QEII Times - Winter 2021

SHINING A LIGHT ON THE QEII HEALTH SCIENCES CENTRE, ITS STAFF, VOLUNTEERS AND DONORS

WINTER 2021

A QEII FOUNDATION PUBLICATION IN ASSOCIATION WITH THE CHRONICLE HERALD

YOUR QEII QEII’s adult CF program changing lives

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Halifax youth turns philanthropist

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Dr. Drew Bethune marks 40 years at QEII

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Dr. Michael Flynn, a psychiatrist at the Nova Scotia Hospital, is grateful for a generous $420,000 donation from Bell Let’s Talk that will bring repetitive transcranial magnetic stimulation (rTMS) — a type of brain stimulation for treating symptoms of depression — to Nova Scotia this spring. QEII Foundation

RESEARCH & INNOVATION QEII heart study examines COVID-19 impact

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New hope for treatment-resistant depression $420,000 donation from Bell Let’s Talk to the QEII Foundation to bring a life-changing brain stimulation technique to Nova Scotians living with depression

New QEII Foundation Endowed Chair in Transplantation Research

Atlantic Canada’s first AngioVac procedure

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ALSO A word from the QEII Foundation

Exciting new developments in 2021 Page 2

Medical physics

By Natalie Jarvis 8

Research projects underway at the QEII Pages 4-5

At first glance, the chair is nothing special to look at. It reclines and offers head support — much like a dentist’s chair.

But this is not an ordinary chair and you won’t find it at your hygiene appointment. This is an rTMS chair — used in conjunction with advanced technology and magnetic coils that deliver what can be a life-sustaining treatment. An innovative, evidence-based treatment called repetitive transcranial magnetic stimulation (rTMS). rTMS is a type of brain stimulation for treating symptoms of depression. The recipient sits in the chair, resting their head in a position that allows a healthcare provider to access their scalp, gently applying specialized paddles that deliver magnetic pulses through coils.

The magnetic pulses stimulate target areas in the brain to alleviate symptoms of depression.

Just like an antidepressant medication, it has the power to change neuronal activity.

We often hear people use the term “depression” to describe feelings of sadness or even disappointment. For a

psychiatrist, like Dr. Michael Flynn of the Nova Scotia Hospital, the term describes something very different.

“Living with depression is almost like the opposite of rosecoloured glasses and, sometimes, it’s very difficult to appreciate anything that might be remotely positive in a situation,” says Dr. Flynn.

“It can extend to the point where one’s ability to attend to things in a reality-based way becomes shifted, so that people can feel persecuted or paranoid in a way. There may be times when the symptoms can be so severe that they contemplate that it’s not worth continuing on living in that way,” he says.

In any given year, five per cent of Nova Scotians will experience major depressive disorder. A third of them will not respond to standard approaches, including medication. For these individuals, introducing a new treatment option, like rTMS, offers hope.

“If you’ve known anybody with treatment-resistant depression, suffered from depression yourself or even heard it discussed, you

... You’re looking at improving the lives of people you might not have been able to address before. That’s what rTMS offers and it’s certainly very exciting.

– Dr. Michael Flynn

know how bleak it can be. And when one has gone through a number of treatment approaches, each new treatment approach that is not successful is another dashing of hopes,” Dr. Flynn says.

“When you have something else to look at, with established efficacy, you’re looking at improving the lives of people you might not have been able to address before. That’s what rTMS offers and it’s certainly very exciting.” rTMS is not to be confused with electroconvulsive therapy

(ECT), a stigmatized but highly effective treatment for depression.

During ECT, an electric current is used to induce a seizure.

Painted as barbaric in popular culture, ECT is, in reality, common practice — and not at all like the violent portrayal in the classic movie One Flew Over the Cuckoo’s Nest, where Jack Nicholson’s character receives ECT following a psychiatric admission.

In real life, it is an easily managed, evidence-based approach for treatment-resistant depression. Clients are given general anesthesia and a muscle relaxant so the procedure is much less intrusive.

“For a usual treatment path, if you’re not responding to medications or psychotherapeutic input, you would then move on to electroconvulsive therapy. rTMS provides an intermediate step that folks could go to before necessarily going on to ECT,” says Dr. Flynn. rTMS could be likened to a less-invasive sibling of ECT. It involves less disruption to daily NEW HOPE – Page 2

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YOUR QEII – WINTER 2021

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A QEII Foundation publication in association with The Chronicle Herald, QEII Times is designed to shine a light on the QEII Health Sciences Centre community.

Editor Paula Bugden Communications, QEII Foundation Jenn Coleman-Ford Director, Content Solutions, Lindsey Bunin Design Lead, Julia Webb Contributors Allison Lawlor Brandon Young Colleen Cosgrove Joey Fitzpatrick Natalie Jarvis Sara Ericsson Susan Mullin Photographers QEII Foundation © The Chronicle Herald 2021 All rights reserved. No part of this publication may be reproduced, stored in retrieval systems or transmitted in any form or by any means without prior written consent from the publisher.

The Chronicle Herald 2717 Joseph Howe Drive PO Box 610 Halifax, N.S. B3J 2T2 902 426 2811 thechronicleherald.ca We want your feedback!

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A word from the QEII Foundation

By Susan Mullin, president & CEO, QEII Foundation 2020 was certainly a year like no other.

While many of us are quick to shut the door on one of the most challenging years of our lives, 2020 shone a light on the incredible support for health care in our province. I am so inspired by the people who choose to stand up for our healthcare heroes. From young philanthropists, like 12-year-old Sawyer Burke (you can read his story in this issue), to businesses and community organizations, Nova Scotians have stepped up for health care in a big way.

For the QEII Foundation, 2021 promises more dramatic impact on health care, thanks to our generous community.

We kicked off the new year with an exciting announcement for mental health care. Bell Let’s Talk provided a very generous $420,000 donation to help bring repetitive transcranial magnetic

stimulation (rTMS) to Nova Scotia. rTMS is an innovative, evidencebased treatment providing new hope for people living with treatment-resistant depression.

You can read more about this lifechanging treatment in this issue.

With more than 200,000 Nova Scotians living with mental illness, the QEII Foundation will continue to focus on supporting mental health care. A $100,000 gift from the RBC Foundation helped launch a new e-Mental health initiative that is now providing immediate, technologybased solutions for those experiencing mild to moderate mental illness, improving both wait times and access to care.

The generous support from RBC Foundation has directly enabled the immediate introduction of this vital tool, helping to provide mental health resources during a critical time.

This is just the start of what we

must accomplish together as part of our commitment to those in need of mental health care across the province.

There are exciting new developments on the horizon for cancer care as well. With donors at the forefront, together we will help transform the delivery of cancer care for patients in Nova Scotia and around the world.

Imagine cancer-fighting technology that’s first in the world, developed right here by our QEII teams. Treatment that is highly personalized and just as unique as the individual receiving it, targeting even the smallest traces of cancer with fewer, more powerful treatments.

The QEII Foundation is also working closely with Nova Scotia Health to ensure that our healthcare professionals reflect the diversity of our province. The 2021 QEII Foundation Diversity in Health Care Bursaries continue the

tradition of supporting students studying in programs such as nursing, pharmacy, medicine and psychology.

As we begin the application process for 2021 (QE2Foundation. ca/DiversityBursary), we look forward to supporting students who now face the added challenge of learning to care for patients in the face of a pandemic.

We continue to be grateful — and proud — of QEII staff and physicians who continue to step up and scrub up every day. From COVID-19 research, to patient care, to housekeeping and everything in between, our QEII health heroes are leading the way.

As we continue to navigate our new normal, we need to take care of one another and be kind.

I am confident and grateful that with continued support from the community, health care will be there for each of us, if and when we need it.

New hope for treatment-resistant depression Continued from Page 1

life, as no anesthetic is required.

With ECT, clients can experience short-lived memory loss and require close monitoring after the treatment, even at home.

As for rTMS, you would hear a “tapping on the skull” that can be loud for the client, but the worst that can happen later on is a headache.

A typical rTMS treatment can be as short as three minutes and up to 40 minutes.

“After treatment, people go back to work or on with the rest of their day,” says Dr. Flynn. It’s fast, safe and effective, making it a much sought-after treatment in Canada for those who don’t respond to — or can’t tolerate — medications.

Dr. Flynn says he and his colleagues have been faced with barriers establishing rTMS care in Nova Scotia, as it’s not just a matter of funding technology, but having the proper infrastructure, including staff training, to make it happen. They’ve had their eyes on offering the service since Health Canada approved rTMS in 2002.

Now, a $420,000 donation

by Bell Let’s Talk is making it all possible. The gift brings the QEII Foundation’s $759,000 fundraising campaign for rTMS treatment to the finish line.

“The generous donation from Bell Let’s Talk to the QEII Foundation is allowing us to take the first step towards setting up

a provincewide rTMS program,” he says.

Until now, rTMS has only been offered in a private clinic in Halifax. With a typical treatment course involving neardaily appointments over four to six weeks, it gets expensive fast, costing clients upwards of $3,000. With donor support, individuals will be able to access this life-changing treatment in a public hospital for free.

Kelly Barry is the health services manager who will oversee the neuromodulation program at Nova Scotia Hospital, where both ECT and rTMS will eventually be offered in Dartmouth. She witnessed firsthand what rTMS can offer

while working in an Alberta hospital in a previous role.

“I believe this will be a welcome development in Nova Scotia,” she says. “We are all just excited to be able to offer the most for our clients — and within public health care. Accessibility is so important.”

Thanks to generous donors, like Bell Let’s Talk, Nova Scotia’s new rTMS program will launch this spring, with treatments being offered at both Nova Scotia Hospital and Valley Regional Hospital to start.

“To Bell Let’s Talk, I would like to say thank you from the bottom of my heart. You have made this treatment accessible,” says Dr. Flynn.

WINTER 2021

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Living for tomorrow

QEII’s adult cystic fibrosis program uses multidisciplinary approach to ensure best possible care for patients

By Sara Ericsson James Best craved two things as a young adult living with cystic fibrosis (CF): a sense of normalcy and a better understanding of his complex disease.

Like many others living with CF, his disease is multifaceted. It’s the most common fatal genetic disease affecting Canadians, according to Cystic Fibrosis Canada. There is no cure and it affects each person living with it differently in a variety of ways.

James was looking for answers to his CF and found them in two places. First, through multidisciplinary treatment provided by the QEII Health Sciences Centre’s adult cystic fibrosis program and then through studying pharmacology and now working as a pharmacist.

“A large part of why I’m as healthy as I am is thanks to my parents and the QEII cystic fibrosis team. I know I wouldn’t be around, let alone be in the shape I’m in, without them,” he says.

Approximately 160 active patients travel to take part in the QEII’s adult cystic fibrosis program, coming from Nova Scotia, New Brunswick and Prince

Edward Island every three to four months for a half day of care.

Patients are seen during their visit by a multidisciplinary team of physicians, a nurse co-ordinator, a dietitian, a physiotherapist, a psychologist, a social worker and a respiratory therapist, who collaborate on their unique treatment plans.

Dr. Nancy Morrison, medical director of the QEII’s adult cystic fibrosis program, says the ultimate goal of this approach is to identify and treat each facet of CF in each person who is impacted by the disease in a multitude of ways, including physically, psychologically and professionally. Along with ongoing lung disease, physical symptoms can include sinus, gastrointestinal, endocrine and fertility issues, among others.

Dr. Morrison says the program’s early detection and treatment of such CF problems helps to prevent a decline in health and more intensive inpatient procedures later and is among the reasons why the program is one of the best in Canada.

“It’s so important for patients with complex medical issues to

have everybody come to them to deliver the care … as opposed to travelling to a clinic here and there,” says program physician Dr. Meredith Chiasson.

The average age of the program’s participants is mid-30s and its oldest patient was 76 at their last clinic visit. Dr. Morrison says the focus on innovative treatments and holistic care has led to participants having milder CF symptoms and living longer and better lives.

For James, this holistic treatment gave him the sense of normalcy he had been seeking.

“Many people living with chronic disease want to be able to plan for normal things, like the future, a mortgage or retirement,” says James. “The care I’ve received at QEII has given me that.”

Part of that success is also owed to the clinical trials the program patients have participated in, through the continued work and research of Andrea Dale, research co-ordinator and respiratory therapist.

“It’s life-changing. One of our patients is now off oxygen.

Two patients no longer need

James Best says he owes his normal life to his QEII family at the adult cystic fibrosis program. Now a pharmacist, James uses his knowledge and experience to help others. QEII Foundation

lung transplants,” she says. “You can’t correct all the damage, but the last several years have been a really exciting time to be working in CF, thanks to these treatments.”

Dr. Morrison says that, through the QEII Foundation, Cystic Fibrosis Canada supports the team in attending the North American Cystic Fibrosis Conference each year, where they collaborate with other CF programs and bring back ideas to further improve care. In October 2020, the CF team participated in the CF conference virtually.

Cystic Fibrosis Canada has also contributed funds to the QEII adult cystic fibrosis program’s nurse co-ordinator position. The nurse co-ordinator brings together all aspects of the program’s multidisciplinary approach and is a point of contact for CF patients, who can reach the nurse coordinator, Sarah Sutherland, via office or cellphone.

Sarah says the program’s best

feature is its development of relationships between patients and healthcare staff, which form naturally over time.

“You develop relationships with these people in order to treat them with the best care possible,” she says.

James is now 37 and has found more answers to his CF questions through studying pharmacology at Dalhousie University and becoming a pharmacist. He now lives in Lower Sackville. His lung function is so healthy that he can run up mountains.

He uses his learned and applied knowledge to help people in his role as a pharmacist and says he owes his normalcy to his QEII family.

“These are people you’ve had your ups and downs with, who see you at your best and your worst,” he says. “I was looking for comfort when I joined the QEII program and I found it quickly, thanks to them.”

Every dollar makes a difference

How a global pandemic inspired a Halifax youth to become a philanthropist

By Colleen Cosgrove Sawyer Burke is a curious 12-year-old who understands the power of giving back. And he’s reaching for his goals, one dollar at a time.

In March 2020, Sawyer found himself at home with his twin sister and elder sibling watching the COVID-19 pandemic unfold from their smartphones and through the windows of their Hatchet Lake home.

Sawyer, an active hockey and baseball player, is also a history buff and savvy researcher who became captivated by the pandemic and the race for a vaccine.

With more downtime than he’s used to, Sawyer says it wasn’t long into his e-learning journey that he started visiting the World Health Organization website and Nova Scotia’s coronavirus fact sheet regularly for the latest information. What was it like caring for the sickest in our community? How many cases worldwide? When will a vaccine be available in Canada? How can I help? Sawyer suddenly wanted to know it all.

“I wasn’t really interested in medicine before COVID-19 but then I started to learn more,” Sawyer says. “Learning about health and research is really fascinating to me now. I thought before it was boring but now I think it would be really rewarding and cool to work in health care.”

It wasn’t long into his research before Sawyer visited the QEII Foundation website and started tuning in to updates from Nova Scotia’s chief medical officer of health, Dr. Robert Strang, and Premier Stephen McNeil.

Hearing day after day about the heroic efforts front-line staff at the QEII Health Sciences Centre’s microbiology lab were undertaking, Sawyer felt compelled to help.

Sawyer, with donations previously sent to Feed Nova Scotia, the Canadian Council for Refugees and the IWK Foundation, knew every bit would help, so he sent a donation and a handwritten letter to the QEII Foundation specifying the money be used to help purchase personal protective equipment for

staff and life-saving equipment for COVID-19 patients.

“I thought I should send them a letter for all of their effort and help and give them a donation and say ‘thank you,’” says Sawyer.

And like all good deeds, the gesture paid off.

The funds were used as directed and Sawyer’s letter made it to QEII staff, who responded with a signed thank you letter and group photo of the team holding a testing kit and a box of N95 masks.

“I felt really proud of myself when I got the letter,” says Sawyer. “It’s very nice to know that you’re helping out other people who are in need or who are in severe condition and in need of treatment and care.”

Sawyer says the response encouraged him to continue his charitable giving and spread his message through his social media channels.

As the pandemic continues, Sawyer’s research and his desire to give back continues to grow.

The Grade 7 student, who likes ATVs and video games, looked

into the QEII Foundation’s fundraising priorities and discovered the world of surgical robots. From there, another fundraising campaign was born.

“I saw robotics for surgeries and they’re really fascinating,” says Sawyer. “The benefits to robotic surgery are things like more precision, gentler on the skin and they lead to shorter hospital stays and less work for the surgeons. They can be very beneficial.”

Sawyer’s interests in philanthropy and research have opened his eyes to the possibility of a career in medicine, specifically as a vaccinologist.

“Vaccine scientists make a good amount of money, so it would give me a good chance to donate more to hospitals and causes like this.”

At publication time, Sawyer raised $700 of his $1,000 fundraising goal for surgical robots and the young philanthropist shows no signs of slowing down. In fact, he’s a bit baffled more people aren’t opening their wallets, even just a

Inspired by the COVID-19 pandemic, 12-year-old philanthropist Sawyer Burke hopes to inspire others to support health care in Nova Scotia. Contributed

little bit.

“I want to show other kids that they don’t have to feel like they’re helpless and can’t do anything,” he says. “It’s not just adults that can donate. We can donate, too, and I want to inspire others to do it. I want to start a flow of people to donate so the hospital can buy new things that will save lives and help the world.”

To learn more about Sawyer’s virtual fundraising campaign for surgical robots at the QEII and to donate, visit https:// my.qe2foundation.ca/fundraisers/ sawyerburke492.

Now is t e time for a blast of Vitamin Sea. Fresh salt air with a tinge of wood smoke is what we call White Point aroma therapy – just one of the many health benefits of a few days at the beach.

We also have music therapy, nightly in the Lounge with live, local entertainment, and hydrotherapy in the warm, indoor pool. Come for morning yoga with Vanessa (MW&F) or start your day with a brisk walk around the golf course.

You can also paint beach rocks, nap, read by the fire, or do a little wine tasting – all very relaxing and good for the soul. We’re well over the hump of winter, heading into what will be another spectacular spring. Come check in to your room or cottage and let your shoulders drop. Our Atlantic Resident policy remains in place – because your health and happiness has been our priority since 1928.

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WINTER 2021

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MEDICAL PHYSICS Medical physics pairs the science of physics with medical diagnosis and treatment.

Medical physicists are healthcare professionals with specialized training in the application of physics to areas such as cancer care and diagnostic imaging (viewing the inside of the body) to provide innovative solutions for advancing care.

At the QEII Health Sciences Centre, the medical physics team supports cancer care at the department of radiation oncology, ensuring the accuracy and quality of radiation therapy treatments, as well as developing and implementing improved techniques and technology. Medical physicists also work in areas like diagnostic imaging to improve image quality and ensure that equipment, such as MRI, is working optimally as well as discovering new technologies to better image disease at research centres like the BIOmedical Translational Imaging Centre (BIOTIC).

The medical physics team, including Masters and Doctoral students from Dalhousie University’s accredited medical physics program – one of only 54 such programs in the world – has many research projects underway to help advance treatments for cancer care tomorrow. The following are just a few examples of medical physics research projects underway at the QEII.

Dr. Amanda Cherpak Medical Physicist Dr. Cherpak says that medical physics combines her interest in medicine and health with her affinity for physics and math. She appreciates the interdisciplinary nature of her role – everyone has their own area of expertise and brings something different to the table so they’re constantly learning from one another.

In 2015, Dr. Cherpak was part of the team that implemented Total Marrow Irradiation – a new way of giving radiation to bone marrow transplant patients to kill the cancer cells and increase the likelihood of the patient’s body accepting the donor marrow. The QEII was one of the first centres to use this method, allowing for increased sparing of healthy organs and increased quality of life post treatment.

Dr. Cherpak continues to work with current and former PhD students, with a shared goal of delivering more personalized patient care.

John Lincoln Doctoral program, medical physics John is pursuing a career in medical physics to help cancer patients receive the safest and most effective cancer treatments.

John is currently researching innovative ways of delivering radiation therapy to cancer patients, with the goal of decreasing treatment times and side-effects, while maintaining the highest quality of treatments.

John hopes that his research will improve radiation therapy treatments for cancer patients. Fewer treatments and reduced side-effects would allow patients to lead a more normal life throughout their treatment.

WINTER 2021

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Parisa Sadeghi Doctoral program, medical physics Parisa chose medical physics to have a direct impact on everyday life. Medical physics is a fast-evolving field of physics with research and innovation continuously advancing clinical practices.

Parisa’s research focuses on a new technology for motion management during brain radiation therapy. This technology can detect sub-millimeter patient motion during radiation delivery. This could increase the precision and accuracy of radiation delivery, while reducing the radiation dose to surrounding healthy tissue.

Sarah Reeve Doctoral program, medical physics With a Masters degree in astrophysics, Sarah Reeve wanted to use her physics knowledge to help people and society on a more fundamental level.

Sarah is doing research with the team at the BIOmedical Translational Imaging Centre (BIOTIC) at the QEII. Using the new 0.5T point-of-care MRI system from Synaptive Medical – a first of its kind in the world – Sarah and the BIOTIC team are investigating how exam time can be decreased while still producing a quality image. The impact of their research will be felt in emergency and point-of-care scenarios where time-sensitive decisions can be made faster, allowing patients to get the care they require sooner.

Dr. Thalat Monajemi Medical Physicist Dr. Monajemi has always been intrigued by applying the principles of physics to challenges in health care. With radiation therapy using some of the most complex equipment in a hospital, every day brings new challenges and it’s her job to help find solutions that will improve patient care.

Dr. Monajemi’s research is focused on the development of a new radiation detector. Her research group is one of the first in the world to explore the use of 3D printing techniques to make a specific radiation detector that gives off green or blue light when it is hit by high energy radiation.

With the ability to produce these detectors inside 3D-printed holders based on the body shape of individual patients, this allows for highly accurate measurements of the amount of radiation being received by the patient.

The detectors will ensure that each patient is receiving the correct dose in the correct location during each treatment. It will also allow clinicians to better understand the way a patient’s skin is affected by radiation.

WINTER 2021

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Caring for the heart Cardiology technologists play critical role in the QEII’s cardiac and vascular care team

By Allison Lawlor On his daily walk along the Bedford waterfront, Starr MacMullin frequently gives thanks to the cardiology team at the QEII Health Sciences Centre — a dedicated team he credits for saving his life.

“Right now, I feel great,” says the 70-year-old retiree whose heart problems started in 2006.

“I can live a normal life now.

I don’t go to bed worried now about whether I can breathe.”

After experiencing chest pains and feelings of heartburn, he was referred to the QEII, where he got an electrocardiogram (ECG), underwent a cardiac catheterization procedure and had a cardiac stent put in to treat his blocked coronary arteries.

A decade later, his health deteriorated. He joined a multiyear heart study and underwent two cardiac ablation procedures.

“The people at the heart clinic really changed my life,” says Starr. “Our healthcare workers are wonderful.”

Ashley Samms, team lead for the cardiology technologists at the QEII and president of the Cardiology Technologists Association of Nova Scotia, is one of those people. A registered cardiology technologist for almost 10 years, Ashley leads the QEII’s team of 35 full-time and part-time cardiology technologists.

“I am part of a patient-centred team,” says Ashley. “We provide a lot of care and support to patients.”

Cardiology technologists assist physicians by using various procedures and equipment to monitor, diagnose and treat heart

and blood vessel disorders.

At the QEII, the cardiology team provides specialized care for people in Nova Scotia and plays a critical role in the QEII’s cardiac and vascular care team. Working with thousands of patients from across Atlantic Canada each year, the QEII’s cardiology technologists conduct stress tests and ECGs, Holter monitoring — a portable device to monitor a patient’s heart for 24 to 72 hours — and work with patients who have implanted devices such as pacemakers.

“We are often one of the first people patients will see in the emergency department,” says Ashley.

Ashley and her team are busy.

On average, they do 80,000 ECGs a year on inpatients and outpatients. An ECG records the electrical activity of a heart at rest. It provides information about heart rate and rhythm and shows if there are cardiac arrhythmias (irregular heart rhythms) or evidence of a current or previous heart attack.

At the QEII’s Halifax Infirmary, a group of cardiology technologists have received additional training to allow them to run the only stress lab in the Atlantic region where they can conduct a cardiac stress test without a doctor being present.

Used to measure the heart’s response to physical exertion in a controlled environment, stress tests are performed on a treadmill or a stationary bicycle. The tests can be conducted on people experiencing undetermined chest pains while exercising or at rest,

inpatients after surgery, those in a cardiac rehabilitation program or someone who is undergoing changes in their medication.

After the technologist completes the test with a patient, which takes about 30 minutes, they complete and send a report to a cardiologist for review. The process not only frees up a physician’s time to read and confirm reports but gives technologists more independence, says Ashley.

“We have valuable skills and knowledge when it comes to reading electrocardiograms and patients’ bodily responses to conduct safe and effective safe stress testing,” she says.

Last March, when the QEII postponed all elective surgeries and procedures due to COVID19, Ashley and her team could only perform inpatient ECGs and emergency stress tests.

Wanting to continue to help outpatient heart monitoring and prevent huge backlogs, they mailed 100 patch monitors to people at home.

The adhesive patch is a small monitor in a silicone patch that is placed on a patient’s skin, with guidance from Ashley and her team, to record heart rate and rhythm. Results from the patch monitors are then sent to cardiologists for review. Funded through the QEII Foundation’s COVID-19 Response Fund, the patch monitors are one example of how donors played a role in patients receiving care at home during the pandemic.

Ashley is excited to offer cardiac outpatients with improved technology that will further help

Starr MacMullin enjoys his daily walks along the Bedford waterfront, frequently thinking about the cardiology team at the QEII Health Sciences Centre — a dedicated team he credits for saving his life. Contributed

The people at the heart clinic really changed my life.

– Starr MacMullin

them monitor their hearts from home, with the recent addition of 100 KardiaMobiles. These portable event recorders enable patients to do a medical-grade ECG in 30 seconds using the KardiaMobile app on their phone.

The results are recorded on

the patient’s smartphone and are emailed directly to the QEII’s cardiology team for review. At any time, a patient can capture their heart rate and rhythm, which can help detect, diagnosis and monitor symptoms such as; palpations, shortness of breath, or atrial fibrillation — a potentially life-threatening irregular heartbeat.

The cardiology department at the QEII is the first in Nova Scotia to use KardiaMobiles as a diagnostic tool.

“It opens up more home monitoring options for patients,” says Ashley.

A lifetime of patient-centred care Dr. Drew Bethune reflects on 40 years of providing cancer care at the QEII

By Sara Ericsson There is something that makes the relationship between lung cancer patients and their doctors unique, according to Dr. Drew Bethune, a former thoracic surgeon — repairing organs in the thorax or chest — at the QEII Health Sciences Centre in Halifax.

He says it’s a relationship made up of interactions that bring patient and doctor together, as they navigate the complexities that come with lung cancer care.

Developing those relationships is also one of the most intricate components of lung cancer care for a doctor to learn.

It’s a relationship Dr. Bethune has mastered after nearly 40 years at the QEII, specializing in lung cancer surgery and working toward the constant improvement of — and access to — top-tier lung cancer care across Nova Scotia.

“Patients’ stories and voices probably have had the biggest impact on me throughout my career,” he says.

Dr. Bethune says he initially felt drawn to lung cancer specifically as a major challenging area of surgery. He trained for five years in general surgery and later subspecialized for two years in chest surgery, becoming familiar with how the specialty goes beyond the technical aspects of care and operations.

“I found that there is an intellectual side to dealing with this cancer, in its multiple

treatment choices and consulting with patients while working out the best approach,” he says.

The advances and continued innovation that have taken place since he began practising in 1982 and arrived at the QEII have helped patients hugely, according to Dr. Bethune, who recalls when hospitals didn’t have ready access to CT scans.

He says current access to technology, like PET-CT scans and sophisticated radiotherapy, means surgery risk is reduced, patients are out of hospital faster and the general rate of innovation will continue increasing rapidly.

“We are now curing more cancers and, even in those cancers that are not cured, the treatments are prolonging lifespan with a better quality of life,” says Dr. Bethune.

Four decades in health care comes with challenges, which Dr. Bethune says have included ensuring timely access to lung cancer care diagnosis and treatment.

Dr. Bethune is proud of facilitating the pioneering use of molecular genetics — the structure of DNA — in lung cancer treatment in Atlantic Canada and advocacy for the further honing of thoracic and lung cancer surgery in Nova Scotia, to ensure top surgeon recruitment and the delivery of top-tier care.

Dr. Bethune says such goals

are also accomplished through the acquiring of technologies like the endobronchial ultrasound (EBUS), purchased with funds raised through the QEII Foundation’s signature event, Ride for Cancer powered by BMO Bank of Montreal. EBUS determines whether cancer has spread to the lymph nodes and helps doctors make decisions about surgery.

“The QEII Foundation’s support enables us to play on the world stage,” he says. “We’re a world leader, rather than playing catch up.”

Dr. Bethune has worked as the first senior medical director of Nova Scotia Health’s Cancer Care Program, a role in which he helped realize the expansion of services and research in Sydney and the strengthening of Nova Scotia’s network of community oncology sites.

He also worked on the recruitment of elite cancer physicians to Nova Scotia and is looking forward to what this new generation of healthcare providers accomplishes.

Most recently, Dr. Bethune says he is proud of the QEII cancer care program’s response to COVID-19, which saw minimal backlogs in surgery, chemotherapy or radiation treatment.

After almost 40 years at the QEII, Dr. Bethune retired on Dec. 31, 2020. He looks back

After four decades at the QEII, Dr. Drew Bethune reflects on his career as a thoracic surgeon and senior medical director of Nova Scotia Health’s Cancer Care Program.

QEII Foundation

The QEII Foundation’s support enables us to play on the world stage. We’re a world leader, rather than playing catch up.

– Dr. Drew Bethune

and remembers big moments, like operating on a man who went on to win a Nobel Prize, alongside smaller moments. Each underscores the importance of patient voices and how listening can further improve care.

“Patients’ voices are much bigger than you’d think and influence me hugely,” says Dr. Bethune. “That’s why I liked my job: it gave me the chance to try and fix things.”

B WINTER 2021

7

Crunching the numbers

QEII study looks at impact of COVID-19 pandemic on cardiac health

By Joey Fitzpatrick The number of deaths directly caused by COVID-19 has been well documented, both in Nova Scotia and across the country.

What’s less examined is the number of deaths indirectly caused by the pandemic.

For example, did cardiac and stroke deaths in Nova Scotia increase because people did not seek emergency care during the lockdown?

This is one of the questions Dr. Ratika Parkash, director of research and heart rhythm in the division of cardiology at the QEII Health Sciences Centre, is attempting to answer with the study titled Physical Distancing and Medical Distancing: Reducing the Cardiac and Neurovascular Impact of COVID-19.

“As soon as the lockdown began, people stopped coming to the emergency department,” says Dr. Parkash.

While cardiac disease is a silent killer, there are clearly defined symptoms that precede an episode of cardiac arrest.

“If you ignore those symptoms and don’t go to the hospital, then bad things will happen,” says Dr. Parkash. Symptoms that are normally simple to treat can lead to severe consequences that could be avoided if treated at the right time.

With $73,750 in funding, Dr. Parkash and her team are investigating how Nova Scotia’s pandemic response has affected morbidity — disease symptoms — and mortality in patients with known or new onset cardiovascular or neurovascular disease.

The study is funded by the Nova Scotia COVID-19 Health Research Coalition, which is a collaborative partnership between Nova Scotia Health, the QEII Foundation, Dalhousie University, Dalhousie Medical Research Foundation, IWK Foundation, IWK Health Centre, Dartmouth General Hospital Foundation, and Research Nova Scotia. This coalition committed $1.5 million to support the Nova Scotia research community on COVID-19 related projects.

“There was a spike in out-of-hospital deaths from cardiac arrest in many jurisdictions around the world during the first months of the COVID-19 lockdown,” says co-investigator Dr. John Sapp, QEII cardiologist and the assistant dean of clinical research for Dalhousie University’s faculty of medicine.

“We were concerned that the contraction of medical services and the fear of COVID-19 in the community was preventing people here in Nova Scotia from seeking care when they needed it,” says Dr. Sapp.

The study’s authors also wanted to know what is happening to patients who were waiting for surgery that was postponed during the lockdown. There were hundreds of patients on waiting lists for valve surgery or bypass surgery when all elective procedures were shut down across the province.

“We want to know what effect this had on patients and if it increased mortality and morbidity,” says Dr. Parkash. “Having this information will help us better allocate resources in future waves of COVID-19.

For example, rather than a blanket shutdown, we would be able to target those areas where there are least likely to be negative consequences.”

Data gathered so far indicates that acuity — the severity of illness and symptoms presented by patients in emergency departments — did increase during the lockdown period from midMarch to late May 2020.

“We were seeing patients waiting too long at home and coming in much more sick than would have otherwise been the case,” says Dr. Parkash.

Data is still being gathered for the period from May to the end of October, she adds. This will provide insight on patients with less acute symptoms who did not seek treatment, either from their family physician or at the emergency department.

“We wanted to look at this systematically, so when facing a second or third wave, we can minimize harm and maximize safety for patients,” says Dr. Sapp.

Dr. Ratika Parkash (upper left), director of research and heart rhythm in the division of cardiology; Dr. John Sapp (upper right), QEII cardiologist and the assistant dean of clinical research for Dalhousie University’s faculty of medicine; Judah Goldstein (lower left), research co-ordinator with EHS; and Dr. Andrew Travers (lower right), the provincial medical director for EHS, are collaborating on research to investigate how Nova Scotia’s pandemic response has affected morbidity and mortality in patients with cardiovascular or neurovascular disease. Contributed

We were seeing patients waiting too long at home and coming in much more sick than would have otherwise been the case.” .

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To get a better picture on outcomes for people suffering out-of-hospital cardiac arrest, the study authors partnered with Emergency Health Services (EHS) Nova Scotia.

Judah Goldstein, research co-ordinator with EHS, says the results will help decision makers with future public health emergencies, particularly with regards to getting the right messages to the public.

“We’re interested in learning if there were unintended consequences about the messaging that went out about COVID19,” says Judah. “The findings should help inform decision makers on their messaging about the safety of calling 911 or going to emergency.”

EHS was able to bring its wealth of research expertise and data to the study.

Dr. Andrew Travers, the provincial medical director for EHS, is excited about the opportunity to have cardiologists working directly with front-line paramedics on a research project.

“We’re breaking down silos with this collaboration between the in-hospital system of care and the out-of-hospital system,” says Dr. Travers. “It creates opportunities for bidirectional data flow.”

The study’s authors want to get the message out that hospital emergency rooms are safe to visit during the pandemic.

Visitors are screened before entering and procedures have been changed to ensure patients are not moving through multiple areas.

“Hospitals are taking every precaution to ensure that visitors are not going to contract COVID-19,” says Dr. Parkash.

“Yes, COVID-19 is a serious issue. But if you have these symptoms, then you should not delay getting treatment.”

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Finding the right approach Newly appointed QEII Foundation Endowed Chair in Transplantation Research aims to improve patient outcomes

By Sara Ericsson The importance of research in the advancement of health care can’t be overstated.

Prioritizing continued research is one of the main reasons behind Atlantic Canadian patients’ continued access to top-tier care at the QEII Health Sciences Centre in Halifax — and it’s an area that receives direct support from the QEII Foundation.

QEII Foundation endowed research chairs work to expand the current knowledge base as they search for ways to innovate treatment and care in their fields.

For Dr. Karthik Tennankore, who was recently appointed as the QEII Foundation Endowed Chair in Transplantation Research, that area is nephrology and kidney transplants. He is aiming to research how patient outcomes and decisions around transplant recipients can be improved.

“I want to find ways that make sure we allow people the best chance of receiving a transplant and deriving good benefit from it, not harm and poor health,” he says.

Dr. Tennankore is the second person to be appointed to this role.

Each QEII Foundation endowed research chair supports the QEII through dedicated research fields and each position is funded through permanent investments.

The QEII Foundation Endowed Chair in Transplantation Research position was established in 2013

with funding from Roche Canada, RBC and other QEII Foundation donors.

Dr. Tennankore is researching how machine learning, patient frailty and patients’ partners may affect kidney patient outcomes and transplant success. His goal through these combined research projects is to improve outcomes — risk-factor identification, patient recovery and quality of life — for nephrology and transplant patients.

“Transplant organs are a limited resource, so we want to make sure that they last as long as possible and provide organ recipients with better quantity and quality of life,” says Dr. Tennankore.

Dr. Tennankore says uncovering how machine learning may aid in transplant recipient selection may reveal how the technology can help physicians decide which patients may get the most benefit from a transplant, as it analyzes their interrelating health factors.

“What I see machine learning doing is not changing our allocation process, but complementing it with a model that’ll tell us, at that point of care, the risk or chance this organ will last a certain period of time,” he says.

Further to this, Dr. Tennankore is focused on unpacking the interrelation of patient frailty and its impact on the success or failure of a transplant. He is hopeful this study’s results may even translate to other organs,

particularly the liver.

“These answers will help us decide how to prioritize patients or find ways to mitigate frailty so that when the time comes for their transplant, they’re in better health,” he says.

His third research area, looking at creating behavioural interventions to increase physical activity, is aiming to objectively identify why people are sedentary, how partners may influence this and how to then work with objective findings and promote healthy habits.

“If we can figure out this relationship, we can suggest a behavioural intervention that works for each patient,” he says.

“This will ultimately improve recovery and quality of health.”

Dr. Tennankore says findings from these combined areas of research will help physicians make the best objective decisions they possibly can, while maintaining a human element in their decisionmaking process.

“We’re not just looking at patients as a number, but doing things where we’re seeing them face-to-face. Things that will be helpful at that point-of-care assessment,” he says.

He says the COVID-19 pandemic has made this area of research incredibly timely, as it has resulted in some people becoming less active.

“This is why identifying how

Dr. Karthik Tennankore, newly appointed QEII Foundation Endowed Chair in Transplantation Research, is working to improve outcomes for nephrology and transplant patients. QEII Foundation

patients and their partners participate in physical activity and sedentary behaviour is crucial, so we can come up with the right kind of intervention,” he says.

“Recognizing that a one-sizefits-all approach doesn’t work in the context of organ transplantation is key here. We’re looking to determine whether there are fairly consistent signals we can identify and use to address how we can improve outcomes.”

I want to find ways that make sure we allow people the best chance of receiving a transplant and deriving good benefit from it, not harm and poor health.

— Dr. Karthik Tennankore

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Dr. Kenneth Rockwood, QEII geriatrician, clinician scientist and director of geriatric medicine research, is working with 27 of his colleagues worldwide as part of the Lancet Commission on dementia prevention, intervention and care. New research reveals individuals can significantly reduce their risk of dementia by leading a healthy lifestyle. QEII Foundation

Reducing the risk of dementia QEII geriatrician’s research examines how healthy lifestyle habits play a significant role

By Brandon Young While genetics and neuropathology — disease in nervous system tissue — can play a role in one’s susceptibility to developing dementia, new research reveals individuals can significantly reduce their risk by leading a healthy lifestyle.

Throughout his career, Dr. Kenneth Rockwood, a QEII Health Sciences Centre geriatrician, clinician scientist and director of geriatric medicine research, has primarily focused on frailty and dementia.

Merging both areas of study, he’s seen the impact of reducing risk factors that aren’t directly related to brain composition but more so related to aging and lifestyle.

“Families often wonder if dementia is inherited,” says Dr. Rockwood. “The older someone is, the less likely there is a specific heritable gene. There are heritable factors but they usually consist of several genes.”

Dr. Rockwood says the question of dementia prevention is one that is top of mind. With 27 of his colleagues worldwide, Dr. Rockwood has been a part of the Lancet Commission on dementia prevention, intervention and care, which identified 12 potentially modifiable dementia risk factors.

In their article titled Dementia prevention, intervention, and care: 2020 report of the Lancet Commission, they list the following factors: less education, hearing loss, traumatic brain injury, hypertension, alcohol consumption (more than 21 units per week), obesity, smoking, depression, social isolation, physical inactivity, air pollution and diabetes.

Reducing the risk of dementia is more effective, depending on when risk factors are eliminated. For instance, someone addressing their hearing loss in mid-life

yields better results versus eliminating that risk later in life.

“Individual items can vary from up to eight per cent reduction for hearing loss, to one per cent for obesity,” says Dr. Rockwood. “But they add up. The more things that people can get control of, the better. None of these things is ever too late to start and benefits can be seen across the life course.”

Many risk factors contribute to what degree of frailty someone lives with. Much of Dr. Rockwood’s research focuses on the relationship between dementia and frailty, which he defines as a state in which individuals have more health problems than their peers.

In the Lancet Neurology article titled Investigation of frailty as a moderator of the relationship between neuropathology and dementia in Alzheimer’s disease: a cross-sectional analysis of data from the Rush Memory and Aging Project, Dr. Rockwood’s team used a frailty index, which was developed in Halifax in 2001 with his mathematician colleague Dr. Arnold Mitnitski.

“This is where we made the most definitive test of the hypotheses that, as important as a neuropathology is to developing dementia, not everyone whose brain carries Alzheimer neuropathology develops dementia. And not everyone who develops dementia has dementia pathology at the degree that you would think they should, based on the neuropathology, which for years we held out as the only way to get a definitive diagnosis of Alzheimer’s disease.”

While 60 per cent of the risk of developing dementia is unknown, individuals could, in theory, reduce their

The work we’ve done shows the risk of developing dementia is reduced. It doesn’t go away, but the risk is reduced by a healthy lifestyle.

— Dr. Kenneth Rockwood

risk of later-life dementia by up to 40 per cent by eliminating all potentially modifiable risk factors.

“The work we’ve done shows the risk of developing dementia is reduced. It doesn’t go away, but the risk is reduced by a healthy lifestyle,” says Dr. Rockwood. “The question is, what does a healthy lifestyle consist of and when should we start?”

In the article titled Reducing the risk of later-life dementia. Evidence informing the Fifth Canadian Consensus Conference on the Diagnosis and Treatment of Dementia, Dr. Rockwood and other Canadian experts recommend people at risk for dementia reduce their risk by adopting a healthy lifestyle.

Recommendations include adhering to a balanced diet modelled on the Mediterranean diet — rich in fruits, vegetables, whole grains and lean proteins; engaging in moderate, energetic physical activity; improving disordered sleep; engaging in cognitive training and intellectually stimulating activities; paying attention to social circumstances;

supporting others and allowing yourself to be supported; improving frailty and minimizing medications that commonly inhibit the brain chemical acetylcholine, which is essential for memory.

The focus of QEII dementia neurologist and cutting-edge clinician scientist Dr. Sultan Darvesh, these medications are often used to treat sleep disorders or problems with bladder control, as well as many other illnesses.

Dr. Rockwood hopes the research he’s participated in will help patients by providing healthcare providers with a better understanding of dementia as not merely a brain disorder.

“We’ve tended to imagine dementia fairly specifically as a brain disorder. Even within that, we’ve imagined it as fairly specifically a cognitive disorder,” says Dr. Rockwood. “This work shows that the brain is affected, the body is likely affected, too.”

Meanwhile, Dr. Rockwood notes dementia patients are seeking healthcare professionals with a deep understanding of their problems. Through his research examining dementia, he hopes others will take note and approach patient care in a nuanced way that considers the multifaceted entirety of people — in all areas of health.

“It’s important that we, as a healthcare system, can look at whole people, recognizing that they often have many problems all at once. We need to train physicians who can provide that care — a growing gap in in Nova Scotia.

Understanding how to think about and treat late-onset dementia is a subset of the ways in which this work is clinically meaningful,” says Dr. Rockwood.

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Blood sample review process made simpler CellaVision technology combines efficiency with education

By Allison Lawlor Advanced technology at the QEII Health Sciences Centre in Halifax is allowing blood laboratories to do more with less — and faster — while at the same time connecting different hospital sites in Nova Scotia.

Thanks to CellaVision, a digital system that uses innovative automation, digital imaging and artificial neural network technology, a blood sample can be taken from a patient at the Cobequid Community Health Centre in Lower Sackville, the Dartmouth General Hospital and soon the Cape Breton Regional Hospital and immediately reviewed by specialists at the QEII. The time spent waiting for a blood sample to be physically transported to the QEII and analyzed is eliminated, allowing for diagnosis and treatment to take place faster.

“CellaVision is a camera in a box with artificial intelligence. It essentially gives a snapshot of all the cells I need to identify, like white blood cells,” says Dr. David Conrad, a hematopathologist, section head for molecular hematopathology at the QEII and hematopathology residency program director at Dalhousie University.

Hematopathologists are specially trained to diagnose diseases of the blood cells.

By eliminating the need to use a conventional microscope,

Dr. Conrad can review a blood sample in half the amount of time it once took him.

This means improved speed of diagnosis for critical cases, such as leukemia, and improved patient care. The digital system also means greater learning opportunities across the province.

“It has enhanced our ability to teach,” says Dr. Tish O’Reilly, a hematopathologist and medical director of microscopy at the QEII and associate director of the hematopathology residency program. “We can save specific cell images in a database.”

Dr. O’Reilly, along with Kimberly Ingalls, an awardwinning technical specialist for microscopy at the QEII, trains medical students, residents and medical technologists from across the province.

Through their teaching they are increasing the level of expertise in Nova Scotia, providing the opportunity for everyone who looks at blood cells to see all the different blood abnormalities that contribute to a diagnosis. Greater diagnostic expertise means better patient care everywhere in Nova Scotia.

Using CellaVision’s advanced software, they have the ability at the QEII to categorize all red and white blood cells. Instead of a group of students crowding over a microscope and learning to identify hundreds of blood

Kimberly Ingalls (left), technical specialist for microscopy, Dr. David Conrad (centre), hematopathologist, and Dr. Tish O’Reilly (right), hematopathologist and medical director of microscopy, say CellaVision – a digital system that uses innovative automation, digital imaging and artificial neural network technology – allows for diagnosis and treatment to take place faster. Contributed

cells all in the same field of view, the digital system allows them to review and categorize specific cells on a computer screen, making it not only more precise but easier for everyone to view the same cells — and a safer way of learning during the COVID-19 pandemic.

The system also allows the QEII team to teach remotely.

“It is much more tailored teaching,” says Kimberly, who received the Canadian Association of Pathologists 2020 Medical Technologist/Technician Award for Continuing Professional Development.

Dr. Conrad is excited not only about the enhanced teaching opportunities, but also to see the CellaVision system expand to Cape Breton. Currently, when a blood sample is taken in Cape Breton and needs to be reviewed by a hematopathologist, the slide must be couriered to Halifax, entered into the digital system and then analyzed. This transfer time can amount to anywhere from eight to 24 hours.

The technology has taken away the distance between the patient sample and the pathologists in Halifax, who are the experts at looking at those blood cells.

–Dr. David Conrad

“The technology has taken away the distance between the patient sample and the pathologists in Halifax, who are the experts at looking at those blood cells,” says Dr. Conrad.

With CellaVision technology, patients at the Cape Breton Regional Hospital will no longer have to wait an extra eight to 24 hours for a result.

“We will be able to see them in real time, almost immediately,” says Dr. Conrad. “We will be able to view, in real time, the slides from Cape Breton while we are sitting here in Halifax.”

Inside the microscopy lab at the QEII, Kimberly and her colleagues daily review 175 to 200 blood specimens five days a week. About 10 per cent of those need to be further analyzed by a hematopathologist.

If she is looking at a blood sample in her lab using the CellaVision system and a red flag is raised, Kimberly calls a medical specialist on the phone.

They can review the same blood cells together, in different offices, because of CellaVision.

Potentially fatal diseases, such as acute promyelocytic leukemia (APL), can be diagnosed promptly.

Patients with APL are at risk of quickly developing blood-clotting or bleeding problems if not treated.

“We are helping treatment happen more quickly,” says Dr. Conrad.

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‘I feel so blessed’

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In December 2020, Atlantic Canada’s first AngioVac procedure for endocarditis was performed in the QEII’s new interventional radiology suites, partially funded by QEII Foundation donors, by a specialized team of about 15 people. QEII Foundation

QEII team performs Atlantic Canada’s first AngioVac procedure

By Allison Lawlor Ceilidh Mailman avoided open-heart surgery and was home for Christmas, thanks to a multidisciplinary team at the QEII Health Sciences Centre, who performed Atlantic Canada’s first AngioVac procedure on her right heart valve.

By undergoing the minimally invasive, image-guided procedure to treat endocarditis, a lifethreatening inflammation of the inner lining of the heart’s chambers and valves, Ceilidh’s recovery time went from several months to several weeks — and she avoided risky side-effects often associated with open-heart surgery.

She was out of bed the day after the procedure and back home in Truro shortly after to celebrate not only Christmas, but her son’s 13th birthday.

“I feel so blessed,” says the 32-year-old mother. “I am so grateful to all the healthcare professionals. The care I have received has just been amazing.”

Ceilidh’s condition was assessed

by QEII cardiac surgeons Dr. Keir Stewart and Dr. Hashem Aliter.

While endocarditis is usually treated through open heart surgery, the QEII’s newly opened interventional radiology (IR) suites offered a new, minimally invasive option.

“Medicine and surgery are continuously evolving,” says Dr. Aliter. “The new IR suites have the latest technology and offer a large space, allowing us to work comfortably with a large team and additional equipment, like a heart-lung machine.”

In early December 2020, a specialized team of about 15 people, including cardiac surgery, interventional radiology, cardiac anesthesia and cardiovascular perfusion, inserted a thin tube into Ceilidh’s heart, via the vein in her neck, to perform the procedure.

Working inside one of the new IR suites at the QEII, funded in part by QEII Foundation donors, the team used X-ray and ultrasound guidance to access the valve on the right side of her heart and remove dangerous bacteria causing the concern.

“She avoided open-heart surgery and avoided having to

get a new artificial heart valve,” says Dr. Rob Berry, head of interventional radiology at the QEII. “It was a great example of multiple teams working together.”

The minimally invasive twohour procedure done on Ceilidh was a success and couldn’t have happened without the expertise and co-operation of several specialties.

“Doing things collaboratively is the way surgery is going to go more and more,” says Dr. Stewart.

Roger Stanzel, a cardiovascular perfusionist at the QEII, is used to playing a vital role during heart surgery. His job is to operate the cardiopulmonary bypass machine — taking over the heart and lung functions of the patient and ultimately keeping them alive throughout cardiac surgery.

For the procedure on Ceilidh’s heart, two small incisions were made and a fine tube inserted into her body, creating a bypass circuit. The cardiac anesthesia team performed a continuous cardiac ultrasound, giving the rest of the team live images of the heart. This allowed the IR team to

guide the AngioVac suction tube to the infection on the heart valve.

Using suction, the team cleaned the bacteria off of Ceilidh’s heart valve, capturing it in a filter trap for analysis at the pathology lab.

Ceilidh’s own filtered blood was then sent back into her body through the bypass circuit.

“During this procedure, the patient has absolutely no blood loss, which reduces the need for blood transfusions and the associated risks of transfusion,” says Roger.

For Ceilidh, the procedure marked what she hopes will be the end of a long, painful journey and the beginning of a new stage in her life.

“I’ve struggled with addiction most of my life,” says Ceilidh, who started using drugs when she was 13 years old and has struggled with her mental health and trauma much of her life.

Injecting cocaine into her body led to an infection. Doctors know that endocarditis is usually caused by an infection. Bacteria, fungi or other germs from another part of the body spread through

the bloodstream and attach to damaged parts of the heart. If it can’t be treated by medication, like in Ceilidh’s case, surgery is necessary.

“I count myself very, very lucky,” she says. “It is a miracle I was able to get this type of procedure.”

Ceilidh’s story isn’t uncommon.

Five years ago, it was rare to see a tricuspid valve infection, says Dr. Stewart. Now, cardiac surgeons at the QEII do as many as 10 surgeries a year, mostly on young people who are intravenous drug users.

Dr. Stewart and Dr. Aliter expect the AngioVac procedure will be helpful to more people in the future.

“It means that more Nova Scotians who are candidates for minimally invasive procedures will have the opportunity to be treated with the newest techniques,” says Dr. Aliter.

After entering an opioid dependency program, Ceilidh has been sober for several months.

“I am creating a new life,” she says.

Dr. Daniel Rayson, QEII oncologist

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Simulation learning prepares QEII teams to respond to the pandemic

By having a simulation session, it allows staff to have an open space to learn and share information.” .

– Phuong Nguyen

By Natalie Jarvis When Phuong Nguyen got a call to co-lead COVID-19 training for operating room nurses at the QEII Health Sciences Centre, she jumped at the opportunity.

An experienced operating room nurse, Phuong co-ordinates training and educates medical professionals as part of the QEII Simulation Program. When COVID-19 reached Nova Scotia in March 2020, QEII simulation teams cancelled all non-urgent sessions. In those early days of the virus, protocols were constantly evolving, as information unfolded at the expert level.

QEII experts rallied to organize teams to care for COVID-19 patients, as well as those at risk of contracting the virus, including care providers and surrounding patients.

Phuong teamed up with dedicated nurse educator Beth Kingsbury to develop a simulation session for nurses caring for COVID-19 patients. The session focused on every detail, from donning and doffing personal protective equipment (PPE), to the safe transfer of patients into the treatment area, providing care to patients and communicating with staff.

The team relied on equipment funded

by QEII Foundation donors to host the sessions, including high-fidelity simulators that support lifelike healthcare scenarios. This is critical, especially in an unprecedented health environment.

“Anxiety was high among staff because, in any working environment, if people don’t know what the plan is, this could cause confusion,” says Phuong. “By having a simulation session, it allows staff to have an open space to learn and share information. It’s also a safe environment to ask questions — a forum for discussion.”

Social distancing meant only five nurses could attend a unique session. With 50 to 60 OR nurses, the team spent a few weeks

completing training.

Every detail was considered — where a binder was placed, the air exchange rate of the room, how much time had to pass before opening a door after a patient goes to sleep and surgery can commence.

This process involved support from QEII engineers and infection control to ensure the safety of all involved.

Dr. Nick Sowers was part of a team of clinician educators at the helm of COVID19 training in the emergency department.

Their focus was on airway management and resuscitation.

From the time a patient places their call to 811, to EHS paramedics being dispatched to assess and treat COVID19 patients prior to their arrival at the Charles V. Keating Emergency and Trauma Centre, every step of the process was evolving and transforming as new research-based information emerged.

Both Dr. Sowers and Phuong credit donors for opportunities provided to improve patient care through simulation learning. Doctors, nurses and respiratory therapists alike grow in these spaces. The skills acquired with a dedicated, risk-free space for learning are unmatched.

An integral part of the QEII Simulation Program, QEII Sim Bay was critical in helping teams prepare to face the pandemic. It may not have been business as usual in the donor-funded facility, but its value was highlighted more than ever.

Here, training sessions were hosted for multidisciplinary teams including paramedics, respiratory therapists, nurses and physicians. In addition to learning the appropriate method to don and doff PPE, staff underwent extensive airway management training.

Procedures such as intubation are complex on the average patient. Now,

imagine a COVID-19 positive patient; it’s a whole new world. Intubation increases the concentration of droplets in the air, which is exactly how COVID-19 spreads.

So, additional measures, including PPE, come into play.

At QEII Sim Bay, teams have a safe space to prepare to face the unknown — like treating COVID-19 patients. Access to clinical-grade cadavers offers an experience that imitates real life.

“The short answer is that this facility saves lives,” says Dr. Sowers.

Phuong Nguyen, a QEII operating room nurse and simulation expert, was called to co-lead COVID-19 training for nurses. Contributed

Funded entirely by donors, QEII Sim Bay opened its doors in November 2018 at the Charles V. Keating Emergency and Trauma Centre. Part of the QEII’s simulation learning ecosystem, QEII Sim Bay allows learners to refine their skills in emergency, trauma, airway and surgical skills. The advanced equipment in this space, including high-fidelity simulators, played a critical role in COVID-19 training for QEII staff.

On behalf of every patient at the QEII and those who care for them, the QEII Foundation is grateful for the community of donors who made this space possible.

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