Hospital News July 2021 Edition by Hospital News

Inside: Ethics | Evidence Matters | Safe Medication | Long-term Care

July 2021 Edition

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Meet the resistance. Here’s who fought the pandemic at ground zero. Nurses and health-care professionals, holding strong for our patients and residents. It’s been a tough fight and we deserve more than respect. But that’s not what we’re getting... and as a result many are thinking about leaving the profession.

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Contents July 2021 Edition

IN THIS ISSUE:

Longtime nurse seen as ‘incredible addition’ to Indigenous Health Program at UHN

▲ Cover story: Bringing reconciliation into healthcare

▲ Meet Barbara: The first patient cared for in Sunnybrook’s Mobile Health Unit

▲ Reconnecting diabetes patients and health-care providers during the shadow pandemic of chronic disease

COLUMNS Guest Editorial ................. 4 Safe Medication .............20 Ethics ..............................22

Long-term Care ...............28 Careers .......................... 32

▲ Researchers develop promising ‘super molecule’ that boosts viral neutralization against COVID-19

▲ Innovative aging and brain health solutions by frontline health workers

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JULY 2021 HOSPITAL NEWS 3

610 Applewood Crescent, Suite 401 Vaughan Ontario L4K 0E3 TEL. 905.532.2600|FAX 1.888.546.6189

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An open letter to Ontario’s ‘missing’ patients:

Health care providers are ready to help you

Editor

Kristie Jones

editor@hospitalnews.com Advertising Representatives

Denise Hodgson

denise@hospitalnews.com Publisher

Stefan Dreesen

stefan@hospitalnews.com Accounting Inquiries

accountingteam@mediaclassified.ca Circulation Inquiries

By Harindra Wijeysundera and Patrice Lindsay hen you think about how COVID-19 has impacted the health of people living in Ontario, it’s natural that your mind goes first to the more than 500,000 who have already been infected, the tragedy in long term care, the plight of essential workers and the uneven burden this pandemic has placed on lower socioeconomic and racialized communities. How to care for those with COVID-19 and protect those most at risk has rightly been top of mind for health care practitioners and public health experts for almost fourteen months. However, there is a side to the pandemic that has not received the attention it deserves – the impacts on people accessing other kinds of care, in particular, for time sensitive conditions such as heart disease and stroke. These are the untold victims of the COVID-19 pandemic. Untold, because so many of these patients have disappeared from hospitals, clinics and doctors’ offices and even emergency departments. Today we, and on behalf of our health-care colleagues, are writing to them: Ontario’s missing patients.

info@hospitalnews.com

To you, the missing patient, we want to say this: we’re worried about you. We are worried you might be ignoring changes to your health because you don’t want to place additional burden on a system that you keep hearing is overwhelmed. Perhaps you feel you would not receive the quality of care you normally would. Or you might be concerned about contracting COVID-19 in our hospitals and clinics. We understand your concerns, but we want to reassure you; while our health care system is very stretched, it is not broken. We want you to know that more than a year into this, we have learned a lot and we have applied what we have learned, including how to protect and care for you when you come to see us. If you experience signs of a medical emergency like a heart attack or stroke, you should call 9-1-1 immediately. For heart attack, these signs include chest or upper body discomfort, sweating and nausea. In the case of stroke, watch for weakness on one side of your body, changes to speech or drooping of the face.

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Lauren Reid-Sachs

Senior Graphic Designer

Johannah Lorenzo

ADVISORY BOARD Barb Mildon,

RN, PHD, CHE VP Professional Practice & Research & CNE, Ontario Shores Centre for Mental Health Sciences

Helen Reilly,

Publicist Health-Care Communications

Jane Adams,

President Brainstorm Communications & Creations

Bobbi Greenberg,

Health care communications

Sarah Quadri Magnotta, Health care communications

Dr. Cory Ross,

B.A., MS.C., DC, CSM (OXON), MBA, CHE Vice President, Academic George Brown College, Toronto, ON

Continued on page 6 ASSOCIATE PARTNERS:

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Monthly Focus: Paediatrics/Ambulatory Care/Neurology/ Hospital-based Social Work: Paediatric programs and developments in the treatment of paediatric disorders including autism. Specialized programs offered on an outpatient basis. Developments in the treatment of neurodegenerative disorders (Alzheimer’s, Parkinson’s etc.), traumatic brain injury and tumours. Social work programs helping patients and families address the impact of illness.

Monthly Focus: Emergency Services/Critical Care/Trauma/ Emergency: Innovations in emergency and trauma delivery systems. Emergency preparedness issues facing hospitals and how they are addressing them. Advances in critical care medicine. A look at medical imaging techniques for diagnosis, treatment and prevention of diseases. + ONLINE EDUCATION SUPPLEMENT + SPECIAL FOCUS: EMERGENCY ROOM

THANKS TO OUR ADVERTISERS Hospital News is provided at no cost in hospitals. When you visit our advertisers, please mention you saw their ads in Hospital News. 4 HOSPITAL NEWS JULY 2021

Hospital News is published for hospital health-care professionals, patients, visitors and students. It is available free of charge from distribution racks in hospitals in Ontario. Bulk subscriptions are available for hospitals outside Ontario. The statements, opinions and viewpoints made or expressed by the writers do not necessarily represent the opinions and views of Hospital News, or the publishers. Hospital News and Members of the Advisory Board assume no responsibility or liability for claims, statements, opinions or views, written or reported by its contributing writers, including product or service information that is advertised. Changes of address, notices, subscriptions orders and undeliverable address notifications. Subscription rate in Canada for single copies is $29.40 per year. Send enquiries to: subscriptions@ hospitalnews.com Canadian Publications mail sales product agreement number 42578518.

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NEWS

First minimally invasive maze procedure for atrial fibrillation performed in Ontario By Anna Wassermann he Cardiac Surgery team at St. Michael’s Hospital of Unity Health Toronto is the first in Ontario to complete a minimally invasive maze procedure to treat atrial fibrillation – the most common type of irregular heart rhythm. The maze procedure is an effective surgical treatment for atrial fibrillation but it’s highly invasive and requires a lengthy recovery time. The minimally invasive technique used by surgeons at St. Michael’s will help patients with atrial fibrillation who haven’t found success with other treatments options, including medication and transcatheter ablation – a procedure that uses a small catheter to deliver energy to the heart, destroying the heart tissue causing the irregular rhythm. “Our minimally invasive method achieves the same results as the traditional maze procedure but uses less invasive endoscopy techniques,” said Dr. Gianluigi Bisleri, the Cardiac Surgeon at St. Michael’s who led this procedure. “It’s going to improve care for patients with atrial fibrillation in Ontario who require surgical intervention.” The technique used by Dr. Bisleri and his team involves a small, 1.5 inch incision on the side of the chest. A miniaturized camera and dedicated instruments are inserted to see the heart and then a probe is used to create barriers of scar tissue throughout the upper chambers of the heart. These barriers, which sometimes look like a maze, block the electrical signals causing the irregular rhythm. The maze procedure is traditionally performed by opening the chest and stopping the heart. Dr. Bisleri and his team spent weeks preparing to be the first team to use the minimally invasive technique. “We had time and space to practice the procedure in the operating room with all the necessary equipment,” said Dr. Bisleri. “We were able to complete several dry runs, which made a huge difference.”

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Dr. Bisleri completed his medical education and cardiac surgical training in Italy before being recruited to Queen’s University and Kingston Health Sciences Centre in 2016, where he expanded the use of minimally invasive techniques for heart surgery in eastern Ontario. His work in Kingston caught the attention of Heart and Vascular Program leadership at St. Michael’s, who recruited the cardiac surgeon to help build the first comprehensive minimally invasive cardiac program at the hospital – and in the city. He joined St. Michael’s in January. “Recruiting Dr. Bisleri adds a critically important piece to our innovative Structural Heart Program, which to date has focused on cutting edge transcatheter heart valve therapies and traditional approaches to mitral valve surgery, including mitral valve repair,” said Dr. Mark Peterson, Medical Director of the BRAIN&HEART program at St. Michael’s and co-Director of the hospital’s Structural Heart Program. The mitral valve separates the heart’s left atrium and left ventricle and ensures blood flows properly between them. Sometimes, it stops working properly and needs to be repaired. “We’re committed to supporting Dr. Bisleri and the creation of an ar-

rhythmia and minimally invasive mitral valve program. Minimizing the incision will allow patients to have high-quality mitral valve repair while regaining function and returning to their normal routine more quickly.” For Dr. Bisleri, the promise of getting patients back on their feet more quickly – and being able to offer these minimally invasive procedures on a routine basis – is exciting. “We have an opportunity here to position ourselves as a leader in this space, to show patients in need of cardiac surgery that in many instances, we can treat their condition without putting their heart and body through

the stress of a major operation,” he said. Two months into his new position, he’s already showing that this is possible. He’s now completed two minimally invasive maze procedures; in the second, he also repaired a patient’s mitral valve using minimally invasive techniques. “I feel fortunate to be part of an organization that encourages innovation and that supported me in this novel endeavour,” said Dr. Bisleri. “I look forward to achieving even more firsts and expanding the portfolio of minimally invasive cardiac procedures with the support of the organization behind H me.” ■

Anna Wassermann is a communications advisor at Unity Health Toronto.

JULY 2021 HOSPITAL NEWS 5

IN BRIEF

Postpartum mental health visits 30 per cent higher during COVID-19 pandemic M

ental health visits for new mothers were 30 per cent higher during the COVID-19 pandemic than before the pandemic, particularly in the first three months after giving birth, found new research in CMAJ (Canadian Medical Association Journal). “Increased visit rates began in March 2020, although the state of emergency was declared only midway through the month, suggesting that distress related to the pandemic translated into an increased need for care very quickly,” writes Dr. Simone Vigod, chief of psychiatry, senior scientist and interim vice president of academics at Women’s College Hospital (WCH), and senior adjunct scientist at ICES in Toronto, Ontario, with coauthors. Postpartum mental illness affects as many as 1-in-5 mothers and can have long-term effects on children and families if it becomes chronic. Researchers looked at mental health visits by 137,609 people in Ontario

during the postpartum period (from date of birth to 365 days after) from March through November 2020 and collected data on age, number of children, neighbourhood income based on postal codes, neighbourhood ethnic diversity and region of residence based on the province’s 34 public health units. They also divided the province into northern and southern public health units. During the study period, mental health visits to both family physicians and psychiatrists were higher than before the pandemic, especially among parents with anxiety, depression, and alcohol and substance use disorders. People living in northern public health units had relatively low increases after July 2020, perhaps because of fewer COVID-19 restrictions in those areas during the latter period. The way care was delivered during the pandemic period differed from the period before: 84.8 per cent of postpartum mental health visits were con-

Continued from page 4

Health care providers are ready to help you But even if it’s not an emergency, let us assess you and determine if it is something that can be safely postponed. Changes to your health including increased lightheadedness, shortness of breath, tightness in the chest or jaw are all reasons to reach out. The bottom line is simple: please don’t triage yourself. Let your health care provider do that – that’s our job and we are here for you. If we can assess you virtually, we will. If we need to see you in person, we will make sure that it’s done safely. And if your symptoms change, our approach will adapt. But we can’t help you if you stay silent. The nature of cardiovascular

disease is that your symptoms may be stable for a time, but then change very suddenly. In our world, days, hours, and even minutes can make a difference. The longer you wait, the more difficult your recovery will be – if you survive. So please don’t wait. The consequences of COVID-19 on the health of Ontario’s missing patients are not hypothetical. Delaying heart and stroke care has very real and very serious consequences. Our health care system and the people who work in it have been challenged by COVID-19, but we are still here and ready to help H you. Please let us. ■

Dr. Harindra Wijeysundera, MD, PhD is Chief of the Schulich Heart Program, Sunnybrook Health Sciences Centre and Canada Research Chair in Structural Heart Disease Policy and Outcomes. Dr. Patrice Lindsay, RN, PhD, is Director of Health Systems Change for Heart & Stroke. 6 HOSPITAL NEWS JULY 2021

ducted virtually in April 2020 compared with only 3.1 per cent of visits in the pre-pandemic period. The authors suggest that increased use of virtual care may have removed barriers to postpartum mental health support, such as the need to travel, find childcare for older children, or manage erratic schedules, enabling more people to seek care. Patients in the lowest income neighbourhoods had the smallest increase in mental health visits compared with people in other neighbourhoods, which the authors noted with surprise. “This raises some concern about the potential for unmet need because low-income patients may have greater barriers to accessing care, including difficulty affording the required

technology or finding private space to attend virtual appointments (e.g., crowded homes), or less opportunity to attend “live” appointments because of employment in front-line jobs,” write the authors. They recommend targeted approaches to providing mental health supports. “Health systems should focus proactively on patients from high-risk groups, monitor waiting lists for care, and explore creative solutions to expand system capacity, with special attention to postpartum patients who may be experiencing barriers to care,” they advise. “Postpartum mental illness during the COVID-19 pandemic: a population-based repeated cross-sectional H study” was published June 7, 2021.■

Airborne transmission of SARS-CoV-2 calls for updated practices to prevent transmission here is a growing body of evidence supporting airborne transmission of SARS-CoV-2, the virus that causes COVID-19. Despite updates from the World Health Organization, the U.S. Centers for Disease Control and Prevention (CDC) and the Public Health Agency of Canada that the virus can be transmitted by short- and long-range aerosols, Canada’s public health guidance has not been adequately updated to address this mode of transmission, argue authors of a commentary published in CMAJ (Canadian Medical Association Journal). Canadian public health guidance and practices should be updated to include more emphasis on the following airborne mitigation measures: ventilation, filtration and better masks. “Ventilation is a key element in the fight against airborne transmission. We need clear guidelines and funding for the assessment and improvement of ventilation in our indoor spaces, particularly our schools,” says Dr. Sarah

Addleman, emergency physician, The Ottawa Hospital, Ottawa, Ontario. Along with ventilation, it is time to revisit Canadian personal protective equipment (PPE) recommendations in health care and other essential settings. “People who work in close proximity to others (in both health care and other settings) are at higher risk of infection from short-range aerosol inhalation, and better masks (such as N95s) are needed to prevent infection,” says coauthor Dr. Victor Leung, infectious disease physician, University of British Columbia, Vancouver, British Columbia. “It took decades for the medical community to accept that tuberculosis and measles were airborne diseases. The science on airborne transmission of SARS-CoV-2 has, in contrast, moved fast. It is time for Canadian guidance and policies to follow swiftly too,” the authors conclude. “Mitigating airborne transmission of SARS-CoV-2” was published June 8, H 2021. ■ www.hospitalnews.com

IN BRIEF

COVID-19-related multisystem inflammatory syndrome in adults: rare but possible n rare cases, adults who have recovered from COVID-19 may develop multisystem inflammatory syndrome, and clinicians should consider this possibility in adults with specific symptoms, as physicians describe in a case published in CMAJ (Canadian Medical Association Journal). A 60-year-old man, who had tested positive for SARS-CoV-2 four weeks before, visited hospital for a range of symptoms, including prolonged shortness of breath, high fever, swelling and severe fatigue. Testing found an enlarged heart and lung swelling as well as other issues. “Given the patient’s recent history of SARS-CoV-2 infection, fevers without localizing symptoms, oral mucosal changes, cervical lymphadenopathy, conjunctivitis and lower extremity changes, we suspected inflammatory post-COVID-19 syndrome. The presentation was similar to reported cases of an uncommon but severe complication in children and adolescents infected with SARSCoV-2, called multisystem inflammatory syndrome in children (MIS-C), as well as to Kawasaki-like illness,” write Drs. Genevieve Kerkerian and Stephen Vaughan, infectious disease specialists, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta. Prompt initiation of medication helped the patient to recover. Previous cases of the syndrome in adults have been documented in people younger than 50. The authors suggest that age should not limit the potential diagnosis. Much is unknown about multisystem inflammatory syndrome in adults (MIS-A). “Unlike for MIS-C, there is currently no requirement to report cases of MIS-A to provincial or state authorities, but this should be encouraged to facilitate research and improve patient outcomes,” the authors conclude. “Multisystem inflammatory syndrome in an adult after SARS-CoV-2 infection” was published June 21, H 2021. ■

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Expanded national After Stroke program he March of Dimes Canada has launched an enhanced After Stroke program. The program will introduce a new personalized service model that supports survivors and their families to navigate the path forward after a stroke. More than 62,000 people in Canada experience a stroke each year. Among them, 60 per cent are left with some level of stroke-related disability, and face a wide array of practical and emotional challenges as they move through their unique recovery journey. After discharge from hospital, many survivors and families face significant difficulties in identifying and accessing supports and services available in their community, compounding the isolation and stress caused by the stroke itself. After Stroke aims to break through these barriers, with an individualized approach that helps people connect to the supports they need to rebuild their lives and achieve their evolving goals

MORE THAN 62,000 PEOPLE IN CANADA EXPERIENCE A STROKE EACH YEAR. AMONG THEM, 60 PER CENT ARE LEFT WITH SOME LEVEL OF STROKE-RELATED DISABILITY after a stroke. After Stroke is delivered through dedicated teams in Ontario, Nova Scotia and British Columbia, but stroke survivors and families in all provinces can access tools, resources and local referrals through the program. People who have had a stroke and their families can engage with the After Stroke program at any point in their experience, whether they are still in the hospital, or have returned to their homes and communities. After Stroke coordinators work one-on-one with stroke survivors and their families to set personal goals, develop an individualized action plan to achieve them, and connect them with pro-

grams and resources that can help. Action plans and support are routinely reviewed and evolve over time, recognizing that new needs and challenges can continue to emerge months and even years after a stroke. The After Stroke program model places stroke survivors and their families at the centre of care. The development of the model was a collaborative effort between teams within March of Dimes Canada, people with lived experience of stroke, and health professionals and academic experts in stroke recovery and rehabilitation. For more information on the After Stroke proH gram visit www.afterstroke.ca. ■

Online health coaching from medical students improves physical and mental health solation measures for Canadians during the pandemic have been shown to reduce healthy eating, regular physical activity, and sleep quality while increasing mental stress and weight gain. In response to this deterioration in physical and mental health, an online health promotion program developed at the McGill Comprehensive Health Improvement Program (CHIP) and funded by Veterans Affairs Canada was made freely available to over 1,600 Canadians during the pandemic. The primary beneficiaries of the program were Canadian Veterans and their families. The clinical impact on physical and mental health was recently presented to the faculty and staff at Department of Medicine rounds, McGill University Health Center. A total of nine Health Missions, each lasting 6-10 weeks, were completed. Overall, participants were very physically active, exercising, on

THE PRIMARY BENEFICIARIES OF THE PROGRAM WERE CANADIAN VETERANS AND THEIR FAMILIES. average, the equivalent of walking five miles daily. During the DROP-5 Healthy Weight Mission, over 40 per cent of overweight participants lost at least ½ pound each week (minimum offive lbs over 10 weeks). Throughout the program, participants also shared their experiences with teammates and rival teams, received daily health tips, and learned strategies to manage stress, sleep better and eat healthier. Overall, mental health indicators including, high stress levels and poor sleep quality, improved by at least 20 per cent in nearly half of all participants. During the past eight months, medical students from McGill’s Faculty of Medicine volunteered to act as online health coaches after they received

training from faculty health professionals. These weekly email contacts, customized to the needs of each participant, further improved the positive impact of the Health Missions. With the addition of health coaching, early drop-outs declined significantly (from 19% to 7%) while participants remained in the Mission 36 per cent longer. Daily exercise levels also increased by nearly 20 per cent. The medical students also benefited from the experience as they learned first-hand the challenges surrounding adopting and maintaining healthy lifestyle habits known to improve both physical and mental health. The upcoming “Mission Zen” will focus on finding balance in one’s life as H we emerge from the pandemic. ■ JULY 2021 HOSPITAL NEWS 7

NEWS

Mental health and substance use

during the COVID-19 Pandemic: Implications for healthcare By Mary Bartram and Robert Gabrys ccording to an on-going series of surveys being led by the Mental Health Commission of Canada (MHCC) and the Canadian Centre on Substance Use and Addiction (CCSA), the mental health and substance use impacts of the COVID-19 pandemic have been profound, and profoundly interrelated. So far, the survey series has highlighted the disproportionate impact of COVID-19 on people with a history of mental illness or substance use disorders, women living with younger children and people living alone. The healthcare system has a critical role to play in stepping up everything from screening and referral, to expanded access to treatment, to mental health and substance use supports for healthcare providers. Since this series started in the Fall of 2020, respondents have been reporting significant mental health concerns at much higher rates than before the pandemic. For example, only 40 per cent of people surveyed reported very good to excellent mental health, compared to 67 per cent in a 2019 survey conducted by Statistics Canada. Anxiety and depression are also being more commonly reported now compared to previous years. Since October 2020, 15 per cent of respondents said that they were experiencing moderately severe to severe symptoms of depression and 25 per cent indicated moderate to severe symptoms of anxiety (increasing to 37 per cent of women living with young children). In March 2021, 25 per cent of respondents who have previously been diagnosed with a substance use disorder reported seriously contemplating suicide in the past month. The COVID-19 pandemic has also been accompanied by an increase in use of alcohol and of cannabis by a large percentage (30 per cent and 35 per cent, respectively) of people who use these substances. Most striking, people with past and current mental

health concerns have consistently displayed the greatest increase in the use of the substances as well as problematic use, highlighting the close connection between mental health and substance use. Not surprisingly, stress has often been cited as the top reason for the increase in use, although boredom and lack of regular schedule have been also commonly reported. Some experts believe that increased availability and access to alcohol and cannabis, through takeout and delivery services, could have also facilitated changes in patterns of use. While the harms associated with the increase in alcohol and cannabis use have not yet been completely documented, a recent report by the Canadian Institute of Health Information (CIHI), for instance, described an increase in hospitalizations due to alcohol and cannabis during early months of the pandemic. Moreover, 21 per cent and 36 per cent of people who use alcohol and cannabis, respectively, report signs of problematic use. These statistics are higher among those with mental health concerns and those who live alone.

Feelings of stress, anxiety and sadness are normal responses to a very abnormal situation, and access to vaccines and lower rates of COVID-19 infection will be a lift for many. However, persistent anxious, hopeless and depressive states can interfere with various aspects of a person’s life, work, social and family responsibilities, and increase the risk of the development of both mental health and substance use disorders. We can expect the mental health and substance use impacts of the pandemic to be delayed, complex and long-lasting. What role can the health system play in mitigating these impacts? Preventative strategies can play an important role. Now is the time to redouble efforts to include screening, brief interventions, and simple conversations about mental health and substance use as a routine part of healthcare, for everyone from mothers with younger children to people who live alone. Spreading the word about free online resources such as the federal government’s Wellness Together Canada portal could be a great starting point. Now more than ever, it is also

important to disseminate the Low Risk Alcohol Drinking Guidelines and the Lower Risk Cannabis Use Guidelines. Additionally, there is an urgent need to strengthen the capacity of the healthcare system to meet the emerging mental health and substance use needs of the population. Treatment services and supports for mental health and substance use were already under-resourced before the pandemic. The pivot to virtual services has expanded access for some but left others – those without broadband access, a phone plan, or a safe and private place to take a call – even further behind. The incredible strain placed on healthcare providers during the pandemic has left them far from immune from its mental health and substance use impacts. Reducing stigma and promoting psychological health and safety in healthcare settings is more important than ever. To access the full reports, please visit https://www.mentalhealthcommission.ca/English/leger-poll-relationship-between-mental-health-and-subH stance-use-during-covid-19 ■

Mary Bartram PhD is the Director, Mental Health and Substance Use at the Mental Health Commission of Canada and Robert Gabrys PhD is the Research and Policy Analyst at the Canadian Centre on Substance Abuse and Addiction. 8 HOSPITAL NEWS JULY 2021

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SPONSORED CONTENT

Alcon Clareon® intraocular lens with the AutonoMe® delivery system represents an innovative step in Canadian cataract surgery hile the pandemic has impacted the delivery of health care across the country, Alcon has continued to innovate and help doctors provide exceptional vision to patients. It’s why Alcon has been able to introduce the Clareon® intraocular lens (IOL) with the AutonoMe® delivery system, which will be welcome news to ophthalmologists and patient counsellors in Canada. Delivering exceptional clarity that lasts, the two new offerings from Alcon are helping cataract surgery patients get back to seeing and exploring what matters most to them.

ADDING CLAREON® TO THE GROWING MONOFOCAL PORTFOLIO

Monofocal lenses remain the most commonly implanted IOL during cataract surgery at over 80 per cent of all implantations. While monofocal IOLs generally provide clear vision at one distance for patients, their design and manufacturing process also determines how clearly a patient will see after cataract surgery. The new Clareon® IOL adds to Alcon’s expansive portfolio, emerging as an attractive option for its innovative design and benefits.

“A lot of patients have had their cataract surgeries delayed over the last year,” says Dr. Raj Rathee, Chair of the Eye Physicians and Surgeons of Ontario and Ophthalmology Service Chief at North York General Hospital. “We know they are looking to have their vision restored quickly and effectively, so innovation in their lens options means we can provide them with the clearest vision possible.”

‘CUTTING EDGE’ DESIGN OF CLAREON®

“After cataract surgery and implantation of an IOL, patients encounter a wide variety of light sources, including direct, on-axis light sources and off-axis light that enter a patient’s eye from an angle,” says Dr. Rathee. “When off-axis light hits the edge of some optics, it can potentially cause a visual disturbance called a positive dysphotopsia, especially in low light settings.” The advanced design of Clareon® is intended to help reduce the risk of these visual disturbances and provide patients with exceptional clarity after cataract surgery. The fully usable 6mm optic and integrated precision edge design is engineered to help reduce glare and positive dysphotopsias. This ultra-smooth lens, made from a new

BioMaterial, also delivers among the lowest level of glistenings, sub-surface nanoglistenings and surface haze of other monofocal IOLs in the Canadian market.

INNOVATIVE IMPLANTATION WITH THE AUTONOME® DELIVERY SYSTEM

Another innovation from Alcon this year is the AutonoMe® delivery system. This first and only automated, disposable delivery system created for IOL insertion comes pre-loaded with the Clareon® IOL, making it easy for surgeons to insert the IOL directly from the device to the eye with no manual manipulation. The AutonoMe® delivery system has been available in international markets since 2017 and is making its debut in Canada this year. The hand-held AutonoMe® instrument is ergonomically shaped with an optimized speed control lever that enables easy, single-handed control of IOL advancement with linear speed adjustment. It also helps lower wound trauma compared to manually loaded IOL delivery systems. “When we are working to clear patient backlogs and complete

long-awaited cataract surgeries, efficiency and effectiveness is key,” says Dr. Rathee. “Having access to surgical devices preloaded with the latest IOL technologies helps us in the operating room and benefits patients in achieving the best surgical outcomes.” From consultation to procedure, COVID-19 has challenged eyecare professionals across all ends of the patient care spectrum. With rollout of the Clareon® IOL with the AutonoMe® delivery system across Canada, there is good news for patients and the future of cataract surgeries. To learn more about Clareon®and the AutonoMe® delivery system, speak H with your doctor. Q

The Clareon® IOL offers excellent clarity and refractive stability, which may contribute to visual and social rehabilitation for patients after cataract surgery. www.hospitalnews.com

JULY 2021 HOSPITAL NEWS 9

NEWS

Left:Barbara’s arrival at the Mobile Health Unit on April 26th 2021. Right: Barbara in the clinic.

Photo credit: Kevin Van Passen/Sunnybrook Health Sciences Centre

Meet Barbara:

The first patient cared for in Sunnybrook’s Mobile Health Unit By Lindsay Smith arbara Alleyne was the first patient admitted to the Mobile Health Unit (MHU) at Sunnybrook on April 26, 2021. She’d been recovering from COVID-19 at another Toronto hospital, and felt nervous about moving to the MHU. “I was very scared to go,” she says. “You don’t know what to expect.” The MHU was erected in one of the parking lots at Sunnybrook’s Bayview campus during the third wave of the COVID-19 pandemic to help ease pressures on the healthcare system. It is 2,088 square metres and resembles a military field hospital. Barbara says she was a little scared about continuing her COVID-19 recovery in a field hospital, but her fears were short-lived. From the moment she got in the ambulance, she started to feel more at ease. “The ambulance guys were great; they made me very comfortable,” she says. “They brought me over to Sun-

nybrook, and it was a great experience. Everyone was… very inviting.” Barbara says she joked with family and friends that she felt as though she was on the set of the movie E.T., or the TV show M.A.S.H., but the setting didn’t impact the care she received: she says her care team was attentive and upbeat, keeping her spirits up while she was in the MHU. And Barbara’s condition did improve. The care provided by doctors, nurses and other members of the interprofessional team, such as physiotherapists, helped Barbara regain her strength and improve her oxygen levels. But what really stands out to Barbara from her time in the MHU is how her care team went out of their way to make her comfortable. For example, while Barbara was in the MHU she had hot flashes. Without ice available, her nurses had to find another solution to help her cool down. “They took water in water bottles and froze it,” she says. “The nurses

were really resourceful and came up with something for me.” There was even a welcome package with some personal care items, a word search and a colouring book. Barbara says she was a little skeptical of the colouring book and word search at first, but they actually helped her feel a little better. “When I started doing the word search and the colouring, I calmed down to a point where I could breathe normally,” she says, adding she has continued the colouring at home because it has been so calming for her. Doris Ho, a registered nurse who has worked for Sunnybrook since 2016, says those kinds of gestures can make patients more comfortable, especially in a unique setting. “It’s just getting creative with your resources,” she says. “That’s one way for us to try and make it better.” The quality of patient care is a testament to the team of people working in the MHU, Doris says.

“The team’s been really good. Everyone’s so helpful,” she says. “It’s a team effort.” And, to Barbara, the teamwork and commitment to patient care were evident. “They did a great job,” she says. “Their job is so important to what’s going on in the world right now, and they’re the bravest people I know.” Barbara is home now and while she is still battling some symptoms, she continues to improve. And she’s grateful for her care team at Sunnybrook and the role they played in her COVID-19 recovery process. “I thank them for taking care of me and just keeping my spirits uplifted,” she says. “I just really appreciate them helping me to get better.” With a recovering health-care system, operations within the Mobile Health Unit winded down over the Victoria Day weekend and no patients are currently in the unit. The facility will be maintained for the foreseeable future, and should the need arise, H MHU teams will be mobilized. ■

Lindsay Smith is a communications advisor at Sunnybrook Health Sciences Centre. 10 HOSPITAL NEWS JULY 2021

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NEWS

Researchers develop promising ‘super molecule’ that boosts viral neutralization against COVID-19 By Jessamine Luck research team led by The Hospital for Sick Children (SickKids) has developed a ‘super molecule’ that combines potent antibodies to neutralize SARS-CoV-2, the virus that causes COVID-19. The molecule was shown to have up to 10,000 times more potency compared to conventional antibodies and an ability to address virus variants, important tools in the fight against infectious diseases like COVID-19. This promising research is now being taken from the lab into pre-clinical development. The study was published in Nature Communications on June 16, 2021. Since the onset of the pandemic, studies around the world have focused on using monoclonal antibodies – immune proteins typically originating from humans that can be produced at large scale in the lab – to target the spike protein of SARS-CoV-2. Led by Dr. Jean-Philippe Julien, the study team set out to understand whether a combination of multiple antibodies on a single molecule could boost viral neutralization, the process to stop a virus before it invades a host cell. The researchers used human apoferritin, a protein found naturally in humans and which is biologically inactive, as a scaffold for the molecule. They tested several human-derived antibody sequences in the lab to see which combinations most effectively neutralized a broad range of SARS-CoV-2 variants. The result was a single molecule that targets three sites of vulnerability on the spike protein and increases the neutralization potency of parent antibodies by ~1,000 to 10,000-fold. “To our knowledge, this is one of the most potent antibody molecules developed to date against SARSCoV-2. We showed that we could use the power of multiple specificities stitched together on a single molecule to create broadly acting, ultrapotent neutralizers that are able to also address the virus as it mutates. This could radically reshape the way we

sure points on the virus,” says Julien, who is also an Associate Professor in the Departments of Biochemistry and Immunology at University of Toronto, and a Canada Research Chair in Structural Immunology.

WHY POTENCY MATTERS IN THE RACE TO DEVELOP NEW THERAPIES

Photo courtesy of the Hospital for Sick Children.

approach treating mutating infectious diseases like COVID-19 in the future – before the next pandemic hits,” says Julien, a Senior Scientist in the Molecular Medicine program at SickKids.

USING A SCAFFOLD PLATFORM TO DELIVER POTENT ANTIBODIES

The Multabody (MULTi-specific, multi-Affinity antiBODY) platform used to develop the molecule is designed to simultaneously target multiple sites on a pathogen to effectively deliver antibodies. Through bioengineering, the team was able to load and deliver more antibodies at one time on the molecule. The platform technology developed by Julien and Dr. Bebhinn Treanor, Associate Professor at the University of Toronto, emerged from years of research on other infectious diseases such as HIV, and was based on discoveries in the 1990s that showed how a

highly mutating virus is significantly weakened when at least three critical sites of the virus are therapeutically targeted at once. When the pandemic hit in 2020, Julien mobilized his lab, colleagues and infrastructure at SickKids to test the platform against COVID-19, screening a range of human-derived, SARSCoV-2 specific antibodies, including some provided by Distributed Bio, now Charles River Laboratories, a research biotechnology partner. “Broadly neutralizing antibodies are rare and difficult to find. We developed a platform that can rapidly leverage antibodies emerging from early discovery efforts into best-in-class therapeutics. With the ability to combine multiple antibodies, one molecule can then attack three sites of vulnerability and only needs a small amount – we’re talking picograms – to be effective. Essentially, we can combine the right antibodies to hit the right pres-

While historically monoclonal antibodies have been used for immunotherapy against infectious diseases, development of such therapies can take years. In that time, a virus can mutate, meaning existing therapies and vaccines may not be as effective over time as new variants emerge. This study shows how higher potency molecules work better against viral mutations. While SARS-CoV-2 has so far shown lower viral diversity when compared to a virus like HIV-1, meaning SARS-CoV-2 variants are not as significantly different from each other, the tri-specific and potent design of the MB platform is already built to handle future virus variants that may emerge. “By using a technology with plugand-play features that allow for the development of a rapid, highly potent and broadly-acting molecule, you can spend less time discovering therapies and reach more people faster, which as we’ve seen is extremely important during a pandemic and in preparing for future pandemics,” says Julien. The next steps for the research are focusing on rapid pre-clinical development to demonstrate the therapeutic potential, supported by a Bill & Melinda Gates Foundation grant. This study was supported by the Ontario COVID-19 Research Fund, Natural Sciences and Engineering Research Council of Canada (NSERC), Canadian Institutes of Health Research, SickKids Foundation, Anke & Kirk Simpson, Christian & Jennifer Lassonde, and infrastructure supported by the Canada Foundation for Innovation H and Ontario Research Fund.■

Jessamine Luck is a communications advisor at The Hospital for Sick Children. 12 HOSPITAL NEWS JULY 2021

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NEWS

Study to examine health impacts of the COVID-19 pandemic for mothers and their new babies By Celine Zadorsky he COVID-19 pandemic has drastically altered many people’s lifestyles. Parents may be working from home, providing additional childcare or experiencing social isolation. Some are dealing with decreased work hours and loss of employment. With all these factors at hand, a team of researchers from Lawson Health Research Institute and Western University are investigating the possible health impacts on mothers and their babies who were born or will be born during the pandemic. “This has been a stressful and pivotal time for everyone in the world, but we know the post-partum experience can greatly affect both the birthing person and their baby, in the short and long term,” says Dr. Genevieve Eastabrook, Associate Scientist at Lawson and Assistant Professor at Western’s Schulich School of Medicine & Dentistry. “We know perceived stress in the perinatal period may have a contribution

to health later in life for the birthing person and their children in terms of overall cardiovascular and metabolic health, bonding experiences, and risk of mood disorders.” Dr. Eastabrook is also an obstetrician-gynecologist (OBGYN) at London Health Sciences Centre (LHSC). As part of the new study, the London research team is using an approach called ‘One Health’ which offers a holistic perspective to explore how various risk factors and social determinants of health interact to affect health. This is being studied through the Department of Pathology and Laboratory Medicine at Western. “It’s important for us to think of the environment as all of our surroundings, including the things around us like health care, grocery stores, education and employment,” says Mei Yuan, MSc research student at Schulich Medicine & Dentistry. “The purpose of this study is to look at the pandemic response rather than the pandemic it-

self. We know that even if women haven’t been infected with COVID-19, it doesn’t mean they haven’t been impacted.” Study participants are asked to complete a 30-minute questionnaire at around 6-12 weeks after their delivery. The questionnaire focuses on perceived stress, postpartum depressive symptoms, perceived social support, the impact of COVID-19, healthcare access and breastfeeding. Data from the questionnaire will be linked with participants’ medical records to look for associations between the various factors and pregnancy outcomes. “Even though the study is mainly focused on maternal health, studies have shown that once mental health is affected it really does impact the infant’s health, especially in the area of attachment between baby and caregivers,” explains Yuan. Data from the study will be compared to the Maternity Experiences Survey, a national survey of Canadi-

an women compiled in 2007 which looked at experience, perception, knowledge and practice during pregnancy, birth and the early months of parenthood. “The unique aspect here is that we have a comparative group using a historic cohort to see whether or not there are differences in markers that increase risk of depression, perceived stress and lack of social support,” adds Dr. Eastabrook. “We will also look at some unique things from the pandemic, such as how the use of virtual care for antenatal, postpartum and baby care impacted people’s experiences.” The research team hopes to recruit 300 mothers for this study who have given birth at LHSC, specifically during the pandemic. Interested participants can email the Pregnancy Research Group at pregres@uwo.ca. Once all the data is collected the goal will be to use the findings to improve post-partum care for mothers and their H babies within this population group. ■

Celine Zadorsky works in Communications & External Relations, Lawson Health Research. www.hospitalnews.com

JULY 2021 HOSPITAL NEWS 13

EVIDENCE MATTERS

What we know about new technologies for managing diabetes (and don’t) By Sarah Garland 021 marks the 100th anniversary of the discovery of insulin. As Canada reflects on this discovery and commemorates this milestone, it’s important to consider the future of diabetes management and highlight new research. CADTH – an independent agency that finds, assesses, and summarizes the research on drugs, medical devices, tests, and procedures – has conducted several reviews of diabetes technologies, most recently on systems for monitoring blood glucose and delivering insulin.

HYBRID CLOSED-LOOP INSULIN DELIVERY SYSTEMS FOR PEOPLE WITH TYPE 1 DIABETES

Hybrid closed-loop systems consist of an insulin pump, a continuous glucose monitor, and a computer program that allows the pump and the monitor to communicate with each other and automatically calculate how much insulin is needed. It’s considered a hybrid system since the user still has to manually account for their insulin needs before eating and then manually confirm the amount of mealtime (bolus) insulin to be delivered. CADTH conducted a health technology assessment to compare hybrid closed-loop systems with other insulin delivery methods in people with type 1 diabetes. CADTH found that these systems generally increase the amount of time a person is in their target blood glucose ranges compared with other insulin delivery methods. At least, this appears to be the case in the short term, for up to six months – there haven’t been any studies following research participants for longer than that. There also wasn’t research available to tell us which people with type 1 diabetes might benefit the most from hybrid closed-loop systems. For people with diabetes and their caregivers, hybrid closed-loop systems can decrease the amount of time and

energy spent on diabetes management. That means they can spend more time on other activities since the system can relieve some of the demands of monitoring blood glucose and technical tasks (i.e., calculating insulin needs). However, it takes time to develop trust in the system and adapt to new routines, and people may experience technical glitches and other technical issues (e.g., system maintenance). Trial periods to ensure hybrid closedloop systems are working well for new users could be considered. In addition, education, support, user-friendly devices, and understandable information are key to helping new users learn to use these systems effectively.

CADTH summarized and critically appraised the evidence on flash glucose monitoring in children and adolescents. The majority of studies suggest that, when compared with self-monitoring blood glucose techniques, flash glucose monitoring may improve some outcomes for this population group – mainly quality of life, patient satisfaction, and confidence with testing. But the evidence was mixed on clinical outcomes such as hemoglobin A1C (a biomarker for diabetes), amount of time in the target blood glucose range, and side effects – some studies found that flash glucose monitoring was associated with improved outcomes, while others found no association.

FLASH GLUCOSE MONITORING SYSTEMS IN PEDIATRIC POPULATIONS WITH DIABETES

FLASH GLUCOSE MONITORING AND CONTINUOUS GLUCOSE MONITORING FOR PEOPLE WITH DIABETES IN ACUTE CARE SETTINGS

Flash glucose monitoring systems involve a sensor inserted into a person’s skin that continuously takes blood glucose measurements and stores them for retrieval later on. A person may use flash glucose monitoring to determine their insulin needs and as an alternative or complement to other kinds of blood glucose testing.

To get a sense of the clinical effectiveness and accuracy of flash glucose monitoring and continuous glucose monitoring in acute care settings, including intensive care units, CADTH looked for the available evidence. (Continuous glucose monitoring devices report glucose measurements in real

time.) Most studies found that, when compared with point-of-care blood glucose testing, flash glucose and continuous glucose monitoring increased the amount of time spent in the target glucose range, improved average daily blood glucose levels, and reduced the number of events where blood glucose was too high or too low. However, there were a couple of studies that didn’t find that these systems had a significant impact on these outcomes. The studies were also mixed when it came to the accuracy of flash glucose and continuous glucose monitoring. So, we’re uncertain how accurate they are compared with other methods of testing blood glucose (e.g., by testing arterial, capillary, or biochemical serum). There have been a couple of advantages to flash glucose and continuous glucose monitoring during the COVID-19 pandemic. Use of these systems within the hospital setting has allowed health care workers to minimize their contact with isolated hospitalized patients who need their blood glucose monitored, thereby also reducing the workers’ use of personal protective equipment. These new technologies for monitoring blood glucose and delivering insulin hold promise, though there are still some evidence gaps. Improving the way people with diabetes monitor their blood glucose could both improve their health outcomes and give them more time and mental space to engage in their daily lives. Given how quickly technologies for diabetes management are being developed, who knows how diabetes will be managed after the next 100 years! For more information, you can visit cadth.ca/evidence-bundles/evidence-diabetes-management for the latest evidence on diabetes, including the CADTH reports listed in this article. If you’d like to learn more about CADTH, visit cadth.ca, follow us on Twitter @CADTH_ACMTS, or speak to a Liaison Officer in your reH gion: cadth.ca/Liaison-Officers. ■

Sarah Garland is a knowledge mobilization officer at CADTH. 14 HOSPITAL NEWS JULY 2021

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NEWS

When it comes to diabetes care, language matters By: Dr. Seema Nagpal and Amanda Sterczyk ords matter. Language has impact. It can leave a profound mark on our thoughts, feelings, behaviours and experiences. For people living with diabetes, hearing the wrong language negatively impacts their self-efficacy and well-being. It can also undermine their experiences with the health-care system and their self-care. The language used when communicating with and about people with diabetes contributes to diabetes stigma and stereotyping. Stigmatizing language is often used when talking about diabetes, both by health-care providers and the public. This is in part due to the risk factors of an unhealthy diet, insufficient physical activity, the association with being overweight or obese, and the myth these factors are well within a person’s control. People diagnosed with type 1 diabetes get lumped into this same mythology, adding to the public’s confusion and lack of understanding of diabetes. Other terms and phrases make people living with diabetes feel like they are not trying hard enough or failing to look after themselves. Sadly, it’s been reported some of these inaccuracies are spoken to them by health-care providers. A study on diabetes stigma conducted by the American Diabetes Association concluded that most adults with diabetes (type 1 or type 2) felt stigma associated with their disease. In addition, they perceived this stigma to be associated with uncontrolled diabetes, higher A1C levels, higher BMI, glucose not within target range, depression, and greater therapy intensity. For a person living with diabetes, the use of insensitive language by health-care providers can lead to feelings of shame and guilt and perpetuate a mendacious relationship between health-care providers and the person

receiving care. It can make people feel unwelcome or unsafe. People who are ashamed of their disease will find it much harder to engage with their healthcare team, negatively impacting their physical and mental health outcomes. Language that focuses on “suffering” or “battling” diabetes frames those living with the condition as fundamentally flawed and helpless. The terms “non-compliant” or “adherent” do not consider the fact that life events or financial constraints can impact a person’s ability to manage their blood glucose; diabetes can be unpredictable and given the progressive nature of the disease, it can be harder to keep blood glucose levels within target range over time. Although the language used in the care of those living with diabetes can have damning and negative effects, the good use of language can promote and encourage positivity and, subsequently, better health outcomes. People living with diabetes deserve to be

spoken with and about in ways that are respectful, inclusive and value based. A guide developed by NHS England sets out practical examples of language to encourage positive interactions with people living with diabetes. These examples are based on research and supported by a simple set of principles for good practice for interactions between health-care professionals and people living with diabetes. In 2020, Diabetes Canada released Language Matters – A Diabetes Canada Consensus Statement to facilitate positive and affirming attitudes towards diabetes, reflected using more appropriate language around diabetes. An important facet of creating a positive environment is framing discussions in ways that focus on empowering messages and people’s strengths. When a health-care provider refers to a person’s glucose levels as being “poorly controlled”, the person living with diabetes hears “it’s my fault”. If the wording is switched to refer to glu-

cose levels “outside the target range”, the conversation moves beyond blame and shame. How we use language goes beyond caring for people with diabetes. A recent paper in The Lancet explored the importance of language in decolonizing global health. The terminology used in referring to global health challenges, writing research questions, papers, teaching students, working with research participants and the public can help shift the power dynamic in a positive way. Diabetes Canada hopes greater attention will be given to the language used when speaking of diabetes, and in turn, contribute to enhancing public understanding of diabetes, its complications, decreasing the stigma, stereotypes and prejudices associated with it. This will contribute to improving the mental, emotional and physical wellbeing of the nearly 11.5 million Canadians living with diabetes and H prediabetes. ■

Dr. Seema Nagpal, Ph.D. is Vice President of Science & Policy for Diabetes Canada. She has expertise in population health, epidemiology, and pharmaceutical sciences with an emphasis on interpretation of science into policy and practice. Amanda Sterczyk, MA, is Manager of Research & Public Policy for Diabetes Canada. She has a background in health promotion research and has been a primary caregiver to her daughter with type 1 diabetes since 2011. 16 HOSPITAL NEWS JULY 2021

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NEWS

Reconnecting diabetes patients and health-care providers during the shadow pandemic of chronic disease By Ann Besner OVID-19 has had a monumental effect on the health-care system since the pandemic was declared well over a year ago. Access to all levels of care has been significantly disrupted, with many services still far from operating as usual. People’s reticence to access the health-care system for non-COVID-related care has been evident over time. Across the country, emergency department visits dramatically declined by nearly 25,000 a day last spring. In Manitoba, Ontario and Nova Scotia, there was a decrease of 13 to 33 per cent in patient visits to all types of physicians between March and June 2020. Of people clinically diagnosed with a chronic disease who participated in a national survey, 38 per cent reported avoiding the healthcare system altogether. Patients can hardly be blamed for ‘disappearing’ from the system– it has been a very confusing and frightening time for people. Whether it’s because they have been trying to abide by public health regulations to stay home, they are concerned about the possibility of contracting COVID in their doctor’s waiting room or they are reluctant to further burden an overtaxed system, huge numbers of patients have stayed away from hospitals and medical practices during the pandemic. This has resulted in their health essentially being put on hold. But the pandemic hasn’t made chronic diseases disappear. In fact, it has caused certain aspects of management to be much more difficult for many people, including those with diabetes. Under normal circumstances, people with diabetes have a higher risk of a host of health issues from heart disease to major depressive disorder, and an all-cause mortality rate twice that of those not living with diabetes. Now, the pandemic has resulted in access to care challenges and delays in treatment that are contributing to the

worsening of Canadians’ physical and mental health.

PATIENTS MUST BE EMPOWERED TO RECLAIM SPACE IN THE HEALTH-CARE SYSTEM

People with chronic disease require support with their management. And they need to know that it is okay to reclaim their place in the health-care system. Not only is it acceptable and safe to do so, it is important for good health. Those living with diabetes should be seeing their health-care team on a regular basis for check-ins, routine blood work and important diabetes tests. When these visits go by the wayside, there is a risk that diabetes management can get off-track or that problems may not be identified and addressed in a timely manner. This can lead to short- and long-term complications and poorer health outcomes. Diabetes Canada urges people living with diabetes to prioritize their health

and resume their regular diabetes visits. People experiencing difficulty with their management should follow up with their team as soon as possible to book an appointment. Those who have not been seen in awhile who feel their diabetes is well-managed at present are still strongly encouraged to schedule a non-urgent visit to reconnect.

VIRTUAL CARE IMPROVES ACCESS TO SERVICES AND SUPPORTS ACROSS MANY POPULATIONS

A lot of care is happening virtually these days. The shift in delivery model happened quite rapidly in the first wave of the pandemic; by April 2020, 52 per cent of care was being conducted through the phone or online. Over the course of the last year, a number of medical practices have adopted a hybrid model of care, wherein certain visits still occur in-person at the clinic, but others are conducted vir-

tually, whether by phone, video chat or secure messaging. There is research to suggest that a hybrid model of care “may lessen the impact of public health measures required to prevent the spread of COVID-19 on chronic disease outcomes, and close health equity gaps in the long term.” Many patients have come to appreciate and embrace virtual care. In a survey of people living with diabetes conducted by Diabetes Canada in June 2020, patients overwhelmingly reported enjoying virtual visits. They found it a convenient way to access their providers and most even said they would prefer more virtual visits in future after COVID ends. To facilitate the continued transition to virtual diabetes care and increase patients’ comfort with this type of interaction, which is new and different for many, Diabetes Canada has developed a variety of educational resources that are accessible online. A number of other health charities, advocacy groups and medical professional associations have also assembled useful online tools and materials on their own sites to help patients and practitioners learn more about, and adapt to, virtual models of care.

CHRONIC DISEASE CARE IS ESSENTIAL TO A HEALTHY POPULATION, IN COVID TIMES AND BEYOND

Welcoming people back to care, whether in-person, virtual or some combination of the two, and inviting them to re-establish a relationship with their health-care team will go a long way to mitigating some of the long-term negative impacts of the pandemic on Canadians with chronic disease. Diabetes care matters and should be optimized to allow people to live their best lives, during COVID and far H into the future. ■

Ann Besner is a Registered Dietitian and the Manager of Research and Public Policy with Diabetes Canada. Her areas of expertise include chronic disease prevention and management specializing in diabetes, health and nutrition policy development and analysis, person-centred care and Canadian healthcare systems improvement. 18 HOSPITAL NEWS JULY 2021

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NEWS

Muskoka residents now receive ‘gold standard’ of advanced cardiac care ason Mahon, 48, and Joan Harvey, 71, have never met and yet they share something in common. They are both residents of Sundridge, Ontario, and were among the first people from north of Muskoka to receive the ‘gold standard’ of cardiac care thanks to an important new heart attack process called the Simcoe Muskoka Code STEMI Protocol. With this protocol, residents with heart attack symptoms who present to Muskoka Algonquin Healthcare (MAHC) Emergency Departments in either Bracebridge or Huntsville, or who call 911 may now be transported by paramedics directly to Royal Victoria Regional Health Centre (RVH) in Barrie for their lifesaving treatment. This ‘gold standard’ of care is achieved when a patient receives advanced cardiac care in less than 120 minutes from first medical contact. Mahon admits he was having second thoughts about calling 911 after experiencing chest discomfort and heartburn, simply because he’s a ‘private guy’. “I called anyway, because

Jason Mahon, 48, will soon be back dirt biking with his son Luke, after receiving lifesaving cardiac care thanks to a new heart attack process called the Simcoe Muskoka Code STEMI Protocol. in the back of my mind I knew I was having a heart attack.” His suspicion was confirmed by the paramedics, who took him to MAHC’s Huntsville site, where the highly-skilled Emergency Department team activated the Code STEMI protocol, facilitating the transfer to RVH, where the cardiac team was waiting for him. Within minutes of arriving at RVH, Mahon was in the Cardiac Intervention Unit (CIU)

undergoing an angioplasty procedure under the care of RVH interventional cardiologist, Dr. Tony Lee. “The Hunstville team relieved all my fears and gave me confidence in the next step of my care and the RVH team were like, ‘synchronized swimmers’, working as one efficient team. My experience has left me knowing that I was in the trusted hands of everyone in the system – paramedics, nurses and physicians – from South River to Barrie,” says Mahon. Following his procedure, Dr. Sanjay Jindal, received Mahon back to MAHC’s Huntsville site and discharged him home three days later. “Having access to this specialized cardiac care closer to home is going to be a great advantage to those residents of Muskoka who present with heart attacks. It’s a game changer and made possible through a partnership between RVH, County of Simcoe Paramedic Services, Rama Paramedic Service, Muskoka Paramedic Services and area hospitals,” says Dr. Jindal. Joan Harvey’s cardiac experience mirrored Mahon’s.

“Despite the fact I still can’t believe I had a heart attack, my entire experience beginning with the paramedics, to the nurses, and doctors in Huntsville right to the CIU at RVH, was quick and efficient, with very compassionate care,” says Harvey. Dr. Anthony Duarte, Harvey’s attending physician at MAHC’s Huntsville site, says, “The Code STEMI went very well, as smooth as butter. The interventional cardiologist at RVH was quick to respond and accept the patient, meanwhile the team managing the patient at HDMH was able to expeditiously execute their role in the protocol.” It is important to know the signs of a heart attack: chest pressure, sweating, neck and jaw discomfort, nausea, shortness of breath or lightheadedness. Mahon and Harvey both have the same words of advice for anyone who thinks they may be having a heart attack, “Call 911, don’t be afraid or hesitant, call for help! It could save your H life.” ■

Enhancing cardiac rehab for women ithin weeks of COVID-19 being declared a pandemic, cardiac rehabilitation (CR) programs around the world suspended in-person services due to social distancing measures put in place to help flatten the curve. Considering the unprecedented disruption to the delivery of traditional CR delivered at hospitals and other health care settings, CR has ‘gone virtual’ by shifting to home-based programs that make use of communication technologies – including phone and videoconferencing, email, smartphone apps and wearable fitness tech – to facilitate the continuum of care for patients with cardiovascular disease (CVD). The problem is, while CR programs are an effective, multidisciplinary, and proven secondary prevention strategy to optimize cardiovascular health,

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COVID-19 has exacerbated gender inequalities – amid the pandemic, the rapid shift to virtual CR has presented unique challenges to women with CVD. “Cardiovascular disease is a leading cause of death among Canadian women,” says Dr. Carley O’Neill, a postdoctoral research fellow working in the Exercise Physiology and Cardiovascular Health Laboratory directed by Dr. Jennifer Reed at the University of Ottawa Heart Institute (UOHI). “Exercise improves physical and mental health and CVD management. Unfortunately, during the pandemic, women have been experiencing an increase in caregiving responsibilities, job insecurities, and domestic violence, impacting their ability to prioritize their health.” In a recently published paper appearing in the April 2021 issue of

Applied Physiology, Nutrition, and Metabolism, Dr. O’Neill and her fellow researchers highlight women with CVD frequently also have a greater number of modifiable risk factors, such as physical inactivity, stress and anxiety, leading to worse physical and mental health compared to men. Moreover, the various social, economic, ethnic, and political inequalities women experience further increase their risk of CVD. To increase exercise participation among women with CVD in all communities during the pandemic and over the long-term, the research of Dr. O’Neill and her colleagues reveals virtual exercise programs must be feasible, flexible and fun, reflecting basic needs and strategies, including the following: Social – Include a friend, partner, or family member to promote social interactions.

Time – Split up longer sessions into shorter ones and keep workout structures flexible. Variety – Include several options (e.g., walking, aerobic dancing, resistance training, online fitness classes) allowing women to choose the exercise most enjoyable for them. Behaviour change – Use an exercise diary or tracker to set small and achievable goals, increase motivation, and remain active long-term. Insurance – Cover home-based cardiac rehabilitation. “Women comprise a large proportion of essential workers who are ensuring access to essential supplies and services throughout the pandemic,” adds Dr. O’Neill. “Combined with their heightened caregiving responsibilities and financial instability, women are also predisposed to burnout and H psychological distress.” ■ JULY 2021 HOSPITAL NEWS 19

SAFE MEDICATION

Hypoglycemia management in patients with diabetes By Stephanie Lau, Andrew Tu, and Certina Ho t the senior home this morning, Marie noticed that her hands were shaking more than usual. She just thought her Parkinson’s was getting worse today, but she progressively felt more lightheaded. When the nurses came to assist for her daily walk, they found her collapsed by the foot of her bed. Marie was immediately transferred to the closest hospital and her admitting diagnosis was determined to be hypoglycemia, which was likely caused by the insulin therapy that she used to manage her diabetes. Hypoglycemia is defined as low blood glucose levels of less than 4 mmol/L for patients with diabetes being treated with either insulin or an insulin secretagogue (i.e. medications that help our body make and release insulin); while normal fasting blood glucose (FBG) levels are within 4-7 mmol/L. Patients can measure their blood glucose levels tthrough the use of a self monitoring device (e.g. together with the use of blood glucose test strips) that can be purchased from any pharmacy. The effects of hypoglycemia can be severe and potentially fatal if untreated; therefore, timely and quick recognition and management of hypoglycemia are critical to improve patient safety and outcome.

on hypoglycemia management. Populations at greatest risk of hypoglycemia include patients with diabetes who use certain types of anti-diabetic medications (such as insulin and sulfonylureas) as well as those who exercise a lot, consume alcohol, undergo fasting, or have renal impairment.

RECOGNIZING HYPOGLYCEMIA: SIGNS AND SYMPTOMS

In the above case scenario, we saw Marie experiencing some signs of hypoglycemia, such as shakiness, lightheadedness, dizziness, and eventual unconsciousness, but other symptoms of hypoglycemia may include hunger, poor concentration, confusion, irritability, sweating, and increased heart rate, as well as more severe effects such as seizures, coma, and death if untreated. Since the effects of hypoglycemia

MANAGING HYPOGLYCEMIA

“Rule of 15” If a patient is experiencing symptoms of hypoglycemia, it is important to measure the blood glucose levels immediately. If the reading is less than 4 mmol/L (and as mentioned above, our target FBG is 4-7 mmol/L), the “Rule of 15” should be employed immediately (Figure 1). If the patient is unconscious and unable to take anything orally (i.e. by mouth), glucagon may be needed. Glucagon is a regulatory hormone that can rapidly increase blood glucose levels in our body. It is available as an subcutaneous, intramuscular, or intravenous injection;

and it is also available as an intranasal spray.

“FIVE TO DRIVE”

Use the “Five to Drive” rule for safe driving: Ensure your FBG is at least 5 mmol/L for at least 40 to 60 minutes prior to driving. If your blood glucose is below 4 mmol/L, apply the “Rule of 15” (Figure 1). If you plan to drive for a long period of time, it is best to take FBG readings every 4 hours to ensure driving is safe and appropriate. Having regular meals, snacks, and taking breaks during a long driving trip may also help. (For further information regarding diabetes and driving, refer to the 2018 Diabetes Canada Clinical Practice Guidelines: Diabetes and Driving, available at http://guidelines. diabetes.ca/cpg/chapter21.) For further information on diabetes and hypoglycemia management, refer to the full 2018 Diabetes Canada Clinical Practice Guidelines along with the 2020 Updates at http://guidelines.diaH betes.ca/cpg. ■

Other Lifestyle Considerations: Alcohol and Exercise Figure 1. Management of Hypoglycemia: “Rule of 15” are rapid, it is, therefore, often considered a medical emergency. (For further information regarding signs and symptoms of hypoglycemia, refer to the 2018 Diabetes Canada Clinical Practice Guidelines: Hypoglycemia, available at http://guidelines.diabetes. ca/cpg/chapter14#sec5)

POPULATIONS AT RISK

In addition to the potentially severe consequences of hypoglycemia, the increasing prevalence of populations at risk of diabetes further demonstrate the need for awareness and education

Alcohol Consumption

Physical Activity

• Alcohol can impair the liver from releasing glucose into the blood, and this effect may last up to 24 hours after alcohol consumption.

• Exercise consumes glucose and can lower blood glucose levels.

• Consuming food or having a meal with alcohol can help prevent hypoglycemia by providing a source of sugar.

• Avoid exercise immediately after insulin administration. Careful timing of meals and insulin with exercise is necessary to avoid hypoglycemia episodes. • Monitor FBG before and after exercise. For prolonged exercise, it is best to measure FBG during exercise and adjust insulin doses accordingly. Apply the “Rule of 15” (Figure 1) to ensure safe engagement (or re-engagement) in physical activities.

Stephanie Lau and Andrew Tu are PharmD Students at the Leslie Dan Faculty of Pharmacy, University of Toronto; and Certina Ho is an Assistant Professor at the Department of Psychiatry and Leslie Dan Faculty of Pharmacy, University of Toronto. 20 HOSPITAL NEWS JULY 2021

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How do we stop the most devastating outcome of diabetes and poor circulation? By Ana Gajic r. Charles de Mestral was drawn to vascular surgery because it offered him the opportunity to directly treat a patient’s health concern through an invasive intervention and also advise patients on how to prevent complications of vascular disease. “As vascular surgeons, we’re part of treating the problem when it happens, but also looking at how to prevent it from ever happening.” says Dr. de Mestral, of St. Michael’s Hospital of Unity Health Toronto. In his medical practice, Dr. de Mestral saw a devastating pattern repeat itself: many people with diabetes and poor circulation – known as peripheral arterial disease – got to a point in their journey where they had to have their leg amputated due to their disease. The most frustrating part, he said, was the fact that with the right preventative care, these patients’ limbs and by extension, quality of life could be saved. Dr. de Mestral, a scientist at Li Ka Shing Knowledge Institute, set out to study how access and use of health care services impacted amputation rates. “We’ve been heavy on anecdotal evidence and we know there’s a problem, but it’s not that easy to lay out data around it – and that’s what my research has aimed to do.” In Ontario, five people lose a leg to diabetes and poor circulation every day

and that number is rising. Fortunately, four out of every five can be prevented with the right type of care, such as frequent foot checks for wounds, foot assessments by a trained health care provider, and prompt evaluation of foot wound infections. To understand how access to healthcare impacts amputation rates, Dr. de Mestral and his team identified 11,658 patients with lower extremity amputation in Ontario. Their research, published last year in CMAJ Open, found that in areas where there were assessments done by vascular surgeons and where procedures to restore blood flow were performed more frequently had less amputation. In particular, rural Northern Ontario areas had the highest rates of amputation, and areas in more urban settings had lower rates. Dr. de Mestral attributes that to the fact that disparities in community prevention and access to expertise in limb salvage. The reality is, however, that gaps exist throughout the system. “To prevent amputation, many layers of care are needed,” Dr. de Mestral says. “Irrespective of where you are in the process, we know there are gaps in preventative care and what my research is trying to do is begin describing the current context of care and what works well in the real-world.” This study is part of a greater body of work that first documents the burden of disease and identifies who’s at

Dr. Charles de Mestral greatest risk of losing a leg. With this information, researchers can begin to understand who’s at greatest risk of not receiving the right type of preventative care so that they can then come up with regional solutions that have targeted initiatives to address amputation prevention. “Amputation is the most feared complication for people with poor circulation,” Dr. de Mestral says. “It has impacts on a person’s mobility, their financial situation, their family members who have to help care for basics of daily living, and their overall quality of life. Sadly, I see this outcome on a weekly basis.”

No one person is responsible for reducing amputations – it takes a team of primary care providers, chiropodists/podiatrists, medical specialists and surgeons. Ideally, Dr. de Mestral said each Ontarian would have access to a team of people to help them with a foot problem. “I’m sitting on the prevention side and the treatment side – that’s not always the case depending on the field of medicine you’re in. In this field, the successes are so motivating because you’ve prevented the most feared complication of this H disease.” ■

Ana Gajic is a senior communications advisor at Unity Health Toronto.

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JULY 2021 HOSPITAL NEWS 21

COVER

Bringing

reconciliation into healthcare By Bob Parke n the last weeks and days, we have been made aware of the painful and tragic truth of what has happened at residential schools. We were informed of the finding of 215 unmarked graves in Kamloops and more recently about the 751 unmarked graves found at the Marieval Residential School in Saskatchewan. In the weeks and months to come the locations of more unmarked graves will be identified. We grieve for the multiple losses experienced by members of our Indigenous communities. Losses not only of pre-

22 HOSPITAL NEWS JULY 2021

cious lives but of language and culture. For survivors of the residential schools there is a trauma that is part of their lives and the lives of generations that follow. Changing laws to ensure culturally safe practices may seem like a daunting task, but we need to begin speaking with policy makers, teachers of healthcare professionals, healthcare executives, and with members of the law profession in order to make this change. Trauma that has taken a toll on their physical and emotional well-being. As healthcare professionals it may feel overwhelming thinking about what to do in response to the history

and tragedies experienced by our Indigenous peoples. I believe that most of us in healthcare want to make a difference to the healing and reconciliation that is so necessary. The best starting point is to review the recommendations of the Truth and Reconciliation Commission. In the “Call to Action” there are recommendations that address “health.” We can become familiar with those recommendations and share them with those in our spheres of influence. If in partnership with Indigenous people we meaningfully begin addressing the recommendations of the Truth and Reconciliation Commission, we will be healers

who provide safe and inclusive care that is culturally safe for all involved. In this context we are rightfully being asked to participate in fulfilling reconciliation with our Indigenous peoples, acknowledge racism, and to meaningfully integrate diversity and inclusion into healthcare. These are positive and important goals to strive towards if we want to provide a just health-care system and ensure that our practices are culturally safe. To be more inclusive and address injustices, our health laws (which affect our practice) need to adapt to current knowledge and societal changes: Specifically, Ontario’s Health Care Consent www.hospitalnews.com

COVER Act, (HCCA) which has remained stagnate since its implementation in the 1990s. A law built on the foundation of white, Anglo-European philosophers who placed a high value on autonomy. While the HCCA upholds the value of autonomy, it does not reflect the reality of most people’s lived experience where decisions are made in relationship to others. Although respecting the dignity and worth of each person is important, our teaching and application of health laws has created situations in which culturally unsafe practices take place. Sometimes, on an individual level or in an ad hoc way, we have found ways to accommodate cultural practices, such as allowing a capable person to defer decision making to another. Doing this may satisfy the immediate needs of a patient and/or family, though those who have strong feelings about the value of autonomy and follow a literal interpretation of the law will challenge that action. Changing laws to ensure culturally safe practices may seem like a daunting task, but we need to begin speaking with policy makers, teachers of healthcare professionals, healthcare executives, and with members of the law profession in order to make this change. We need to make the point that cultural safety must be a priority when we create policies, teach approaches to healthcare, enforce standards of practice within the workplace, and when legal advice and actions are required. As we seek to influence policies, curriculum, and laws, we need to ensure that the right people and voices are at these tables. I am always reminded of the words from members of the disabled community: “If you are not at the table, you are on the menu.” Literally and metaphorically, we need to look around the table to see who is and who is not present. We also need to ensure that the voices we need to hear are not only present but being listened to throughout the process of the work being done. While we wait for new laws to be developed and/or for amendments to current laws, we need to advocate for a nuanced response to health laws so that culturally safe practices are integrated into our present health-care practice. To achieve this, we need to find ways to accommodate culturally safe practice even if it departs from our training in the HCCA. There are several areas of the HCCA which could be critiqued, beginning with the concept www.hospitalnews.com

CHANGING LAWS TO ENSURE CULTURALLY SAFE PRACTICES MAY SEEM LIKE A DAUNTING TASK, BUT WE NEED TO BEGIN SPEAKING WITH POLICY MAKERS, TEACHERS OF HEALTHCARE PROFESSIONALS, HEALTHCARE EXECUTIVES, AND WITH MEMBERS OF THE LAW PROFESSION IN ORDER TO MAKE THIS CHANGE. of who makes health-care decisions. The law is predicated on a view of autonomous capable decision-makers. Yet for many people, decision making is a collective or relational process taking into consideration the family and community context of the person. When one participates in advance care planning, the impact on the person and those in their community (i.e., anyone who might narrowly or broadly be defined as family by the person) are often considered. Also, in the direct process of an immediate treatment decision, the person may want to include others who are not family but who they trust to provide support and advocacy, especially in situations where a person may feel vulnerable due to race, power imbalances, and prejudices. Another specific domain of the HCCA which presents a barrier to culturally safe practice and where accommodation should be made is in the hierarchy of substitute decision-makers (HCCA, sec.20). As it is presently written, taught, and practiced, it serves as a barrier to cultural safety. Recently, I had the pleasure of completing learning modules from Virtual Hospice on the topic of cultural safety with our First Nations peoples in the context of palliative care. This is a learning opportunity I highly recommend. In working through the modules, it reinforced my belief that health laws with a hierarchy of decision-makers do not include opportunities for expanded participation in decision making for people like Chiefs, Elders, Healers, and others who may be wanted on their health care journey. First Nations peoples have historically encountered and continue to encounter racism, prejudice, and physically unsafe as well as culturally unsafe care. Because of these historical injustices, allowing extended participation in care and decision making should be given high priority by health-care staff when working with Indigenous peoples.

Health-care professionals have been taught that we should work with the patient if capable and only with the substitute decision-makers indicated on a hierarchy when the person is incapable. Consequently, while we are compliant with the law, we may often be participating in a culturally unsafe practice. For health-care practitioners who aspire to culturally sensitive practice, this can be extremely uncomfortable and unsatisfying. For persons needing care, we are putting them into a very vulnerable situation.

Recognizing that while I am making some suggestions for changes to practice, I accept that it is and ought to be the person who decides what is culturally safe for them. If we, as healthcare providers, can move beyond the HCCA’s hierarchy of decision-makers and engage differently with those we care for, then we can provide quality care that is safe and satisfying for all. We like to use catch phrases like “patient or person-centred care” but is it patient-centred care if current health laws present barriers to our ability to provide culturally safe practices? In the spirit of reconciliation and to address racial injustice in healthcare, I hope that we can be advocates to amend current health laws to create environments where cultural safety has a greater likelihood of being experienced. If laws cannot easily be changed, then can we nuance our teaching and interpretation of our health laws to be culturally safe and H inclusive until they are? ■

Bob Parke is a bioethicist whose practice has a focus on palliative care. A practice which is inclusive of the person’s culture, tradition and abilities, in order to provide optimal physical, spiritual, social and psychological care.

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NEWS

Using a human protein to treat patients with sepsis By Celine Zadorsky t’s a discovery that has been more than ten years in the making, the use of a human protein to potentially treat patients with sepsis. Lawson Scientist Dr. Qingping Feng noticed that a human protein called annexin A5 showed positive results in mouse models with sepsis back in 2007. Fast forward to now 2021, 14 years later, and this discovery could very well not only be the first ever viable treatment for sepsis patients, but also for severe COVID-19 patients who develop sepsis. “With COVID initially, it is in the airway and then in the lungs, then from there the inflammatory response in fact spreads to

the whole body,” says Feng, Ivey Chair in Molecular Technology at Schulich Medicine & Dentistry. “Sepsis causes major organ dysfunction and carries a high mortality unfortunately.” It has become a challenging issue for Intensive Care Physician at London Health Sciences Centre, Dr. Claudio Martin, who can only do so much to treat severe COVID-19 patients that develop sepsis. “What we have seen is a very primary severe respiratory failure to the lungs for severe COVID patients,” says Dr. Martin, Associate Scientist at Lawson. “We have used steroids and other treatments to try to help, but the results and effects aren’t dramatic and we see patients who have these treatments and still progress and end up in the ICU.”

However, Dr. Feng and his team has found in a pre-clinical study, that annexin A5 can inhibit inflammation and improve organ function and survival when treating sepsis in animal models. Another potentially deadly situation for COVID-19 patients is cell death and blood clots, specifically near the lungs. The good news is that the research team also believes the annexin A5 drug will prevent these complications through the drugs anti-apoptotic (cell death prevention) and anti-coagulant (blood clot prevention) properties. The research team has launched a clinical trial with critically ill COVID-19 patients, using a manufactured form of annexin A5 which was manufactured through a joint partnership with Yabao Pharmaceutical Co,

based in China. The goal is to enroll a total of 60 patients for the clinical trial, and enrollment has already begun. “Patients are receiving standard treatment and then those enrolled will also receive the annexin,” says Dr. Martin. “It’s a placebo blinded clinical trial, so patients will either get a lower dose of annexin, a higher dose of annexin, or a placebo.” If the clinical trial shows promising results, Dr. Feng says the team plans on expanding into a larger phase three trial with not just COVID-19 patients with sepsis, but other sepsis patients as well. “If in fact Annexin A5 is shown to be effective in sepsis, then this will be a huge benefit for society because sepsis is the leading cause of death H worldwide.” ■

Celine Zadorsky is a Communications Consultant at Lawson Health Research Institute.

Canadian first: The Department of Surgery implants a new biological aortic prosthesis he Montreal Heart Institute’s (MHI) surgery department has implanted a new biological aortic prosthesis in a patient, a Canadian first. This cutting-edge medical device reduces the time required for surgery and the risk of complications; thus, patients enjoy a better quality of life. “Patients requiring such surgery are usually under 65 years of age,” says Dr. Philippe Demers, a cardiac surgeon at

24 HOSPITAL NEWS JULY 2021

the MHI. “This new biological prosthesis allows these younger and active patients to maintain their lifestyle, as it does not require them to take anticoagulant medication.”

AORTIC VALVE DISEASES

There are four chambers in the heart, each with a valve to control blood flow. Of these, the aortic valve controls the flow of blood from the left ventricle to the main artery of the

body, the aorta. This valve opens to carry oxygen-rich blood from the heart to the rest of the body and closes to prevent it from flowing backwards and mixing with oxygen-poor blood. Aortic valve diseases occur when the valve in the aorta can no longer open or close properly. Usually caused by a birth defect, infective endocarditis (the inner layers of the heart), aging, or rheumatic fever in childhood, they can lead to heart failure or hypertro-

phy of the heart, which is an increase in the size of the heart.

THE BENTALL PROCEDURE The treatment of aortic valve diseases can be done with medications or medical procedures. Among these, the Bentall procedure is a complex and technical cardiac surgery involving the replacement of the aortic valve and aortic root with a mechanical or biological valve and tube.

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COVID-19 and its unintended consequences on cancer care By Jaimie Roebuck here is no pause button for cancer. We have no ability to postpone, hold or reschedule it for a later date. But COVID-19 forced an abrupt and immediate halt to crucial cancer screening, tests and treatments. With the gradual re-opening of health services, we must prioritize resuming cancer care, as further delays and interruptions could ignite another public health crisis. A survey commissioned in 2020 by the Canadian Cancer Survivor Network revealed that more than half (54 per cent) of Canadian cancer patients, caregivers and those awaiting confirmation of a cancer diagnosis had appointments, tests and treatments postponed and cancelled. Seventy-four per cent said these delays have had a major impact on their mental and emotional health. “I’m concerned that we’re going to lose the great advances we’ve made in being able to catch cancers very early, or even when they’re pre-cancers. We’re going to lose some of that benefit and may experience what many are referring to as a tsunami of cancer, where people are diagnosed at a later

On May 31, 2021, Dr. Philippe Demers performed the first Canadian implantation of Edwards’ KONECT Resilia biological aortic prosthesis, approved by Health Canada earlier on December 18. This medical device is the first to be ready to use, meaning that the tube and valve are already assembled, thus reducing the time and risk associated with surgery. “Since its inception, the Montreal Heart Institute has strived for excellence in specialized patient care,” explains Mélanie La Couture, President and CEO of the MHI. “With that in mind, we strive to make the latest advances in cardiovascular medicine H available to our patients.” ■ www.hospitalnews.com

stage than they would have been,” explains Dr. Aisha Lofters, Chair in Implementation Science at The Peter Gilgan Centre for Women’s Cancers at Women’s College Hospital. “There may be significant consequences that trickle down from these delays.” When the pandemic first began, little was known about COVID-19 and non-essential services, including routine cancer screenings, were put on hold. As restrictions begin to lift, these types of health services must be prioritized. With strict infection prevention and control protocols implemented in healthcare institutions and organizations across the country, the likelihood of virus transmission during a routine cancer screening appointment is very low. It is imperative that people feel comfortable and confident to connect with their primary care providers for screening, testing and treatment appointments.

“It’s our responsibility as physicians to continue reinforcing that it’s safe to come into the hospital or visit a doctor’s office, and then make sure that it truly is safe,” reiterates Dr. Lofters. “We need to resume cancer screening to reap the benefits of catching cancers and pre-cancers early before they cause significant harm. Although we have rightly put a great deal of focus on COVID-19 over the past year, other health problems have not been put on pause.” A year later, COVID-19 has proved its endurance and longevity, triggering safety concerns around in-person doctor visits. These fears are valid and important, but one of the biggest factors to surviving cancer is early detection. Even a small delay can impact prognosis. As the pandemic persists and health services gradually resume, it is critical that Canadians do not hold off on routine screening appointments.

Health care needs, specifically cancer concerns, should not be put aside because of COVID-19 –they are more important now than ever. Cancer patients who experienced a cancellation, disruption or delay with imaging, biopsies, surgery, radiation or chemotherapy must re-book those appointments. Further delays could lead to severe health implications – the longer cancer goes undetected or untreated, the more advanced and difficult it becomes to manage. According to The Canadian Cancer Society, cancer is the leading cause of death in our country and is responsible for 30 per cent of all deaths. Based on 2020 estimates, lung, breast, colorectal and prostate cancer are the most commonly diagnosed types of cancer in Canada, accounting for just under half (48 per cent) of all new cancer cases. But screening can save lives and early detection can increase survival rates. It is important to note that five to 10 per cent of cancers are inherited. Whether or not someone has a family history of this disease, it is essential to reduce risk by finding cancer early through routine screening. COVID-19 triggered a seismic shift, disrupting the way healthcare services are provided in Canada and around the world. But for now, our healthcare system is staying open, and we have to resume proactive and reactive cancer care. Public health messaging must continue to amplify that patient safety during the pandemic is top of mind. Canadians need to feel reassured that coming in for a screening or treatment appointment will not put them in jeopardy, rather, the greater threat to their health would be to wait. To avoid another major public health crisis, it is crucial that previously postponed or cancelled screening and treatment appointments resume – cancer care for Canadians can no lonH ger come at the cost of COVID-19. ■

Jaimie Roebuck is a communications specialist at The Peter Gilgan Centre for Women’s Cancers at Women’s College Hospital. JULY 2021 HOSPITAL NEWS 25

LONG-TERM CARE NEWS

Innovative aging and brain health solutions

by frontline health workers and researchers By Arielle Ricketts ABHI recently selected 24 projects to participate in Spark-ON and SparkCU, subsidiaries of its Spark Program which supports the development of grassroots solutions by frontline healthcare workers and researchers to solve real-world critical care challenges. The Centre for Aging + Brain Health Innovation (CABHI) launched its Spark-ON program just months after COVID-19 was declared a global pandemic. Through Spark-ON, CABHI invited frontline care workers, clinical managers, and clinical researchers to submit an innovative, COVID-19-related idea

EACH PROJECT SHARES A COMMON GOAL: IMPROVING THE QUALITY OF LIFE FOR OLDER ADULTS, PEOPLE LIVING WITH DEMENTIA, AND THEIR CAREGIVERS DURING THE PANDEMIC AND BEYOND. aimed at improving the lives of older adults, persons with dementia, and their care partners. The program was part of CABHI’s rapid response to the pandemic and acknowledged frontline care workers as uniquely positioned to address the needs of Ontario’s older adult population during the current health crisis.

The Spark-ON program is designed to address the current healthcare needs of older adults. The Spark-CU program was launched to help Ontario students – Canada’s future innovators – scale their innovative aging and brain health solutions into businesses. Through Spark-ON and Spark-CU, CABHI will invest close to $1 million

in support of these 24 projects, which range from water intake initiatives to intergenerational learning and digital literacy skills development for older adults. While unique, each project shares a common goal: improving the quality of life for older adults, people living with dementia, and their caregivers during the pandemic and beyond. We’ve listed some of the 24 innovations below:

SPARK-ON: PANDEMIC RESPONSE

Virtual micro-credentialing for unregulated care providers Project Lead: Faith Boutcher

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LONG-TERM CARE NEWS Organization: Baycrest (Toronto, ON) The COVID-19 pandemic has revealed the growing need for education addressing the healthcare of older adults. This project will refine a 12week part-time micro-credentialed certificate designed to teach the basics of geriatric care to unregulated healthcare providers (i.e., healthcare aides, private companions), and assess the benefits and educational outcomes of a virtual 12-week certificate program. The course will be delivered through an established virtual learning platform (ALPHA), which uses a simulated educational environment to foster effective, interactive, and motivated learning. The certificate will blend individual and group work, simulation, and case-based learning, and will offer participants a forum for live discussions with experts. Remote calendar application training for older adults with memory impairment Project Lead: Brandon Vasquez Organization: Baycrest (Toronto, ON) Memory difficulties are common in older adults and can be worsened by a

variety of neurological conditions such as stroke, cardiac arrest, or mild cognitive impairment. Memory impairment can limit independence and social connectedness and increase the po-

tential for loneliness. Baycrest’s Memory Link program involves training memory-impaired individuals to use their smartphone as an external memory aide. The one-of-a-kind training

method, developed at Baycrest, leads to improved day-to-day memory, independent functioning, and quality of life. Continued on page 28

What is Home Care?

Home care is about trust. It is feeling comfortable with a provider ĐŽŵŝŶŐ ŝŶƚŽ ǇŽƵƌ ŚŽŵĞ ĂŶĚ͕ ƉŽƐƐŝďůǇ͕ ĂƐƐŝƐƟŶŐ ǇŽƵ ǁŝƚŚ ƚŚĞ ŵŽƐƚ ŝŶƟŵĂƚĞ ĐĂƌĞ͘ Bayshore’s home care services are extensive and varied, depending on your needs. They ƌĂŶŐĞ ĨƌŽŵ ŵĞĂů ƉƌĞƉĂƌĂƟŽŶ͕ ŵĞĚŝĐĂƟŽŶ ƌĞŵŝŶĚĞƌƐ͕ ĐŽŵƉĂŶŝŽŶƐŚŝƉ Žƌ ĂƐƐŝƐƟŶŐ ǁŝƚŚ errands to nursing, respite care, wound care, ƐĞƌŝŽƵƐ ŝŶũƵƌǇ ĐĂƌĞ͕ Žƌ ƉĂůůŝĂƟǀĞ ĐĂƌĞ͘

Caregivers wear PPE

and follow clinical guidelines to ensure your safety

Home care is personalized for you, so you can experience the best in your day-to-day living – in your own home.

Support is just a phone call away.

1.877.289.3997 clientservice@bayshore.ca

bayshore.ca www.hospitalnews.com

JULY 2021 HOSPITAL NEWS 27

LONG-TERM CARE NEWS Continued from page 27

brain health solutions TO READ ABOUT ALL 24 INNOVATIONS PLEASE VISIT CABHI.COM The current project aims to test our newly developed Memory Link Calendar mobile application in older adults with varying levels of memory dysfunction. The Memory Link Calendar is designed to simplify remote program delivery and dramatically reduce overall training duration, allowing trainers to provide intervention services to a greater volume of clients. Implementing a scalable intergenerational Dementia companions certification program Project Lead: Dean Henderson Organization: Dementia Society of Ottawa & Renfrew County (Ottawa, ON) This project will use the expertise of the Champlain Dementia Network (CDN), a tool designed to help families and healthcare providers find the right type of support for people living with dementia, to train secondary students to become Dementia Champions. As Dementia Champions, students will help support social connectedness among older adults living with dementia. The curriculum will integrate components of existing education modules in an evidence-based format and incorporate individual and group-based online learning. A project coordinator will implement this certification with three high schools and facilitate the matching of students with families needing respite and social engagement opportunities. Advancing community paramedicine practice in response to COVID-19 Project Lead: Amber Hultink Organization: County of Renfrew Paramedic Service (County of Renfrew, ON) Already well situated in the community, paramedics work collabora-

tively with other community partners to help ensure patients receive the services that they require and the high quality in-home and in-community care they deserve. The Community Paramedicine Program aims to help patients in all stages of life (e.g., seniors, persons with disabilities, persons living with chronic disease) remain safely at home, decrease unnecessary 911 calls, decrease emergency room visits and length of stay in hospital, educate and relieve stress for family and caregivers, and improve the quality of life for patients by keeping them actively engaged and informed. During home and community visits, community paramedics can complete a host of healthcare tasks, including fall risk assessments, medication management and administration, and blood work. VRx@Home: Evaluating the impact of immersive Virtual Reality therapy on the wellbeing of caregivers and people with dementia living at home Project Lead: Lora Appel Organization: OpenLab, University Health Network (Toronto, ON) This project team is designing and rigorously evaluating the first Virtual Reality (VR) therapy program for people with Alzheimer’s/dementia (PwAD) living at home, administered by their informal caregivers. VR therapy is a drug-free approach to reducing symptoms of Alzheimer’s/ dementia such as apathy, feelings of loneliness, sundowning, and the use of harmful sedating medications. Caregivers of PwAD are more likely to feel worried, tired, overwhelmed, and depressed than non-PwAD caregivers. Managing symptoms may help PwAD remain in their home for longer and improve quality of life for them and

their caregivers. VR therapy also has the potential to reduce the healthcare needs of caregivers, allowing them to continue providing support to PwAD. This project will measure the impact of VR therapy in a randomized controlled trial assessing its feasibility, sustainability, and scalability.

SPARK-CU: SUPPORTING FUTURE AGING AND BRAIN HEALTH INNOVATORS

Combatting loneliness in older adults through a novel sensory stimulating communication tool Project Team: Diya Jhuti, Anabela Cotovio School: McMaster University (Hamilton, ON) In Canada, up to 77 per cent of bedridden older adults cannot see their loved ones’ faces when they are confined in hospitals or long-term care for extended periods of time. The lack of access to face-to-face communication tools drastically increases social isolation and loneliness. Even more concerning, this absence is known to affect the neural synchronizations that are correlated with an increased risk of cognitive decline and premature mortality. To address this issue, this project is developing a sensory stimulating communication tool to combat loneliness in older patients. Sunshine Connected: Supporting digital literacy among older adults Project Team: Jenna Mulji, Samantha Gardner, Aminah Beg, Sydney Grad School: Queen’s University (Kingston, ON) Sunshine Connected pairs older adults and students using a quiz that matches common interests, facilitating mutually beneficial conversations and strong intergenerational relationships. In its next phase, this project will introduce pre-recorded and live workshops (including workshops that are older adult-led) to support digital literacy among older adults.

Community-based social connectedness program to reduce loneliness among older adults living in Ontario Project Team: Neerjah Skantharajah, Rabail Siddiqui, Joanna Law, Carly Thrower School: University of Toronto (Toronto, ON) This project will use peer-reviewed research from experts in the geriatric field and reports on the lived experiences of seniors to deliver community-based programming designed to reduce loneliness in adults aged 65 and over living in Ontario. Using multigenerational storytelling to create connections Project Team: Aranza Zuniga, Sheri Burke School: Seneca College (Toronto, ON) This project will pair older adults and persons with disabilities (PwD) with young people to decrease social isolation and improve brain function through the use of skill development and storytelling. The project will consist of a series of workshops that will support reading, writing, and digital literacy skills among participants. The longterm goal is to scale this project and target a wider geographic audience. Memorias-Community: Building community for older adults and those living with dementia Project Team: Sneh Patel, Shuayb Badoolah, Laura Gonzalez School: Sheridan College (Oakville, ON) Memorias-Community is a tablet app that connects older adults and individuals living with dementia through brain training games and a socialization platform. Visit cabhi.com to read about all 24 H innovations ■

Arielle Ricketts is the Marketing & Communications Content Specialist at CABHI. 28 HOSPITAL NEWS JULY 2021

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UHN’s first Indigenous healing garden is taking root at The Michener Institute of Education at UHN rom design to implementation, the garden – located at the corner of Elm and McCaul Streets in downtown Toronto – is Indigenous-led, following the practices and protocols for planting a Gitigan (the Anishinaabemowin word for garden) that have been passed down through generations. The Gitigan is a place to grow plants native to the area, traditional medicines and many plants used by Indigenous nations for their healing properties to help improve physical, mental, emotional and spiritual health. “This project has me so excited,” says Ashley Migwans, Program Coordinator, Indigenous Health & Population Health and Social Medicine, UHN. “The garden is a place to reflect and honour our Indigenous culture, our history, our stories, our language, our traditional medicines and how all of that is interconnected within the healthcare and education system, the teachings and values.” In the past, the location of the healing garden has been used as a flower garden, overseen by Michener’s Director of Facilities, Paul Martin, who said each year annuals were planted. Paul said he connected with the Indigenous Health Program after a student alerted him to a dogwood plant in the garden and its uses in Indigenous culture and medicine – from pipe ceremonies to relief from poison ivy. “That discovery got the ball rolling,” says Paul. “So I told them, ‘I have a garden, I have a budget – there’s no barrier.’” From there, a group was formed to design and plant UHN’s first Indigenous healing garden. The group includes Ashley, experienced Indigenous Earth Worker Kateri Gauthier – who was recruited to design the layout – as well as the Energy and Environment team and Paul’s team at Michener, who are part of the Facilities Management-Planning, Redevelopment & Operations Department (FM-PRO) at UHN. The process began with Kateri visiting the site to ask Shkagamik-Kwe (Mother Earth) for permission to move forward with the project.

Ashley Migwans, Program Coordinator, Indigenous Health & Population Health and Social Medicine, UHN, joined a group of volunteers to plant the Indigenous healing garden at the Michener Institute of Education. Photo: UHN

“One of the first things I did was hold tobacco in my hand and ask for permission to be here in this space. I told her what our intentions were and asked for guidance to begin our work in a good way,” says Kateri. Once she received that permission – which can come internally from a place of stillness – she knew the planning process could begin. While the working group wanted to incorporate the four sacred medicines: tobacco, sage, sweetgrass and cedar, Kateri prayed again for guidance on the rest of the plants to include. “The process that I followed, it was really in connection with spirit,” says Kateri. Building an Indigenous healing garden is much different than planting a flower garden, adds Ashley. “We don’t just plop on any piece of land and do what we want with it,” she says. “We did it from a place of respect for the land, the spirit and the life that the land itself has there. “We’re relational people and the land is really important to who we are as a people.” Kateri started by making a list of 100 plants intending to prioritize endangered plants due to overharvesting, narrowed it down to 40, then 25. She incorporated plants that would not only thrive in the space, but also benefit Michener programming. For example, the garden is home to dan-

delion, which can benefit the Diabetes Educator Certificate Program, as it’s traditionally used to help steady blood sugar levels for someone with diabetes. It’s also home to plantain, which can be used by the Chiropody Program (healthcare for the foot and foot-related conditions), as it’s traditionally used in compresses for foot sores. Kateri also worked with Miinikaan, a Toronto based landscape, design and garden company, which specializes in Indigenous healing and teaching gardens. “There’s a really big need for this,” Miinikaan co-founder Lara Mrosovsky says, adding that she’s seen an increase in demand for these gardens across the city. “For some of the non-Indigenous groups, there’s a newfound awareness – maybe through the Truth and Reconciliation Commission – that they have an opportunity to be inclusive and look at not just doing what they always did.” Ashley, Kateri, Lara and a team of volunteers worked together to build the garden earlier this month, following traditional Indigenous practices, such as planting with pieces of tobacco to welcome the plants to their new home and to give thanks for being part of the new space. Now that the healing garden is planted, the team is working with FMPRO to install educational plaques throughout the site. The plaques will hold a land acknowledgement of the

Indigenous nations across Turtle Island as well as a message welcoming visitors to the space. There will also be QR codes dispersed throughout the garden, so visitors can learn more about each plant, its Indigenous names, uses and healing properties. “It’s meant to be a learning opportunity,” says Ashley. “There’s all different kinds of uses for all of these plants and this will provide an opportunity to have people understand why they’re so important.” Ashley also sees the garden as an opportunity to include Indigenous health and well-being practices into Michener programming, so that students – and UHN staff – have awareness and understanding when working with Indigenous patients. “It can serve as a way to build bridges between institutions and Indigenous ways of knowing, health and well-being,” she says. “The garden just really aligns with everything that the Indigenous Health Program is striving for. “I hope that this is a starting point: the first Indigenous garden at UHN that will hopefully inspire other locations to do something similar.”

TIPS ON VISITING UHN’S NEW INDIGENOUS HEALING GARDEN

• The garden is open for anyone to enjoy – all are welcome. • Do not pick the plants, medicines or flowers. • Learn about the plants and their medicinal purposes: “Have reverence for the plants, for all that they bring and see them as having a spirit, as being alive and not just inanimate objects. They’re sentient beings, talk to them,” suggests Kateri. You may be surprised when they talk to you! • Educate yourself on the Gitigan by using the educational plaques and QR codes. • Make sure you’re “in the right frame of mind,” says Kateri. Be aware of the energy you’re bringing into the space and what you’re leaving behind. • Questions? Connect with IndigeH noushealth@uhn.ca ■

This article was submitted by UHN News. 30 HOSPITAL NEWS JULY 2021

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Longtime nurse seen as ‘incredible addition’

Photo: UHN

NEWS “The history of Indigenous people is important to understand,” says Leonard Benoit, the newest member of the Indigenous Health Program at UHN. “Many have personally suffered or know of others who suffered, which must be taken into account when providing care.”

to Indigenous Health Program at UHN eonard Benoit wants to bridge the gap between Western medicine and Indigenous spiritual practices. A member of the Qalipu Mi’Kmaq First Nation in Newfoundland and Labrador, Leonard is the newest addition to Indigenous Health Program at UHN. He will serve as the Regional Indigenous Cancer Patient Navigator for Toronto Central (Toronto Regional Cancer Program). “The medical system was not designed for Indigenous folks,” says Leonard, a nurse for more than 20 years. There have been efforts to make changes, however, they have been done without key stakeholders and consideration for Indigenous people, which has led to a dysfunctional healthcare system, Leonard says. He has witnessed the improper treatment of Indigenous people within that system. Drawing on his professional background and Indigenous lived experience, Leonard hopes to bring about change in his new role.

EVERY PATIENT NEEDS TO BE LOOKED AT PAST THEIR ILLNESS

Leonard comes to UHN from St. Michael’s Hospital, where he was a navigator for the past three-and-a-half years. His role is designed to ensure Indigenous people dealing with cancer are treated fairly, respectfully and with dignity within the healthcare system. While his home base is at UHN, he will continue to see and help patients all over the city at any hospital. “Every patient needs to be looked at past their illness,” says Leonard. “The history of Indigenous people is important to understand. “Many have personally suffered or know of others who suffered, which must be taken into account when providing care.” Some instances of suffering include the Residential and Day School system, forced sterilization, “Indian” hospitals, and missing and murdered women. “They [Indigenous people] bring their invisible luggage,” says Leonard. While advocating for Indigenous people to be seen for who they are www.hospitalnews.com

with respect to their history, Leonard also lends his knowledge to the healthcare team on Indigenous care and spiritual ceremonies. “We, as healthcare providers, want to do the right thing, but we don’t always know what that is,” he says. The medical community has been very receptive to the merger of Western medicine and Indigenous spiritual practices, Leonard says of his experience as a navigator. There is a lack of awareness when it comes to Indigenous history and practices by many healthcare providers, but there’s an eagerness to learn in order to provide more inclusive care, he says. “At times there is a sigh of relief when I walk in,” Leonard says. Ashley Migwans, Program Coordinator, Indigenous Health & Population Health and Social Medicine, UHN, says Leonard is “an active member in the community and has spent many years building and strengthening those relationships. “His passion and commitment to supporting and advocating for the community and Indigenous health equity, combined with his knowledge of navigating the healthcare system and the lifelong journey of continual learning from Elders, Knowledge Keepers, Healers and the community, make him an incredible addition to the Indigenous Health Program circle, and to UHN as a whole,” says Ashley. There is a lack of trust in the healthcare system after decades of mistreatment of Indigenous communities. Leonard is working to provide emotional support to Indigenous patients in order to provide safe and trusted access to care. With no word for cancer in Indigenous language, Leonard works to provide information and create an understanding about what the illness is in a way that connects with patients. Leonard recalls supporting a patient who wanted to go into surgery wearing her moccasins. At first, the nurse did not agree with the request because it was against standard hospital protocol. The nurse didn’t understand the “why” behind the request. Once Leonard explained the importance of the

Team continue to grow. He also hopes there will be more access to Elders and spiritual ceremonies within hospitals, an increase in artwork and wellness spaces, and more done to raise awareness and positively influence Indigenous patient experiences at UHN. “There is a lot of work to be done and we recognize we cannot do it H alone,” he says. ■

moccasins, the two worked together and the request was allowed. These decisions that may seem small to some, make all the difference for others. Leonard is working to bridge this knowledge divide to provide understanding between care providers and Indigenous practices and beliefs. Looking forward, Leonard hopes to see the Indigenous Health

This article was submitted by UHN News.

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JULY 2021 HOSPITAL NEWS 31

Hospital News July 2021 Edition

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