Hospital News June 2025 Edition

“Our governments have failed in maintaining home care. We are totally not prepared for our aging population. And we’re actually in a crisis right now. We don’t have the staff, so who is going to look after these patients?”

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care nurses are demanding better.

Trump’s tariffs would upend Canadian healthcare

– but we could use

it as an opportunity for meaningful reform

By Jason M. Sutherland

It is widely known now that American President Trump has implemented is threatening more widespread tariffs on Canadian products and services, and that this would have devastating economic repercussions for many Canadians.

But what has yet to be part of the national conversation is the impact tariffs would have on our health system. And what we should do to prepare for such an outcome.

Winston Churchill’s saying, ‘Never let a good crisis go to waste’ is particularly apt. Canadians may see a crisis unfold in our commitment to sustain quality universal healthcare through a prolonged trade war; we should use such a crisis, should it arise, to open the door to new solutions.

What’s the connection between tariffs and our health system?

Economists have noted that a possible depression induced by tariffs would cause many Canadians to lose their jobs. Add to this the ripple effect of businesses going bankrupt because they rely on these Canadian consumers to survive. If tariffs stay in place for an extended period, widespread unemployment plus business bankruptcies would cause a precipitous drop in federal and provincial tax revenues.

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JULY 2025 ISSUE

EDITORIAL: June 13

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Cardiovascular Care/Respirology/Diabetes/ Complementary Health: 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 and allergies. Prevention, treatment and long-term management of diabetes and other endocrine disorders. Examination of complementary treatment approaches to various illnesses.

Provincial spending on healthcare is already almost 50 per cent of all money spent by provincial governments. That always makes healthcare a prime target for governments trying to reduce their spending – something that would be exacerbated in a tariff-induced depression.

Yet provincial governments would have a difficult time finding ways to save money on healthcare as it is organized and delivered today.

Canada has more seniors than ever; Canadians are living longer with more medical problems; and recent population growth will continue to drive immense public pressure for ever-more healthcare. Governments in many provinces are also bound to multi-year wage increases for nurses and physician payments that in part redress recent high inflation.

And if a depression takes hold, hundreds of thousands of Canadians could also lose extended health benefits related to their place of employment, including insurance for dental and vision health, access to mental healthcare and coverage for prescribed drugs. Some Canadians would be forced to defer or forgo their and their families’ health needs. In some instances, this could lead to avoidable emergency department visits and hospitalizations that further crowd acute care.

Provincial and federal public drug and dental insurance programs would have to absorb many new enrollees and push up government spending.

Continued on page 6

AUGUST 2025 ISSUE

EDITORIAL: July 11

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Paediatrics/Community Engagement and Patient Advocacy /Social Work: Paediatric programs and developments in the treatment of paediatric disorders including autism. Specialized programs offered on an outpatient basis. Community engagement initiatives. Empowering patients –tools and strategies for improving patient education and self-management. The role of patient advocates and how healthcare professionals can support advocacy efforts. Social work programs helping patients and families address the impact of illness .

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Prostate cancer discovery opens door to more tailored treatments

Prostate cancer has distinct genetic properties in different groups of men that can be targeted to improve patient outcomes, UVA Cancer Center researchers have discovered. Based on new findings in Chinese men, the researchers are urging similar studies in other groups to advance precision medicine and better tailor treatments.

An international team of researchers co-led by UVA’s Hui Li, PhD, looked at what are known as “chimeric RNA” in Chinese men and found both similarities and differences to those seen in Western men. These RNAs can contribute to the growth of cancer and are widely used as both indicators of cancer and targets for cancer treatment.

By targeting chimeric RNA specific to Chinese men, doctors may be able to develop better, more effective prostate cancer treatments for Chinese patients, Li says. He notes that Asian populations have the highest ratio of prostate cancer deaths to new cases (40%) – higher than in Europe (18%), Northern America (10%) or even worldwide (25%).

But the findings also speak to the potential of the approach for improving cancer care for other groups.

“Prostate cancer is a worldwide problem. It is the most common cancer in men, with clear racial disparities,” said Li, of the University of Virginia School of Medicine’s Department of Pathology. “More than 70% of Asian prostate cancer patients are in the intermediate or advanced stage at the first diagnosis. They are more prone to metastasis and drug resistance, which is consistent with a 5-year survival rate of less than 30%. Our findings may not only explain the racial disparity, but provide some handles we can use to tackle the disease.”

CHIMERAS IN CANCER

Chimeric RNA combines operating instructions from two or more different genes; these fusions are found in both healthy cells and cancerous ones.

In cancer, they can influence tumor formation and growth by producing particular proteins, for example, or by altering gene activity.

To better understand chimeric RNA in a specific patient population, Li and his team analyzed data from the Cancer Genome Atlas and the Chinese Prostate Cancer Genome and Epigenome Atlas. They found that Chinese men had several distinct chimeric RNA patterns, including in cancer epithelial cells as well as in macrophages and T cells, immune cells found in and around tumors.

The scientists then discovered how the chimeric RNA drive tumor growth and reshape cellular communications surrounding the tumors. They also revealed how the chimeras contribute to the activity of stromal cells that play a crucial role in cancer’s formation and progression.

“This is the first comparison between two prostate cancer populations focusing on chimeric RNAs,” Li said. “It is also the first study to examine chimeric RNAs in different cell types within cancer.”

PRECISE PROSTATE CANCER TREATMENT

The new findings offer important insights into how prostate cancer develops in Chinese men. But the scientists also use their new paper outlining the discovery to highlight the potential of the approach to benefit all patients. By better understanding how chimeric RNA differs in various populations, doctors can target these distinct RNA profiles to develop more tailored – and more effective –prostate cancer treatments.

Further, chimeric RNA isn’t just found in prostate cancer but in cancer generally. So the approach could open doors in the battle against many forms of the disease.

“We were able to validate over 100 chimeric RNAs, the largest list in the field, with some having clear diagnostic and prognostic potential,” Li said. “In addition, we have identified multiple chimeric RNAs that influ-

ence prostate cancer or tumor microenvironment, which contribute to the tumorigenesis [tumor formation].

Chimeric RNAs as such represent a hidden repertoire for biomarkers and/ or therapeutic targets.” n H

The researchers have published their findings in the scientific journal iMeta. The research team consisted of Qiong Wang, Shunli Yu, Jirong Jie, Justin Elfman, Zhi Xiong, Sandeep Singh, Samir Lalani, Yiwei Wang, Kaiwen Li, Bisheng Cheng, Ze Gao, Xu Gao, Hui Li and Hai Huang. The researchers have no financial interest in the work.

Biological markers for teen depression

Using a novel lab method they developed, McGill University researchers have identified nine molecules in the blood that were elevated in teens diagnosed with depression. These molecules also predicted how symptoms might progress over time.

The findings of the clinical study could pave the way for earlier detection, before symptoms worsen and become hard to treat.

“Alarmingly, more and more adolescents are being diagnosed with depression, and when it starts early, the effects can be long-lasting and severe,” said senior author Cecilia Flores,

Continued from page 4

RESEARCHERS’ BREAKTHROUGH COULD PROVIDE A MORE OBJECTIVE, EARLIER WAY TO IDENTIFY ADOLESCENTS AT RISK AND TO PREDICT HOW THEIR SYMPTOMS WILL PROGRESS OVER TIME

James McGill Professor in McGill’s Department of Psychiatry, a researcher at the Douglas Research Centre and a principal investigator at the Ludmer Centre. “Teens with depression are more likely to struggle with substance use, social isolation and experience

Trump’s tariffs would upend Canadian healthcare

In other words, if a prolonged trade war ensues, provincial governments will have to make tough choices. Governments will likely avoid cutting services that directly affect patients or cause longer wait lists.

The effects of government cuts on healthcare austerity will not be spread equally.

Services most vulnerable to cutting include rehabilitation and mental health services, public health and prevention efforts. Organizations that promote healthcare quality, standards or health information organizations will be targeted. Modernization efforts such as team-based primary care reforms will be postponed or scuttled.

So, what are the solutions?

Massive public debts and deficit financing may be the only route to ensure public access to the healthcare systems we have now, taking a page from the COVID-19 playbook. Doing so would maintain healthcare delivery system stability through preserving the status quo.

But if governments run massive public debts due to the high cost of healthcare, the public should demand fundamental reforms that improve health and well-being for all Canadians. Let’s make use of the crisis.

Crises can open the door to new solutions. Provinces have been slow to

change their healthcare systems over the past decades. Productivity in the healthcare sector has stalled and billion-dollar electronic medical record modernizations have not realized expected efficiency gains.

Governments should be emboldened to use the crisis as a foundation for significant reforms to their healthcare delivery systems.

New initiatives may include paying healthcare providers to keep their population healthy rather than paying for illness care, link health with social care and housing security, and acknowledge that mental health is as important as physical healthcare.

A multi-year vision should incorporate flexible health care budgets that can be moved across settings, organization types and across budget years to maximize the impact of spending on Canadians’ health.

A prolonged tariff war may never come to pass, but the fractures in our health system are already profound and would be amplified if a crisis arises owing to the tariffs. We shouldn’t give up our hard-fought right to universal healthcare, nor the impetus to dramatically improve it.

Elbows up: we could turn such a crisis into rapid healthcare reform that would benefit Canadians for generations. n H

Jason M. Sutherland is Professor and Director of the Centre for Health Services and Policy Research at the School of Population and Public Health at the University of British Columbia.

symptoms that often don’t respond well to treatment.”

Notably, the nine molecules – known as microRNAs – have not been linked to adult depression, suggesting they reflect biological processes unique to teens.

A MINIMALLY INVASIVE AND SCALABLE APPROACH

The study, conducted in collaboration with colleagues at the University of California, Los Angeles and Stanford University, focused on 62 teenagers: 34 with depression and 28 without. Researchers collected small volumes of blood samples, let them dry, and then froze the samples to preserve molecular integrity over time. Such samples are taken with a simple finger prick and are easy to store and

transport, making the approach practical and scalable for broader use.

The McGill team developed the lab method used to extract and analyze microRNAs from the samples.

“Our findings pave the way for using dried blood spots as a practical tool in psychiatric research, allowing us to track early biological changes linked to mental health using a minimally invasive method,” said first author Alice Morgunova, postdoctoral fellow at McGill.

Diagnosing depression mostly relies on self-reported symptoms. The authors say this could delay care, especially if teens don’t recognize the signs or aren’t ready to talk about them. A blood-based screening tool could provide an additional and more objective metric to identify teens at risk.

The researchers plan to validate their findings in larger groups of adolescents and to study how these microRNAs interact with genetic and environmental risk factors.

“Peripheral microRNA signatures in adolescent depression” by Alice Morgunova and Cecilia Flores et al., was published in Biological Psychiatry Global Open Science. n H

Study investigates the genetic

cause of premature ovarian insufficiency

Sinai Health is leading a study that could uncover the genes responsible for premature ovarian insufficiency (POI) – offering hope for improved patient outcomes.

POI affects nearly two per cent of individuals in Canada. It is a condition where the ovaries stop producing eggs before the age of 40, and it can have a significant impact on quality of life.

Not only does POI cause similar symptoms of menopause that can be debilitating, but it can also affect fertility at a stage in life where some individuals are planning or starting families.

There are some definitive causes of POI, such as after chemotherapy or radiation, but in most cases, the cause is unknown. But now, emerging evidence suggests that there is likely a genetic link.

The donor-funded study, in partnership with Women’s College Hospital, is examining saliva samples from ten sets of patients with suspected familial

POI. What makes this study unique is that exome sequencing is being performed in both patient and their family member with POI. Exome sequencing is a test that can help to understand if a medical condition has a genetic cause.

“Our hope is to gather enough evidence around a gene or genetic pattern associated with POI to launch a larger-scale study, and build the body of research around this understudied condition,” explains Dr. Wendy Wolfman, co-principal investigator of the study and director of Sinai Health’s menopause and premature ovarian failure clinics.

Identifying genes responsible for the development of POI could support early identification in those who are at higher risk, and could one day lead to the development of groundbreaking treatments. The Premature Ovarian Insufficiency (POI) clinic at Mount Sinai Hospital is uniquely positioned to lead this research, as Canada’s only clinic specializing in POI. n H

Opioid prescribing standards changed practices in BC, but with caveats

An opioid prescribing clinical practice standard for chronic noncancer pain in British Columbia changed prescribing behaviours but reduced access to opioids for people with cancer or receiving palliative care, found new research in CMAJ (Canadian Medical Association Journal).

In an effort to curb misuse of opioids and prevent overdose deaths, the College of Physicians and Surgeons of British Columbia released a legally enforceable practice standard, Safe Prescribing of Drugs with Potential for Misuse/Diversion, in 2016. This document limited prescribing of opioids for chronic noncancer pain (CNCP) with specific prescribing practices that clinicians were obligated to follow.

In research that tested the effects of the 2016 practice standard on prescribing to patients with CNCP, researchers found that its introduction had a marked impact on prescribing practices. Pre-existing declining trends in doses of opioids (measured in morphine milligram equivalents) accelerated, as did declines in highdose prescribing, coprescribing with hypnotics like benzodiazepines, and prescribing larger supplies of medications. As well, the number of patients who had doses aggressively tapered increased, which can result in improper pain management. The analysis included data on all opioid prescriptions dispensed to community-living adults in BC between October 2012 and March 2020.

“This demonstrates the ability of practice standards to modify physician behaviour but also highlights how misinterpretation can harm patients,” writes Dr. Dimitra Panagiotoglou, associate professor at McGill University, Montréal, Quebec, with coauthors. “Patient groups and physicians affected by standards or guidelines should be consulted before their release to reduce unintended consequences.”

When the 2016 practice standard was replaced in 2018, the downward trends slowed.

“[T]hese findings demonstrate that prescribing guidelines and practice

“THIS DEMONSTRATES THE ABILITY OF PRACTICE STANDARDS TO MODIFY PHYSICIAN BEHAVIOUR BUT ALSO HIGHLIGHTS HOW MISINTERPRETATION CAN HARM PATIENTS.”

standards can have immediate and long-lasting effects on physician prescribing. Although most of the changes may be positive (e.g., fewer opioids in the community, a reduction in coprescribed benzodiazepine), incorrect interpretation can increase harms for some patients. Aggressive tapering can have downstream consequences, including people resorting to unregulated opioids for pain relief despite their risks,” write the authors.

People living with chronic pain and opioid use disorder (OUD) in Canada are often unable to access evidence-based treatment, which can reduce effectiveness of treatments for OUD, according to a commentary in the same issue.

“Overcoming barriers – such as siloed care for OUD and chronic pain, and restricted access to allied health services that can improve pain management and OUD outcomes – is

essential to effectively addressing the needs of patients with comorbid OUD and chronic pain,” writes Dr. Kiran Grant, an emergency medicine resident at the University of British Columbia, Vancouver, BC, with coauthors.

They suggest interdisciplinary approaches, such as including pain management specialists in care, could help improve outcomes for people with chronic pain and OUD.

“The effects of a provincial opioid prescribing standard on opioid prescribing for pain in adults: an interrupted time-series analysis” and “Integrating chronic pain management into care for patients with opioid use disorder” are published May 12, 2025. n H

Clinician entrepreneurs can benefit Canada’s health and economy

Clinical entrepreneurs – physicians, nurses, and other health care professionals –who understand Canada’s health care challenges first-hand could help improve the health system and grow the economy, argue 2 physicians in a commentary published in CMAJ (Canadian Medical Association Journal).

“Successful Canadian-controlled private corporations developed by these entrepreneurs could fuel economic growth and help protect the sovereignty of our health care system,” according to Drs. Kumanan Wilson of Bruyère Health Research Institute and University of Ottawa, Ottawa, Ontario, and Dante Morra, founder of the CAN Health Network and a physician with THP Solutions and the University of Toronto, Toronto, Ontario.

However, health entrepreneurs in Canada face many barriers that will need to be addressed. These include lack of product fit for the market; risk aversion and fear of failure; financing challenges, such as access to capital for start-ups; complex intellectual property protection; and conflict of interest concerns.

THE

AUTHORS RECOMMEND CREATING CLINICIAN ENTREPRENEURSHIP PROGRAMS IN ACADEMIC CENTRES, ANALOGOUS TO CLINICAL SCHOLAR PROGRAMS FOR

SCIENTISTS.

“Even if a clinician entrepreneur is successful in creating a business, Canada does not have a successful record of supporting Canadian-controlled companies, and competition from international companies can be difficult to overcome,” the authors write. “Finally, there is the concern of clinicians leaving practice while Canada faces a crisis in health human resources.”

The authors recommend creating clinician entrepreneurship programs in academic centres, analogous to clinical scholar programs for scientists. These programs would provide business expertise to clinicians interested in entrepreneurship and create academic recognition and incentives for entrepreneurship. The programs could work with local business accelerators to create health-care-specific partnered en-

trepreneurship programs, pairing people with business expertise and clinicians to co-found companies. Changes in public health system procurement policies are key to ensure adoption of solutions created by Canadian entrepreneurs.

“Leveraging and training talented, motivated clinicians to work with partners to build successful companies can produce useful solutions to important health care problems and generate revenue to sustain our health care system. This requires a fundamental cultural change to how Canada’s health care and academic enterprise views the role of clinicians as entrepreneurs, who can drive much-needed change in Canada’s health care systems.”

“Clinician entrepreneurs should be supported to address Canada’s health care challenges” was published May 20, 2025. n H

By Shauna Mazenes

arold Harris has always led an active life.

H Robotic-assisted partial knee replacement transforms life of patient

From directing films to playing tennis and even making music, his passion for movement was undeniable.

However, arthritis in his knee gradually eroded his ability to enjoy these activities, leaving him struggling with everyday tasks.

“When you lose your mobility, it’s unexpected – no matter what age you’re at,” says Harold, 71.

That changed in late April when he became one of the first patients in Canada to undergo a robotic-assisted partial knee replacement at UHN. This cutting-edge procedure, performed in UHN’s Sprott Department of Surgery at Toronto Western Hospital, promises faster recovery and more consistent outcomes, thanks to the precision of robotic technology.

“For those patients who are candidates, partial knee replacements have well-described benefits as a less invasive surgery with fewer complications and higher satisfaction rates,” says Dr. Michael Zywiel, the orthopedic surgeon who led the team performing Harold’s surgery. “But there has been limitations in its adoption because it’s a more technically demanding procedure.

“By applying the latest generation of robotics to partial knee surgery, we’re able to very accurately size and position the implants to get just the right ligament tension and achieve all those benefits.”

Harold’s journey with knee arthritis began just over two decades ago when he tore his ACL playing tennis. While it was initially reconstructed, he tore it again shortly after, forcing him to give up running and tennis.

“For the past 21 years, there’s been a rise and fall in my ability to do things with my legs,” says Harold.

Not only was he unable to do what he loved, but simple tasks such as helping out around the house, going up the

stairs, or carrying his guitar became a daily challenge.

Dr. Zywiel says it’s a common story.

“Knee arthritis or general wear and tear of the knee is not something that can be reversed,” he says. “It’s all about managing symptoms.

“But it gets to a point where patients are miserable on a regular basis and it can really impact quality of life.”

That, he says, is when doctors suggest the option of a knee replacement.

Total knee replacements generally substitute all three compartments of the knee with plastic and metal. Partial knee replacements only deal with one of those affected areas.

A partial knee replacement may be a better option for some patients, as it’s less invasive with an easier recovery and better results. However, partial knee replacements are more difficult to perform and associated with greater risks if done incorrectly.

Dr. Zywiel says potentially up to 45 per cent of patients presenting to knee and hip clinics are considered good candidates for a partial knee replacement. Yet, only five per cent of knee replacement surgeries in Canada are partial. One reason may be because of how finicky and technically-challenging the procedure is.

But the VELYS system is changing that. By leveraging such robotics, UHN aims to increase the adoption of this technique across the country, giving more patients access to the benefits of a partial knee replacement.

Scheduled to open in 2028, the new Surgical Tower at Toronto Western Hospital will feature advanced operating rooms designed for complex orthopedic surgeries such as these. The infrastructure will allow for the integration of artificial intelligence, augmented reality and minimally invasive robotic procedures – positioning UHN at the forefront of medical innovation.

UHN performed Canada’s first robot-assisted total knee replacement with the VELYS system in 2023, a surgery led by Dr. Zywiel.

Dr. Michael Zywiel, (C), led the team in UHN’s Sprott Department of Surgery at Toronto Western Hospital as they performed one of the first robotic-assisted partial knee replacement surgeries performed in Canada using the VELYS system.

“FOR THOSE PATIENTS WHO ARE CANDIDATES, PARTIAL KNEE REPLACEMENTS HAVE WELLDESCRIBED BENEFITS AS A LESS INVASIVE SURGERY WITH FEWER COMPLICATIONS AND HIGHER SATISFACTION RATES.”

While the thought of a robot-assisted knee replacement was a daunting one, Harold wasn’t afraid to take the risk.

“Over the last couple of years, it’s certainly gotten worse to the point where I made the decision to have elective surgery to cut a piece of my knee away and get a piece of metal stuck in there,” he says.

“That’s a pretty big decision. But clearly, it was the right thing to do.”

Harold says his experience post-surgery has been nothing short of transformative. He was stunned by how much better he felt almost immediately after waking up.

“It’s fantastic,” Harold says. “The fact that I was able to walk out of the hospital comfortably and function quite well is better than I hoped.”

One week in, his mobility has already significantly improved. Harold is able to walk greater distances, exercise better, and negotiate heavier tasks with minimal pain.

“I’ve had skateboarding injuries that hurt worse,” he jokes, referencing his teenage years.

As he does rehab with a specialist at UHN, Harold looks forward to swimming again and feels good about his recovery.

Now, he wants other Canadians to know that having access to a procedure like this is a gift.

“The fact that no matter where you’re at in terms of your money, your status – if you’re Canadian – you have as much opportunity as the next person to have a better quality of life,” he says.

“And that’s pretty incredible.” n H

Shauna Mazenes works in communications at UHN.

Photo: Courtesy Michael Zywiel.

AHEAD Program bridging gaps

in pulmonary fibrosis care across Canada

By Beatrice Politi

If he didn’t have a nurse educator in his Winnipeg office, community-based respirologist Dr. Lawrence Homik, knows his pulmonary fibrosis patients would not be nearly as well served.

“It’s tremendously helpful. There is a gap,” says Dr. Homik. “Clinicians can spend the time they need to make the diagnosis, but patients need to hear more about the impact it will have on their lives. Pulmonary Fibrosis is serious, and a potentially fatal condition, and it’s a great help to have someone who can spend a little more time reinforcing the diagnosis, the ins and outs of management choices, helping to access timely care dealing with any side effects that might occur, answering questions and directing them to other resources like support groups.”

The nurse educator is made possible through the Access to Health Education and Disease Management (AHEAD program) with unrestricted support from Boehringer Ingelheim Canada. Allied healthcare professionals (AHCPs) work within clinics to support patients living with interstitial lung disease (ILD).

ILD refers to over 200 lung disorders involving damage to the interstitium, the tissue supporting the air sacs. Inflammation and scarring disrupt gas exchange, resulting in shortness of breath and cough. Causes include autoimmune diseases, environmental factors, and genetics, but some cases have unknown causes. The damage can become irreversible, affecting lung function.

Aiming to improve patient outcomes, Boehringer Ingelheim Canada launched the AHEAD ILD pilot program in December 2024. The program seeks to achieve this by improving timely diagnosis and condition management, while also reducing the burden on patients through enhanced access to health resources for education, symptom control, management adherence, and life planning. Over the course of the last six months, ten ILD

programs have been running concurrently across the country.

“Those who have progressive pulmonary fibrosis, a term used to describe ILD that exhibits a specific pattern worsening over time, have limited life expectancy and need support to manage as best as possible,” says Dr. Homik.

Immediately following a diagnosis, the program works by providing patients with an hour-long meeting with an AHEAD nurse educator to discuss the diagnosis, provide patients with information about the management options and address questions. The nurse educator then serves as an on-going navigator, coordinating and monitoring frequent blood work, adherence to management plans, and directing questions to ensure timely answers.

“Patients living with ILD benefit greatly from the support provided by allied healthcare professionals. These professionals offer counseling, access

to pulmonary rehabilitation and management plans, and connect patients with a range of essential education and services, including transportation, home care, support groups, and emotional support,” says Dr. Rasha Eldesouky Abouelabbas, Vice President, Medical and Regulatory Affairs, Boehringer Ingelheim Canada.

Dr. Homik is grateful for the unrestricted support from Boehringer Ingelheim Canada. He would like to see other hospitals and clinics adopt the program but acknowledges “the barrier is just getting support for these sorts of things.”

Preliminary evaluation survey results of the AHEAD ILD programs running in Canada suggest this project has addressed a gap or need in the clinic, improved daily workflow and led to positive behavioral changes in participants.

This spring, when surveyed, clinicians reported that participating

clinics unanimously (100 per cent) experienced improved access to helpful information, resources, disease management, and overall quality of life. “We know that patients do better when they have the education and resources at their fingertips,” says Dr. Eldesouky.

Dr. Homik sees so much value in the program that if the support for the nurse educator in his office were to disappear, “I would probably do it out of pocket. It is simply better healthcare. That matters.”

Boehringer Ingelheim Canada is dedicated to addressing critical gaps in the healthcare system. Programs such as AHEAD contribute to better health outcomes and strengthen the overall infrastructure of healthcare delivery, ensuring that people living with ILD receive the support they need.

To learn more about Boehringer Ingelheim Canada, please visit www.boehringer-ingelheim.com/ca n H

The Structural Heart Program at St. Michael’s Hospital makes history

St. Michael’s Hospital performs 10 TAVIs in a day, paving the way for more efficient care, faster healing

By Jade Vyfhuis & Marlene Leung

n the Hybrid Operating Room at St. Michael’s Hospital, lights reflect off polished instruments, staff scrub in with practiced movements, and patients wait, moments away from their heart procedures. A landmark day begins.

In just eight hours, the Structural Heart team will have changed the way Transcatheter Aortic Valve Implantation (TAVI) is done in Toronto. TAVI is a minimally-invasive procedure that replaces a narrowed or leaking aortic valve. While high-quality TAVI procedures are routinely done at St. Michael’s Hospital, what the team is aiming to improve is how efficiently TAVI is performed, how resources are used, and how the hospital operates as a whole.

In recent years, the demand for catheter-based procedures has surged, and the patient population for TAVI has grown rapidly. This need has driven the adoption of a new, more efficient workflow at St. Michael’s Hospital, a globally-recognized leader in Heart, Lung and Vascular care.

TAVI is a less invasive way to replace a damaged aortic valve that helps to restore proper blood flow to the body. Doctors guide a new heart valve into place through a catheter, typically inserted through the leg. For patients with severe aortic ste-

nosis, TAVI offers a safer alternative to open-heart surgery, with a faster recovery time.

The Structural Heart Team is aiming to perform 10 TAVIs in a single day, something that has never been done before in Canada. This ambitious goal comes with significant considerations, from logistical hurdles to ensuring patient safety. Each patient’s journey has been customized to meet their individual needs for optimal recovery. Each TAVI procedure takes a specialized team, advanced imaging, and careful post-procedure monitoring. As well, the team and hospital must ensure that enough procedural rooms and recovery beds are available.

A transport nurse wheels the first TAVI patient into the prepped OR. After months of planning and preparation, every team member stands ready to play their part. The Structural Heart team wants to set a new standard of care within the Canadian healthcare system.

“The St. Michael’s Hospital Heart, Lung and Vascular program is committed to delivering high quality and efficient care, designed around the unique needs of each patient,” said Senior Clinical Director Desa Hobbs. “We are committed to advancing and evolving how we operate to increase access to world-class care. It is truly a team approach, everyone is invested in creating outstanding patient experi-

ences while leading the way in creating more efficient models.”

THE SWING

Dr. Neil Fam, Director of the Structural Heart Program at St. Michael’s Hospital, sees a future where TAVI procedures are performed more efficiently, improving patient care and reshaping medical practices. Key to this vision is the Swing Room approach – a widely used method in hospitals that use two operating rooms at the same time to make better use of resources.

“Given our excellent outcomes with TAVI, demand for the procedure is growing,” said Fam. “We started with two a day, then four, then five, and now six a day seems to be the limit in a single room without incurring overtime. By using two adjacent rooms, we can treat more patients in a shorter time, making the most efficient use of hospital resources and reducing our waitlist at the same time.”

At St. Michael’s, implementing the Swing Room will allow more patients to receive care in a shorter amount of time. The approach uses resources in the most efficient way possible by engaging different teams in the OR and across the Heart, Lung and Vascular program – including the TAVI team, Catherization (Cath) Lab technicians, Anesthesia, Perioperative staff, and Nursing. This way, each procedure has the best staffing

support possible to deliver highquality patient care.

While each TAVI procedure takes about 20 minutes, another 30 minutes is needed to prepare the OR for each new patient.

As one procedure is underway, with doctors and Cath Lab technicians focusing on the case, the perioperative team and OR staff prepare the adjacent OR for the next patient. Once the first TAVI is complete, Fam is able to scrub in again and immediately proceed to the adjacent OR to start the next TAVI without delay.

This allows for a smooth transition between patients, reducing wait times and keeping the day running efficiently.

The day was the result of careful interdepartmental collaboration, planning and training, says Jordana Radke, clinical nurse educator.

“Nurses played a key role in room mockups, equipment planning, and workflow design to ensure the space could safely and efficiently support TAVI procedures. Our cardiac technicians completed extensive training on new X-ray and hemodynamic systems, bringing the technical expertise essential to the day’s success,” Radke said. “This achievement was a true team effort – every discipline contributed their expertise and dedication to ensure patients received the safe, efficient, and high-quality care that St. Michael’s is known for.”

Photos: Yuri Markarov

HISTORY MADE

If you blink, you might miss it. As the clock inches towards 3 p.m., the Structural Heart Team gathers outside the OR doors, leaning in, trying to catch a glimpse of history in the making.

Yuri Markarov, Unity Health’s corporate photographer, scans the hallway for a clock to capture the exact moment of this milestone. In the OR, the catheter glides into position, the replacement valve poised for its final destination.

Then, in an instant the valve unfurls like a blooming flower, expanding within the aorta. A heartbeat later, it locks into place, restoring the rhythm of life.

TO THE FUTURE

“We could’ve done 12,” a team member says after completing the final TAVI of the day. It’s a statement that speaks volumes – not just about what was accomplished, but about what’s possible.

Like athletes striving for their next personal best, this team is always

looking ahead, pushing boundaries, and finding ways to do more for their patients.

After completing 10 TAVI procedures in a day, the goal is to make this a regular practice at St. Michael’s Hospital, offering it once a month. This approach means faster recoveries, shorter hospital stays, and better care for patients.

“This was a landmark day for St. Michael’s Structural Heart Program –10 TAVIs by 3 p.m., three patients went home the same day, with excel-

lent outcomes,” said Fam. “This is only possible with a great team that is passionate about the work they do every day. Our team never stops looking for innovative ways to deliver care to our patients-the best is yet to come!” This was possible with the support of donors Walter and Maria Schroeder and the Schroeder Family Foundation, Joe Vitale, Aldo di Felice, Canadian Italian Business Professionals Association, Ruggiero Family Foundation, St. Michael’s Foundation’s President’s Council, and so many others. n H

First patients in Canada enrolled in global radioligand therapy trial for metastatic cancer

One year after becoming the first centre to open a global clinical trial of a radioligand therapy for metastatic prostate cancer, the MUHC is now offering a second trial of the same kind – this time for patients with other advanced cancers – marking another promising step forward in precision nuclear medicine.

Patients with advanced pancreatic, lung or breast cancer at the McGill University Health Centre (MUHC) are the first in Canada to test the safety and efficacy of a new radioligand cancer therapy. Unlike chemotherapy, immunotherapy or traditional radiation therapy, radioligand therapy (RTL) uses elements called ligands and radioisotopes to target and kill cancer cells, wherever they are in the body. The drug tested in this international clinical trial has shown significant antitumour activity in preclinical studies and produced positive results in the trial’s first phase.

In this phase 2 of the so-called LuMIERE clinical trial, sponsored by Novartis, the investigative drug – [177Lu] Lu FAP 2286 – will be administered intravenously, either as a monotherapy in patients with pancreatic ductal adenocarcinoma (PDAC), non-small cell lung cancer (NSCLC) or breast cancer, or in combination with chemotherapy in patients with untreated PDAC or relapsed NSCLC.

“We are leading the charge in bringing radioligand therapy to Canadian cancer patients. This trial is a major milestone that reinforces our role as a national leader in nuclear precision medicine. Our goal is clear: to offer new hope and innovative experimental treatment options to patients who have exhausted conventional therapies,” says Dr. Ramy Saleh, medical oncologist at the MUHC’s Cedars Cancer Centre and Medical Director, Oncology Clinical Trials, at the Centre for Innovative Medicine (CIM) of the Research Institute of the MUHC (The Institute).

HOW DOES THE THERAPY WORK?

The investigational treatment specifically targets fibroblast activating proteins (FAPs), which are produced by cancer-associated fibroblasts –groups of cells within the tumour microenvironment that interact with the tumour.

And that’s where the potential of this therapy lies: by honing in on FAPs, it could enhance treatment effectiveness while sparing healthy tissue.

“Radioligand therapy is an exciting new frontier in oncology, and at the MUHC, we are determined to be at the forefront of this revolution. Our commitment is to push the boundaries of cancer treatment and bring cutting-edge clinical trials to our patients here in Quebec and in Canada,” adds Dr. Saleh, also Investigator in The Institute’s Cancer Research Program and Assistant Professor in the Gerald Bronfman Department of Oncology at McGill University.

With this clinical trial, made possible through the collaboration of the MUHC’s medical oncology and nuclear medicine teams, and The Institute’s Centre for Innovative Medicine, the MUHC confirms its commitment to remaining at the forefront of cancer treatment trials, in order to offer the latest therapeutic innovations to Quebec patients and contribute to the advancement of science. n H

“This therapy is designed to zero in on FAPs, ensuring the radioactive treatment reaches cancer cells while sparing normal tissue. This level of precision could redefine cancer treatment as we know it,” explains Dr. Farzad Abbaspour, Head of the MUHC Nuclear Medicine Division within the Department of Medical Imaging. “To confirm the presence of FAPs, patients will undergo PET scan screening with a specialized imaging agent before starting treatment.”

Jade Vyfhuis & Marlene Leung work in communications at Unity Health.

Scientists engineer precision tool for mitochondrial DNA manipulation

Many mitochondrial diseases have been difficult to study and treat due to the inherent challenges in accessing mitochondrial DNA (mtDNA). Now, researchers from Japan have optimized mitochondrial-targeted compounds that can selectively modify the ratio of normal versus mutant mtDNA in patient-derived stem cells. This technology enables the creation of research models with varying mutation loads and demonstrates potential as a therapeutic strategy for reducing mutant mtDNA in patients, offering hope for mitochondrial disease treatment.

Mitochondrial diseases affect approximately one in 5,000 people worldwide, causing debilitating symptoms ranging from muscle weakness to stroke-like episodes. Some of these conditions result from mutations in mitochondrial DNA (mtDNA), the genetic material housed in these organelles. For patients with the common m.3243A>G mutation, which can cause MELAS syndrome (mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes) and diabetes mellitus, treatments remain limited. A fundamental challenge in mitochondrial disease research is that patients typically have a mix of both normal and mutated mtDNA within their cells. This condition, known as heteroplasmy, makes targeted therapies difficult to develop, as the normal-to-mutated mtDNA ratios can vary greatly from tissue to tissue.

Additionally, current basic research into mtDNA mutations faces significant obstacles that stem from a lack of disease models. The complex relationship between mutation load (the per centage of mutated mtDNA) and disease severity remains poorly understood, in part because there are no tools to precisely manipulate heteroplasmy levels in either direction. Without the ability to create cellular models with different mutation loads, scientists cannot ef-

The proposed system can selectively increase or decrease the proportion of mutant to normal (or ‘wild-type,’ WT) mitochondrial DNA, serving as a fundamental tool in mitochondrial disease research and paving the way to novel therapeutic strategies.

NEWLY DEVELOPED SPECIALIZED ENZYMES CAN SELECTIVELY INCREASE OR DECREASE SPECIFIC MUTATION LOADS IN MITOCHONDRIA TO STUDY COMPLEX DISEASES

fectively study how varying per centages of mutated mtDNA relate to disease manifestation.

Against this backdrop, a research team led by Senior Assistant Professor Naoki Yahata from the Department of Developmental Biology, Fujita Health University School of Medicine, Japan, has developed a technology that can modify heteroplasmy levels in cultured cells carrying the m.3243A>G mutation. Their paper was made available online on March 20, 2025, and will be published in Volume 36, Issue 2 of the journal Molecular Therapy Nucleic Acids on June 10, 2025. It was co-authored by Dr. Yu-ichi Goto from the National Center of Neurology and Psychiatry and Dr. Ryuji Hata from

Osaka Prefectural Hospital Organization. In it, they detail the engineering and use of optimized mtDNA-targeted platinum transcription activator-like effector nucleases (mpTALENs) –specialized enzymes that can selectively target and cleave specific DNA sequences.

The researchers first established cultures of patient-derived induced pluripotent stem cells (iPSCs) containing the m.3243A>G mutation and then designed two versions of their mpTALEN systems: one that targets mutant mtDNA for destruction and another that targets normal mtDNA. This bi-directional approach allowed them to generate cells with mutation loads ranging from as low

as 11 per cent to as high as 97 per cent, while still maintaining the cells’ ability to differentiate into various tissue types. “Our study is the first to demonstrate an increase in the proportion of pathogenic mutant mtDNA by programmable nuclease,” notes Dr. Yahata.

Key innovations in their approach included the use of novel non-conventional repeat-variable di-residues and obligate heterodimeric FokI nuclease domains, which enhanced the technology’s specificity and reduced unwanted degradation of off-target mtDNA. The team also employed additional techniques, such as uridine supplementation, to establish stable cell lines with different mutation loads, even those that might typically have a growth disadvantage. “Our results demonstrate that our mpTALEN optimization process created a useful tool for altering heteroplasmy levels in m.3243A>G-iPSCs, improving their potential for studying mutation pathology. This enhanced efficiency also holds promise for using mpTALENs in therapeutic strategies for treating patients suffering from m.3243A>G mitochondrial diseases,” says Dr. Yahata.

Overall, the study represents a significant advancement in mitochondrial medicine for several reasons. First, it provides researchers with multiple isogenic – otherwise genetically identical – cell lines that differ only in their level of heteroplasmy. This allows for a precise study of how mutation load affects disease manifestation. Second, it suggests that mpTALEN technology may become therapeutically valuable for reducing mutant mtDNA load in patients.

“Our proposed method could be adapted for other mutant mtDNAs and may contribute to understanding their associated pathologies and developing new treatments, potentially benefiting patients with various forms of mitochondrial disease,” concludes Dr. Yahata. n H

Photo: Dr. Naoki Yahata from Fujita Health University School of Medicine, Japan

When George sings, life becomes joyful.

It’s impossible not to smile when George is around. That’s because he’s usually playing a guitar and singing a song. And at 99 years of age, he’s been doing that for a long time.

At Christie Gardens, we celebrate George—his career, his personality and his incredible musical gift. A gift that is shared, and received, with joy.

St. Michael’s Hospital performs Toronto’s first robotic mitral valve repair

By Marlene Leung

The surgery took place in St. Michael’s Hospital’s Schroeder BRAIN&HEART

Centre, where a highly coordinated team of surgeons, anesthesiologists, nurses, and perfusionists worked seamlessly to repair a patient’s mitral valve using state-of-the-art robotic technology. Global News highlighted the achievement in their national broadcast.

St. Michael’s Hospital, a site of Unity Health Toronto, offers world class specialty programs for the most complex and urgent cases, including minimally invasive cardiac surgery and pioneering robotics in neurosurgery, stroke care and more.

“We have been dedicated to advancing our minimally invasive cardiac surgery program over the past four years, and the introduction of a robotic platform is a significant step forward,” said Dr. Gianluigi Bisleri, Director of Minimally Invasive Cardiac Surgery in the Heart, Lung, and Vascular Program. “This technology enhances precision, reduces patient trauma, and improves recovery times.”

PRECISION AND INNOVATION IN ACTION

Working as a team, Cardiac Surgeon Dr. Daniel Burns stood by the patient directing the procedure’s prog-

ress, while Bisleri – the Joseph Vitale and TLN Media Group Chair in Minimally Invasive Cardiac Surgery – operated the robot from a nearby console.

The robot’s instruments, introduced through small chest incisions, translated Bisleri’s precise hand movements into delicate, controlled actions within the patient’s chest.

The robotic system provides a magnified, high-definition view of the heart, allowing for meticulous surgical precision.

“The clarity is astounding,” remarked Burns, describing the enhanced visibility of the mitral valve. “Additionally, the wrist action of the robotic console allows improved dexterity when completing the valve reconstruction.”

Having both surgeons involved in the procedure facilitates discussion on repair execution, as well as support for completion of the repair itself.

Compared to traditional open-heart surgery – which requires dividing the

breastbone – robotic mitral valve repair results in smaller incisions, less trauma, shorter hospital stays, and faster recoveries. “This is a game-changer, particularly for the crucial first weeks of healing,” Burns noted. “Compared to a conventional approach, we expect the patient to return to normal activities by about two weeks after the procedure, much earlier than with a conventional approach.”

A COLLABORATIVE EFFORT

The successful introduction of this robotic procedure followed months of rigorous preparation, training, and simulations. The team carefully adapted their workflows, refining every aspect – from optimal equipment placement in the OR to managing additional surgical instruments and cables.

Additionally, the combined robotic expertise from both Bisleri and Burns allowed a seamless transition to the robotic platform. “Coming from a busy robotic practice, it has been a delight to help grow and develop this program with the team at St. Michael’s Hospital, and I look forward to this program’s future,” said Burns.

“It truly takes a village,” said Registered Nurse Sarah Lam, emphasizing the teamwork required to integrate this cutting-edge approach safely and effectively.

In a groundbreaking milestone for cardiac surgery, St. Michael’s Hospital has become the first in Toronto to successfully perform a robotic mitral valve repair. This achievement places the hospital among a select few in Canada offering this advanced, minimally invasive procedure.

Dr. Rod Bremner, a Senior Investigator at the Lunenfeld-Tanenbaum Research Institute, part of Sinai Health, with Dr. Danian Chen, a Scientific Associate and the first author of the study that found cell cycle length as a key mechanism of cancer resistance.

To ensure the highest level of patient safety, St. Michael’s has structured its robotic program with multiple specialists available at every stage.

“This setup allows us to operate as a cohesive, adaptable unit, ensuring a safe and predictable approach to these complex procedures,” added Bisleri.

Going forward, Bisleri and Burns plan to work as a unit, with both taking on the bedside and console roles respectively, supporting the development of a true surgical robotics team.

LOOKING AHEAD

Four hours after the surgery began, the operation concluded successfully, with the patient expected to return home within days.

“This marks a pivotal moment for St. Michael’s Hospital’s Heart, Lung and Vascular Program,” said Bisleri.

“We have built a team capable of tackling the most challenging cardiac cases, and with this robotic technology, we are redefining how minimally invasive heart surgery is performed. As one of Canada’s highest-volume cardiac centers, we are committed to expanding our robotic program and bringing its benefits to more patients.”

This milestone underscores St. Michael’s Hospital’s leadership in innovation and its ongoing commitment to improving patient care through cutting-edge technology. n H

Marlene Leung works in communications at Unity Health.

Research reveals why some cells are more susceptible to cancer

The ability of mutations to cause cancer depends on how fast they force cells to divide, Sinai Health researchers have found.

The study, led by Dr. Rod Bremner, a Senior Investigator at the Lunenfeld-Tanenbaum Research Institute, part of Sinai Health, has identified cell cycle length – the time it takes one cell to divide into two daughter cells – as a critical factor in determining whether a mutation actually drives cancer or is completely harmless.

The research findings, published today in Nature, have implications for developing new treatments that enhance the body’s natural defences against cancer.

Cancer starts when cells acquire genetic mutations that prompt them to proliferate out of control, forming tumours. Not all cells that carry such mutations will turn into cancer, however. This is because the body has evolved ways to prevent cancer from forming by neutralizing or destroying the suspect cancerous cells. The protective mechanisms include apoptosis, or programmed cell death and clearance by the immune system, among others.

“An average adult has millions and millions of cells which have mutations in them, yet thankfully, we don’t develop cancer all the time,” said Dr. Bremner, who is also a Professor in the Departments of Ophthalmology and Laboratory Medicine & Pathobiology at the University of Toronto.

Now, Dr. Bremner and team have identified the speed at which mutated cells divide as another mechanism of cancer resistance.

Spearheaded by Dr. Danian Chen, Scientific Associate, their study shows that mutated cells that divide rapidly and have shorter cell cycles are more prone to turning cancerous. In comparison, those with longer cycles exhibit resistance. The finding was consistent across various tissues and types of cancer, including retinoblastoma, pituitary cancer, and lung cancer.

The researchers also found that most mutation-carrying cells eventually exit the cell cycle and stop dividing.

Dr. Bremner explains, “The most common way that mutated cells escape cancer is just by becoming normal cells. They divide abnormally a little bit and then they stop and look like any other normal cell.”

To explore the relationship between cell cycle length and cancer, the team examined the effect of suppressing cancer by introducing known tumour-suppressing mutations in several preclinical models. They began by targeting retinoblastoma, a cancer of the retina, and observed that every manipulation that blocked cancer increased cell cycle length. Most importantly, they then discovered that the mutated cell type from which retinoblastoma originates divides faster than mutated cell types that never form cancer.

Other experiments showed that slowing down the rate of cell division suppressed cancer independently of

other known resistance mechanisms, such as apoptosis and immune clearance, indicating that cell cycle length is a distinct mechanism of cancer resistance.

The team also demonstrated that in other tissues, such as the lung and pituitary gland, cancer consistently develops in the mutated cell type that divides the fastest, while those with slower division rates are protected from cancer. Furthermore, the researchers showed that the cell cycle length consistently predicts the cancer cell of origin, regardless of when the tumour-suppressing mutation was introduced.

Combined, the findings suggest that interventions targeting cell cycle length could be a strategy for cancer prevention. By targeting the cell cycle length, it may be possible to develop therapies that prevent the initiation of cancer in high-risk individuals.

“Our work suggests that we might be able to intervene in cancer-prone cells to slow them down a little bit with the right therapeutic agents. But first, we need to understand the mechanisms governing cell cycle rate in different cell types. There’s definitely a lot to be learned from the trillions of cells that are resistant to cancer, and we have only just got started,” said Dr. Bremner.

The research was supported by grants from the Canadian Institutes of Health Research and the Krembil Foundation, and also a Rankine Family fellowship to Dr. Chen. n H

Photo: Katie Cooper

Pharmacy is everywhere healthcare happens: a new era for pharmacy professionals

By Katie Hollis and Jody Ciufo

You can find pharmacy anywhere healthcare happens. It’s easy to picture the pharmacist behind a counter, diligently checking doses and ensuring patients get the right medications. But today, that image is only a small snapshot of the bigger picture. Pharmacy professionals are now everywhere – embedded in family health teams, hospitals, working in long-term care homes, visiting patients in their own homes, supporting digital health initiatives, and even helping shape healthcare policy.

In short, pharmacy is evolving, and so are the people who practice it.

Over the past few years, especially since the COVID-19 pandemic, healthcare-systems across Canada have been tested like never before. Staff shortages, stretched resources, and changing clinical landscapes have

made it clear that healthcare needs to adapt – and pharmacy professionals have stepped up in a big way. From expanding roles in primary care to leading medication safety in “hospital at home” models, pharmacists and pharmacy technicians have shown that their impact reaches far beyond traditional hospital walls.

And our national professional association is evolving right along with all this change.

The Canadian Society of Hospital Pharmacists (CSHP) has long been the go-to voice for hospital pharmacy in Canada. But here’s the thing: we’re far more than hospital pharmacists. That’s why, in a bold step forward, CSHP has changed our name to better reflect the diverse roles and settings pharmacy professionals now occupy as the Canadian Society of Healthcare-Systems Pharmacy/Société cana-

dienne de pharmacie dans les réseaux de la santé.

Why the change?

We’re not just working in hospitals – we’re embedded across the entire healthcare system. From primary clinics to remote community care up north via telehealth, from acute care in hospitals to Canadian Air Ambulance, in multidisciplinary oncology clinics to enabling drug access to patients as Drug Access Navigators, pharmacy professionals are essential in every corner of care. The new name acknowledges that shift and embraces the full spectrum of where and how we serve.

CSHP has been steadily expanding its reach and inclusivity. In 2022/23, for example, pharmacy technicians were welcomed as full members of the Society – a recognition of their growing role and regulatory authority in many provinces. And across the country, legislative reforms are opening new doors, enabling pharmacists and pharmacy technicians to collaborate and lead with more autonomy than ever before.

These changes matter, not just because they empower professionals, but because they lead to better outcomes for patients.

Throughout this evolution, CSHP has been a steady source of connection and support. Whether it’s networking

through communities, learning at conferences, or publishing in the Canadian Journal of Hospital Pharmacy, the Society brings pharmacy professionals together to learn, collaborate, and advocate. That sense of community – sharpened and strengthened during the pandemic – continues to grow.

And as the organization grows, so does its role as a national voice for the profession. A modern, inclusive name gives CSHP more power when it comes to advocacy and public engagement. It helps the Society speak for all pharmacy professionals – pharmacists, pharmacy technicians, and students – no matter where they work or who they serve.

Of course, change can be challenging. But just as we adjust a patient’s treatment when their goals shift, we need to adjust the way we define ourselves as a profession. The old name served us well for more than 75 years. But it’s time to move forward with something that captures who we are –and where we’re going.

So, whether you’re working on the frontlines of a hospital ward, collaborating in a primary care team, virtually delivering care, or supporting system-wide medication safety and access strategies – this is your Society, and this is your moment.

Let’s step into the future together. n H

Jody Ciufo, MBA is the Chief Executive Officer at CSHP and Katie Hollis, BScPhm, MHA is the CSHP President.

Jody Ciufo

Katie Hollis

Pharmacy professional collaboration in motion in air and on ground, wherever care goes

By Mathew Demarco

With a mandate to deliver life-saving critical care transport to over 14 million patients across more than one million square kilometres of Ontario’s vast and diverse geography, Ornge plays a vital role in the province’s healthcare system. From remote First Nations communities in the north to urban trauma centres in the south, Ornge’s 14 bases – equipped with eight fixed-wing 12 rotor-wing aircrafts, and 13 land ambulances – provide over 20,0000 emergent and non-urgent medical transports per year to patients with critical care needs. These services bridge the gap between location and access, ensuring that all Ontarians, regardless of geography, can receive timely, specialized care.

THE PHARMACIST’S ROLE IN SAFE AND EFFECTIVE MEDICATION USE AT ALTITUDE

As the clinical pharmacist overseeing Ornge’s medication use processes, I play a central role in supporting and advancing safe and effective practices across the organization. My main responsibilities span medication safety policy development, aligning medical directives with best practice evidence for the medications Ornge administers, or designing drug information or online education to support advanced care and critical care paramedic continuing education needs. Additionally, during periods of critical drug shortages, I have led the implementation of inventory monitoring communications and contingency protocols to uphold patient care standards.

Recognizing the complexity of highalert medications-the most harmful medications when used in error-coupled with the stressful and challenging environments that Ornge’s patient care takes place. I have created policies that govern Ornge’s practices across the province. These policies include every stage of the medication

use process for these medications –from storage, labelling, transport, prescribing, preparation, administration, and patient monitoring. For example, to minimize errors while urgently administering medications, Ornge has standardized medication orders, IV pump concentrations, dosing, mixing IV formulations, and administration protocols. Since I began working at Ornge in 2014, I have had the opportunity to continuously implement these safeguards to mitigate medication errors by analyzing Ornge’s error data against national safety guidelines from the Institute of Safety Medication Practices (ISMP).

Through this comprehensive medication safety framework and the continuous pursuit for quality improvement, my work as a pharmacist has supported Ornge in achieving and retaining its status as “Accredited with Exemplary Standing” from Accreditation Canada since 2018, signifying our commitment as healthcare-systems pharmacy professionals to providing high-quality air ambulance and critical care transport services to Ontario’s patients.. It also highlights the transformative thinking required to re-imagine best practices for patient safety at altitude, in high stress environments, or wherever patients need us to go to deliver innovative, safe, high-quality patient care.

CENTRAL OPERATIONS: REGULATED PHARMACY TECHNICIAN EXCELLENCE FROM THE GROUND UP

To maintain a province wide reach, each base must be ready at a moment’s notice. This includes maintaining a consistent and safe supply level of medications, medical supplies, and equipment. Supporting these efforts is Ornge’s central pharmacy, and equipment is based out of the warehouse in Oakville, Ontario. It’s here that regulated pharmacy technician Catherine Dawes supports frontline operations and patient care throughout the province. From this hub, she procures, prepares, and distributes medications and supplies to Ornge bases across the province. She ensures helicopters, planes, and ambulances are stocked with the medications required for high-acuity patient transport.

Catherine meticulously maintains inventory and drug distribution across broad geography while adhering to cold chain, stability, and storage requirements. She communicates critical drug shortages, coordinates restocking, and responds to urgent resupply requests in real-time. Her role is also vital in working collaboratively to design and implement many of the safeguards we have introduced in the past decade. Her expertise regarding high alert medication storage,

standardizing packaging and labelling that work to minimize the chance of mediations errors for patients during transport is truly invaluable.

A recent career highlight for her included being awarded the national Pharmacy Technician of the Year from the Canadian Association of Pharmacy Technicians for her work during the COVID-19 pandemic with Ornge. She was recognized for travelling with Ornge paramedics to remote regions in Ontario where she conducted screening and administered COVID-19 vaccinations in Indigenous communities. Our work exemplifies how collaborative healthcare-systems can extend beyond four walls to mobile, high-risk healthcare environments. It is through our teamwork and collaboration that we are successful as a healthcare-systems pharmacy team in ensuring medications are always clinically appropriate, safely handled, and readily available across Ornge’s operations. From implementing and evolving high alert medication standards and safeguards to managing inventory in a complex environment, we maintain system integrity and ensure it follows each patient care journey throughout the province. Teamwork is what allows Catherine and I to demonstrate that healthcare-systems pharmacy happens anywhere healthcare happens – even thousands of feet in the air. n H

Mathew completed his entry-level PHARM D degree at the University of Waterloo in 2011 and has worked as a clinical pharmacist employed at Ornge since 2014.

By Eli Tran and Tina Thomas

A Antimicrobial stewardship at a distance: How telepharmacy is fighting superbugs in hospitals across Canada

ntimicrobial resistance develops when bacteria no longer respond to the drugs we use against them. This is a growing concern both globally and in Canada, with Public Health Ontario identifying it as a major public health issue. If antibiotics are used inappropriately, bacteria can adapt to them and become harder to treat. In today’s global community, that puts everyone at risk, including patients in smaller and remote hospitals in Canada.

In many parts of our country, especially in the north, hospitals often face staffing shortages, including limited access to antimicrobial stewardship pharmacists, who are trained in how to best use antibiotics. This poses a major challenge for treating infections safely and effectively, particularly in hospitals where resistance is high.

However, telepharmacy (pharmacy services delivered remotely) can narrow the divide, allowing many hospitals to receive the support they need to optimize antibiotic use through a growing practice in Canada called telestewardship. It’s one way healthcare teams are working together, even across long distances, to protect patients and improve healthcare quality.

The expansion of North West Telepharmacy Solutions’ Antimicrobial Stewardship Program (NTS ASP) includes the management of hospital pharmacy operations throughout Canada, including remote areas where on-site antimicrobial stewardship expertise may not always be available. Remote pharmacists are helping to bridge that gap.

Originally launched in 2013 and implemented at over a dozen small hospitals, the program was revitalized and reintroduced in late 2024. The updated program now coordinates antimicrobial stewardship initiatives at three new hospitals of varying sizes across Canada. While each site is at a different stage for stewardship, all

IN MANY PARTS OF OUR COUNTRY, ESPECIALLY IN THE NORTH, HOSPITALS OFTEN FACE STAFFING SHORTAGES, INCLUDING LIMITED ACCESS TO ANTIMICROBIAL STEWARDSHIP PHARMACISTS, WHO ARE TRAINED IN HOW TO BEST USE ANTIBIOTICS.

are benefiting from consistent guidance on using antibiotics wisely and safely, with strategies tailored to each hospital.

At Norfolk General Hospital, one of the participating sites, the collaboration has already shown early success.

“the program has been a transformative step forward for our hospital,” says Roger Ma, Director of Pharmacy.

“As a community-based acute care facility, we face the common challenge of balancing limited resources with growing expectations for robust stewardship practices. NTS has provided a high-impact, collaborative solution to that problem.”

What’s sometimes overlooked is that smaller and remote hospitals can face just as much pressure from resistant organisms. In fact, in some underserved communities, such as First Nations populations in northern regions, infection-related illnesses are a leading cause of hospitalization. After

accounting for the number of patients and how long they stay, antibiotic use at these hospitals can actually match or even exceed rates at larger Canadian teaching hospitals.

That’s where telestewardship comes in. Remote pharmacists support onsite staff by reviewing antibiotic use and helping ensure they are selected, dosed, and timed as effectively and safely as possible. This might mean suggesting more targeted antibiotic options, reviewing lab results, or deciding when a drug is no longer needed. For smaller hospitals, stewardship might translate to more customized strategies, like stocking the right drugs, and using the right treatment guidelines. But stewardship is more than just numbers and drugs. It’s also about communication and teamwork.

Even while working remotely, remote pharmacists can stay closely connected with local hospital staff. They collaborate daily with doctors, nurses,

and on-site pharmacists, providing recommendations and making care decisions together. That partnership helps ensure that high-quality care is delivered, regardless of where the pharmacist is located. In fact, over 90 per cent of the program’s care recommendations are accepted by on-site physicians at participating hospitals, speaking to the existing degrees of trust and collaboration. And involving and educating on-site staff helps make stewardship efforts more sustainable, building local capacity so that hospitals can carry this work forward, with stronger teams on the ground.

Roger Ma shares this sentiment towards the program: “ brings a collaborative culture that strengthens our internal team’s confidence and capacity. They deliver both value and vision. Their pharmacists are not just external consultants – they are trusted members of our extended care team.”

The program’s team is also broadening their stewardship efforts beyond hospitals, working with primary care providers to share guidance on antibiotic use with family health teams. Since the majority of antibiotics are prescribed in outpatient settings, this kind of early intervention can play a key role in preventing resistance before it starts.

Antimicrobial stewardship pharmacists wear many hats: they fine-tune drug therapy, educate healthcare providers, develop institutional policies, collaborate with infectious disease doctors, and analyze antibiotic trends to improve quality of care. It isn’t flashy work, but it makes a real difference, quietly improving patient outcomes and protecting antibiotics for the future.

And thanks to telepharmacy, this kind of expertise can now stretch to patients in places that once seemed out of reach. Because good care doesn’t depend on where you are – it depends on working together, wherever you are. n H

Eli Tran and Tina Thomas are Clinical Pharmacists for North West Telepharmacy Solutions (NTS). Eli Tran is the pharmacist lead for NTS Antimicrobial Stewardship services and Tina Thomas leads NTS pharmacy services at the Sioux Lookout Meno Ya Win Health Centre.

By Alan Birch

Imagine being prescribed a life-changing medication – one that could manage your condition, improve your quality of life, or even save it. But then, reality hits. Will your insurance cover it? How do you apply for financial aid? What if the approval process takes weeks or even months? That’s where a healthcare-systems pharmacy professional working as a Drug Access Navigator (DAN), steps in – quietly working behind the scenes to make sure patients aren’t just prescribed the right medication but actually get it.

THE HIDDEN HEROES OF MEDICATION ACCESS

In Canada’s healthcare system, DANs are often the overlooked problem-solvers who bridge the gap between patients, healthcare providers, insurance companies, and pharmaceutical programs. Their mission? To turn complex and sometimes overwhelming drug access processes into a clear path forward for patients.

This is especially important in fields like oncology, where medications come with a hefty price tag. While support from government programs and private insurance can help, the paperwork and wait times can be

intimidating. This is where DANs shine.

WHAT EXACTLY DOES A DRUG ACCESS NAVIGATOR DO?

Think of a DAN as equal parts advocate, detective, problem-solver, and logistics coordinator. Here’s what they do:

• Navigate insurance and drug coverage options: They assess a patient’s insurance, determine eligibility for public or private drug programs, and handle prior authorizations.

• Secure Financial Assistance: If a medication isn’t fully covered, DANs connect patients with man-

The role of drug access navigators in healthcare-systems pharmacy Primary care that is essentially unique

By Jamison Falk

I’ll be the first to admit that I’ve always been fascinated with interesting styles, different design features, and aesthetically novel ways of doing things. We often refer to these things as unique. At the same time, the practical side of me asks, “are these things really necessary?”

In an environment of stretched health care resources and a primary care crisis, there’s little room for unique if it’s not essential. In 2022, an article published in the Journal of General Internal Medicine quantified what has been perceived to be true about the value of team-based primary care. Simulating the provision of full preventative, chronic, and acute care, team-based care was estimated to save 65 per cent of primary care provider time. Considering the immense time and resource pressures that have put primary care into crisis mode, this potential for massive lightening of physician load is not simply good timing but should be seen as a life preserver for the healthcare system.

But let’s move beyond the lightened load model that also strives for continuous and better patient care. It would, of course, be naïve to assume that simply composing a primary care team of health care professions X, Y, and Z assures better care. Rather, for a team to be of high value, each member must contribute high value care.

As a healthcare-systems pharmacist, I inevitably ask the question of how a pharmacist practices high value care that compliments the care of the multidisciplinary team?

The significant role healthcare-systems pharmacy has in primary care provision has been documented repeatedly for decades, showing not only improved medication adherence, disease risk factor reduction but, more importantly, decreased hospitalizations and emergency room visits. These outcomes are a likely product of the pharmacist’s appropriately worn label of medication manager. While the role is unique, the skill set only becomes truly unique and essential when the pharmacist proactively seeks

out high value care: the role of medication management master takes the stage. A master asks unique questions that others will not, to get to the heart of issues others have not, that lead to unique and essential solutions for patients that link with the needs of the team as a whole.

As a pharmacist in primary care, the baton being passed is often a diagnosis or clinical assessment. The next leg of the race, in order to be run effectively, requires the essential tenets of evidence-based practice to be put into action: understanding of best evidence, assessing the clinical scenario, and engaging in the unique values and preferences of the patient. The nuanced clinical judgment encompassing this paradigm by the pharmacist and, necessarily, the collective team results in the highest chance of providing high-value care. Bypassing this step or approaching it simply with passive reaction to the decisions or recommendations of others without using specialized insightful skill sets will increase the likelihood of low

ufacturer support programs or other forms of financial aid.

• Work Closely with Pharmacy and Healthcare Teams: They collaborate with pharmacists, physicians, and hospital staff to make sure the right medication is approved and delivered without delay.

• Educate and Empower Patients: Beyond paperwork, DANs support patients by explaining their options, advocating for fair access, and even appealing denied claims when necessary.

WHY THIS ROLE MATTERS

In busy hospital and healthcare settings, time and efficiency are criti-

value (or no value) care. Hierarchies, assumptions, and a restrictive system can quickly result in reactive practice which tends to be neither essential for care for the patient, nor satisfactory for the practitioner.

Our best healthcare system models need to seek out what is both unique and essential. For a primary care team to provide high value care, the system around them needs to provide the space for the collective team to learn, adapt and flourish, capitalizing on the unique and essential features of each of its members that make care sharper, smoother, and more effective. Current systems will need to move beyond the satisfaction of delivering a concept developed at the boardroom table to ensuring true integration where all team members know how to optimally practice in their setting and have the support and space to adapt and innovate alongside each other.

Unique is interesting. Unique is fun. In primary care, being essentially unique as a healthcare-systems pharmacy professional is a necessity. n H

Dr. Jamie Falk is an associate professor at the College of Pharmacy, Rady Faculty of Health Sciences. He also practices as an extended practice pharmacist with the Department of Family Medicine at Kildonan Medical Centre in Winnipeg, MB.

cal. Without DANs, pharmacists and physicians would spend even more time tackling paperwork and wrestling red tape. This would delay treatments and take away from time that could be spent directly caring for patients. By taking on the administrative and financial hurdles, DANs allow pharmacists to focus on what they do best – ensuring safe and effective medication use.

More importantly, DANs play a key role in promoting health equity by making sure that access to medication is based on need, not on a patient’s fi-

nancial status or ability to navigate the system.

LOOKING AHEAD: THE FUTURE OF DRUG ACCESS NAVIGATION

As new, high-cost therapies enter the market, the need for skilled DANs will only grow. While digital solutions, AI-driven claims processing, and centralized drug access programs may streamline parts of the process, there’s no substitute for the human empathy, expertise, and advocacy that DANs bring to the table

So, the next time you hear someone say, “I wouldn’t have gotten my medication without my Drug Access Nav-

igator,” you’ll know exactly why this role is essential in healthcare-systems pharmacy. n H

By Clara Elchebly

W Oncology pharmacists: Medication specialists in cancer care

hen you or a loved one is facing cancer, a dedicated team of healthcare professionals works tirelessly to provide patients with the best care. Among these crucial individuals are oncology pharmacists. These are specialized pharmacists who play an essential role in your treatment journey. Most people think pharmacists only count pills or mix drugs, and when I present myself as an oncology pharmacist, the reaction is often one of surprise, as most people are unaware pharmacists play pivotal roles within hospitals and other healthcare-systems settings. So, what does an oncology pharmacist do? Oncology pharmacists specialize in oncology and are involved in many aspects of patient care. This includes ensuring medications are safe and effective, managing potential side effects, taking part in research to develop new treatments, and working to improve overall healthcare-systems pharmacy services.

Whether patients receive their treatment in the outpatient clinic or require a hospital stay, oncology pharmacists are there to support the patient, the oncologist, and nurses. In the outpatient clinic, before patients receive their medication, pharmacists meticulously review their blood tests and prescriptions to ensure proper dosing and administration of antineo-

plastics drugs. The treating team will often consult pharmacists for medication review and drug interaction management, dose adjustments and management of side effects.

When patients begin a new treatment, they will always meet with an oncology pharmacist for a detailed consultation and will have the time and the opportunity to ask all their questions regarding the treatment. Pharmacists also play a crucial role in communication. If needed, they will get in touch with community pharmacists to share important information about treatments, especially with newer therapies like immunotherapy. Because of its mechanism of action and potential grave side effects, it’s vital that all healthcare providers are aware of patients receiving these medications to avoid interacting medications like corticosteroids, which could reduce its effectiveness, in order to promptly recognize and manage any potential immune-related side effects.

On the hospital wards, oncology pharmacists continue to be essential members of the care team. Beyond the typical tasks of a hospital pharmacist, they help coordinate the administration of medications, especially when patients have limited intravenous access or are receiving drugs that are not stable over long periods of time. They ensure that medications are compatible and that patients receive the necessary hydration, which can be signifi-

cant for some treatments (sometimes three or four litres of fluid per day) or require specific measures like urine alkalinization to help the body eliminate the drug effectively. To further personalize treatments, oncology pharmacists may also plan therapeutic drug monitoring to ensure drug efficacy, assess risks of toxicity, or monitor drug elimination, and by adjusting doses based on these results.

As drug specialists, oncology pharmacists are constantly learning about new cancer treatments and new ways to use existing medications. Once a new drug is approved in Canada, it still needs to go through a review process for public funding. During this time, the pharmaceutical companies often have patient support programs to help patients access new therapies sooner. Oncology pharmacists work closely with oncologists and drug access navigators to enroll patients in these programs, to ensure they receive their medication promptly, while monitoring for any side effects, and providing necessary counseling.

Hospitals, including my own workplace, the McGill University Health Centre, are also actively involved in clinical trials, which are crucial for developing the next generation of cancer treatments. Oncology pharmacists play a key role in this field by reviewing protocols with the hospital ethics committee, ensuring proper drug preparation and administration, managing

side effects, and taking part in audits by pharmaceutical companies and Health Canada to ensure the research is conducted properly.

Beyond direct patient care and research, oncology pharmacists often take on leadership roles within their hospital, outpatient clinics, their province, nationwide, or even internationally. Locally, they work to create a safe environment by ensuring that hazardous drugs are handled and stored correctly. With hospital directives and governments, they contribute to the development of practice guidelines and make recommendations on healthcare-systems pharmacy practice.

Excitingly, the role of oncology pharmacists is continuing to evolve. In recent years, more jurisdictions have expanded the scope of practice for pharmacists, including oncology pharmacists. Advanced practice agreements have also become more common. Those legislative changes and agreements now allow oncology pharmacists to autonomously prescribe and adjust support medication for patients, ensuring the best care is provided and side effects are managed in a timely fashion. Pharmacy colleges and oncology pharmacy associations are actively working to further advance this field, promising an even greater role for these dedicated healthcare-systems pharmacy professionals in the fight against cancer and the future of cancer care. n H

Alan Birch is the Associate Director of Provider Solutions Oncology at Sentrex Health Solutions, the founder of Drug Access Canada, a pharmacy technician and a Drug Access Navigator.

Clara Elchebly is a Clinical oncology pharmacist at McGill University Health Centre in Montréal, QC.

Pharmacy without walls: Redefining acute care with hospital at home

By Sean P. Spina, Tara McMillan, and Winnie Lam

Hospital at Home (HaH) at Island Health is an innovative model that delivers acute-level hospital care to patients in their homes. Developed to improve clinical outcomes, enhance patient, family caregiver, and healthcare provider experiences, and alleviate pressure on traditional hospital infrastructure, HaH reflects a strong commitment to patient-centered care. Patients and family caregivers have been involved at every stage of the program’s development and evaluation, ensuring that care delivery meets both medical and experiential needs. The care team includes the full complement of interdisciplinary team members that are present in the brickand-mortar hospital. Notably, over 97 per cent of patients and caregivers have reported positive experiences, highlighting the value of receiving high-quality care in the familiar setting of home.

Pharmacy services are deeply embedded in the HaH model, with clinical pharmacists contributing to care planning, Best Possible Medication History to support medication reconciliation, and patient education. Pharmacists provide operational support and customized medication dispensing tailored to the home environment, facilitating safe and effective medication management. Their integration into the interdisciplinary team has significantly reduced drug therapy problems and enhanced continuity of care during transitions from one care environment to another. Impressively, 100 per cent of patients and caregivers surveyed recognized the essential role pharmacists played in their care.

As a learning health system, HaH engaged in quality improvement and research activities to evaluate its impact across multiple domains, including clinical outcomes, patient and

HOSPITAL

AT HOME

(HAH)

AT

ISLAND HEALTH IS AN INNOVATIVE MODEL THAT DELIVERS ACUTE-LEVEL HOSPITAL CARE TO PATIENTS IN THEIR HOMES.

family caregiver satisfaction, and staff experience. Under the leadership of Principal Investigator Dr. Sean Spina, the “Alternatives to Traditional Hospital Care Offered in Monitored Environments” (ATHOME) program team consisted of an interdisciplinary group of patient partners, academic researchers, clinicians, and program leaders.

This program contributed to the development of the model and supported Island Health’s involvement in this emerging area of care. Launched in Victoria, BC, in November 2020 as a grassroots initiative led by the Hospitalist Program with nine virtual beds, HaH has since expanded to 24 virtual beds and one other site on Vancouver Island and has served over

3,200 patients. The program combines virtual and in-person care, and patients keep the same hospital admission status as those in traditional hospital settings.

HaH’s success underscores the value of co-design with patients and families and shows how evidence-based, patient-oriented research can transform care delivery. International recognition of the program speaks to its global relevance and potential for scalability. As healthcare systems around the world explore sustainable, patient-centered alternatives to traditional models, HaH stands out as a blueprint for the future: personalized, responsive, and aligned with the evolving needs of communities. n H

Sean is the Regional Clinical Pharmacy Manager at Island Health and leads the AT-HOME research team as Principal Investigator, evaluating the impact of Hospital at Home (HaH) models on patient care. Tara is the Manager of Research Programs and Facilitation at Island Health and Research Manager for the AT-HOME research team. Winnie is the Pharmacy Operations Manager for the Victoria and Cowichan area hospitals within Island Health. She led the medication management portion of the HaH implementation and introduced the elastomeric IV balls for patient home use.

HHS pharmacy sets national benchmark: First-ever delivery of groundbreaking

$4.5M Hemophilia

Hamilton Health Sciences (HHS) outpatient pharmacy recently made history by becoming the first in Canada to receive a delivery of Hemgenix, a $4.5 million, one-time gene therapy for adults with Hemophilia B, a rare genetic bleeding disorder. The delivery to the outpatient pharmacy at HHS McMaster University Medical Centre (MUMC) involved following a wide range of protocols for receiving and storing this highly valuable drug, and underscores the HHS pharmacy team’s leading-edge capabilities in handling ultra-specialized medications.

HHS outpatient pharmacies serve many specialized patient populations, including patients visiting clinics during the day for appointments rather than staying overnight, and patients being discharged from hospital. There are HHS outpatient pharmacy locations at MUMC/McMaster Children’s Hospital, Hamilton General Hospital and Juravinski Hospital and Cancer Centre.

Hemgenix can dramatically improve the quality of life for people with Hemophilia B. About 800 people in Canada have this disease, where their bodies can’t make enough of the Factor IX protein needed for blood to clot properly. Hemgenix’s effects are often long-lasting with many people having fewer bleeding episodes, or none at all, for years after just one treatment. While Hemgenix is approved for use in Canada, it’s not yet on the market. Ontario Health handles approvals for patients receiving this medication, and covers the cost.

HHS is among Canada’s largest and highest-ranked academic health sciences centers, and is a national leader in gene therapy through involvement in advanced treatments and pioneering research. Our pharmacies are among the few in Canada qualified to handle medications worth several million dollars, which require highly specialized delivery and storage protocols, and advanced inventory tracking.

B treatment

A VERY SPECIAL DELIVERY

Given Hemgenix’s hefty price tag, there’s no room for error when it comes to receiving and storing it, says Wassim Houneini, HHS outpatient pharmacies manager.

Houneini was on hand to personally receive Canada’s first-ever shipment of Hemgenix in April, which involved following standard operating procedures so detailed, the document containing them is almost 50 pages long. “Only three hospitals in Canada are currently receiving Hemgenix, and we were the first,” says Houneini.

THE PLAYBOOK

Standard operating procedures include a temperature-controlled supply chain so the drug stays at the correct temperature at every stage, including transportation, handling, delivery and storage. Hemgenix is shipped from Europe to Toronto, and then transported by a courier to Hamilton. It was a fairly easy drug to transport and store because it didn’t require dry ice packaging or extra-cold storage, says Houneini.

Every handoff from the manufacturer, to the distributor, to the pharmacy was documented and tracked, and the drug could only be accepted and handled by qualified staff who checked to ensure it arrived in a sealed and undamaged tamper-proof container with a tracking number.

Pharmacy staff got advance notice of the delivery, so they would be ready. Upon approval it was immediately inspected, temperature logs were checked, and it was quickly transferred to a freezer for storage.

All steps along the way were logged, including delivery time, the medication’s condition and the staff members involved. Insurance, security and other risk protocols were also in place. And because it’s a personalized treatment, information about the patient receiving it is directly attached to the medication.

BUILT ON KNOW-HOW

This isn’t the first time that the HHS outpatient pharmacy has accepted delivery of a highly valuable medication involving a myriad of protocols, says Houneini, adding that mock de-

livery runs are held to prepare for the arrival of medications like these.

A few weeks before Hemgenix’s delivery, the lab held a mock delivery run using a placebo medication for a different expensive drug also used to treat Hemophilia B. This medication arrived in dry ice, with specialized instructions that included storage at -70° C. A standard lab freezer is -25° C.

“Our storage is able to accommodate this, since we have a -100° C freezer,” says Houneini. However, Hemgenix treats the same patient population with easier storage and compounding requirements. But that dry run helped the team prepare for Hemgenix’s arrival.

The HHS outpatient pharmacy was also the first in Canada to receive and store the gene therapy drug Zolgensma, a $3 million, one-time treatment for kids born with spinal muscular atrophy, a genetic disease that damages the muscles and impairs the child’s ability to move.

“I’m proud of our pharmacy teams across HHS, whose specialized training makes life-changing, lifesaving treatments available to our patients,” says Houneini. n H

S World first: Canadian innovation enhances drug access to brain areas affected by ALS

unnybrook scientists in the Hurvitz Brain Sciences Program made history this week as they non-invasively opened the blood-brain barrier (BBB) to deliver a small dose of immunotherapy directly to the brain of a patient with ALS. This is a world-first achievement.

“As with most drug therapies, the BBB limits or completely blocks access to the brain, impairing target engagement of the most promising therapeutics in patients with ALS,” says Dr. Agessandro Abrahao, co-lead investigator of the clinical trial and a neurologist in the Hurvitz Brain Sciences Program at Sunnybrook Health Sciences Centre. “For the first time in ALS, we were able to temporarily disrupt this barrier in order to allow the drug flow through.”

On the procedure day, the first of six ALS patients received an infusion of immunoglobulin (IVIg), a potential modulator of ALS-related neuroinflammation, followed by an MRI-guided focused ultrasound procedure to open the BBB over the motor cortex on both sides of the brain.

Under the direction of Dr. Nir Lipsman, Sunnybrook’s director of the Harquail Centre for Neuromodulation and chief of the Hurvitz Brain Sciences Program, the research team used the in-house-developed Next Generation Dome Helmet to deliver focused ultrasound, guided by MR imaging. The sound waves from the Dome Helmet non-invasively and temporarily breach the BBB, allowing for the IVIg to successfully enter the brain.

Senior scientist and vice president of research and innovation at Sunnybrook Research Institute, Dr. Kullervo Hynynen, has worked with industry and Sunnybrook partners for over two decades to develop both the initial and the current Next Generation Helmet technology, and bring them to a clinic-ready state.

“This new helmet provides enhanced image guidance, faster treatment times and targeting capacity for the investigation of personalized

therapies for patients with a variety of neurological conditions and diseases of the brain,” says Dr. Hynynen, also a professor in the Department of Medical Biophysics with the Temerty Faculty of Medicine at University of Toronto.

The use of the Dome Helmet under real-time MRI guidance in this current trial is an intermediary step in the development of an MRI-free focused ultrasound device in the future. The benefits of eliminating the need for MRI guidance would include an improved experience for patients, and overcome access and cost hurdles that come with the use of MRI.

“This world-first clinical trial highlights both the promise of focused ultrasound and the impact of technological innovation in medicine,” said Neal F. Kassell, MD, Founder and Chairman of the Focused Ultrasound Foundation. “By introducing this innovative device, we also move closer to providing accessible, personalized treatment options for ALS and other devastating brain disorders, offering new hope to patients worldwide.”

A total of six participants will be included in the first phase of the study, which is testing the safety, tolerability and preliminary biological effects of the enhanced delivery of IVIg to the brain with focused ultrasound.

“As an ALS clinician researcher, I have witnessed numerous promising therapies fail in ALS trials, but many of these drugs had limited-to-no BBB permeability and did not adequately reach the motor cortex where ALS is believed to start,” says Dr. Lorne Zinman, co-lead investigator and director of the ALS Clinic at Sunnybrook, the largest of its kind in Canada. “This innovation could be a game-changer for ALS and after future development, will significantly enhance our capacity to deliver the most promising therapeutics directly to the brain, accelerating our search for more effective treatments.”

Amyotrophic lateral sclerosis (ALS), commonly known as Lou Gehrig’s disease, is a neurodegen-

erative disorder that affects nerve cells in the brain and spinal cord. ALS causes the loss of muscle control, worsening over time and affecting one’s ability to move, eat and breathe. There is currently no cure for ALS, with patients receiving an average life expectancy of two-to-five years after diagnosis. Sunnybrook is home to the largest treatment centre for ALS in Canada.

This research is funded by the Focused Ultrasound Foundation, ALS Society of Canada, Brain Canada and the ALS Association. The research equipment is funded by the Weston Family Foundation, the WB Family Foundation, Gerald & Carla Connor, and the Temerty Foundation. The research has also received significant support from the Canadian Institutes of Health Research and National Institutes of Health. n H

The research team comprised of neurosurgeons, physicists from the focused ultrasound lab, ALS clinician-researchers, imaging research technicians, and anesthesiologist.

Clinicians and researchers in the Hurvitz Brain Sciences Program from left to right: Dr. Pedro Castro, Dr. Isabelle Aubert, Dr. Agessandro Abrahao; Jahan Mookshah, Dr. Lorne Zinman and Caroline Giuricich.

Study investigates efficacy of safety planning interventions for suicide prevention among children and adolescents

Mental health among children and adolescents is a growing concern around the world. In North America, healthcare visits for suicide-related thoughts and behaviours among young people have surged in recent years. One commonly used support tool in hospitals is safety planning interventions – a structured plan developed with patients to help reduce suicide ideation and self-harm behaviours during a mental health crisis. Originally created for adults, safety plans are now used with children and adolescents in hospitals and various clinical settings across North America. But do they work for this age group?

A new meta-analysis, published in JAMA Pediatrics, takes a closer look at the effectiveness of safety planning interventions for suicide prevention in children and adolescents. The study, led by The Hospital for Sick Children (SickKids) in partnership with Nation-

META-ANALYSIS HIGHLIGHTS THE NEED FOR EFFECTIVE INTERVENTIONS THAT ARE TAILORED FOR PAEDIATRIC POPULATIONS.

wide Children’s Hospital, evaluated the impact of these interventions on reducing suicide ideation, self-harm behaviours, suicide attempts, and re-presentation to healthcare settings. The findings showed no significant association between safety planning interventions and reductions in these outcomes, when safety planning was the only intervention used.

“Children and adolescents who seek care for self-harm thoughts and behaviours are at increased risk for suicide attempts, so there is a pressing need for accessible and effective interventions to help these patients,” says Dr. Daphne Korczak, senior author, Staff Psychiatrist and Senior Scientist in the Neurosciences & Mental

Health program at SickKids. “Despite the widespread use of safety planning interventions for suicide prevention, our study found limited evidence supporting their effectiveness for children and adolescents.”

Safety planning interventions are routinely used as treatments for children and adolescents in emergency departments, urgent treatment centres, and crisis hotlines. To help evaluate their efficacy in these settings, the authors conducted a comprehensive review of existing research and examined 10 studies involving more than 1,000 children and adolescents. The meta-analysis of these study findings assessed outcomes including suicide ideation, suicide-related behaviour,

suicide attempts, and return visits to healthcare settings.

“While safety planning interventions have shown promise in adult populations, the needs of children and adolescents may differ. These findings highlight the importance of evaluating whether safety plans should be adapted or integrated with other supports to better meet the needs of younger individuals,” says Jeffrey Bridge, co-author, Epidemiologist and Director of the Center for Suicide Prevention and Research at Nationwide Children’s Hospital.

The authors note that most of the included studies were pilot studies conducted in the United States and call for further research including those in other regions to identify which components of safety planning interventions are most effective in paediatric settings, and how they could be best implemented with other suicide prevention strategies. n H

By Anna Wassermann

N Study shows promise for treating progressive multiple sclerosis

ew research led by a St. Michael’s Hospital clinician-scientist and published in the prestigious New England Journal of Medicine suggests that a therapy called Tolebrutinib could reduce disability progression in people with non-relapsing progressive multiple sclerosis (MS) – a subtype of MS that doesn’t respond well to current disease-modifying therapies.

Tolebrutinib belongs to a new class of medication for anti-inflammatory diseases, called Bruton’s tyrosine kinase (BTK) inhibitors. The drug works by inhibiting the BTK enzyme to reduce activation of B cells that contribute to brain and spinal cord inflammation in MS. It’s also thought to modulate a specific immune cell called microglia, which is linked to MS progression.

The new research, led by scientist and staff neurologist Dr. Jiwon Oh, evaluated the safety and efficacy of Tolebrutinib compared to a different type of medication, called Teriflunomide, in people with relapsing MS – the most common subtype of MS. While both medications showed similar effects on the rate of relapses, Tolebrutinib showed a clear difference in disability progression, suggesting that it targets the mechanisms responsible for progressive disease.

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We sat down with Oh, who’s also the Medical Director of the BARLO MS Program at St. Michael’s, a site of Unity Health Toronto health care network, to learn more about this research, what it means for people with progressive MS and how it could change the treatment landscape.

What was the impetus for this study?

The most common type of MS is relapsing MS, where people present with relapses or attacks – sudden onset of neurological symptoms that tend to get better over time. With progressive (or non-relapsing) MS, people have very slow neurological progression over time and no clear relapses. The greatest clinical unmet need in MS care is a meaningful treatment for progressive MS. There are so many treatments available for relapsing MS but they don’t seem to have a profound effect on progressive disease. We really wanted to find a treatment that gets into the brain and targets some of the unique processes responsible for progressive disease.

What were your findings?

We conducted two phase-three trials (GEMINI I and II) [the final stage of testing before a drug can be used in humans] of people with relapsing MS, and found that Tolebrutinib didn’t meet its primary endpoint, meaning that compared to Teriflunomide, there wasn’t a difference in annualized relapse rate (ARR) – the average number of relapses experienced by patients in a year. Compared to baseline, both drugs reduced ARR. However, despite not showing a difference in reducing ARR, there was a clear difference in reducing disability progression.

These results emphasize what we saw in the HERCULES clinical trial, which evaluated Tolebrutinib in non-relapsing secondary progressive MS, and found that it clearly reduced the risk of disability progression versus a placebo. Even in relapsing MS, there’s disease progression. We usually think that most of the progression in relapsing MS is related to relapses but when you compare two drugs that have a similar reduction in relapse

rate, yet one of them very clearly reduces disability compared to the other, it further highlights the point that it’s targeting progressive disease processes. What was your reaction to the findings?

Right before this study, there were phase three-trials reported on another BTK inhibitor that showed absolutely no effect on relapses or disability progression compared to Teriflunomide. The whole field was so depressed. I was optimistic going into this study, given what we know about Tolebrutinib and how easily it gets into the brain, but because of the recent failure and some of the similarities in drugs of the same class, we were a bit worried. I’m not surprised by the results, but I’m relieved that it showed an effect in both non-relapsing secondary progressive MS and on disability progression, even in relapsing MS. We’ve been talking about this class of therapy with patients with progressive MS for so long, and to be able to tell them that there’s something coming forward that will hopefully help, it’s such a wonderful thing.

What does this mean for people with progressive MS?

It’s really a new era for people with non-relapsing, secondary progressive MS. This population’s almost purely progressive, so to find a drug that’s shown an effect is exciting. More importantly though, this study showed that even many people with relapsing MS are having progressive disease unrelated to relapses. We would’ve loved to see more than a 30 per cent reduction but it’s still exciting to have a treatment that gets into the brain and targets some of the processes that

cause progressive disease, which our existing therapies don’t do. I always say that the first treatments for relapsing MS became available only 30 years ago, and at the time, they reduced relapses by about 30 per cent. Today, the efficacy is closer to 70 to 90 per cent; that’s how far we’ve come in 30 years. In a way, this is the same beginning for progressive MS as it was 30 years ago for relapsing MS. Seeing that Tolebrutinib has a 30 per cent effect on progressive disease processes is incredible. For nearly 10 years, we’ve recognized that the greatest unmet clinical need in MS is a targeted treatment for progressive disease, so it’s exciting. I’m really hopeful.

What are the next steps for this treatment?

The next step is regulatory approval. We’re trying to get approval from the FDA, Health Canada and the European Medicines Agency. Once we have that, we’ll figure out which patients should receive the drug. Progression happens across the spectrum of MS, so there may be patients with other types of MS who benefit from this treatment too. Once patients are on it, there will be frequent monitoring in the first couple of months. Very rarely, people receiving this drug can experience significant liver enzyme elevation, but we’ll keep a close eye on that through regular blood testing.

*Dr. Oh has received research funding from Biogen Idec, Brain Canada, EMD Serono, Roche, the MS Society of Canada, the National MS Society and NIH. She has received consulting and/or speaking fees from Biogen-Idec, EMD Serono, Horizon Therapeutics, Novartis, Roche and Sanofi Genzyme. n H

Anna Wassermann works in communications at Unity Health.

Dr. Jiwon Oh

A Study identifies new genetic cause of neurodevelopmental disorders

seminal study from researchers at the Icahn School of Medicine at Mount Sinai and their collaborators in the United Kingdom, Belgium, Spain, the Netherlands, and Iceland has uncovered a new genetic cause of neurodevelopmental disorders (NDDs). The discovery offers both closure and hope to potentially thousands of families worldwide who have long been searching for answers.

The study, published in the April 10 online issue of Nature Genetics [DOI: 10.1038/s41588-025-02159-5], reveals that mutations in a small, previously overlooked non-coding gene called RNU2-2 are responsible for relatively common NDD. Non-coding genes are genes that don’t produce proteins but may still play critical roles in regulating cell functions.

ilarities, but patients with RNU2-2 syndrome tend to be more severely affected by epilepsy.

“Our identification of RNU2-2 mutations as a cause of NDDs is particularly notable because it cements the biological significance of a class of small non-coding genes in NDDs,” says the study’s first author, Daniel Greene, PhD, Assistant Professor of Genetics and Genomic Sciences at the Icahn School of Medicine at Mount Sinai. “These mutations tend to occur spontaneously, rather than being inherited from an affected person’s parents.”

NDDs are disorders that affect the development of the brain and nervous system. They include conditions such as intellectual disability, autism spectrum disorder, and motor disorders. These NDDs, which often have a ge-

Mutations (blue) in U2 snRNA cause a neurodevelopmental disorder about one-fifth as common as the RNU4-2/ReNU disorder, which is linked to mutations (orange) in U4 snRNA. snRNAs are shown in black, pre-mRNA in green, and gray lines show how different snRNAs interact with pre-mRNA during gene splicing. Greene et al, Nature Genetics 2025

Building on their landmark discovery of RNU4-2/ReNU syndrome last year, the research team has identified the new, related disorder caused by mutations in the non-coding gene RNU2-2. RNU4-2/ReNU syndrome and RNU2-2 syndromes share sim-

netic basis, manifest in early childhood and can lead to lifelong challenges in learning, behavior, and communication. The current findings involve a newly discovered form of NDD.

“We know from years of experience supporting patients and families with

rare genetic conditions how receiving a diagnosis like this can be life-changing and the first step on the journey to putting in place the right support and care,” says Sarah Wynn, PhD, Chief Executive Officer of Unique, an organization that provides support, information, and a voice for all those affected by rare chromosome or gene disorders.

Advances in genetic sequencing, including whole-genome sequencing of more than 50,000 individuals by Genomics England, made the development possible. This enabled the researchers to identify the cause of the novel disorder as mutations in RNU22, a gene once thought to be inactive. The authors also identified a separate mutation in RNU2-2 that tends to arise in unaffected individuals as they age, which may have implications for age-related conditions.

“We estimate that the prevalence of RNU2-2 disorder is approximately 20 per cent that of RNU4-2/ReNU syndrome, one of the most common monogenic types of NDD. This means there must be thousands of affected families worldwide,” says senior study author Ernest Turro, PhD, Associate Professor of Genetics and Genomic Sciences at the Icahn School of Medicine at Mount Sinai.

“With a genetic diagnosis in hand, families can connect with others in similar situations, share valuable experiences, and gain a better understanding of how to manage the condition. This discovery also makes possible further research to explore the molecular mechanisms underlying the disorder,” says Dr. Turro. The paper is titled “Mutations in the snRNA gene RNU2-2 cause a severe neurodevelopmental disorder with prominent epilepsy.” n H

E Stroke protection and brain health

very day, millions of people worry about losing their memory, having a stroke, or dealing with depression later in life. It’s no wonder as stroke, dementia and late-life depression are three of the most common and life-altering brain conditions affecting people as they age.

But what if it was possible to lower the risk for all three at the same time by changing just a few things in your daily routine?

A new study has found exactly that. It was led by Dr. Sanjula Singh of Brain Care Labs at Massachusetts General Hospital and co-authored by Dr. Aleksandra Pikula from UHN’s Jay and Sari Sonshine Centre for Stroke Prevention and Cerebrovascular Brain Health.

The research brings good news: these diseases, while serious, are not inevitable. In fact, a large portion of cases may be preventable by addressing everyday lifestyle habits.

The study looked at years of global research to find what stroke, dementia and late-life depression have in common. It found they often share the same underlying issues such as poor circulation in the brain and the same lifestyle risk factors.

The good news is that many of these risks can be reduced with small, manageable changes.

“Maintaining brain health is a complex challenge that requires a comprehensive approach,” says Dr. Pikula. “However, it’s reassuring to know that focusing on just one habit or risk factor can significantly reduce your risk of developing these three major brain conditions.”

In total, the team identified 17 modifiable risk factors that appeared in at least two of the three conditions. Hypertension and chronic kidney disease contributed most to risk, while physical activity and social connection were the most protective.

Risk factors that increase the likelihood of developing dementia, stroke or late-life depression include:

• High blood pressure

• High body mass index

• High blood sugar

• High total cholesterol

• Depressive symptoms

• Diet high in red meat, sugar-sweetened drinks, sweets and sodium

• Hearing loss

• Kidney disease

• Pain, particularly forms that interfere with activity

• Sleep disturbances – insomnia, poor quality or for periods longer than eight hours

• Smoking history

• Loneliness or isolation

• General stress or stressful life events

Factors that protect against developing dementia, stroke or late-life depression include:

• Regular cognitive activity such as reading, doing puzzles

• A large social network

• Diet high in vegetables, fruit, dairy, fish and nuts

• Moderate or high levels of physical activity

• A sense of purpose in life

• Low to moderate alcohol intake

Notably, two factors – diet and social network size – showed both protective and harmful associations depending on their quality. For example, a diet high in vegetables was protective, while one high in processed foods increased risk.

“This study puts agency into the hands of the population and patients,” says Dr. Pikula. “With the evidence now in hand, medical providers are also empowered to fully support pa-

• Stay connected: Loneliness and low social engagement were linked to worse brain outcomes. Call a friend, join a group, or just chat with a neighbour.

Other improvements people can make include managing blood sugar, hearing health, stress levels, kidney health and keeping a sense of purpose in your daily life.

So, when is the best time to start?

While it’s never too late, Dr. Pikula says, research shows that the most effective time to take action is in midlife or earlier. Addressing risk factors early can help prevent or slow the progression of disease with age.

Just as importantly, it lays the foundation for a healthier, more sustainable lifestyle as we grow older, she says.

tients as they work to make positive behavioral and lifestyle changes.”

WHAT CAN YOU DO?

With 17 risk factors, it can feel overwhelming to know where to start. But the study offers some helpful tips.

• Get blood pressure under control: High blood pressure stood out as one of the strongest contributors to brain disease risk.

“Keeping your blood pressure in check is a powerful way to support brain health,” says Dr. Pikula. “Know your numbers. Simple steps like cutting back on salt, staying active and managing your weight with a healthy and sustainable diet based on whole, fresh foods can make a big difference.”

• Move more: Even moderate physical activity such as walking 30 minutes a day was linked to better outcomes for all three conditions.

• Challenge your brain: Whether it’s reading, puzzles, or learning a new language or skill, cognitive activities keep the brain young.

“Engaging your mind in cognitive activities can be an effective way to protect against dementia, potentially dramatically reducing the risk for stroke when combined with other health lifestyle habits,” says Dr. Pikula.

• Don’t ignore sleep: Both too much and too little or poor-quality rest can raise the risk. Aim for seven to eight hours of solid rest each night.

THIS RESEARCH MATTERS MORE THAN EVER

These brain conditions aren’t just affecting a small segment of the population. According to global health data, stroke, dementia and late-life depression are three of the biggest contributors to disability and reduced quality of life around the world.

Treatments are improving, but they’re still not enough to meet the scale of the problem and likely never will be.

That’s where prevention comes in and why it’s so important. As this research shows, there’s now a roadmap, and it starts with everyday habits.

The team behind the study hopes their findings will lead to practical tools – such as the brain health tracking tool Brain Care Score – that help people understand their risk profile and take steps to reduce it. They’re developing a new version of the Brain Care Score based on the 17 modifiable risk factors identified in this study.

But even before further tools arrive, the message is clear: people don’t need a prescription to start protecting their brain. A proactive approach, even one starting with small changes – going for a walk, reducing salt intake or calling a friend – can make a meaningful difference. n H

High blood pressure is the leading modifiable risk factor for developing brain disease.

R Cutting-edge cancer therapy program

eengineering a patient’s own immune system to hunt down and destroy cancer cells sounds like science fiction, but it’s not. It’s called Chimeric Antigen Receptor (CAR) T-cell therapy, and it’s now available at Kingston Health Sciences Centre (KHSC).

“This is a long time coming,” says Dr. Annette Hay, hematologist at KHSC and senior investigator with the Canadian Cancer Trials Group. “CAR T-cell therapy is personalized, precision medicine. It’s the next new advancement in cancer care.”

KHSC is now just the fourth site in Ontario to offer this groundbreaking therapy, joining hospitals in Toronto, Ottawa and Hamilton. It means patients in southeastern Ontario can now receive this advanced treatment closer to home.

A NEW WAY TO FIGHT CANCER

CAR T-cell therapy takes a different approach than chemotherapy or radiation. Instead of destroying cancer cells directly, it strengthens the body’s immune system to do the work.

T-cells are white blood cells which help detect and fight infections. But cancer cells can learn to hide from them. The therapy works by collecting a patient’s T-cells and re-engineering them to help them find and attack the cancer.

This highly targeted treatment means that the T-cells are attracted to cancer cells like a magnet to iron. It can be effective even when other treatments haven’t worked.

“For patients with blood cancers like leukemia and lymphoma, it gives us another option,” says Dr. Hay. “When cancers stop responding to chemo, CAR T-cell therapy can lead to longer remission – or even get rid of the cancer entirely.”

“IT’S GOING TO SAVE LIVES”

For Cathy Tidman, what started as back pain in early 2018 turned into something far more serious. After months of persistent discomfort, a series of scans confirmed the diagnosis: lymphoma.

Initial treatment included six rounds of chemotherapy and a stem cell transplant at KHSC, which put her cancer

into remission for six months. But when the cancer returned in 2019, Dr. Hay determined that Cathy would be a good candidate for CAR T-cell therapy – which was only just arriving in Canada at the time.

Cathy was originally confirmed for a clinical trial in Toronto, but when her cancer changed, she needed to travel to Cleveland, Ohio for the treatment instead.

“It was a case of leaving home and family and moving away from our entire support network. Mentally, we had already been through the ringer, but it was a low point having to leave home. It was another country, and it seemed like it was a million miles away,” explains Cathy.

Cathy’s husband, Dave, joined her in Cleveland to support her as a caregiver.

They first went down for several days while her T-cells were collected. They then came home for six weeks while the cells were sent to California to be processed, and returned to Cleveland for the procedure. Two weeks were in hospital, four were in a nearby hotel so she could continue to be monitored.

Cathy and Dave are confident that having CAR T-cell therapy in Kingston is going to make a big difference for patients.

“Had we had this in Kingston at the time, we wouldn’t have had to leave,” she says.

“It’s going to save lives,” says Dave. “We wanted to go to Cleveland – and we could – but a lot of people aren’t able. There’re a million reasons someone might not make it.”

Today, Cathy is cancer-free and when she and Dave reflect on their journey, Kingston remains at the core. “We always felt relief when we got back to Kingston and got care here,” she says. “It’s so much more personal.”

“The team here in Kingston – I think it’s one of the best in Canada, if not the world,” says Dave. “And from what I see as a volunteer with Cancer Care Ontario, you can prove it. The research happening here, the doctors and care teams – it’s world class. Sometimes I don’t think people realize what a big deal this is. It’s really state-of-the-art stuff – and it’s right here in Kingston. I don’t think we brag enough about what’s done here in terms of research and what the staff are doing. The more you see it, the more amazed you are.”

BUILT ON TEAMWORK, DRIVEN BY HOPE

The program at KHSC took more than five years to build. Teams from

nearly every corner of the hospital were involved – from the ICU, Hematology, Emergency Department and Clinical Labs, all of which are involved in delivering the treatment, to the IT and legal teams to who worked to build the infrastructure and contracts to make the program possible.

“I’m so proud of what this team has built. It shows we’re a leader in this space. It’s exciting – but it’s also serious. These patients need treatment quickly, and we need to make sure we do it right,” says Dr. Annette Hay

The launch of CAR T- cell therapy is the beginning of a journey. The success of this type of treatment will mean new applications and increased demand, and the team at KHSC plans to become a leader in this type of care. It starts with high-quality imaging, like PET-CT, but once the current standard-of-care program is fully established, the team plans to begin clinical trials with the goal of eventually engineering therapies in Kingston.

“This is going to need continued support to make sure this ramps up,” adds Dr. Hay. “But it’s an outstanding example of what we can achieve when we work together. It’s about giving patients the best possible care – and hope.” n H

t’s a space for the community built by the community.

A first-of-its kind Indigenous Wellness Centre is open at UHN’s Toronto Western Hospital (TWH), offering a welcoming and gathering place, a space for Indigenous ceremony and traditional medicines, and a spot for patients, visitors and staff to learn more about Indigenous health and wellness.

“It’s supposed to be a community space, but also, for UHN at large, we

want it to be a low-barrier, low-risk, ask-and-learn space,” says Dr. Mike Anderson, Strategic Lead for the Indigenous Health Program (IHP) at UHN.

“So much of the notion of reconciliation is tokenistic, words minus any action. But this is action and the institution deserves to be commended for it.”

As part of the effort to redress the legacy of residential schools and advance the process of Canadian reconciliation, UHN, through the guidance

SHN leads global advancement in endoscopy education

By Jenner Pratt

I H Indigenous Wellness Centre helping build trust in health care system

ealth care is continually advancing, with new technologies and techniques being developed regularly. This ongoing evolution can pose challenges for healthcare practitioners who must learn and adopt the innovations that arise after they have completed their initial training in order to stay on the cutting edge.

One such breakthrough is in the specialty of gastrointestinal endoscopy, called optical diagnosis. This technique uses specialized light and imaging during an endoscopy to help predict, in real-time, whether a growth or polyp is cancerous or pre-cancerous, eliminating the need for a biopsy.

A recent paper published in Gastroenterology authored by Dr. Samir Grover, Executive Vice-President, Academics here at Scarborough Health Network (SHN), and Drs. Robert Bechara and Michael Scaffidi at Queen’s University, outlines a practical guide for endoscopists starting to learn this optical diagnosis technique. The guide focuses on training strategies and foundational knowledge needed to build proficiency.

WHAT WAS IN SCOPE FOR THE STUDY?

Endoscopy is crucial for diagnosing conditions like colorectal cancer and inflammatory bowel disease. This study explored a new technique called “optical diagnosis,” which uses special imaging during endoscopy to get a better real-time look at growths and predict if they are cancerous. This allows endoscopists to decide immediately whether to remove growths, rather than waiting for the results of a sample taken. Since learning new techniques can be challenging, the study focused on finding better ways to train doctors in optical diagnosis, offering practical steps and tools to help them gain skills and confidence.

The study’s insights on teaching optical diagnosis go beyond improving individual doctors’ skills. The framework helps modernize medical education by showing more practical and efficient ways to train healthcare providers in advanced techniques that may emerge in the future.

IMPACT ON CARE IN SCARBOROUGH

By improving the training of healthcare professionals, the study offers the

of the IHP, has committed to enacting and being accountable to the Calls to Action related to health care from the Truth and Reconciliation Commission of Canada.

Among them is effecting change within the Canadian health care system “to recognize the value of Aboriginal healing practices and use them in the treatment of Aboriginal patients in collaboration with Aboriginal Healers and Elders where requested by Aboriginal patients.”

The construction of the new centre at TWH, in the location of a former restaurant, began last fall. The preparatory work included architectural drawings developed in collaboration with an Indigenous design team and sourcing natural materials. Consultations to ensure smudging could be done without negatively impacting the hospital’s air ventilation and smoke detection system took time and the experience helps inform a model that could be used elsewhere.

potential for faster and more accurate diagnoses and decisions on gastrointestinal conditions, such as gastrointestinal cancers. This is particularly relevant in Scarborough, where enhanced skills in optical diagnosis can significantly improve the detection and care for conditions like early-stage gastric cancers, which may be more prevalent in East Asian demographic groups.

Moreover, by enhancing the capabilities of SHN’s team, patients in Scarborough can receive top-of-theline care locally, reducing wait times, increasing access to high-quality care, and contributing to a healthier community overall.

LOOKING AHEAD

Initiatives like this study, which focus on incorporating advanced

techniques into clinical practice, position SHN at the forefront of medical training. Dr. Grover’s team also collaborated with Drs. Catharine Walsh and Kathy Boutis at Sick Kids and the team at ImageSIM to develop “PRIME” – a module to teach optical diagnosis to endoscopists worldwide.

This work aligns with SHN’s expansion in education, including their partnership with the University of Toronto on the new Scarborough Academy of Medicine and Integrated Health. It exemplifies SHN’s commitment to leadership in postgraduate specialist education, ensuring healthcare professionals are equipped with the skills needed to effectively utilize new technologies for the best possible patient care within the community and beyond. n H

Dr. Samir Grover.

Jenner Pratt is a Communications Officer at SHN.

“I like to think of it as we did 18 months of building a solid foundation and then over six months we put up a house,” Dr. Anderson says. “In the process, we built a better relationship with health care.

“If community members are feeling uncomfortable in other parts of the hospital, there’s now a place to go and feel safer. It builds trust when they look and say: ‘wow, an institution has invested in us.’”

Members of the IHP and UHN’s Facilities Management – Planning, Redevelopment & Operations (FMPRO) team worked with the Indigenous Design Studio of Brook McIlroy, fellow Toronto architectural firm C& Partners and PCL Construction to bring to life the cultural significance of the centre.

“The space footprint is quite small but the impact is huge,” says Danny Roy, a member of the Indigenous De-

houettes of soaring eagles, cedar, sage, tobacco and sweetgrass. The floor is coloured to represent natural landscapes of the shield, river, forest, shore and lake.

Wood is a central element with a ceiling slat based on the Four Directions and a stunning feature wall with carved footprints of clan animals –cranes, loons, sturgeon, eagles, bears, martens, deer, foxes and turtles. A glass display case filled with items for ceremony sits on one wall and in the coming weeks pieces from Indigenous artists will be hung on other walls.

mony, spoke and offered prayers as part of the centre opening. “Hopefully this sets the tone for all other hospitals.”

Sarah McKerracher, a research assistant at 2-Spirited People of the 1st Nations, says schools, hospitals and other institutions can be “inherently traumatizing and create a lot of anxiety” for some Indigenous people. To have a space like the new centre where they can go visit with fellow community members, sip cedar tea, talk to Elders and use traditional healing practices “will help lower barriers,” she says.

sign Studio, a collective of architects from diverse Indigenous backgrounds.

“Having the IHP team guide the process, share their vision and see it come to fruition is really gratifying for all the teams.”

Indigenous perspectives are woven into the architecture of the centre.

The front windows feature etched sil-

Using AI to cut wait-times

for patients in need of mental health care

Mental health programs across the country are facing long wait times. For many people, the delay in getting care can make their condition worse, resulting in a mental health crisis. At Kingston Health Sciences Centre (KHSC), Dr. Nazanin Alavi is using technology to help change that.

Dr. Alavi and her team introduced an artificial intelligence (AI)-assisted triage system in the Mental Health and Addiction Care program. Between 2023 and 2024, it helped cut appointment wait times by more than 50 per cent.

“If a patient doesn’t get timely care, a mental health condition could evolve and they could end up in the emergency department,” said Dr. Alavi. “That’s not ideal because Mental health needs a structured approach, not emergency intervention.”

The system uses machine learning to assess each patient’s needs and help staff decide the right level of support. Patients are asked to share their story and fill out secure online questionnaires. Their answers are analyzed by the platform, which then sends a sum-

mary to staff. If someone is in crisis, the system flags it right away for urgent help. All responses are still reviewed by staff.

This is about using technology to offer more personalized care. It’s AI-assisted, not AI-led. It supports our team so we can focus on connecting people with the right care, faster.

The triage platform also connects patients with online therapy modules led by trained therapists. While patients wait for their first appointment, nursing staff offer support and can adjust care if a person’s needs change. This helps lower the risk of a crisis.

The results have been strong. In 2023, the outpatient mental health clinic handled about 3,000 referrals. After the AI system launched as a trial in 2024, wait times dropped by more than half.

Dr. Alavi has always been interested in how technology can help people.

“This started when I was a postdoc at Queen’s. People wanted support, but there were barriers. I began with email therapy modules, but it wasn’t scalable. By 2017, technology had improved, and it became possible.”

“This is groundbreaking because we’re allowed to practice our traditions, our culture, in our own way, and that is a step in the right direction towards truth and reconciliation,” says Clay Shirt, Traditional Knowledge Keeper in Residence at the University of Toronto’s Dalla Lana School of Public Health, who led a smudging cere-

“It will make a hospital stay, which is not the usually the best time in someone’s life, a bit easier,” says Sarah, who was among numerous Indigenous community members attending the centre’s opening.

“Having a space like this shows the community that they matter, people are thinking about them.” n H

Dr. Nazanin Alavi is using technology to cut wait-times for patients in need of mental health care.

In April, Dr. Alavi received additional funding from the Ontario Centre for Innovation to continue using the AI platform. Her team has also formed research partnerships with other universities, and plans to expand the approach to KHSC’s inpatient unit.

“In hospitals, this could shorten stays and reduce the chances of someone needing to return to the emergency department,” Dr. Alavi says.

The goal is to provide measurement-based care.

She adds, “You can ask someone, ‘How are you doing?’ but that’s just

one moment in time. With AI, patients can journal daily. We can analyze the results and establish trends. This helps us see patterns and better guide care.”

At its core, this project is about improving access to mental health support and helping the community.

“I’m proud of how this started from nothing when I first came to Kingston. This platform is an important way to advocate for patients and I’m hopeful we can make a change in mental health. Kingston is home, and I believe this can really make a difference in the community.” n H

Singer Kaeden Pelletier helped open the Indigenous Wellness Centre at UHN’s Toronto Western Hospital.

Photo: UHN

What you need to know about medication safety

By Mona Mollaeizadeh, Heather Amann, and Certina Ho

X Gender-affirming hormone therapy:

ander (they/them), a 22-year-old non-binary person assigned female at birth (AFAB), arrives at their local pharmacy with a new prescription: injectable testosterone cypionate, 50 mg IM (intramuscular) weekly. It’s an exciting milestone –Xander is finally starting gender-affirming hormone therapy (GAHT). But they’re also anxious about this new medication. “How should I inject this? Is there anything else I should know?”

This article is meant to help answer medication related questions just like Xander’s. Whether you’re starting GAHT, supporting a loved one, or a healthcare provider unfamiliar with gender-affirming care, it is important to understand medication safety aspects of hormone therapy.

GENDER-AFFIRMING HORMONE THERAPY (GAHT)

GAHT supports individuals in aligning their physical traits with their gender identity. GAHT can significantly reduce gender dysphoria, improve mental and physical well-being

and may be used alone or alongside surgery and social transition. For some individuals, it also supports long-term health, such as preserving bone density after certain organ removals.

Further Resources for Healthcare Providers on Patient Support and Education

From the Government of Canada: 2SLGBTQI+ Terminology & Common Acronyms used within the Government of Canada https://www.canada.ca/en/women-gender-equality/free-to-beme/2slgbtqi-plus-glossary.html

From Rainbow Health Ontario: Guidelines for gender-affirming primary care with trans and non-binary patients: A quick reference guide for primary care providers (PCPs) https://www.rainbowhealthontario.ca/wp-content/uploads/2020/10/ QRG_full_rev2023.pdf

From the Canadian Pharmacists Association: Resource Round-up: 2SLGBTQI+ patient health: https://www.pharmacists.ca/news-events/news/resource-round-uplgbt2sq-patient-health/

Before starting GAHT, discuss fertility preservation with your healthcare provider if future family planning is important to you. Many clinics use an informed consent model, where

providers explain the benefits, risks, and what to expect from treatment while supporting the level of change that feels right for you – whether that is full or partial masculinization or feminization.

TYPES OF GAHT

Feminizing Hormone Therapy is used by trans women and transfeminine or non-binary individuals. Estrogen, often combined with anti-androgens like spironolactone, encourages breast development, skin softening, and fat re-distribution. It comes in different dosage forms – oral (to be taken by mouth), patch (to be applied on skin), and injectable. Oral estrogens may carry a slightly higher risk of blood clots compared to patches or injections, but they are more affordable and commonly used. If you are concerned about the risks of blood clots associ-

ated with estrogen, discuss with your healthcare provider.

Masculinizing Hormone Therapy, or testosterone, is used by trans men and transmasculine or non-binary individuals. Testosterone deepens the voice, increases muscle mass, stops menstrual periods, increases libido, shifts fat distribution and body hair patterns. Testosterone is most often given as weekly intramuscular (IM) or subcutaneous (SC) injections, which are cost-effective and widely used. Gels and patches are alternative topical dosage forms for individuals who do not prefer needles or injections; however, topical dosage forms may transfer the medication to others through skin contact and cause unwanted masculinizing effects.

How should Xander inject the medication? After learning about the potential risks of topical transfer with gels or patches, Xander decides to stick with testosterone injections.

SAFE INJECTION PRACTICES

If you have not been formally trained with the use of injectable medications, ask your pharmacist or healthcare provider to walk you through the steps. Community clinics, public health units, and resources like Rainbow Health Ontario (https://www. rainbowhealthontario.ca/): A Guide to Self-administering Intramuscular or Subcutaneous Injections (https://www. rainbowhealthontario.ca/resource-library/a-guide-to-self-administering-intramuscular-or-subcutaneous-injections/) may also offer help and support. When using injectable testosterone (or other injectable medications), safe medication use considerations are essential. For example:

• Always use a sterile needle and never re-use it. Dull needles will increase pain and infection risk.

• Draw up the medication with a wider needle (e.g., 18-gauge), then switch to a smaller one (e.g., 25-gauge)

for injection to minimize pain and scarring.

• Never share needles. This will increase the risk of infections (e.g., HIV and hepatitis).

• Dispose used needles in a sharps container. Many pharmacies and harm reduction programs offer free sharps disposal service. Is there anything else Xander should know?

MEDICATION THERAPY MANAGEMENT/ MONITORING

Hormones are powerful medications that require monitoring. Regular blood work helps track hormone levels and monitor liver function, cholesterol, red blood cell counts, etc. Based on your anatomy, you may also need cancer screenings like pap smears or mammograms. Let your healthcare provider know if you smoke or vape. Individualized care is key, especially during your transition.

MEDICATION SHORTAGES

Testosterone shortages are quite common. If a medication shortage occurs, avoid turning to unregulated or street-sourced hormones, which may be unsafe, contaminated, or improperly dosed. Instead, talk to your pharmacist about alternatives, such as compounded hormone therapies (see below). Supportive clinics may sometimes be able to offer temporary solutions.

COMPOUNDED HORMONE THERAPIES

Some individuals use compounded estrogen or testosterone in dosage forms like customized gels or creams. These are prepared by specialty compounding pharmacies that are accredited and regulated by provincial pharmacy regulatory authorities (or Colleges). DIY or unverified hormonal products could be harmful and should be avoided. n H

Mona Mollaeizadeh and Heather Amann are PharmD Students at the Leslie Dan Faculty of Pharmacy, University of Toronto; and Certina Ho is an Assistant Professor, Teaching Stream, at the Leslie Dan Faculty of Pharmacy and Department of Psychiatry, University of Toronto.

UPCOMING EDITIONS

JULY 2025

JULY FOCUS: Cardiovascular Care, Respirology, Diabetes, Complimentary Health: 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 and allergies. Prevention, treatment and long-term management of diabetes and other endocrine disorders. Examination of complementary treatment approaches to various illnesses.

Advertising Booking Deadline June 20th

Material Deadline June 24th For more info email advertising@hospitalnews.com

AUGUST 2025

Paediatrics Supplement Paediatrics Supplement

AUGUST FOCUS: Paediatrics, Community Engagement and Patient Advocacy and Social Work:

Paediatric programs and developments in the treatment of paediatric disorders including autism. Specialized programs offered on an outpatient basis. Community engagement initiatives. Empowering patients – tools and strategies for improving patient education and self-management. The role of patient advocates and how healthcare professionals can support advocacy efforts. Social work programs helping patients and families address the impact of illness.

Advertising Booking Deadline July 25th

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SEPTEMBER 2025

SEPTEMBER FOCUS: Emergency Services, Critical Care, Trauma, Emergency and Online Education:

Innovations in emergency and trauma delivery systems. Emergency preparedness issues facing hospitals and how they are addressing them. Advances in critical care medicine.

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Canadian Surgeons Volunteer Onboard the World’s Largest Civilian Hospital Ship

In April 2024, Quebec surgeons Dr. Jean-Martin Laberge and Dr. Louise Caouette-Laberge volunteered on the Global Mercy in Freetown, Sierra Leone, to offer free surgery to the population.

As President Julius Maada Bio of Sierra Leone stated just prior to Mercy Ships’ field service, “Mercy Ships, provides a continuous humanitarian and medical support towards providing treatment to people with various medical conditions worldwide”. At the time if the announcement, the partnership agreement included a 10-month deployment of the Global Mercy, offering free surgical care in and training healthcare professionals to build capacity within Sierra Leone’s national health system.

As she prepared to come aboard, Dr. Caouette-Laberge shared her excitement at being able to work aboard the Global Mercy. “The advantage of having a state-of-the-art hospital like this is that it has international standards. It allows us to perform complex surgeries that we wouldn’t be able to do in an African country because they don’t have the necessary infrastructure.”

The couple was recognized for their humanitarian work by the Collège des Médecins du Québec, which jointly awarded them the Prix d’humanisme in 2013. As for Dr. Laberge, in addition to participating in missions with his wife, he has contributed to the training of pediatric surgeons in Kigali, Rwanda. Through their respective work in pediatric surgery, they have between them changed countless lives of children both in Canada as well as Africa.

“We receive much more than we give! The people we operate on for free are so pleased, they thank us and are happy. We take for granted the training we receive and how lucky we are to be able to study. There are no teachers there. You don’t realize it until you leave home and see the reality of others,” says Dr. Louise Caouette-Laberge. After all

these years in the field, they are now part of an international team of medical specialists that serve onboard Mercy Ships.

The Global Mercy’s volunteer crew of nearly 600, both short- and longterm, works with dedication and excellence to welcome patients for life-changing surgeries. Darryl Anderson, Executive Director of Mercy Ships Canada, stated, “We are grateful for medical staff and all hospital volunteers who, like Dr. Laberge and Dr. Caouette-Laberge, share a passion for our mission of Hope and Healing.” Anderson also announced, “We are excited that the President of Sierra Leone has extended our partnership for another field service into 2024.”

Mercy Ships Canada is one of 16 National Offices dedicated to raising funds, building awareness, recruiting volunteers, and supporting impactful projects for Mercy Ships’ global programs. Mercy Ships operates the world’s two largest civilian hospital ships, delivering free, life-changing surgeries and healthcare, along with training and mentoring for local healthcare professionals, ensuring communities have sustainable healthcare long after the ships depart.

Mercy Ships believes that everyone deserves a life full of promise and potential. That every mother deserves to see her child grow healthy and thrive. We believe that healthcare is a human right, and we are committed to reaching children and families in need of safe surgical care with state-of-the-art hospital ships filled with compassionate volunteer healthcare providers.

Dr. Louise Caouette-Laberge, conducting a surgery with her husband Dr. Jean-Martin Laberge, onboard the Global Mercy

To learn more on volunteering visit mercyships.ca/en/get-involved/volunteer WITH VOLUNTEERS