supportive care for pre-term infants as they develop.
Life in the NICU Kristen says from the beginning the staff were very supportive. “I was discharged from the hospital on my second day. The NICU nurses gave me their number and said I could call anytime day or night. I never did call, but knowing I could was comfort enough.” During his first few days of life, Nolan
PRHC’s Paediatric Outpatient Clinic Continued from page 1 For the Coultire-Matthews family, PRHC’s POP clinic provides peace of mind and helps reduce the family’s stress. “The care and attention from the POP team is amazing,” noted Natalie CoultireMatthews, mother to Oliver Matthews who’s one of the clinic’s regular patients. “Prior to the clinic’s opening; we spent a year and half travelling to Toronto or Montreal for Oliver’s medical care for Brittle Bone disease. Now we can come to PRHC’s POP clinic and receive coordinated care for items such as x-rays that can be sent to Sick Kids in advance of our appointment.” “Our goal is to make children smile and ease parents’ anxiety,” noted Hazell. “We make a child’s treatments and care as fun as possible, while growing our services in order to benefit children and their families in our local and surrounding communities.”
Services offered at POP: • A Newborn Follow-up clinic allows families with newborns the option to return to the clinic to see a peadiatric Nurse Practitioner and Lactation Consultant who help address any new parents’ concerns. • Neonatal Follow Up Clinic provides support, consultation, assessment, care and treatment for families with high risk HOSPITAL NEWS JUNE 2013
babies for (up to) 2 years, to ensure the infant/child is meeting developmental milestones. The team works in collaboration with Five Counties Children’s Centre to ensure that high quality care, focused on infant and child development, is delivered collaboratively and seamlessly for these high risk children and their families. • Retinopathy of Premature Infants (ROP) Clinic: Under the direction of Dr. McReelis and Dr. Yeung the ROP clinic provides healthcare to our smallest patients who are at high risk for retinopathy in the comfort of their home. The clinic reduces the need for families to travel to Sick Kids for eye exams, while providing high quality care close to home. • Chronic Infusion Clinic: PRHC’s POP clinic, in collaboration with The Hospital for Sick Children, and community partners, offers a core group of patients’ access to chemotherapy, blood products, iron infusions and provides ongoing follow up and timely intervention allowing families to seek specialized care locally. • Peadiatric Diabetes Clinic: For children 18 years old and under with Type 1 & Type 2 Diabetes. The clinic operates 3.5 days/week. • Personal Health Improvement Team Clinic (PHIT): A 14-week program de-
signed to provide peadiatric patients with a history of childhood obesity and cardiovascular disease access to a dedicated healthcare team that is committed to improving a patient and family’s lifestyle, health and personal fitness. For nine year old Ethan Howcroft, the Paediatric Outpatient clinic feels like family. “Jodi and Shay are wonderful,” said Erin Howcroft, Ethan’s mother. “They have been so helpful at answering any questions we have about Ethan’s chemotherapy. Plus the team makes Ethan feel like the special boy he is – like celebrating his last chemotherapy treatment by decorating the room and bringing him a treat. Or making sure he gets to pick a toy from the ‘blood sucker bucket’ after doing blood work – it’s the small things that make a huge difference and leave a positive lasting memory.” Since opening a year ago, PRHC’s POP clinic has provided access to high quality specialized paediatric care to more than 5,000 patient/family visits. “Ensuring our youngest patients and their families receive high quality patient care at the right time and in the right location is what’s making PRHC’s POP clinic a H shining success,” added Ferkl. ■ Amanda Roffey is Communications Advisor at the Peterborough Regional Health Centre.
was treated for jaundice with phototherapy and had an IV to hydrate him. For three weeks he received his food through a feeding tube. Nolan also had apnea where he would stop breathing and his heart rate would decrease. When that happened an alarm on the monitor would sound and the nurses would assist him. He received caffeine for a couple of weeks to help stop these apnea "spells" from occurring. In order to be discharged from the NICU Nolan had to be off the caffeine and not have any spells for seven days. He needed to be gaining weight and had to be feeding by mouth (no tube feeds) for 48 hours. When it was time to go home, Kristen was able to spend the first night with her son in the “Care by Parent” room. Just like at home Kristen was responsible for his care, but had the comfort in knowing help was just around the corner if she needed it.
Continued support Kristen says leaving the hospital was bitter sweet. “Although we were excited to have our son home with us, in a way the unit began to feel like home.”
“It is hard to leave your baby at the hospital, but we were never very upset about it because we knew he was perfectly cared for when we weren’t there.” The support from the nurses continued even after she left the NICU – “They told me to call anytime I had concerns. They knew Nolan best and there was times I did call. It was great knowing I had that support, even after we left the hospital.” Kristen says she thinks we are so lucky to have an amazing department like the NICU with staff like this right here in North Bay. “None of the nurses treat their position like a job. What they do is not a job requirement – it’s being an amazing person”.
Central fetal monitoring system Currently the North Bay Regional Health Centre Foundation is helping the community raise funds to support the purchase of a Central Fetal Monitoring System for Labour and Delivery. It will provide a vital window into the womb and give valuable medical information to the care team. The most important thing during labour and delivery is response time when there is a concern. With the ability of obstetricians to be able to view the monitoring remotely, they can assess the diagnostics and determine a course of action, even while they are on the way to the hospital. The electronic medical record allows archiving of data, which will allow nurses to spend more time with patients. The new monitor will provide remote on-line monitoring of every baby’s heart rate and the mother’s uterine contractions and vital signs. With the “real-time” assessment – physicians can instantly access all data from a smart phone, home or office and make important qualitative diagnostic aid for time-critical, life-saving decisions H and interventions. ■ Lindsay Smylie Smith is a Public Relations Consultant at North Bay Regional Health Centre. www.hospitalnews.com
Natasha Rajah, Ph.D. is Director of the Douglas Institute Brain Imaging Centre.
Discovering the Douglas Institute Brain Imaging Centre By Lyna Morin
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id you know that the Douglas Institute’s Brain Imaging Centre (BIC) is open to all researchers involved in brain study, whether they work at the Douglas Mental Health University Institute or elsewhere? Inaugurated in the spring of 2012, the BIC offers an environment that few research facilities in the world can match. It combines under one roof, all the stateof-the-art equipment and expertise to fully support an entire research cycle. The BIC was conceived to facilitate the translation of fundamental research findings into clinical studies. With the two magnetic resonance imaging (MRI) scanners – one for humans, the other for small animals – researchers use several non-invasive imaging methods to understand how brain structure and function are altered in individuals with a mental illness. Natasha Rajah, PhD, Director of the BIC, explains: “The researchers use the MRI scanners to study how several mental ill-
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We have the expertise, skill and resources to assist you and your family and ensure you receive all assistance, beneﬁts and compensation that you are entitled to. Human MRI scanner – Siemens 3-tesla magnetic resonance imaging (MRI) unit nesses, including schizophrenia, depression, post-traumatic stress disorder and attention-deficit disorders, are related to changes in underlying brain structure and function. MRI technology also allows us to deepen our understanding of cognitive functions such as emotional and spatial processing, memory and stress in healthy adults, so that we can understand how to promote good H mental health in our society.” ■ Lyna Morin is an Advisor in the Communications and Public Affairs Directorate at the Douglas Institute.
What the Douglas Institute’s two MRI scanners can do 3-tesla MRI for humans
Note: this is a research only scanner. Not for clinical use.
Currently, diagnoses for schizophrenia, major depression and anxiety disorders are based on study of patients and their own self-assessment. Brain imaging will help identify biological markers of specific mental disorders.
Because it provides highly accurate data, an MRI scan enables researchers to better predict how an illness is likely to progress for each individual and adjust treatments accordingly.
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Longitudinal Access to on-site scanners makes it easier for studies researchers to monitor more patients for longer periods. 7-tesla MRI for small animals
Researchers will be able to monitor animal brains and see how they react under certain conditions, for example stress and substance abuse. JUNE 2013 HOSPITAL NEWS
How simulation is improving care By Lauren Muir
t Holland Bloorview Kids Rehabilitation Hospital, healthcare providers and students are using simulation to invigorate teaching practices, facilitate our professional development and impact client care. The work, led by the Teaching and Learning Institute at Holland Bloorview, is a first in pediatric rehabilitation. “It is our goal, in the Teaching and Learning Institute at Holland Bloorview, to be trailblazers in simulation for pediatric rehabilitation education,” said Dr. Golda Milo-Manson, V.P. Medicine and Academic Affairs at Holland Bloorview. “Most recently hospital code whites and the unique challenges for responding to the needs of autistic children were studied through simulation.” Code whites are called when a patient is upset and is causing or has the potential to cause a threat to him or herself or others through their physical behaviour. When the code is called, a team of healthcare professionals rush to the scene to help defuse the situation. If the code is called for a child with autism, the excitement of the team arriving further escalates the threatening behavior because of their sensitivity to sound, light and movement. “When it was originally created, the code white system was not designed with autistic clients in mind,” says Kathryn Parker, Director of Academic Affairs and the simulation lead. “We needed a new internal process to calm clients and allow healthcare providers to better respond to children with autism in an emergency.” As a result, Holland Bloorview partnered with the Standardized Patient Program at the University of Toronto to produce an alternative scenario through simulation that has improved our internal processes and allowed us to better manage these situations. This scenario will be used to inform future processes on how we respond to code whites with autistic clients. “We are very mindful of the complexity of our healthcare system and excited to continue to build simulation opportunities that reflect it,” says Kathryn. “We’re thrilled with the results we’ve achieved through simulation today and we’ll continue to ensure that we build simulation programs that will allow us to provide our clients and families with H the highest quality of care.” ■ Lauren Muir is Communications Coordinator at Holland Bloorview Kids Rehabilitation Hospital
Nina Ruberto shared the story of her breast cancer journey with 460 women at the 15th Annual Elekta Bachelors for Hope Charity Auction in Thunder Bay, Ontario. In appreciation of the exceptional cancer care she received, Nina has pledged to donate 5 per cent of her real estate sales to the Northern Cancer Fund of the Thunder Bay Regional Health Sciences Foundation, which provides ongoing support for cancer research, equipment and programs in Northwestern Ontario.
A year in the life: how local cancer care made all the difference for Nina Ruberto By Graham Strong
wo days after her 40th birthday, Nina Ruberto was diagnosed with an aggressive form of breast cancer. That’s the day, she said, that everything changed. “When you get diagnosed, you don’t really realize what you’ll have to go through,” Nina said. “It’s all kind of a blur in a way, looking back.” Nina’s cancer journey started shortly before New Year’s 2011 when she found a lump in her breast during a self-examination. A biopsy revealed the worst. Because Nina is so young, her doctors prescribed the most aggressive – and gruelling – treatment plan. Nina immediately had a lumpectomy, 16 weeks of chemotherapy through the summer, followed by a double mastectomy, reconstructive surgery, and five weeks of radiation therapy that ended in January 2013.
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In all, Nina endured a year of tests and treatments, along with all the emotional highs and lows that go with it. Some days, Nina literally couldn’t get out of bed after chemotherapy. Other days, she experienced some of the closest moments with her family. As difficult as that year was, it would have been much harder without the care and support Nina received at Regional Cancer Care Northwest at Thunder Bay Regional Health Sciences Centre.
"I really do believe that one day, I will be grateful for this journey,” Nina said. “It’s so life changing." “I think we’re really fortunate – we have an awesome cancer centre,” Nina said. “There’s enough you have to worry about when you’re getting cancer care, I can’t imagine having to worry about going out of town for it too.” Nina also would not have been able to get the same support from her family. She was upfront with everyone about her cancer right from the start (though it was hardest telling her three young children, her eldest being just 14 then). She was extremely grateful her family could be there at every step. “I tried to stay focused on the treatment at the time as opposed to thinking ahead,” Nina said. “I celebrated everything.” Nina stressed that convenience of local care isn’t enough. We’re lucky to have some of the best quality cancer care available. She brought this message forward to 460 women at the 15th Annual Elekta Bachelors for Hope Charity Auction in early April where she was the guest speaker. “The cancer centre staff are so bend-
over-backwards for you too – Supportive Care, the chemotherapy nurses, everybody. It’s individual care,” Nina said. “We have a gem there. We could never lose that centre; it’s literally priceless.” Social media helped her during her cancer journey too, allowing her to share her story and even get support in return. “I took a picture of myself the night before my first chemotherapy treatment and I posted it on Facebook with a little blurb about this being the last day of feeling normal,” Nina said. “I woke up the next morning and I regretted it right away, so I went back to get rid of it. But there were all of these messages – I started reading them and I couldn’t get over how supportive everybody was. My little Facebook post must have been shared 150 times, and I had hundreds of emails and messages. It was like, ‘Are you kidding me? This is crazy!’” The journey also put life into perspective for Nina. As busy as she was with her real estate business and her retail store Global Experience, that all had to be put on hold for the year as she underwent treatment. Nina was looking forward to going back to work in 2013 but she approached it with a different attitude, determined to put family and friends first no matter what. “I really do believe that one day, I will be grateful for this journey,” Nina said. “It’s so life changing.” In recognition of her outstanding care, Nina has committed to donate 5 per cent of her real estate sales to the Northern Cancer Fund. Her support will ensure life-saving equipment, like new Elekta Infinity linear accelerators, is available for future cancer patients. Elekta and Regional Cancer Care Northwest are dedicated to identifying ongoing opportunities for innovation to ensure that patients like Nina have the best H chance to survive their cancer journey. ■ Graham Strong is a Freelance Writer. www.hospitalnews.com
If it were not for a cord blood stem cell transplant, Nate would not be alive
Canada’s new national public cord blood bank will help save more lives By Annie Barrette
fter Amy and Mike Lupton’s son, Nate, was born on April 7, 2010, he was diagnosed with Wiskott Aldrich Syndrome, a rare immune deficiency that affects one in 250,000 live male births. The disease impacts the body’s ability to produce platelets and fight infection. The only cure lies in a bone marrow transplant, meaning Nate needed to find a stem cell donor through the OneMatch Stem Cell and Marrow Network. Soon a match was found and at 8 months old, Nate received his cord blood transplant at Toronto’s Sick Kids Hospital. At any given time, the OneMatch Network is searching on behalf of almost one thousand Canadian patients in need of an unrelated blood stem cell donor. Approximately 50 per cent of patients who need an unrelated blood stem cell transplant are unable to find a suitable match. Canadian Blood Services is building a national public cord blood bank that will be dedicated to the unique needs of Canadian patients and will provide additional opportunities for finding a match. Demand for stem cells in Canada is growing at a staggering rate. The number of Canadian patients waiting for lifesaving stem cell transplants has tripled over the past five years and continues to grow. In March 2011, the provincial and territorial ministers of health (outside of Quebec) approved the total estimated cost of $48 million to establish and operate a national public cord blood bank with the goal of obtaining 20,000 ethnically diverse cord blood donations over eight years. Canadian Blood Services committed to raise $12.5 million through a three-year fundraising campaign, “For All Canadians,” to help cover the $48 million cost. Canadian Blood Services National Public Cord Blood Bank will benefit Canadian patients and the country’s health care system by providing those in need of stem cells with increased opportunity for transplant. Approximately 70 per cent of Canadian patients requiring a stem cell transplant must look outside of their immediate families for a match. Canada has a greater need than most other nations for a national public cord blood bank. The unique diversity composition of Canada www.hospitalnews.com
has presented a large gap in our ability to find matches for patients, even with the ability to access over 19 million potential adult donors and over 500,000 public cord blood units worldwide. Dr. Donna Johnstone, paediatric haematologist-oncologist at CHEO, states that “the cord blood banks that exist right now, where we find matches, are not really ethnically diverse. By creating a national public cord blood bank, patients not represented will potentially have more donors available to them.” There is a pressing need for these patients to have better access to stem cell treatments. According to Johnstone, “patients who need a transplant need a transplant to save their life.”
lection hospitals in Ottawa, Brampton (GTA), Edmonton and Vancouver. Collections will begin in Ottawa in September 2013 and in Edmonton, Brampton (GTA) and Vancouver in 2014. For more information, H visit www.blood.ca/cordblood. ■ Annie Barrette is a Communications Specialist at Canadian Blood Services.
“As a mother, I appeal to other mothers to donate cord blood and save lives like my son Nate’s.” Cord blood stem cells are used for stem cell transplantation. “It’s a wide array of people that can be cured with a stem cell transplant,” explains Johnstone. “That can be people with malignancies such as leukemia or lymphoma. But it can be used for other things as well, such as for people with metabolic disorders or people with inherited haemoglobin disorders like Sickle Cell Disease and Thalassemia.” If it were not for a stem cell transplant, Nate Lupton would not be able to smile a triumphant smile as he learns to swim, blow kisses to his parents before bed, or race his two older brothers and golden retriever, Fran. If it were not for a stem cell transplant, Nate would not be alive. “Cord blood has given my son a chance at a normal life and to experience all things great in life,” says Amy Lupton, Nate’s mother. “As a mother, I appeal to other mothers to donate cord blood and save lives like my son Nate’s.” Canadian Blood Services National Public Cord Blood Bank will consist of col-
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JUNE 2013 HOSPITAL NEWS
Innovation leads to better efficiency, improved patient care in Rouge Valley Chemotherapy Clinic By Akilah Dressekie
echnology being used in Rouge Valley Health System’s chemotherapy clinic is helping to improve efficiency, accuracy and patient care. One simple solution is a computer on a wheeled cart that has allowed one oncologist to use electronic documentation and voice recognition software to help create more accurate, easily accessible patient records. “It’s instantaneous and facilitates optimal patient care,” explains Dr. James Chiarotto, medical director of the Rouge Valley Health System (RVHS) oncology program, and main user of the computer cart. “In the cancer world, everything has to be done as quickly and as accurately as possible. So this does a great job in making that possible.” The project, which has been in place since spring 2012, was designed specifically for the Rouge Valley oncology clinic by the hospital’s clinical informatics and information technology teams. The innovation is as a result of a Cancer Care Ontario (CCO)-directed project to allow data collection and reporting to take place right at point-of-care.
How it works The system features a cart with a computer, dual screens, a keyboard, mouse and power supply with a cord so that it can be charged when it’s not in use. It can be moved into any examination room throughout the clinic. The cart computer provides access to three applications: Dragon, a voice recognition program; Meditech, where the patient’s chart is contained, and where Dr. Chiarotto can dictate his notes directly into the patient’s chart; and the Oncology Patient Information System (OPIS), a computerized physician order entry (CPOE) application developed by CCO.
The OPIS system allows orders that are created with fewer errors – something that is especially critical to patients undergoing chemotherapy treatment. The mobile cart allows Dr. Chiarotto to go into any patient room, order medication, access the most recent patient results and do his documentation right in front of the patient. During a consultation or assessment, he can examine the patient, order chemotherapy, find out how they’re responding to medication, and electronically generate a prescription. After speaking with the patient, he then puts on a headset outfitted with a microphone and begins to dictate his findings and notes into Meditech, using the voice recognition software. As he speaks, the words appear on one screen, while Meditech shows the patient’s HOSPITAL NEWS JUNE 2013
Dr. James Chiarotto, medical director of the Rouge Valley Health System (RVHS) oncology program, with the computer cart being used in the Rouge Valley Centenary Chemotherapy Clinic. The cart allows him to do dictations, order chemotherapy, and charting electronically. electronic chart on the other. While the carts are now working well in the chemotherapy clinic, it wasn’t always this easy. A year ago, each examination room in the chemotherapy clinic had its own PC equipped with voice recognition software so that Dr. Chiarotto could do his dictations. However, this system wasn’t seamless, and he would need to log into each computer every time he entered the patient room. “By the time I went into a patient room, all of the programs had timed out. So you can imagine how frustrating it was to have to go in and re-initialize the programs each time,” he explains. When he brought the issue to Lynn Tkac, project manager of clinical informatics at Rouge Valley, she pointed out that carts equipped with laptops were being used in the hospital’s general medicine inpatient unit. The carts featured Meditech and a wireless connection, and allowed physicians to access patient information right at the patient’s bedside. A similar solution could be created for the chemo clinic. Working with the hospital’s information technology and clinical informatics team, a mobile cart specific to the chemo clinic’s needs was designed. A wireless network was soon installed in the clinic, and not too long after, OPIS was introduced, and was installed on the chemo clinic cart computer. “Our goal of this project was to have documentation available right at the point-of-care. To do that, we needed mobile devices,” explains Tkac. “From a continuity of care perspective, it’s important that a physician receive this information in real time.” “Without voice recognition, there is always a lag when notes are added to the
patient’s chart. But through this process, notes are added right away,” explains Thodoros Topaloglou, RVHS chief information officer. “By putting both the expediency of voice recognition in electronic documentation together, and the safety of computerized physician order entry, we’re using the highest level of patient care. This makes for a much better patient experience.” The OPIS system allows orders that are created with fewer errors – something that is especially critical to patients undergoing chemotherapy treatment. Notes from the visit can also be sent to other specialists, their family doctor, or to another healthcare facility through Meditech. These notes can also be printed instantly, and the patient can keep a copy for their own records. The dictation is also done in front of the patient, adding even more value, Dr. Chiarotto explains. “The patient can hear what I’m saying, and if there’s any issue with accuracy, it can be corrected immediately. From my perspective, that’s most important,” says Dr. Chiarotto. “The patient also hears the same information that’s being shared with their family physician. They should have the clearest possible understanding of their health status.”
Impact on physicians and staff Seven similar, scaled-down versions of the carts are also being used in other areas of the clinic. Nurses use them to electronically document medication administration in OPIS when patients are receiving chemotherapy. The chemotherapy clinic pharmacist uses another cart with OPIS to receive physician orders, which can be done with fewer errors and better accuracy, improving patient safety. Traditional paper
charts are still being used in the chemo clinic, however electronically documenting medication administration has helped to improve the quality of care dramatically. “It’s great that the carts are mobile. We’re also able to better read doctors’ orders than if they were hand-written, so legibility has improved dramatically,” explains Sandy Shovlin, a registered nurse in the clinic. This process improvement, which combines technology with Lean methodology – widely used in all areas across Rouge Valley – has helped to save Dr. Chiarotto much of the time he used to take doing dictations. “Knowing that this can all be done together is such a feeling of satisfaction. For example, if I’m assessing a patient for chemotherapy, I can do my documentation, order the chemotherapy, and everything is done,” Dr. Chiarotto explains. The innovation also improves patient safety by keeping all of the patient’s information together in one location. If the patient arrives at one of the hospital’s two emergency departments (whether at Rouge Valley Centenary or Rouge Valley Ajax and Pickering), the emergency physician treating the patient is able to see their most recent health information, including the oncologist’s orders, in Meditech. Administratively, it’s also making a difference. “It’s almost instant, which is very helpful for me. Using this format means that I receive the entire report as well as the dictation together, and within minutes,” explains Liz Naunheimer, unit clerk in the RVC chemo clinic. Traditional dictation, Naunheimer adds, can take up to 24 hours H to receive. ■ Akilah Dressekie is a Senior Communications Specialist at Rouge Valley Health System. www.hospitalnews.com
Quality dependencies in medical imaging By Glenn Gale and George Gorthy
t a time when issues around cost and efficiency continue to plague the healthcare system, the medical imaging practice is coming under scrutiny due to its high capital cost and high fee-for-service billings. It’s a area of healthcare rife with potential to drive up costs, due to repeated imaging examinations, as well as increase a patient’s length of stay or treatment time. Quality in healthcare is about the best possible outcome based on a series of inputs. However, when it comes to medical imagining, there are three factors that affect those inputs – people, processes and technology – and quality of service can be impacted by each.
People The medical imaging exam process involves a number of healthcare roles: the clinician who requests examinations for their patients; the technologist who perform the exams; the radiologist who interprets the images; and various support staff in the care chain. How these various workers share information has a direct impact on service delivery and quality. It is important the ordering clinician’s request for an imaging exam defines the most appropriate imaging test for the clinical question being asked. Poor information during the patient assessment leads to lack of information to aid the radiologist’s interpretation.
Less than optimal reporting can be the byproduct of a lack of relevant clinical history from clinicians or suboptimal imaging techniques. The technologist also requires appropriate clinical information to ensure the appropriate images are taken, proper patient positioning, correct image mark-up and appropriate post-processing of images so any underlying pathology is demonstrated. Radiologists have been criticized for sometimes vague and ambiguous interpretations, but to provide the highest quality diagnosis they need an exam requisition that includes a description of the clinical condition, symptoms, a complete clinical history, and other relevant information such as lab results and a list of the patient’s medications. Less than optimal reporting can be the byproduct of a lack of relevant clinical history from clinicians or suboptimal imaging techniques. This can also lead to repeat examination and/or further imaging workups. In fact, the 2005 Canadian Association of Radiologists study cited, on average in this collaborative practice outpatient clinic, 28 per cent of imaging orders were changed to more appropriate imaging procedure for demonstrated clinical indications. www.hospitalnews.com
Process No professional in the healthcare delivery system willingly gets up in the morning and commits to underperforming in their duties. There is an underlying commitment to provide quality services. Focusing on “Best Practices,” implementing standard procedures sets, and high professional standards are important to ensure consistency in clinical workflows and patient imaging exam encounters. Continuing education and workshops can help clinicians and technologists remain current on “Best Practices,” and will drive behaviors that improve the quality of information flowing to radiologists, and enable them to better interpret images. A process to ensure order appropriateness can also improve the quality of the report findings to the referring physician. An often neglected quality indicator in imaging is the communication of “clinical standards of practice” change with each modality evolution. Knowing what to order with technology cycles is onerus for non-specialists. There are also a number of healthcare jurisdictions working to improve the quality of exam interpretation through automating peer review and ensuring peer review compliance. Automated tools randomly select previously reported medical imaging exams to be interpreted by another radiologist. Quality measures are created based on diagnostic accuracy in reporting outcomes between radiologists.
Technology Information systems have a direct impact on radiology service delivery and qual-
ity. Integrating the Healthcare Enterprise (IHE) has been working with information systems technology vendors and clinical experts to define end document workflow. The IHE deployment frame works and profiles use standards based practices to ensure the best information flow throughout the medical image exam process. IHE extends to multiple other clinical domains to provide relevant documents to the clinician.
Integration of these tools in the ordering systems, especially in the clinician’s office, is critical to ensuring quality input. Information systems and information sharing are at the intersection between service delivery and quality. Lack of quality information from the people and processes described earlier has a direct impact on reporting and perceived quality of service. Healthcare facilities and provinces have made significant investment in information sharing technologies. Complementary investments in process automation, access to relevant prior images, historical clinical documents, and advanced image processing tools, all have the potential to improve medical imaging exam quality and service. Further investments in clinical decision support tools ensure appropriateness and rapid dissemination of changes in clinical practice. Integration of these tools in the ordering systems, especially in the clinician’s office, is critical to ensuring quality input. Provincial investments in Electronic
Health Records (EHR) have intended to create centralized access to patients “longitudinal” records. EHR repositories store patient data for life or a predefined information life cycle. Access to multiple EHR repositories is enabled through use of the IHE Cross Document Sharing Profile (XDS). This IHE profile can provide access to missing pieces of clinical information. Images, reports, lab, pharmacy, discharge summaries, or any other document, could all be accessed via an EHR portal or other IHE-validated device, such as a radiologist’s workstation. There has been significant activity internationally and in Canada to address the challenges that come with an increase in electronic information. Information technology systems need to communicate in a manner that compliments workflow, ensures clinical documentation, and images are accessible, regardless of the location. Interoperability is achieved provided the host systems and the consuming systems use the standards and frameworks prescribed by IHE. Lack of quality information from the people and processes has a direct impact on imaging reporting quality and perceived quality of service. While there is still much work to do, the future path is more defined through recent IT investments and a stronger understanding of workflow requirements. This can only lead to improved medical imaging exam interpretaH tion and service. ■ Glenn Gale is a Business Development Executive and George Gorthy is a Managing Consultant at IBM Healthcare.
JUNE 2013 HOSPITAL NEWS
Mackenzie Perry and her mother Marci are participating in a five-year study on breast cancer.
Millennials help scientists transform breast cancer research By Sandeep Dhaliwal
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hat compels a 12-year-old to commit to a five-year research study? It’s a mixture of cool and curiosity. Just ask Mackenzie Perry, who volunteered to participate in the largest breast cancer study of its kind in Canada. Led by Mount Sinai scientists the goal of the study is to understand the influence of behaviour, environment and diet on pubertal growth in girls aged six to 13 and how these factors might impact their risk of breast cancer later in life. “My mom told me about this project when she was diagnosed with breast cancer,” said Mackenzie. “I just wondered… if your parent wasn’t diagnosed with cancer, whether you still had a good chance of getting it. And because my mom did have it, what that meant for me. I thought the study was kind of cool.” Mackenzie was just shy of her 13th birthday when she signed up. Now every six months, she and her mother travel from Stoney Creek, Ontario to downtown Toronto – an almost two-hour bus ride – to fill out questionnaires and give blood, urine and saliva samples. The research study, named the LEGACY Girls Study, looks at whether the habits
and development of young girls are related to breast health in older women. The unique initiative will enrol an estimated 180 girls in Ontario as well as their parent or guardian, and contact them every six months for follow up. Like Mackenzie, half of the girls in the study will come from families with a history of breast cancer, while the other half will come from families with no history of the disease. Drs. Irene Andrulis and Julia Knight, Senior Investigators at Mount Sinai’s Samuel Lunenfeld Research Institute will have finished recruiting all of the girls in the Canadian arm of the study in the first half of 2013. They are working closely with their American colleagues in San Francisco’s Bay Area, New York, Philadelphia and Utah, which are also all sites of the Breast Cancer Family Registry. As a molecular geneticist and also the principal investigator of the LEGACY study, Dr. Andrulis explores the clinical importance of genetic alterations to identify risk factors and lifestyle modifications early enough to prevent or diminish the effects of cancer. The ultimate goal is to identify measures that could be taken to prevent breast cancer and to identify novel targets for new cancer therapeutics. Continued on page 26 www.hospitalnews.com
A new technology that lets us “hear” children who cannot communicate due to profound multiple disabilities By Claire Florentin
ommunication issues can make it difficult to interact with children with Profound Multiple Disabilities (PMD), even making it hard for those who take care of the child to perceive him or her as a person. Now imagine you could hear music generated by that child that reflects his body signals. Would “biomusic” help strengthen the connection between a child with PMD and his caregiver? That’s what Dr. Patricia McKeever and a team of researchers set out to learn with biomusic in a small study conducted by the Bloorview Research Institute at Holland Bloorview Kids Rehabilitation Hospital. Biomusic is a novel technology that translates real-time autonomic nervous system signals including heart and breathing rates and skin temperature, into musical sounds. The team’s research, funded by a Norman Saunders Complex Continuing Care Grant from Sick Kids Foundation, sought to determine whether biomusic could change
caregivers’ perceptions of their interactions with children with PMD. The researchers were happy to find that by providing audible evidence of the changing physiological state of children with PMD, biomusic seemed to enhance the perceived personhood of these children and enrich interactions with their parents and caregivers.
Making Biomusic Three children and their families, plus seven staff from Complex Continuing Care took part in the research study. Special equipment collected body signals from each child using non-invasive electrodes on the hands, and a customized computer program transformed those signals into biomusic. Each child’s biomusic was played over several visits with their different caregivers. Following each visit, parents and caregivers were interviewed about their relationships with the children, and impressions of how biomusic affected their interactions. Most parents and caregivers described
their interactions before listening to biomusic as affectionate and warm, demonstrating that these young people were valued and cherished. Yet the frustration and the uncertainty associated with not knowing what these children were thinking or feeling was a clear challenge faced by all. In both clinical and parental encounters, study participants valued the transformation of body signals into musical sounds because the sounds seemed to enhance interpersonal interaction. The biomusic also seemed to change how parents and caregivers viewed the children. One participant said “Sometimes, we forget as caregivers…we just kind of (don’t) look at the person, and just do what we have to do. (Biomusic) make us step back and actually think… ‘Okay, so this is a person.’” Most study participants predicted that regular exposure to biomusic could have significant and positive effects on the quality of their interactions. Helen Donnelly worked as a therapeutic clown with one of the children in the study, and enjoyed hearing his biomusic.
“The whole experience was valuable because it looked at enhancing the quality of time we spend with this client, this playmate. With my client, it added a refreshing element which assisted us as artists in our imaginative play with him. Story lines and bits of song were woven into his biosong and made the experience richer.” Based on these positive findings, lead author Stefanie Blain-Moraes says the team is excited to find future applications for biomusic. “Since the biomusic technology enables us to ‘tune in’ to the physiological reactions of non-communicative individuals, we hope it may eventually be used to improve the interactions with and the quality of life of some of the most vulnerable members of society.” This work was recently published in Augmentative and Alternative Communication. For more information, contact Dr. Shauna Kingsnorth at the Holland Bloorview Kids Rehabilitation Hospital at skingH firstname.lastname@example.org. ■ Claire Florentin is a Communications Associate at Holland Bloorview Kids Rehabilitation Hospital.
Unique social media platform aids in breaking down hospital walls for young patients By Elaine Dean
efore the birth of social media – Facebook and Twitter – two young girls longed to stay connected while in hospital and away from their families, friends and each other. In February 2002, teenager Christina Papaevangelou was admitted to the Intensive Care Unit at McMaster Children's Hospital with a life-threatening illness. Shortly after, Christina’s best friend, Katy McDonald, was diagnosed with cancer and had to be hospitalized for a long period of time at The Hospital for Sick Children.
Upopolis is the only private, secure and trusted online social networking tool specifically designed to connect children in care to other patients, their families, friends and school. While hospital visits were made, the two girls desired to stay connected in the same capacity they once had. Sadly, Katy lost her battle with cancer; however their friendship and common experiences inspired Christina to explore ways of helping children in care stay connected to their loved ones. Fuelled by a passion to connect hospital inpatients to their loved ones, Christina www.hospitalnews.com
teamed up with her father, Basile Papaevangelou and founded Kids’ Health Links Foundation. The organization sought to help alleviate stress, isolation and loneliness for children receiving inpatient medical care in order to help them heal faster and overcome traumatic medical experiences. In December 2007, Upopolis.com was born. First launched at McMaster Children’s Hospital, Upopolis is the only private, secure and trusted online social networking tool specifically designed to connect children in care to other patients, their families, friends and school. “When we launched Upopolis in 2007 it was only a dream. Today it has connected children in nine hospitals across Canada to their friends and loved ones,” said Basile Papaevangelou, chairman and founder of Kids Health Links Foundation. “With each launch we are one step closer to bringing Upopolis to every Canadian children’s hospital.” Kids Health Links Foundation works in collaboration with TELUS Health who develops, maintains and operates Upopolis and provides familiar features of social networking to young inpatients, including personal profiles, micro-blogging, instant chat, group chats, multiple photo uploading and event calendars. In addition, the platform gives patients the opportunity to stay up-to-date with their schoolwork, navigate through child-friendly health and wellness information and connect children with similar experiences and interests. “Social networks and technology are a ubiquitous part of the lives of many Canadian children today and young patients
also want the opportunity to stay connected while receiving care,” said Paul Lepage, President, TELUS Health. “Upopolis empowers children in care and gives them the opportunity to network and share experiences, thoughts and feelings with other
kids under similar circumstances, fostering a community of support. On behalf of TELUS, we are thrilled to be a part of something that truly makes a difference in the lives of young inpatients in hospitals.” Continued on page 18
JUNE 2013 HOSPITAL NEWS
Providing urgent pediatric care at Mackenzie Health By Stefanie Kreibe
n late October 2012, Mario Santos’ four-year-old son fell suddenly ill. Within 12 to 18 hours, the little boy was obviously not his energetic and happy-go-lucky self. He wouldn’t speak or move, eat or drink. He was extremely lethargic. His parents knew something was seriously wrong. They went to see his pediatrician who took one look at the little boy and told his parents not to sit down, but to go straight to the Pediatric Urgent Care Clinic (PUCC) at Mackenzie Health. “It was, to be brutally honest, quite a scary day as a parent,” Mr. Santos says. “I had my son in my arms, I never even sat down, and we went immediately to the hospital.” Diane Cole, the nurse in the PUCC brought instant relief to the worried parents with her reassurances. They were told they could remain at their son’s side through the entire process. Staff started treatment and the admitted the young patient right away.
These are children who can’t really go home, but need a few hours of intervention. “Diane included my wife and I in everything that was done,” says Mr. Santos. Together they went to get X-rays and ultrasounds, his son in his arms all the while. “They have a way of putting parents at ease. It takes the pressure off you and lets you focus on your child.” Their son, it turns out, had been hit hard by an uncommon strain of the flu and had become severely dehydrated and required lifesaving IV fluids. The following morning his son was already improving. “We started to see some colour back in his skin, he started to show signs of coming around,” Mr. Santos says. In total, the little boy spent four days in hospital, nurses checking on him every two hours. Patients come to the PUCC from two main sources. The first is the Emergency Department (ED). Children treated in the ED are often well enough to go home, but need a follow-up appointment with a pediatrician. “There’s an expertise that’s involved,” says Dr. Gerald Friedman the Medical Director of the Woman and Child Program at Mackenzie Health. The second source is from doctors’ offices. In these cases, children are seen by their family doctor or pediatrician and need care that goes beyond the average physician’s office, but does not require a visit to the emergency room. Examples include mild dehydration or breathing difficulties such as asthma, croup or bronchiolitis. HOSPITAL NEWS JUNE 2013
Dr. Jeff Weisbrot, Chief of Pediatrics and RN Diane Cole, the pediatric nurse in the Pediatric Urgent Care Clinic at Mackenzie Health. “These are children who can’t really go home, but need a few hours of intervention,” adds Dr. Friedman. “It could be an IV for some fluids, inhalations for asthma, blood work or X-rays after which the pediatrician at PUCC decides whether to admit a child to hospital or enable him or her to return home.” The PUCC runs from 10 a.m. to 6 p.m., Monday to Friday and sees children with a variety of pediatric issues including asthma, jaundice, rashes, urinary tract infections, headaches, abdominal pain, vomiting, dehydration and other illnesses that require further investigation. Local family physicians and pediatricians refer their patients directly to the clinic, for a same day appointment to have a consultation with the pediatrician. The PUCC is able to carry out investigations including blood work, catheterized urine, ultrasound and CT scans. Treatments in the PUC Clinic include inhalation therapy, IV rehydration, phototherapy and if need be, immediate admission to the Pediatric inpatient unit. Prior to the implementation of the PUCC at the hospital, children were often seen by their pediatrician or family doc-
tor and were referred to the emergency department if they required advances services. This could lead to long wait times for the children and potential deterioration of the clinical situation.
I felt as if they were looking after one of their own children; they cared that much.
Mr. Santos is grateful for the highly skilled staff that specialize in working exclusively with children. “They are trained to understand the impacts of illnesses on babies, toddlers and children,” he says. “Illnesses affect kids quite differently than they do you and I, as adults.” The clinic has two major goals: caring for kids in a child-friendly environment and not overwhelming the emergency department with children who need special-
ized attention. The busy clinic is staffed by a nurse and one of 10 rotating pediatricians. Almost 2,000 patients are seen at the clinic each year. Dr. Jeffrey Weisbrot, Chief of Pediatrics, is one of the pediatricians who work in the clinic. Because patients register and then go directly to the PUCC, he says wait times can be as little as a few minutes to half an hour. “The benefits of this clinic are huge. Children do not wait in emergency, they receive urgent immediate blood work, Xrays and ultrasounds and diagnosis, as well as expert follow-up for conditions such as asthma,” Dr. Weisbrot says. “We even provide parent education helping them to understand what is happening and what their child will need once leaving the hospital.” “Thankfully, my son is a happy, healthy little boy today with no permanent effects from what he went through,” says Mr. Santos. “I felt as if they were looking after one of their own children; they cared that H much.” ■ Stefanie Kreibe is a Consultant in Communications and Public Affairs at Mackenzie Health. www.hospitalnews.com
Legal Update 15
New mental health safety standard Employers’ duties related to employee mental health could be impacted By Maria Gergin
ecent studies have shown that one in five Canadians will experience a mental illness in their lifetime, and that mental health is the number one cause of disability in Canada, accounting for nearly 30 per cent of disability claims. The reality suggested by these statistics undoubtedly impacts Canadian workplaces, affecting employee-employer dynamics, organizational structure, and overall productivity. Employers are increasingly grappling with the effects and accommodation of mental illness in the workplace, and a recently released mental health safety standard suggests that providing a psychologically safe workplace may soon become a legal requirement. In January 2013, as part of a Health Canada mandate, the Mental Health Commission of Canada released the National Standard of Canada: Psychological health and safety in the workplace (the Standard). The Standard represents a new, first-of-its-kind, voluntary national standard on psychological health and safety in the workplace, and sets out a number of initiatives employers are encouraged to implement in order to promote employees’ mental health.
For instance, some of the most common workplace psychological stressors identified by employees are changes to work procedures, staffing, or products. The Standard has already received much attention for the notably broad definition of mental health it has adopted, and because, although voluntary, it sets out policy and process guidelines with a potentially farreaching impact on employers’ operations. Perhaps most significantly, Ontario courts and tribunals are likely to take the Standard into consideration when determining the standard of care employers are expected to meet in the context of safeguarding employee mental health in the workplace.
The Standard: an overview The Standard provides that its guidelines are intended to assist employers in cultivating a psychologically healthy and safe workplace, which the Standard defines as a workplace that “actively works to prevent harm to worker psychological health, including in negligent, reckless or intentional ways, and promotes psychological well-being.” In many ways, the Standard affirms Ontario employers’ existing legal obligations under the Ontario Occupational Health and Safety Act (the OHSA) the Ontario Human Rights Code (the Code), and the Accessibility for Ontarians with Disabilities Act (the AODA). For instance, the Standard calls for employers to identify, assess, and control hazards to worker health, including psychological health, in the workplace – a duty which employers alwww.hospitalnews.com
ready have under the OHSA. Similarly, the Standard’s emphasis on an individualized and interactive approach to determining employees’ mental health needs is an extension of employers’ existing duty, under the Code, as well as the Employment Standards under the AODA, to provide accommodation to employees with mental health conditions. A notable difference, however, is that while employers’ duty to accommodate pertains to existing, diagnosed mental health conditions for individual employees, the Standard implies a wider duty to ensure psychological health and safety is promoted in the workplace as a whole. The Standard’s main compliance component involves developing a psychological health and safety management system (PHSMS) in the employer’s workplace. The PHSMS a meant to be a set of policies and processes to assist the employer in identifying and analyzing risks to psychological health in the workplace, controlling risks associated with organizational changes and job demands, and training su-
pervisory staff regarding the prevention of psychological harm. The PHSMS should also include critical event preparedness, and a process relating to the reporting and investigation of work-related psychological health and safety incidents. For instance, some of the most common workplace psychological stressors identified by employees are changes to work procedures, staffing, or products. A PHSMS would assist an employer in managing this type of stressor by having in place a change-management procedure consisting of clear dialogue between management and employees impacted by the change, information and training sessions for impacted staff, and the provision of support necessary for employees to adapt to the changes, such as temporary modified work arrangements. To determine other types of events which are likely to present stress and risks to psychological health, employers are encouraged to assess their organizational culture, rates of turnover, rates of absenteeism and disability benefit utilization rates. Also relevant are employees’ job demands, work/life balance, workload management, engagement, protection from violence, bullying and harassment, and leadership and expectations. Notably, a large component of risk assessment under the Standard emphasizes consulting with employees themselves through the use of focus groups, surveys and audits in order to obtain their direct input with respect to their psychological health needs. Another key principle put forward by the Standard is that its guidelines must be tailored to the size, nature and complexity of each workplace, and that psychological health is the responsibility of all members of the employer’s workplace. As such, the Standard’s implementation allows for
At some point, everyone can use a hand.
some flexibility and is intended to reflect the specific realities faced by each organization. This is reinforced by the Standard’s provision of a number of resources, such as case studies and audit tools geared towards different types of organizations.
Implications for hospitals and other employers Employers’ duties with respect to assessing workplace mental health risks and addressing employee mental health issues continue to be defined by the OHSA, the Code, and other relevant legislation. Unlike the OHSA and the Code, however, the Standard does not have the force of law, and as such does not create legal obligations. The Standard’s voluntary nature means that employers are not legally required to adopt its recommendations. However, courts and other adjudicative bodies will likely consider the Standard in their determinations of the standard of care employers must meet in the context of providing a psychologically safe workplace. For instance, a court may well look to the Standard when assessing employee claims relating to mental stress and other psychological health issues experienced in the course of work. While the significance and interpretation courts will give the Standard remains to be seen, employers should nevertheless familiarize themselves with the Standard and assess the degree to which its guideH lines accord with its current practices. ■ Maria Gergin is an associate in the Toronto office of Borden Ladner Gervais LLP. She practises labour and employment law, human rights law and education law and can be reached at email@example.com or at 416.367.6449.
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JUNE 2013 HOSPITAL NEWS
Cancer researchers discover new type of retinoblastoma in babies By Jane Finlayson
team of Canadian and international cancer researchers led by Dr. Brenda Gallie at the Princess Margaret Cancer Centre, University Health Network (UHN), has discovered a new type of retinoblastoma, a rapidly developing eye cancer that affects very young babies – a finding that can immediately change clinical practice and optimize care for these children. The finding, published online recently in Lancet Oncology, is a breakthrough in recognizing that a single cancer gene (an oncogene) drives an aggressive retinoblastoma that starts long before birth in families with no history of the disease, says surgeon Dr. Gallie, an ophthalmologist who is also affiliated with The Hospital for Sick Children (SickKids) and a Professor in the Faculty of Medicine, University of Toronto. “This research completely challenges conventional thinking and clinical practice,” says Dr. Gallie. “The common type of retinoblastoma is initiated by damage to both copies of the RB1 tumor suppressor gene; the predisposition to this type of retinoblastoma can be inherited, so the other eye of the child and those of infant relatives are at risk to develop tumours. When
We’ve thought for a long time that all retinoblastoma were caused by loss of the retinoblastoma gene. Our study now reveals that’s not the whole story.
we remove the eye with a large tumour in very young babies and show it is the new oncogene-driven type of retinoblastoma, there is believed to be zero risk for retinoblastoma developing in the other eye or in other infants in the family. This is a major advance in personalized cancer medicine for these children and families.” The oncogene-driven tumours are much larger than those anticipated in children with inherited retinoblastoma at the same age. “The earliest diagnosis comes when parents observe a white (instead of black) pupil of the eye, and the doctors lis-
ten to their observations and understand the urgency of referral. Sometimes Mom really does know best and clinicians should pay close attention.” Although less than two per cent of unilateral retinoblastoma tumors are driven by the oncogene, the early age of onset predicts that about one in five babies diagnosed under six months of age actually has oncogene-driven retinoblastoma. “All the babies were completely cured by surgery,” says Dr. Gallie. “We’ve thought for a long time that all retinoblastoma were caused by loss of the
Music therapy comforts cancer patients By Brandon Westman
omoko Okumura wields the power of music and uses it for the good of others. At the Juravinski Cancer Centre (JCC), Tomoko has hit a high note with her music therapy program. She provides an alternative form of care by sharing music with patients through singing and acoustic guitar melodies. “Patients tell me that when I do music for them, they don’t have to worry about things,” says Tomoko. “They can forget about their pain for a while.” Tomoko’s gift of music is truly comforting for her patients. “They feel like an ordinary person,” she adds. With family members often in the hospital visiting loved ones, Tomoko sees her music therapy as a gift from the family to the patient. She notes that her music is primarily about meaning. “The music means something different from person-to-person,” says Tomoko. “Most of the time, people have certain songs that they are really attached to. They feel meaning behind it.” Tomoko recreates the experience for her patients, allowing them to remember and reflect. “It’s a way of validating their identity.” For many patients, staying positive in the midst of illness comes with challenges. It becomes easy for them to start identifying with their illness; distancing the person they ‘used’ to be and changing how they see themselves. Tomoko believes HOSPITAL NEWS JUNE 2013
that sharing music can provide a space for patients to review where they have come from, where they are now, or who they are. Solidifying a patient’s identity through music can help to relieve the stress of illness by allowing them to revisit memories and explore strengths that are associated with certain songs. “I see patients become nostalgic when I play music for them,” says Tomoko. “I enjoy seeing their reaction when I notice them feeling less anxiety or pain after the music is over. That’s the best part of my job.” Dr. Michele Bertothy works with Tomoko and is a big advocate of the music therapy program. “We received funding through the HHS Palliative Care Fund for Tomoko to come to Juravinski,” says Michele. She notes that music therapy has been around since the 1950s, but that it is not common in Canada. “It’s special when people get to experience it,” says Michele. Michele explains that Tomoko focuses on four areas: pain relief, relaxation, mood and quality of life. “Tomoko has very special training,” adds Michele. “She knows how to approach the patients and when to back-off. Tomoko has fit-in very well.” “Juravinski is unique because it has music therapy while most hospitals don’t. Music therapy is popular in hospices, but not as popular in hospitals, so Tomoko’s work is very progressive,” says Michele. She believes that the effects of music on
patients are helpful, especially for those who are struggling with other issues. While Tomoko usually plays existing songs for patients, at times she will develop original pieces. “Patients and families often give me song requests, but occasionally I can write original songs for the patients,” says Tomoko. “It becomes ‘their’ song. I love seeing their response when they enjoy the work I create.” Sometimes she likes to modify existing songs and tailor them to particular patients. For example, Tomoko tells that she once modified the lyrics of “If I Had a Million Dollars” by Barenaked Ladies, changing the parts about what they would buy with a million dollars to things that the patient would like to buy. Tomoko recalls an Intensive Care Unit (ICU) patient who was a big fan of country music. “He didn’t have control over what he ate or when he slept; little privacy. He was near machines and noises and he didn’t like it. His family really appreciated my music since it added contrast to the hospital environment.” Tomoko built a meaningful relationship with him by allowing him to remember certain memories through country music. Other ICU patients heard Tomoko’s melodies and began requesting songs of their own. The entire ICU eventually H took to Tomoko’s music. ■ Brandon Westman works in the public relations department at Hamilton Health Sciences.
retinoblastoma gene. Our study now reveals that’s not the whole story: a new type of retinoblastoma, with normal retinoblastoma genes, is instead driven by extra copies of a powerful cancer gene, causing the cancer to grow very rapidly long before birth. The average age of diagnosis is four months.” This study, on which several clinical laboratories collaborated, demonstrates that molecular diagnostics can identify novel malignant diseases that elude traditional microscopic study of tissue. The researchers analysed more than 1,000 primary unilateral non-familial retinoblastoma tumours to validate oncogene-driven retinoblastoma. The Canadian research team included three UHN Research Institutes; Impact Genetics, Toronto; the B.C. Cancer Research Centre and University of British Columbia, Vancouver; the Cross Centre, Edmonton; The Hospital for Sick Children and the Ontario Institute for Cancer Research. The international collaborators were from the Netherlands, Germany, France and New Zealand. The research was funded by the National Institutes of Health, the Canadian Institutes of Health Research, the Canadian Retinoblastoma Society, Hyland Foundation, Toronto Netralaya and Doctors Lions Clubs, the Alcon Research Institute, and the Ontario Ministry of Health and Longterm Care. Dr. Gallie’s research is also funded by The Campbell Family Cancer Research Institute through The Princess Margaret Cancer Foundation at UHN. The Princess Margaret Cancer Centre and its research arm, Ontario Cancer Institute, which includes the Campbell Family Cancer Research Institute, have achieved an international reputation as global leaders in the fight against cancer and delivering personalized cancer medicine. The Princess Margaret, one of the top five international cancer research centres, is a member of the University Health Network, which also includes Toronto General Hospital, Toronto Western Hospital and Toronto Rehabilitation Institute. All are research hospitals affiliated with the University of Toronto. For more information, go to www.theprincessmargaret.ca H or www.uhn.ca. ■ Jane Finlayson is Senior Public Affairs Advisor at the Princess Margaret Cancer Centre. www.hospitalnews.com
TARGetting kids for a healthier future By Evelyne Jhung
magine being able to predict – and prevent – whether a twoyear-old will be at risk of developing high cholesterol and suffering from a heart attack at the age of 45? A collaborative initiative called TARGet Kids! is attempting to do just that. “We’re linking nutrition during early life to chronic diseases and health problems in later life,” said Dr. Jonathon Maguire, one of the lead investigators of TARGet Kids! and a pediatrician and scientist at St. Michael’s Hospital. “What happens to us as a child has lasting impacts over the course of our lives. Studying nutritional health in the early years may lead to tremendous benefits in preventing health problems that affect us later on.” Three years ago, researchers and children’s health care providers (family physicians and pediatricians) from St. Michael’s Hospital and the Hospital for Sick Children (Sick Kids) came together to form TARGet Kids! – which stands for The Applied Research Group for Kids! – the only primary care research network for children in Canada. The network is a registry that enrols healthy children, from birth through five years of age, with the aim of linking early nutrition with later health issues, such as obesity, cardiovascular disease and developmental problems and developing interventions to prevent them. The example above is an ongoing TARGet Kids! study of childhood obesity, led by Dr. Catherine Birken, a SickKids pediatrician. Researchers are studying whether early nutrition and growth patterns are related to the development of high cholesterol. “If we can figure out at the age of two if that child is likely to develop cardiovascular disease later in life, we can help prevent that by developing early interventions; for example, by working with the child’s family to develop healthy lifestyle habits before lifestyle habits are set,” said Dr. Nav Persaud, a physician and scientist at St. Michael’s Hospital who is working with Dr. Birken on the obesity study. Dr. Julia Morinis, a pediatrician and Centre for Research in Inner City Health Achieve postdoctoral fellow at St. Michael’s Hospital and member of TARGet Kids!, uses TARGet Kids! data to better understand the social determinants of childhood obesity. “TARGet Kids! looks at all aspects of a child’s life to better understand what it is that we can do to make a difference in their health over time. It makes available a broad range of children’s health information, including information on sedentary and physical activity, nutrition, health and development.” Parents are keen to know the answers to common health questions (for example, “how can I help my child from becoming obese?”) and are highly motivated to do the right thing for their children. Not only does TARGet Kids! data help arm primary care physicians and parents with the right information, the platform also allows new www.hospitalnews.com
Dr. Jonathon Maguire examines a young patient at his well-child checkup at St. Michael's Hospital's Pediatric Clinic. The patient recently enrolled to participate in TARGet Kids! so his health information will be tracked as he grows and develops. interventions aimed at preventing chronic disease to be tested. What initially began as a proof of priniciple now has 5,500 Greater Toronto Area children enrolled in the registry and is set to expand to include Montreal and Winnipeg with plans to roll out across Canada. “The doctors, allied health professionals and parents involved really get the idea of prevention and believe that by working together, we can make this a huge success,” said Dr. Maguire. “Imagine what we could do with a national collaboration and registry of 20,000 children across Canada. We could tackle some of the greatest health challenges of our time.”
Where is all this information kept? TARGet Kids! is based on the concept of embedding research within primary care practice, providing a large, heterogeneous sample and providing an opportunity for children from diverse socioeconomic and cultural backgrounds to participate in health research. The result is a massive volume of data, which is where St. Michael’s Hospital’s Applied Health Research Centre comes in. It serves as the data co-ordinating centre. When a research assistant embedded in the primary care practice inputs the systematic data he or she has collected about the children, it goes into a centralized database through a highly secure web portal. Laboratory data is also fed into this portal creating a rich database that researchers use to tease apart the causes of common health problems. The AHRC provides all data and analytic services for TARGet Kids!. For more information, visit www.targetH kids.ca ■ Evelyne Jhung is senior communications adviser at St. Michael’s Hospital.
JUNE 2013 HOSPITAL NEWS
Unique social media platform Continued from page 13
Upopolis was recently redesigned to model social media platforms young patients are familiar with. New features include private and public discussion groups called My Spaces, enabling children to share information and photos and discuss topics on common interests. The restructured site also features a personalized newsfeed to keep users informed on everything that is important to them. All previous features have been updated to make it easier for patients to surf through the network site with ease. Child Life Specialists at the hospitals champion Upopolis and work with patients and their families and other caregivers to help manage stress, pain and anxiety associated with hospitalization. Selena, a 12-year-old patient with cystic fibrosis at The Hospital for Sick Children in Toronto had her first lung transplant two years ago and is currently waiting to have her second. As a result she can’t attend school and often feels out of touch with reality inside the walls of her hospital room. During her first transplant her Child Life Specialists brought her outside world back into her life when they introduced her to Upopolis.
Today Upopolis connects children in care in nine Children’s Hospitals across Canada. “My Child Life Specialist said “Hey, Selena do you want to try Upop?” I said “What’s that, that’s a crazy word.” She told me it was like Facebook for kids in the hospital and it was run by Child Life Specialists too,” Selena said. “She said The Child Life Specialists would show me how to use it and hang out with me and stuff. I like that because I was pretty bored. She also said there were other kids with CF on there, which is cool because I don’t get to talk to them at the hospital because of isolation.” Today Upopolis connects children in care in nine Children’s Hospitals across Canada. In March 2013, Upopolis launched at the first hospital in Southwestern Ontario: Children’s Hospital at London Health Sciences Centre. In addition to Children’s Hospital, the social networking site connects children at other Canadian hospitals including McMaster Children’s Hospital in Hamilton; CHEO in Ottawa; The Hospital for Sick Children and Holland Bloorview Kids Rehabilitation Hospital in Toronto; Ste. Justine in Montreal and Lutherwood in Waterloo. In June 2013, the program will launch at Montreal Children’s Hospital. The Upopolis team and TELUS Health have worked together to adapt the program in order to meet the specific needs of each hospital, whether adding French language capabilities or information specific H to mental health. ■ Elaine Dean is Director of Communications at TELUS Health. HOSPITAL NEWS JUNE 2013
Supporting cancer patients and their families through the cancer journey is the role of Phil Taylor, RN, Patient Navigator and Clinical Nurse Specialist, at Bluewater Health’s Cancer Care Assessment & Treatment Centre in Sarnia.
Progress against cancer By Meaghan Lawrence-Kreeft
t’s been three years since Bluewater Health first saw an opportunity to transform its cancer program and refocus priorities on the needs of patients and families beyond just treatment. In that time, the hospital’s cancer services have touched thousands of lives and it continues to advance its vision of better coordinated care closer to home. “We really saw our vision as a blueprint for advancing and enhancing cancer care in our community,” said Vicki Lucas, Business Director of Surgery, Rehabilitation, Ambulatory Care and Oncology at Bluewater Health. “Our plan set out the most important actions that needed to be taken to improve quality of care and access for patients. Our goals supported those of Cancer Care Ontario as well as other provincial government strategic priorities related to wait times, access to care and quality – ultimately, what we created was a strategic cancer care program at Bluewater Health, one that is comprehensive, coordinated and patient and family focused – built around patients and families, for patients and families.” With the opening of the Cancer Care Assessment & Treatment Centre, Bluewater Health has seen early and dramatic results. Through the role of the Patient Navigator, the hospital is now providingmore support to patients and familiesand creating
links to community agencies and care partners, especially family physicians. In the year since its opening, referrals to the centre have risen sharply which can be attributed to better continuity of care thanks to the supportive and facilitative role of Phil Taylor, RN, Patient Navigator and Clinical Nurse Specialist. Phil’s focus is on engaging with patients from the time of diagnosis or decision to treat through to surgical or chemotherapy treatment. Walking hand in hand with the patient through their cancer journey is improving the patient experience during a time of high anxiety and fear.
‘Thank you so much Phil for being there for me. I was able to go through everything because of the way you talked to me. I know you will still be there for me when I need you.’ Grace, a patient with the Cancer Care Assessment & Treatment Centre Bluewater Health’s talented team of surgeons shared the organization’s vision for a better coordinated cancer program, to provide more care, close to home and ultimately create greater awareness and confidence about the top notch cancer care
service available here in Sarnia-Lambton. They played an integral part in co-creating Diagnostic Assessment Plans. These plans prescribe how each cancer care patient – by type of cancer – is assessed, treated, and advanced through the system of care in a quicker, standardized and more convenient way. Knowing the journey is half of the battle. In Ambulatory Care, Oncology and the Breast Assessment Program area of Diagnostic Imaging, the hospital continues to improve access to treatment and specialists. With the recent introduction ofthe Oncology Patient Information System or OPIS,a computerized drug ordering and entry system, the hospital is enhancing patient safety and provider efficiency. OPISimproves access to best practice guidelines andcoordinates chemotherapy treatments faster and more seamlessly. Cancer surgery wait times at Bluewater Health are excellent and continue to be better than the provincial target. Simply put, better coordinated care, shorter waits, and quicker results and procedures, is better patient care! For more information about Bluewater Health’s cancer care services, please visit www.bluewaterhealth.ca and click on ProH grams & Services. ■ Meaghan Lawrence-Kreeft is Communications Co-ordinator at Bluewater Health. www.hospitalnews.com
New HIV medicine for kids makes treatment easier to swallow By Dr. Christos Karatzios
rying to get a child to take their cough syrup can prove to be a difficult task, but the worst that can happen if they donâ€™t, is a sleepless night â€“ especially considering that non-prescription cough medicine isnâ€™t really effective anyway. But what if the consequences of not taking a medication as prescribed were much more serious? One of the biggest challenges to properly treating people infected with HIV is getting them to take their medications as prescribed. In Canada, HIV is no longer a death sentence and many adults and teens can become complacent about their treatment. Taking HIV medicines as prescribed is vital to prevent the virus from developing resistance to life-saving medications. When the virus becomes resistant, the drug is no longer effective and if new ones are not available, treatment fails. The issue of adherence to medication is especially challenging when dealing with children. In general, children dislike the taste of HIV medicines, and subsequently refuse to take them altogether, or vomit after swallowing them. While there are over 16 different antiHIV medications available to HIV-infected children, the first chewable HIV medication (childrenâ€™s raltegravir) was recently approved for kids in Canada.
Our job as healthcare professionals for these children is to help support the family as they move through the different stages of life. We must always aim to educate infected children early on (but at an appropriate age) about living with HIV and how it will affect them throughout their life. Our hope is that by the age of 14 years, the infected adolescents will know and understand their illness.
This includes taking ownership of their health by regularly adhering to their therapy and realizing that by doing so they can lead long, normal and productive lives free of serious medical issues as well as looking forward to adulthood and having non-infected children thus breaking the cycle of despair and death that defined HIV/AIDS up until a H few years ago. â–
Christos Karatzios, MD, FRCP(C) is an Assistant Professor of Pediatrics in the Division of Infectious Diseases at McGill University Health Care Centre's Montreal Children's Hospital, and an Associate Member in the Division d'immunologie SpĂŠciale at the Centre Hospitalier Universitaire Sainte-Justine, UniversitĂŠ de MontrĂŠal.
â€œ Focus on the things you can do, not ZKDW\RXFDQĂ–WDQG\RXZLOOĂ&#x;QG just like I did, that life is fantastic.â€? â€“ Danny McCoy
Our hope is that by the age of 14 years, the infected adolescents will know and understand their illness. Doctors now have a new therapy that we expect children will take more readily for the simple reason that it is palatable and to a child who can not appreciate the importance of their medication, taste matters. While the prevalence of HIV in children in Canada is low, it is still an in important health concern. Excellent progress has been made to reduce mother-to-child transmission in Canada to levels below two per cent however there are still new cases of infection in children who have emigrated from countries where HIV is endemic. Beyond prescribing life-saving medications, we must take a multidisciplinary approach to supporting families of these children living with HIV. The biggest challenge for families is accepting that their child is infected. Once theyâ€™ve accepted that reality, often we need to work with parents to manage their feelings of guilt, especially if a mother has transmitted the infection to her child. www.hospitalnews.com
Danny McCoy was rendered a paraplegic in a terrible car accident at the age of 43. Before the accident he was an avid sailor. After the accident, Danny became one of the top ranked competitive disabled sailors in the world. Heâ€™s also the founder of the Disabled Sailing Association of Ontario and one of the sportâ€™s foremost international ambassadors. Thomson, Rogers is a proud supporter of The Disabled Sailing Association of Ontario. We are honoured to have represented Danny McCoy in his lawsuit and to count Danny as a friend and one of the many everyday heroes we have been able to help.
YOUR ADVANTAGE, in and out of the courtroom
416-868-3100 | 1-888-223-0448 www.thomsonrogers.com JUNE 2013 HOSPITAL NEWS
Paediatricians gather to discuss hot topics in child and youth health
he Canadian Paediatric Society’s 90th Annual Conference, June 19-22 in Edmonton, will showcase the latest research and developments in child and youth health. More than 900 paediatricians and other child and youth health professionals from across Canada are expected to attend. The program includes 127 scientific abstracts in areas such as neonatology, developmental paediatrics, adolescent medicine, bioethics, healthy active living, infectious diseases and mental health. The conference features: • A keynote address by musician Chris Hendricks. Diagnosed with cerebral palsy at an early age, Mr. Hendricks began reaching out to students as part of his an anti-bullying initiative Breaking Down Barriers. • Timely workshops and concurrent seminars on child and youth health. Topics include drug therapy, diagnostic imaging, infectious diseases, sport medicine, adolescent health, developmental paediatrics, managing obesity, hematology, and mental health. • Paediatric Update: Presentations on some of the timeliest issues in the field including melatonin, growth charts, live attenuated influenza vaccine, early introduction of solids/allergenic foods, contraception and probiotics in paediatrics. Paediatric Update is Saturday, June 22. The Canadian Paediatric Society is a national advocacy association that promotes the health needs of children and youth. Founded in 1922, the CPS represents more than 3,000 paediatricians, paediatric subspecialists and other child health profesH sionals across Canada. ■ Learn more about the conference by visiting www.annualconference.cps.ca.
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HOSPITAL NEWS JUNE 2013
Following a year away due to cancer, Sarah Berger’s transition back to the classroom has been supported by the paediatric cancer support program at London Health Sciences Centre.
Helping kids with cancer transition back to school A
t a glance, 10-year-old Sarah Berger looks just like her fifth grade classmates. Like many of them, she loves going to school and spending time doing outdoor activities. And unless she mentions it, one would never guess that Berger missed her entire fourth grade year while she battled leukemia. After Berger suffered repeat bouts of the same mysterious illness during the summer after Grade 3, Berger’s parents began to suspect that something more serious was going on. A visit to the emergency department at Children’s Hospital at London Health Sciences Centre (LHSC) led to
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the discovery of a build-up of calcium on her kidneys and the eventual diagnosis of leukemia. Berger’s two-and-a-half-month stay in the hospital, plus weekly followup treatments, kept her out of school for an entire year. She is just one of the many children who are impacted by childhood cancers each year. Over the past 20 years the survivor rates for childhood cancers have steadily improved in Canada. Today more than 80 per cent of children survive cancer, so the importance of addressing the things that will impact their lives as they transition to adulthood, such as education, is greater
than ever. To help address this, Children’s Hospital at LHSC has implemented a school liaison program. “School is a vital part of a child’s life and cancer is a huge interruption in a child’s development – socially, emotionally, cognitively and physically,” says, Ann Klinck, psychological associate, school liaison for the paediatric cancer school support program at LHSC. “My role as a school liaison is really to help minimize that interruption as much as possible.” As the regional referral centre for paediatric oncology, the school liaison program at LHSC works with children and their families in 17 different school boards. The program provides support to both the family and the school. Following a referral to the program, Klinck will meet with the child and family, assess their needs and begin to develop a plan to help the child continue with their education during treatment. If the child is well enough to continue attending school, even on a limited basis, they are strongly encouraged to do so. Some of the ways that Klinck provides support include: • Provision of a teacher’s handbook (a free online resource she helped to develop) • Discussions with the classmates and peers of children with cancer and their siblings • In-services with teachers • Counselling with children and parents as they prepare to go back to school • Collaboration with families and schools to help prepare for the instances H when the child will not get better. ■ Originally published in the Winter 2013 issue of London Health Sciences Centre’s inside publication, visit inside. lhsc.on.ca to read the full account of Sarah Berger’s journey through childhood cancer and the paediatric cancer school support program. www.hospitalnews.com
Lots of support needs, lots of choices: what’s best to do? 8. When and how do you provide regular updates on what the care team finds is happening or not with my parent? 9. How often do we have a formal review of how the relationship is going? 10. What process and procedures do you have in place to manage any sudden critical situations that might occur with my parent? 11. What past clients can I talk with to check on your work? 12. If my loved one or I aren’t pleased with the quality of service, what recourse do we have?
Families across Canada are more and more facing a dilemma: how to ensure aging parents and other loved ones have the kind of personal care support they need now or will soon. By Bart Mindszenthy
nd that’s precisely why we see an increasing number of the kinds of ads and billboards and posters like this one I saw last month (see below). The fact is, the need grows at a rapid pace and family members who genuinely want to be helpful strive to do all they can. But the fact also is that those family members often are squeezed at both ends: by meeting the needs of aging parents, and also meeting the new or renewed needs of growing children. Whether in the health care field and thus generally more knowledgeable, or families outside health services, we’re all actually facing the same issues and challenges. And a growingly overriding one is how to get help. While the health care system provides some relief, generally speaking it’s not nearly enough.
Many choices in the marketplace That means looking for the kind of service pictured above. There are now dozens of national and hundreds of regional and local such services. Some cater to the wider demographic, and some are very targeted to specific cultural swaths of our Canadian mosaic. Some offer every possible kind of service, while others focus on some specific kinds of needs like support for those suffering from some form of dementia.
While the health care system provides some relief, generally speaking it’s not nearly enough.
Interestingly, virtually all have found the right phrases to use, the right emotional buttons to push with potential clients. These include: safe… reliable… professional… trained… dependable… experienced… caring… gentle… compassionate… licensed… understanding… meeting all your loved one’s needs… providing relief… bonded… and the list often goes on. Most offer at least two levels of actual in-home support. One level is the personal support worker, who has taken special training usually in a community college and who has passed some testing and demonstrated a level of reliability. The other is www.hospitalnews.com
the Registered Nurse or Registered Nursing Assistant, either of whom have much more extensive professional training and testing. There are other personal helpers as well: drivers to take aging parents for medical, hair or other appointments; meal preparation support as needed, and others. Support for aging family members is getting to be a serious and big business.
The bottom line
What to look for And precisely because it’s all getting to be a big business, whether being delivered by a small local company or a large national company, if you’re in the market for this kind of support service now or in the future, there are some key guidelines you might want to consider in your selection process. Here are 12 key questions to ask yourself and the management of the potential service you are considering hiring: 1. How do you identify and define what my love one really needs? 2. How do you determine and recommend how much time is required? 3. What’s the time on a daily and weekly basis; what’s the cumulative amount of time being recommended and what’s that going to cost me? 4. What specifically will be done during the course of each visit?
Support for aging family members is getting to be a serious and big business.
5. Who will come? 6. Do I have the right to first meet and approve of the person or those who will be helping my aging parent? 7. Can you guarantee that I get the same person or people all the time?
Obviously, the press of work, personal space, the needs our grown children may well have, plus the very real needs our aging loved ones will have, combine to make trying to do it all pretty well an impossibility. Thus, the attraction of an outside specialized service. There are many choices. Lots do a good job, some do not as well; those that do poorly as a rule don’t survive. But always take the time to probe and prod the nature and scope and record of any independent support service you may want to engage for a loved one. In other words, avoid surprises at the far side by doing solid research at the near side of deciH sion making. ■ Bart Mindszenthy, APR, FCPRS is the Host of www.mycarejourney.com and best selling author on the issues and challenges of caregiving for elderly family members. His column on caregiving appears quarterly in Hospital News.
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Therapy & Rehab JUNE 2013 HOSPITAL NEWS
RN Halona Scott on her way into Victoria Hospital's OR.
Improving the paediatric day surgery patient experience By Scot Magnish
n January of 2012, Registered Nurse Halona Scott of London Health Science Centre (LHSC) was challenged with finding a way to give teary-eyed children waiting for day surgery in the hallways outside operating rooms the confidence they needed to be brave. "In the past, a porter or a SSW would bring our paediatric patients to us,” says Scott, chair of the CQI Council for Victoria Hospital’s OR unit. “We’d do our preop prep work with them outside the OR; check arm bands, look at consent, check NPO status and anything else we need to know.” But the process wasn’t always conducive to courageous children – or parents. Young patients from Children’s Hospital, Scott explains, were often separated from their mother, father or guardian for up to 20 minutes before meeting their nurse for the first time and going into surgery. "Children are taught not to talk to strangers, and what parent wouldn’t want to meet the nurse that’s going to be caring for their child?” Scott asks rhetorically. “We wanted to improve the experience for everyone involved.” The solution, she says, was to start checking paediatric patients with the parents present in Day Surgery Prep before accompanying the child and SSW to the OR. "We went to the College of Nurses of Ontario for guidance and after looking at the five components of the nurse-client therapeutic relationship and examining the best practices in place at other hospitals, we decided to start going to the patient instead of relying on the patient to HOSPITAL NEWS JUNE 2013
come to us,” Scott says of the new procedure that went live in May of last year. "The parents get to meet you, and in doing so the child gets to see that their parents trust you.” Not only does the new process raise everyone’s comfort level, it reduces the possibility of errors occurring. Scott says by meeting with parents and/or guardians, nurses are able to do things like go over the procedure with parents and confirm con-
sent – and by accompanying their patients to the OR, they are able to ensure the right patient is in the right place at the right time. "It eliminates the possibility of the wrong patient ending up in the wrong operating room,” says Charge Nurse Belinda Keating-McLeod, noting the unit handled 3,432 patients last year alone. “From my perspective, this new process has been excellent and has been a positive experience for parents and children alike.”
LHSC’s CQI councils were established by Professional Scholarly Practice to enable staff at the point of care, who have the specific knowledge of the issues and the solutions, to implement the changes necessary to increase the quality and safety H of care delivery. ■ Scot Magnish is a Communications Consultant at London Health Sciences Centre.
Canadian winters freezing out breast cancer
Effects reduced by up to 30 per cent by low-vitamin D season By Julia Capaldi
or women diagnosed with a form of breast cancer known as estrogen receptor positive (ER+) breast cancer, tamoxifen is an essential drug used in the treatment and prevention of recurring breast cancer. Currently, tamoxifen is used in a one-sizefits-all approach where the same dose is prescribed for every patient. New research at Lawson Health Research Institute has found that in addition to patient-specific genetic factors, lack of exposure to vitamin D during the long winter months affects the body’s ability to metabolize the drug. The findings, which have been reported in the journal Breast Cancer Research and Treatment, are the first to identify this seasonal effect. Dr. Richard Kim, who is a physician at London Health Sciences Centre (LHSC) and holds the Wolfe Medical Research Chair in Pharmacogenomics at Western University, reports
that during the winter months nearly 30 per cent of patients are at risk for less than optimal level of the active form of tamoxifen, called endoxifen, and therefore may not benefit as much from the therapy. In the liver, tamoxifen is converted to the active form of the drug called endoxifen by a protein called CYP2D6. “We know that endoxifen is nearly 100 times more potent against the estrogen receptor relative to tamoxifen,” says Dr. Kim. “Our research has shown that patients with normal CYP2D6 activity can easily convert tamoxifen to endoxifen, whereas patients with no CYP2D6 activity have a significantly limited ability to convert tamoxifen to endoxifen.” In addition to the seasonal effect, Dr. Kim found that the simultaneous use of a common antidepressant can also substantially lower the body’s ability to metabolize endoxifen levels. “Patients who are either partly or completely deficient in CYP2D6 and who are prescribed the
SSRI class of antidepressants are at major risk for subtherapeutic endoxifen levels,” says Dr. Kim. Nearly 10 percent of Canadians completely lack CYP2D6 enzymatic activity. Given the available data that show patients who possess low CYP2D6 activity have a greater likelihood for disease recurrence, Dr. Kim has started a personalized medicine clinic at LHSC for tamoxifen therapy. “Our most recent findings are important additions to the pool of data we already have on tamoxifen therapy,” says Dr. Kim. “These new clinical and genetic markers can aid physicians to better identify patients who will benefit from tamoxifen, as well as those patients at risk for suboptimal benefit. We believe this has the potential to be used as part of our Personalized Medicine-based treatment H strategy for our breast cancer patients.” ■ Julia Capaldi works in Corporate Communications and Public Relations at Lawson Health Reserach Institute www.hospitalnews.com
Exploiting autophagy for therapeutic gain in prostate cancer By Anthony Joshua
am pleased to have the opportunity to share some insight into my current research proposal that is supported through one of Prostate Cancer Canada’s Rising Star in Prostate Cancer Research awards, funded by Movember. In its inaugural year, the Rising Star program provides funding to four scientists to support careers as independent investigators researching prostate cancer. The program allows for research scientists in the first five years of their first academic or research appointment to work under the guidance of an experienced mentor, providing intensive career development in prostate cancer research. Each recipient receives a grant of $150,000 a year for salary support and research expenses, for a period of three years. The awards provide the opportunity for junior research scientists to develop and demonstrate independence in initiating and conducting prostate cancer research. Currently, with an estimated 26,500 new cases of prostate cancer diagnosed and 4,000 deaths in Canada in 2012 alone, novel treatments and approaches for prostate cancer are sorely needed. Despite important advances in understanding molecular events that drive the progression of prostate cancer, most mechanisms responsible for acquired resistance
to radiation, hormonal therapy and chemotherapy remain unclear despite recent advances in the development of novel hormonal agents in the prostate cancer armamentarium such as enzalutamide (a potent androgen receptor antagonist).
Currently, with an estimated 26,500 new cases of prostate cancer diagnosed and 4,000 deaths in Canada in 2012 alone, novel treatments and approaches for prostate cancer are sorely needed. In our current research study, we aim to take advantage of recent insights into prostate cancer tumour biology based on our previous work to propose a novel paradigm for a treatment adjunct across a broad range of prostate cancer treatments outlined above. Cancer cells are often under stress in the cancer microenvironment, commonly lacking oxygen, sugar as well as other essential nutrients. When this occurs, the cancer cells may turn to a newly discovered strategy known as autophagy to survive. This process involves recycling parts of the cell that are no longer needed to be used as
fuel for survival. Therefore, the central hypothesis of my Rising Star research project is that autophagy can be used for therapeutic gain in prostate cancer. In the grant we hope to fulfill three objectives: 1. To develop therapeutic approaches for prostate cancer including castrate-resistant prostate cancer (CRPC) based on inhibition of autophagy 2. To validate the utility of autophagy inhibition in combination with docetaxel chemotherapy 3. To develop novel therapeutic strategies in cases of prostate cancer that are resistant to enzalutamide (ENZ). In greater detail, we have recently refined the use of a non-toxic autophagy inhibitor, which is actually the commonly used anti-acid medication pantoprazole, in high doses. In addition, we have data suggesting that this approach will be even more potent in stressing and therefore killing the cancer cells if we treat the cells with metformin. Metformin a commonly used diabetic medication that we have recently proved can fool the cancer cell into thinking it is starving but inhibiting a protein known as mTOR. By using these two treatments together, we hope to improve the efficacy of radiation, hormonal and chemotherapy for prostate cancer. We will also explore alternative stressors to cancer cells such as hypoxia (low oxygen) and low glucose to mimic the cancer
environment. We will explore these synergies with hormonal, chemotherapeutic and radiation therapies. To supplement this work, we will look at the importance of autophagy in a clinical trial we are running with pantoprazole to see if we can predict outcomes by examining prostate tissue for markers of autophagy. Finally, using the unique facilities in our laboratory, we will carry out a “screen” for new ways to target and kill prostate cancer by reducing 78,000 different genes in the prostate cancer and seeing what effect they have on the survival ability of the cells in particular in the setting of resistance to the latest prostate cancer anti-androgen, enzalutamide.
Significance of Research The significance of this work is that it provides a novel and controllable therapeutic mechanism to increase the utility of a number of treatments in prostate cancer with minimal increase in toxicities. Specifically, this research is aligned with the goals of Prostate Cancer Canada in that it proposes a novel treatment paradigm for men that will rapidly be adaptable to the clinic across a number of treatment modalities in prostate cancer care to improve H outcomes. ■ Dr. Anthony Joshua is a medical oncologist and researcher with Princess Margaret Hospital.
JUNE 2013 HOSPITAL NEWS
24 Care Giving
Why didn’t my daughter’s therapist ” check with me about this counselling? ‘‘
By Kevin Reel
one are the days when healthcare practitioners needed to recall the legal age of consent for treatment – 18, 12, nine, 15? In most Canadian provinces, we now look for a person’s ‘capacity’ to make a particular decision – rather than their age. In Quebec, though, the minimum age is 14; any age below that requires consent from a parent or guardian. This ‘capacity’ notion relates to healthcare treatments (and, typically, personal support services and admission to care facilities, as well). As a result confusion may still exist when muddled with all those other ‘legal ages’ – for driving, drinking, smoking, entering into contracts…and consenting to sex – that one’s very complicated. So, does that mean we always let 9 yearolds consent to or refuse their treatment plans? No, but nor can we always consult with parents about their child’s treatment options if they are capable to make the decision and to choose it be kept confidential. In Ontario, the Health Care Consent Act (HCCA) outlines two things that must be clear for someone to be ‘capable’ to consent to or refuse a proposed treatment plan: 1. The person must understand the relevant information (the treatment and alternatives; the side effects; the chances of success; what happens if they refuse the treatment). 2. They must also appreciate what it means to them in their particular situation, at this point in time regarding this particular treatment (or plan to apply to a care facility or bring in personal assistance). This assessment of capacity can be complicated. The emphasis on specific decisions means that the same person might not be capable of making one decision, but might be capable of making another decision. Healthcare practitioners must therefore be on their toes at all times – to be sure they follow the law and follow a capable patient’s wishes. Where a patient is not capable of making the decision, the practitioner or team must turn to their substitute decision maker (SDM). The SDM is the person or persons defined by law to decide. A Power of Attorney (PoA) for Personal Care appoints someone in advance to make decisions if the patient needs this in future (i.e. if they become incapable as defined in the HCCA). Without such an advance arrangement, the HCCA will dictate who becomes the decision maker (family members in a listed priority, then others if need be). It is really important that any patient’s health record makes clear the PoA or SDM, and not simply indicate ‘next of kin’ – they may not be the same. In paediatric situations, that capacity question becomes even trickier. There are plenty of cases in which capable ‘children’ make decisions with which their parents do not agree. Examples of this might include: receiving speech therapy, starting contraceptives or joining a group counselling drop-in session. These decisions can be made by a capable teenager and while most professionals would encourage full communication with parents or loved ones, it cannot be demanded of a capable patient of any age. There have in recent years been stories HOSPITAL NEWS JUNE 2013
in the media about other, more profound decisions being made by capable teens – such as refusing further cancer treatment. Already a trying situation, the unexpected fact that a teen could make such a decision on their own can make things more distressing for all involved. Given how complicated it can be to figure out if someone is ‘capable’ under consent laws, it is wise for all professionals to
review the law from time to time as there are many details and duties that must be considered. And there may also be new best practice ideas for assessing capacity. If ever you’re not certain, don’t hesitate to seek someone else’s help. Regulated health professionals have regulatory colleges and professional associations they can call for advice, and some hospitals have ethicists who are familiar with the details of consent
law. When it’s a really unusual situation, it’s always best to contact a legal advisor. For parents, the key may be in keeping open channels of communication with children about all health matters. If your kids feel you will respect their choices, they are more likely to share these choices with you and even seek your opinion. However, if they do choose to ‘go it alone’, it is important to remember that the healthcare professional is bound by laws that might prevent them from letting you know about some of your child’s decisions. Consent laws are in place to preserve a person’s right to choose their own care. They may not be perfect, but they do now recognize that the capacity to choose is not as simple as counting the candles on your H birthday cake. ■ Kevin Reel is the clinical and organizational ethicist at Mackenzie Health and Southlake Regional Health Centre, a registered occupational therapist and a member of the Joint Centre for Bioethics where he codirects a course on the MHSc bioethics program.
YWCA Toronto names Dr. Ophira Ginsburg a Woman of Distinction O
n May 2, YWCA Toronto honoured Dr. Ophira Ginsburg with a 2013 Woman of Distinction award. A physician, scientist, and advocate for women’s right to medical care, Ophira has worked globally and locally to ensure all women have access to breast cancer treatment. She is Medical Director of the Cancer Prevention and Screening Program, and director of Familial Oncology at RS McLaughlin Durham Regional Cancer Center. With a clinical and research background in breast cancer genetics and medical oncology, Ophira is also an adjunct scientist at Women’s College Research Institute and holds appointments as adjunct assistant professor at the University of Toronto’s Faculty of Medicine and the Dalla Lana School of Public Health. In addition to her local projects, Ophira works internationally. Ophira has been volunteering in Vietnam since 2004 and in Bangladesh since 2009, with the International Breast Cancer Research Foundation. In rural Bangladesh, cancer has traditionally been considered a curse. As a result, women with breast cancer have very limited or no access to treatment. Ophira addressed this inequity by co-founding the Amader Gram “Our Village” Breast Care clinic where Bangladeshi women, most from impoverished villages, are provided with free breast cancer treatment. She also helped develop clinical guidelines for Bangladeshi doctors to assist them in their provision of evidence-based breast cancer treatment. In Toronto, Ophira also works with the Thorncliffe Neighbourhood OfficeCrescent Town, assisting with education about breast cancer and encouraging newcomer and immigrant women to seek proper breast cancer diagnosis and
Dr. Ophira Ginsburg has worked globally and locally to ensure all women have access to breast cancer treatment. treatment. For many of the South Asian women she serves, breast examinations and mammograms are not encouraged for cultural reasons.
In Toronto and around the world, Ophira H is transforming women’s health care. ■ This article was submitted by the YWCA www.hospitalnews.com
New Xenon Polarizer in place to advance imaging research By Donna Faye
n Friday, April 26, the Honourable Reza Moridi, Ontarioâ€™s Minister of Research and Innovation, viewed the Thunder Bay Regional Research Instituteâ€™s (TBRRI) xenon polarizer. The equipment was recently installed at Thunder Bay Regional Health Sciences Centre (TBRHSC), where the Minister conducted a brief tour. The Province of Ontario provided $1 million towards the purchase of the polarizer to support the research of Dr. Mitch Albert, scientist at TBRRI and Research Chair and Professor of Chemistry at Lakehead University. Specifically, the funding provided substantial help to offset the purchase of the state-of-the-art xenon polarizer to advance imaging research, translate discovery to clinical trials, and commercialize products such as smaller scale HP (hyperpolarized) gas MRI products for broad distribution world-wide. The xenon polarizer is expected to be operational within the next few weeks, and used in clinical trials to test the effectiveness of treatments of various lung disorders. â€œOur government takes great pride in supporting the incredible thinkers and innovators in Northwestern Ontario. From
Matt Fox, left, is a postdoctoral fellow working with Dr. Mitch Albert, seen here with the Honourable Reza Moridi, Ontario Minister of Research and Innovation and Dr. Roxanne Deslauriers, Acting Vice President, Research, Thunder Bay Regional Health Sciences Centre and Scientific Director, TBRRI. cutting-edge, imaging technology to worldleading scientific research on the diagnosis and treatment of breathing disorders, the TBRRI is a jewel of the Northwest. Inno-
vation like this is what leads to incredible health breakthroughs, new companies in new industries and new jobs,â€? says Reza Moridi, Ontario Minister of Research and Innovation. â€œTBRRI is transforming patient care at TBRHSC as researchers and clinicians work together to solve clinical challenges. We were pleased to celebrate the arrival and installation of the polarizer with Minister Moridi, whose government is clearly committed to supporting life-saving and life-enhancing medical research,â€? says AndrĂŠe Robichaud, President and CEO of TBRHSC. â€œThanks to the generous support from the Province of Ontario, Dr. Albert and his team are even closer to improving imaging capability for our patients, which translates to earlier detection, better treatment plans, and improved patient outcomes,â€? says Dr. Roxanne Deslauriers, Acting Vice President, Research, Thunder Bay Regional Health Sciences Centre (TBRHSC) and Scientific Director, TBRRI. Dr. Albert is an experienced innovator who co-invented hyperpolarized (HP) gas MRI, a new technology that improves imaging for asthma, COPD, cystic fibrosis, pulmonary embolism, lung and breast cancer, stroke, atherosclerosis, and diseases of the brain. Keith Jobbitt, Chair of the TBRRI Board
of Directors, notes the importance of funding patient-centred imaging research to fuel the growing bio-medical economy in Northwestern Ontario. â€œThe $1 million contribution by the Ministry of Research and Innovation supports Dr. Albertâ€™s important Research and Development platform, and brings expertise, equipment and grants to develop new technology, translate ideas to clinical trials, and, ultimately, commercialize the technology for use in Canada and world-wide,â€? he says. The xenon polarizer enhances the MRI signal by 100,000 times to produce highly detailed images of changes occurring in body tissue, including the lungs and brain, which have traditionally resisted conventional MRI. HP gas MRI is also non-invasive, avoids the use of ionizing radiation, and is tremendously valuable to medical science. Leading-edge medical research in Northwestern Ontario is further supported by donations from the community. Gifts to the Thunder Bay Regional Health Sciences Foundation through the Health Sciences Discovery Fund help bring DiscovH ery to Life. â– Donna Faye is Communications Officer at Thunder Bay Regional Health Sciences Centre.
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JUNE 2013 HOSPITAL NEWS
26 From the CEO's Desk
Responding to a sentinel event Why having a policy in place is critical By David Musyj
People ask me – what is the most difficult part of your day to day job as a Hospital CEO? For me, responding to a sentinel event where, a patient is harmed and that harm results in death or serious physical or psychological injury is one of the most difficult responsibilities of the position. How effectively an organization responds to a sentinel event is directly proportional to how important patient safety and quality is to that same organization. Since studies have indicated that at least ten per cent of the patients that attend any healthcare organization on a daily basis is harmed by us and not healed, addressing sentinel events is an unfortunate reality. It is also an unfortunate reality that many hospitals do not have a sentinel event response policy. One is generally required for accreditation purposes. However, there is a big difference between having one and having one that is effective. If your organization does not have one or you have not looked at your sentinel event policy for awhile, it is not something you want to create as you are responding to an event. Responding to the event itself will take all of your organization’s energy and focus. Drafting an effective policy at the same time you are responding to an event is not wise and not recommended. That would be the equivalent of changing a flat tire going 100 km/h on a busy highway. Also, conducting a table-top response exercise to a mock sentinel event using your policy is also a good idea rather than testing it for the first time when an event occurs.
Drafting an effective policy at the same time you are responding to an event is not wise and not recommended.
When drafting or reviewing your sentinel event policy, I suggest you look at the policy from the position of the patient and/ or family member of the patient that was harmed. What information would you want to know, how would you want that information told to you and when would you want that information disclosed to you or your loved one? From meeting new team members at our new-staff orientation to my day-to-day role, I always try to put myself in the position of the patient/family that is attending our organization. I always say to our team members, “When in doubt over how to respond to situations, ask yourself this question, how would I want my loved one to be treated/informed? You follow that answer and you will never be wrong.” An effective sentinel event policy will contain the following key elements: • Is the harm isolated or does action need to be taken immediately to stop further harm to be individual patient or other patients? HOSPITAL NEWS JUNE 2013
• Clinical team to be made aware immediately. • One of the following: CEO, Chief of Staff and Chief Nursing Executive to be notified; it is up to them to notify each other. • Make sure you have a point person for responding to the incident. For my organization, it is the CEO, Chief of Staff or CNE as point person, always. The CEO needs to be directly involved throughout the response to the event. • Point person works with clinical team on gathering information to notify patient and/or family immediately. Ensure you have enough information to respond to the questions: how, what, why, when and what next. • Make sure you have the right people at the disclosure meeting with the patient/ family. You need to have a contact person for the family to reach out following the first meeting. • Generally, the patient/family is not ready to ask any questions at the first meeting. They are just digesting what you are telling them. Many questions will follow the first meeting and you must be prepared for that ongoing dialogue. Appoint someone that the family can call 24/7. • Ensure the necessary emotional, physical and psychological support is available for the impacted patient/family. • That point person ensures a sentinel event response team is assembled. This team meets regularly with prepared agendas, reporting on actions assigned to them and discussing next steps. • Make sure relevant stakeholders are notified including your Board of Directors, internal staff, relevant Ministries and other
Do not forget that your team members are traumatized by the event as well and may need some support to address their ongoing issues.
David Musyi is President and CEO of Windsor Regional Hospital. healthcare providers in the region to name a few. • Start addressing the root cause of the sentinel event or respond to the sentinel event if it is occurring over multiple days. Timing of notification to the patient and/or family member is always debated. Many people who do not even want to notify the patient and/or family (yes there are always some of them) will use the excuse that you do not have all the facts with exact certainty as a reason to delay disclosure to family and/or a patient. Do not wait for perfection of all the facts before you notify the patient/family. You have to balance timing of disclosure with waiting for all the
facts. Waiting for all the facts is most of the time not reasonable and those questioning or debating whether one needs to even notify the patient and/or family will use the lack of “all the facts” to delay notification from happening at all. Once the event has been addressed, you need to focus on the root cause of how the event occurred, examine your response to the event, did it follow policy and/or does the policy need to be revised and the psychological impact to your team members? Do not focus on “Who did it” but on “How did it happen”. Do not forget that your team members are traumatized by the event as well and may need some support to address their ongoing issues. I have always stated, as a system, we need to accept that mistakes do happen and we have to learn from them to avoid them from happening again. The only chance we have in reducing patients being harmed is to accept responsibility, treat the patient/family as if they were your loved one and learn from the mistake to prevent H others from happening. ■ David Musyj is President and CEO of Windsor Regional Hospital.
Breast cancer research Continued from page 12
“In a previous study, we identified families with alterations in genes that increase the risk of breast cancer. The women in that study asked us how our efforts would help their daughters…and so that’s partly how the LEGACY study came about,” said Dr. Andrulis. “We designed the LEGACY study to find out what other factors are involved in breast health in addition to the genes we know about – factors such as diet, lifestyle, physical activity, even levels of Vitamin D.” In addition to collecting questionnaires and biospecimens, the LEGACY study staff are also studying the breast tissue composition of these young girls when they are assessed for body measurements during each visit, using a technique called optical spectroscopy. The technique – developed by Dr. Lothar Lilge, Senior Scientist at the Ontario Cancer Institute and also one of the study’s investigators – involves holding a light probe over parts of the breast for about 30 seconds. From this, different wavelengths of light can provide information about the breast’s water and fat composition. Dr. Julia Knight, an epidemiologist and co-principal investigator of the
LEGACY study, will analyze the study’s results when enough baseline data has been gathered this year. She is working to bring the optical spectroscopy tool to Mount Sinai’s Prosserman Centre for Health Research. “Optical spectroscopy is actually one of the few tools we have to gather data on changes in breast health as these girls mature into young women. With this new tool, we will be able to quantify how much variation there is in fat, water, and collagen in breast tissue over time and we hope that this will tell us about breast cancer risk at an early stage,” said Dr. Knight. “Compared to mammography, which carries significant radiation exposure for a young woman, optical spectroscopy is harmless and gives us a way to see what’s changing in the breast tissue very early on.” Danielle Hanna, a certified genetic counsellor at the Ontario Familial Breast Cancer Registry and co-ordinator of the LEGACY Girls Study, commented that so far since the study began, not a single mother/daughter pair has dropped out. Although the two-hour assessment is typically long for a study visit, interactive aspects of the visit keep the young girls engaged. “The girls participate in what we call
our Junior Scientist Program, which takes place after the assessments and questionnaires wrap up. It’s a big draw for the girls because they’re taken into a real lab here at Mount Sinai and actually get to see how their samples are processed for the study. They also get to participate in hands-on activities using actual lab equipment. In a way, we’re mentoring future scientists,” said Danielle. Funded by the U.S. National Institutes of Health (NIH), the LEGACY Girls Study will potentially create a recipe for a number of preventive measures that girls can follow as early as age six, in order to reduce their risk for breast cancer in the future. Mackenzie admits that her habits are already changing just from filling out the study questionnaires. “There are questions that ask about how much exercise you do in a week, and it makes me wonder if I am doing enough,” she said. Referring to her friends who she also told about the study, and even helped recruit to the control group, Mackenzie added thoughtfully, “I think we’re all changing.” H ■ Sandeep Dhaliwal is the Communications Specialist for Mount Sinai Hospital’s Samuel Lunenfeld Research Institute. www.hospitalnews.com
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JUNE 2013 HOSPITAL NEWS
A guide to better health at your fingertips By Joe Chawla
or many of us, having a smartphone or tablet allows us to check our e-mail, update our social status or even tweet a friend, anytime or anywhere. But now, having a smartphone or tablet will also help healthcare providers appropriately screen a patient for cancer, thanks to a free new app from Cancer Care Ontario (CCO). CCO’s Cervical Screening Program (OCSP) app is now available on Apple’s App Store and is giving healthcare providers easy and immediate access to the information they need to assess patients for cervical cancer. A web-based mobile version is also accessible at https://screening. cancercare.on.ca for users of other mobile platforms. The app offers healthcare providers easy access to the OCSP’s cervical cancer screening cytology (Pap test), guidelines and step-by-step recommendations for follow-up of abnormal screening test results. Providers are also able to easily download and print, or e-mail, educational materials, such as handouts, for their patients at point-of-care. "In an effort to make this tool easy to use both for those who are technologically savvy, as well as those who are not, the app underwent an evaluation where it was tested against well-known principles for usability,” says Deborah Chan, from Healthcare Human Factors, the company which reviewed and tested the app. CCO’s mandate is to reduce the number of people diagnosed with cancer, and to make sure patients receive better care every step of the way. This app is the third created by the organization – a Symptom Management app and Drug Formulary app are already available on CCO’s website – and is another example of how the organization is working with healthcare providers to ensure preventative screening is conducted to help catch and prevent the onset of cancer in Ontario patients. “This app is the first tool in CCO’S multimodal approach to disseminating cancer screening guidelines to healthcare providers,” says Dr. Joan Murphy, Clinical Lead for the Ontario Cervical Screening Program. “As well as presenting clinical guidelines in print and electronic PDF format, we are broadening accessibility by having more digital options. Our aim is to ensure the information is easily available, in a format providers want to receive it in, for use in clinical settings.” CCO also has plans to expand the app to support screening for breast and colorectal cancer. “Having this app on my phone makes it easy for me to quickly refer to the guidelines no matter where I am, be it in clinic with a patient or during an educational session with peers. It is very clear and easy to use,” says Dr. Edward Kucharski, a family physician with Sherbourne Health Centre and one of CCO’s Regional Primary Care Leads for the Toronto Central LHIN. For more information about Cancer Care Ontario, visit www.cancercare.on.ca. For information about cancer screening and links to the new Cervical Screening App, H visit www.cancercare.on.ca/screenforlife. ■ Joe Chawla is a Communications Advisor with Cancer Care Ontario. HOSPITAL NEWS JUNE 2013
Cancer patients benefit from WE-Can program By Heather Vita
he WE-Can program is a tenweek Wellness and Exercise program for individuals living with Cancer and has four com-
ponents: 1) Individualized assessment (Complete medical history and physical fitness assessment) 2) Wellness & Exercise Program (Cardio and strength training, warm up, cool down and stretching) 3) Educational Group Presentations (Physical activity, home-based exercise programs, nutrition) 4) Group Support (Share experiences with others) The program takes place at the Canada Games Complex in Thunder Bay, Ontario, with guidance given on activities to be done at home. A referral from an oncologist or primary care provider is required and an assessment done by a physiotherapist and kinesiolgist is provided by program staff to determine suitability for the program. Janet Baillie, a breast cancer survivor shares her experience with the WE-Can Program.
I began to realize that I had an unhealthy lifestyle and I had to take care of myself. Exercise was missing in my life, even though I was a big advocate of driving my kids to be involved in every sport you can think of. “I really enjoyed the program and did it just when I was finishing up my radiation. It was tough while I was recovering from the burns and had to miss a few sessions, but overall by the end, I felt very strong and more energetic than I had in a long time. It was actually the start of my getting healthy program. You see, after I was diagnosed I refused to concentrate on the disease of cancer, but concentrate instead on getting healthy. Something I hadn't done in a long time take care of myself. I always had an excuse not to exercise – driving kids, too tired, no time, whatever you could imagine, I used that excuse. When I was diagnosed with Breast Cancer, I was ashamed that, as a healthcare professional, I wasn't aware of the changes in my body until one day I discovered the large lump in my breast! I began to realize that I had an unhealthy lifestyle and I had to take care of myself. Exercise was missing in my life, even though I was a big advocate of driving my kids to be involved in every sport you can think of. Beginning the WE-Can program was difficult! My husband laughed with me
Janet Baillie (on right), breast cancer survivor and WE-Can program participant, with her son’s fiancée, Danielle Perrier, skiing at Loch Lomond in preparation for a trip to Whistler. Janet says, “I’m doing things I never thought I would do! Exercise played a huge role in my recovery.” when I couldn't believe I was pooped out exercising on a chair for 45 minutes. By the end of the program, I could participate and work my body to feel energized and happy to be able to do things I hadn't done in a long time. My range of motion improved and I have never had any post surgical problems. I believe this is because I participated in the WE-Can program. I currently have lost a significant amount of weight and continue to challenge my body physically doing snowshoeing, downhill skiing and walking outdoors; not every day, but more than I have in a long time. I will soon start “a learn-to-run program” sponsored by The Running Room for breast cancer survivors. Thank you for making me feel alive and discovering that exercise is a big part of recovery!”
The WE-Can program relies on funding from a variety of sources to continue operation. Generous donations, like the one from ‘Run with Me TBay’, give individuals living with cancer an opportunity to experience the benefits of exercise and healthy living. To donate to the program, please contact the Health Sciences Foundation at (807) 345-HOPE or www.healthsciencesfoundation.ca For more information about the WECan program, please contact Kelly-Jo Gillis, Thunder Bay Regional Health Sciences Centre at (807) 684-7221 or H firstname.lastname@example.org. ■ Heather Vita is Manager, Marketing & Communications for Thunder Bay Regional Health Sciences Foundation www.hospitalnews.com
Technology enhances safety and efficiency of chemotherapy medication compounding By Niels Erik Hansen, Ph.D.
hemotherapy is perhaps the most complex medication treatment patients receive. Chemo protocols and regimes not only require the compounding of toxic chemicals, but a patient’s specific medication needs can change over the course of a treatment cycle. For these reasons – and the fact that most chemotherapy treatments continue to be compounded manually – risks exist in almost every step in the process. Unfortunately, problems with manual compounding are all too common. Following last fall’s meningitis outbreak linked to contaminated steroids, three other compounding pharmacies – in Georgia, New Jersey and another in Massachusetts – recalled compounded medications due to concerns about contamination earlier this year. While contaminated medications can have serious effects on reasonably healthy individuals, the impact on people battling cancer can be disastrous.
Dorothy Richard, co-owner of Heart in Hand Boutique, models a wig in her boutique for women recovering from cancer.
Heart in Hand boutique helps women recovering from cancer By Dorothy Richard
The critical drivers of an integrated chemo compounding solution are safety and efficiency. That’s why a growing number of hospitals and other chemotherapy providers are turning to hardware and software solutions such as automated compounding technology and computerized process management applications. Each of these solutions provides substantial benefits on its own, but can be even more effective when used in tandem to enhance the accuracy of chemo medication ordering, verification and administration, minimize contamination risk and protect pharmacy staff from exposure to cytotoxins. The critical drivers of an integrated chemo compounding solution are safety and efficiency. There tends to be little waste with chemo processing; doses are generally not made in anticipation of orders, but when the patient arrives and needs are confirmed via lab work. The prepared products are mostly bags, and the bags often need to have their fluid volumes adjusted to either control the fluid administered to a patient or achieve a target concentration. Because of these requirements, the manual process can be very labor intensive and slow. Intelligent Hospital Systems in Winnipeg has worked to develop an automated pharmacy technology that virtually eliminates the need for manual preparation of compounded medications. The result of this work is RIVA, a fully-automated IV compounding system. Continued on page 31 www.hospitalnews.com
helley Gable and I opened Heart in Hand Boutique in the fall of 2012 when we both saw a need for a one stop boutique for ladies with cancer. As a cancer survivor I know the hardship of shopping for products – bras camisoles, hats, wigs. Where do you shop for these special things? How much are they? Those are the questions that went through my mind. At Heart in Hand Boutique we wanted to take the worry out of finding a pretty bra or a fashionable wig so we put everything under one roof. Women who are being diagnosed with breast cancer are younger and they don’t want to wear something that isn’t pretty, or that isn’t attractive. Times have changed and mastectomy wear is no longer ugly. At Heart in Hand Boutique you will find pretty post-op camisoles which ladies need before surgery. These camisoles are designed with drain pouches and they come in different colours. After your surgery you will want to return to the boutique to be fitted for your prosthetics also known as breast forms. These breast forms come in many different shapes and sizes. We also carry a large selection of bras and bathing suits in different sizes and styles. Aqua swim is a great form of exercise after surgery. We also carry the swim form for you bathing suit. Our expert has over 15 years of fitting prosthetics experience so she will ensure the fit is perfect. Losing your hair can also be part of your treatment for cancer. At Heart in Hand Boutique we have many styles and colors of wigs. Long, short blonde or brunette and if you don’t see it, we can get it. If you can make it in before you lose your own hair we will even try to match a wig that looks like your own. We also carry a line of hats and scarves.
At the boutique we measure and fit for Lymphedema and compression garments. Lymphedema can be primary and secondary diagnoses. Secondary is the most common as it can be the result of a surgery, radiotherapy or injury. Lymphedema can be very painful and sometimes fatal. Primary is less common but still very painful. Compression garments and stockings come in different pressures, along with many different styles and colors. Compression can be worn for spider veins, varicose veins, leg or arm injury or after surgery.
We are a certified ADP (Assistive Device Program) location so we work very closely with the government to help with payment for your Lymphedema garments. Through privacy, empathy and respect our Certified Mastectomy Fitter and ADP Certified Lymphedema Expert will ensure that your experience is a positive one. Please check out our web site at www. heartinhandboutique.com or we can be H reached at 905-877-4327. ■ Dorothy Richard is a cancer survivor and co-owner of Heart in Hand boutique.
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We try to list all events and information but due to space constraints and demand, we cannot guarantee it. To promote your event in a larger, customized format please send enquiries to “firstname.lastname@example.org” ■ June 18-19, 2013 Workplace Wellness and Mental Health The Old Mill and Spa, Toronto Website: www.conferenceboard.ca/conf/workwellness/default.aspx ■ June 20 & 26, 2013 Live Online Training, Minimizing Risk Through Best Practices In Endoscope Reprocessing Website: www.shop.csa.ca ■ June 25-28, 2013 Child and Youth Care World Conference Sheraton Hotel Newfoundland, Halifax Website: www.cycworld2013.net
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■ July 7-10, 2013 International Tumor Necrosis Factor Conference Quebec City, Quebec Website: www.tnf2013.com ■ July 9-11, 2013 Biennial Conference on Brain Injury in Children Park Hyatt Hotel, Toronto Website: www.sickkids.ca/BrainNetwork
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■ June 27-29, 2013 American Association of Heart Failure Nurses Conference Le Centre Sheraton, Montreal Website: 2013.aahfn.org
■ July 10-14,2013 World Congress on Thyroid Cancer Sheraton Centre Toronto Hotel, Toronto Website: thyroidworldcongress.com ■ July 17-20, 2013 World Glaucoma Congress New Vancouver Convention Centre, Vancouver Website: www.worldglaucoma.org ■ July 24-28, 2013 Brain Development & Learning: Making Sense of the Science The Westin Bayshore, Vancouver Website: www.braindevelopmentandlearning.com ■ July 26-29, 2013 International Academy of Cardiology – 18th World Congress on Heart Disease Hyatt Regency, Vancouver Website: cardiologyonline.com ■ Sept 8-10, 2013 Csao Conference – Canadian MDRD Processes Double Tree Hilton, Toronto Website: www.csao.net ■ Sept 13-14, 2013 Canadian Association of Ambulatory Care Conference Delta Toronto East, Toronto Website: www.canadianambulatorycare.com ■ Sept 22nd-24th, 2013 Dynsmics 2013 Conference – Shattering the Silence – Voices for Advocacy in Critical Care Nursing World Trade & Convention Centre, Nova Scotia Website: www.caccn.ca ■ Sept 25-27, 2013 Brain Injury Association of Canada Conference Ambassador Conference Resort, Kingston Website: www.biac-aclc.ca ■ Oct 3-4, 2013 I.T. Healthcare Canada Conference and Exhibition International Centre, Toronto Website: www.ithealthcare.ca www.hospitalnews.com
Continued from page 29 RIVA provides process accuracy and repeatability, and prepares bags or syringes in a fully-enclosed ISO Class 5 environment that is USP<797> compliant. RIVA also can be configured with negative air pressure to protect pharmacy workers during chemotherapy compounding. Earlier this year, Intelligent Hospital Systems teamed with Cato Software Solutions to integrate its chemocatoÂŽ software with RIVA hardware. chemocatoÂŽ is an oncology software solution that provides support across all stages of therapy: longterm planning, current therapy ordering, preparation of cytotoxic drugs and more. RIVAâ€™s photo documentation, step-bystep time stamping and electronic audit trail add more layers of safety and verification â€“ checks that are important when compounding any medication, but critical when preparing oncology compounds. With the RIVA/chemocatoÂŽ solution, chemotherapeutic medications can be loaded into the machine in advance, while the software maintains records of a patientâ€™s regime that can be adjusted based on lab work. Once the physician inputs the order, the machine makes exactly the right dose, without the need for manual intervention â€“ saving time and substantially reducing the risk of contamination and miscalculation. This combination of hardware and software offers the safest and most flexible system for delivering verified patient-specific chemotherapy medications. In addition, enhanced safety and accuracy reduces the risk of inadvertent adverse drug events and the associated liability cost. Throughout the healthcare system, technology has been implemented to enhance the safety and efficacy of any number of procedures and systems â€“ not only because technology is more efficient and accurate, but also because safety reduces costs. When treating a vulnerable population such as people with cancer using highly complex regimes of toxic compounds, safety and accuracy are critical. Fortunately, technology continues to offer ever-better solutions to these challenges, while benefitting patients and pharmacy H staff alike. â– Dr. Niels Erik Hansen is president and CEO of Intelligent Hospital Systems in Winnipeg.
Second MRI offers flexibility at Mackenzie Health By Stefanie Kreibe
RI scans have become vital diagnostic tools for hospitals around the world. Without exposing patients to radiation, MRI scans can show more precise detail and differentiation between the soft tissues of the brain, muscles and heart than CT scans or X-rays. Demand for this technology at Mackenzie Health in Richmond Hill, Ontario, has made the addition of a second machine necessary. Leasing a mobile MRI unit is an innovative solution to continue to maintain patient volumes, while the hospital completes the purchase, renovations to the space for the second permanent MRI and its installation. â€œMRI is an invaluable study to aid in the diagnosis of many medical conditions,â€? says Dr. Peter Stroz, Medical Director, Diagnostic and Therapeutic Program and Chief of Medical Imaging at Mackenzie Health. â€œThis addition of a second permanent MRI will allow our healthcare team to continue to make timely and accurate diagnoses. This will assist in getting patients on the
In April 2012, the hospital leased a second temporary MRI, offering more flexibility. â€œHaving two scanners enables the hospital to book exams at more convenient times for patients,â€? says Cindy Draycott, the hospitalâ€™s Operations Director, Diagnostic and Therapeutic Pro-
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MRI technology is advancing An MRI scanner uses powerful magnets, radio frequency fields and computers to construct 2D and 3D images of the body. The new second permanent magnet will be a 3 Tesla (3T) MRI. This magnet has advanced imaging capabilities and will help provide physicians with clearer and more detailed scans, enabling accurate diagnoses. Certain MRI examinations can be completed more quickly with a 3T magnet, enabling the hospital to also increase patient volumes and decrease wait times. In order to maintain two MRI machines at the hospital, Mackenzie Health Foundation has launched â€œPicture This,â€? a fundraising initiative for the second, permanent MRI. The campaign has reached $3.9M toward the $5M goal. With the addition of a second MRI, patients will continue to be able to remain closer to home to access this crucial H test. â– Stefanie Kreibe is a Consultant in Communications and Public Affairs at Mackenzie Health.
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gram. â€œWe no longer run the MRI 24 hours a day. Patients are booked from 7:30 a.m. to 11:30 p.m., avoiding inconvenient middle-of-the-night appointments. Another advantage is we always have a scanner available in the event that the other requires maintenance.â€? Maintenance for an MRI scanner is more complex than for many other diagnostic machines in a hospital. During this time, an MRI scanner can be off-line for numerous hours. Having a second scanner allows the hospital to continue to provide timely MRI scans, without having to rebook patients to future date. Located in a mobile unit outside of the hospitalâ€™s Emergency Department, the temporary MRI operates seven days a week and is used primarily to scan ambulatory or mobile patients.
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Having two scanners enables the hospital to book exams at more convenient times for patients.
Bernard Saieh, a Registered MRI Technologist at Mackenzie Health in the hospitalâ€™s mobile MRI unit.
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correct treatment path and assist in a more rapid recovery for our patients. â€? Although the demand for this test has increased dramatically in recent years, continuous process improvement initiatives and additional funding have enabled the organization to reduce wait times to be well under the provincial and LHIN targets.
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