Hospital News 2015 July Edition

INSIDEEthics .................................................... 9

From the CEO’s desk .......................... 11

Evidence Matters ...............................14

Legal Update ......................................20

Careers ...............................................24

Solving the mysteries of heart surgery

What makes a diabetes care program a success?

6 10

FOCUS IN THIS ISSUECARDIOVASCULAR CARE/RESPIROLOGY/DIABETES/COMPLEMENTARY HEALTH:Developments in the prevention and treatment of vascular disease, including cardiac surgery. Advances in treatment for various respiratory disorders, including asthma and allergies. Prevention, treatment and long-term management of diabetes. Complementary treatment approaches to various illnesses.JULY 2015 | VOLUME 28 ISSUE 7 | www.hospitalnews.com

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Story on page 18

Understanding asthma“Asthma is an invisible illness. Even at the hospital they ask, ‘How bad is your asthma attack?’ What difference does it make? An asthma attack is an asthma attack and I need help, otherwise I wouldn’t be here.”

HOSPITAL NEWS JULY 2015 www.hospitalnews.com

2 Focus CARDIOVASCULAR CARE/RESPIROLOGY/DIABETES/COMPLEMENTARY HEALTH

ne minute Mark Thompson was watching a soccer match on television and the next he was lying on his living room

fl oor fi ghting for his life. The 41-year-old Barrie man and father

of two young children had the mother of all heart attacks, known as the ‘widow maker’. When he arrived at Royal Victoria Region-al Health Centre’s Emergency department, he had no vital signs.

He was defi brillated seven times. Eleven of his ribs were broken during CPR.

After almost two hours, his wife Sabrina was called into the trauma room to say her goodbyes.

But RVH’s Emergency team just wouldn’t give up.

Then a faint pulse was found and with it, hope.

Thompson’s chance for survival meant a trip down the highway for cardiac an-gioplasty – a procedure not offered at any hospital in Simcoe Muskoka. It was a risky ride for a man whose life was hanging in the balance. With a police escort clearing the road ahead of him, an ambulance raced Thompson to Newmarket to receive this lifesaving cardiac procedure.

He wasn’t out of the woods yet though. Because the emergency team had worked on him for so long, Thompson had to be placed in a hypothermic coma following his angioplasty to allow his body to recover. He was in the coma for four days.

The heart would heal, but the physi-cians were worried his brain would not. “If RVH had an Advanced Cardiac program I wouldn’t have had to go through all that. All I needed was a stent put in. It wasn’t like I needed open heart surgery,” says Thompson, who has since fully recovered.

“Don’t get me wrong, if it wasn’t for RVH I wouldn’t be alive. They could have pulled the sheet over my head and called it a day

and they would have done nothing wrong. They wouldn’t give up on me and I’m so grateful, but they need the tools to fi nish the job. They need to be able to do angio-plasty here in Barrie and not have to ship a patient to another facility. That doesn’t make sense to me. It shouldn’t happen.”

But that is exactly what is happening.North Simcoe Muskoka is the only re-

gion in the province that doesn’t have an Advanced Cardiac Centre which means, every year 3,600 people must travel outside the region for their lifesaving cardiac care.

“When it comes to the heart, time is muscle. Heart attack patients need to get to an Advanced Cardiac Centre as quickly as possible – ideally within 90 minutes – so that angioplasty can open up the artery, re-move the clot, and get blood fl owing again,” says Dr. Brad Dibble, clinical director, Car-diovascular and Renal program, RVH.

The reality is, most heart attack patients outside the City of Barrie can’t get to the nearest cardiac centre within that critical 90 minute window. In fact, last year only 76 patients suffering a severe heart attack were close enough to be transported direct-ly to Newmarket for immediate lifesaving intervention. Instead most of this region’s heart attack patients get the ‘drip-and-ship’ standard of care. That means patients re-ceive medication at their home hospital to

help dissolve the clot causing the heart at-tack and then they are sent to a specialized cardiac centre for treatment.

That scenario is all about to change.In early May the Ministry of Health

and Long-Term Care gave the green light to RVH to develop an Advanced Cardiac program, in partnership with Southlake Regional Health Centre, and since then the health centre has aggressively moved forward with plans for a comprehensive heart program.

RVH now boasts a team of seven car-diologists which provides 24/7 cardiology coverage to ensure patients from through-out the region have access to specialized care day or night. Meanwhile, a new re-gional Urgent Cardiology Clinic provides speedy assessment and testing for patients who come to RVH’s Emergency depart-ment or surgical pre-admission clinic and are found to be at high risk for a heart at-tack. In 2012, RVH opened the region’s only Cardiac Care Unit (CCU), along with a dedicated 32-bed Cardiac Renal Unit.

“These are all important pieces of the puzzle and pave the way for opening the Advanced Cardiac Centre, bringing this lifesaving service closer to home,” says Dr. Brad Dibble, RVH clinical director, Cardio-vascular and Renal program. “Opening the Advanced Cardiac Centre will be a game changer for heart attack patients through-out Simcoe County and Muskoka.”

For Mark Thompson, opening an Ad-vanced Cardiac Centre at RVH can’t hap-pen soon enough “Everyone deserves the right to get the care they need in the region where they live. We need to bring this care here. Forget about you having the heart at-tack yourself, what if it happens to someone you love and they can’t get the care they need. Think about that!” ■H

Donna Danyluk is with the Corporate Communications department at Royal Victoria Regional Health Centre in Barrie.

Barrie chef is cooking up support for

By Donna Danyluk

O

Mark Thompson is the chef at the Queens Hotel in Barrie who recovered from a heart attack with the help of Royal Victoria Health Centre.

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t is a tribute to the extensive education efforts of the past 20 years that the general pub-lic has a good understanding

about many things to do with cardiovas-cular disease: heart attack, arterioscle-rosis, cholesterol, high blood pressure, cardiopulmonary resuscitation, and even defi brillation (thanks to all those hospital TV dramas).

There is, however, one glaring exception in this good level of public cardiovascular knowledge, and it’s a big one: heart failure.

Though hard data are diffi cult to come by, it is clear there is an important gap in public knowledge about what heart failure is, its consequences and what could be done to help prevent it.

This knowledge gap is important be-cause heart failure is a serious condition. With our aging population, there will be an even greater epidemic of heart failure in the coming years, with important con-sequences not only for those affected and their families but for our health system.

Perhaps the problem starts with the name, “heart failure.” This gives rise to too much confusion with heart attack – a sud-den-onset event from which most people recover. Heart failure on the other hand, is a chronic condition which can begin sud-denly, but more often occurs gradually. It is an inability of the heart to pump suffi cient blood to meet the body’s needs and can exist at many different levels, and left un-checked, usually progresses over time from mild to severe, with ultimately fatal con-sequences. From a public education point of view, it would be better if heart failure were called “progressive heart weakness” or “heart disability,” terms which would not imply that it is “game over” or that those who suffer from it have “failed”. The French term for the condition, “insuffi -sance cardiaque” – “cardiac insuffi ciency” – is much more precise.

It is more remarkable that heart failure is so little understood given the huge toll it takes on Canadians. One in fi ve Cana-dians will develop heart failure (men and women equally) in their lifetime and more than 600,000 have heart failure right now. It is responsible for about nine per cent of all deaths in Canada or about 22,000 per year, which is more than the deaths from breast, colon and prostate cancer com-bined.

Heart failure is not an easy disease. As people develop more symptoms – both physical and cognitive impairment – they can do fewer and fewer activities and re-quire more care, placing a huge burden on spouses and family members, often to the detriment of the caregivers’ health.

Continued on page 7

advanced cardiac careBy Dr. Jonathan Howlett

I

Closing the knowledgegap in heart failure:The misunderstood cardiovascular disease

From a public education point of view, it would be better if heart failure were called “progressive heart weakness” or “heart disability.”

JULY 2015 HOSPITAL NEWSwww.hospitalnews.com

3 In Brief

The Technology Evaluation in the El-derly Network (TVN), announced details of a health research competition that is expected to lead to substantial improve-ments in the quality of care received by frail elderly Canadians. Dr. John Musce-dere, TVN scientific director, says this research call is a rare and unique oppor-tunity to help shape the future course of care that will potentially impact millions of frail elderly Canadians over the next 25 years.

Dr. Muscedere explains that one of the most significant emerging challenges fac-ing Canada’s health care system is the mis-alignment of resources, clinical practices and care options for the more than one million older Canadians today deemed to be frail – a distinct health state character-ized by debility, the presence of multiple, chronic health conditions, and higher risk of poor health care outcomes including death. Transformative research that is eligible for funding in this competition embraces patient-centred projects that: • are scaling up from existing, successful

demonstration projects • apply pathways, processes, tools or tech-

nology developed from existing knowl-edge or evidence

• apply care pathways currently in practice in other health care systems around the world

• build on current TVN-funded research that would apply to wider health care systems, and to other regions or prov-inces in Canada.

Research proponents have until October 1, 2015 to file their intention to apply for funding support, which is matched by financial and other support they receive from other sources. Proponents have until December 1, 2015 to submit full proposals. ■H

Only one in five Canadian adults walk or cycle to school or work, a figure that has remained unchanged since 2007, ac-cording to the 2015 Cancer System Per-formance Report, the sixth annual report from the Canadian Partnership Against Cancer (the Partnership) measuring can-cer system performance across the coun-try. Regular physical activity can help protect against colon cancer and is poten-tially protective against post-menopausal breast cancer and endometrial cancers. Regular physical activity can also help prevent obesity, which is a risk factor in several other cancers, including those of

the colon, rectum, breast, endometrium, pancreas and kidney, and other chronic diseases such as diabetes or cardiovascu-lar disease.

“These findings point to a need to make healthy options easier for Canadians, ” says Dr. Heather Bryant, Vice President of Cancer Control at the Partnership. “Communities and municipalities have a vast array of untapped policy options that would encourage more Canadians to use active transportation, which could in turn help reduce the risk of certain cancers.” The percentage of adults from Canadian provinces who reported cycling or walk-

ing to and from work or school in 2013 ranged from 12 per cent in Newfoundland to 26 per cent in British Columbia. The figure was highest in Canada’s three ter-ritories, reaching 51 per cent in Nunavut.

The report also looks at 17 core in-dicators of cancer system performance, including smoking prevalence, which re-mains unchanged at 19.3 per cent of Ca-nadians; self-reported screening rates for breast, cervical and colorectal cancers; growing use of a standardized tool to mea-sure patient distress; and the number of patients enrolled in clinical trials, among others. ■H

Only 22 per cent of Canadians

In the sixth report in its signature Substance Abuse in Canada series, the Canadian Centre on Substance Abuse (CCSA) released research shedding criti-cal light on how using cannabis (also known as marijuana) affects the devel-oping adolescent brain. Canadian youth have the highest rate of marijuana use in the developed world, and marijuana is the most commonly used illegal drug among Canadians aged 15 to 24 years. Today’s report confirms that early and frequent marijuana use among this age group in-volves a greater risk of cognitive and be-havioural impairment than marijuana use among adults.

Compiled by several well-known and respected experts in the field of marijuana research, The Effects of Cannabis Use during Adolescence provides a high-level, broad overview of the latest research on the issue. It gives valuable and useful evi-dence to teachers, health care providers and policy makers to help them develop and employ more effective youth drug use prevention and intervention programs. It will also help increase knowledge and understanding among parents, communi-ties and people working with youth about the effects that marijuana use, particu-larly regular use, can have in adolescence and beyond.

CCSA sought to answer the following questions in the report: • What is the impact of marijuana on the

brains and behaviour of young people? • Is there a link between marijuana use

and mental illness? • Is marijuana addictive?

The report answers these questions with evidence that marijuana is not a benign substance. Early and frequent use can seriously limit a young person’s edu-cational, occupational and social develop-ment, and some of these adverse effects may be irreversible. Marijuana is also linked to mental illness, it is addictive, and it produces cognitive and motor func-tion impairment that can present a safety hazard for drivers. Furthermore, previous CCSA research has shown that youth do not perceive marijuana to be a harmful substance, and there is evidence showing that as perceptions of risk decrease, rates of use increase.

CCSA makes recommendations on what further steps should be taken, including: • Early identification and more effective

treatment of problematic marijuana use; • Expanded prevention and intervention

programs targeted at youth; and • More Canadian-based research and better data to inform policy, practice and programs. ■H

Adolescent marijuana use and its impact on the developing brain

walking, biking to work or school

The first-ever national survey of physi-cians who deliver palliative care in Cana-da has provided critical direction for im-proving access to palliative care services for all Canadians. The survey gathered responses from 1,114 physicians from across Canada who provide palliative medicine. Quick facts: • For the vast majority (84 per cent) of physicians who provide palliative medi-cine services, it is not their primary field of practice; • Family physicians with a focused prac-tice in palliative medicine and palliative medicine specialists (16 per cent of all re-spondents) reported working an average of 36 hours per week in palliative care. Physicians who provide palliative care as part of their other clinical duties (84 per cent of respondents) reported working an average of seven hours providing pal-liative care services; • 78 per cent of palliative care physicians reported that they do not see children and only 50 per cent of respondents re-ported having access to specialized pedi-atric palliative care services; • Just 35 per cent of palliative medicine physicians in rural and remote areas reported having specialized palliative care teams to provide care in their area,

compared to 79 per cent of physicians in urban areas. Formal home healthcare for patients wishing to die at home was reported to be available by 49 per cent of urban palliative medicine physicians ver-sus 30 per cent of rural physicians.Key findings: • Canada needs an adequate palliative medicine workforce. Physicians provid-ing palliative care services must be prop-erly trained and assessed to ensure they are capable of providing the highest stan-dard of care. • Primary care providers need more support for palliative care education and training. Primary care has been the focus of palliative care programs in the hope that many family physicians will provide the basic day-to-day symptom management required. This group needs to be adequately supported, with both resources and compensation, so that it can continue to grow to meet patients’ health care needs. • Palliative medicine as a distinct disci-pline must be further developed to better meet the complex needs of patients. • Canada must ensure minimum pal-liative medicine standards are met. Na-tional standards for practice, including guidance for interdisciplinary care, hours of coverage etc., need to be developed. ■H

National Palliative Medicine Survey highlights areas for action to improve access to care

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4 Guest Editorial

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AUGUST 2015 ISSUEEDITORIAL JULY 10ADVERTISING: DISPLAY JULY 24CAREER JULY 28MONTHLY FOCUS: Pediatrics/Ambulatory Care/Neurology/Hospital-based Social Work:Pediatric programs and developments in the treatment of paediatric disorders including autism. Specialized programs offered on an outpatient basis. Developments in the treatment of neuro-degenerative disorders, traumatic brain injury and tumours. Social work programs helping patients and families address the impact of illness.

SEPTEMBER 2015 ISSUEEDITORIAL AUGUST 7ADVERTISING: DISPLAY AUGUST 21CAREER AUGUST 25MONTHLY FOCUS: Emergency Services/Critical Care/Trauma/Emergency Preparedness/Infection Control:Innovations in emergency and trauma delivery systems. Emergency prepared-ness issues facing hospitals. Advances in critical care medicine. Programs imple-mented to reduce hospital acquired infec-tions. Developments in the prevention and treatment of drug-resistant bacteria and control of infectious diseases.

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Cindy Woods, Senior Communications OfficerThe Scarborough Hospital, Barb Mildon, RN, PHD, CHE , CCHN(C)VP Professional Practice & Research & CNE, Ontario Shores Centre for Mental Health Sciences

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r. Chancellor, Mr. President, distinguished guests, soon-to-be MDs and their deeply indebted family members. I’m

touched and humbled to receive an hon-orary degree from the University of Mani-toba. Thank you for letting me share this special moment with you.

I’m not a doctor. I never will be. I’m a lowly journalist. I tell stories.

For almost 30 years I’ve tried to help Canadians understand their health system and their medical care.

In that time, I’ve seen tremendous ad-vances in medicine and I’ve met, quite literally, thousands of health professionals, from students to Nobel Prize winners – and patients, from those with rare genetic mutations to those with everyday ailments, from those cured miraculously to those who died needlessly.

Today, I’d like to take few minutes to share some of what I’ve learned from tell-ing their stories.

One of the greatest privileges in our society is to have the letters M.D. af-ter your name. Those two letters confer great power. And with that power comes great responsibility, to quote Voltaire – or Spiderman, depending on your literary predilections.

Shortly, you will be taking the Hippo-cratic oath. You’ve probably all heard that it says: “First do no harm.” It doesn’t actu-ally – that’s just bad media reporting.

But it does say a lot of important things. I think the line that matters most in the oath is this:

“Whatsoever house I may enter, my visit shall be for the convenience and advan-tage of the patient.”

Sadly, too many physicians fail to honor that part of the pledge.

We have built a sickness care system rather than a health system. We have de-signed that system for the convenience of practitioners, not patients.

Modern medicine has become so spe-

cialized that many physicians treat specifi c syndromes and body parts, and the patient herself gets lost in the process. We have fi lled our temples of medicine with such bedazzling hi-tech tools that we’ve forgot-ten that we should treat people where they live.

In our desire to cure, we over-treat. We fail too often to say the three most

important words in medicine: “I don’t know.” We see death as a failure, instead of aspiring to make patients’ comfortable and at peace at end-of-life.

In our unrelenting quest for effi ciency and measurement, we too often lose sight of what really matters. The patient.

What does your patient want? What are his or her goals? Those are the ques-tions that must guide your practice.

For some of your patients, the goal is to repair their acute woes, to help them live long. But most of your patients will be older, and have a number of chronic condi-tions and be nearing the end-of-life. Their goals are different.

They’re not going to be cured. You have to focus on their quality of life.

They want to be at home. They don’t want to fall. They don’t want to be in pain. They don’t want to be a burden. They don’t want to be alone. They don’t expect miracles – but they would like respect.

They don’t fear dying. They fear losing their autonomy and their dignity. They don’t care about your metrics, or your age-adjusted mortality rates, or your fancy new genomic test. They want to be listened to, and heard.

We hear a lot these days about personal-ized medicine, about drugs and treatments that can be tailored to specifi c genomic and epigenetic markers. But you know what people really long for: personal medi-cine, not personalized medicine.

They crave a human connection. Not just care, but caring.

The very best medicine you can offer your patients is a listening ear. The very

best treatment you can offer them is a compassionate heart.

Now you may be sitting there thinking, this is all feel-good nonsense. It’s not. The more sophisticated and complex medi-cine becomes, the more the basics matter.

What did you learn in medical school? Anatomy, biochemistry, genomics, count-less mnemonics to help you remember bits of knowledge; you know how to de-liver babies and treat cancer and diabe-tes and depression and asthma, take out people’s appendix and do MRIs and PCIs, and countless other things.

What you’re going to learn now, in the real world, is that physical woes are the least of patients’ worries. Their health problems aren’t strictly caused by mu-tating cells, opportunistic pathogens and poor genes, but by poverty, lack of education, poor housing, stress and social isolation.

You’re going to, sooner or later, learn humility. And, the earlier you do, the bet-ter the doctor you’re going to be.

In this, the Internet age, we are drown-ing in information, but starving for wis-dom. I urge you, as you forge long, suc-cessful and prosperous careers, to not just be smart, but be wise.

In every interaction you have, em-brace the ancient wisdom of Hippocrates: “Whatsoever house I may enter, my visit shall be for the convenience and advan-tage of the patient.”

A version of this speech was delivered May 14, 2015 to the graduating class at the University of Manitoba. ■H

Convocation speech delivered to graduat-ing MDs at the University of Manitoba on the receipt of an honorary doctorate.

André Picard is a health reporter and columnist at The Globe and Mail, where he has been a staff writer since 1987. He is also the author of three bestselling books.

MBy André Picard

Sickness care systemWe have designed that system for the convenience of practitioners, not patients


5 CARDIOVASCULAR CARE/RESPIROLOGY/DIABETES/COMPLEMENTARY HEALTH Focus



t. Michael’s Hospital, cardio-vascular surgeon Dr. Subodh Verma was troubled by the lack of data to guide decision

making and treatment choices for patients undergoing heart or vascular surgery.

“There are still too many unknowns when it comes to cardiovascular surgery outcomes,” says Dr. Verma. “I think the best way to fi nd those missing links is by connecting smart people and asking smart questions.”

Dr. Verma formed a research hub, called CARDIOLINK, to answer questions that will improve care and prevent hospitaliza-tion for patients with heart and vascular disease or diabetes.

CARDIOLINK brings together top ex-perts from across St. Michael’s, Canada and the world to address fi ve major themes of cardiovascular surgery: atrial fi brilla-tion, aortic aneurysms, peripheral arterial disease, valvular heart disease and com-munity-based interventions to reduce re-hospitalization.

“For each of our fi ve themes, there is a randomized clinical trial being developed – each designed to address an important gap in cardiovascular research and deliver de-fi nitive and potentially practice-changing results,” says Dr. Verma.

The SEARCH-AF trial will investigate whether using a new heart rhythm moni-toring device after heart surgery will un-cover new rhythm irregularities and help identify individuals at risk of having a

stroke following heart surgery. This trial is funded and underway.

The ACE trial is aimed at comparing strategies to protect the brain when sur-geons need to cool the body and stop blood circulation during complex aortic surgery. Dr. Verma says brain protection is the Achilles’ heel of aortic surgery and ACE will help answer whether a new technique – developed at St. Michael’s – is safe for patients undergoing these operations.

Critical limb ischemia is a serious prob-lem that affects patients with peripheral arterial disease. It carries a high risk of limb amputation and a 50 per cent chance of dying within fi ve years. CARDIOLINK has developed the EXTINGUISH trial to test whether an anti-infl ammatory medication can reduce rates of death in patients with critical limb ischemia.

The CAMARA-1 trial will compare two different ways to repair the mitral valve to see whether one is better at improving the functional capacity of patients and restor-ing them to more meaningful lives.

The ENABLE-NP study will try to fi nd better ways to meet the complex needs of vulnerable patients by engaging their communities. It will evaluate whether in-terventions delivered by nurse practitio-ners in the community can reduce rates of re-hospitalizations after peripheral artery surgery. ■H

Geoff Koehler is a Senior Public Affairs Adviser at St. Michael’s Hospital.

By Geoff Koehler

S

Dr. Subodh Verma is linking experts around the globe to CARDIOLINK – a collection of researchers working to advance cardiovascular surgery research. (Katie Cooper, Medical Media)

In creating CARDIOLINK, Dr. Verma teamed up with cardiovascular anesthesiologist, Dr. David Mazer, and Dr. Muhammad Mamdani, director of the Applied Health Research Centre.

Several other members of St. Michael’s are leading or involved in individual CARDIOLINK themes. Dr. Mark Peterson is working on the ACE trial; Dr. Mohammed Al-Omran on EXTINGUISH, Dr. Howard Leong-Poi on CAMARA-1 and Dr. Akshay Bagai on ENABLE-NP. CARDIOLINK includes representation from Calgary, Hamilton, Ottawa and London, Ont., as well as Saudi Arabia and Australia.

Solving the mysteries of heart surgery

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t only takes a few minutes of conversation with any member of Hôpital Montfort’s Diabetes Clinic to grasp the amount of

success stories their team has witnessed in the last few years. Members of the team stopped counting the number of patients, most often affl icted with complex cases of type 2 diabetes, who walked out of their offi ces feeling more confi dent and autono-mous in their pursuit of a healthier lifestyle.

“The motto of our clinic is ‘self-manage-ment’: patients leave the hospital with the necessary tools to manage their diabetes, and their overall life,” explains Eva Arg-ibay Poliquin, a registered nurse diabetes educator who works alongside a registered dietitian diabetes educator, two internists, a pharmacologist, a social worker and a psychologist in order to provide education-oriented care to their patients.

The interprofessional team takes care of approximately 2700 visitors every year, who are either diagnosed with type 1, ges-tational, or complex type 2 diabetes. The team has adopted an approach that is well-known at Montfort when it comes to the treatment of chronic diseases: teaming up professionals of diverse health fi elds and collaborating with several commu-nity organizations to be able to offer well-rounded, complete patient-oriented care.

After getting referred to the clinic by their family doctor or health specialist, patients are directed to one of the internists, who evaluates their case and either refers them to a community service (such as the Com-munity Diabetes Education Program, www.diabeteseducation.ca, who hosts work-shops all over the Ottawa region) or to the Diabetes Clinic team.

Interviews are based on the motiva-tional interviewing model, which evalu-ates the importance patients concede to their condition and the level of confi dence they have in their ability to live a healthier

life, before looking for concrete solutions to help them reach their own health goals. Once they are admitted to the program, the services they are offered merge towards an overall healthier lifestyle. Members of the care team can, among other things, help patients understand their medication and provide nutritional advice, exercise plans, psychological help and directions to fi nancial resources. This integrated approach helps patients understand and manage their condition, ultimately lead-ing to fewer complications and less overall time spent at the hospital.

With more than 10 years of existence, the clinic has not only provided education to thousands of patients, but has also wel-comed dozens of students for observation days and internships in the fi elds of nursing and nutrition. The members of the team also work with other units of the hospital in order to conduct a wide variety of re-searches: among others, a study on effec-tive management of diabetes and comor-bid depression was published last month, as the result of a collaboration between the Diabetes Clinic, the Health Psychol-ogy team, and the “Institut de recherche de l’Hôpital Montfort” (IRHM). ■HEmy Lafortune is an intern in the communications department at Hôpital Montfort.

Fighting diabetes with interdisciplinary educationBy Emy Lafortune

I

The Diabetes Clinic team at Hôpital Montfort.

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Integrated care is becoming a reality, and hospitals need systems and solutions that give them a full overview of the patient, while sharing and collaborating with all stakeholders in the patient care continuum. The Portal is the first step to achieving that full integrated care model. It provides an easy-to-integrate and -use portal for image and results delivery. With the Portal, Agfa HealthCare has taken the knowledge and experience it has built up with proven solutions that share images and other data and is extending it beyond the hospital walls, to eventually integrate all players in healthcare delivery.

Agfa HealthCare PortalA gateway to integrated care

Heart failure reduces patient quality of life by causing shortness of breath, fatigue, swelling of legs and cognitive impairment, among other symptoms. These symptoms can fl are at different times as the condition progresses, requiring hospitalization. As a result, heart failure is the second leading cause of hospitalization in patients over 65 years of age. These patients generally stay longer in hospital than others and the 30-day hospital readmission rate for Canadian heart failure patients is 21 per cent, creat-ing an additional burden.

Treatments for heart failure have greatly improved over the years, with reductions in death and hospitalization of up to 80 per cent in some cases. However, as the above statistics show, there is certainly much room for improvement – for the benefi t of patients, caregivers and the health system. We are certainly not yet at the stage of be-ing able to stop or reverse heart failure, but there are promising new treatments antici-pated to be available in the near future that could delay activity-limiting symptoms and the need for some hospitalizations provide great overall benefi t.

We also need to correct the knowledge gap about heart failure, which is one of the missions of the Canadian Heart Failure Society. As we have seen with other condi-tions in the past, knowledge is a key part-ner with treatment in lessening the burden of illness. ■HDr. Jonathan Howlett, MD, FRCPC, FACC is Clinical Professor of Medicine at the University of Calgary, Libin Cardiovascular Institute of Alberta, and President of the Canadian Heart Failure Society.

Continued from page 2heart failure



or patients, the Canadian Dia-betes Association 2013 Clini-cal Practice Guidelines for the Prevention and Management

of Diabetes in Canada (Guidelines) pro-vide an opportunity to take control of their diabetes and share information with their health care team. For health care provid-ers, they provide the most up-to-date rec-ommendations for the management of dia-betes based on the best available evidence.

However, the Guidelines won’t do any-one any good if they just sit on health care providers’ shelves. In order to affect change and create better patient outcomes and a better quality of life for the more than 10 million people in Canada who live with diabetes or prediabetes, they must be ac-cessible and useful. To meet this goal, the committee responsible for Guidelines dis-semination and implementation, under the leadership of Dr. Catherine Yu, has devel-oped professional tools and materials, as well as patient resources.

The committee also identifi ed fi ve key areas that are essential for improving the quality of life for people living with diabe-tes, improving the quality of diabetes care, and reducing illness and death from diabe-tes and its complications. They are screen-ing and diagnosis, vascular protection, blood glucose lowering, self-management education, plus team and organizing care. Here are tools from our web-based Guide-lines that providers can incorporate into their daily practices.

In-hospital diabetes management

Diabetes is common in people who are in hospital for a variety of other diagnoses. Proper management of the diabetes in hos-pital can help improve certain outcomes. The nine recommendations within chap-ter 16 address the issues of organization of care, glycemic targets, and hypoglycemia (or low blood glucose) in different hospi-tal populations. Hands-on tools include a how-to document and checklist, and tem-plate order sets/protocols for

Subcutaneous Insulin Adult Inpatient Acute;IV Insulin Adult Inpatient Acute;Insulin Infusion Critical Care Adult;Diabetic Ketoacidosis (DKA) – Adult;Adult Hypoglycemia

Sick day medication list: SADMAN

When people with diabetes experience acute dehydration, it is important that they do not take certain medications as they can lead to serious conditions, such as acute kidney injury, low blood sugar, or high po-tassium. We developed the Sick Day Medi-cation List in chapter 39 to remind health care providers and people with diabetes which medications should be temporar-ily held. It includes an easy-to-remember acronym, SAD MAN, which stands for sulfonylurea, ACE-inhibitor, diuretic, met-formin, angiotensin receptor blocker, and non-steroidal anti-infl ammatory.

Diagnosis & screening: Screen wisely, diagnose precisely

The most signifi cant update to this theme for the 2013 Guidelines is the addi-tion of hemoglobin A1C for diagnosing dia-betes (A1C ≥6.5%) and prediabetes (A1C 6.0-6.4%). The previous options of fasting glucose (≥7.0 mmol/L), oral glucose toler-ance test (2 hour glucose ≥11.1 mmol/L), or high random glucose level (≥11.1 mmol/L) remain. An interactive Screening and Diagnosis Calculator allows health-care providers to enter a patient’s fasting blood glucose and/or A1C value(s) and to determine the proper diagnosis or the need to repeat specifi c tests.

Vascular protection: Do your part, protect their hearts

Cardiovascular disease is the most com-mon cause of death among people with diabetes. That is why reducing this risk is the fi rst priority in managing diabetes. The Guidelines include the ABCDEs recom-mendations:A is for A1C and the importance of achiev-

ing glycemic control; B is for blood pressure control; C is for cholesterol; D is for drugs to protect the heart (for ex-

ample, a statin, ACE-inhibitor or ARB or aspirin);

E is for exercise and eating properly;

S is for smoking cessation and stress reduction. The criteria for determining which pa-

tients should be placed on a statin, ACE-inhibitor, ARB, or aspirin for vascular protection has been updated and can be determined using the Reducing Vascular Risk assessment.

Blood glucose lowering: Individualizing targets

Lowering blood glucose levels reduces the risk of health problems later in life. There are many ways to do this, such as lifestyle and medications. One of the ma-jor themes of the Guidelines is the idea of “individualizing” blood glucose lowering choices based on the best fi t for a particular patient. The Individualizing Your Patient’s A1C Target is designed to help health care providers do this easily. There are also spe-cifi c tools for type 2 diabetes, the frequency of self-monitoring of blood glucose, insulin use and more.

Self-management education: Help people take charge of their diabetes

Proper self-management of diabetes is critical to live healthily with diabetes. That’s where diabetes education services can help people get on the right track. Referring patients is important to consider as they prepare to leave the hospital. The Self-Management Education section pro-vides a framework for assessing and teach-ing self-management, physical activity, and dealing with mental health issues.

Team and organizing care: Engage teams to promote self-management

The support people with diabetes re-ceive from their healthcare teams and their healthcare systems (hospitals, family health teams, regions) has been shown to improve their care. A comprehensive discharge plan with clear communication between mem-bers of the interprofessional team is key. To encourage and support healthcare provid-ers, the Team & Organizing Care section

includes healthcare and patient resources, such as communication logs, diabetes fl ow sheets, and the video, “Angie’s Story: Build-ing a Diabetes Care Team” about the roles and responsibilities of the various members of the diabetes team.

With the help of the Guidelines, more people with diabetes will be armed with the best information and, hopefully, an eager-ness to take care of their diabetes. In ad-dition, healthcare providers will also be provided with the most up-to-date tools to to provide effective care for people with or at risk for diabetes – and in the process, change outcomes and lives. ■H

Dr. Alice Cheng, MD, FRCP is an Endocrinologist, Credit Valley Hospital and St. Michael’s Hospital; Associate Professor, Dept of Medicine, University of Toronto and Chair, Canadian Diabetes Association 2013 Clinical Practice Guidelines Committee.

Bringing diabetes guidelines to lifeBy Dr. Alice Cheng

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Guidelines on the goPrefer to access the Guidelines on your smartphone or tablet? Download the CDA CPG App which is available for Apple and Android platforms.

Guidelines on the web The online version of the 212-page, 36-chapter Canadian Diabetes Association 2013 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada (Guidelines) includes these additional features: •A quick reference guide• Downloadable resources for

health-care providers and people with diabetes

• Case studies •Slides and videos •French resourcesFor more information, visit guidelines.diabetes.ca.


9 Ethics

he advance directive move-ment officially began in 1990 following the landmark case of Nancy Cruzan in the

United States. The lengthy court battle over her life-sustaining treatment fu-elled advocacy for the use of advance directives. The thought was that wide-spread use of advance directives would prevent such lengthy battles over treat-ment. The reality, however, is that ad-vance directives are nowhere near the panacea people thought they would be. Twenty-five years later the use of ad-vance directives remains quite low: only 10-15 per cent of the general population have completed such documents. And experience has revealed a host of prob-lems with their implementation, one of which is that the documents are rarely accessible when they are needed most. Additionally, the recent media attention over the Margot Bentley case in B.C. has caused many people to ask, “What’s the point?” Ms. Bentley actually had completed an advance directive, which her family tried to implement, but the courts have ruled that the nursing home where she resides is actually obligated to

feed her – in direct contradiction to her previous wishes.

While there are a host of problems with advance directives, those problems simply highlight the flaws with rely-ing solely on documents. Advance care planning is about much more than writ-ten advance directives – in fact, one can engage in advance care planning with-out ever completing an advance direc-tive document. Advance care planning is a process of reflection and dialogue about what is important to you and how you want health care decisions made for you when you can no longer make those decisions yourself. While the process of advance care planning can be awkward and uncomfortable for many people,

there are several reasons why it is an im-portant and worthwhile process – espe-cially for patients with chronic illnesses.

One reason is that while most of us would prefer to die comfortably at home, odds are that few of us will actually get to die this way. Recent statistics suggest that 70 per cent of Canadians will die in hospital, and 10-15 per cent of those will experience an admission to an intensive care unit during their last hospital visit. If this is not the kind of death you want, especially the ICU part of it, advance care planning can help you avoid it.

Second, many people avoid advance care planning because they trust their loved ones to know their wishes and make the right decisions. The problem is, studies show your loved ones aren’t very good at predicting what you would want! A recent meta-analysis of these studies concluded an accuracy rate of about 68 per cent. That means for any-one trusting their loved ones to make the decision they would make, only two-thirds of them will get it right.

Third, and perhaps most importantly, the process of having to make end-of-life decisions on behalf of a loved one

is an extremely stressful and emotion-ally difficult experience. A 2011 study of surrogate decision makers found many of them experienced symptoms such as anxiety and depression, symptoms which they carried with them long after the hospital experience ended. But one of the important findings of the study was that knowledge of the patient’s wishes was one of the factors that reduced the psychological and emotional impact on surrogate decision makers.

The most important part of the ad-vance care planning process is the dia-logue with your loved ones, especially those who will be making decisions on your behalf. The dialogue will help them understand what is important to you and will give them guidance if and when the time comes to make difficult decisions on your behalf. If you’re not going to do it for yourself, at least do it for them. ■H

Jonathan Breslin, PhD is an Ethicist for Southlake Regional Health Centre and Mackenzie Health and an Assistant Professor at The University of Toronto.

Advance care planning for

By Jonathan Breslin

T The use of advance directives remains quite low: only 10-15 per cent of the general population have completed such documents.

patients with chronic illnesses



n the spring of 2014, Alanis*, a 60-year-old woman, ar-rived at an emergency room at Grey Bruce Health Ser-

vices in Owen Sound, Ontario ,with ex-tremely high blood glucose (sugar) levels. Living in extreme poverty in an isolated rural community, she had no car and no family doctor to care for her type 2 diabe-tes. In many places, Alanis’s health care prospects would have been poor at best and she might not have received the help she needed.

A year later, Alanis tests her blood glu-cose (sugar) regularly, is receiving treat-ment for her diabetes, high blood pressure and cholesterol, and has a family doctor.

This outcome is the result of the work of Diabetes Grey Bruce (DGB), a dedicated team of health care professionals offering diabetes education, support and treatment at seven hospital sites across a region that stretches from Mount Forest in the south, to Tobermory in the north, Kincardine in the west, and Collingwood in the east.

This is a great example of the Cana-dian Diabetes Association 2013 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada

(Guidelines) in action in the area of team care and the organization of diabetes care. Support from health care teams and systems has been shown to improve care for people with diabetes – Alanis is proof of that.

A recipe for successA conversation with DGB manager

Lynda Hoffmeyer reveals that DGB owes its success to the exceptional commitment of its team members, their collaboration with community partners and their belief that they are part of the community and that their clients are like neighbours. “We very much see our clients as part of our community,” says Hoffmeyer. “We’re all at risk of diabetes.”

Commitment The team will go to impressive lengths

to see clients get the care they need. For example, in addition to providing Ala-nis with diabetes education and treat-ment, DGB’s nurse practitioner, Patti Byne, looked after her diabetes and other health issues (which included high blood pressure and high cholesterol). The team

also helped her fi nd a family doctor so that she could receive ongoing care and even helped her apply for government-assisted funding to cover the cost of her medications.

Collaboration The health care team recognizes that

many factors, such as poverty or mental health issues, can infl uence whether diabe-tes treatment succeeds or fails. DGB works in close partnership with other agencies, including hospitals, community health centres and mental health services.

Community Rather than seeing themselves as serv-

ing the community, the health care provid-ers at DGB consider themselves very much part of it. As diabetes educator Joanne Reid put it, “We can meet up with clients in the grocery store.” It is this outlook that inspires team members to go the extra mile for clients like Alanis.

Setting a new standardRegistered nurse and certifi ed diabetes

educator, Shelley Jones, is the Director of

Quality for the Canadian Diabetes Asso-ciation’s (CDA’s) Diabetes Educator Sec-tion – Standards Recognition Program Committee. In its recent annual awards, the committee singled out DGB for rec-ognition. “It really resonated with us [the committee]…how Diabetes Grey Bruce partnered with community organizations outside the diabetes fi eld and how they were using that to help their patients,” says Jones. She identifi ed a number of factors that set DGB apart.• Self-referral Any resident in the Grey Bruce area can access services without needing a doctor’s referral.• Treating the whole patient By working with many different community agencies and organizing frequent education efforts on everything from blood sugar control to healthy cooking, DGB addresses many dif-ferent aspects of life that affect the health of people with diabetes.• Virtual teamwork Team members con-nect easily across different sites, using the Grey Bruce Health Network Integrated Patient Records and communicating by secure e-mail.• Accessible hours In addition to daytime hours, all rural sites are open early one weekday morning to make diabetes ser-vices as accessible as possible. The site in Owen Sound, Ont., is open two evenings a week.• Ongoing self-assessment. DGB uses regular surveys and patient questionnaires to assess the effectiveness of their pro-grams, and adapts programs to meet the changing needs of their clients.

Jones adds, “Diabetes Grey Bruce is a program that offers superior diabetes care and education and is well supported by a dedicated manager and many community partnerships.” And the happy result is that people living with diabetes, like Alanis, are better able to manage their diabetes and enjoy a better quality of life. ■H

*Alanis is not her real name.

Alexis Campbell is a medical writer.

What makes a diabetes care program a success? By Alexis Campbell

I

A commitment to collaborating with patients and community partners to achieve the best outcomes possible

Joanne Reid, RN, CDE and Carla Campbell, RD, CDE provide insulin pump training to a patient.

Patti Byne, RN (EC), CDE teaching health care professionals at a conference in Owen Sound, Ont., hosted by Diabetes Grey Bruce.

Working together to improve careWhere can health-care providers and patients fi nd helpful resources to get them started or improve diabetes team care? The Guidelines’ Team & Organizing Care chapter is a good place to start. It features a range of materials, such as communication logs, diabetes fl ow sheets, and the video, “Angie’s Story: Building a Diabetes Care Team” about the roles and responsibilities of the various members of the diabetes For more information, including printable and downloadable tools, visit http://guidelines.diabetes.ca/organizingcare.


11 From the CEO's Desk

or years now, experts have been warning us that Canada is on the cusp of a silver tsu-nami, one that threatens to

overwhelm our hospitals and long-term care homes in the decades to come. And if we are to continue caring for our seniors the way we have done in the past, they may be right.

Our population is aging rapidly, and with that comes increased numbers of those liv-ing with dementia and other conditions that make it diffi cult for older adults to remain independent. In Ontario, where more than 40 per cent of every tax dollar is spent on healthcare, there is a realiza-tion that helping seniors age in the setting of their choice is both more economical and more patient-centred – and yet the re-quired supports simply don’t exist.

In May, it was announced that Baycrest Health Sciences would lead a newly-mint-ed partnership dedicated to developing, validating, commercializing and encourag-ing adoption of new aging and brain health products and services – innovations that will help seniors maintain their cognitive, emotional and physical well-being for as long as possible, wherever they may live.

Known as the Canadian Centre for Ag-ing and Brain Health Innovation (CC-AB-HI), the $123.5 million venture brings to-gether government, health care, academic and industry partners to accelerate the

development and adoption of technologies and new care practices that can transform the journey of aging for millions of seniors, here in Canada and around the world. The initiative includes investments of $42 mil-lion from the federal government, $23.5 million from the Province of Ontario, $25 million from the Baycrest Foundation, and $33 million from 40 industrial, academic and not-for-profi t partners.

The investment in CC-ABHI is unprec-edented, and represents the single larg-est investment in aging and brain health in Canadian history. I believe it will be a game changer for our community-based se-nior care sector, and will give life to a gold mine of innovative ideas we all know exist on the front lines of healthcare. Tradition-ally, we have looked almost exclusively to acute care research hospitals, academia and industry to develop health care re-lated solutions and bring them to market.

CC-ABHI, however, will demonstrate that community-based health care providers and the senior care industry in particular will play a substantial role in introducing the next generation of care practices, prod-ucts and services to address the rapid aging of the population.

And the imperative couldn’t be greater. The number of seniors in Canada is ex-pected to double to more than 10 million in the next two decades, and with that comes a doubling of those with dementia. And the cost to our national economy of caring for those with dementia is already $33 billion annually.

Partners in this new venture include large and small technology fi rms, software developers, pharma industry leaders, con-sumer product designers, and social media outlets. Baycrest and other health care organizations that are members of the Se-niors Quality Leap Initiative (SQLI) will provide their unique expertise to enable the evaluation, dissemination and adop-tion of new care practices while design-ing and beta-testing emerging technolo-gies that support seniors well-being in real world care settings. Some of the inaugural innovations that will be pursued by the new Centre include an on-line cognitive assessment, consumer-directed cognitive neuro-rehabilitation strategies, facial rec-ognition software, remote wellness moni-toring, health coaching software solutions,

mobile medication monitoring and tele-dementia care.

Along with our dynamic partners across the full continuum of acute, residential and community based healthcare, we will fi nd better ways to optimally meet the needs of seniors wherever they may be. We believe this is a model that can truly trans-form seniors’ care in Canada and around the world, and it’s one that we are proud to lead. ■H

Dr. William Reichman is President and CEO, Baycrest Health Sciences.

investment a game changer for seniors’ health care sectorBy Dr. William Reichman

F

The number of seniors in Canada is expected to double to more than 10 million in the next two decades, and with that comes a doubling of those with dementia.

Dr. William Reichman is President and CEO, Baycrest Health Sciences.

Aging and brain health innovation



orthwestern Ontario has higher than average rates of cardiac disease. Now, those in need of treatment for com-

plex heart disease, including heart attacks, have access to brand-new equipment in the cardiac catheterization labs at Thun-der Bay Regional Health Sciences Centre (TBRHSC).

“Since 2011, we have had two cath-eterization labs in Thunder Bay, providing 24/7 service to patients in our community,” explains Dr. Mark Henderson, Executive Vice President, Patient Services, TBRHSC and Regional Vice President, Cancer Care Ontario. “Direct angioplasty is the gold standard for treatment of a heart attack and having two labs available meant we could treat patients right away, prevent further damage and save lives. The equip-ment in our older lab was installed in 2005, and after 10 years of heavy use, it needed to be replaced to ensure we could continue to provide life-saving care for our patients.”

The catheterization labs provide 24/7 services for emergent cardiac cases, as well as 80 hours of scheduled cases each week. Altogether in one year, interventional car-diologists provide 2,150 cardiac catheter-izations, 710 percutaneous coronary inter-ventions (angioplasty with a stent), and 210 pacemaker insertions.

Each lab is equipped with a C-arm and imaging equipment to allow cardiologists to visualize the inside of arteries. In the original lab, the C-arm has been com-pletely replaced, along with associated imaging equipment at a price of $1.4 mil-lion. The second, newer lab has also re-ceived necessary software upgrades to its existing equipment.

“What is so incredible about the new C-arm is that the new unit gives us added capabilities, including 3D images, which give us a better view of the inside of the arteries,” says Dr. Andrea MacDougall, Interventional Cardiologist, Medical Program Director Cardiovascular and Stroke and Chief of Cardiology, TBRH-SC. “Another advantage is that the new unit exposes patients to less radiation than before, without sacrificing image

quality, which is of utmost importance.”“It is reassuring to know as a patient

that our interventional cardiologists like Dr. Henderson and Dr. MacDougall have the best equipment available to continue to provide life saving services to patients here at home that may require their in-tervention,” says Lawrence Dorey, a pa-tient who received his first stent in Ot-tawa, and his second in Thunder Bay. “I am deeply thankful to all the donors who made this possible – there’s really no way to express how much of a difference it meant to me and my family to be able to receive my care here.”

“The quality of patient care and in-novation in the field of healthcare are at the heart of the J.Armand Bombardier Foundation and Bombardier employees. The J.Armand Bombardier Foundation is grateful for the opportunity to provide funding support to help the Thunder Bay Regional Health Sciences Centre treat patients and to facilitate the delivery of contemporary healthcare to community residents and our employees in a familiar setting,” says George Gasbarrino of the J.

Armand Bombardier Foundation. “The upgrades to the Cardiac Catheterization Labs will help offer sustainable, consis-tent services for years to come. Improv-ing lives is embedded within Bombar-dier’s purpose, and our employees take great pride to provide support that will improve access to quality healthcare for the community and our families.”

“When we think about the care we want for our families and friends, we know that we are not willing to settle for substandard care. Donors, like the J. Armand Bombardier Foundation, along with Balmoral Park Acura, and countless others are absolutely vital in ensuring that we have equipment in Thunder Bay that allows our interventional cardiolo-gists to perform life-saving procedures,” says Tracey Nieckarz, Chair, Board of Directors, Thunder Bay Regional Health Sciences Foundation. “I’m very thank-ful that our community recognizes the critical importance of donations to our cardiac care program. At this time, we are still raising funds to complete the purchase of the new C-arm and other new equipment for our cath labs, and I encourage people to make a donation to help fulfill our commitment to this proj-ect which is directly responsible for sav-ing lives.” ■H

Heather Vita is Manager, Marketing & Communications at Thunder Bay Regional Health Sciences Foundation.

Vital upgrades to cardiac catheterization labs enhance patient careBy Heather Vita

N

It is reassuring to know as a patient that our interventional cardiologists have the best equipment available to continue to provide life-saving services to patients here at home that may require their intervention.

(above) Dr. Andrea MacDougall (left), Interventional Cardiologist, Medical Program Director Cardiovascular and Stroke and Chief of Cardiology, along with Marnie Javis, Registered Nurse, show the new equipment in the Cardiac Catheterization Lab at Thunder Bay Regional Health Sciences (right) Donors to the Northern Cardiac Fund were instrumental in making possible the $1.4 million upgrades to TBRHSC’s Catheterization Labs



earing you need open heart surgery can be frightening. Of-ten, it comes as a surprise – a visit to the Emergency Depart-

ment with chest pain can reveal advanced heart complications. Even more routine cardiac procedures like angioplasty, where blocked heart vessels are cleared to help the heart function better, can be daunting for a patient. Trillium Health Partners has a unique peer mentorship program to help see patients and families through these challenging times.

Started in 2000, Healing Hearts is a volunteer-based support program at Trilli-um Health Partners that acts as a comple-ment to cardiac care, providing emotional support and practical advice for patients undergoing a cardiac procedure or cardiac surgery. Volunteers in the program have all undergone and recovered from cardiac catheterization or cardiac surgery.

“When I was 56, I had a heart attack at work, but didn’t know it. When I came home, I still wasn’t feeling well. My wife and I decided to go to Trillium Health Centre at the time to check things out,” says Dave Burns, volunteer Team Leader with the Healing Hearts program, one of 13 individuals who currently volunteer. “I ended up having four cardiac arrests that night. I spent three weeks in the hospital, four days of it in a medically induced coma to help my heart rest. All in all, this hos-pital has saved my life three times, includ-ing a quintuple bypass in 2004. In 2002, I decided to give back by becoming a vol-unteer. Since then, I’ve helped over 7000 families through Healing Hearts.”

Healing Hearts volunteers have a fi rst-hand understanding of what patients can expect before and after procedures and are able to be there to provide support while they are on their journey. Often, fear of the unknown is what can contribute most to emotional distress, and having the mys-tery removed by being walked through what can be expected every step of the way helps patients prepare and heal faster.

Healing Hearts volunteers visit Trillium Health Partners’ Cardiology, Cardiac Sur-gery Unit and Cath Lab Short Stay Unit patients before and after procedures. Oth-ers partner with Occupational Therapists and Social Workers on the unit to run discharge classes for patients and fami-lies. During these classes, Healing Hearts volunteers talk about their own cardiac journey, recovery, what to expect, what sort of activities they can do and when, and important lifestyle and rehabilitation choices.

The impact on patients is signifi cant. This past June, quadruple bypass patient

Mr. Robert Leonard got some tips from Mr. Burns before going home to recover: “Dave is very up-beat, the kind of person you want to talk to in a situation like this,” he says. “He’s just got that look about him that makes you want to listen and take in what he’s got to say, because he’s been there and done that. He told me what worked for him, and what didn’t. I’m one of those hands-on people that just keeps on going and doesn’t stop, I’m always ac-tive. He told me not to overdo it, and I will be listening to him because I know that if I push it, I’ll end up back in the hospital.”

Healing Hearts volunteers like Dave

are in a unique position to build credibil-ity and trust with patients. According to Brenda Diduck, Clinical Leader on Tril-lium Health Partners’ Cardiac Surgery Unit, they are often able to have conversa-tions with patients that can help the clini-cal team tremendously. They play a major role in lowering anxiety levels and provid-ing hope and support to patients and their families. “For many patients, the news that they need heart surgery often comes as a complete shock. Healing Hearts volun-teers really help ease their anxiety,” says Ghita Beswick, Social Worker on Trillium Health Partners’ Cardiac Care Unit. “It’s

very reaffi rming. They help patients feel it’s not the end of the world.”

Part of Trillium Health Partners’ com-mitment to deliver exceptional quality healthcare in the Mississauga and West Toronto community means always looking at the full picture of what our patients and families need to heal as well as possible – Healing Hearts is a testament of how the hospital fulfi lls its mission to create a new kind of healthcare for a healthier commu-nity, one patient and family at a time. ■H

Ania Basiukiewicz is a Communications Advisor at Trillium Health Partners.

Healing hearts, easing mindsBy Ania Basiukiewicz

H

Healing Hearts is a volunteer-based support program at Trillium Health Partners that acts as a complement to cardiac care, providing emotional support and practical advice for patients undergoing a cardiac procedure or cardiac surgery.

Trillium Health Partners’ Healing Hearts Volunteer Dave Butler puts a patient at ease.Trillium Health Partners’ Healing Hearts Volunteer Dave Butler puts a patient at ease


14 Evidence Matters

he number of Canadians with diabetes is rapidly increasing. According to the Canadian Diabetes Association, more

than 20 Canadians are diagnosed with the disease every hour of every day.

Diabetic foot ulcers (DFUs) are the most common chronic complication from diabetes, affecting four to 10 per cent of patients. DFUs can last a year or longer and can happen again in up to 70 per cent of people who have previously been af-fected. Patients are more likely to develop DFUs if they have had diabetes for a long time, have poorly controlled blood sugar, have foot injuries or infection, are older, or smoke. However, neuropathy, dam-age to the nerves, which may result in a lack of feeling in the feet, and peripheral artery disease, which reduces the blood fl ow to the limbs, may be the most sig-nifi cant causes. Because of nerve damage and numbness, an individual with diabe-tes may not be aware that they have a sore or wound, leading to even minor injuries getting worse or becoming infected. De-creased blood fl ow caused by peripheral vascular disease may prevent healing once an injury occurs.

When DFUs become infected, the bone or skin can also become infected. This can lead to signifi cant pain and suffering; poor quality of life for patients; amputation of a leg, foot, or toe; increased treatment and hospitalization costs and can even lead to death.

The good news is that many foot com-plications are preventable with diabetes management and proper foot care, includ-ing regular foot exams and aggressive treat-ment of infections. Debridement (remov-

ing dead skin and tissue), taking pressure off the foot ulcer (off-loading), infection control, and wound care with appropriate medications or dressings are some of the key aspects in the treatment of DFUs.

CADTH – an independent, evidence-based agency that fi nds, assesses, and sum-marizes the research on drugs, medical de-vices, and procedures – recently looked at the evidence on two treatment approaches that are based either on off-loading or the application of controlled pressure around the wound area to stimulate DFU healing.

Off-Loading DevicesReducing the pressure on the bottom

of the foot from surfaces below (plantar pressure) can be used in the treatment and prevention of DFUs. Devices that off-load the plantar pressure include removable options such as customized footwear, cast walkers, and orthoses (sometimes called orthotics) or devices that cannot be re-moved by patients such as total contact casting (requiring a skilled technician) and instant total contact casting (making a re-movable walking cast permanent by wrap-ping it in casting material).

The CADTH review found that non-re-movable off-loading devices — total con-tact casting and instant total contact cast-

ing – appear to be more effective than removable devices in the treatment of DFU by providing bet-ter healing rates and heal-ing times for ulcers. Non-removable devices may be more effective simply be-cause patients keep the de-vice on or because the device restricts physical activity.

Although they may be more effective, because non-removable off-loading devices are time consuming to apply, don’t allow for regular wound assessment, and decrease pa-tient mobility compared with removable devices, clinicians might be more likely to suggest that their patients use remov-able off-loading devices. Of the removable devices, cast walkers may be the most effective for the treatment of DFU; however, the evidence is limited.

Compression TherapyWhile pressure off-loading is a ma-

jor aspect of diabetic foot care, therapies that apply controlled pressure around or onto the wound offer a different way for promoting the healing of DFUs. One such treatment approach, compression therapy, was also reviewed by CADTH.

The goal of compression therapy for DFUs is to improve blood circulation by controlling external pressure through the application of bandages, specialized stock-ings, or infl atable garments. Intermittent pneumatic compression devices, which

infl ate and defl ate to simulate the blood fl ow experienced while walking, and compressed air massage, in which a stream of compressed air is applied directly to the wound, are different methods of compres-sion therapy.

The limited evidence CADTH found on these technologies suggests that intermit-tent compression therapy and compressed air massage may be better than standard wound treatments (such as antibiotics, in-sulin infusion, strict bed rest, daily clean-ing of wounds with saline, and antiseptic cream dressings) for healing and reducing fl uid retention. A clinical practice guide-line also suggests that foot compression in addition to standard wound care may be more effective for healing infected DFUs than standard care alone.

These DFU treatment options may not be suitable for all patients with diabetes. However, knowing the evidence and tak-ing into consideration other important fac-tors such as patient characteristics, patient preferences, the local health care context, and costs will help to determine the best use of these promising technologies.

To learn more about CADTH, visit www.cadth.ca, follow us on Twitter: @CADTH_ACMTS, or talk to our Liaison Offi cer in your region: https://www.cadth.ca/contact-us/liaison-offi cers. ■H

Eftyhia Helis is a Knowledge Mobilization Offi cer at the Canadian Agency for Drugs and Technologies in Health (CADTH).

Under pressure By Eftyhia Helis

T

Diabetic foot ulcers (DFUs) are the most common chronic complication from diabetes, affecting four to 10 per cent of patients.

– promising treatments for the healing of diabetic foot ulcers



magine feeling like your heart is racing all the time. A new study shows that, for more than 200,000 people across

Canada who suffer from atrial fi brillation (AF), treating the condition is simpler than fi rst thought.

Southlake Regional Health Centre’s Cardiac Care Program is once again cel-ebrating as new ground-breaking research led by Dr. Atul Verma, Electrophysiologist and Director of Arrhythmia Services for the Regional Cardiac Care Program, could change the way clinicians look at treating heart conditions.

“The results are dramatic and will likely change guidelines that currently recom-mend doing more involved interventional procedures to treat AF,” says Dr. Verma. “Although we often think that doing more is better for the patient, it is important to test this in proper clinical trials. Sometimes more is not better.”

Ablation is a minimally invasive pro-cedure that can be done to treat patients with atrial fi brillation, a common heart rhythm problem. Some patients are in AF all the time and suffer from palpitations, shortness of breath and fatigue. Until re-cently, it was believed that you had to per-form extra ablation on top of the standard procedure to get better results.

It turns out that the fi ndings of this new international research study show that the simplest and fastest way to treat persistent AF by ablation has proven to be as effec-tive as the other two most common, more complicated, techniques that require addi-tional intervention. The study, published in the New England Journal of Medicine, ‘Ap-proaches to Catheter Ablation for Persis-tent Atrial Fibrillation,’ was led by Dr. Atul Verma, Electrophysiologist and Director of Arrhythmia Services at Southlake in New-market, Ontario.

“I am thrilled that we have produced this level of research here at Southlake.

This really speaks to the cutting-edge, international caliber of cardiac care we offer,” says Dr. Verma. “I’m very happy that data from our hospital has the poten-tial to change practice around the world and make a difference for the patients we treat.”

Southlake President and CEO Dr. Dave Williams echos those sentiments, “I am so excited to see Dr. Atul Verma’s study pub-lished in the New England Journal of Medi-cine, one of the most prestigious medical journals. Our clinicians are at the fore-front of innovative research that creates the potential to further elevate the world-class care we provide to Southlake cardiac patients. I am very proud of the level of clinical research that is happening at our hospital.”

The study followed 589 patients with AF, from 48 centres, in 12 countries. They were enrolled between November 2010 and July 2012. Patients were randomly as-signed to one of three procedures. One was the “standard” shorter procedure which involves using small wires inside the heart to burn away abnormal tissues around the

pulmonary veins (an area that has been shown to transmit electrical signals that trigger AF). The other two procedures in-volved adding more ablation to the stan-dard procedure. Patients were then rigor-ously monitored each week for 18 months.

In the end, doctors involved in the re-search study were surprised to learn that patients experienced the same, if not bet-ter results, after undergoing the shorter “standard” ablation procedure compared to patients who had the more extensive procedures.

Affecting millions of people world-

wide, AF is a condition in which the up-per chambers of the heart beat rapidly and erratically, disturbing the heart’s ability to adequately pump blood to its lower cham-bers and the rest of the body. The condi-tion is responsible for 15 to 20 per cent of all strokes, is a contributor to heart failure and is a leading cause of hospitalizations, causing debilitating symptoms and poor quality of life. ■H

Kathryn Perrier is a Media and Government Relations Specialist at Southlake Regional Health Centre.

‘Keep it simple’

By Kathryn Perrier

I

AF is a condition in which the upper chambers of the heart beat rapidly and erratically, disturbing the heart’s ability to adequately pump blood to its lower chambers and the rest of the body.

Ground-breaking Research led by Southlake Doctor proves that a simple heart procedure is more effective than other options that require additional intervention

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Ground-breaking research led by Dr. Atul Verma, Electrophysiologist and Director of Arrhythmia Services for the Regional Cardiac Care Program, could change the way clinicians look at treating heart conditions.

when treating serious heart condition


16

HOSPITAL NEWS JULY 2015

OHHA Profile

The Ontario Healthcare Housekeepers’ Association

he Ontario Healthcare Housekeepers’ Association (OHHA) had its inception in 1957, when housekeeping

personnel gathered at the OHA Annual Convention and formed an association of house keepers dedicated to the ad-vancement of healthcare housekeep-ers as professionals in the healthcare of patients and residents in Ontario. The prime directive was to provide its Mem-bers with education and the latest infor-mation needed to provide a safe, clean and healthful environment for patients and residents in health care facilities in Ontario.

The OHHA has advanced that prime directive with a purpose that to this day provides opportunities for housekeeping managers, supervisors, lead hands and those housekeeping staff looking to up-grade their qualifi cations as professionals through:• Education through the OHHA Profes-sional Development Courses – House-keeping Methodology, Infection Control, Laundry/Linen Technology and our new-est course Environmental Services for Front Line Staff – courses developed by professionals who work in healthcare• Certifi cation process for our Members that is continually upgraded to refl ect the changing needs of our residents and pa-tients in the battle against ever develop-ing new challenges such as ‘super bugs’, budget effi ciencies, adhering to cleaning standards, etc. Certifi ed Members earn the designation of Professional Health-care Housekeepers (P.H.H.)• Annual OHHA Professional Devel-opment Seminars with multiple topics refl ective of the “hot issues” of the day. Presented by recognized experts and your peers• The OHHA publishes a newsletter three times a year, presenting news in the health care fi eld, regional activities and OHHA business• The OHHA developed the “Cleaning Standards For Health Care Facilities”; a nationally recognized document used by many health care districts, acute care and long term care facilities across Canada. This document is given to all new Mem-bers of the OHHA• The OHHA sponsors regional meet-ings across Ontario so that attendees can network with their colleagues, sharing experiences on the many challenges they face every day in health care facilities• The OHHA sponsors an annual “Housekeepers Week”, recognizing housekeeping frontline and management staff for their contributions as an integral part of the health care team dedicated to provide a safe, clean and healthful envi-ronment for patients, staff and residents• The OHHA also hosts our own web-site www.ohha.org providing the latest information regarding OHHA, including career opportunities.

The OHHA urges you to encourage your staff that manage and supervise your housekeeping activities, to inquire about Membership in the Ontario Healthcare Housekeepers’ Association Inc.

We all want to ensure that our people have the “tools” necessary to provide the best environments for the patients, resi-dents, staff, and visitors to our health care facilities.

For more information email: [email protected] or visit www.ohha.org. ■H

Association Profi le

T

Dear Healthcare Housekeeping Professional;

The Healthcare Housekeeping Profession has changed dramatically over the years.

Like many departments within a hospital setting, we are being challenged more than ever.

We are seeing the deadliest bugs and threats in years and new strains of disease to fi ght that plague our hospitals and Long

Term Care Facilities, budget cuts, erosion of head count; doing more with less continues to be our mantra. Notwithstanding

the myriad of other factors, like an aging workforce and the effects of global immigration and related language barriers that

compete with our time and own skill sets, day in and day out.

One thing that has been a constant through these recent changes and those experienced over the last nearly 60 years is

and has been The Ontario Healthcare Housekeepers Association Inc. (OHHA)

Starting in 1957 as a group of health care professionals who set out to fi nd a common ground in the cleaning vocation,

share ideas and professionalize the industry, we have come quite a long way!

We presently are and have been a proud allied partner of the Ontario Hospital Association (OHA) for most of these years.

We work closely with the OHA providing the professional knowledge and expertise for their Educational Programming. We

also coordinate an Educational Session at the OHA Health Achieve Convention each year in November.

The OHHA, in partnership with the OHA provides educational programs for supervisors and managers of housekeeping

and environmental services in health care settings. The OHHA continues to support our front line staff by providing education

for them through our Environmental Services for Front Line Staff course. To date there has been approximately 700 people

take this course. We recently partnered with Algonquin College in Ottawa to provide this course part-time, through in-class

study with an 80 hour fi eld placement.

This is quite unique. To our knowledge, no other professional program exists like ours in Ontario. We have members who

have benefi ted from taking our courses from all parts of Canada as we understand that our educational programs are unique

and almost exclusive to our industry.

The OHHA was a key partner, working with the Regional Infection Control Network (RICN) and the Provincial Infectious

Disease Advisory Committee (PIDAC) in developing the Tool Kit for Best Practises for Environmental Cleaning for Prevention

and Control of Infections document. We will be working with them again, commencing this fall as revisions to the document

begin.

We have had and continue to enjoy a long standing and very positive partnership with the Canadian Sanitation Supply

Association (CSSA) over the years. We contribute relevant and pertinent industry articles to the very popular Sanitation

Canada Magazine six times a year, as well; we provide Educational Sessions at the Can Clean Show, which is held every two

years.

Four years ago we started hosting our own annual conference and trade show and so far, we have travelled across

Ontario to Welland, Kingston and Innisfi l. Our Conference is attended by Directors, Managers, Supervisors, Team Leaders

from hospitals and long-term care facilities within Ontario. We also attract Public Health Inspectors, Infection Prevention and

Control Practitioners and of course, the best manufacturers and suppliers of chemicals and equipment in the country. Our

Conference and Trade show has the reputation of the best show of its kind in Canada, by delegates and vendors alike.

The OHHA fundamentally exists to:

• Foster and promote harmony and co-operation among its members.

• Collect and disseminate information and current data on new and improved techniques and equipment for the Health-

Care Housekeeping/ environmental service professionals.

• To encourage, arrange and promote educational programs for and on behalf of Association members for the

Housekeeping / environmental service profession in the interest of improved patient/ client care.

Refl ecting on where we have been, we have enjoyed a stellar cast of some rather excellent people who have been

members, regional chairs and board of directors.

These same people have advanced our Health Care Housekeepers profession in signifi cant and sustainable ways with our

educational courses and designation (PHH), countless industry contributions and have been the voice of those who work in

our vocation by volunteering thousands of hours towards these ends.

As we look to the future we welcome and are eager to embrace the youth of our profession, the drive, energy and creativity

that focused and likeminded individuals have to bring and the knowledge that continuous improvement for the betterment of

all stakeholders we serve, lies between those who are part of our association now, and those who are yet to come.

We warmly invite you to have a look at our web page, inform your opinions further and learn more about who we are and

what we are all about.

You can fi nd us at www.ohha.org

We look forward to meeting you in the near future!

Sincerely, The OHHA and all of its members! l of its membe



f you listen closely in the hall-ways of McMaster Children’s Hospital (MCH), you might just catch the strumming of an

acoustic guitar and a voice that is sure to brighten your day.

Music therapist Adrian Mollica spends his Tuesdays and Thursdays with young patients at MCH on behalf of Fermata Music Therapy. Through his music Adrian fi nds a unique connection with each of the patients.

“It has this really wonderful, non-threat-ening and engaging way of interacting with the kids,” explains Adrian.

Ultimately, the goal of music therapy is to positively affect both the child and their family, and to take their minds away from what has brought them in to the hospital. In addition, Adrian provides the family opportunity for relaxation while he’s interacting with a child.

Reed Wales, 18 months, was diagnosed with Leukaemia and is currently a patient at MCH. Adrian has had many visits with Reed, and the Wales family is overjoyed with the effect that the music has had thus far.

“He gets so engaged with the music,” says Reed’s father, Brett Wales. “Even ear-lier, Adrian was holding down the chords while Reed was strumming the guitar. He loves it!”

Reed’s favourite songs that Adrian plays are “The Wheels on the Bus” and “Jesus Loves Me”. His usual reaction is to giggle, smile, and sometimes even fall asleep on his dad’s shoulder.

“It gives us a break,” says Brett. “The music distracts us from why we’re here and allows us to relax as a family.”

Adrian attended Berklee College of Mu-sic where he obtained his Bachelors in Mu-sic with a major in Music Therapy. Once he was at Berklee, Adrian knew that he wanted to continue his work down a more meaningful path. Helping those who are ill and vulnerable is exactly what he was look-ing for.

“Being able to put a smile on [the kids’] faces, and engaging them in fun and im-proving their quality of life is invaluable.” ■H

Carlyn McGill is a Public Relations Intern at Hamilton Health Sciences.

By Carlyn McGill

I

Ultimately, the goal of music therapy is to positively affect both the child and their family

Healing sounds

Music Therapist Adrian Mollica and patient Reed Wales.

six-month study out of Hol-land Bloorview Kids Reha-bilitation Hospital revealed that children with autism who

consumed omega-3 fatty acids did not im-prove their core symptoms, which chal-lenges current thinking on a widely-used alternative therapy for autism. This study does not support a common belief that previously connected the consumption of omega-3 fatty acids with an improvement in core autism symptoms.

Led by Dr. Evdokia Anagnostou, Cana-da Research Chair (Tier II) in Translation-al Therapeutics in ASD and Senior Clini-cian Scientist in the Bloorview Research Institute, study fi ndings indicate that while the intake of omega-3 fatty acids may be benefi cial from a nutritional standpoint, the consumption of a much higher dose – typically administered to children with autism and often advocated as an autism-specifi c supplementation – did not en-able skill acquisition or improvement in social functioning.

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that affects brain development, and is defi ned by chal-lenges in social communication and re-petitive behaviour. Most recent estimates from the U.S. Centers for Disease Control (CDC) note that 1 in every 68 children are born with ASD. As a result, accord-ing to the Autism Society of Canada, an estimated 515,000 Canadians are living with ASD. ASD becomes apparent in early childhood.

Treatments for ASD that target core symptoms are limited, and alternative and complementary therapies for children with ASD are often explored. Autism has many causes, but no individual cause explains why children and adults have the disor-der. Investigations are underway to im-prove treatments and narrow in on which treatments will work for whom. Comple-mentary therapies are sometimes used even in the absence of good quality data to support them.

“It is critical that we evaluate such therapies as our practice should be guided by evidence,” says Dr. Anagnostou, on the subject of using therapies in advance of them being studied.

The study, ‘A randomized, placebo con-trolled trial of omega-3 fatty acids in the treatment of young children with autism’ was published in Molecular Autism in

March 2015. This study was a collabora-tion between the Bloorview Research In-stitute at Holland Bloorview Kids Reha-bilitation Hospital, and the Department of Pediatrics at the University of Toronto.

Dr. Anagnostou is also the co-editor of a new book called Clinicians Manual on Autism Spectrum Disorder (published by Springer, UK) alongside Dr. Jessica Brian, Clinician Investigator, Psychologist and co-lead of the Autism Research Centre in the Bloorview Research Institute.

Clinicians Manual on Autism Spectrum Disorder is a clinical handbook that pro-vides an overview of best-practices in ASD care, and is designed to support cli-nicians with research-based guidance in the diagnosis, treatment, and long-term management of autism, including behav-ioural therapies, current clinical trials, and emerging pharmaceutical treatments. The manual also includes a chapter on person-centred care for individuals with ASD and their families.

“ASD research is providing unique in-sights to help clinicians better understand and manage symptoms of autism in their patients,” says Dr. Brian. “The handbook is a clinically-focused tool that will support clinicians with diagnosing and managing autism, based on the latest research and best practices.” ■H

Michelle Stegnar is a communications associate at Bloorview Research Institute at Holland Bloorview Kids Rehabilitation Hospital.

High doses of omega-3 fatty acids offer no benefi t in children with autismBy Michelle Stegnar

A

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that affects brain development, and is defi ned by challenges in social communication and repetitive behaviour.



ulia is a mother of three, her youngest son, Nathan, aged 13, has asthma. Nathan was fi rst diagnosed with asthma

at the age of fi ve and since then Julia has spent many sleepless nights in the emer-gency room and has missed signifi cant time off from work to take Nathan to doc-tor’s appointments and to take care of him when his symptoms prevent him from at-tending school. Nathan has been on sev-en different medications since he was fi rst diagnosed, but none have been successful at effectively managing his symptoms.

Earlier this year, Julia took Nathan to see a Respirologist at their local asthma clinic. Eight years after fi rst being diag-nosed, Julia was shocked to learn from the specialist that Nathan’s asthma, which had previously been diagnosed as moder-ate asthma, was in fact Severe Asthma, or SA. Nathan was prescribed a treatment better suited to deal with his Severe Asth-ma symptoms and since then has seen his exacerbations and symptoms decrease and he has managed to avoid any visits to the emergency department.

Asthma is the third-most common chronic disease in Canada affecting more than three million Canadians, including about 600,000 children, causing pain, suf-fering, and asthma exacerbations. This means lost sleep, lost work days, scared children and parents, more days in phy-sicians’ offi ces and hospital emergency rooms.

Severe Asthma (SA), a more severe form of asthma and a greater threat to life, impacts the health and economic well-being of between 150,000 and 250,000 Canadians. Approximately 250-300 Canadians will die this year from asthma. Beyond personal costs, asthma is the leading cause of hospital admissions in Canada. Between 2010 and 2011, direct and indirect costs associated with treat-ing asthma topped more than $1-billion dollars.

Julia and Nathan’s story is not unique. Canadians with asthma are being misdiag-nosed far too often. The Asthma Society of Canada believes this problem is furthered by an unclear standard defi nition for Se-vere Asthma, leaving the patient and phy-sician with the diffi cult job of identifying the appropriate diagnosis and prescribing the optimal treatment.

Last year, the Asthma Society of Cana-da released the fi rst-ever patient study of Severe Asthma in Canada. The study, Se-vere Asthma: The Canadian Patient Journey, takes an in-depth look at the personal, so-cial, medical and economic burden of Se-vere Asthma in Canada.

“The good news in this report is that SA is a disease Canadians have the possibility to control. We need more research into SA, more attention to the issue by physi-cians and government, and more resources to educate patients about how to manage their disease,” says Robert Oliphant, Presi-dent and CEO of the Asthma Society of Canada. “If we can rally against SA, we will save lives and improve the quality of life for hundreds of thousands of patients and their families. All we need to do is act.”

Severe Asthma: The Canadian Patient Journey, included extensive interviews

with SA patients in Alberta, Ontario and Quebec, as well as responses from every province through an on-line survey. It highlights the patient experience of SA, in their daily lives, the health care system, with respect to treatment options and with family, friends and in the work place. The study defi ned important discoveries about SA’s impact on Canadians.

The study found that SA is generally poorly understood and diagnosed, and in-consistently managed by health care pro-viders. Its severity is also discounted by patients themselves, sometimes as a result of the stigma associated with the disease. Despite all study participants having SA, as identifi ed by the Canadian Consensus Guidelines, 21 per cent of respondents said their physician had described their asthma as ‘mild’ or ‘moderate.’ Additionally, more than half of respondents (64.6 per cent) said that they have felt stigmatized at some point because of their asthma, with 22.2 per cent saying they feel stigmatized ‘quite often.’ Similarly, 66 per cent of respon-dents felt that their asthma interferes with the quality of their social interactions with others.

The impacts of SA are signifi cant and were identifi ed as reducing the personal, social, fi nancial and health outcomes for many Canadians. There is also a noticeable impact of SA on the Canadian economy. Many patients identify cost as a signifi cant barrier to better health outcomes. More than a third of respondents reported their household income as being under $50,000 which was identifi ed as a barrier in their ability to manage their asthma. Seventy-four per cent of respondents have been de-nied coverage for physician-recommended treatment options by insurance programs. One respondent described having to rely on sample medication to maintain the treatment schedule: “My doctors help me with the cost by giving me samples of most of my inhalers, but when I have to pay for them, except for the Ventolin which is

reasonably priced, I have to take on extra work to help pay for my medication.”

According to the Conference Board of Canada, the cost of hospitalization for asthma in 2010 was $250,728,024. The physicians who cared for these patients cost $196,321,334. The cost of asthma medication in 2010 was $535,681,566. Fi-nally, indirect costs of asthma, including decreased productivity, was estimated at $646 million dollars. Thirty per cent of re-spondents reported that they missed work or school because of their asthma. Sixty-six per cent missed fi ve days or more in a given year, and 31.9 per cent missed more than 10 days.

Understanding asthma

By Noah Farber

J

“When I found out I had asthma I felt like I was drowning: I was having diffi culty breathing which made me feel like I was struggling under water. Everything was so overwhelming that I didn’t know where to turn or what to do.”

Continued on page 19

“The worst part of living with asthma used to be that nobody believed me. It’s kind of an invisible illness. You don’t always want to say ‘I am not feeling well, I have asthma’ because there is still a stigma. Even when you go to the hospital they ask, ‘Well, how bad is your asthma attack?’ What difference does it make? An asthma attack is an asthma attack and I need help, otherwise I wouldn’t be here.”

About the Study

• Severe Asthma remains one of the least understood and least studied manifestations of asthma.•To examine the complex health, social and economic issues related to SA, the Asthma Society of Canada conducted a study of Canadians about their experience with SA. The study, which included in-depth interviews as well as an on-line survey, was conducted in the summer and fall of 2013. It sheds light on how SA, controlled and uncontrolled, affects a patient’s quality of life, expectations for the future, medication preferences and experience with the health care system.•All participants in the study were Canadian adults 18 years and older who live with severe, controlled or uncontrolled, asthma. All potential participants were evaluated through a strict screening process and only qualifi ed applicants were interviewed.

Cover Story



Patients clearly indicated a preference for being able to see a specialist to help treat and manage their asthma, however only 31.6 per cent of respondents indi-cated that they had access to a respiratory specialist. Forty per cent had access to a respirologist, 33.7 per cent could access a community asthma clinic and only 22.1 per cent had access to a Certifi ed Asthma/Respiratory Educator.

Even when patients are able to see a specialist, there is widely inconsistent cri-teria and differing diagnostic techniques used when diagnosing and grading asth-ma. The study showed that only half of respondents reported being given any lung function or pulmonary tests prior to their diagnosis. Tests often don’t include stan-dard allergy testing or elementary objec-tive lung function tests such as spirometry. Additionally, less than half of respondents said their health care practitioner dis-cussed proper inhaler techniques, Asthma Action Plans and the benefi ts and risks of an inhaled steroid medication.

Of additional concern is that a surpris-ingly large number of patients are not be-ing given information about the newest

kind of therapies for their asthma. Patients knew little about new biologics available for the treatment of SA and none had heard of Bronchial Thermoplasty despite its availability in several centres geograph-ically near interview participants.

At the conclusion of this study, the Asthma Society of Canada issued a Call to Action, calling upon:• Professional medical associations to es-tablish a clear defi nition of SA based on new international guidelines that patients can understand and physicians will use to make diagnoses; • Physicians to make full use of objective lung function testing before diagnosing Severe Asthma instead of simply relying on symptoms as reported by patients;• Patients to learn to manage their asth-

ma and to recognize when their asthma is not under control before ending up in a hospital;• Governments to recognize the fi nan-cial burden of SA on the patient and to increase funding for research into SA, its causes, types, treatments and cure;• Employers to accommodate employees with SA regarding workplace environ-ment, fl exible working hours and medical leave when required, without adding to the stigma often faced by people with Se-vere Asthma. ■H

Noah Farber is the Director of Communications and Government Relations, Asthma Society of Canada and Executive Director, National Asthma Patient Alliance (NAPA).

Continued from page 20

VS.

YOUR ADVANTAGE, in and out of the courtroom.

www.thomsonrogers.com

What Patients with Severe Asthma Want

Patients with SA showed a general willingness to take medications when associated with the strong desire to live normal lives, participate in routine household activities and daily exercise and attend the hospital for asthma-related issues less frequently.

Nighttime symptoms and the consequent loss of sleep were ranked more critical than daytime symptoms, but an overwhelming number of respondents simply wanted to be able to go to work and be involved in the economic life of Canada.

Activities that other Canadians take for granted continue to be the dream of people with SA. They ranked the following as their main goals with respect to their disease: •To function normally while completing household activities, walking and enjoying life (98% very important, 1% somewhat important) •To not have to visit the emergency department or be admitted to hospital (89% very important, 9% somewhat important) •To sleep without nighttime symptoms (87% very important, 11% somewhat important) •To exercise without asthma symptoms (80% very important, 17% somewhat important) •To go to work (84% very important, 5% somewhat important) •To improve breathing test results (74% very important, 17% somewhat important) •To live without daytime symptoms (68% very important, 26% somewhat important) •To lower the overall amount of asthma medication taken (69% very important, 17% somewhat important) •To escape from dependence on reliever medications (55% very important, 24% somewhat important)


20 Legal Update

n 2006, the Ontario Human Rights Code was amended to remove age 65 as the upper limit of prohibited discrimina-

tion based on age. Many hospitals inter-preted this to mean that they could no longer require physicians, based on age, to retire or to transition from active staff to consulting or locum staff.

This interpretation and the issue of late career transitioning has now been brought to the forefront by physicians themselves who are recognizing that, due to the large size and longevity of the baby boomer generation and other economic pressures, there is a disproportionate number of phy-sicians who are continuing to practice be-yond traditional retirement age.

As a result, many hospitals today do not have any effective succession planning in place to manage their aging medical staff. This creates several issues, including: • patient safety and quality of care risks, in relation to decline in performance that usually accompanies advancing age (stud-ies have demonstrated that there is a precipitous decline after age 55 in cogni-tive function, inductive reasoning, verbal memory and overall reasoning)• a barrier to entry for younger doctors recently trained in the latest medical pro-cedures• personal health risks relating to the well-being of aging physicians who are poorly prepared to transition to retirementHowever, even before these 2006 amend-ments, there has always been a body of law recognizing that an employer can establish a discriminatory practice based on age, if the discrimination is indeed a reasonable and “bona fi de” qualifi cation of employ-ment (e.g., pilots, police, fi refi ghters), particularly where the discrimination is validated by research and related to public health or safety.The concept of a bona fi de occupational requirement has always applied to hospi-tals and, accordingly, hospitals should re-quire physicians of a certain age to develop late-career transition plans that provide :• the reclassifi cation of their privileges, perhaps to a “senior staff” category

• reduced access to resources in consider-ation of reduced call responsibilities• mentoring opportunities and resource sharing with new recruits• ongoing meaningful participation in teaching, research and administration, considering a marked diminution in clini-cal activities

Until recently, however, hospitals have largely ignored these age-related risks to patient safety and quality of care, allowing aging physicians to self-determine when they will retire, regardless of the inevita-bility of cognitive function decline and the inability to put an orderly succession plan in place.

In some U.S. jurisdictions, medical boards and associations have collabo-rated to develop best practices in late ca-reer transitioning policies and procedures which, among other things, call for the creation of in-hospital “well-being com-mittees” that are separate from credentials committees. These policies acknowledge that hospitals do not currently provide suffi cient resources to assist with the well-being of physicians as they transition to retirement.

The mandate of a well-being commit-tee is essentially to oversee the implemen-tation of enhanced peer reviews for all physicians of a certain age at the hospital. The aim is also to establish a collaborative protocol for conducting peer reviews by a committee that has no authority to take disciplinary action against staff. The pro-tocol includes provisions for confi dentiality and physician support, including advising physicians on the outcome of such reviews. However, it also makes clear that in the event that information demonstrates that the health or known impairment of a med-ical staff member poses an unreasonable risk or harm to patients, such information may be referred to a credentials committee for corrective action.

In conclusion, hospital boards, adminis-trators and physician leaders must be able to put in place meaningful succession plans for their medical staff that clearly identify that quality patient care is paramount, but that also provides assistance in transition-ing physicians from an active staff practice to a transitioning practice with meaning-ful hospital roles that eventually results in retirement. ■H

Michael Watts is a Partner in the Toronto offi ce of law fi rm Osler, Hoskin & Harcourt LLP, and is Chair of the fi rm’s Health Industry Group.David Solomon is an Associate in the Toronto offi ce of law fi rm Osler, Hoskin & Harcourt LLP and is a member of the fi rm’s Health Industry Group.

Hospital succession planning requires physicians to develop late career transition plansBy Michael Watts and David Solomon

I

Until recently, however, hospitals have largely ignored these age-related risks to patient safety and quality of care, allowing aging physicians to self-determine when they will retire.

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September 13-15, 2015 Canadian Association of Environmental Management Over the Top for Clean conference and Trade Show Scotia Bank Conference Centre, Niagara Falls Ontario

September 15-16, 2015 National Elder Friendly Hospital Conference Marriott Bloor Yorkville, Toronto Website: www.healthcareconferences.ca

September 17-18, 2015 2015 iHT2 Health IT Summit Rosewood Hotel Georgia, Vancouver Website: www.ihealthtran.com

September 22-24, 2015 Network Leadership Symposium 2015 University of Alberta, Lister Centre, Edmonton, Alberta Website: www.augustana.ualberta.ca

September 26-30, 2015 2015 AHIMA Convention and Exhibit New Orleans, United States Website: www.ahima.org

September 29, 2015 Doing CPOE Right: Patient-Centred Design and Evidence-Based Culture In-Person Live Webcast, Toronto Website: www.oha.com

September 30-October 1, 2015 3rd Annual National Forum on Patient Experience Toronto Airport Marriot Hotel Website: www.patientexperiencesummit.com

October 5-6, 2015 Innovations in Laboratory Management for Lab Leaders Conference Marriott Bloor Yorkville Toronto Website: www.exec-edge.com

October 25-28, 2015 Critical Care Canada Forum Sheraton Centre Toronto Hotel Website: www.criticalcarecanada.com

October 28-29, 2015 2nd Annual Healthcare Practitioners’ Mental Health Conference Marriott Bloor Yorkville, Toronto Website: www.healthcareconferences.ca

November 2-4, 2015 Health Achieve 2015 Metro Toronto Convention Centre, Ontario Website: www.healthachieve.com

November 16-19, 2015 World Forum for Medicine Duesseldorf, Germany Website: www.medica-tradefair.com

November 29- December 4, 2015 RSNA Annual Meeting 2015 McCormick Place, Chicago, United States Website: www.rsna.org



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INSIDEEvidence Matters ................................. 6

Nursing Pulse .....................................11

From the CEO's desk ..........................16

Health Care Technology .....................18

Careers ...............................................19

PALLIATIVE CARE IN THE COMMUNITY

FASTER RECOVERY WITH LAPAROSCOPIC HYSTERECTOMIES

8 9

FOCUS IN THIS ISSUESURGICAL PROCEDURES/PAIN MANAGEMENT/PALLIATIVE CARE:Non-invasive surgery, plastic surgery, orthopedic surgery and new surgical techniques including organ donation and transplantation procedures. New approaches to pain management and palliative care delivery.

MAY 2015 | VOLUME 28 ISSUE 5 | www.hospitalnews.com


A round of applauseTHANK YOU for ensuring access to the right careMost Community Care Access Centres of Ontario are governed by the requirements of the French Language Services Act. We provide services in French and encourage applications from bilingual candidates.

We are committed to accommodating people with disabilities as part of our hiring process. If you have any special requirements during the recruitment process, please advise Human Resources.

to our Care Coordinators and Registered Nurses

ccacjobs.ca

Theassisteddying debateUnderstanding the Supreme Court rulingBy Sarah Quadri Magnotta

INSIDEEvidence Matters ................................. 5Ethics .................................................... 9Data Pulse .......................................... 17Safe Medication .................................20Nusring Pulse .....................................22From The CEO's Desk ........................23Careers ...............................................27

FOCUS IN THIS ISSUEFACILITIES MANAGEMENT AND DESIGN/HEALTH TECHNOLOGY/GREENING HEALTHCARE/INFECTION CONTROL:Innovative and efficient health care design, the greening of healthcare and facilities management. An update on the impact of information technology on health care delivery. Advancements in infection control.FEB. 2015 | VOLUME 28 ISSUE 2 | www.hospitalnews.com


Ninety- nine per cent of Canadians have at

least one hospital clinical report or immunization

record available in electronic form

The digital health

revolution

INSI

DE INFECTION CONTROL SUPPLEMENTSee page C1

APRIL 2015 HOSPITAL NEWSwww.hospitalnews.com

INSIDESafe Medication ................................ 8Data Pulse ....................................... 10Ethics ............................................... 19Evidence Matters ............................ 21Nursing Pulse .................................. 23From the CEO's Desk ...................... 26Careers ............................................ 31

Palliative care volunteers have profound impact on patients

Research improves air ambulance planning and dispatch

22 30

FOCUS IN THIS ISSUE HOSPITAL FUNDING/VOLUNTEERS AND FUNDRAISING/HEALTH PROMOTION:An examination of hospital funding and pay-for-performance models. Financial planning and issuance options for people in the health care industry. Innovative approaches to fundraising and the role of volunteers in health care delivery. Programs designed to promote wellness and prevent disease including public health initiatives, screening.APRIL 2015 | VOLUME 28 ISSUE 4 | www.hospitalnews.com


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22 Health Care Technology

ome to one of the richest pools of scientifi c knowledge and clinical expertise in the world, Canada’s research talent is

refl ected in the ground-breaking innova-tions taking place in our academic health care organizations. Among these innova-tions are those related to the prevention, early detection, and effective treatment of chronic disease.

HealthCareCAN, the national voice of health care organizations across Canada, highlights many of these developments in Innovation Sensation, a database funded by the Canadian Institutes of Health Re-search (CIHR) that features over 500 sto-ries related to cardiovascular and respirato-ry health. A selection of stories that feature new and innovative technologies to help alleviate the burden of these chronic dis-eases are highlighted below.

Doctors and pharmacists are now able to utilize a mobile phone application to help them better manage medications for patients with heart failure. Designed by Al-berta Health Services and the University of Alberta in Edmonton, the step-by-step instructions help determine proper dosages and manage complications as they arise. Clinicians have traditionally relied on na-tional guidelines, a drug’s instructions and their own experience to fi gure out medica-tions for patients, but a large document of guidelines can be cumbersome. The an-swers that doctors need will now be a click away on their phones.

Researchers at Alberta Health Services have also developed a portable machine that is opening up a world of possibilities when it comes to lung transplants. Known as “lungs in a box”, the machine will save countless lives by changing the way lungs are transported. For the past 30 years, an ice cooler would be used to move a donated set of lungs. However, of all the lungs do-nated every year, three out of four are re-jected due to damage – often from the ice used during this traditional transportation.

The machine uses state of the art tech-nology to keep donated lungs warm, and infused with oxygen and nutrients.

Physicians at London Health Sciences Centre have designed a robot to conduct open heart surgery. Surgeries performed by the DaVinci robot are far less invasive to a patient than conventional open heart sur-gery. The benefi ts of this new treatment are smaller incisions, less pain, less blood loss and earlier release and recovery. The same technology has been used by doctors at To-ronto General Hospital to rid early stage lung cancer patients of tumors.

Rather than open a patient’s chest and spread the ribcage, the surgeons can now make four small incisions in the chest

through which they insert a small camera and their surgical instruments.

Surgeons are able to operate more pre-cisely and see better with the aid of 3-D images. The technique allows surgeons to remove the tumour and any affected lymph nodes, and as little of the lung as possible, with minimal damage to the surrounding tissue. In the end, patients usually have less pain and scarring after their surgery, as well as shorter hospital stays.

A team of researchers at McGill Uni-versity Health Centre in Montréal have developed an online tool that will help Ca-nadians lower their risk of heart attack and stroke. The “Heart Age Calculator” allows users to discover their cardiovascular age. Studies show that patients are signifi cantly more likely to reach recommended treat-ment targets when they know that their cardiovascular system is aging faster than they are, but that they can reduce the risk of a heart attack or stroke by reducing their blood pressure and cholesterol, exercising more, losing weight or giving up smoking. They are more likely to stick with treat-ment, more likely to modify their lifestyle and more likely to adhere to medication.

Researchers at B.C. Children’s Hospi-

tal have developed a new mobile applica-tion that can measure respiratory rates in children roughly six times faster than the standard manual method. “RRate” allows caregivers to measure respiratory rate by tapping the touch screen every time the child inhales. In addition to calculating the rate of inhalations during a given time, the app also provides an animation of a breath-ing baby allowing for a direct comparison with the breathing patient.

Chronic disease is an increasing chal-lenge for clinical researchers. Cardiovas-cular disease, the second leading cause of death in Canada, contributes to over 180,000 deaths annually. However, the cardiovascular death rate in Canada has declined by nearly 40 per cent in the last decade – largely due to research advances in surgical procedures, drug therapies and other innovative treatments. (Statistics Canada, 2011, Heart and Stroke Founda-tion of Canada, 2015)

Similarly, respiratory conditions rep-resent a high health burden for children and adults alike. Over 3 million Canadi-ans of all ages have a serious respiratory disease. After cardiovascular disease and cancer, respiratory diseases are responsible for the third-highest share of hospitaliza-tions and deaths in Canada. Although Canada has seen a decrease in respira-tory diseases over the past few decades, aging populations are expected to lead to a surge in these diseases in the future.

Canadian researchers revolutionize cardiovascular and respiratory care with new technologiesBy Claire Samuelson

H Innovation Sensation is a database funded by the Canadian Institutes of Health Research (CIHR) that features over 500 stories related to cardiovascular and respiratory health.

Continued on page 23


23 Health Care Technology

magine having to drive across a province for hours to reach an appointment with a top specialist for a complex new

medical condition that you are very con-cerned about. The hospital you’re going to is known for being state-of-the-art with the most advanced medical care and equipment currently available. Yet upon arrival, the specialist asks “Why are you here?” indicating that the specialist does not have access to your referral, even though you know it was completed and sent weeks earlier.

Having the latest in health technol-ogy is great, but it isn’t effective if it can’t bridge the long-standing communication gaps within our health care system.

When Canada was introduced to the electronic health record (EHR), it was initially hailed as the Holy Grail solution to the many issues rampant in our system. Yet nearly 15 years later, one issue has be-come clear: while EHRs serve as a critical enabling technical foundation for a fully integrated care system, they alone are not enough to drive the major changes needed in healthcare. Canada needs greater inte-grated efforts and innovations that lever-age the foundational EHR in order to best manage an entire population’s health.

Too often the health care system func-tions in reactive mode, dealing with acute patient issues as they arise, rather than de-livering a complete, well coordinated and effi cient long-term solution. We are mov-ing towards the next generation of health-care, where patients are more actively involved in their care, wait times are re-duced and the burden of chronic diseases is effi ciently managed. As we proceed, it is crucial that we combine the best of tech-nology and human interactions, to deliver real population health management.

Blending enabling technology and the human touch

It’s the heart of winter and while away on a ski holiday you’ve taken an unfor-tunate tumble, injuring your knee in the process. You’re rushed to a local hospital where you’re immediately assessed and treated. As the ER physician is prepar-ing your discharge, your family physician intervenes and warns that the painkiller the ER physician is prescribing may have adverse reactions to your current medi-cation. How is this all possible? Through the power of e-Notifi cations and seam-

less integration, your family physician was alerted to your situation. Your physician was then able to review your fi le electroni-cally and pass on pertinent information to the ER Physician in a very timely manner. This is a perfect example of care continu-ity and the benefi ts it yields for both pro-viders and patients.

Focusing on care continuity, technology becomes an enabling platform that opens the lines of communication between care providers, as well as between patients and providers, so that a proper coordinated pa-tient-centric care plan can be developed. Through active collaboration, providers can merge multiple care plans address-ing different health concerns into one continuous, coherent plan. This ‘living’ plan evolves based on the changing needs of the patient and allows patients to be-gin making active decisions in their own healthcare.

Managing the population’s health through technology

An open line of privacy-controlled communication improves the quality and effectiveness of care across the continu-um. It is an essential tool in the drive to deliver higher value healthcare. Leverag-ing data to stratify a population’s health

risks allows providers to identify relevant gaps in care and distinguish patients with high priority conditions. It also allows them to respond to high importance situ-ations in Public Health such as disease surveillance and emerging epidemics. Harnessing this technology allows physi-cians and clinicians to appropriately care for more patients than they could ever hope to in a paper-based system.

Solutions such as e-Referral and EHR have made it possible to retire outdated and unreliable methods of communica-tion (goodbye faxes) while improving the quality of patient data collection. How-ever, the way in which we collect data often lacks strategic insight, direction and proper governance. For instance, data col-lection may only focus on a certain type of population or patient, which results in a limited or biased set of insights. The

other issue that occurs is when data col-lection results in health insights and pa-tient patterns that could lead to improved healthcare, but are not implemented into the system. Canada needs to put learnings into action so that the system evolves to provide more effective care for both indi-viduals and for the population as a whole.

Technology is a necessary and power-ful enabling tool that, when implemented and used to best effect, can provide pow-erful support for the care of individuals as well as managing entire populations. ■H

Dr Hobson is the Chief Medical Offi cer for Orion Health. He is a primary care physician with great depth of experience working globally, developing and implementing care integration, Health Information Exchange and care management solutions.

The future of health By Dr. Chris Hobson

I

– Fixing communication gaps and delivering improved population health

(The Conference Board of Canada, 2015) “Researchers in our member orga-nizations conduct research in health and health systems,” says Dr. Tina Saryed-dine, Executive Director, Research and Innovation at HealthCareCAN, “at HealthCareCAN we look to shine a light on their successes to show the return in research investment and share leading practices.”

With the burden of chronic disease increasing, the need for clinical research-

ers to generate new and innovative tech-nologies is intensifying. The capacity to turn basic science into effective treat-ments, revolutionary therapies and new technologies allows Canadians to enjoy longer, healthier lives. ■H

Claire Samuelson, is Policy Analyst, Research and Innovation at HealthCareCAN. Innovation Sensation is a searchable database available at www.healthcarecan.ca.

Continued from page 22New technologies

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While EHRs serve as a critical enabling technical foundation for a fully integrated care system, they alone are not enough to drive the major changes needed in healthcare.



Your monthly donation or one time donation will go directly to ensuring our programs remain open and available. ALL staff are volunteer at this time, so you KNOW when you donate, WHERE the money is going!

Changing the landscape of Poverty, one person at a time!

Ottawa Freedom Centre

Benji is real, he is local and he now works at the Ottawa Freedom Centre (OFC). His real story is how he got to the Ottawa Freedom

Centre and stayed. He fell to the bottom of the pit and was buried in ashes. Benji lived on the streets of Ottawa; he didn’t care for life, fought a lot and was always in trouble. Benji was a drug addict and an alcoholic – his family disowned him. He lived a life of shelters and the street, always alternating between the two. One day something triggered inside Benji, he witnessed the birth of a daughter and then another. The birth of two daughters triggered the light, the light changed Benji into the man he is today.

Benji is now Benjamin, cleaned up and now back living with his two daughters, his common law partner who is the caring mother of his children. Benjamin got a part time job, went back to school. Benjamin enrolled in the Community Service Worker program at Herzing College. We met Benjamin when he took a placement position at the Ottawa Freedom Centre. Benjamin has graduated

Worker. Today he is still at the Ottawa Freedom Centre; he is our Community Outreach Counselor.

There are many “Benjamin’s”; you may know one of your own. This is a true local story, a Benjamin who we respect and work with. This man is in his 20’s and lives with his two beautiful daughters and their loving mother. He comes to the Ottawa Freedom Centre everyday where he hopes to be the trigger for people that were just

light and a new life.Everyday he sees others that are just like he

once was, knowing exactly what they are going through. When Benjamin is told, “you don’t know what it feels like” he can turn and say, unlike most social workers, “I do, I’ve been there”.

Benjamin is a part of our team and we are extremely proud of him. He is not in some far off country that we send money to – he lives here, he works here, in Ottawa. He is a member of our community.

At the OFC we are trying desperately with all of our programs to help the hungry and impoverished in Vanier, Ottawa and beyond. We have the only program that is open late on Thursday nights that feeds the hungry (hot and cold food). Our Thursday late night features live music and big

screen movies. But our late nights are about helping those in need in Vanier. We have Counselors on duty to assist with harm reduction and so much more.

OFC is a place where we have a variety programs available 7 days a week. To help meet the need in our community due to recent funding cuts, we are introducing a Tuesday Night Aboriginal program.

We are open past when many other agencies close. Our doors are open Monday and Tuesday until 6pm and the rest of the week we’re open late. Weekends? Our doors are open. On Saturdays our ‘Single Moms” and new Single Parent programs take place. We have AA programs, housing placement workers (5 days a week ) - and when we are not open – we’ve expanded our services to include a 24-hour live response answering service.

We are not ‘everything to everyone’, but we are ‘something to many’ in our community. For those many, our doors need to stay open. There are many more Benji’s that are yearning to become Benjamin. Help us help others become Benjamin. Please give today for the Benjamin’s of tomorrow.

for their support as well as the dentists in each community!

Special thanks to our MPP, Madeleine Meilleur, MPP

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Hospital News 2015 July Edition

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