File - Sunnybrook Health Sciences Centre
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File - Sunnybrook Health Sciences Centre
Issue No. 4, July/August 2014 Family Navigation Project supporting youth mental health Sunnybrook recently launched a first-ofits-kind navigational service to guide and support families who have youth struggling with mental health and addictions concerns. Sunnybrook’s Family Navigation Project (FNP) is a new call-in and email program that partners “navigators” (clinically trained health professionals) with youth who are experiencing mental health and addictions struggles, and their families, to guide them through the complex GTA mental healthcare system and connect them to the right services. “Families don’t know where to go or how to find the services their children need. Parents have told us they’ve waited months for help, only to be told they’re in the wrong line,” says Dr. Anthony Levitt, medical director and co-founder of the FNP. “With the Family Navigation Project, there is no wrong line. It gives them a way to start and a path to follow in their journey to recovery, with someone there to support them along the way.” Nearly 70 per cent of mental health and addiction issues have their onset in adolescence, and without timely and appropriate care, these concerns frequently develop into lifelong struggles that can drastically impact individual and family health, quality of life and productivity, as well as place significant burden on the health-care system. “Timing is of critical importance in finding the right treatment program and yet only one in five of these young Canadians gets access to the specialized care and treatment they need,” says Jeanne Foot, chair of the Parent Dr. Anthony Levitt (left) is medical director and co-founder of the FNP. Naomi Algate is one of the project’s expert navigators. The FNP is the first-of-its kind in Canada. Advisory Council that helped set up the FNP. Some of these families will have already sought services or programs but may be on multiple waiting lists for months, or have not yet found the appropriate service. “Often the problems will have gone on for some time, and parents will reach out to us because they want to avoid losing more time or making further missteps,” says Naomi Algate, an FNP navigator. “In many situations, problems will have developed quickly and seemingly out of nowhere, and will be severe. Parents who have little experience with the mental health or addictions service system will seek our assistance because they are facing a serious situation, require assistance on an urgent basis, and have no clear pathway to follow,” Algate adds. The FNP’s goal is to improve access to treatment for youth aged 13 to 26 and to support their families so they receive the help they need. The navigators are experts who can provide tailored insight into the mentalhealth and addiction systems, follow up with families throughout the journey to monitor and ensure that the process is working, and build relationships with the various mentalhealth services and providers so they are able to provide families with insightful first-hand information about the resources from clinical and parent perspectives. Proceeds from the RBC Run for the Kids have been integral in supporting the launch of the FNP. The second annual event takes place Sept. 20 at Mel Lastman Square in Toronto. Visit RBCRunForTheKids.ca for full details. Nadia Norcia Radovini If you are a youth with mental health and/or addictions problems in the GTA between the ages of 13 and 26, or a concerned family member, please call: 1-800-380-9FNP or email familynavigation@sunnybrook.ca and expect to get a response within one business day. The Family Navigation Project is not a crisis response line; people who find themselves or their family member in an emergency situation must call 911 or go to the nearest hospital emergency room. Personal Health Navigator Planning for end of life care when you have no next of kin The question: My husband and I have no children and no close blood relatives. I worry about what’s going to happen to us when our health fails. I’ve heard that written instructions – like living wills – aren’t good enough. Who can help us if we can no longer speak for ourselves? The answer: Your concerns are shared by a growing number of people – especially as the size of the traditional family has become smaller in recent decades. The changing demographics mean there will be a lot more people in similar circumstances. In some respects, it’s like being an orphaned senior. And you are correct that there are shortcomings with written medical instructions, which are called advanced care plans in Canada. (Living will is a term that first arose in the United States.) Such written plans may not take into account all the circumstances you could face. But rest assured you can appoint anyone to represent your interests through a legal document known as a Power of Attorney for Personal Care. It doesn’t have to be a blood relative. “It could be a neighbour, a friend from your faith group, or someone you have grown up with,” explains Lorrie Hamilton, an ethicist at Toronto East General Hospital. “The most important thing is finding someone who can honour your wishes.” In fact, in certain situations, people may be Paul Taylor, Sunnybrook’s Patient Navigation Advisor, provides advice and answers questions from patients and their families, relying heavily on medical and health experts. Email your questions to AskPaul@ sunnybrook.ca better off asking a friend, rather than a relative, to carry out this crucial role. “Sometimes people will find that their friends understand them more than their family does,” Hamilton says. What’s more, families may be reluctant to withdraw life-sustaining therapies – even though the patient might prefer to slip away. Or, relatives may be deeply divided over the course of your care. So don’t look upon the lack of relatives as a disadvantage. Instead, it can be an opportunity to select the person who you feel best understands you. The process of appointing someone as your Power of Attorney for Personal Care is relatively easy. If you live in Ontario, you can download the document online from a provincial website. You don’t even need to hire a lawyer. It just needs to be witnessed by two people. However, I don’t want to leave the impression that going through these steps is like a leisurely walk in the park. You will have to engage the person you choose in some pretty deep discsions about what you would like for your care. Fortunately, there are useful online resources. The Canadian Hospice Palliative Care Association has launched Speak Up, a national campaign to increase public awareness about end-of-life advance care planning. The campaign’s website – AdvanceCarePlanning. ca – contains a workbook and other materials to help frame your discussions. “You want this person to understand your values, your beliefs and how you view life,” Hamilton notes. When choosing your substitute decision-maker there are several practical matters to consider. “You have to ask them if they are capable of making these decisions and if they feel comfortable advocating on your behalf,” says Doreen Ouellet, past chair of the Advance Care Planning Work Group at the East Toronto Health Link. You also need to select someone who will be readily available. It’s not a good idea to pick someone who doesn’t return phone calls or goes away for prolonged periods without leaving any contact information. Ouellet suggests you should keep the name of your substitute decision-maker in your wallet or another place where emergency responders are likely to look for identifying information should you become unconscious in public. Sunnybrook nurse named ‘nursing hero’ in national contest Linda Jurincic, a registered nurse in the Odette Cancer Program, celebrated the recent National Nursing Week in a special way. Certified in oncology nursing and working primarily with patients receiving internal radiation therapy for the treatment of gynecological, prostate and breast cancers, Jurincic was awarded first place in the annual Nursing Hero Awards organized by Hospital News, one of Canada’s leading health-care publications. “Linda is an outstanding nurse who has touched the lives of countless patients and families in the most meaningful of ways,” says Tracey DasGupta, Sunnybrook’s director of interprofessional practice. “To both love what you do and be recognized for this work by peers and patients is very fulfilling,” says Jurincic, who describes herself as a “hands-on kind of nurse.” She was nominated for the award by Kimberly Fulcher, a Sunnybrook patient, Laura D’Alimonte, an advanced practice radiation therapist, and Dr. Lisa Barbera, a radiation oncologist with the gynecological cancer care team. For Fulcher, Jurincic demonstrates the “heart of nursing.” Dr. Barbera and D’Alimonte praised her as an inspiration to others and made special mention of her strong devotion to patients, as well as her dedication to professional development and lifelong learning. The Hospital News Nursing Hero Awards, announced annually during National Nursing Week, salutes Canadian nursing Linda Jurincic, Kristie Jones, editor of Hospital News, and Dr. Lisa Barbera. heroes and highlights their exceptional work. In May, three winners were selected from 120 candidates from across Canada, with Jurincic receiving the top award. Natalie Chung-Sayers Sunnybrook helping to fill gap in post-stroke cognitive rehab Sunnybrook and Toronto Stroke Networks are leading initiatives to address rehabilitation for stroke patients experiencing cognitive impairment. This is a growing concern with rates of cognitive impairment increasing. “When cognitive impairment is identified it tends to worsen outcomes, so people with cognitive impairment after stroke have worse functional recovery, greater impairment in their daily living, higher risk of recurrent stroke and higher risk of short-term risk of death,” says Dr. Rick Swartz, a Sunnybrook stroke neurologist. “There is a huge gap in our system, as there is very little in the community in terms of specialized resources and programming that focus on the various aspects of cognition to allow somebody to regain the skills they had and reintegrate back into their life,” says Beth Linkewich, regional director of the North & East GTA Stroke Network at Sunnybrook. Stroke patients experiencing cognitive impairment may be able to walk and talk, but may experience significant challenges with work, interactions with family and daily routines. “They seem fine, they don’t go to rehab, and then they experience huge problems at home as they are unable to return to life as they knew it before their stroke. The everyday tasks that we often take for granted – such as driving, working, taking care of our families or other responsibilities – can be very difficult when an element of your cognitive ability is affected,” says Jessica Comay, an occupational therapist with the Regional Stroke Best Practice Team and the Assistive Technology Clinic at Sunnybrook. About two-thirds of stroke patients experience some degree of cognitive difficulties, and 19 per cent of them are rejected for rehab because there is a limited capacity to support persons with cognitive impairment. The multidisciplinary team at Sunnybrook, together with Toronto Stroke Networks, is filling this gap through an outpatient clinic that sees patients living at home or in an institution. Patients are referred from Sunnybrook inpatient programs, the secondary stroke prevention clinic, or by their family doctor. Services provided include occupational and physical therapy and speech language pathology. “We provide them with real-life situations and help them to go through and plan, and problem solve based on different issues that may arise,” Comay says. Nadia Norcia Radovini Sunnybrook has many clinical and research initiatives underway in the area of stroke and cognition, including: Clinical: Research: • The Vascular Cognition Clinic specializes in cognitive impairment after stroke, its frequency and neurological bases, and the contribution of vascular factors to stroke recovery and dementia • • The DOC Tool, a cognitive screening tool developed here, resulted in screening more than 1,500 stroke clinic patients The L.C. Campbell Cognitive Neurology Research Group is studying longitudinal brain-behaviour relationships with a focus on cerebrovascular disease and less common dementias, such as Lewy Body Disease and frontotemporal degeneration, using clinical, neuropsychological, neuroimaging and genetic biomarkers • The Regional Stroke Best Practice Team is a rehab group with extensive experience with cognitive changes and the challenges they present for stroke patients • • Working on implementing the CO-OP approach to support stroke and cognitive impairment in rehabilitation One of the key partner sites in the Canadian Partnership in Stroke Recovery, a national joint initiative between the Heart & Stroke Foundation and six leading academic institutions across Canada. Our site is known for its work in the areas of brain-behaviour relationships and is engaged in research into dementia, stroke prevention and acute care • Contributing internationally to knowledge of post-stroke brain changes after exercise • Showing that aerobic exercise is beneficial not only for the heart but also for the brain • Developing screening tools and using multi-modal type assessments to evaluate an individual’s ability to return to driving • Developed a system that links specialized exercise equipment with Google Earth’s virtual world to safely take stroke patients around the world to increase fitness and improve cognition Bringing cognition to the forefront of stroke rehabilitation Sunnybrook’s Regional Stroke Best Practice Team plans to bring together interprofessional teams at two rehab sites, Sunnybrook’s own St. John’s Rehab site, as well as West Park Health Centre, to test an approach known as CO-OP (Cognitive Orientation to daily Occupational Performance). “It is an occupational therapy approach that has been around a long time in acute and community care, but it has yet to be applied in an interprofessional way within a medical system on the rehab end,” says Beth Linkewich, regional director of the North & East GTA Stroke Network at Sunnybrook and leader of the collaborative project. “We’re looking at a broader understanding of cognitive impairment within teams. It’s a different way of thinking, where cognition will be one of the driving forces in the rehab process, and not a limitation.” The model is a function-based, problemsolving approach. “The patients select their own personal goals and work with the therapist to develop individualized strategies to achieve them,” says Sara McEwen, a scientist at the St. John’s Rehab site. “It shifts philosophy of care to be even more patient-centred, where the patient is in more control of the rehab process. And the best part is patients continue to use the problem-solving skills learned in CO-OP to achieve new goals once they have returned to the community. ” The ideal outcome will be the adoption of specific skills and approaches that can facilitate the achievement of a wide range of patient goals. Nadia Norcia Radovini Higher surgeon volumes linked to lower risk for patients, study finds A team of researchers, including three from Sunnybrook, have found that patients whose hip replacement surgeries are performed by surgeons who do 35 or more hip replacement procedures per year have fewer complications. The study was recently published in The BMJ. Studies estimate that about 35 per cent of all cancers are preventable, and diet and lifestyle can make a big difference in your overall risk of developing cancer. Sunnybrook dietitian Pauline Wisdom-Gilliam offers her best advice for staying healthy: “It’s been established that surgeons who perform a lot of a certain procedure gain technical skill and ability, and that usually translates into better results and fewer complications after surgery,” says Dr. Richard Jenkinson, an orthopedic surgeon involved in the study. “But the biggest issue with the body of literature in this field is the question of ‘how many is enough?’” The researchers analyzed data of patients who underwent hip replacement surgery between 2002 and 2009 and obtained a group of about 40,000 who had hip replacements for standard types of conditions. They were then able to determine which patients had surgery performed by surgeons who had high volumes and their outcomes. “Using the data, the number that seems to be associated with better outcomes is about 35 hip replacements per year,” Dr. Jenkinson says. “People who did many more than 35 had about the same complication rates as those who performed at least 35. When surgeons did fewer than 35, you started to see increased complications and the need for revision, particularly when surgeons were performing much fewer than 35.” The study also considered first-year surgeons. “Of course, you have to start somewhere,” Dr. Reducing your cancer risk through lifestyle changes Weight matters Achieving and maintaining a healthy body weight is a key element to disease prevention. If you need to lose weight, do so gradually and using methods that are safe and sustainable. And remember that even a small decrease in your overall weight can have an impact. Move it A new study published recently in The BMJ finds patients whose surgeons perform more than 35 hip replacements per year have fewer complications after surgery. Jenkinson says. “So if a new surgeon has appropriate high-volume training in their residency and fellowship, they should be able to perform reasonably without complications.” Staying physically active is important to reduce your risk of cancer and many other diseases. Aim for at least 150 minutes of moderate-intensity activity, like walking, or 75 minutes of vigorous intensity, like running, every week. Choosing an activity you enjoy will help you maintain it over time. The study’s finding can help inform healthcare policy-makers and administrators to ensure surgeons have the resources to perform this volume of surgeries and maintain their competency, Dr. Jenkinson says. Surgeons should consider aiming to perform 35 cases or more per year, the authors wrote. Alexis Dobranowski Eat well Studies point to the preventive benefits of a largely plant-based diet rich in vegetables, fruits, whole grains and legumes. This should be the foundation to which other healthy foods, like lean meats, can be added. Avoid processed foods that are often high in salt, fat and sugar. Also, limit your intake of red meat, which includes pork, lamb and beef. Raise a glass, but not too often If you drink, limit alcoholic drinks to two for men, and one for women daily. Supplements Sunnybrook entered a team in this year’s Toronto GoodLife Marathon, raising awareness and money for Sunnybrook’s 4P Clinic, which aims to help new moms lower their risk of developing cardiovascular disease. Pictured is Dr. Dini Hui, Dr. Janet Bodley, Dr. Betty Chen, and Dr. Karen Fleming together with former patients Elizabeth Seger and Melanie Chryssafis, and Melanie’s daughter, Maddy. Learn more about cardiovascular health after pregnancy at sunnybrook.ca/4PClinic. The basis of a healthy strategy should be a balanced diet, not supplementation. The bottom line is, don’t rely on supplements to keep you well! Monica Matys Skin-to-skin C-sections promote health, bonding between mother and baby In April, Brandon Gill New gave birth via a “skin-to-skin” Caesarean section, becoming just the second mother to deliver her baby using this technique at Sunnybrook. “It was a really amazing experience to be able to have a C-section and then have your baby come right on top of you, and transition into the world in such a peaceful way,” she says. This innovative way of delivering babies is being led in Canada by Sunnybrook physicians. “We are using the technique of skin-to-skin Caesarean sections because the benefits of skin-to-skin contact between mother and baby immediately after birth are clear. This is done with babies born vaginally, and now we are bringing this practice to babies born by Caesarean section,” says Dr. Jon Barrett, chief of Maternal-Fetal Medicine at Sunnybrook and director of the Women & Babies Research Program at Sunnybrook Research Institute. Babies born by Caesarean are typically given to their mothers three to five minutes after the birth, after being cleaned off and receiving routine care. In a skin-to-skin C-section, the baby is put directly on the mother’s upper abdomen, and the medical team pushes the baby underneath the drape separating the medical team from the mother’s upper body. The baby then settles directly on the mother’s bare chest. “Skin-to-skin contact immediately after birth helps babies regulate their temperature and glucose levels. It promotes bonding, and babies often initiate breastfeeding on their own from that position as well,” Dr. Barrett notes. However, he emphasizes that a skin-to-skin C-section is not possible in every birth. “It may not be indicated even in low-risk deliveries, and is not appropriate for emergency C-sections. The obstetrician needs to be experienced, and the procedure does require an extra member of the medical staff to be in the operating room,” Dr. Barrett says. Sybil Edmonds Sunnybrook prostate cancer surgeon honoured as Active Surveillance leader Sunnybrook surgical oncologist Dr. Laurence Klotz, known internationally for pioneering the Active Surveillance approach for men with low-risk prostate cancer, has been awarded the prestigious Lister Prize from the University of Toronto’s Department of Surgery. The benefits of staying active during pregnancy Being active is important during all stages of your life, including pregnancy (with your doctor’s approval, of course). At Sunnybrook’s latest Speaker Series, “Healthy Mom, Healthy Baby,” a leading panel of experts discussed mental health, exercise and diabetes in pregnancy. It’s a good idea to discuss your exercise routine with your doctor when you become pregnant. Generally, it’s recommended that women with low-risk pregnancies exercise three to five times per week at moderate intensity. Low-impact activities like swimming, walking or stationary biking are great options. If your doctor has determined exercise is safe for you, Sunnybrook family physician Dr. Karen Fleming says mothers can enjoy many benefits, including: • • • • fewer physical symptoms decreased depression/anxiety easier weight management prevention and/or control of gestational diabetes decreased risk of high blood pressure improved cardiovascular fitness, which can help during labour improved pain tolerance in labour fewer interventions The prize recognizes his “outstanding and continuing productivity of international stature, as evidenced by research publications, grants held, students trained and other evidence of stature of the work produced.” • • Dr. Klotz was also recently awarded The Society of Urologic Oncology Medal for making a significant and far-reaching impact in the field of urologic oncology. To view a webcast of the Speaker Series, check out sunnybrook.ca/SpeakerSeries. And when exercising, remember to choose an activity that is safe, that you enjoy and to have fun! Monica Matys A professor in the Department of Surgery at U of T, Dr. Klotz led the multidisciplinary Sunnybrook team that implemented and reported on Active Surveillance, a novel approach for patients with low-risk prostate cancer based on initial expectations of management, with strategic intervention for the minority of patients who were diagnosed higher risk over time. Coined by Dr. Klotz, Active Surveillance emphasizes close monitoring and selective, definitive intervention. Dr. Klotz continues to be a strong proponent of the approach to reduce overtreatment, and is widely considered to have been instrumental in driving its acceptance by the urological community internationally. A 2010 study led by Dr. Klotz found that • • Dr. Laurence Klotz Active Surveillance has a resounding positive benefit for patients. The research followed 450 Canadian men with low-risk prostate cancer over a 13-year period. For men managed with Active Surveillance with Selective Delayed Intervention, the 10-year prostate cancer actuarial survival was 97.2 per cent. Two thirds of patients avoided intervention entirely. Active Surveillance with Selective Delayed Intervention is now a standard option for the management of men with localized, well-differentiated prostate cancer, and is considered the treatment of choice for men with very low-risk prostate cancer. The concept is increasingly being adopted for other cancers, particularly ductal carcinoma in situ, the most common type of non-invasive breast cancer. Natalie Chung-Sayers Check out the Your Health Matters portal on your computer or mobile device for videos, blogs, slideshows and more. Visit health.sunnybrook.ca How to reach us: Your Health Matters Sunnybrook Health Sciences Centre 2075 Bayview Avenue, Suite D1 00 Toronto, ON M4N 3M5 P: 416.480.4040 E: news.articles@sunnybrook.ca Your Health Matters is published monthly by the Communications & Stakeholder Relations Department and Sunnybrook Foundation. Submissions to Your Health Matters are welcome, however, they are subject to space availability and editorial discretion. Sunnybrook Health Sciences Centre is inventing the future of health care for the 1.2 million patients the hospital cares for each year through the dedication of its more than 10,000 staff and volunteers. An internationally recognized leader in research and education and a full affiliation with the University of Toronto distinguishes Sunnybrook as one of Canada’s premier academic health sciences centres. Sunnybrook specializes in caring for high-risk pregnancies, critically-ill newborns and adults, offering specialized rehabilitation and treating and preventing cancer, cardiovascular disease, neurological and psychiatric disorders, orthopaedic and arthritic conditions and traumatic injuries. The Hospital also has a unique and national leading program for the care of Canada’s war veterans. For more information about how Sunnybrook is inventing the future of health care please visit us online at www.sunnybrook.ca Pregnancy significantly increases risk of serious traffic accidents: study Sunnybrook researchers have found that pregnancy is associated with a significant risk of a serious car crash requiring emergency medical care during the second trimester, according to a study recently published in the Canadian Medical Association Journal. “Pregnant women frequently ask me about other risks to their health, such as air flights, hot tubs and rollerblading. Not once has a woman asked me about road safety, despite it being a much greater risk,” Dr. Redelmeier says. “Our major finding was a 42-per-cent increase in the risk of a serious motor vehicle crash during the middle three months of pregnancy,” says lead author Dr. Donald Redelmeier, a researcher with the Institute for Clinical Evaluative Sciences and a staff physician with Sunnybrook’s Division of General Internal Medicine. Co-author Dr. Jon Barrett, chief of maternal fetal medicine at Sunnybrook, was not surprised by the study’s findings. Statistically, the researchers found about 1-in-50 pregnant women will be involved in a motor vehicle collision at some point during pregnancy. Traffic mishaps place mother and baby at risk of fetal death, chronic disability and complicated emergency medical care. “I see pregnant women who have a lot of demands on them. Between work, taking care of their older children and other demands on their time, they are burning the candle at both ends and are often exhausted,” Dr. Barrett says. Both researchers emphasize that the message is not for pregnant women to stop driving, or to hand off driving responsibilities to their significant other. “The message is for pregnant women to start driving more carefully,” says Dr. Redelmeier. He suggests paying closer attention to the rules of the road, such as using the turn signal when changing lanes, and coming to a full stop at intersections with a stop sign or traffic lights. Sybil Edmonds Helpful summer first-aid tips fydfdf While prevention is always the best medicine, it’s important to know what to do when accidents happen. For minor injuries, here are some first-aid tips everyone should know. Cuts & scrapes – First, stop the bleeding by applying pressure with clean gauze. Once stopped, clean any excess blood away and apply antibiotic ointment. Wrap the wound with sterile gauze and tape or a bandage. Be on the lookout for signs of infection, including pain, swelling and redness. Sprains – If you can bear some weight on the injury without a lot of pain, chances are it’s a sprain and not a break. Keep the acronym RICE in mind: rest, ice, compress and elevate. Dr. Marc Jeschke, director of Sunnybrook’s Ross Tilley Burn Centre, Kerry Comiskey, a former burn centre patient, and Ken Shaw, co-anchor of CTV News at Noon and Six, take part in a discussion during Sunnybrook Foundation’s Donor Celebration on May 22. As the event’s emcee, Shaw interviewed patients and their physicians to provide the community with personal accounts highlighting Sunnybrook’s impact. “Sunnybrook is making a tremendous difference in the lives of patients and their families. We wanted our generous donor community to get a taste of this first-hand,” says Dr. Jon Dellandrea, president and CEO of Sunnybrook Foundation. Bee stings – Don’t pick the stinger out with tweezers. Instead, pull the skin taut around the stinger and try to flick it away with the edge of a credit card. Apply ice to the area to offer some relief and reduce swelling. Then, cover the area with a sterile bandage. Watch for signs of a severe allergic reaction, including hives or swelling, which warrant immediate medical attention. Monica Matys
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