Volume 6 No. 1 February 2010

Sunnybrook Raises Funds to Rebuild Hospitals in HaitiIn an effort to support the long-term health-care needs of the people of Haiti, Sunnybrook Foundation announced the creation of the Sunnybrook Fund for Haiti’s Hospitals to help rebuild hospitals destroyed by the recent earthquake.

Since the launch of the campaign on January 15, Sunnybrook staff, volunteers and community members have raised more than $34,000 to help rebuild and re-equip Haiti’s hospitals and health-care infrastructure.

Sunnybrook Foundation will provide Save the Children Canada every penny donated to this fund. All donations made by individuals by February 12 were matched 100 per cent by the Government of Canada.

“In light of the tragic events unfolding in Haiti, Sunnybrook Foundation, on behalf of the community at Sunnybrook Health Sciences Centre, felt the need to help in a sig-nificant way,” said Kevin Goldthorp, CEO of Sunnybrook Foundation. “So many generous Canadians are respond-ing to provide immediate relief to the people of Haiti in the form of food and shelter, but equally critical in the long term is the health care infrastructure of that region.

New Procedure Meets Needs of Aging, Complex Heart Patients By Laurie Legere

A new program at Sunnybrook’s Schulich Heart Centre is improving access to a potentially life-saving heart procedure for elderly or frail patients not well enough to undergo traditional aortic valve replacement surgery.

Narrowing of the aortic valve, or “stenosis,” is a fairly common condition in today’s aging population. It occurs when the aortic valve, which keeps oxygen-rich blood flowing from our heart into the largest artery in our body, becomes partially blocked, impairing flow of blood to the rest of the body. If left untreated, stenosis can cause the heart muscle to thicken as it works harder to pump blood through the body – potentially leading to heart failure.

“Surgical replacement of the diseased valve with an artifi-cial one is considered the best treatment for aortic valve stenosis,” says Dr. Sam Radhakrishnan, interventional cardiologist and physician-lead of the Percutaneous Aortic Valve Intervention (PAVI) program at Sunnybrook.

“Unfortunately, many of the patients we see with this condition have significant co-existing medical issues that render them unable to withstand the physical trauma of open-heart surgery. In the past, we have had to treat these patients with drugs alone, which are proven to be less effective than with valve replacement.”

Sunnybrook’s Cardiac Surgery Founder Receives Order of CanadaBy Laurie Legere

Sunnybrook Health Sciences Centre is proud to congratulate Dr. Bernard S. Goldman on his recent appointment to the Order of Canada. This esteemed designa-tion recognizes a lifetime of outstanding achieve-ment, dedication to the community and service to Canada.

Dr. Goldman founded the cardiac surgery pro-gram at Sunnybrook’s Schulich Heart Centre, which has become one of the country’s leading

research and teaching centres for surgical interventions to treat cardiovascular disease. He served as head of the Division of Cardiac Surgery from 1989 to 1999 and as surgeon-in-chief at Sunnybrook from 1999 to 2003.

Dr. Goldman is a renowned clinician, researcher and edu-cator who has been a mentor for countless professionals in this field and has saved the lives of literally thousands of patients over his 41-year career. He has pioneered new approaches to aortic valve replacement, coronary artery bypass grafting and cardiac pacing.

“Dr. Goldman is a true innovator and leader in his field and Sunnybrook is fortunate to have him as a member of our team,” said Dr. Barry McLellan, president and CEO of Sunnybrook Health Sciences Centre. “This is a well-deserved honour that complements what has been an outstanding career.”

In addition to his role as cardiac surgeon, Dr. Goldman is a professor of Surgery at the University of Toronto, editor of the Journal of Cardiac Surgery and chairman of Save a Child’s Heart Canada, providing heart surgery to children from underprivileged countries at no cost. He has led numerous research efforts to improve the care of cardiovascular surgery patients, has authored hundreds of peer-reviewed articles, contributed chapters to medical textbooks and has recently published the second edition of Heart Surgery in Canada: Memoirs, Anecdotes, History and Perspectives.

To honour the significant contributions of Dr. Goldman, Sunnybrook has established the Dr. Bernard S. Goldman Chair in Cardiovascular Surgery. The Goldman Chair was created to address the changing face of cardiovascular surgery, to train surgeons who are adept at leading edge procedures and attract the best international talent in the field.

Dr. Goldman was also the recent recipient of the Sunnybrook Foundation’s Rose Award for his outstanding service in support of Sunnybrook’s philanthropic objec-tives. Among his many other philanthropic activities, Dr. Goldman played an active role in raising funds for the renovation of the Schulich Heart Centre, currently underway at Sunnybrook. The $25-million project will create a world-class, technologically-advanced Schulich Heart Centre.

Dr. Bernard Goldman

With the introduction of the PAVI initiative at Sunnybrook, patients who are considered too high-risk for convention-al open heart surgery to replace or repair the aortic valve may be candidates for a substantially less invasive proce-dure. In this procedure, a team of doctors including an interventional cardiologist, cardiac surgeon and vascular surgeon are able to implant a new valve percutaneously (without opening the chest).

During a PAVI procedure, the team of doctors inserts a catheter (tube) into an artery in the groin through which they are able to pass further catheters to the diseased heart valve. The doctors are able to see the position of the valve on a screen displaying X-ray images of the inside of the patient’s chest. This technique greatly minimizes the operative risks and patient trauma associated with opening up the chest and stopping the heart. The whole procedure takes an hour and a half, as opposed to twice as long for conventional open heart surgery, and may be carried out under general anesthesia or local anesthesia, with or without sedation.

Minimally invasive valvular interventions offer many ben-efits to patients including reduced pain and less need for postoperative pain medication, smaller scars, a shorter stay in the hospital and a faster recovery. People who un-dergo percutaneous valve interventions can often return home after only a few days and resume many normal activities within a couple of weeks rather than a couple of months.

“This program will do wonders to improve the health of some of the most critically-ill heart patients in Ontario,” says Dr. Brian Gilbert, chief of the Schulich Heart Centre. “About half of all patients with stenosis do not get treated because they are considered too old or too frail for tradi-tional surgery. This program makes it possible for us to offer the very best cardiovascular care for our patients so they can return to the best possible quality of life sooner.” To help Sunnybrook continue providing this life-saving procedure to patients, Sunnybrook Foundation is raising funds to purchase the heart valves used in this procedure. To make a donation, please visit www.sunnybrook.ca.

This need must be addressed and not forgotten in the days and months ahead.”

“This partnership with Sunnybrook Foundation will allow us to bring even more hope during this time of despair,” said David Morley, president and CEO of Save the Children Canada. “The health-care needs in Haiti are desperate now, but will continue to be critical in the months and years ahead. We are thankful for Sunnybrook Foundation’s support and vision for the future of Haiti’s children.”

“We are rebuilding our own hospital – not because it’s been destroyed, but because we want to do more for our patients. In the region of Haiti affected by the earthquake, there are no properly functioning hospitals at all,” added Goldthorp.

Donations can be made online at www.sunnybrook.ca or by calling 416-480-GIVE. All donations made to the Sunnybrook Fund for Haiti’s Hospitals are tax-deductible and a tax receipt will be provided by Sunnybrook Foundation.

The PAVI team at Sunnybrook’s Schulich Heart Centre

Photo by Doug Nicholson

SunnybrooknewsSunnybrook News is published twice a month by the Communications & Stakeholder Relations Department (Public Affairs) at Sunnybrook Health Sciences Centre. Submissions to Sunnybrook News are welcome, however, they are subject to space availability and editorial discretion.

Editor: Christine HenryVisit us online at: www.sunnybrook.ca

About Sunnybrook:Sunnybrook Health Sciences Centre is transforming healthcare through the dedication of its 10,000 staff members, physicians and volunteers. An internationally recognized leader in research and education and full affiliation with the University of Toronto, distinguishes Sunnybrook as one of Canada’s premier health sciences centres. Sunnybrook specializes in caring for critically-ill newborns, adults and the elderly, treating and preventing cancer, cardiovascular disease, orthopaedic and arthritic conditions and traumatic injuries.

How To Reach Us:

Room D100

Sunnybrook Campus

2075 Bayview Avenue

Toronto, ON M4N 3M5

P: 416.480.4040

F. 416.480.5556

E-mail: News.Articles@sunnybrook.ca

Submission deadline for next issue: March 19, issue date: March 26

Hurry Up and WaitCafé Scientifique Discusses Emergency Department Wait TimesBy Laura BriStow

Sunnybrook brought a Café to the Hospital on February 3, and while coffee and cakes were on the menu, the topic of Emergency Department (ED) wait times was too.

In 2007, the Canadian Institutes of Health Research created the Café Scientifique program to provide a forum to pro-mote health research-related issues of popular interest to the general public, and in turn provoke questions and pro-vide answers. It is intended to spark a discussion between members of the public and researchers about some of the most interesting — and sometimes contentious — research currently underway in Canada.

“These kinds of events are invaluable to Sunnybrook’s strategic planning process in the area of patient flow,” says Keith Rose, executive vice president and chief medical executive. “They help us gauge the awareness of and im-pact these issues have on the public and our staff and then develop ways through our patient flow steering committee and working groups to address the issue in an effective way.” Attendees do not need any formal training or qualifications, just a deep-rooted desire to talk about a particular health-care subject. The hope is that it also allows participants to learn how health research may provide answers to any common health and health-care questions.

Titled Hurry Up and Wait, the Café Scientifique at Sunnybrook focused on issues surrounding waiting times in hospital emergency departments, a very serious problem which plagues every hospital in Ontario and which almost everyone has experienced at one time or another.

Sunnybrook is taking a lead role in studying and improving its wait times and patient flow through some very compel-ling research and organization-wide projects. Management, and clinical and research leaders presented and discussed the issues at hand and the innovative solutions that are being implemented.

Four projects in particular were highlighted: •The ACCESS initiative, a new way of coordinating general

surgery consults to the ED•The MDRNT project, a study in the ED that is looking at

the efficiency of having a physician at triage in addition to the triage nurse

•The ED-GIM Ethnography project at the Holland Orthopaedic & Arthritic Centre, which is currently look-ing at intra-professional communication as a barrier to efficiency

•The new Bed Management System, software that is help-ing staff working in in-patient units get a precise picture of bed usage in the Hospital at a glance

Following the presentations, the audience was given the opportunity to ask questions and discuss concerns in an open format. Photo by Dale Roddick

Drivers Could Lead Longer Lives by Slowing Down SlightlyBy Laura BriStow

Sunnybrook researcher Dr. Donald Redelmeier and col-leagues have found that each hour spent driving in North America leads to about a 20 minute loss in life expectancy for the average driver due to the risks of a fatal crash.

That is, spending about 60 minutes in a car costs about 80 minutes in total for the average driver as time gone from that person’s life.

“When drivers try to speed to get to their destination faster,” says Redelmeier, lead investigator of the study and staff physician at Sunnybrook, “they actually lose more time because the savings from faster travel are offset by the increased prospect of a crash.”

The estimates suggest that slowing down slightly by about 3 km/h would cost average drivers about three minutes daily in trip time but save them about three hours annually in overall survival.

The data indicate a 1 km/h increase in speed above aver-age yields a 26-second increase in total lost time for the average driver because the savings from reduced travel time are more than offset by the raised risk of a crash.

A modest 3 km/h decrease in average driving speeds for North America yielded about 11,000 fewer crashes each day, saved about $10 million from property damage each day, and conserved about 199 cumulative life years for society annually.

The study was based on a combination of computerized traffic modelling, national statistics covering driving on public roadways and the laws of physics.

“The study suggests that small changes can have large consequences so that, at a population level, such chang-es would translate to approximately three million fewer property damage crashes, one million fewer injurious crashes, and 9000 fewer fatalities each year in the United States,” says Redelmeier, also a professor of medicine at the University of Toronto. “The savings may be especially large for young drivers.”

The efforts to reduce speeding deserves more attention overall, including a focus on photo radar techniques, traffic-calming programs and street-racing crackdowns. The results of the study were published in the February 2010 issue of the Journal of Medical Decision Making.

Sunnybrook Speaker SeriesNot Just a Phase: Understanding Mood and Anxiety in YouthBy Sandeep punia

On January 25, approximately 300 community members attended the Speaker Series session Not Just a Phase: Understanding Mood and Anxiety in Youth, presented by the Department of Youth Psychiatry.

The evening was introduced with opening remarks by Frank Wagner from Sunnybrook’s Board of Directors and moderated by Dr. Anthony Levitt, psychiatrist-in-chief. Guest speakers in the evening’s line-up included Dr. Amy Cheung, Dr. Ben Goldstein and Dr. Gili Adler Nevo.

Sunnybrook’s experts provided the latest information in understanding mood and anxiety disorders. The expert panel addressed family members, friends, patients and students who may be struggling to cope with the many facets of mood and changes during youth.

The guest speakers are well-known nationally and even internationally for their groundbreaking work to advance research in the field. In some cases, these experts estab-lish guidelines and help educate entire states and sys-tems, including family doctors, on how best to care for young people struggling with a mood or anxiety disorder.

The evening stressed the vital role of mental health in our overall health and how it is essential for everyday living. It influences how we feel, think, communicate and un-derstand. Without good mental health, we are unable to fulfill our potential or play an active part in everyday life.

Mental illness affects people of all ages, education and income levels, and cultures. It is estimated that 10 to 20 per cent of Canadian youth are affected by a mental illness or disorder — the single most disabling group of disorders worldwide. And yet in Canada, according to the Canadian Mental Health Association, only one out of five children who need mental health services receives them.

Youth are a precious segment of our population and it is only fitting that our youth psychiatrists provide us with a much-needed better understanding of mood and anxiety in our youth.

Sunnybrook operates Canada’s largest mood and anxiety disorders clinic for teens. The Hospital is committed to broadening access to comprehensive care for youth with bipolar disorder or at high risk of developing it. Sunnybrook’s bold vision for the future of care for youth with this condition includes Canada’s first Centre of Excellence in Youth Bipolar Disorder.

For a re-cap of the evening’s presentation or to read the informational slides, please visit sunnybrook.ca and click on the ‘Mood anxiety’ link at the bottom right-hand cor-ner of the home page. Photo by Doug Nicholson

Dr. Anthony Levitt, left, moderates the January 25 Speaker Series session, while Dr. Amy Cheung answers questions from the audience.

Above left to right: Dr. Fred Brenneman, Medical Director, Trauma Program; Debra Carew, Operations Director, Trauma, Emergency & Critical Care Program; Dr. Ivy Cheng, Physician, Emergency Department; Fiona Webster, Scientist, Holland Mus-culoskeletal Program.

SunnybrooknewsSunnybrook News is published twice a month by the Communications & Stakeholder Relations Department (Public Affairs) at Sunnybrook Health Sciences Centre. Submissions to Sunnybrook News are welcome, however, they are subject to space availability and editorial discretion.

Editor: Christine HenryVisit us online at: www.sunnybrook.ca

About Sunnybrook:Sunnybrook Health Sciences Centre is transforming healthcare through the dedication of its 10,000 staff members, physicians and volunteers. An internationally recognized leader in research and education and full affiliation with the University of Toronto, distinguishes Sunnybrook as one of Canada’s premier health sciences centres. Sunnybrook specializes in caring for critically-ill newborns, adults and the elderly, treating and preventing cancer, cardiovascular disease, orthopaedic and arthritic conditions and traumatic injuries.

How To Reach Us:

Room D100

Sunnybrook Campus

2075 Bayview Avenue

Toronto, ON M4N 3M5

P: 416.480.4040

F. 416.480.5556

E-mail: News.Articles@sunnybrook.ca

Sentinel Lymph Node biopsy reduces a patient’s complications such as pain and lymphedema (chronic swelling) of limbs and or soft tissue, and is used widely in melanoma, breast and vulva cancers. Sentinel Lymph Node biopsy removes one to two sentinel lymph nodes (the first lymph nodes to drain from the primary tumour, hence the first to harbour metastases) compared to pelvic lymphadenectomy which involves the removal of ten to 30 lymph nodes, and increased complications.

It took a compelling opportunity to lure Dr. Ben Goldstein back to Sunnybrook Health Sciences Centre. Until 2009, he was settled into a faculty posi-tion and a productive lab studying bipolar disorder — a condi-tion of radical mood swings — in children and adolescents at the University of Pittsburgh Medical Center.

But having done his medical residency at Sunnybrook under the

mentorship of Dr. Anthony Levitt, psychiatrist-in-chief and a professor at the University of Toronto, Goldstein knew Sunnybrook’s Department of Psychiatry to be col-legial — a huge draw.

In his new role at Sunnybrook, 20 percent of Goldstein’s time will focus on clinical work in the department of Psychiatry’s youth division, which is the largest in the country, while 80 percent will be protected for research in the Brain Sciences Program. Although he expects the hours spent with patients to creep up as he builds a practice, the dedicated time for research is critical, says Goldstein.

“When you start your own lab, it’s so easy to lose momen-tum. If you don’t have protected time for grant writing, and access to research staff and resources, you can’t get forward traction.”

Psychiatrist Returns to Sunnybrook to Tackle Bipolar Disorder in YouthBy JiM oLdFieLd

Goldstein has secured a grant from the Ministry of Health and Long-Term Care to monitor and study risk factors for heart disease in adolescents with bipolar disorder. Adults with bipolar disorder are at least twice as likely to die of heart disease than those without it, and on average 15 to 25 years earlier than adults in the general population.

“In adolescents, studies have shown that adherence to guidelines from professional associations like the American Diabetes Association is low,” says Goldstein. “So one thing we can do is watch to see that their weight and blood pressure aren’t getting out of control.”

Moreover, mapping the biology underlying the link be-tween heart disease and bipolar disorder early — which for as many as two-thirds of patients means during ado-lescence, when the illness first arises — would further help physicians identify those most at risk. This would enable intervention at a stage when the condition is more malleable. A potential biological marker of the connection between heart disease and bipolar disorder is inflamma-tion, and Goldstein will be pursuing that link in studies over the next couple of years.

Goldstein’s long-term goal is to do the Toronto 1,000, a large-scale study of adolescents with and without bipolar disorder that would stretch over two decades.

While researchers have made great strides in identifying adolescent bipolar disorder, Goldstein says there’s still much work to do.

“I’d like to see a future where there are medications that aren’t such a burden on the body,” he says. “There are whole classes of drugs, like anti-inflammatories, that have yet to be tried and that could be effective from a mind and body perspective. But we need research to prove which are best.” Photo by Doug Nicholson

EVENTSnight of Starsdate: Monday, May 17, 2010Location: The Princess of Wales Theatre

An evening filled with a glitter-ing array of Canada’s hottest comedic, dance and musical talent, sharing the stage for one night only. Produced by Ross Petty. All proceeds will fund the renovation of a new operating suite at the Holland Orthopaedic & Arthritic Centre. For more information, check out nightofstars.ca.

Sunnybrook golf Classic date: June 8, 2010Location: Eagles Nest Golf Club

All proceeds support the Schulich Heart Centre. For more information, please contact: kelli.burton@sunnybrook.ca

Become a Sunnytwin! On September 12, 2010, the Women & Babies Program will move into their new home in the M-wing at the Bayview campus. As with any move, Women & Babies staff have many questions about their new home.

This is where you come in! We’re looking for enthusiastic volunteers from both the Women & Babies Program and from throughout the Bayview campus, from every area and profession. For staff from the Bayview campus, you’ll be a trusted source of information by providing valuable tips on:•Commuting to Bayview (Parking, driving tips

and TTC)•Amenities on the campus•The best places to eat•How to avoid getting lost•Much, much more

SunnyTwins will connect online, in person and over the phone. There is no official time commitment, but we’re looking for Bayview campus staff who are keen to share the “ins and outs” of what it’s like to work at the northern campus and for Women & Babies staff who are keen to learn more about their new home. To sign up, please visit http://sunnynet.ca/Default.aspx?cid=104925&lang=1.

A Promising, Newer Way in the Management of Cervical CancerSentinel Lymph Node biopsy used less in cervical cancer, but tells moreBy nataLie Chung-SayerS

In a study published in Gynecologic Oncology, and re-ported for the first time ever in relation to cervical cancer, Sunnybrook researchers have shown higher detection of lymph node metastases using Sentinel Lymph Node (SLN) biopsy, compared to complete pelvic lymphadenectomy. Lymph node metastases is one of the most telling factors about the course of disease.

“These findings inform a newer way of thinking about the management of cervical cancer,” says Dr. Allan Covens, lead investigator, surgical oncologist and head, Gynecology Cancer Care Team, Sunnybrook’s Odette Cancer Centre. “In our view, complete lymphadenectomy as a gold standard for lymph node assessment in cervical cancer is cogently challenged.”

“Our findings of higher lymph node metastases (in-cluding micrometastases) detection using SLN biopsy together with known reduced complications for patients and low false-negative rates, suggest a strong efficacy advantage of this procedure over the standard complete pelvic lymphadenectomy procedure in early stage cervi-cal cancer,” says Dr. Covens, who is also a professor

of Obstetrics and Gynecology and director Gynecologic Oncology Fellowship at the University of Toronto.

Findings indicate a lymph node metastases detection rate is almost three-fold higher with SLN biopsy compared to pelvic lymphadenectomy. All sentinel lymph node metas-tases were smaller than one centimetre. The researchers suggest the higher detection rate may be due to exten-sive sectioning in SLN biopsy. They also suggest the rate may relate to unusual locations of sentinel lymph nodes in cervical cancer.

Over 21 per cent of the cohort of 87 patients who un-derwent SLN biopsy, had sentinel lymph nodes located in areas where they would not be typically removed in a standard pelvic lymphadenectomy.

The researchers compared 81 of the 87 patients who underwent SLN biopsy, to 218 matched patients who had complete pelvic lymphadenectomy. Both groups subsequently underwent radical hysterectomy or radical trachelectomy.

Dr. Allan Covens (right) supporting gynecological laparoscopy best practices in Hong Kong at the Prince of Wales Hospital, af-filiated with the Chinese University of Hong Kong.

“More frequent use of Sentinel Lymph Node biopsy in cervical cancer detects more lymph node metastases which may have a positive overall impact on survival,” says Dr. Covens.

Nominate someone TODAY for the fourth an-nual Bertin awards for excellence in Customer Service.

Named in honour of former Board of Directors’ member Paul Bertin for his significant contri-bution and years of service, the award allows the Hospital to recognize and celebrate the exceptional staff who continually go above and beyond their usual role to exemplify the values of Sunnybrook Health Sciences Centre.

In April, the award will recognize five non-clini-cal staff (i.e. administration, clerical, technical, service and support) who work on a regular part-time or full-time basis at Sunnybrook and dem-onstrate a commitment to excellent customer service in their daily work with patients, families and/or colleagues.

Please nominate someone you feel is deserving of this award by March 10, 2010. The nomina-tion form with the details is available in the Human Resources Department or can be down-loaded from http://sunnybrook.ca/media/item.asp?c=1&i=285&page=.

2010Bertin Award Nominations

Dr. Ben Goldstein

Neonatal Care Leader Appointed Chief of Department of Newborn & Developmental Paediatrics

Sunnybrook is pleased to announce the appointment of Dr. Shoo K. Lee as the chief of the Department of Newborn & Developmental Paediatrics at Sunnybrook Health Sciences Centre.

Dr. Lee becomes the first Joint Chief of a partnership that includes Mount Sinai Hospital, The Hospital for Sick Children and the University of Toronto. Dr. Lee has leadership posi-tions in all three partner organizations. He is the chief of the Department

of Paediatrics at Mount Sinai Hospital, the head of the Division of Neonatology at The Hospital for Sick Children, and the professor and head of the Division of Neonatology at the University of Toronto.

Dr. Lee is a medical graduate of the University of Singapore. He completed his paediatrics residency both in Singapore and at the Janeway Children’s Hospital in Newfoundland and Labrador. Subsequent fellowships in London, Ontario and Boston were followed by a PhD in Health Policy (Economics) at Harvard University.

After a 10-year stay at the University of British Columbia, Dr. Lee became professor of Pediatrics at the University of Alberta in 2005. In 2006, he was awarded a Canada Research Chair. He moved to Toronto in 2009.

Dr. Lee is a world leader in collaborative research in Neonatology. In 1995, he founded the Canadian Neonatal Network, which now includes all 29 tertiary-level Neonatal Intensive Care Units across Canada. Garnering over $10 million in research funding, the Network has published over 150 manuscripts and abstracts in peer-reviewed journals. Many of the publications have forged clinical practice guidelines and policy, mainly through the Canadian Paediatric Society. In 2004, the Network received the Knowledge Translation Award from the Canadian Institutes of Health Research.

Dr. Lee’s leadership also extended the impact of the Canadian Neonatal Network internationally, with the creation of the International Neonatal Collaboration in 2006, which includes over 200 hospitals world-wide. Dr. Lee also holds leadership positions in several other networks and organizations dedicated to improving the quality of neonatal care.

In addition to his research productivity, Dr. Lee is a gifted clinical teacher as well as a valued mentor for many in-dividuals undertaking research and quality enhancement activities locally and internationally.

Managing Diabetes with MyChart™By Laura BriStow

Sunnybrook’s eHealth Services and the Anne Johnston’s Mid-Toronto Diabetes Education Program have recently partnered to improve personal health management of diabetes using Sunnybrook’s MyChart™, a personal elec-tronic health management record system.

The Hospital and community partnership will focus on improving access to information for personal diabetes management in the community. Using Sunnybrook’s MyChart™, Anne Johnston’s clients can now set up, man-age and share their own personal health information with their care team at Anne Johnston’s Health Station, family members who participate in their care, and with multiple clinicians in the community or hospital.

“The ability for our clients to self-manage their Diabetes is integral to community-based, client-centred care,” says Brenda McNeill, executive director of the Anne Johnston Health Station.

“The MyChart™ system provides easy access to educa-tional material about diabetes, self monitoring supports that help record meal planning, exercise diary, test dates, test results and medications all in one record that is set up, managed and stays with the consumer,” says Sarina Cheng, director, eHealth Strategies & Operations at Sunnybrook. “In other words, the MyChart™ personal health record system is managed by the consumer and can be used in partnership with community care teams, primary care physicians, hospital clinicians, and pharma-cists to help monitor and manage living with diabetes.”

MyChart™ is unique as it is a combination of clinical and personal health information with electronic sharing fea-tures. It can also be set up as a family health record with family health details, allergies, contact and emergency information.

With MyChart™ the health consumer has access to relevant information to help make decisions about their health as they need to, such as tracking daily blood glucose levels, symptoms, and medications. This is especially useful for individuals who depend on caregivers, travel, see mul-tiple clinicians or are caring for others.

The Diabetes Education Care team at Anne Johnston’s Health Station and Sunnybrook Health Sciences Centre are working together to provide support and education for healthier communities.

Prostate Cancer Biopsy Effective but Lacks

Practice StandardsBy nataLie Chung-SayerS

The first large study of complications after transrectal ultrasound- guided prostate biopsy shows significant rise in hospital admission rates, and more infection-related cases.

In the first, long-term study of its kind, Sunnybrook researchers provide compelling evi-dence to support much-needed practice standards in transrectal ultrasound-guided prostate biopsy.

The 10-year, Canadian population-based study of seri-ous complication rates requiring hospital admission after transrectal ultrasound-guided prostate biopsy reports a significant four-fold increase in hospital admis-sion rates over the study period, with over 70 per cent of cases caused by infection. The findings from this study, which is the largest conducted to-date, are published in the Journal of Urology.

Transrectal ultrasound-guided prostate biopsy is the most common method to confirm a prostate cancer diagnosis by obtaining tissue from the prostate gland using a small probe and echoes of ultrasound waves to form a picture through the wall of the rectum. The pro-cedure is not standardized despite the test’s diagnostic effectiveness.

“Data from this study add critical momentum for the de-velopment of standards to make transrectal ultrasound-guided prostate biopsy as safe as possible for patients,” says Dr. Robert Nam, lead investigator and urologic on-cologist, Genitourinary Cancer Care team, Sunnybrook’s Odette Cancer Centre.

The researchers suggest possible factors in the increase of complications including non-standardized practice of antibiotic prophylaxis, inconsistent use of mechani-cal bowel preparation, and increasing rates of bacterial resistance to antibiotics. Sunnybrook has developed a comprehensive approach to preventing complications after transrectal ultrasound-guided prostate biopsy pro-cedures, for every patient.

In 2009, Winston Chi, age 67, developed an Escherichia coli (E. coli) infection after a second biopsy. Despite rigorous preparation with bowel cleansing and prophy-lactic antibiotics both times, he became infected with an antibiotic-resistant strain of the bacteria and required admission to hospital. The second biopsy based on the Prostate Cancer Risk Calculator despite a negative first result was worthwhile for Winston. The repeat biopsy detected aggressive prostate cancer and he received early surgical treatment at Sunnybrook. Today he is both infection-free and cancer-free with his PSA (Prostate Specific Antigen) level at zero.

“For me, the biopsies were important to catch the cancer, but now I also think more about safety and standards — that this is also important to help reduce infection and avoid resistant situations like mine,” says Winston.

“Next steps in our research is full chart reviews to con-firm findings and to identify any key trends and compare them to a control group of patients, to help inform the development of practice standards,” says Dr. Nam, who is also an associate professor with the Department of Surgery at the University of Toronto.

The study involved 75,190 men who underwent a tran-srectal ultrasound-guided prostate biopsy in Ontario, Canada between 1996 and 2005. The researchers fo-cused their analyses on 41,682 men with no diagnosis of prostate cancer to separate the diagnosis of prostate cancer from biopsy-related complications which may have been simultaneously in question at the time of hospital admission.

Of the non-prostate cancer group, 781 were admitted to hospital within 30 days of biopsy: 1.0 per cent in 1996 but steadily rising to 4.1 per cent in 2005. Of this group, 71.6 per cent or 556 were admitted for infection-related complications. Photo by Doug Nicholson

Sunnybrook ALS Champions Awarded GrantsNew battery of tests may improve our understanding of ALSBy nadia radovini

Dr. Lorne Zinman, medical director of the ALS Clinic at Sunnybrook, and Yana Yunusova, associate scientist at Sunnybrook, were recently awarded the second annual Bernice Ramsay Discovery Grants by the ALS Society of Canada for their research projects.

“The goal of the Discovery Grants program is to sup-port the development of a new ‘higher risk’ technology or to encourage a new investigator from another field to bring their expertise to ALS research,” says Denise Figlewicz, vice president of research at ALS Canada.

Using a newly developed computerized test, Dr. Zinman and Yunusova hope to improve our understanding of the cognitive, speech and brain changes that occur in patients with ALS. The ALS-Computerized Frontal Battery (ALS-CFB) will probe areas of the brain that have never been evaluated before in subjects with ALS.

The ALS-CFB is short in duration, requires only minimal motor response during testing and can be performed at all phases of the disease. It was developed to measure cognitive function in previously untapped regions of the frontal lobes. Because of its unique design, ALS-CFB has potential to become a new standard for the assessment of cognitive functions in patients with ALS.

Dr. Zinman and Yunusova’s study will be the first to ex-amine the link between the profiles of cognitive fronto-temporal impairment and correlating neuro-anatomical changes using the ALS-CFB and various imaging tech-niques. The study also examines the relationship be-tween cognitive deficit and bulbar motor deficit, which have been associated in the past, though the nature of this association remains open.

“I believe it will have a significant impact on our under-standing of the neural bases of the changes we see in the motor and cognitive systems of patients with ALS,” says Yunusova. “With new technologies and analysis methods becoming available, we should not miss the opportunity to make a careful examination of the foun-dations of functional changes with disease progression. Understanding the disease is the first step in conquer-ing it in the future.”

Both recipients are assistant professors at University of Toronto, and are co-investigators on this project with Dr. Victor Rafuse, associate professor at Dalhousie University.

Dr. Shoo K. Lee

Dr. Robert Nam