hospital news july 2014 edition

INSIDEFrom the CEO's desk ......................... 19

Evidence Matters .............................. 21

Ethics ..................................................24

Healthcare Technology ......................27

Travel ...................................................30

Careers ...............................................31

Future directions in cell transplantation for Type I Diabetes

World's smallest heart monitor

7 11

FOCUS IN THIS ISSUECARDIOVASCULAR CARE/RESPIROLOGY/DIABETESDevelopments in the prevention and treatment of vascular disease including cardiac surgery, diagnostic and interventional procedures. Advances in treatment for various respiratory disorders including asthma, allergies. Prevention, treatment and long term management of diabetes and other endocrine disorders.

JULY 2014 | VOLUME 27 ISSUE 6 | www.hospitalnews.com

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DiabetesEpidemic

By Dr. Jan Hux

Every hour of every day 20 Canadians are

diagnosed with diabetes

Story on page 16

HOSPITAL NEWS JULY 2014 www.hospitalnews.com

2 In Brief

Bill of health

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3 News

Urinary tract infections (UTIs) are com-mon among Canadian children, yet many are diagnosed when there is no actual in-fection. The Canadian Paediatric Society is reminding physicians about the impor-tance of accurate diagnosis of UTI to pre-vent the overuse of antibiotics and unnec-essary invasive investigations.

"Doctors are worried about missing a UTI, and so they often diagnose with any symptom or laboratory result that could possibly mean that the child has a UTI. This leads to unnecessary antibiotic treat-ment," says Dr. Joan Robinson, chair of the CPS Infectious Diseases and Immunization Committee. "They worry that missing the diagnosis of UTI for a day or two could lead to long-term health effects includ-ing high blood pressure and renal failure, but there is no evidence to support this concern."

In a new position statement, authors note that many of the recommendations for the management of UTIs are based on expert opinion because studies are lack-ing. In the absence of evidence to support the belief that a missed diagnosis will lead to greater health issues, the CPS is urging physicians to take the time to properly di-agnose a UTI.

"Doctors need to ensure accurate di-agnosis with each individual case," says Dr. Robinson, one of the statement's co-authors. "Procedures like rapid urine tests and bag samples often lead to false positive results because samples are easily contami-nated. Invasive radiologic tests for most UTIs are not needed. For very young chil-dren with a UTI a simple ultrasound is suf-fi cient to rule out any serious abnormality."

To properly diagnose a UTI, the CPS recommends:• Babies between two and 36 months of age with a fever of greater than 39°C and no other obvious source for fever should have urine collected and analyzed. Urine should be collected by a catheter or supra-pubic aspiration (SPA). • In toilet-trained children, a midstream urine sample rather than a catheter or SPA specimen should be submitted for urinaly-sis and culture. • Urine collected by bag should never be used on its own for diagnosis of a UTI. ■H

Paediatricians call for better diagnosis of urinary tract infections

Canadians want end-of-life care While Canadians have diverse views

on end-of-life care issues, there is a strong desire across the country for more pallia-tive care services to help ensure a "good death, " the Canadian Medical Association (CMA) says. This is the principal fi nding in the CMA's fi nal report from its Na-tional Dialogue on End-of-Life Care tour between February and late May 2014.

"This cross-country effort was not about telling Canadians about CMA's position, it was about listening to Canadians about what their health care system could do to help ensure not only a long, healthy life but also a good death, " says CMA Presi-dent, Dr. Louis Hugo Francescutti. "What we heard in spades was that the public is eager to learn more about end-of-life care and to use that knowledge to inform dis-cussions and decisions with their loved ones about their own wishes."

Fewer than 30 per cent of the Canadi-ans who will die in 2014 will have access to palliative care.

The report makes a number of conclu-sions based on the consultation including: • All Canadians should discuss end-of-life wishes with their families or other loved ones. • All Canadians should prepare advance care directives that are appropriate and binding for the jurisdiction in which they live.

• A national palliative care strategy is needed. • All Canadians should have access to ap-propriate palliative care services. • Medical students, residents and practic-ing physicians need more education and training about palliative care approaches and greater knowledge about advance care directives. • Should Canada change laws to allow physician-assisted dying, strict protocols

and safeguards are required to protect vul-nerable individuals and populations.

The national dialogue focused on three main issues: advance care directives, pal-liative care, and physician-assisted dying. Beyond seeking input from Canadians on their views about the status of end-of-life care in Canada, the National Dialogue also sought to establish a common set of defi ni-tions and terminology to inform and frame discussion on end-of-life care issues. ■H

Memory experts If you are in the 50 to 79 age bracket,

worried about your memory changes and whether you need to see a doctor, there is a free online brain health test developed by the memory experts at Baycrest Health Sciences that will help you with that deci-sion. The test – co-developed by the brain health solutions company Cogniciti Inc. (owned by Baycrest and partner MaRS Discovery District) – takes about 20 min-utes to complete and is available to the public at www.cogniciti.com.

The game-like tests tap into functions such as memory and attention, which are affected by aging and brain disease. You can take the test on a desktop or laptop computer at home (with internet access), and receive an overall score of your cogni-tive health immediately after you fi nish.

According to the test's creators, the majority of people will score in the nor-mal, healthy range for their age – which will help reassure the "worried well". For the small percentage (approximately two – three per cent) that scores below average for their age and education, those adults will be encouraged to re-test after a week. If their score again falls below the normal threshold for their age, they will be pro-vided with a personalized report to help them start the conversation about their brain health with a doctor.

Designed by a team of clinical neuro-psychologists and cognitive scientists at Baycrest Health Sciences and its world-renowned Rotman Research Institute – and lab tested with 300 adults aged 50 to 79 recruited from various sources includ-

ing CARP Canada's subscriber base – the brain health assessment hammers a stake in the ground in an increasingly crowded fi eld of online brain fi tness products.

"Our aim with the brain health test is to reassure the worried well and nudge that small percentage of people who do have serious memory issues to discuss their concerns with a doctor," says Dr. Angela Troyer, program director of Neuropsychol-ogy and Cognitive Health at Baycrest, and a lead member of the research team that developed the test.

After completing the test, users will receive a Yes/No report about whether to take their memory concerns to their doc-tor. If a score is below normal, the indi-vidual will be provided with a personalized report to print and take to the doctor. ■H

Women nearing menopause have higher levels of a brain protein linked to depression than both younger and menopausal women, a new study by the Centre for Addiction and Mental Health (CAMH) shows. This fi nding may explain the high rates of fi rst-time depression seen among women in this transitional stage of life, known as perimenopause.

"This is the fi rst time that a biological change in the brain has been identifi ed in perimenopause which is also associ-ated with clinical depression," says Senior Scientist Dr. Jeffrey Meyer of CAMH's Campbell Family Mental Health Research Institute. Specifi cally, Dr. Meyer's research

team found elevated levels of the chemi-cal monoamine oxidase-A (MAO-A) among women aged 41-51. During peri-menopause, a common symptom is mood changes such as crying. Rates of fi rst-time clinical depression among this group reach 16 to 17 per cent, and a similar number get milder depressive symptoms. On average, levels of MAO-A were 34 per cent higher in women with perimeno-pause than in the younger women, and 16 per cent higher than those in menopause. The results suggest new opportunities for prevention, says Dr. Meyer, who holds a Canada Research Chair in the Neuro-chemistry of Major Depression. ■H

Brain protein may explain depression in pre-menopause

launch 'thermometer' for the mind


4 Guest Editorial

THANKS TO OUR ADVERTISERSHospital News is provided at no cost in hospitals. When you visit our advertisers, please mention you saw their ads in Hospital News.

AUGUST 2014 ISSUEEDITORIAL JULY 4ADVERTISING: DISPLAY JULY 25CAREER JULY 29MONTHLY FOCUS: Ambulatory Care/Neurology/ Volunteer Programs and Fundraising:Specialized programs offered on an outpatient basis. Developments in the treatment of neurodegenerative disorders, traumatic brain injury and tumours. Innovative approaches to fundraising and the role of volunteers in health care delivery.

SEPTEMBER 2014 ISSUEEDITORIAL AUGUST 8ADVERTISING: DISPLAY AUGUST 22 CAREER AUGUST 26MONTHLY FOCUS: Emergency Services/Critical Care/Trauma/Emergency Preparedness/Research:Innovations in emergency and trauma delivery systems. Emergency preparedness issues facinghospitals and how they are addressing them. Advances in critical care medicine. An overview of current research initiatives.

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ASSOCIATE PARTNERS:

hen a healthcare system can-not make the best use of re-sources at its disposal, con-sequences can be dire, and

such is the case with the Canadian health system.

A recent study from the Cana-dian Institute for Health Information (CIHI) found that between 12,600 and 24,500 deaths could be prevented each year in Canada if our health system were perfectly effi cient. That is, with-out spending a penny more than what we spend now, without increasing the contributions made by Canadians to their provincial public health care sys-tems, we could be saving thousands of lives.

To reach that conclusion, expenditures on various types of health care services were measured, including hospital care, physician and nurse services, prescription drugs, and nursing homes. Also measured were the number of premature deaths across 84 small regions in Canada – deaths taking place before the age of 80 and due to causes that are treatable, such as dia-betes, pneumonia and asthma (but not lung cancer). The study then compared how different regions spend their health-care dollars and found that the average region could improve what it does by be-tween 18 and 35 per cent – and save lives in the process. Who said health policy was boring?

The study also detailed the drivers of ineffi ciency, and they might be a sur-prise to many. Contrary to what is typi-cally assumed, effi ciency is not only based on how hard and how smart the people involved in a system – hospital and in-stitution managers, doctors, nurses and regional health authorities – work. It may also be linked to factors beyond their control.

Of course, a region that works hard at monitoring stays in hospitals to make sure they are not unduly prolonged, while maintaining quality so that re-admissions after discharge are not too frequent, will be able to prevent more premature deaths for the same level of expenses. Similarly, a region that controls the proportion of specialists among its physician workforce (thus making sure patients can access family doctors) will prevent more deaths. And a region that makes sure individuals at the bottom of the income distribution get access to their family doctors will also save more lives for the same amount of dollars spent.

However, regions also operate within constraints they can only partially con-trol. For instance, a higher rate of smokers or physically inactive individuals in the population of a region will eat up more resources with poorer outcomes, includ-ing premature deaths. For example, when more individuals smoke, it costs more to prevent deaths due to asthma; similarly, it costs more to prevent deaths due to dia-betes when more people are obese.

Another signifi cant factor that af-fects health outcomes, and which health authorities cannot control, is income. Health regions in which the population has higher income on average are less effi cient than those in which the popu-lation has lower income. This could be because regions with wealthier popula-tions are using their resources in ways that are not reducing premature deaths, but may be achieving other goals, such as faster access to advanced technologies or hip replacement procedures. Similarly, regions with higher proportions of immi-grants, non-aboriginal individuals or in-dividuals with higher education manage to save more lives with the same level of expenditures, because these populations

have lower mortality rates than the rest of Canadians, on average.

What can we do with such fi ndings? First, we need to learn from the best health regions across the country how to monitor hospital stays (length and quali-ty), guarantee access to family doctors for the poor, and make sure family physicians make up a reasonable proportion of the physician workforce. Secondly, we need to invest in public health – not necessarily spending more – to fi nd ways to curb smok-ing rates, obesity rates, and to encourage physical activity.

Finally – and perhaps, most impor-tantly – we need to re-think the way we allocate resources to regions in Canada. Not all regions require similar resources for the health of their populations. Re-gions which attract fewer immigrants, have more aboriginals in their popula-tion, and fewer individuals with higher education should receive more funding per capita because it costs more than in other regions to achieve similar levels of health gains. Conversely, regions with more immigrants, fewer aboriginals, and more highly educated individuals don’t need the same healthcare dollars to get the same results.

Equality and equity are not the same thing where health is concerned. It’s time we spread the health dollars where they are needed most. ■H

Michel Grignon is an expert advisor with EvidenceNetwork.ca, an associate professor with the departments of Economics and Health, Aging & Society at McMaster University and Director of the Centre for Health Economics and Policy Analysis (CHEPA). He contributed to the research published by CIHI.Reprinted with permission from Troy Media.

health care systemBy Michel Grignon

W

Thousands of lives could be saved every year by improving our


5 News

t. Mary’s General Hospital in Kitchener is the fi rst Ontario hospital to offer a satellite lo-cation for pacemaker patients

to perform device checkups remotely. This has the potential to signifi cantly reduce patient travel time and expense, while ensuring their pacemakers are operat-ing properly. The hospital operates a tier one Regional Cardiac Care Centre, which offers a full range of cardiac services to residents of Waterloo-Wellington Region and beyond.

The fi rst group of patients completed their pacemaker device checkups at the YMCA-YWCA in Guelph, Ontario in late May. This was after months of research, planning and screening of potential St. Mary’s patients. The YMCA-YWCA has been a key partner in bringing this service to patients and allowing St. Mary’s to work within the community at a convenient and accessible location which enhances the pa-tient experience.

At the satellite location, a small group of eligible patients had their Medtronic pacemaker devices checked with the sup-port of a representative from St. Mary’s and by holding a Medtronic Carelink Ex-press® monitor antenna over the patient’s implanted cardiac device for two to fi ve minutes. The data from the pacemaker de-vice is instantly and securely transmitted over the telephone lines to secure servers owned and operated by Medtronic Inc. Within minutes the transmission data is viewable by the device clinic staff at St. Mary’s which is 30 kilometers away. Device performance and diagnostic data trans-mitted from the pacemaker is scheduled to be read within 24 hours by St. Mary’s staff. Any concerns with the information received, is communicated directly to the patient and a follow up appointment at St. Mary’s may be requested.

Some pacemaker patients and their caregivers previously travelled up to 1.5 hours to have their device checked at the hospital. This new service allows those who are deemed eligible to have every sec-ond device check performed at a location closer to their homes. The recommended interval between device checks varies from patient to patient. A key aspect of the proj-ect is identifying patients who would most benefi t from the service because they re-quire more frequent checks.

Remote checkups do not take the place of care and health monitoring required by

a family practitioner and at this point the technology is limited to specifi c pacemaker devices, manufactured by Medtronic and compatible with Medtronic’s CareLink Ex-press® technology.

St. Mary’s has provided Medtronic CareLink home monitors to a small num-ber of pacemaker patients for some time on an in-home and single patient basis for patients who can’t travel even a short distance for health reasons. However, St. Mary’s is the fi rst hospital in Ontario, and only second in Canada, to use Medtronic’s CareLink Express technology to set up a service model for multi-patient trans-mission of pacemaker data from a re-mote monitoring satellite location to a cardiac centre.

St. Mary’s chose Guelph as the fi rst sat-ellite location for this pilot project because the timing of the availability of this tech-nology combined with the recent transi-tion of Guelph pacemaker patients to St. Mary’s created an appropriate group for this project. For now, remote monitor-ing in Guelph will be scheduled once a month. If successful, the service could be extended to other outlying areas served by St. Mary’s.

“At St. Mary’s we strive to ensure that all patients in the region have convenient access to the most advanced cardiac care,” says Dr. Claus Rinne, a Cardiologist at St. Mary’s. “We hope that this project helps us to learn about a new way to provide seamless care that enhances the overall patient experience.”

Health care organizations in the United States, Australia, New Zealand and Eu-rope and a site in Quebec are currently us-ing this technology to offer broad remote pacemaker monitoring. In order to evalu-ate the success of the project, St. Mary’s collected baseline information which will be used to evaluate key performance indi-cators during the pilot, such as the patient experience and resource use.

“St. Mary’s is proud of its cardiac excel-lence and we are always looking for new and innovative ways to improve patient

care,” says St. Mary’s President Don Shil-ton. “After extensive research and dis-cussions with industry and government partners, we determined that remote mon-itoring technology has evolved in Canada to the point where it can now be a safe, vi-

able and highly benefi cial option for many pacemaker patients in our community.” ■H

Angela Volpe is Manager, Communications at St. Mary’s General Hospital.

New satellite model for remote monitoring of pacemaker patients By Angela Volpe

S

St. Mary’s is the fi rst hospital in Ontario, and only second in Canada, to use Medtronic’s CareLink Express technology to set up a service model for multi-patient transmission of pacemaker data from a remote monitoring satellite location to a cardiac centre.

Anna Sampson, Project Manager for the Remote Monitoring Pacemaker Project at St. Mary’s General Hospital.


6 Focus CARDIOVASCULAR CARE/RESPIROLOGY/DIABETES

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he Canadian Foundation for Healthcare Improvement has selected the biggest and most diverse cohort to date

of inter-professional senior health care teams for the 11th year of its fl agship EXTRA program.

During the 14-month program, par-ticipants will acquire skills and knowledge to initiate, implement and sustain major quality improvement initiatives of strate-gic importance in their organizations and regions, with the goal of enhancing pa-tient outcomes, quality of care and cost-effectiveness.

“On behalf of the federal government, I extend my congratulations to these 42 health leaders who were awarded a unique opportunity to become change agents in health care improvement,” says the Hon-ourable Rona Ambrose, Federal Minis-ter of Health. “Through funding for the Canadian Foundation for Healthcare Improvement, we are helping build lead-ership capacity to improve patient out-comes and realize health care effi ciencies through innovation. I look forward to see-ing the results from these strong teams.”

The eleven teams will implement im-provement projects across Canada in a range of health care areas, including a quality improvement framework to im-

prove patient safety; an integrated am-bulatory assessment service for mental health services; and an emergency de-partment dashboard to improve timely patient care.

“The EXTRA program is a catalyst to transform innovation into action,” says Canadian Nurses Association past-presi-dent Barb Mildon. “Health professionals, especially those on the front lines of care delivery, are invaluable sources of insight, knowledge and ideas about better health and better care. CFHI and CNA are com-mitted to harnessing this expertise and giving them a platform through which they can lead real change.”

One example of a strong and innova-tive team is a unique collaboration be-tween two provinces from each end of the country aiming to solve a common chal-

lenge. Fraser Health in British Columbia and Capital Health in Nova Scotia will improve healthy aging in their regions by jointly addressing a disconnect between near frail seniors and community care sup-ports . The interprovincial team will work together to transform the current system to enable seniors to live a higher quality of life within their community longer, re-duce unnecessary emergency room visits, avoidable admissions to acute care and premature admission to residential care.

“We have been a long-time supporter of the EXTRA program, having many graduates in our midst contributing to ev-idence-informed practice daily. This year we are extremely excited to participate in a unique partnership with Fraser Health and a private corporation, Shannex, to explore initiatives related to the near frail elderly,” says Chris Power, President and CEO, Capital Health.

“This will be the fi rst time that two health care regions have come together within EXTRA to address an issue that we all deal with, sharing and spreading our fi ndings with each other. We are extremely grateful for this opportunity and look for-ward to contributing to new knowledge for Canadians,” adds Power.

“One problem, two provinces, one col-laborative solution. This is what makes

the EXTRA program unique in Canada,” says Dr. Jean Rochon, Chair of EXTRA’s Advisory Council which selects the teams on behalf of CFHI and its EXTRA part-ners – the Canadian College of Health Leaders (CCHL), the Canadian Medical Association (CMA), the Canadian Nurses Association (CNA) and a consortium of 12 Quebec partners represented by the Initiative sur le partage des connaissanc-es et le développement des competences (IPCDC).

“The Canadian College of Health Leaders has been privileged to serve as an EXTRA partner since this innova-tive program was launched 11 years ago. Over that time hundreds of health leaders across Canada have been trained to apply evidence in designing and executing im-provement projects that have benefi ted organizations and health systems. By de-veloping the organizational capacity to apply evidence, the EXTRA program has contributed greatly to improving health leadership in Canada,” says Ray Racette, CHE, President and CEO, Canadian Col-lege of Health Leaders. ■H

Paulette Roberge is a senior communications specialist at the Canadian Foundation for Healthcare Improvement.

By Paulette Roberge

T

The eleven teams will implement improvement projects across Canada in a range of health care areas.

Transforming innovation into action


7 CARDIOVASCULAR CARE/RESPIROLOGY/DIABETES Focus

ype I Diabetes is a chronic condition caused by a loss of insulin-secreting beta cells. These cells are normally locat-

ed within the islets of the pancreas but Dr. James Shapiro at the University of Alberta found a second home for them in the liver. In 2000, Shapiro published his landmark Edmonton Protocol in the New England Journal of Medicine when he conducted is-let transplantations in seven patients with Type I Diabetes. Shapiro’s team has per-formed over 400 procedures in more than 200 patients, providing one of the most revolutionary treatments for diabetes since Banting’s discovery of insulin in 1921.

The team works with donated pancre-ata, separating the islets from the organ tissue and transplanting them into the pa-tient’s liver. Within a few weeks the beta cells are able to make and secrete insulin, reducing or eliminating the patient’s need for injections. Most patients need two sep-arate transplant procedures, requiring at least two donated organs.

Islet transplantation is recommended for diabetics with frequent or severe epi-sodes of hypoglycemia. Most patients re-main insulin independent for about two-and-a-half years following transplant with only 15-20 per cent maintaining this status at the fi ve-year mark. The remaining 80 per cent of patients still benefi t from lower doses of insulin to maintain stable blood sugars and freedom from hypoglycemia. All patients require immunosuppressive therapy as long as the islet transplant is functioning. Research continues to work on improving long-term islet graft sur-vival and function by further refi nement of immunosuppressant therapy, alterna-tive transplantation sites and fi nding other sources of beta cells.

The need for multiple donor pancreata per patient coupled with low rates of or-gan donation has lead to the search for other sources of the insulin-secreting beta cells. Advances in embryonic and induced pluripotent stem cell biology provide the potential to generate these cells in a pe-tri dish. Embryonic stem cells are sourced from embryos generated by in vitro fertil-ization and donated to research and are unique in that they can become any cell type in the body and repeatedly self-renew. Induced pluripotent stem cells are adult cells (such as blood or skin cells) altered by genetic technology so they function like embryonic stem cells.

No laboratory has been able to generate bona fi de human beta cells. However, a re-cent discovery has shown that a key cell (beta cell progenitor) can be developed from human embryonic stem cells. When

these progenitor cells are transplanted into mice, they can create functional beta cells, meaning they are sensitive to glu-cose levels and release insulin accordingly. US-based companies are in the process of launching clinical trials to test these cells in humans. Dr. Shapiro has been working with ViaCyte, Inc., a regenerative medi-cine company based in San Diego, for the last ten years. Together they are ready to

start a Phase 1 Clinical Trial to test the safety and effi cacy of the cells. They will also evaluate a special device, Encaptra, which assists with the delivery of the cells and protects them from attack by the pa-tient’s immune system.

Shapiro indicates there are some chal-lenges with this therapy, “Is it safe and ef-fective? How much will the therapy cost? Will the cells last once they’ve been trans-

planted? These are the questions we are asking right now. This clinical trial is an incredible milestone for diabetes research and it’s exciting that it’s happening right here in Canada.”

Dr. M. Cristina Nostro, Scientist at Uni-versity Health Network, and Harry Rosen Chair in Diabetes Regenerative Medicine Research at the McEwen Centre for Re-generative Medicine, agrees protecting the cells from attack by the immune system is a challenge.

“As cell therapy for Type I Diabetes is moving to the clinic, scientists and engi-neers around the world are working to-wards the generation of devices that will not only protect the beta cells from the im-mune system but will also provide the right support for the growth and survival of the transplanted cells,” says Nostro.

Nostro is working towards the develop-ment of an effi cient method to generate the beta cell progenitors from either em-bryonic or induced pluripotent stem cells. Nostro indicates that, “A method that could be applied to any pluripotent stem cell line will allow for more universal ap-plications.”

These are exciting discoveries that give hope to diabetics around the world but continued patience and caution is neces-sary, “Human embryonic stem cell-derived cells are already in clinical trials for the treatment of macular degeneration. I look forward to seeing the start of the fi rst trial using these cells for the treatment of Type I Diabetes as it will revolutionize the way we treat and think of this disease,” says Nos-tro, a member of the Ontario Stem Cell Initiative. ■H

Sandra Donaldson is Program Manager, Ontario Stem Cell Initiative (OSCI).

Take the next step in your career in community servicesContinuing Education at George Brown CollegeGeorge Brown College has a range of certificates that are offered on a part-time basis through Continuing Education.

Courses for these certificates start this September:

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416-415-5000, ext. 2126 [email protected].

By Sandra Donaldson

T

Islet transplantation is recommended for diabetics with frequent or severe episodes of hypoglycemia

Dr. James Shapiro and his team provide one of the most revolutionary treatments for diabetes since insulin.

Future directions in cell transplantation for Type I Diabetes



avigating your way through the health care system can be chal-lenging, especially if you have a chronic illness like Chronic Obstructive Pulmonary Dis-

ease (COPD) or Congestive Heart Failure (CHF).

Thanks to St. Joe’s Patient Naviga-tor and Registered Nurse, Janice Klutt, patients experience a smooth transition from their hospital care and back into the community. Klutt supports patients with COPD and CHF to manage their illness, through education and assessment while they are in hospital and coordinating follow up care when they are discharged back home.

The Patient Navigator role has been in place for two years and stems from St. Joe’s work to reduce re-admission rates for patients with COPD and CHF. “Liv-ing with any chronic disease is diffi cult be-cause of the drastic lifestyle changes that patients need to make,” explains Klutt. “The changes are needed to stay healthy, but it’s hard. Not being able to maintain

these changes is often the reason COPD and CHF patients are re-admitted back to hospital,” Klutt adds.

Klutt’s fi rst connection with patients is right at the bedside when they are admit-ted to St. Joe’s. Many patients she sees are elderly and have additional health issues on top of their chronic illness. The socio-economic status of her patients is another huge factor that affects their overall health. For these reasons, Klutt works closely with them so they are educated about their con-dition and know what to do if they start feeling unwell and what other resources they can access.

“I explain to them what their condition is, what to watch out for and what to do to prevent the exacerbation of either condi-tion,” says Klutt. Both COPD and CHF are chronic illnesses that need to be managed closely once a person is diagnosed, because there is no cure. COPD is a long-term dis-ease caused most often by smoking, and in-cludes chronic bronchitis and emphysema. The damage caused by COPD makes the movement of air in and out of the lungs diffi cult. CHF is a common condition that develops once the heart is damaged by diseases like heart attacks or other medical illnesses.

When patients are ready to go home, Klutt arms them with an educational pack-age including pamphlets that explain their condition in simple, easy-to-understand language. They also get a “stop light” visu-al, in the form of a fridge magnet, outlining what warning signs should prompt a call to Klutt for advice, a visit to the family doc-tor or an immediate trip to the Emergency Department (ED).

A crucial step Klutt oversees for patients before they leave the hospital is booking a follow up appointment with their fam-ily doctor for a week after discharge. By the time the patient shows up for their appointment, their doctor has a full sum-mary of their recent hospital stay, thanks to the information she sends them. Klutt also guides patients in making the neces-sary changes to their lifestyle to improve their health and monitors how well they respond to these changes.

The biggest piece of advice given to her COPD patients is to quit smoking. “I con-nect them with our smoking cessation pro-gram here at St. Joe’s or at the Centre for Addiction and Mental Health,” says Klutt. “Many of the patients I see are lower-in-come individuals and can’t afford medica-tion so I try to fi nd programs that they are able to manage.”

“For CHF patients, they need to restrict fl uid and salt intake – and it really opens up their eyes to the types of food they are eating, especially pre-packaged food. But for many, that’s all they can afford because they don’t have the resources to buy fresh food and cook from scratch,” says Klutt. Community agencies like Meals on Wheels are a great resource to access healthier foods, at least for the fi rst few weeks when patients are home from the hospital and re-gaining their strength, she adds.

Klutt also makes referrals to the Toronto Central Community Care Access Centre’s (CCAC) Rapid Response Team for pa-tients that are high-risk for re-admission. Risk factors include a long stay in hospi-tal, how many times the patient has been to the ED in the last six months and any other co-morbidities they may have. The team is deployed to the patient’s home within 24 hours of their discharge, where

they do a full “head to toe” assessment of the patient, review their medications with them, and alert Klutt to any concerns that come up during the home visit. The team checks in with patients via phone calls or ongoing visits when needed, over a 30-day period.

The Rapid Response Team was designed on the model Klutt used when her role fi rst launched. This collaborative relationship with St. Joe’s and the CCAC means that high risk patients have support at home, also allowing her to spend more time with patients in hospital.

Ultimately, education, follow up care and ensuring patients are connected with their family doctors and other commu-nity resources are ways Klutt is helping them manage their conditions at home to avoid being re-admitted to hospital. When patients have the right tools and support they need, their quality of life can improve so they can live well even with a chronic illness.

Klutt feels a sense of pride in building strong relationships with her patients and being an important part of their care to support them in the hospital and once they are at home.

“I help to ensure wrap around care for patients, so they don’t fall through the cracks. The key is educating them so they understand their condition and linking them to their family doctor and CCAC. I facilitate those connections and build those partnerships so that our patients can get the best care when they need it – whether they are here at St. Joe’s or in the community.” ■H

Michelle Tadique is a Communications Associate at St. Joseph's Health Centre Toronto.

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Education, follow up care and ensuring patients are connected with their family doctors and other community resources are ways Klutt is helping them manage their conditions at home

Janice Klutt, St. Joe's Patient Navigator, ensures patients experience a smooth transition from hospital care back into the community.

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arents of children in a ground-breaking diabetes trial in Lon-don are enjoying peace of mind and a good night’s sleep for the

fi rst time in years. The North American trial is looking at ways to prevent danger-ous low blood sugars overnight in children with type 1 diabetes, and it’s helping both children and parents go to bed worry free.

The study is a partnership between the Centre for Diabetes, Endocrinology and Metabolism of St. Joseph’s Health Care London and the pediatric diabetes group at Children's Hospital, London Health Sciences Centre. Dr. Irene Hramiak, chair/chief of the Centre for Diabetes, Endocri-nology and Metabolism is collaborating with Dr. Cheril Clarson, section head of pediatric endocrinology at Children's Hos-pital. Both Dr. Hramiak and Dr. Clarson are also Lawson Health Research Institute scientists.

Low blood sugar, or hypoglycemia, is a condition that can lead to coma, seizures or death for individuals with diabetes, explains Dr. Hramiak. More than half of these episodes occur during sleep hours. In children, the rate is higher – 75 per cent of hypoglycemic seizures occur during sleep. Dr. Clarson describes the fear of hypogly-cemia, particularly at night, as one of the most serious concerns reported by parents of children with type 1 diabetes.

The goal of the clinical trial, known as the pump shut-off study, is to test a system that mimics the pancreas to reduce the rate of nocturnal hypoglycemia. The sys-tem is a combination of an insulin pump to deliver insulin, a continuous glucose moni-toring system to measure blood sugars in the patient every fi ve minutes, and a com-puter algorithm (software) that predicts for each individual when they are at risk for hypoglycemia (low blood sugar).

When operating, the sys-tem avoids low blood sugar while the patient is sleeping by turning off the insulin pump when it predicts low blood sugar could oc-cur and then turning the pump back on when there is no longer a risk of low blood sugar.

“It’s a simple solution to a major prob-lem for individuals wearing an insulin pump,” says Dr. Hramiak, principal in-vestigator of the trial in London – the only Canadian centre participating. “We have tested the system in adults and now are testing it in a group of 20 children ages three to 15. This system could po-tentially prevent overnight hypoglycemia and is a fi rst step to developing a system that functions like a native pancreas.”

For Nicole Tracey, mom of 10-year-old Charlise, the study “has absolutely given me the ability to sleep at night. Before using the system, my fi rst thought every time I woke up was “is she okay?” In the past if I had a good sleep I would wake up in a panic because I didn’t check on her during the night. On the other hand, on nights when I do check her three or four times during the night, I am unable to get a proper night’s sleep. With the system, I go to bed worry free and I can sleep the whole night knowing she will be okay.”

Anne Crosby, mom of six-year-old Heather, is also going to bed with peace of mind. “My daughter has had a lot of lows during the night and when we are sleeping we don’t realize she is dropping low. It can be very scary. The study has helped to give her better control and I can relax because I know the system will stop her from dropping too low.”

Funded in Canada by the JDRF Ca-nadian Clinical Trial Network, the trial is also underway at Stanford University and the University of Colorado in the U.S. A total of 45 adults have been pre-viously studied and now a total of 90 children are being studied. The pediat-ric trial is expected to be completed in September 2014.

Future plans for pump shut off studies will address high blood sugar – or hyper-glycemia – in addition to low blood sugar, fi rst in adults, then in children. ■H

Dahlia Reich works in Communication & Public Affairs at St. Joseph's Health Care, London.

Diabetes trial testing

By Dahlia Reich

P

The North American trial is looking at ways to prevent dangerous low blood sugars overnight in children with type 1 diabetes, and it’s helping both children and parents go to bed worry free.

Young participants in an insulin pump shut-off study in London proudly display drawings depicting their experience in the novel diabetes trial. From right is Heather with her mom, Anne Crosby, and sister Hannah, along with Nicole Tracey and her daughter Charlise.

9 Y/DIABETES Focus

ting, the sys-w blood sugarnt is sleeping byinsulin pump when blood sugar could oc-urning the pump backi l i k f l

Six-year-old Heather is one of 20 London-area children taking part in an insulin pump shut-off study, which is looking at ways to prevent dangerous low blood sugars overnight in children with type 1 diabetes. Here, Heather shows off a picture she drew of her experience in the trial.

ways to prevent low blood sugar during the night



hen Health Canada offi cially approved the revolutionary, catheter-based, MitraClip therapy last April, interven-

tional cardiologists and surgeons at the University of Ottawa Heart Institute knew they had been pioneering an innovative and novel procedure.

Now providing physicians in Canada with a breakthrough treatment option that can signifi cantly improve symptoms, dis-ease progression and quality of life for cer-tain patients with a heart condition called mitral regurgitation (MR), the MitraClip device has been approved for people with degenerative MR who are too high risk for mitral valve surgery based on evaluation by a team of cardiologists and surgeons at the Ottawa Heart Institute.

“This extraordinary achievement in in-terventional cardiology would not be pos-sible without the exceptional teamwork our highly specialized experts have dem-onstrated over the last years. Our ability to continuously develop our innovative approach is truly the product of our team’s unique dedication and limitless ambition,”

says Dr. Marino Labinaz, Cardiologist and the Director of both the Cardiac Catheter-ization Laboratory and the Cardiac Fellow-ship Program at the University of Ottawa Heart Institute.

Degenerative MR is a type of mitral re-gurgitation caused by an anatomic defect of the mitral valve of the heart. Treatment with the MitraClip device can be effective in reducing the symptoms associated with severe mitral regurgitation, such as short-ness of breath and fatigue, which may help people lead a more active lifestyle.

Mitral regurgitation is a common con-dition, affecting an estimated one in 10 people aged 75 and above. Severe mitral regurgitation can be a debilitating, progres-sive and life-threatening disease in which a leaky mitral valve causes a backward fl ow of blood in the heart. The condition can raise the risk of irregular heartbeats, stroke, and heart failure. Open heart mi-tral valve surgery is the standard-of-care treatment, but many patients are too high risk for an invasive procedure. Medications for the condition are limited to reducing symptoms and do not have the ability

to stop the progression of the disease. “Multiple trials, published reports, and

registries of patients treated with the Mi-traClip device consistently demonstrate a positive safety profi le, a reduction in mi-tral regurgitation, improvements in symp-toms, and a reduction in hospitalizations for heart failure,” says Dr. Thierry Mesana, cardiac surgeon and the President and CEO of the University of Ottawa Heart Institute.

Developed by Abbott, the MitraClip repairs the mitral valve without the need for an invasive surgical procedure. The device is delivered to the heart through the femoral vein, a blood vessel in the leg, and once the device is implanted, allows the heart to pump blood more effi ciently, thereby relieving symptoms and improving quality of life. Patients undergoing Mitra-Clip treatment typically experience short recovery times and short hospital stays of two to three days. ■H

Vincent Lamontagne is Senior Manager, Public Affairs, University of Ottawa Heart Institute.

Bringing ground-breaking innovations to the bedsideBy Vincent Lamontagne

W

Ottawa Heart Institute leads the way with new minimally invasive treatment improving quality of life for patients with mitral valve disease

The MitraClip device has been approved for people with degenerative MR who are too high risk for mitral valve surgery.



r. Atul Verma, cardiologist at Southlake Regional Health Centre in Newmarket, On-tario, recently inserted the

world's smallest implantable cardiac moni-toring device available – the Medtronic Reveal LINQ Insertable Cardiac Monitor System – in a patient. This was the fi rst time the implant had been inserted in an adult in Canada.

The small, wireless device is designed to allow doctors to continuously monitor, and quickly and accurately diagnose patients who suffer from cardiac arrhythmias, or ir-regular heartbeats, that can lead to severe and unexplained fainting spells or stroke.

A made-in-Canada innovation and the smallest of its kind, at approximately one-third the size of a AAA battery, the Reveal LINQ monitor is more than 80 per cent smaller than other implantable cardiac monitors. Placed just beneath the skin through a tiny incision of less than one cm in the upper left side of the chest, the monitor is nearly invisible to the naked eye once inserted.

There are several technologies available that can help physicians diagnose patients who suffer from the effects of cardiac ar-rhythmias. Yet, these devices are only able to track a patient's heart behaviour for a limited period of time, such as days or weeks. For some patients, this isn't a prob-lem because the majority of their symptoms occur within the required test window.

For 65-year-old Huntsville, Ontario resident Michael Smith, that window sim-ply wasn't long enough. Smith, a patient of the Heart Rhythm Program at Southlake, has been suffering from dizziness, nausea, and unpredictable and unexplained near-fainting spells for close to eight years.

Originally believed to have vertigo – a type of dizziness in which a patient inap-propriately experiences the perception of motion – Smith saw a physiotherapist in his hometown to ease his symptoms. When that treatment yielded no results, he went back to the drawing board.

“When we ruled out vertigo, my doc-tor began to suspect I was suffering from a cardiac condition,” says Smith. “I could go months before I experienced symptoms again, and through all of the various tests I took, we were never able to actually cap-ture a time when I was having an episode.”

Smith was referred to specialists at Southlake's Regional Cardiac Care Pro-gram, an internationally renowned pro-gram that – fortunately for Smith – ser-vices residents in communities as far north

as Muskoka. When he met with Dr. Zaev Wullfhart, electrophysiologist and physi-cian leader of the Cardiac Program, Smith was identifi ed as an ideal candidate for the Reveal LINQ monitor implant. On May 12, Smith became the second adult recipient at Southlake to have the implant inserted.

“Michael's symptoms are so intermittent in nature,” explains Dr. Verma. “Using the new implant, we will be able to accurately and quickly identify the root cause of his condition when he next experiences a near-fainting spell.”

The device is placed using a minimally invasive insertion procedure, in as little as two minutes and on an outpatient basis, simplifying the experience for both physi-cians and their patients. Through a spe-cialized and remote monitoring network, physicians can also request notifi cations to alert them if their patients have had car-diac events.

“The LINQ device is part of a power-ful system that allows us to monitor a pa-tient's heart for up to three years, with 20 per cent more data memory than its larger predecessors,” says Dr. Verma.

The implantable cardiac monitor was originally invented by a Canadian phy-sician, Dr. George Klein, as a result of collaboration between Dr. Klein and Medtronic of Canada, the manufacturer of the device. The prototype was developed in London, Ontario, and the fi rst iteration was manufactured by Medtronic in Missis-sauga, Ontario. The monitor has evolved dramatically over time and the current version received Health Canada license in March 2014.

“The Regional Cardiac Care Program at Southlake is no stranger to innova-

tion,” says Dr. Dave Williams, Southlake president and CEO. “Time and again, the talented team of professionals who support our world-class program actively seek out opportunities to do things better, all with the goal to provide our patients with the absolute best the health care system has to offer. I commend Dr. Verma on his per-severance in making this happen for our patients, and I look forward to the possi-bilities that this new system brings with it.”

The introduction of the Reveal LINQ monitor provides physicians with the added ability to diagnose heart rhythm disorders that can be rare in their occur-rence, but can still have dramatic and life-threatening impacts for a given patient. In April 2014, Emily DePaepe, a 13-year-old from southwestern Ontario, became the fi rst person in Canada to receive the Re-veal LINQ monitor. This procedure was performed by Dr. Elizabeth Stephenson, a cardiologist at The Hospital for Sick Chil-dren (SickKids). ■H

Kate Porretta is a Media and Government Relations Specialist at Southlake Regional Health Centre.

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world's smallest heart monitor in adult patient By Kate Poretta

D

The small, wireless device is designed to allow doctors to continuously monitor, and quickly and accurately diagnose patients who suffer from cardiac arrhythmias, or irregular heartbeats.

This small wireless monitor provides long-term remote monitoring to help physicians diagnose and monitor patients suffering from irregular heartbeats,

Southlake implants



visit to the ER is a rarity for 73-year old John Myers*. But when symptoms of a heart at-tack prompted him to check

into the emergency department at Trillium Health Partners, he got his results within hours, thanks to Cardiac DART (Direct Accelerated Response Team).

Launched in November 2013, Cardiac DART provides patients with quicker ac-cess to specialists so they are assessed, tested and treated without being admitted to the hospital.

“The program was designed to avoid unnecessary admissions to a hospital bed,” says Elena Holt, Director of Cardiac Health at Trillium Health Partners. “It pro-vides patients access to the most appropri-ate care in a timely manner.”

Ideal candidates for Cardiac DART are patients who are experiencing some type of heart related symptoms, such as chest pains, heart failure or arrhythmia (irregular heartbeat), but who are not having a heart attack. Once assessed by the ER physician, they can be referred to the Cardiac DART for further tests to determine if there’s a risk of heart problems in the future.

Cardiac DART is staffed with a nurse practitioner and a cardiologist, who pro-vide specialized care closer to the door so patients can get fast access to testing and quicker results. “We’ve simply eliminated some of the steps to care, so patients can get their answers faster, which reduces their anxiety,” says Holt.

It worked well for John Myers who had been experiencing heart-related symp-toms. When his symptoms became worse he decided to go to the ER to fi nd out ex-actly what he was experiencing. He was di-agnosed as an ideal candidate for Cardiac DART, where it was determined that his situation was not grave as he’d anticipated.

“This is a common situation,” says Ele-na Holt. “Patients aren’t really sure what they are experiencing, and Cardiac DART allows for early access to highly a skilled cardiac nurse practitioner and cardiologist to determine appropriate testing and treat-ment, or if they can be discharged with fu-ture follow up.”

First piloted at Credit Valley Hospital, Cardiac DART delivered results quickly, reducing the wait time from approximately 20 hours to just under fi ve hours. A higher number of patients avoided admissions to a hospital bed, given the ability to access specifi c cardiac testing without admission.

While it’s still in the early phases of implementation across the hospital sites of Trillium Health Partners, the results are positive. “We’ve defi nitely seen the de-mand for cardiac beds decrease,” says Holt. “And while it’s still a work in progress, the commitment of our nurse practitioners and cardiologists at all sites have made the success of this program possible.”

John Myers and his wife Ann were very pleased with the outcome of their visit to the ER at Trillium Health Partners and said they felt relaxed for the fi rst time in

days because they knew they were in good hands. John has been put on the list for follow up so the hospital can monitor his situation.

The Mississauga couple may not be aware of the extensive planning and process that went into developing the groundbreaking program that helped them through a diffi cult time last December. But when they followed up with a letter to the hospital to express their gratitude, describ-ing the Cardiac DART team as their ‘an-gels’, it is an indication that the program is on the right track.

*Names have been changed to protect patient privacy. ■H

Priya Ramsingh is a Senior Communications Advisor at Trillium Health Partners.

Cardiac DART By Priya Ramsingh

A

Cardiac DART is staffed with a nurse practitioner and a cardiologist, who provide specialized care closer to the door so patients can get fast access to testing and quicker results.

A patient meets with a nurse practitioner and a cardiologist as part of the DART program which helps patients get faster access to testing.

provides care closer to the door



n summing up his view on the value of research, heart-attack survivor Tom Lancaster doesn’t mince words: “If it

weren’t for heart research, I wouldn’t be here right now.”

When he suffered a major heart attack last June, the 81-year-old Edmontonian soon found himself at the Mazankowski Alberta Heart Institute where he was di-agnosed with a blocked artery and several narrowed vessels.

As he received treatment, Lancaster helped to reinforce the fi ndings of a study led by the Mazankowski that’s answering one of the biggest questions about heart attack care which could lead to longer, healthier lives for survivors.

Typically, patients who suffer a major heart attack with a blocked heart artery are rushed to a catheterization laboratory for an angioplasty. Diagnostic imaging lo-cates the clot, followed by the insertion, via catheter, of a balloon to widen the ar-tery. Then a tiny wire-mesh tube, known as a stent, keeps the artery open.

Once blood fl ow is restored, cardiolo-gists face questions that, at present, have no clear, evidence-based answers.

“Do we just leave other narrowed blood vessels and continue with medications? Or do we fi x those narrowed vessels with other stents? What’s best for the patient?” says Dr. Kevin Bainey, an Alberta Health Services (AHS) interventional cardiologist who specializes in clearing blocked arter-ies, as well as an Assistant Professor of Car-diology at the University of Alberta.

Dr. Bainey and his cross-country re-search team systematically reviewed the outcomes of 46,234 patients around the world and their fi ndings showed a two-stage treatment plan – in which the patient returns at a later date to clear up any other signifi cant blockages – guarantees the best short- and long-term health and recovery for the patient.

Patients who underwent a staged an-gioplasty procedure plus medication had a 26 per cent reduction in long-term mor-tality compared to patients who received medication only, according to their study published in the January issue of American Heart Journal. Dr. Bainey is the lead author.

Dr. Bainey’s analysis has now set the stage for a comprehensive international trial, which will involve the recruitment of 4,000 patients already underway. The Mazankowski is one of several partici-pating sites in this Canadian-initiated, international trial.

Lancaster successfully experienced this two-stage approach to restoring his blood fl ow – and also chose to be part of the new study, as a way to pay it forward.

When the artery that was causing the heart attack was opened, Dr. Bainey deter-mined Lancaster had another coronary ar-tery with signifi cant narrowing. Lancaster returned to the Mazankowski two weeks later, where Dr. Bainey put a stent in the second artery. Lancaster was discharged the following day and will be followed by the study for fi ve years.

Adds Lancaster: “If it will help some-body down the road, that’s all that matters. And that’s why I signed up for this new re-search. It’s a major thing.”

“I’ve already changed my practice, in being more aggressive with these other blockages,” says Dr. Bainey, who believes this new approach to restoring blood fl ow also holds the promise to reduce emer-gency department visits; free up hospital beds (as patients will be able to go home between procedures); and eliminate future hospital stays as patients live longer.

“My study shows patients who are ready to be discharged, but who need to have that other blockage fi xed, don’t need to stay two to three days in hospital to wait for that blockage to be fi xed. It’s safe to go home, then come back as an outpatient, have the procedure done, and be dis-charged later that day,” he says.

Nowadays, Lancaster hits the treadmill or exercise bike daily as he eagerly awaits

spring thaw – and a new season of golf – so he can get back out on the links.

The Faculty of Medicine & Dentistry at the University of Alberta is one of the world’s top 100 medical schools where faculty members are committed to im-proving patient care through teaching and research.

Alberta Health Services is the provin-cial health authority responsible for plan-

ning and delivering health supports and services for more than four million adults and children living in Alberta. Its mission is to provide a patient-focused, quality health system that is accessible and sus-tainable for all Albertans. ■H

Gregory Kennedy is a Senior Writer / Communications Advisor at Alberta Health Services.

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Heart-attack studyBy Gregory Kennedy

Patients who underwent a staged angioplasty procedure plus medication had a 26 per cent reduction in long-term mortality compared to patients who received medication only, according to a study published in the January issue of American Heart Journal.

Interventional cardiologist Dr. Kevin Bainey examines heart-attack patient Tom Lancaster

I

could lead to longer lives



oping to build on last year’s success and extend its reach, the Primary Care Diabetes Support Program (PCDSP) of

St. Joseph’s Health Care London is once again offering to help Muslims with diabe-tes fast safely during Ramadan.

Beginning June 28, thousands of Mus-lims in London will start a month of a daily fasting from dawn until sunset in obser-vance of Ramadan. This is an important period of religious devotion and spiritual refl ection but for Muslims with diabetes it can pose serious health risks if planning is not done well ahead.

For the second year, the PCDSP is offer-ing a special service to people with diabetes who observe Ramadan. Individuals can re-ceive the guidance and support they need through the PCDSP with no referral neces-sary.

“Last year, dozens of Muslims with diabe-tes took advantage of our service to avoid running into problems with highs and lows in blood sugar levels – a common problem during this period of fasting,” says Dr. Mer-vat Bakeer, a family physician who special-izes in diabetes. “They learned that fast-ing can be done safely but education and

changes to their diabetes management are needed.”

Dr. Bakeer is hoping that word spreads further this year so that those with diabetes who fast are doing so with proper guidance. Without it they are taking signifi cant risks with their health, she says.

Those risks include hyperglycemia or hypoglycemia and diabetic ketoacidosis –high levels of blood acids called ketones, explains Dr. Bakeer. “Other problems may arise due to dehydration, such as thrombo-sis and acute kidney injury, especially for people with chronic kidney disease or on blood pressure medication.”

An estimated 3,000 Muslims in London are living with diabetes and many will fast. Research indicates that more than 40 per

cent of Muslims with type 1 diabetes and nearly 80 per cent with type 2 diabetes fast during Ramadan, says Dr. Bakeer. Most, she adds, don’t change how they manage their diabetes while fasting and may be hesitant to ask their doctor for support for fear they will be discouraged from fasting. “So they do it on their own.”

“It’s critical they plan for Ramadan by learning how to adjust their medica-tions for fasting, about insulin use and careful monitoring when fasting, when to break the fast, and proper diet during Ramadan.”

Dr. Bakeer urges people to see their family doctor before Ramadan or to call the PCD-SP to make an appointment. At the PCDSP, located at St. Joseph’s Family Medical and Dental Centre on Platt’s Lane, individuals will be assessed and a plan developed to see them through Ramadan, including weekly visits or monitoring by phone or email. Written information is also provided and is available in Arabic, Farsi, Urdu and English. Those interested can call 519 646-6100 ext. 67268. ■H

Dahlia Reich works in Communica-tions & Public Affairs at St. Joseph's Health Care, London.

Service supports Muslims with diabetesBy Dahlia Reich

H

Those observing Ramadan, which starts June 28, should plan ahead to fast safely.

Dr. Mervat Bakeer is a family physican who specialized in diabetes, reminds Muslims with diabetes to make changes to their diabetes management while fasting for Ramadan.

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Research indicates that more than 40 per cent of Muslims with type 1 diabetes and nearly 80 per cent with type 2 diabetes fast during Ramadan



heart valve procedure is enough to make any patient nervous, but Gisela Wegner didn’t show any nerves as doc-

tors at St. Paul’s Hospital performed a transcatheter heart valve (THV) implan-tation on her while she lay awake without sedation. Wegner’s calm was even more impressive because the procedure was being broadcast around the world and to a conference of doctors in downtown Vancouver.

“If no valve replacement was becoming available or if Dr. (John) Webb had not considered me a candidate, if I went just by medication…the deterioration is frighten-ing, it’s coming so fast,” Wegner said prior to the procedure.

The THV implantation, on June 5, was the 1,000th procedure for the Centre for Heart Valve Innovation at St. Paul’s Hos-pital. THV procedures involve inserting a thin tube with a replacement valve into the body through a small incision, then di-recting it to the heart through an artery. It can be done by making a small hole in the leg or the chest wall. Dr. John Webb, director of interventional cardiology at St. Paul’s, was the fi rst to successfully perform a transcatheter aortic valve implantation (TAVI) through an artery in 2005, which involves inserting a new valve from a small puncture in the leg.

“The Centre for Heart Valve Innovation at St. Paul’s is recognized internationally as a pioneer of innovative, minimally invasive heart valve replacement procedures that provide an alternative for patients who are at higher risk for open-heart surgery. By performing this surgery on patients that are awake, we can reduce the stress and risks of surgery, improve results and avoid complications, and allow patients to return home sooner,” says Dr. Webb.

Only patients who are at high risk for surgery are considered for THV proce-dures. The Centre for Heart Valve Inno-vation is now performing half of its THV procedures on patients that are awake. In addition to TAVI, the Centre for Heart Valve Innovation also performs other transcatheter procedures for people with valve disease, including percutaneous

mitra l va lve repa i r (“MitraCl ip”) . Dr. Webb is recognized internationally

as a leader in these procedures, having the broadest experience in the world and hav-ing taught these techniques to health care professionals in more than 25 countries. He is not only breaking new ground with medical procedures, but also in the way he teaches others how to conduct this pro-cedure. From offering three-day courses locally, to traveling to all corners of the world to assist with initial cases, Dr. Webb and his team are dedicated to sharing their knowledge so that the TAVI procedure is accessible to all of those who qualify for it. In 2011, St. Paul’s launched the Virtual Teaching Laboratory which provides live feeds of the TAVI procedures at St. Paul’s to medical professionals around the world.

“We bring together cardiologists, car-diac surgeons, nurses, geriatric medicine specialists, the patient and also the fam-ily doctor to discuss whether this is some-thing that we can do but also whether it is something that we should do,” says San-dra Lauck, clinical nurse specialist at St. Paul’s.

Wegner’s procedure was broadcast to the Transcatheter Valve Therapies confer-ence held in Vancouver. The conference was designed for interventional cardiolo-gists, cardiovascular surgeons, cardiac im-aging specialists, clinical cardiologists, car-diac nurses, cardiovascular technologists, and other health care professionals with a

special interest in the fi eld of transcatheter valve therapy.

“In just nine years, St. Paul’s Hospi-tal has grown from a trailblazer in TAVI procedures to the home of the Centre for Heart Valve Innovation. This milestone is evidence of the deep commitment of our caregivers and researchers, who have put the needs of patients fi rst and dared to push the boundaries and fi nd new solu-tions,” says Dianne Doyle, President and CEO of Providence Health Care, which operates St. Paul’s.

Wegner used to exercise regularly but her condition deteriorated dramatically. Without this procedure, doctors expected her lifespan to be shortened considerably.

“Things were quite alright. I exercised, I was in the (St. Paul’s Hospital) Healthy

Heart Program. Then I felt my strength was going down, I was having more and more problems and had to give up exercise altogether,” she explains.

The Vancouver program is a partnership between St. Paul’s Hospital and Vancouver General Hospital. Sites of the provincial THV program also include Royal Colum-bian and Royal Jubilee Hospitals.

From her hospital bed just four hours after the procedure, Wegner gave some advice to others who might be in her situa-tion. “If you have the chance to be chosen, be grateful and grab it…I feel blessed. I feel fi ne, certainly better than before.” ■H

Dave Lefebvre is a Senior Communications Specialist at Providence Health Care in BC.

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Dr. Webb is recognized internationally as a leader in these procedures, having the broadest experience in the world and having taught these techniques to health care professionals in more than 25 countries.

The 1000th transcatheter heart valve procedure was broadcast to the Transcatheter Valve Therapies conference held in Vancouver.

heart valve procedure

Centre performs 1,000th transcatheter


16 Focus

ore than nine million Canadi-ans are living with diabetes or prediabetes. With more than 20 people being newly diag-

nosed every hour of every day, chances are the disease affects someone you know. That could be a relative, friend, neigh-bour, co-worker or someone who’s part of your personal or professional community. In Ontario alone, there has been a 68 per cent increase between 1995 and 2005. The majority of cases are of type 2 diabe-tes and that is where most of the growth is seen. The need to ensure optimal care and outcomes for people living with diabe-tes has always been great, but is now being brought into sharper focus by the magni-tude of the situation.

A chronic disease, diabetes is often de-bilitating and sometimes fatal. The body either cannot produce the hormone insu-lin (type 1 diabetes), or it cannot properly use the insulin it produces (type 2 diabe-tes). This leads to high levels of glucose (sugar) in the blood, which can damage or-gans, blood vessels and nerves and result in a variety of complications. To use sugar as an energy source, the body needs insulin. People with prediabetes have higher-than-normal blood sugar levels that aren’t high enough to be diagnosed with type 2 diabe-tes. Without intervention, 50 per cent of those people will develop type 2 diabetes.

What accounts for the dramatic rise in the number of people with diabetes?

There are four reasons for the rise in the numbers.

LONGEVITY People are living lon-ger with diabetes, and we are successfully treating them. That’s a good news story, and we want that trend to continue even though it is a major contributor to the growing prevalence of diabetes.

GENES Genetic factors can put a per-son at greater risk of developing type 2 dia-betes. We also know that the risk varies for people of different ethnicities. These fac-tors cannot be modifi ed. On the Canadian Diabetes Association’s (CDA’s) website at www.diabetes.ca, we have a risk assess-ment that provides people with more infor-mation about factors that could put them at risk for diabetes.

LIFESTYLE We are becoming a more sedentary society, consuming more calo-ries, and more calories of an unhealthy variety. This can lead to obesity, which is of concern not only to people with diabe-tes, but to everyone. In Canada, obesity is a public health crisis. And like smoking, it needs a multi-pronged public health re-sponse.

ENVIRONMENT We are seeing that more recently designed neighbourhoods

are unwalkable. Research, such as the CDA-funded study by Dr. Gillian Booth and her team, found that neighbourhood walkability was a strong predictor of a per-son’s risk of developing diabetes, indepen-dent of his or her age and income, particu-larly among recent immigrants. Poverty accentuated these effects. Linked to that is the idea that some neighbourhoods rep-resent “food deserts,” where people have tremendous diffi culty obtaining foods that are nutritious, such as fresh fruits and veg-etables, that provide healthful calories. This can be due to unaffordability or un-availability, or both. For instance, if you live on First Nations reserve in northern Manitoba, it’s very diffi cult to get enough calories without eating a lot of added sugar.

What can health care professionals do to help people living with diabetes?

CREATE A CONNECTION. As part of the Canadian Diabetes Association 2013 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada (www.guidelines.diabetes.ca), we emphasize the importance of a person with diabetes connecting with a health-care team. A person’s diabetes care team can include a family doctor, nurse, phar-macist, dietitian, endocrinologist, certifi ed diabetes educator, and more. It’s a proven approach that can improve treatment and a person’s quality of life. Whether an in-dividual is treated by many health care professionals or just a few, it’s important for each team member to have a clear role that the patient understands, and for the team to talk to each other and share in-formation. CDA volunteer Christina Vail-lancourt, a registered dietitian and patient care specialist at Lakeridge Health Dur-ham Region Diabetes Network in Whitby, Ont., believes that everything health care

professionals do should start with the per-son living with diabetes. In other words, the system should fi t the patient, not the other way around.

SUPPORT EDUCATION. People liv-ing with diabetes need information about how to manage the disease and live health-ily. Health care professionals can play an important role in educating people and helping them put the information to prac-tical use in their everyday lives. Encourag-ing a healthier lifestyle is an important goal for everyone, especially those with predia-betes. As the Diabetes Prevention Pro-gram (DPP) study showed, modest weight loss achieved through dietary changes and physical activity can delay or even prevent the onset of type 2 diabetes.

At the CDA, we suggest small, simple steps that are realistic and achievable. Creating targets and goals is another way for people to stay on track with their dia-betes management. We have tools on our website to help people prepare for diabetes visits, create action plans and track their progress – these can be used in conjunction with their health care team. Other valu-able resources, which the CDA has worked with volunteers to develop, include local support, whether it’s a peer-based support group; one-on-one support, in person and online; and webinars.

STAY INFORMED. The 2013 Guide-lines provide health care professionals with the best and most current evidence-based clinical practice data. They were devel-oped over a fi ve-year period by a CDA volunteer committee of diabetes experts who assessed and reviewed the latest sci-entifi c evidence about diabetes prevention and management. Rated among the best in the world, the 2013 Guidelines support the CDA’s commitment to being a global leader in diabetes care, management and prevention. We have just released the

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“Each person experiences the diagnosis of a chronic disease, like diabetes, in a different way. But one of the themes common to people with diabetes is the loss of fl exibility in their lives.”

Diabetes EpidemicCover Story


17 Cover Story

Patient-centred care is your specialty.

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The Canadian Diabetes Association is pleased to introduce even MORE interactive tools and resources to help you apply the Clinical Practice Guidelines in your daily practice.

Look for the NEW tools on guidelines.diabetes.ca or in your favourite app store.

Clinical Practice Guidelines app (CDA CPG) for health-care providers – an inter-active, searchable and mobile-friendly re-source with interactive tools. It’s available from the App Store and Google Play.

What’s new with diabetes?TYPE 2 Twenty-fi ve years ago in medi-

cine, we had a rule of thumb that said any-one under the age of 30 with diabetes must have type 1 diabetes. That is no longer the case. Today, children are being diagnosed with type 2 diabetes. For instance, Dr. Jill Hamilton of the Hospital for Sick Children in Toronto says she sees children who are developing type 2 diabetes at an increas-ingly younger age in her practice. With funds from the CDA, Dr. Hamilton and her team are studying the link between mothers who develop gestational diabetes (which occurs during pregnancy) and their babies who may be at greater risk for obe-sity and diabetes later in life.

The face of diabetes is also changing among gender lines. Traditionally, the prevalence of diabetes (those living with the disease) has been higher in men, but the greatest increase in rates is among young women aged 20 to 49 years old.

TYPE 1 Unlike type 2, which can be prevented, the cause of type 1 is unknown and there is currently no cure. However, there are two good news research stories on the horizon.

Islet Transplants Canada’s fi rst success-ful islet cell (the pancreatic cells that pro-duce insulin) transplant was conducted in 1991 by Dr. Garth Warnock. Building on his work, a University of Alberta research team – whose investigative work is funded by the CDA – announced a breakthrough technique for islet cell transplantation for patients with severe type 1 diabetes. This became known as the Edmonton Protocol. As of June 2012, more than 300 islet cell

transplant procedures have been success-fully performed across Canada.

Today, there are a host of researchers working in the area of islet cell trans-plantation. One of them is CDA-funded researcher, Dr. Pere Santamaria, a Uni-versity of Calgary professor and director of the Julia McFarlane Diabetes Research Centre (which supports research focused on fi nding a cure for diabetes), who has developed a vaccine that could increase the success of transplants.

Artifi cial Pancreas Whether it’s wear-able or implanted, an artifi cial pancreas is an automated system that mimics a func-tioning pancreas by delivering insulin in response to the body’s changing glucose levels. De Montfort University in Leices-ter, England, recently announced that the fi rst human trials of an implanted artifi cial pancreas created by one of its professors could be just two years away.

On this side of the pond, CDA-funded research by Dr. Rémi Rabasa-Lhoret and his team has evaluated conventional insu-lin pump therapy versus an insulin pump that uses a continuous glucose monitor (CGM) to calculate insulin dosages with-out any input from the wearer. Dr. Rabasa-Lhoret is currently comparing a two-hor-mone – insulin and glucagon (a hormone that responds to correct low blood sugar levels) – system that would function as a wearable artifi cial pancreas. It wouldn’t re-quire any input from the wearer and would normalize blood sugar levels.

What’s ahead for people living with diabetes?

This spring, the CDA released the Dia-betes Charter for Canada, which outlines the rights and responsibilities of people living diabetes, their caregivers, health-care providers, governments and others who may provide care and support. This all-hands-on-deck approach underscores how important it is for everyone to work together to fi ght this disease. Our hope is that this document will foster positive change that will lead to equal access to diabetes care and support for all Canadi-ans living with diabetes or at risk for the disease, no matter where they live. ■H

Dr. Jan Hux is chief science offi cer for the Canadian Diabetes Association (CDA). For more information about the CDA, visit diabetes.ca.

3.3 million living with diabetes (type 1, type 2) 5.7 million have prediabetes (abnormal blood sugar, or glucose, levels); without intervention, almost 50 per cent of people with prediabetes will develop type 2 diabetes

Cost of diabetes:$13.5 billion in 2014 (TBC)Expected to rise to $17 billion by 2024

Growth of diabetes:Prevalence (those living with the disease) – 2000: 4.2%; 2010: 7.6%; 2014: 9%; 2024: 11.8%Number of Canadians affected – 2000: 1 million; 2010: 2.7 million; 2014: 3.3 million; 2024: 4.8 million



hen Cook Medical chose to debut the newest model of its endovascular stent graft to the world, it chose an expe-

rienced team at St. Michael’s Hospital.Dr. Tony Moloney, an endovascular

surgeon with the Heart and Vascular

Program, was the first to use Cook’s new Alpha graft to repair a patient’s aorta and treat an abdominal aortic aneurysm.

An abdominal aortic aneurysm, often called a “Triple-A,” is when part of the aorta –the largest artery in the body– is weakened and may rupture. One way to repair the aorta is with an endovascular stent graft – a tube containing a mesh stent that will expand and support the artery’s weak spot.

Surgeons insert stent grafts through the femoral artery and deftly lead it up to the damaged area. When they’ve reached the correct spot, surgeons pull on a cord and release the compressed mesh. That mesh expands to fit the ex-act framework of the patient’s injured arterial wall and provide structural sup-port.

“Rather than pulling on a cord, the Alpha graft is released with a twisting motion,” says Dr. Moloney. “A twisting release gives us more control and stabili-ty which should be safer for patients and make placement more precise.”

Placement is crucial when it comes to repairing an aneurysm. If you’re off by a few millimeters, the aorta may not get

the structural support it needs. Having a stent graft that is small enough to ma-neuver through tight spots can be the difference between having a minimally invasive procedure, such as a stent graft, and undergoing surgery. The Al-pha graft is slimmer than Cook Medi-cal’s other endovascular grafts so access is easier.

"Other medical device companies have grafts that are similarly slimmer or released with the twisting motion,” says Dr. Moloney. “But because each aorta is different, we need many different kinds of grafts. With this world-first, we’ve added a new arrow to our quiver.” ■HGeoff Koehler is a Media Relations Adviser at St. Michael’s Hospital.

unnybrook is the fi rst centre in Canada to use a new remote control system for treating ar-rhythmia that is more effective

and safer for patients than other options."Adding this technology to our

minimally invasive arrhythmia lab, which is already cutting-edge with its use of robotic imaging-guided technology, is further enhancing the precision and safety of heart procedures," says Dr. Eugene Crystal, cardiologist and Director of Arrhythmia Servies at Sunnybrook’s Schulich Heart Centre.

"We can now access really challenging areas of the heart chambers, which results in greater accuracy during ablation and a reduced risk of complications for patients."

The VdriveTM system from Stereotaxis is the latest addition to Sunnybrook's ar-rhythmia suite that treats about 300 pa-tients a year for irregular heartbeats that occur when the electricity that fl ows through the heart to trigger the pumping action "short circuits", or gets blocked, and disturbs the heart's normal rhythm. Heart palpitations, fatigue, dizziness, chest pain and shortness of breath are all symptoms, which if left untreated can lead to heart at-tack and stroke.

The sophisticated GPS-like technology controls powerful magnets near the patient to map a pathway through a patient's blood

vessels and heart to the diseased heart tis-sue. The magnets lead a soft catheter gen-tly along this pathway by guiding its mag-netic tip, precisely identifying the location of the faulty electrical site in each patient. Clinicians from the Schulich Heart Centre then ablate, or destroy, damaged heart tis-

sue that causes the electrical malfunction to restore a regular heart rhythm.

"This is win-win technology that greatly benefi ts both patients and the health care teams looking after them. Patients receive the best care for irregular heart rhythms in the safest possible environment, and they

can often go home the same day with such minimally invasive treatment," adds Dr. Crystal, Associate Professor, Department of Medicine, University of Toronto. ■HMarie Sanderson works in Communications at Sunnybrook Health Sciences Centre.

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Dr. Eugene Crystal, Director of Arrhythmia Services at Sunnybrook, is pictured in the control room of the hospital's Arrhythmia Suite.

By Geoff Koehler

St. Michael’s adds another world fi rst

Dr. Tony Moloney was the world’s fi rst to use Cook’s new Alpha graft. He’s shown here performing a different vascular procedure.

Photo courtesy of Cook Medical

W

irregular heart beats


19 From the CEO's Desk

arlier this year, I stood on the front of a large piece of heavy construction machinery with the Providence Care Board

Chair as we marked the groundbreaking of our new hospital redevelopment project. It was an exciting moment – we are now building a facility that will benefi t patients and their families from across southeastern Ontario.

When it opens in 2017, Providence Care Hospital will be one of the fi rst in North America to combine long- term, specialized mental health services in the same building as complex care and reha-bilitation. Right now, we provide these ser-vices at two different hospital sites.

Historically, psychiatric hospitals in On-tario have been built and operated separate from other hospital programs. However, more and more, we are seeing commonali-ties between patients seeking these servic-es, particularly as care is delivered through an interprofessional team approach. Se-niors diagnosed with dementia also rely on physical rehabilitation services, and just as individuals who have experienced a signifi -cant injury may also require mental health care. Psychiatric hospitals have also been stereotyped as very institutional and dis-connected from the rest of the community. The new Providence Care Hospital will help change the perceptions around men-tal health and how care is provided.

Providence Care Hospital will bring to life the concept of patient-centred care, where services are not siloed in separate facilities but instead are working in col-laboration to meet the physical, emotional, social and spiritual needs of each person.

In our new building, patients, clients and families will use the same entrance, there are spaces for informal and formal gatherings, and inpatient rooms and units are designed to be consistent – no matter what services are being provided.

We’re committed to welcoming all peo-ple – creating a homelike and person-cen-tred care environment at Providence Care Hospital. One way we hope to do this is by designating spaces within the building to showcase artwork by people with lived experience of mental illness, and by reha-bilitation or complex care patients.

I came to Providence Care this year, with a background of many years working in community care. There is a real shift in health care today toward ensuring that hospital stays are “transitions” and not a place for individuals to spend indefi nite periods of time.

With this in mind, the Providence Care Hospital will support patients as they pre-pare to leave the hospital to return home to the community or alternate care setting. We have two trial discharge apartments (one located with a mental health inpa-tient unit, and another with a rehab unit) to support clients as they complete their hospital stay.

These elements refl ect a shift in how mental health care is delivered in Canada:

it is one part of the broader continuum of health services. Integrating mental health with complex medical care and physical re-habilitation is one way Providence Care is demonstrating its holistic, person-centred approach. We meet the ‘physical, social,

emotional and spiritual needs’ of each per-son – and in the process, we’re working to destigmatize mental healthcare in our community. ■HCathy Szabo is President & CEO, Providence Care, Kingston.

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Providence Care’s new hospital in Kingston will change the perception of mental healthcareBy Cathy Szabo

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fter months of exercise and dedication, Niagara Health System (NHS) cardiac patient Garwin Cockhead has accom-

plished a remarkable feat – improving his heart health enough that he’s been taken off Ontario’s heart transplant list.

A severe heart attack in August 2012 and related cardiovascular complications left the 52-year-old Niagara Falls man with a failing heart that doctors initially said needed to be replaced.

He was placed on the cardiac transplant list at Toronto General Hospital in early 2013. He was given a pager so he could be notifi ed immediately if a health compatible heart became available.

But Garwin didn’t sit idly waiting for the pager to buzz. He got busy trying to repair the damaged heart he already had. He was referred to the NHS’s Cardiovascular Health and Rehabilitation Program and committed himself to exercise and improv-ing his cardiac health.

This regional program offers a variety of cardiovascular rehabilitation and risk reduction services, such as supervised exercise programs, nutrition counseling, stress management, smoking cessation and health teaching in both group and indi-vidual forums.

Almost 800 new patients participated in the program last year, logging almost 14,000 exercise visits. The YMCA of Ni-agara is a partner in the program.

Garwin completed the 16-week program at the YMCA’s Niagara Falls location, fo-cusing on cardiovascular exercises, such as walking, spinning on stationary bikes and using the treadmill, as well as some light weights to improve his strength. He continues to exercise at the Y at least fi ve times per week, even though he completed the rehab program.

All of Garwin’s sweat and hard work have paid off. He recently received the good news that his cardiac health has improved to the point that he no longer needs a new heart.

“The exercise rehab program was a life-saver,” says Garwin. “When I began I could barely walk from one side of the room to the next. Now I can do 25 minutes of car-dio and some strength training in a session.

The program is also a place to be with people who are experiencing the same challenges you are; it’s a great support.”

It’s rare for patients with failing hearts to get well enough that they no longer require a transplant. The Trillium Gift of Life Net-work reports that between four and nine cardiac patients have been removed from transplant lists in Ontario each of the past fi ve years because of improved health. On average, there are typically up to 165 peo-ple on the transplant list each year.

Garwin is among the fortunate ones –he was recently able to return the pager he wore for nearly a year, anxiously wait-ing for a change of heart. Garwin’s medical team credits his involvement in the NHS cardiac rehab program in part for his re-markable progress.

“We see benefi ts with most of our pa-tients, and everybody progresses differ-ently,” says Steve Walker, NHS Exercise Specialist with the program. “Garwin has worked very hard, and we are really pleased with his progress.” ■H

Caroline Bourque Wiley is Manager, Communications at Niagara Health System.

Off the transplant listBy Caroline Bourque Wiley

A

The Trillium Gift of Life Network reports that between four and nine cardiac patients have been removed from transplant lists in Ontario each of the past fi ve years because of improved health.

Garwin Cockhead improved his heart health enough to be taken off the heart transplant list.

diabetes trial starting at St. Jo-seph’s Hospital is testing a po-tential magic bullet to combat both diabetes and the often-

deadly complications of heart disease. St. Joseph’s is one of 29 Canadian sites

– and about 1,200 sites around the world – taking part in the DECLARE study to test a novel agent called Dapaglifl ozin, which experts hope will become a much-needed new tool in the diabetes care “toolbox”. The purpose of the trial is to lower blood sugar in people with type 2 diabetes and prove it to be safe in heart disease. About 80 per cent of people with diabetes will die as a result of a heart attack or stroke.

St. Joseph’s endocrinologist Dr. Irene Hramiak has recruited 25 patients with type 2 diabetes who are over age 40 and at high risk of heart disease or who have had a heart event, such as a heart attack.

“Currently, there is only one drug avail-able, Metformin, for those with type 2 dia-betes that has been found to be good for both diabetes and heart disease,” explains Dr. Hramiak, chair/chief of the Centre for Diabetes, Endocrinology and Metabolism and a scientist with Lawson Health Re-search Institute. “But you can’t just use one drug forever. Diabetes is a progressive disease so we have to keep adding treat-ment. It’s not like other conditions where you can stay on the same pill for 20 years. With diabetes the loss of pancreatic func-tion is ongoing. We always need more tools in the toolbox.”

Dapaglifl ozin works to block an enzyme in the kidney that pulls sugar back into the blood from the urine. By blocking the en-zyme the sugar leaves the body by way of the urine and improves blood sugar levels.

Ironically, if the drug works effectively, sugar in the urine will be good news while many years ago it was considered bad news, says Dr. Hramiak. Before blood glu-cose monitors became readily available, diabetes patients tested their urine as an indication of how they were managing their disease. If sugar in their urine was high, it meant that sugar in the blood was likely high. In the DECLARE study, sugar in the urine will mean the new drug is do-ing its job.

“We’re changing how we think about diabetes treatment,” explains Dr. Hramiak.”We’re changing the dynamics in the kidney. Here’s an agent that in fact puts sugar in the urine as a form of treat-ment. The kidney is causing more sugar to leak out and the sugar in the blood is drop-ping.”

The hope, she adds, is that the drug is proven safe in diabetics with, or at higher risk of, heart disease.

About 17,150 patients worldwide will be taking part in the fi ve-year study, which is being coordinated by the Timi Study Group in Boston, MA. ■H

Dahlia Reich works in Communications & Public Affairs at St. Joseph's Health Care, London.

By Dahlia Reich

Trial of novel drug targets both diabetes and heart disease

A


21 Evidence Matters

s wireless device use becomes an integral part of our daily lives, we are asking for fewer restrictions on their use in hos-

pitals. Devices such as smart phones and tablets provide many potential benefi ts in this environment. Patients can use wireless devices to connect with friends and family or pass time in the waiting room, making their hospital visit a more positive expe-rience. Clinicians can use wireless tech-nology to do their work more effi ciently — quickly consulting with other care providers, easily accessing information re-sources and electronic health records, and viewing and recording patient data on the spot. But, the potential for electromagnetic radiation generated by wireless devices to interfere with medical equipment remains a concern to patient safety.

In 2011, CADTH conducted an en-vironmental scan of hospital policies on wireless device use. At that time most of the Canadian hospitals surveyed were ei-ther in the process of revising their poli-cies or had revised them within the last three years. The newly implemented poli-cies attempted to strike a balance between convenience and safety — limiting wire-less device usage within a specifi c distance from medical equipment and prohibiting their use in patient care areas where medi-cal equipment is heavily used, while al-lowing their use in hospital waiting areas, lounges, private offi ces, and cafeterias.

But are such restrictions actually required? What do we know about the interference to medical equipment caused by wireless devices and the extent to which this interference compromises patient safety?

To answer these questions, CADTH’s Rapid Response service undertook a re-view of the available evidence on the use of wireless devices in health care environ-ments. The studies looked at several types of wireless devices — ultra-high frequency radios, various mobile phones, and a vari-ety of Bluetooth-enabled devices — using a broad range of transmission technolo-gies such as code division multiple access (CDMA), general packet radio service (GPRS), global system for mobile commu-nication (GSM), Terrestrial Trunked Radio

(TETRA), universal mobile telecommuni-cations system (UMTS), wireless local area network (WLAN) and analog. The effect of these devices on the performance of sev-eral types of medical equipment was inves-tigated in the studies, including defi brilla-tors, ventilators, brain stimulators, pumps, and ophthalmic equipment.

The CADTH review found that elec-tromagnetic emissions from wireless de-vices do frequently cause interference with medical equipment. This interference manifests itself in several ways — noises, screen distortions, false alarms, complete stoppages, and malfunctions in output parameters. Equipment is more likely to be affected if the wireless device is using the same radio frequency, transmitting a strong signal, or in close proximity to the equipment. Incidences of the interference affecting medical equipment to such an extent that it compromised patient safety were, however, found to be uncommon. When it did occur, the equipment and the wireless device were in very close prox-imity to one another — less than three feet apart.

However, the available evidence on this issue has limitations. Not all types of medi-cal equipment were assessed, and there may be some equipment that is more suscepti-ble to interference than those that were in-cluded in the studies. The technology used to design both wireless devices and medi-cal equipment is constantly changing — in the near future it may create more interfer-ence or be more susceptible to interference than was the case at the time. Some of the studies were conducted with a single piece of equipment in the room, which may not be the case in every health care setting.

Even without these limitations, any risk of electromagnetic interference resulting in a malfunction in medical equipment exposing patients to risk of harm, misdi-agnosis, or incorrect treatment is cause for concern. The unrestricted use of wireless

devices in health care settings, therefore, cannot generally be considered to be a safe practice.

Given that the popularity of wireless de-vices among patients, visitors, and health care providers is here to stay and likely to continue increasing, there are measures that need to be taken to limit harm to patients. Hospitals are, and will continue todevelop policies to regulate wireless de-vice use in highly instrumented areas to protect sensitive equipment from exposure to hazardous electromagnetic interference. And experts in these technologies can help hospitals select equipment that is less sus-ceptible to interference from commonly used wireless devices. Such measures will protect patient safety while allowing for the continued use of wireless devices to benefi t medical practice and improve con-venience.

For more information about CADTH visit www.cadth.ca and follow us on Twit-ter @CADTH_ACMTS. ■H

Barbara Greenwood Dufour is a Knowledge Mobilization Offi cer at CADTH.

Cutting through the noise:

By Barbara Greenwood Dufour

A

The technology used to design both wireless devices and medical equipment is constantly changing — in the near future it may create more interference or be more susceptible to interference than was the case at the time.

What we know about the safe use of wireless devices in hospitals



he nursing world of work con-tinues to evolve. In light of changes in the health care system, the patient population

characteristics and the society in general, nurses are faced with unique challenges despite which they continue to strive for better healthcare for all. Nurses are situ-ated in close proximity to the patients and hence directly experience any patient-re-lated changes in practice, be it new legis-lation that urges to reduce wait-times and improve wound care, or a new regulation that affects the general public, such as the smoking ban. The environment in which nurses work has been recognized as an im-portant place to not only prevent disease and promote health in nurses, but also as instrumental in sustaining quality patient care.

A Healthy Work Environment is a prac-tice setting that maximizes the health and well-being of nurses, quality patient/client outcomes, organizational performance and societal outcomes” (RNAO HWE Best Practice Guidelines). Creating a healthy work environment is not merely an ideo-logical construct; rather, it has fi rm and ev-idential underpinnings. A culture of safety is one component of the evidence that leads to a healthy work environment and nurses have a pivotal role in keeping them-selves and patients safe. One need only to refl ect over the past 15 years at such sober-ing events as Acquired Immunodefi ciency Syndrome (AIDS), severe acute respira-tory syndrome (SARS), aggressive nosoco-mial infections, and increased violence to distinguish the permanent changes nurses and organizations were obligated to make in the last decade to protect themselves and, equally important the patients or

clients they care for. Many aspects of the response to AIDS and SARS are worth re-membering as they led to innovations such as needleless systems, personal protective gear, and improved isolation products, to protect nurses and other health care work-ers.

The work of nurses is sometimes por-trayed as a fragile balancing act between caring for oneself and others. The haz-ards of nursing work can impair health both physically and mentally. The result-ing health impacts include musculoskel-etal injuries, frequent infections, changes

in mental health, and cardiovascular and metabolic disorders. Musculoskeletal inju-ries among nurses and health care workers continue to be the major source of disabili-ties and time loss at work (Health Canada, 2012). Nurses had a rate of absence due to illness or disability nearly twice the rate for all other occupations and higher than all other health care occupations in 2010.

Ontario reported approximately 147,000 nurses for 2012, of these 96 per cent of On-tario’s nurses, or 108,500 were women, and four per cent, or 4,500, were men (College of Nurses Ontario). In Ontario, nearly

one-third (33 per cent) of nurses reported experiencing high job strain. Job strain re-sults when the psychological demands of a job exceed the worker’s discretion in de-ciding how to do the job (Health Canada, 2012). Approximately two-thirds of nurses in Ontario (65 per cent) reported that their jobs were highly physically demanding. The fi gure for all of Canada’s nurses was 62 per cent (Health Canada, 2012).

Along with the physical strain nurses are under, the last decade has also revealed per-sistent levels of workplace violence. Work-place violence includes physical aggres-sion, sexual violence, verbal or physical, and psychological violence including bul-lying (RNAO, BPG Preventing and Man-aging Violence in the Workplace, 2009). Governments have responded favourably with legislation to protect nurses and other workers against violence through the intro-duction of Bill 168 which requires employ-ers to develop, implement and maintain a workplace violence policy and program.

A key driver to the transformation of health and safety practices in the nursing profession has been federal and provin-cial legislation. For example, a number of regulations across Canada followed the To-bacco Act that impacted the manufacture, sale, labelling and promotion of tobacco products. Provincial legislation prohibit-ing smoking in enclosed workplaces later evolved in order to protect workers from exposure to second hand smoke. It is hard to imagine that at one point in time you could be working on a Cardiac fl oor, pro-viding health teaching on the impact of smoking and effect it has on the heart, and then documenting on the patient in a smoke-fi lled nursing station.

In addition to federal and provincial legislation, the global epidemic of Severe Acute Respiratory Syndrome (SARS) in 2003 pushed medical infrastructure to the limit. SARS outbreaks greatly impacted Canada’s largest city, Toronto. SARS placed heavy pressures on Toronto's pub-lic health and health care system. The re-gion's health care professionals, as frontline workers vital to controlling the disease, were at heightened risk for contracting the disease, and under considerable physi-cal and psychological stress. Many patients required intensive care, hospitals had to close, elective procedures were cancelled, and procuring adequate types and quanti-ties of supplies to combat the disease was diffi cult. SARS also placed unprecedented demands on the public health system, chal-lenging regional capacity for outbreak con-tainment, surveillance, information man-agement, and infection control.

Through the SARS experience, the em-ployers’ legislated responsibility to main-tain a safe work environment was greatly challenged. Many issues involving occupa-tional health and safety surfaced from N95 respirator availability and applicability, to proper mask-fi t testing and use. Workers rights such as the right to refuse unsafe work and right to know about health and safety hazards in their workplace were de-bated and tested.

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Continued on page 23

Transformation of health and safety practices in the nursing profession

The healing hands of time:

Through Toronto’s SARS experience, the employers’ legislated responsibility to maintain a safe work environment was greatly challenged.



To better understand how nurses feel about the changes in nursing health and safety practices throughout the last de-cade, a group of nurses from Public Ser-vices Health & Safety Association and the Registered Nurses’ Association of Ontario, put together a survey asking nurses to share their experiences and perspectives on the changes in nursing practice. Participants were asked about the changes observed related to health and safety practices in the nursing profession and what are some of the infl uential events and system devel-opments that led to these changes. The respondents provided an insightful look at the evolution of health and safety prac-tices in nursing in the last decade. Seven experienced nurses who lived through the changes shared their thoughts on the strengths and areas for improvement re-lated to workplace health and safety in the nursing profession. Respondents’ years of nursing experience in Canada ranged from 13–34 years. Most of the nurses reported diverse nursing experience and had worked in a variety of setting, including Pediat-rics, Intensive Care, Emergency, Obstet-rics, Gerontology, Occupational Health, Medical Surgical, Urgent Care Clinics, Administration, Public Health, Commu-nity and Long-term Care, and specialized care clinics. Their responses fall into six broad themes, including infection preven-tion and control; workplace violence and bullying; smoke-free workplace; technol-ogy; general workplace safety; and looking forward.

Infection prevention and control

SARS certainly came out as the most signifi cant event, “a turning point to in-creasing nurse’s safety,” according to one participant, among all related events and changes. Participants have reported an in-crease in awareness and emphasis on hand hygiene; increased and appropriate use of personal protective equipment (PPE); reg-ular mask-fi t testing for health care staff; screening of respiratory symptoms; and stronger partnerships with the local health units, Ministry of Health and Long-Term Care, as well as the World Health Organi-zation. Some participants noted that the downside of introducing these practices is the time it takes to get it done right! Handwashing between patients is criti-cal, as is additional screening of patients for infectious diseases but the nurses are required to complete these tasks within their already busy days. The tragic events associated with the global SARS pandemic made most employers realized that they have responsibilities when it comes to staff safety. Completing a screening for patients, particularly in the time with emerging an-tibiotic resistant organisms and acute re-spiratory illnesses, nurses are not only con-cerned about their patients, but also their own health and wellbeing.

Workplace violence and bullying

There were times when nurses accepted physical and verbal abuse as part of their job. The place of work has evolved for nurses with more nursing care being pro-vided in patients’ homes. This heightens nurses’ awareness about safety because of the increased risks associated with working away from a controlled health care facility

environment. Today, the nurses felt that in most workplaces, workplace violence and bullying is not being tolerated. This is a result of continued education and aware-ness raising in workplaces.

Smoke-free workplace Smoke-Free Ontario Act went into ef-

fect in 2006, and aims to protect Ontarians from exposure to second-hand smoke by banning smoking in workplaces, enclosed public spaces and also in motor vehicles where a child under the age of 16 years is present.

Although the survey participants ac-knowledged the benefi t of creating smoke-free workplaces for all involved, some felt it is important to note that nurses, as a result of this ban, have been given more respon-sibilities with screening patients and asking if they would like smoking cessation aids.

Technology – cannot live with it, cannot live without it

For the most part, advances in technol-ogy, in the form of electronic charting and online learning have certainly improved the overall working lives of nurses. A common concern is that introducing rapid technological changes has led to nurses spending much of their time learning how to operate the technology, then operating the technology which can sometimes be-come a barrier to spending more one-one-one time with the patient. An insuffi cient number of charting stations and malfunc-tioning computers are some of the troubles nurses experience with technology.

General workplace safetyOverall, workplace safety is much more

of a priority now in places where nurses work and care for patients. One nurse recalls how back in the day, no PPE was worn while caring for a patient who was hemorrhaging; and nurses mixed chemo drugs themselves without hoods. In some workplaces, nurses lacked a clear defi nition of where their duties ended and did every-thing from bathing a patient to plunging the toilet.

Looking forward The nurses felt that overall, there has

been great progress and a general con-sensus around creating healthy and safe workplaces. Employers recognize that when nurses have the opportunity to provide care in a safe and healthy work environment, everyone involved benefi ts, including the nurse, patient and their family. Some of the challenges and bar-riers to sustaining healthy and safe envi-ronments for nurses is the fact that nurses themselves need to actively participate to upkeep the new and innovative practices. This places more time pressures on the nurses who fi nd it diffi cult to cut back on patient-nurse time.

The nurses called for appropriate and adequate education on safety measures being implemented. At times, a new prac-tice is introduced and nurses fi nd them-selves struggling trying to understand the rationale behind the intervention. Good examples of successful program imple-mentation are the RNAO best practice guidelines on Professionalism, Fatigue Management and Confl ict Management.

It was recommended to continue to break the silos between healthcare sub-sectors to work together on developing and successfully implementing standard-ized tools that address healthcare system challenges. Communication is still frag-mented and information sharing, particu-larly around resources, tools and databas-es, is diffi cult. It is still common to see great ideas and innovative solutions re-main within one organization while many others are seeking answers and left trying to reinvent the wheel.

Although a number of valuable inter-ventions and practice changes have been introduced in healthcare workplaces, some are done without a proper evalua-tion. This is important when we want to understand the effectiveness and areas for improvement.

Every professional in the health care system plays an important role in car-ing for the patient and assisting them in achieving better health. However, nurses are in a very special place when consid-

ering their proximity to the patient and ability to connect everyone in the circle of care.

Recommendations Keeping nurses safe and healthy is a

natural extension of providing qual-ity care. Every worker has the right to be free from harm. Commitment to high standards of professional practice doesn’t mean bearing the burden of risk, but rather managing risk for better out-comes.

Nurses and employers need to work together to eliminate occupational in-juries, illnesses, and fatalities. Bringing about further change requires strong collaboration. Efforts need to heighten awareness, promote knowledge mobiliza-tion, and support ongoing engagement.

Nurses have the responsibility to raise health and safety concerns and the right to be part of the solution. Employers have the duty to invest in their work-force. ■H

Authors - Liz Sisolak, Althea Stewart-Pyne, Tina Dunlop, Olena ChapovalovReviewers – Connie Limnidis, Janice Gallant.

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During the SARS crisis many issues involving occupational health and safety surfaced from N95 respirator availability and applicability, to proper mask-fi t testing and use.

Continued from page 22healing hands


24 Ethics

new study suggests that mod-est delays in receiving trans-catheter aortic valve imple-mentation (TAVI) for severe

aortic stenosis could have a substantial impact on the effectiveness of treatment.

Aortic stenosis is a narrowing of the aortic valve opening that restricts normal blood fl ow to the body. Patients are typical-ly older and often have other health issues, making them high risk for conventional surgery.

TAVI has emerged as the preferred treatment for these patients as the replace-ment valve is implanted through a small incision in the groin or between the ribs, eliminating the need for a large chest in-cision. There is, however, a lack of data about what is an acceptable wait time for patients deemed as good candidates for TAVI.

A team of investigators from the Uni-versity of Toronto and the Institute for Clinical Evaluative Sciences in Toronto have used mathematical modeling with the results from a landmark randomized trial, Placement of Aortic Transcatheter Valves (PARTNER), to look what hap-pens when TAVI wait times are increased. Even modest increases in wait times were found to have a substantial impact on how effective TAVI is in otherwise inoperable patients and high-risk surgical candidates.

“To our knowledge, our study is the fi rst to evaluate the effect of delayed access to TAVI, and provides insight into the im-portance of wait time and outcomes,” says lead investigator Dr. Harindra Wijeysun-

dera, interventional cardiologist at Sunny-brook’s Schulich Heart Centre and assis-tant professor at the University of Toronto. “Creating benchmarks for appropriate wait times should be a priority.”

Published in the Canadian Journal of Cardiology, the study suggests that al-though TAVI would result in fewer deaths in patients deemed inoperable regardless of wait time, the magnitude of benefi t decreased dramatically. In the high-risk surgical candidates, at TAVI wait times beyond 60 days, TAVI was less effective on average compared with conventional surgery.

“Our fi ndings have implications on care delivery for severe aortic stenosis patients who are TAVI candidates. Because of the importance of wait-time monitoring, ideal-ly, detailed information should be collect-ed on the time of referral for TAVI work-up, the time at which diagnostic work-up is complete, and the time at which a patient is accepted for the procedure,” says Dr. Wi-jeysundera. “Data on delays in any of these intervals should be made available to pro-grams in a timely fashion, such that cases can be triaged. This is especially important for the patients deemed as good candidates for surgery. The clinical decision of when high-risk surgery is preferable over TAVI should incorporate the program’s current TAVI wait time, and the associated poten-tial wait-time mortality.” ■H

Marie Sanderson works in Communications at Sunnybrook Health Sciences Centre.

Guidelines needed for Transcather Aortic Valve ImplementationBy Marie Sanderson

The TAVI procedure involves implanting a new heart valve without opening the patient's chest. Benefi ts to patients include reduced pain, smaller scars and a faster recovery.

xtraordinary developments in treatments for various condi-tions have meant a new lease on life for many individuals.

Some of these treatments are clearly not a cure – they are management ap-proaches that minimize the effects of the condition and often slow its progress signifi cantly. The idea of a time limited lease is particularly apropos in the ex-ample of the Implantable cardioverter defi brillator (ICD) – without which the individual’s demise could be sudden.

Other interventions might be a clearer ‘fi x’ to avoid death, but come with high-er risks – such as cardiac surgery that presents the only real prospect for sur-vival. This is increasingly being offered to patients whose age or general state of health makes the typical risk shift to an even higher level. A great thing – if it works in the end. These examples il-lustrate two distinct challenges to the process of informing – whether or not to make it clear at the outset that ‘the fi x’ is temporary (for the ICD) and be-ing explicit about the risks of failure and/or post-operative complications in the high-risk surgery.

So what does ‘informed consent’ mean when there is likely no other option? There are two signifi cant factors at play – impending tragedy (i.e. death), and the trust placed in the practitioners who can offer these interventions. On the latter point, McKneally and Martin (2000) explored what they called ‘an entrust-ment model of consent’ – identifying some of the elements at play in patients’ consenting to surgery (in their study it was esophagectomy for cancer). Among these were the general ‘belief’ in surgical interventions and the multiple dimen-sions of being referred to and receiving a recommendation from a ‘specialist’. Should it bother us that these factors play such a central role in the consent of the patient? My own feeling is that these are less of a concern when they are acknowledged by the practitioner, and efforts are made to avoid them carrying undue infl uence in the informed consent process.

Schwarze et al (2010) examined an-other dimension of the consent process – a sort of agreement in advance about the possibly complex after care post-surgery – they called it ‘buy-in’. This involves acknowledging that the post-surgery recovery may take a while, and may in-volve a high level of intensive support. They found this part of an exceptionally complex, quasi-contractual relationship between surgeon and patient. This quite likely creates an immense internalized pressure on the practitioner to continue aggressive interventions post operatively. But then what if a substitute decision maker then says ‘no more’ at some point in that post-op period, insisting this was not what the patient was expecting?

The age old tension in the informed consent process comes to the fore here: the question of how much information?

Does one acknowledge that the fi x is ef-fectively temporary, and you’ll have to discuss other options later to manage the nearly inevitable decline? Does one concede that the risks of a procedure are real and high…despite one’s expertise…and there should be a frank exploration of potential preferences for withdrawing care, while still focusing on the hope of the grand surgical solution?

Looking at it ethically, the issue is about the value of truth telling and honesty. One can offer truth that is not entirely honest and open. So the ICD can be a clear and reliable improvement – its medium term nature can be a con-versation saved for later, if one chooses to leave it. The high risk surgery is un-doubtedly an option preferable to im-minent death…even discussions about the risks pale in comparison to the dying soon. But how far should informed con-sent go to prepare for the honest possibil-ity of a poorer outcome than hoped for?

Clinically, the story is usually made even more complex by the time (not) available for these discussions, the urgen-cy, the concern about diluting hope, the lengthy list of potential complications, the understandable hesitancy around facing one’s own professional limitations as a healer…all of these make the moral muck of consent a deep one.

Complexity does not absolve us from trudging through that muck in pursuit of best practice, especially if we’re part of a team that is wading into it regularly. The worst thing is to become inured to that moral muck…to stop pursuing bet-ter practice. If some of that moral muck can be avoided by taking time to create a high quality process for approaching high risk consent – is there not a degree of ob-ligation to make it happen, somehow? Could there be a team process, in part – standardized as far as possible? Is there a possibility for a principled decision mak-ing approach to making informing and consenting as moral and as meaningful as possible? Have any teams developed such approaches already?

Let us know – tell the Ethicist at Hospital News….we’ll aim to share the responses. Email [email protected] ■H

Kevin Reel is Ethicist, The Centre for Addiction and Mental Health and Assistant Professor, Department of Occupational Science and Occupational Therapy, University of Toronto.

By Kevin Reel

Photo courtesy of Doug Nicholson, Sunnybrook Media Source.

Is there a possibility for a principled decision making approach to making informing and consenting as moral and as meaningfulas possible?

What makes ‘informed consent’ moral and meaningful?

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program that uses technol-ogy to link people in their own homes with specially-trained medical staff is aiming to ad-

dress one of the biggest challenges of to-day’s health care system – chronic disease.

Telehomecare is a self-management pro-gram that engages patients as partners in their own care plan, in their own home. It is expanding across Ontario to reach people living with chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF). It is also running a pilot project for people with diabetes. Telehomecare is a program of the Ontario Telemedicine Net-work (OTN).

Patients receive a tablet monitor and standard medical devices to measure blood pressure, oxygen levels and weight and answer simple questions about how they are feeling. A dedicated, specially-trained nurse or respiratory therapist monitors results and provides health and lifestyle coaching.

Doctors say the technology delivers objective data that enables direct and im-mediate feedback which patients grow to trust. That, in turn, helps medical staff teach participants how to manage their disease.

“[Telehomecare] has been very power-ful and I think it has really allowed us to treat patents and avoid some of the hos-pital emergency room visits that otherwise would have happened,” says Thuy-Nga Pham, director of the South East Toronto Family Health Team and deputy chief of the Department of Family Medicine at To-ronto East General Hospital.

In one recent case, a man in his late 60s had been identifi ed by Toronto East Gen-eral Hospital as a COPD patient at high risk for re-admission. The individual was enrolled in Telehomecare and, within a few weeks, Dr. Pham’s offi ce noticed a drop in his oxygen levels. A physician assistant immediately contacted him and learned he was not taking his medication. He came to the offi ce the next day for further training on how to take his medication and avoided the need to return to hospital.

The anecdote is refl ective of early re-sults from the OTN Telehomecare, which is funded by the Ontario Ministry of Health and Long-Term Care and Canada Health Infoway. The William Osler Health System reported a 71 per cent reduction in in-patient hospital stays among COPD and

heart failure patients in the Telehomecare program between April and September in 2013. The program also saw a 43 per cent decrease in emergency room visits in the same period, when compared with the pre-Telehomecare rate.

“OTN offers many opportunities that I think we could be utilizing much more,” Pham says. “I think the uptake in our province could go much faster and more broadly. We need to incorporate it into our daily practices more. It shouldn’t be inno-vation anymore. It should just be some-thing we do.”

The number one reason that CHF pa-tients are re-admitted to hospital is that they stop following their medical and/or dietary schedules. “Telehomecare ad-dresses this shortfall by building trusting relationships with patients on which they can be coached and taught to behave dif-ferently,” says Sacha Bhatia, a cardiologist and the director of the Institute for Health System Solutions & Virtual Care at Wom-en’s College Hospital.

“The most important notion is, can we prevent hospital admissions by acting ear-ly, ” he says.

“The Telehomecare program represents a fundamental shift to proactive care from reactive care. But for medical staff to be able to step in and help in a timely fashion, projects should be set up so that the infor-mation gathered from patients’ homes goes directly to their primary care physicians, ” Pham says.

While Pham has dedicated a physi-cian assistant in her offi ce to monitor the stream of data coming out of the homes of the 10 to 15 Telehomecare patients on her roster, most Telehomecare patients are monitored on behalf of their primary care providers by dedicated clinicians in Com-munity Care Access Centres or hospitals like William Osler or Southlake Regional Health Centre.

When there is a signifi cant change for any individual, the clinician immediately informs the primary care provider who de-cides what steps to take.

“Most specialists monitoring cases of chronic disease don’t see their patients for months at a time. These large gaps can be reduced in some degree with home-based programs such as Tele-homecare,” says Deborah Casey, a res-pirologist at Toronto Western Hospital who has referred several patients to Telehomecare.

“The technology is useful to reach a greater number of people with chronic disease and to capitalize on “teachable moments,” when patients are most open to change,” she adds.

“The power of this is in the patient, who you can teach to better manage their disease,” Casey says. The goal for technology-based, home-centred care should be to improve patients’ knowledge of their own conditions, increase their self-efficacy and introduce behavioral changes. ■H

Sharon Rose Airhart is Telehomecare Communications Lead, OTN.

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PAUL FERLEYAssistant Chief Economist, RBC

ANTOINE CANTIN, World Record Holder for solving the Rubik’s Cube one-handed

DR. DAVID SACKETTDirector, Trout Research and Education CenterProfessor Emeritus, McMaster University

EDWARD FANIP Partner, Torys LLP

DR. MARK KNUDSONChairman and Chief Executive Officer, Venturi Group

RODNEY I. JONESExecutive Director of the Ontario Aerospace Council

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BJ HARDMANCEO, Sanarus Technologies

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LAURA FORTINOGold medal Olympian, Canadian Women’s Hockey Team

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Telehomecare for COPD and Heart Failure: Using technology in the home to tap the power within the patientBy Sharon Rose Airhart

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Telehomecare is a self-management program that engages patients as partners in their own care plan, in their own home.



hen Martina Tierney worked as an Occupational Therapist (OT) in hospitals, the com-munity and long-term care

with adults and children both, she was continually frustrated by the chairs she had to use with her patients. Standards of care in many other areas had moved on in leaps and bounds, but seating seemed to be stuck in the past.

“As OTs, we were always being told to use evidence-based practice,” says Marti-na. “But when it came to seating, we were having to use chairs that had no clinical evidence to support their use, and in a lot of cases that is still happening today. In ad-dition, there were lots of good choices for people who needed transport chairs for go-ing down the street to the shops. For those who had pressure ulcers, there were little or no choices backed by solid, impartial clinical evidence.”

With her engineer-husband and her family, Martina set out to design the Seat-ing Matters range of chairs that would help to reduce pressure ulcers, improve posture and comfort and be backed by strong clini-cal evidence to prove their effectiveness. With their range of chairs being used ex-tensively throughout the world, Martina partnered with a prestigious university in the UK, the University of Ulster, to de-velop a research project and clinical trial that would examine the use of the chairs and their effects on a range of clinical out-comes, including pressure ulcer reduction, quality of life and functional ability.

“Independence and objectivity is impor-tant when doing research. We wanted the results to refl ect what would happen in a real-life environment, with real caregivers, real patients and real variables in a typical hospital or care facility. For these reasons, the University of Ulster carried out the study and gained ethical approval for the clinical trial. This ensured that the results were true to life and not subject to any bias,”explains Martina.

The research project was carried out over 12 weeks in three different facilities. Each participant was assessed before the study started to gain a full picture of the amount of pressure ulcers they had, their blood oxygen levels and functional ability together with interviews with caregivers, families and the participants themselves. This allowed the researchers to examine the effects on the entire person by using the Seating Matters chairs. The group was then split in two at random, the control group using their existing chairs, typical to hospital and care facilities, the inter-vention group using the Seating Matters chairs.

Over the next 12 weeks the participants were monitored and the assessments were repeated at the end of the study. Those re-sults enthused the researchers that what they were doing could make a big impact on patient care.

“In the control group using their exist-ing chairs, there were fi ve per cent more pressure ulcers at the end when compared with the beginning. In the intervention group using the Seating Matters chairs, there was 88 per cent less pressure ulcers

in the exact same period of time. This is a really signifi cant reduction,” says Martina.

“When you look at the cost of pressure ulcers to our health care systems and the fact that around 23 per cent of people in hospitals and care homes have a pressure ulcer right now, knowing that we have a method to reduce the incidence of these costly and painful sores by 88 per cent marks a huge leap forward.”

Martina and the therapists in her clinical team travel the world to share these results and to help their fellow clinicians raise the standard of care. Martina has also written 'The Clinician's Seating Handbook' as a reference guide to clinical seating provi-sion, explaining the fundamentals of seat-ing and how these can be implemented in real-life situations.

Her family have also set up a network of home health care providers across Canada

and around the world to provide the Seat-ing Matters chairs to patients. They are used extensively in hospitals, long term care homes and in the community.

“It’s fantastic to see that the Seating Matters chairs, designed by therapists and backed by quality clinical evidence are be-ing used so widely across Canada. It makes me proud that we are able to positively impact patient care, reduce pressure ul-cers and make people more comfortable through something that my family pours our heart and soul into.”

To learn more about the clinical trial, or to request a free copy of Martina’s seating handbook, visit www.seatingmatters.com To contact Martina directly email [email protected]. ■H

Olivia McVey OT is a member of the Seating Matters Clinical Team.

Enhancing the standards of

care in seatingBy Olivia McVey

W

Martina Tierney OT and ‘The Phoenix’. Named after the symbol for OT in Ireland, the Phoenix is shown to help reduce pressure ulcers by 88 per cent.

hile effi ciency and better pa-tient care are the ultimate goals of eHealth initiatives and integrated electronic

health records, the actual implementa-tion of electronic health records has prov-en to be a challenging project for some hospitals.

North York General Hospital has been steadily implementing advanced clinical systems throughout the hospital and is now almost entirely electronic – having been one of only three large hospitals in Canada to earn a Stage 6 designation from the Healthcare Information Management Systems Society in 2011. Because of the success the hospital has seen through eC-are, the name NYGH has given its elec-tronic health records strategy, other hos-pitals nation-wide have been looking to NYGH to help apply this success to their own organizations.

Sonia Pagliaroli is the Manager of Clinical Informatics at NYGH and has been working on eCare since its incep-tion in 2006. Pagliaroli says that it’s a common occurrence for other hospitals to call NYGH asking for assistance with one of their own eHealth projects – and inversely, it’s easy for NYGH to reach out to other hospitals for assistance as well.

“I think we’ve established a strong col-laborative environment amongst hospi-tals implementing similar clinical systems. Just as we feel comfortable reaching out to others for their advice and experience, we try to be as generous as possible with our time in supporting our colleagues with their eHealth projects,” says Pagliaroli.

Pagliaroli says this kind of inter-hospital collaboration is benefi cial not only to the hospital seeking assistance, but for all hos-pitals involved. While launching Phase 4 of eCare at NYGH, which involved

bringing eCare to surgery and maternal-newborn units, NYGH brought in trainers from Toronto East General Hospital and Mount Sinai to help with the process.

“With Phase 4, having Toronto East’s assistance was hugely benefi cial for us, since they had already implemented the same electronic surgery application, and

their experience and knowledge was in-valuable. Mount Sinai also benefi tted greatly from observing our implementa-tion, as they will be embarking soon on their own maternal-newborn project,” says Pagliaroli

NYGH has also been collaborating with hospitals from coast to coast, includ-ing Vancouver Island Health Authority in B.C. and Health PEI.

“Collaboration provides a tremendous opportunity to learn from the experiences of others,” says Angela Doucette, a phar-macist and clinical analyst for Health PEI. “Often times the "lessons learned" from another hospital on what worked, and more importantly what didn't, are invalu-able in moving a project forward.”

Two heads better than one when it comes to eHealthW

A patient being scanned with one of the hand-held devices that scans the patients ID bracelet and the patients medication before administering the medicine to ensure the right medication is going to the right patient.

North York General Hospital has been steadily implementing advanced clinical systems throughout the hospital and is now almost entirely electronic

Continued on page 27

By Leah Hanna


27 Healthcare Technology

he new system, a Canadian fi rst, gives care providers access to patient information any-time, anyplace, improving care

coordination, effi ciency and effectiveness. The Centre for Diabetes, Endocrinol-

ogy and Metabolism of St. Joseph’s Health Care London has long been a leader in innovation and diabetes care, and now another ground-breaking milestone has been reached. The team has successfully combined clinical and research work with technology to implement an innovative electronic medical record (EMR), the fi rst of its kind in Canada.

Web DR (Web-based Diabetes Records) is a fully functional diabetes-specifi c EMR. With no existing EMRs available to meet the needs of the outpatient diabetes clinic, the team, over the past two years, built this new system from the ground up under the leadership of Dr. Stewart Harris and Dr. Irene Hramiak, and project leads Dr. Ta-mara Spaic and Selam Mequanint.

“Web DR is a diabetes-specifi c, web-based, researchable, electronic medical record and database,” explains Dr. Spaic. It is simultaneously used by the primary and tertiary diabetes specialists, medical trainees, diabetes educators, allied health professionals and administrative staff at three locations: the Diabetes, Endocrinol-ogy and Metabolism Clinic at St. Joseph’s Hospital, Diabetes Education Centre also at St. Joseph’s Hospital, and the Primary Care Diabetes Support Program at St. Jo-seph’s Family Medical and Dental Centre. (All are part of St. Joseph’s Centre for Dia-betes, Endocrinology and Metabolism.)

“Each patient has a unique Web DR medical record that can be used by all diabetes team members,” says Dr. Stewart Harris. “This allows coordination of care across disciplines and helps improve the ef-fi ciency and effectiveness of care delivery.” Web DR was built by an external vendor and is now fully supported by Information Technology Services at St. Joseph’s, pro-viding maintenance and sustainability. It has a bidirectional link with the hospital electronic medical record system (Cerner), providing multiple interfaces with Cerner

to receive patient information and also send completed assessments and clinic notes back to Powerchart in Cerner. The clinic note, previously requiring transcrip-tion, is now created automatically using a unique combination of dropdown menus, checkboxes, and free text fi elds. This pro-motes ease of use and speed, while still pre-serving the narrative nature of the note.

Web DR currently houses more than 15,000 patient records from the diabetes care programs at St. Joseph’s. At present, 14 physicians and more than 40 aligned health care professionals use Web DR for more than 90 per cent of patient visits.

“There has been a great interest in Web DR across the region,” says Dr. Hramiak. “The next expansion will include the Pae-diatric Diabetes Clinic at the Children’s Hospital, London Health Sciences Centre. Future plans are to continue to expand to other care providers in the region.”

Through the creation of Web DR, “we have learned that accepting new and let-

ting go of old requires time, support and strong leadership,” adds Dr. Spaic. “But once Web DR was fully adopted in the clinical practice, it was diffi cult to imagine not being connected and having informa-tion at your fi ngertips – anytime, anyplace. Today, we can say we are at the forefront of diabetes patient care. It is wonderful to see so much involvement from everyone, and the support from the hospital has been great.” ■H

Dahlia Reich works in Communications & Public Affairs at St. Joseph's Health Care, London.

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Continued from page 26

New diabetes-specifi c electronic medical record Canadian fi rstBy Dahlia Reich

T

Heather Reid, left, health information administrator, and endocrinologist Dr. Tamara Spaic were part of the team at the Centre for Diabetes, Endocrinology and Metabolism of St. Joseph's Health Care London that developed Canada's fi rst electronic medical record specifi cally for diabetes - a web-based system that is enhancing care coordination and effi ciency as well as diabetes research.

Doucette says that Health PEI has been collaborating with hospitals across the country through the Cerner Regional User Group, comprised of all Cerner client hos-pitals in Canada.

“It has been invaluable to have other analysts share with us what did or didn't work for them as far as design and work-fl ow,” says Doucette. “NYGH and (To-ronto East General Hospital) in particular were very generous with time and resourc-es – hosting site visits for our team as well as answering questions over e-mail and sharing documentation.”

Pagliaroli says that it`s crucial to suc-cess for hospitals to watch each other and learn from each other’s experiences.

“After a hospital completes a project, there’s always a ‘lessons learned’ event

that everybody can benefi t from,” says Pa-gliaroli. “Hospitals face similar challenges when implementing systems, so if they can learn from others implementations, it can ensure a smoother transition.”

Doucette says that inter-hospital collab-oration has not only been a major asset for Health PEI’s own initiatives, but has also helped them grow to the point where they can offer their assistance as well.

“As we mature as an eHealth jurisdic-tion we are evolving into a position where we are able to give some advice and guid-ance,” says Doucette, “where traditionally we have been the ones seeking it out.” ■H

Leah Hanna is an intern, Corporate Communications and Public Affairs at North York General Hospital.

Two heads better than one

Web DR Benefi tsImproved documentation and effi ciency: • From paper-based to electronic-based practice • From a desktop-based computer system to a web-based system that is enhanced to meet the needs of care providers anywhere, anytime, and improve care delivery • From dictation to electronic documentation • From manual faxing of consult notes to electronic distribution to referring physicians Improved coordination of care: • Interface with the Cerner system for demographic information and real time laboratory results • One-patient, one-chart approach for optimization of care and enhanced patient safety • A dynamic link between providers to enhance information sharing and delivery of best practice in care of diabetes patientsQuality Improvement and research • Facilitates access to researchable data for researchers, as well as medical students, research fellows and residents as part of their training • Allows care providers to measure workload, quantify their patient population demographic as well as a clinical profi le for strategic planning and budgeting purposes. • Allows for the creation of reports for practice audits and infl uencing changes in care process


28 Health Technology

espite researchers’ best ef-forts, no one has ever fallen in FallsLab. The newest lab in Toronto Rehab’s iDAPT

Centre safely simulates falls so scientists can determine how to prevent them. A so-phisticated robotic safety harness protects people from hitting the ground when they lose their balance.

The FallsLab research may help pre-vent some of the 180,000 fall-related in-juries Canadians aged 65 and over suffer every year.

A Public Health Agency of Canada re-port documents that falls account for 85 per cent of seniors’ injury-related hospital-izations. Forty per cent of these falls result in hip fractures that lead to death for one in fi ve seniors a year. These injuries are costly – Canadians spend approximately $2 billion annually on direct health care costs alone. Preventing a small percentage of falls could help seniors maintain their independence, enjoy a better quality of life and also ease the strain on the health care system.

“Toronto Rehab is attacking this prob-lem from two directions,” says Dr. Geoff Fernie, institute director, Toronto Rehab. “We’re helping train people who’ve recov-ered from a brain trauma and other injuries to regain their ability to resist falling. We’re also making changes to the environment to reduce the risk of falling. These chang-es include safer building code standards for stairs and better non-slip footwear for winter.”

FallsLab is the largest of its kind in the world. Force plates that measure the weight of the person moving or standing on them are attached together to form a moving platform. Researchers use infrared cameras and refl ective sensors to watch how subjects move and react as the platform shifts. The measurements make it possible to analyze falls and test the effectiveness of interventions such as training or safety equipment.

Other research at FallsLab is look-ing at how to best treat injuries affecting mobility.

Dr. Adam Katchky, an orthopaedic sur-gery resident at the University of Toronto, was fi rst in line when the lab opened. He is researching two types of knee replacement devices to see which one provides patients with the best balance after surgery.

“Older platforms were too slow to make people fall, and too small to allow subjects to walk naturally. This platform creates motions jarring enough to simulate the types of falls that cause serious injuries. My research wouldn’t be possible without it,” says Katchky.

“It feels like being on the subway when it stops suddenly,” says research participant Patrick Keenan. “Only the direction and the intensity changes each time, making the movement impossible to anticipate. Sometimes it’s really startling.”

“FallsLab fi ts perfectly with iDAPT’s mission: keeping people safe and inde-pendent in their home as they age,” says Fernie. “People experience more slips and trips as they get older. Recovering becomes harder, and injuries worse. This research will advance falls prevention and treat-ment strategies that help people maintain their independence, a primary factor in quality of life.” ■H

Michael Ronchka is a member of the University of Health Network's Public Affairs and Communications team.

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FallsLab aims to keep Canadians uprightBy: Michael Ronchka

D

Falls cause more than a third of all injury-related hospital admissions. Researchers at Toronto Rehabilitation Institute want to fi x that.

ast Fall, the Ontario govern-ment announced the cre-ation of the Ontario Health Innovation Council (OHIC)

– an exciting initiative that has the ca-pacity to transform the way that the medical technology sector operates in the province.

The Council, which is led by the On-tario Ministry of Health and Long-Term Care, and Ministry of Research and In-novation, seeks to “accelerate the adop-tion of new technologies in our health care system and support the growth and competitiveness of Ontario’s health technology sector.”

The OHIC Terms of Reference state that the “council’s specifi c focus is to consider how Ontario can: 1) Facilitate technological innovations that promote health and well-being, im-prove access to health and health servic-es, and deliver effective, effi cient, quality care; 2) Strategically fi nd ways to use the purchasing power of the province and broader public sector to accelerate the growth of the health technology sector; and 3) Expand the adoption of innovative new technologies more broadly across the health care sector (e.g., including hospitals, but also in-home and long-term care settings).

With the recent re-election of the gov-erning Ontario Liberal Party, the council is ensured an opportunity to continue their work. The government has direct-ed the council to deliver a fi nal report by late 2014 containing evidence-based strategic advice on how the objectives in the terms of reference can be achieved.

As the association that represents Canada’s medical technology industry, MEDEC enthusiastically supports this initiative. Brian Lewis, President and CEO of MEDEC, says “With the an-nouncement of this council, the Wynne Government has recognized that medical

technology companies are key partners in delivering better patient care, while creating new jobs and contributing to a more sustainable health care system.”

Since the council offi cially convened, MEDEC staff, as well as many other sec-tor leaders, have already taken the op-portunity to present to its advisory board, highlighting opportunities that exist to better leverage the province’s innova-tive medical technology industry in or-der to improve patient outcomes, make the health care system more sustainable and improve the economy. One of the key messages delivered to the council by MEDEC was that in order to capitalize on these opportunities, we need to bet-ter adopt new medical technologies that have been created in Ontario and we need to make these adoption processes faster and easier to navigate.

The council is chaired by Dr. Dave Williams, President and CEO of Southlake Regional Health Centre and its advisory board consists of individuals from various sectors that impact health care. They include leaders from hospitals, the medical technology industry, home care, academia, and more – all bringing a variety of different perspectives to the table. “When we embrace innovation as collaborative partners, we increase the likelihood that Ontarians can gain more timely access to the best medical tech-nologies available” says Neil Fraser, one of the council’s advisory board members and President of Medtronic Canada. He adds, “The true promise of innova-tion lies in simultaneously increasing the quality of patient care, while lowering the total cost of each patient’s journey through the health care system.”

The council is seeking ideas about how to accelerate the adoption of inno-vative new technologies into Ontario’s health care system and grow the prov-ince’s health technology sector. Join the conversation at: http://www.ohic.ca/en/join-conversation ■H

Improving the adoption of innovative health technologiesL

A researcher demonstrates FallsLab’s moving platform and robotic safety harness.



Educational & Industry Events

July 14–16, 2014 Health technology Assessment for Decision Makers Dalhousie University, Halifax Website: www.theta.utoronto.ca

July 15–17, 2014 Virtual health Informatics Bootcamp Online Series, Canada Website: www.nihi.ca

August 6–8, 2014 The 6th International Conference on Patient and Family Centered Care: Partnerships for Quality and Safety Westin Bayshore, Vancouver Website: www.cfhi-fcass.ca

September 20–21, 2014 Minimally Invasive Gynaecologic Surgery University of Toronto Conference Centre, Toronto Website: www.cpd.utoronto.ca/migs/

September 26, 2014 CPAS – APAGBI Joint Meeting Montreal, Quebec Website: www.pediatricanesthesia.ca

September 29–30, 2014 National Interprofessional Healthcare Conference Metro Toronto Convention Centre, Toronto Website: www.healthcareconferences.ca

October 19–21, 2014 CAPHC Annual Conference Calgary, Alberta Website: www.caphc.org

October 22–23, 2014 2nd Annual Reducing Hospital Readmissions & Discharge Planning Conference Marriott renaissance Harbourside, Vancouver Website: www.healthcareconferences.ca

October 28–29, 2014 National Healthcare Practitioners Mental Health Conference Double Tree by Hilton, Toronto Website: www.healthcareconferences.ca

November, 2014 2nd Annual National Correctional Services Healthcare Conference Ottawa Website: www.healthcareconferences.ca

November 3–5, 2014 HealthAchieve 2014 Metro Toronto Convention Centre, Toronto Website: www.healthachieve.com

November 30–December 5, 2014 RSNA 2014 McCormick Place, Chicago Website: www.rsna.org

December 4–5, 2014 2nd Annual National Operating Room Management Conference Vancouver Website: www.healthcareconferences.ca

To list your event, send information to “[email protected]”.

We try to list all events and information but due to space constraints and demand, we cannot guarantee it. To promote your event in a larger, customized format please send enquiries to “[email protected]”

To see even more healthcare industry events, please visit our website

www.hospitalnews.com/events

new mobile app developed by the Centre for Addiction and Mental Health (CAMH) of-fers those who want to reduce

or quit drinking alcohol the ability to track and manage their drinking habits.

Excessive alcohol consumption is a ma-jor public health concern, leading to over 200 diseases and injuries. In May 2014, the World Health Organization released a report that showed Canadians drink more than the global average, with 23 per cent of drinkers engaging in binge drinking.

Saying When AppThe new app, called Saying When, is a

mobile version of a self-monitoring pro-gram pioneered by Dr. Martha Sanchez-Craig while a Senior Scientist at the former Addiction Research Foundation (now CAMH). Previously a paper-based manual, the program is clinically sound and has helped people cut back or quit drinking successfully for over 25 years.

“We’ve been waiting for the technol-ogy to catch up to this program, ” says Wayne Skinner, Deputy Clinical Director at CAMH. “The ability to discreetly track and monitor urges and consumption in real time will help people who are con-cerned about their drinking be successful with their goal to reduce or abstain.”

Saying When is designed for people who are concerned about their drinking, but who do not have a severe alcohol use disorder.

On launch, Saying When app users are presented with a tour of the app’s fea-tures, including an introduction to Can-ada’s Low Risk Drinking Guidelines de-veloped by the National Alcohol Strategy Advisory Committee. Before moving on to track urges and consumption, app us-

ers will complete a section called “Taking Stock” to help determine current drink-ing patterns and set a baseline for future success.

“Recent studies have shown that enter-tainment-based apps including drinking recipes or drinking games are the most common type of alcohol-related app, ” says Tim Tripp, Director, Library Services & Knowledge Mobilization at CAMH. “To our knowledge, Saying When is the only mobile tool based on an established clinical program that helps people moni-tor their drinking and efforts to cut back or quit.”

To make personal tracking easy and precise, the Saying When app describes and defi nes standard drinks through info-graphics. Each drink entered is measured when the app user fi lls the interactive glass and determines how many standard drinks they have consumed.

Throughout the tracking process, the app is programmed to offer tips for suc-cess as the user makes progress. The cop-ing section of the app also provides users with the opportunity to learn what strate-gies work best for them as they rank the success of each one over time.

“Many people are motivated to change their drinking behaviour, ” says Skinner. “Saying When gives them a way to do so on their own or, if they are getting help, to set goals and keep track of how they are doing, day by day. Having a mobile ver-sion of this resource will allow us to reach and help more people.”

The Saying When app is now available for purchase in the iTunes store. ■H

Kate Richards works in Media Relations at The Centre for Addiction and Mental Health.

Mobile appKate Richards

A

helps people reduce or quit drinking


30 Travel

anada is a country that evokes a sense of untouched land-scapes and pristine wilderness teeming with wildlife, where

pure mountain air blows across crystal clear glacial lakes. There is no better way to experience this tranquillity than with a stay in a luxury lodge, and Canada has some indulgent options for those looking to do exactly this. Here are my top 5 luxury lodges in Canada.

Clayoquot Wildnerness Lodge

It’s a 55 minute sea plan across the Strathcona Provinicial Park to reach the Clayoquot Wilderness Resort, and this property well and truly lives up to its name. 23 luxurious, safari style tents make up the accommodation, each lavishly decorated

with antique furniture and boasting some impressive touches such as down duvets and cotton bathrobes.

For those wanting to take advantage of their remote surroundings, activities include clay pigeon shooting, kayaking, mountain biking and horse riding, while those simply wanting to relax will welcome a visit to the property’s spa, where guests can take in their remarkable surroundings from the comfort of an outdoor hot tub.

Nimmo Bay Wilderness Resort

Ever heard of British Columbia’s Great Bear Rainforest? If so you’ll know it’s is one of the largest tracts of unspoiled temperate rainforest left in the world, and one of my favourite places to stay in this area is Nim-mo Bay Wilderness Resort. This property is

a family-owned resort offering an intimate experience in a fantastic location.

You will stay in one of just nine luxury cabins at Nimmo Bay, feast on fresh coastal cuisine and take part in some of the many activities on offer. Bear viewing is a given here, but don’t miss out on the opportunity to heli-hike, fi sh, go beachcombing or on a glacier tour.

The WickaninnishThe Wickaninnish is a Relais and Cha-

teaux property, a name synonymous with luxury. “Rustic elegance on Canada’s west coast” is how the hotel is described and rightly so; it sits on the shoreline looking out across the Pacifi c ocean. This is a great hotel for those who care about travelling responsibly as it has attained Five Green Keys (out of a possible fi ve) in the Green

Key certifi cation scheme which awards ac-commodation facilities for exemplary envi-ronmental stewardship. Only 50 hotels in the world have achieved this so it is a great refl ection of the hotel’s commitment to re-ducing its carbon footprint.

All of the rooms at ‘The Wick’ have wa-terfront views and the Pointe restaurant is the only 4 Diamond restaurant north of Victoria – make sure you book well in ad-vance if you want to dine here!

Arctic WatchThe Arctic Watch Wilderness Lodge

itself is not the most luxurious of proper-ties, but there is no denying the location certainly is. Located 500 miles north of the Arctic circle, Arctic Watch is the most northerly and remote lodge in the world, presenting a unique opportunity to explore the magical Arctic environment in rela-tive comfort. The lodge claims to serve the best food in Nunavut and I think it’s got a strong case! Sample musk ox tenderloin or fi sh caught fresh that day as you catch a waft of freshly baked bread from the prop-erty’s kitchen.

Wildlife thrives on Somerset Island and is one of the best places for beluga whale sightings. You can also expect to see musk oxen, caribou, arctic foxes and even polar bears.

Fogo Island InnA contemporary hotel off the northern

coast of Newfoundland, Fogo Island Inn is a fantastic place in which to unwind and enjoy your isolation. There are 29 suites at the property as well as a library, art gal-lery, lounge, cinema, gym and hot tubs, not to mention an enticing restaurant serving tasty local dishes, all created by a renowned local chef.

Take in your wild surroundings through the fl oor to ceiling windows in your room, where the sea views seemingly go on forev-er. Wireless internet is available for those who don’t want to feel completely cut off from the outside world. ■H

Craig Burkinshaw is a Founding Director of Audley Travel.

People with serious injuries often need a variety of health care services

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Therapy & RehabBetter care for a better life

Luxury in the wilderness: Canada’s lodgesBy Craig Burkinshaw

C



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ackenzie Health is transform-ing care through the creation of an Innovation Unit, a fi rst-in-Canada project which fea-

tures a unique integration of advanced technology that transforms the delivery of care.

A fi rst in Mackenzie Health’s Innova-tion Journey, the Innovation Unit is an acute care medical unit that has been transformed into a living and breathing laboratory for innovations to be developed, evaluated and adopted by other patient care units at Mackenzie Richmond Hill Hospital, as well as the new Mackenzie Vaughan Hospital and at the health sys-tem level.

The Innovation Unit includes 17 Smart Patient Rooms (34 beds) which feature “smart” badges, “smart” stations, “smart” therapeutic beds, patient call lights and hand hygiene support systems as part of a multi-phase implementation designed to enhance the quality of care.

Enabled by an interactive environment, the beds have a number of features that communicate information directly to the clinical staff who are caring for patients, including patient and bed rail positioning, and if patients are entering or exiting their bed.

“Smart” stations with an enhanced user interface are installed in every room and at the Nursing Station to provide staff with

access to patients’ information and status.Each staff member wears a badge which

identifi es their location on the unit, alerts them of any patient calls, enables staff communication and records patient call response times.

Dome light indicators outside each room alert the staff to whether patients are at risk for falls, track the nurses’ location and communicate real-time information to the status boards.

The hand hygiene support solution uti-lizes a system that reviews hand hygiene and proactively alerts staff of potential “missed” hand-hygiene opportunities

through proximity sensors. “The Innova-tion Unit is about using innovation to drive change and become more patient-centred,” says Tiziana Rivera, Chief Nurs-ing Executive and Chief Practice Offi cer, Mackenzie Health. “By implementing technologies that are designed and inte-grated to improve the patient experience and clinical outcomes, doctors and nurses are better able to perform their roles and deliver safer, more effi cient care to pa-tients.”

The concept, design and implementa-tion of the Innovation Unit have been de-veloped by Mackenzie Health in collabora-tion with Hill-Rom, a leading provider of medical technologies for the healthcare industry.

Mackenzie Health has also partnered with the Ivey School of Business to evalu-ate the impact of the integration of tech-nology on quality, safety and patient care. Once the evaluation of the Innovation Unit has been completed, the fi ndings will inform plans for the future expansion of this new and innovative approach to care across the hospital and beyond.

On June 19, 2014, Mackenzie Health celebrated the offi cial launch of the unit alongside technology, academic and com-munity partners, local government repre-sentatives, hospital leaders, as well as staff and physicians. ■HCatalina Guran is a Communications and Public Affairs Consultant at Mackenzie Health.

By Catalina Guran

M

First in Canada: Innovation Unit helps deliver patient-centred care

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