Our Shared Purpose newsletter - April 2019

OUR SHARED PURPOSE April 2019

The healing power of music Using iPods to help people living with dementia (pg. 7)

A mother-daughter transplant tale Their journey from St. Joseph’s to St. Michael’s (pg. 8)

ELIMINATING

RESEARCH BARRIERS 101 WITH TECHNOLOGY What it takes to Enhancing equity and access in health innovate (pg. 4) care by virtually connecting patients and providers (pg. 4)

New resources for mental health care St. Joseph’s Mental Health Emergency Services Unit renovated and enhanced (pg. 2)

The right diet for a healthy life The role of a registered dietitian in a long-term care home (pg. 3)

New space for mental health care

The right diet for a healthy life

St. Joseph’s Mental Health Emergency Services Unit renovated and enhanced

The role of a registered dietitian in a long-term care home

by Amber Daugherty

by Selma Al-Samarrai

Shannon McManus, registered dietitian in the Cardinal Ambrozic Houses of Providence is pictured here with resident Lisa Fitzsimmons (Credit: Yuri Markarov)

The renovated Mental Health Emergency Services Unit is opening mid-April at St. Joseph’s

People living with mental illness in Toronto’s west-end will soon

for emergency care,” said Donna Didimos, patient care manager of

Registered dietitians work closely with clients to identify a diet plan

and dietary staff to assess any nutritional issues that a resident may

have a more specialized space to go to when they need urgent

the MHESU and Emergency Department. “In those situations, people

that fits both their health challenges and personal preferences.

have.

support. The Mental Health Emergency Services Unit (MHESU)

depend on us to be there for them and our new unit will help us

at St. Joseph’s has been refreshed and is

“

now features separate areas for youth and

People depend on us to be there for them and our new unit will help us continue to provide the safest care when needed most.

adult patients, bright murals, more natural

DONNA DIDIMOS

ensure patients have the best experience possible.

The unit saw almost 2,000 visits last

year and provides valuable care to those in the community experiencing crises as a result of mental illness. Thanks to generous donors, including the Ontario government, the unit has been completely renovated. It

light and a brand new patient lounge to make the

PATIENT CARE MANAGER ST. JOSEPH’S

stay more comfortable.

“We’re a community hospital in an area where many people

live with mental illness and we know this is a necessary resource

“

opening mid-April with new features to

In long-term care homes, the primary focus of the conversation

She then implements dietary interventions that ensure the

continue to provide the safest care when

is often about agreeing on the right meal plan for residents that

resident is eating well, enjoying their meals and getting the nutrients

needed most.”

balances healthy eating and quality of life, says Shannon McManus,

they need.

Patients coming into the Emergency

who has been a registered dietitian in the Cardinal Ambrozic Houses

Department experiencing a crisis will go

of Providence for ten years.

loss, dysphagia, self-feeding difficulties, hydration and constipation,

right into the MHESU, which allows for

and others that occur in association with illnesses such as dementia,

more privacy during what can be a difficult

meal options while managing their medical nutrition issues,” says

heart disease, diabetes and renal failure.

time. There, they will have access to

McManus.

specialized support and care from our team

population for a variety of reasons, often related to swallowing

in a therapeutic environment. Everything is

to them? Do they want my help or suggestions? And if they are

impairment, dementia or other health issues,” said McManus.

designed to maximize and enhance their

agreeable to my suggestions, how can I modify their diet in a minimal

recovery.

way that doesn’t significantly impact their quality of life?”

maximize safety, minimize risk and maintain quality of life,” said

McManus.

“We’re really excited because this new

space will make a huge different to our patients,” said

“My goal is to keep residents comfortable and satisfied with their

“My priority is always the resident – is my concern of concern

An average day for McManus looks something like this: she

McManus commonly assesses nutritional issues such as weight

“There is a high prevalence of malnutrition in the elderly

`“Dietitians plan menus to meet individual nutrition needs,

works with long-term care residents and their families, and nurses

Didimos.

“Everything has been considered to help get patients healthy

and home as quickly as possible.”

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Eliminating barriers with technology Innovative model was developed in collaboration with St.Michael’s telemedicine team

by Emily Dawson

Clinicians are breaking down geographic, social-economic, and

psychosocial barriers that traditional in-person treatments create

Merrick uses a real-time, videoconferencing connection to offer Risk

by simply sitting in front of a computer and reaching across the

one-on-one sessions in support of her therapy goal to feminize her

support.

Telepractice – a specific application

of telemedicine for the delivery of speech language pathology - helped Amber Risk, a trans woman living in North Bay, access voice feminization therapy. This service isn’t provided in her home town but is available almost four hours away at St. Michael’s.

“Without telepractice, I would not have

access to this kind of therapy. None of the

“

voice and communication style.

(Telepractice) certainly makes voice therapy accessible and helps bridge the gap for those who otherwise wouldn’t receive the care they need.

Speech Language Pathologists in my city specializes in trans care,” said Risk. “I would have

MARTA DELUCA

SPEECH LANGUAGE PATHOLOGIST ST. MICHAEL’S

to travel to Toronto for every appointment, which would be cost and time prohibitive for me – as it would be for many people.”

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province to someone who needs their

St. Michael’s Voice Clinic Speech Language Pathologist (SLP) Gwen

Merrick also runs group therapy

programs for trans women out of the hospital’s same clinic.

“When I think of the future of my practice, From the comfort of home: Evolving OTN technology allows Amber Risk to virtually join Gwen Merrick for

I think of people like Amber being able to

a Voice Clinic appointment. (Credit: Katie Cooper)

participate in and benefit from group therapy as well even though they are hundreds of

sessions for people with voice, swallowing and breathing disorders.

kilometres away,” she said.

Telepractice is allowing SLPs to reach a greater number of patients

2017, clients had to travel to a designated Ontario Telemedicine Network

while also addressing equity and access issues.

(OTN) site to access the clinic’s services. Less than two years later, clients

anxiety. Although she decided to join us in

are now accessing OTN on their personal computers, tablets or other

person, her anxiety could have created a barrier

hands-on care,” said Marta DeLuca, another of the clinic’s SLPs, who

mobile devices.

for her care. Telepractice could allow someone

understands that there are some limits to the technology.

to join the group virtually from home and still benefit

makes the therapy much more personal – we’re bringing our care right

from the group.”

the gap for those who otherwise wouldn’t receive the care they need. I

“I have a client in my group with social

Every year the Voice Clinic provides more than 2,000 therapy

“There are things we cannot do via telepractice in terms of

“But it certainly makes voice therapy accessible and helps bridge

And as technology goes, it is evolving quickly. Even as recently as

“Accessing telepractice from a client’s home, office or mobile

to those who need it,” said Merrick.

even have a patient in his 80s who now accesses therapy on his iPad!”

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HOW WAKEFULNESS IMPACTS GETTING PATIENTS OFF VENTILATORS IN THE ICU Critically ill patients are more likely to be weaned off of a breathing machine if they have higher levels of wakefulness and both their right and left brains experience the same depth of sleep, suggests a recent study from the Centre of Excellence in Mechanical Ventilation of St. Michael’s.

This new research could play an important role in improving patient care in the intensive care unit. “While mechanical ventilation is life-saving, it can cause lung damage, infections and other health problems, so patients should be taken off a breathing machines as soon as medically possible,” said Dr. Laurent Brochard, author of the study and scientist at the Keenan Research Centre for Biomedical Science. Monitoring for wakefulness early may lead physicians to change the management of a patient.

The healing power of music Partnership between Providence and Alzheimer Society of Toronto uses iPods to help people living with dementia

Dr. Laurent Brochard is a scientist at the KRCBS and a physician in the Critical Care Department of St. Michael’s. His research focuses on mechanical ventilation – or breathing machines in the ICU. (Credit: Medical Media)

by Selma Al-Samarrai

NO ‘ONE-SIZE-FITS-ALL’ APPROACH TO GENETIC TESTING Patients’ approaches to genome sequencing might be as varied as their genetic codes, suggests a new study, which identified five profiles that reflect different approaches to making decisions about genome sequencing and additional information they may glean from it – called incidental results.

“Based on our interviews, we found that groups of patients shared common values and concerns about incidental results,” said Dr. Yvonne Bombard, study author and scientist at the Li Ka Shing Knowledge Institute.

The profiles identified were: Information Enthusiasts, Concerned Individuals, Contemplators, Individuals of Advanced Life Stage and Reassurance Seekers.

“By identifying patients’ profiles, clinicians could target their counselling based on values, concerns, or misconceptions that are relevant to specific patients,” said Chloe Mighton, who co-led the study.

Adult Day Program staff Navneet Marwaha (left) and Erin Leneeuw provide iPods to caregivers at Providence Healthcare as part of the Music Project partnership with the Alzheimer Society of Toronto (Credit: Yuri Markarov)

It’s well-documented that listening to music can offer

is a tremendous help not only in making her happy and engaged but

tremendous benefits to people living with dementia. The quality

also in providing me, her caregiver, some downtime to do housework.

of life improvements can include heightened engagement with

I’m so grateful for this.”

surroundings, increased connection to memories, and better

temperament.

Day Program, says the reported impacts of the iPods have been

overwhelmingly positive.

A few years ago, Providence Healthcare collaborated with the

Navneet Marwaha, a clinical resource co-ordinator at the Adult

Alzheimer Society of Toronto to provide iPods, preloaded with a

personalized playlist, to dementia patients as part of the society’s

have even said that when their loved one is anxious, they find comfort

Music Project. Not only does the project help people living with

in listening to music that’s familiar to them,” explained Marwaha.

dementia, it also provides a break for their caregivers.

SHARING MEDICAL IMAGING DATA THE LANCET, ELIFE PUBLISH TO CUT RADIATION STUDIES OUT OF ST.DOSES MICHAEL’S CGHRmight WITH GLOBAL Patients expect radiation IMPACT doses for CT scans to be

Providence, and Providence’s Scotiabank Learning Centre is where

comparable from one hospital to the next, but a team at The Centre for Global Health Research (CGHR) of St. Michael’s St. Michael’s Hospital says the dose variance can be startling. recently published two research studies with global implications.

The team is collecting and analyzing data from eight hospitals

Dr. Prabhat Jha, director of CGHR, and Benjamin Wong, for the Medical Imaging Metadata Repository of Ontario (MIMRO) epidemiologist, uncovered that a mass measles vaccination to help reduce the province’s average radiation dose per scan. campaign saved 41,000 to 56,000 children’s lives in India between Using artificial intelligence to sort the hospitals’ data, the team 2010 and 2013. This research was published in eLife. generated comparative data by facility, scanner and exam to help

Additional research from the CGHR published in The Lancet determine best practices. MIMRO is funded primarily by and co-led by Dr. Jha and Dr. Shaza Fadel, the CGHR’s lead child St. Michael’s and was created by two of its radiologists, health epidemiologist, suggests that most deaths of children aged Drs. Timothy Dowdell and Bruce Gray. five to 14 in India, China, Brazil and Mexico arise from preventable or treatable conditions.

Radiologist Dr. Bruce Gray and data analyst Lianne Concepcion review data

Dr. Yvonne Bombard and Chloe Mighton (second and first on right in back) and the team behind the GENOMICS ADvISER, a decision aid. (Credit: Yuri Markarov)

Anita Delos Reyes Llamoso, 89, started showing signs of

“Music helps people with memory loss reminisce and caregivers

The Alzheimer Society of Toronto has a satellite office inside

Alzheimer’s disease a few years before her diagnosis in 2013. Her

caregivers are directed to pick up their iPods.

daughter, Alice Celis, picked up an iPod for her mother at Providence

last year and has since noticed a positive impact.

much sense and was really a match made in heaven for caregivers,”

said Erin Leneeuw, clinical resource co-ordinator for intake and family

“My mother is a caring and loving person, it was very sad to

“Our collaboration with the Alzheimer Society of Toronto made so

see these personality changes in her. However, her love for music

guidance at the Adult Day Program.

did not change. She is always happy and cheerful when listening

to music and of course, surrounded by family and friends who love

iPod, many caregivers are walking into Providence’s Scotiabank

her,” explained Celis, who has been taking her mother to Providence’s

Learning Centre for the first time, which allows us the opportunity

Adult Day Program since 2014.

to immediately support and engage them with new information on

caring for a loved one with memory loss.”

“The iPod project that enables her to listen to her favourite songs

“What we find is, in addition to being able to pick up the

submitted to MIMRO. (Photo: Katie Cooper)

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A family’s transplant story A patient’s journey from dialysis at St. Joseph’s to transplant at St. Michael’s

by Ana Gajic

As Lauren Garraway and her mother Prema prepared for their surgeries, Lauren gave her mom a thumbs-up and said: “We’re going to come out of this laughing.”

(L-R) Lauren Garraway completed the CN Tower Edge Walk after transplant (Credit:

Lauren Garraway), Lauren’s mom, Prema, helped give her the gift of life through the

Lauren was preparing to receive a kidney, and Prema was getting

ready to donate one of hers. Though Prema and Lauren were not

National Kidney Paired Donation Program (Credit: Prema Garraway).

a match, the two were part of the National Kidney Paired Donation

a family,” said Jennifer Arnaiz, Lauren’s home dialysis nurse and

program. Prema would donate her kidney to another kidney patient

transplant coordinator at the St. Joseph’s dialysis unit. “Our program

in need, and in turn, Lauren would receive one from a stranger.

provides primary nursing care, which facilitates continuity and

Then 32, Lauren had been on dialysis for 15 months after an

consistency of care for our patients.”

unexpected kidney failure diagnosis.

team found a transplant option that would work for her family.

Within 48 hours of diagnosis, she picked which type of dialysis

Lauren’s transplant care took place at St. Michael’s, where the

to go on. She learned she would eventually need a transplant.

“We always felt like the teams always had our backs,” Prema said.

Prema and Lauren received their surgeries within a few days

“I was overwhelmed,” she said. “In some ways, it was better that

it all happened quickly – I had no time to harp over it.”

of each other, and then recovered in matching hammocks in the

backyard over the summer.

Prema remembers feeling terrified of losing her daughter, who

never faltered throughout the journey.

of the Kidney Transplant program at St. Michael’s. They hope their

“There is no one stronger than Lauren,” she said. “She’s the

Now, the two are sharing their story in celebration of 50 years

backbone, the strength.”

experience helps others who need a transplant, or those considering

giving the gift of life.

Lauren and her family found themselves visiting the dialysis unit

at St. Joseph’s monthly. She had picked home dialysis and the

St. Joseph’s unit provided support and checked in regularly.

and feel our joy,” Prema said. “Every day we get to celebrate Lauren’s

life.”

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“We develop close relationships with our patients - similar to OUR SHARED PURPOSE

“We have a happy ending and we need to let people know this