Each year, the Research Institute of St. Joe’s – Hamilton publishes an annual report to highlight how research at our hospital impacts the science of medicine and the lives of patients around the world.
This year’s report explores regional and international collaborations, state-of-the-art treatments, new ways of thinking about cardiovascular disease, the vision of the urological oncology research centre, and even the science of research design. Download your copy today to learn about the exciting advancements made throughout 2018.
Article: The Toronto Star | Reporter: Theresa Boyle | March 2, 2019
A week after having part of a cancerous lung removed, Grant Lewis grew concerned that the incision wound on his chest had become infected.
The 54-year-old Beamsville construction worker dug out a phone number he had been given when he was discharged from hospital. Call it any time, day or night, if you run into trouble, he was told.
Lewis dialed the number and was connected to his nurse, Anna Tran, at St. Joseph’s Healthcare in Hamilton. On her advice, he used his mobile phone to snap a photo of the inflamed and seeping lesion, and then emailed it to her.
Almost 40 kilometres away, Tran looked closely at the image on her cellphone. She then forwarded it to the home-care arm of St. Joe’s, along with an email requesting that Lewis be seen that same day for wound care.
Within hours of placing the call, Lewis answered a knock at his front door. It was a visiting nurse. She cleaned his wound, changed the dressing, and then updated his medical record on her tablet computer.
Tran and the rest of Lewis’ care team at St. Joe’s all had access to his electronic medical record. The home-care nurse’s update assured them all he did not have an infection and was recovering well.
This little scenario, which took place in January, provides a glimpse into the future of health care in Ontario, as Health Minister Christine Elliott envisions it.
The sectors have a reputation for being siloed. The weakest parts of the health system are the transfer points between them. Hand-offs can be bumpy and patients can fall between the cracks.
Requisitions for ongoing services don’t always get passed along in a timely fashion. Sometimes it seems like they don’t get passed along at all.
Patients, still feeling unwell, can be left to navigate their own way through the Byzantine health system, which is a world unto itself with a seemingly foreign language full of acronyms and jargon.
Because Ontario is not as far along as it could be when it comes to electronic medical records, it can take days for updates to get transmitted between providers. When care is delayed, patients’ health can deteriorate, families can panic and unnecessary trips can be made to the emergency department.
Elliott told a news conference that the overall intent of her plan is to make the system easier for patients to navigate by “seamlessly” connecting sectors and making greater use of digital tools.
Critics of the government’s plans say they are overkill and are worried that the health system could be destabilized while “radical” changes are made. That has been the experience of other provinces that have gone this route, they note. They argue that this much change is not necessary for the Conservative government to make good on election campaign commitments to end hallway medicine, open more long-term care beds and create more mental health and addiction services.
Following Elliott’s Tuesday announcement, the Star followed up with her office to get a better idea of what her reform plans would look like on the ground. It was suggested we take a look at St. Joseph’s Healthcare in Hamilton, specifically at its Integrated Comprehensive Care (ICC) program in which Lewis was a patient.
The program started as a pilot back in 2012. Known then as the “bundled care” program, it was designed to connect surgical patients with a single team of clinicians who could care for them before, during and after their operations.
To date, more than 17,000 patients have gone through St. Joe’s ICC program. In addition to thoracic surgery patients such as Lewis, they include patients who have had hip and knee replacements, suffered from chronic obstructive pulmonary disease and heart failure, undergone cardiovascular surgery and been on peritoneal dialysis.
It has resulted in a savings of up to $4,000 per patient, a 30 per cent reduction in emergency department visits and 30 per cent reduction in hospital readmissions, a savings of more than 30,000 bed days and an increase in patient satisfaction, according to the hospital.
St. Joe’s is in the process of expanding it to all surgeries and some ER patients. There are plans to further expand it to mental health and long-term care patients, and to frail seniors in their homes.
Elliott would like to see this type of program emulated across the province.
“Patients should be fully supported when returning home from the hospital and be connected to home-care services right away. A connected and co-ordinated system is our vision for a patient-centred health-care system,” she said in a written statement provided to the Star.
“The integrated-care model at St. Joseph’s Healthcare in Hamilton is a prime example of the important work that can be achieved when health care is centred around the patient,” her statement continued.
Lewis said he was very pleased with the care he received. Any concerns he had were immediately addressed and he felt confident he was in good hands, he said in a phone interview.
Best of all, he only had to stay in hospital for three nights, he noted. Assurances of good, ongoing care at home allow for quicker discharges.
“I wanted out. I am much more comfortable and relaxed in my own place,” Lewis explained
He had “virtual” followup appointments with Tran, an ICC co-ordinator and Lewis’ main point of contact in the program. Through Skype and a specially designed app, they could have face-to-face conversations, using cellphones, tablets or laptop computers.
The program has been a success with caregivers such as Lewis’ wife Nancy who said she appreciated the immediacy of it: “When you are in a hospital bed and you need help, you press a call button. That’s what this app is like. Anna Tran, someone with so much knowledge, is right there.”
Need a knee replacement? St. Joseph’s Healthcare has a robot that does that
St. Joe’s will do research to prove the technology works to avoid pitfalls plaguing robotic prostate cancer surgery.
Feb 25, 2019, by Joanna Frketich The Hamilton Spectator
Canada’s first knee replacements by a doctor-controlled robot have taken place at St. Joseph’s Healthcare as part of a study to prove the effectiveness of the technology and avoid the ongoing funding pitfalls plaguing prostate cancer surgery.
The robot has been used in four knee operations since Jan 18 in a pilot study funded by hospital donors.
“It’s very fledgling,” said Dr. Anthony Adili, who did the surgeries. “We’re just starting down a very exciting path … At the end of the day I think patients will benefit immensely from this new technology.”
St. Joseph’s, which specializes in robotic surgery, is getting the proof it needs from the start to show the technology is worth the extra cost so it doesn’t end up embroiled in the same dispute it faces with prostate cancer surgery.
“We’re in a golden opportunity to do that kind of pivotal research to inform our decision-making,” said Adili, chief of surgery at St. Joseph’s. “The research is being done (elsewhere) but it’s not high quality research so it’s hard to make definitive decisions and definitely difficult to make policy decisions. We want to produce that high quality data.”
The research is significant because a lack of evidence was behind a controversial recommendation in 2017 by the Ontario Health Technology Advisory Committee (OHTAC) against publicly funding robotic surgery to remove a cancer patient’s prostate gland.
It was a stunning blow to St. Joseph’s, where the vast majority of radical prostatectomies are done with the help of the da Vinci robot system.
Currently, the province pays the hospital the same price as the traditional operation and donors make up the extra cost of the robot. It’s an increasing burden on the St. Joseph’s Healthcare Foundation as the robot is rapidly becoming the surgery of choice with men from Kitchener to Niagara willing to travel and wait longer to get it.
A final decision on whether the province will eventually fund the robot for prostatectomies at an estimated cost of $800,000 — $3.4 million a year has been put off while St. Joseph’s gathers evidence on how it saves the health care system in other ways, such as a faster recovery time, since it’s no longer possible to do randomized trials.
“It’s so ubiquitous and it’s almost the standard of care,” said Adili. “It’s impossible to randomize someone to robotic prostatectomy versus an open prostatectomy. Nobody will go for it. We lost that opportunity.”
Orthopedic robotic surgery was approved in Canada and the United States only in the last year so high-quality studies can still be done. It’s the same for robotic thoracic cancer surgery with St. Joseph’s already running a multicentre trial.
“We don’t know who it’s going to benefit so we can do these randomized trials and develop that data that will help drive decision-making,” said Adili.
The biggest roadblock is that St. Joseph’s is the only centre in Canada doing robotic orthopedic surgery, making a multi-site trial of thousands of patients impossible to do here. With a price tag of $2 million a robot, it will be hard to find other centres with the appetite to join in.
“We’re going to have to partner with centres in the United States and convince them to contribute data,” said Adili. “The problem is they are buying robots like crazy because it is driving their business. They are going to be less inclined to want to randomize one versus the other. Some of our progress will be hampered until we get more units in Canada because Canadians have a very different mindset and will participate in trials.”
In the meantime, St. Joseph’s has started the pilot study that it hopes will provide enough evidence to get grants for the eventual large trial.
It’s important because Adili says one in five patients are currently unhappy with the outcome of their knee replacement and the robot’s precision could drop that number substantially. In addition, it makes partial knee replacements much easier, so surgeons will be more likely to do them.
“By replacing just the bad part of the knee, I’m leaving more of the patient’s normal anatomy behind,” said Adili. “It should feel like a more normal knee, recovery should be quicker and they should have better functionality. A total knee, although it is a successful procedure, it still does not match the mechanics of a normal knee.”
With the popularity of the robot for prostate cancer, Adili doesn’t expect any difficulty in recruiting patients.
The first was 66-year-old Peter Sporta from Oakville, who waited an extra two months to get a robotic partial knee replacement on Jan. 18.
“I wasn’t scared at all” Sporta said about being the first patient. “I couldn’t wait.”
Sporta was in the hospital for one night and walking the next day.
“Within three days I threw away my crunches and my cane,” he said. “For sure I would recommend this.”
Two Hamilton researchers will study post traumatic stress in emergency services
Media Outlet: Hamilton Spectator | Date: February 14, 2019 | Reporter: Joanna Frketich
Hamilton researchers are teaming up with scientists in France to determine the links between mind and body that could one day bring about more personalized mental health treatments.
“The hope for the patients one day is that when they come with depression, we don’t give them only an anti-depressant,” said Dr. Flávio Kapczinski, professor of psychiatry at McMaster University and St. Joseph’s Healthcare.
“We give them a whole strategy on how they would get outside the risk zone for depression.
“We could give them exercise, correct their metabolism with some sort of diet and give them anti-inflammatories.”
The partnership with the Pasteur Institute was one of three new Hamilton mental health projects launched in February.
The other two will investigate post-traumatic stress injuries (PTSI) in public safety personal such as firefighters, paramedics, police officers and correctional workers.
Both received grants of up to $150,000 from the Canadian Institutes of Health Research as part of $2.95 million in federal funding announced Feb. 8 to studies that increase understanding of how to identify, treat and prevent PTSI.
Margaret McKinnon, chair in mental health and trauma at McMaster, will do a randomized control trial to test a new way to treat PTSI in public safety personal with other health conditions.
Occupational therapist Sandra Moll plans to design a mobile health approach to prevention and peer support.
“Public safety personnel put themselves in harm’s way to protect Canadians, putting them disproportionately at risk of post-traumatic stress injuries,” federal minister of public safety and emergency preparedness Ralph Goodale said in a statement.
“Our country must do more to protect the mental well-being of public safety officers on-the-job. The initiatives will help address gaps in PTSI research and inform long-term plans to support the mental health and well-being of our public safety personnel.”
Meanwhile, the new partnership with the French researchers is significant because it gives St. Joseph’s Healthcare and McMaster access to basic science research that they don’t have now.
In turn, they offer Pasteur large cohorts of patients from West 5th hospital that the French are currently missing.
“We are accumulating a lot of data in this field now and thanks to this collaboration we’re going to have access to large cohorts,” head of Pasteur’s perception and memory unit Dr. Pierre-Marie Lledo said during a trip to Hamilton on Feb 7.
“We get a full picture of how the brain functions by having access to the clinical data.”
It’s also unique because French researchers generally team up with Quebec investigators.
“When France would partner with Canada they never crossed the Gatineau River,” said Kapczinski.
“Now the commitment of the French Embassy is to bring to the attention of French scientists this whole perspective of dealing with many other centres like McMaster. We are looking to the idea of strengthening the scientific links between Canada and France.”
So far, funding is primarily from their own institutions and the French Embassy, but they are working on applying for grants to study many different potential mind and body links.
“We were finding our patients when they have depression, they have a lot of inflammation in their blood,” said Kapczinski.
“We didn’t know the cause of that. Pasteur is famous because it’s where immunology and inflammation started to be understood … so we reached out to the director and he was very excited.”
Other questions vary from gut bacteria to exercise to metabolism to electric signalling between fatty tissues of the brain.
“People who suffer from depression they suffer a lot of brain changes like accelerated aging,” said Kapczinski.
“The brain and the body as a whole starts to age faster and we want to understand the mechanisms associated with that.”
Watch Dr. Tom Stewart, CEO of St. Joseph’s Health System talk about the Integrated Comprehensive Care program that’s changing how Ontarians are receiving care.
By Jim Rankin Toronto Star Reporter | Sun., Dec. 23, 2018
HAMILTON—Think virtual reality and you might picture a fantasy world to be explored and enjoyed. But researchers and staff at a Hamilton hospital are using the technology to better understand what it feels like to be in a seclusion room, the health-care equivalent of a jail segregation cell.
“We wanted to see what it was like to be on the other side of the door,” said Gary Chaimowitz, head of the forensic psychiatry program at St. Joseph’s Healthcare and a professor at McMaster University. “I think many of us can imagine, or recall times when you’ve been in places by yourself, when you didn’t want to be by yourself, left alone, but this puts you, as a staff person, in our rooms.”
Using a VR headset and hand controllers, staff are transported into a room modelled after real seclusion rooms at the hospital, and another set in a jail cell.
SimWave, an Ottawa-based company, used photographs to recreate the experience.
In two of three VR training modules being used at the program, you try to get the attention of virtual staff on the other side of the door. The seclusion room has no bathroom, and your bladder is full. You can ask for help, pace the room and knock or even pound on the door.
Your call for help returns one of 10 programmed responses, ranging from, a polite, “Yes, we’ll get you something,” to “Hold on a sec, we’re a little bit busy right now,” to a little more pointed response, Chaimowitz said.
“The tone, if you’re on the receiving end of that, obviously it makes a hell of a big difference,” he said.
Sometimes, there is no response, or the “patient” hears laughter. In another scenario, you actually get to use the bathroom.
“We’re looking at how long you can be in there before you get anxious,” Chaimowitz said, “and what it’s like to have a different staff response, the idea being that we are going to try to sensitize staff to what it’s like to be on the inside, which might change the way they interact with patients, both in terms of their tone and also a recognition of what it’s like to be there.”
Some staff have had to remove the headset after a while because they feel so enclosed by being in the room, Chaimowitz said, adding no one has found the experience to feel fake. “People have acknowledged that this is very different than being on the other side of the door,” he said.
The artists and developers at SimWave paid close attention to the finest of details. “If you press your virtual nose against the walls you can really see the details,” said Matt Thomas, SimWave’s head of business development.
Many of the hospital’s patients come from jails and return after treatment. Chaimowitz said the hospital hopes to share this training experience with provincial and federal corrections systems, where the use of segregation is under intense scrutiny.
In federal and provincial jails, inmates are being held in segregation for great lengths of time, and often exceeding 15 consecutive days, a point beyond which the United Nations has called to be banned because of the proven psychological harm it can cause.
This fall, as part of a human rights case settlement, Ontario’s Ministry of Community Safety and Correctional Services released two months’ worth of data on inmates either awaiting trial or serving short sentences who had spent time in segregation.
Of 3,998 placements in segregation, 778 were for periods longer than 15 consecutive days, the data revealed.
Half of the inmates had mental health alerts on their files and more than a third had a suicide alert.
“The correctional system is behind,” says Chaimowitz, who gave expert testimony at the coroner’s inquest into the 2007 death of Ashley Smith, who spent more than three years in segregation.
He recalls his first visit, decades ago, to a Hamilton jail. “I could hear people screaming and recognized there were mentally unwell people.”
“I don’t think anybody there is being cruel,” he said. “But it is frightening, and it is one of those sort of things that I can’t believe, in our cities, that we house people like this.”
The VR training can’t replicate everything in a seclusion or segregation setting, such as the degree of noise, the clanging and the smells, but the idea is that “if we can walk in someone’s shoes, even if it’s the way you deal with people, that it will be a little bit more humane,” he said.
Another training module simulates a search for contraband in a psychiatry patient room complete with a full bathroom. A more complex simulation still in the works involves an educational night-shift scenario that begins with hearing a noise and escalates into a hostage-taking situation.
The hospital’s forensic psychiatry unit has 114 beds and will be adding four correctional beds, as part of a pilot project with the provincial ministry that overseas corrections. Those beds should cut down visits by mentally ill inmates to hospital emergency rooms, where staff are “uncomfortable” with corrections patients who are shackled and handcuffed, Chaimowitz said.
“We’ll be in a better position to treat them and get their mental illness under control,” Chaimowitz said. “The idea is to bring them in here and get them well enough” to return to the general jail population, he says. “I think it the potential for making a big difference is very, very high.”
As for more the potential for virtual reality, Chaimowitz and his team would like to see patients given the opportunity to use the technology to escape their rooms and units and explore.
“They are basically stuck in their unit and the perimeter around St. Joe’s and Hamilton. So, they can’t do a lot,” said psychiatrist Sébastien Prat. “We want to develop that kind of project, in order to make them able to travel to a beach or somewhere they want to go, so they can enjoy something.”