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.”
The townhouses will be fully accessible and offered to seniors to rent
Dec 4, 2018 by: Kenneth Armstrong Guelphtoday.com
St. Joseph’s Housing Corporation is planning to begin construction of 28 rental townhouses geared to seniors on its land this spring.
“There is a housing need in the County of Wellington and Guelph, so we have been working on this for quite some time to meet the need in the community,” said Sharmilla Rasheed, chief financial officer for St. Joseph’s Health Centre Guelph.
The 28 semi-detached townhouses, collectively called Silver Maple Townhomes, will be constructed on a five-acre portion of vacant land facing Westmount Road, directly adjacent to St. Joseph’s Health Centre.
The townhouses will remain owned by St. Joseph’s Housing Corporation and offered to seniors to rent.
“The object is to provide housing for seniors in an affordable manner,” said Rasheed.
The two-bedroom townhouses are intended for seniors with mobility issues or disabilities and are being constructed as a single-level home with no steps.
“They are designed to be fully accessible and will have some services linked to the health centre,” said Rasheed.
The project will house between 28 and 56 seniors, depending on whether the occupants are single or move in with a second senior.
Rasheed said local contractors will be employed for the construction of the townhouses.
The preliminary cost of Phase 1 of the project is $7 million, with construction expected to begin in early spring. Phase 1 of the project is expected to take one year to complete.
A second phase still in the early planning stages would see an affordable housing apartment building constructed on another portion of the plot of land.
“We are actively working with management and the board, as well as with external parties, as to what Phase 2 will look like. We’re not ready to disclose it,” said Rasheed.
November 29, 2018 (Kitchener)
St. Mary’s General Hospital continues to be recognized as one of the safest hospitals in Canada, with the seventh lowest mortality rate in the country and readmission rates that are significantly lower than the national average.
These achievements were recognized with today’s release by the Canadian Institute for Health Information (CIHI) of performance indicators for 2017-18, including Hospital Standardized Mortality Ratio (HSMR) and readmission rates. HSMR measures expected deaths versus actual deaths in acute care hospitals, with a ratio lower than 100 indicating fewer than expected deaths. St. Mary’s score was 74, compared to a national average of 89.
“These excellent results confirm the commitment by staff and physicians to St. Mary’s vision to be the safest and most effective hospital in Canada,” said Marco Terlevic, Acting President at St. Mary’s. ”St. Mary’s has consistently had among the lowest HSMR scores in Canada and we continue to be among the very best.”
St. Mary’s readmission rate for all patients is 7.6%, compared to the national average of 9.1%. By focusing on quality, senior friendly care, harm reduction and support for patients that extends after their discharge, St. Mary’s has continued to keep readmission rates low.
An example is St. Mary’s Integrated Comprehensive Care Program (ICC), a program pioneered by St. Joseph’s Health System which provides the right care at the right place, reducing emergency department visits and readmissions and improving the patient experience. The program gives the patient one number to call for 24/7 access to a care coordinator. Patients and families participate in the care plans which are customized and integrated across all episodes of care, and all members of the care team see the same health record for safer and more seamless decision making.
“The Integrated Comprehensive Care program is breaking down hospital walls and delivering high-quality care to our patients when they need it, and where they need it,” said Tom Stewart, President and CEO of St. Joseph’s Health System. “Empowered by technology, the ICC program has resulted in better patient outcomes, decreased the length of hospital stays and reduced the number of patient readmissions to hospital after their discharge.”
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The following article was featured in Canadian Healthcare Technology on November 8, 2018. Written by Dianne Daniel.
Community hospitals have also invested in new software, enabling physicians, care partners and patients to access information more easily
Complex cardiac care in Ontario is no longer limited to major urban teaching hospitals. New technologies and management techniques – coupled with strong partnerships – are strengthening advanced regional programs, bringing excellent care closer to cardiac patients where they live and dramatically improving medical outcomes.
Royal Victoria Regional Health Centre (RVH) in Barrie launched its regional cardiac program in partnership with Newmarket’s Southlake Regional Health Centre in January, enabling its cardiac team to perform angiograms and percutaneous coronary intervention (PCI or angioplasty). The program is supported by 10 cardiologists, a dedicated seven-bed coronary care unit, two catheterization labs (cath labs) accompanied by a 16-bed recovery unit, and a 32-bed cardiac/renal unit for general cardiac care.
Planning for advanced care delivery began in 2012 and was based on a strong vision to create a comprehensive, centralized electronic system specifically for cardiac care. “We really felt our solution needed to describe the patient’s cardiac journey and that journey should be available essentially anywhere in the world a physician would need it, if they needed access to that information,” said Selma Mitchell, operations director of the Simcoe Muskoka Regional Heart Program & Regional Renal Program.
To streamline workflow throughout its cardiac care program, RVH partnered with Philips, implementing the IntelliSpace Cardiovascular image and information management solution along with supporting applications for nursing documentation and patient monitoring. Physicians log in to see all patient test results, including echocardiograms, electrocardiograms, cath lab exams and holter monitors, and the system is integrated with RVH’s existing Meditech electronic health record system.
As Mitchell explained, it’s not only the diagnostic report that’s available, but the live image too. “Our patients love it. We pull this up at the bedside, after the patient has had the procedure, and their physician will show them what their angiogram looked like,” she said. “It’s really interesting for them to see their images in real life.”
The advanced system is accessible beyond the walls of RVH. If a patient is transferred to Southlake for a more complex procedure or surgery, for example, the treating physician there is able to access and view all prior diagnostic testing.
“You can’t just deliver a hardware system,” explained Mitchell. “You need to be able to connect it to the patient and the software piece is integral … that was probably the most important aspect for us, having a system where we could connect all of the dots.”
The “dots” are also being connected between RVH and the smaller regional hospitals within its catchment in the Central local health integration network (LHIN). Recently, RVH integrated its electronic cardiac system with the Huntsville District Memorial Hospital site of Muskoka Algonquin Healthcare, enabling physicians there to share images and reports with cardiologists at RVH.
“A few years back, if a patient had to be referred to another physician, we would have had to taxi a CD down to that partner hospital which took time,” said RVH Cardiac IT team member Stef Keown. “Now they can access it in seconds versus hours.”
By 2020, the new regional program will operate 24/7 with paramedics transporting North Simcoe Muskoka heart attack patients directly to RVH for treatment, providing lifesaving intervention within 90 minutes for most patients. In the meantime, the plan calls for a cautious, phased ramp-up of cardiac services, supported by ongoing partnerships with Philips for infrastructure and Southlake for tertiary and quaternary services, including advanced cardiac surgery and heart rhythm interventions.
Janice Allen, director of Southlake’s Regional Cardiac Care Program, said the most important objective of the regional focus is to deliver excellent cardiac care while reducing patient travel. “It truly is one program with two sites,” said Allen, adding that the Southlake cardiac surgery team conducts satellite clinics at RVH as needed for complex patients. “It’s really great from a regional perspective to be able to offer this cutting-edge care closer to home for our patients. Otherwise they would have to be travelling to academic centres,” she said.
In February 2018, Southlake completed a redevelopment of its cardiac labs, providing more efficient care for patients in need of complex cardiac interventions across the region. The third largest cardiac centre in Ontario, it now operates three cath labs outfitted with state-of-the-art imaging systems for diagnostic angiograms, angioplasty and structural heart procedures, and three dedicated electrophysiology suites for heart rhythm diagnostic studies, ablations and implantable devices such as pacemakers and defibrillators. The new equipment – which includes the latest in 3D imaging and mapping – creates opportunities for future growth, said Allen.
Since inception, the centre’s Regional Cardiac Care Program has treated more than 160,000 patients, completing 93,370 diagnostic tests and exams last year alone. In addition to more than 6,000 diagnostic catheterization procedures, 1,000 surgeries, 752 electrophysiology studies and 687 cardiac ablations, the centre performed 71 transcatheter aortic valve implants (TAVIs) in 2017 and is awaiting approval from the Ontario Ministry of Health and Long-Term Care to add mitral valve clipping procedures.
“The other procedure we’re looking at doing is left atrial appendage closure for patients who have Afib (atrial fibrillation), who are at high risk of bleeding on an oral anticoagulation therapy,” said Allen.
Remote monitoring of patients is another part of the regional program which is contributing to fewer hospital readmissions and reduced lengths of stay. Patients who receive pacemakers or implantable cardioverter defibrillators (ICDs) and who provide consent for remote monitoring are able to download information from their devices daily for review by nurses. Monitoring is also provided for congestive heart failure patients, who track their weight, oxygen saturation levels, heart rate and blood pressure.
“If patients are trending in the wrong direction – if their weight is going up or their oxygen saturation is trending down – they may not be symptomatic at that point, but our team can pick up on that and call them,” she said, noting that the same monitoring service is provided to elderly patients who reside in long-term care settings.
An added advantage of the regional program is that Southlake is able to bundle contracts with industry partners and vendors into one “innovative procurement with multiple streams,” Allen said. Innovative procurement means vendors don’t simply sell products, they work with the hospital to improve quality performance indicators such as readmission to hospital, length of stay and mortality rate. “It was a lot of work,” she said. “We’re very proud because we were able to deliver benefits to our patients through a procurement strategy. We haven’t seen that before.”
St. Mary’s Hospital in Kitchener is also aiming to use innovative procurement to support its strategy for a new regional cardiac program. As Chief of Cardiovascular Services Dr. Brian McNamara described, the approach is more about outcomes than widgets.
“Traditionally, hospital procurement has been ‘we use 2,500 stents per year, we promise to buy them from you at this price,’” he said. “This is more about ‘we want to have a lower stent thrombosis rate, or a shorter door to balloon time or a shorter length of stay. How can you help us do that?’”
The hospital will meet with local technology companies and leaders in October to provide them with an outlay of its plan for a Waterloo Wellington Regional Cardiac Program – an expansion strategy that is supported by the Waterloo Wellington LHIN and is currently seeking funding approval by the Ontario Ministry of Health and Long-Term Care. Dr. McNamara said the need for additional services is “irrefutable.”
Over the past 15 years, St. Mary’s Hospital has grown its cardiovascular services to the point where it is now completing more than 6,000 cath lab procedures each year. Nine years ago, the centre performed 900 PCIs per year; this year it completed more than 1,800. Yet the underlying infrastructure hasn’t changed, meaning the two existing cath labs are used around the clock, straining equipment and resources.
“A few years back St. Mary’s leadership and the Board instituted a Lean management strategy to try to extract the most value from the resources we have – both physical and financial – and those efforts have squeezed absolute maximum capacity out of the existing infrastructure,” he said.
Services provided by St. Mary’s include pacemaker and ICD insertions, coronary artery bypass and valve surgeries, catheterizations and PCI procedures, Transcatheter Aortic Valve Implantation (TAVI) and diagnostic coronary angiography. There is a very busy pacemaker and ICD and CRT Program. The Cardiac program is supported by 18 cardiologists, four surgeons, five cardiac anesthetists and a dozen nurse practitioners. According to a 2017 national report on quality outcomes at Canada’s 38 cardiac centres, St. Mary’s is performing better than the national average and is among the top three.
“For a small place, we do PCI and cardiac surgery at a level that’s commensurate with the top three places in the country and some of our metrics are better,” said Dr. McNamara. For example, Canadian average mortality rates following cardiac procedures range from 1.3 to 2.3 per cent whereas St Mary’s rate ranged from 0.5 to 1.6 per cent. The average readmission rate following PCI was 7.4 per cent; St. Mary’s was 5.8 per cent.
In addition to the hospital’s strong cardiac performance, the community is now better served due to changes in outpatient care delivery. The cardiologists are aggregated together into one, large outpatient clinic. Before, family doctors would fax referrals and send consult requests all over the Kitchener-Waterloo region. Now the entire service is staffed out of one clinic and each cardiologist leaves a few openings in the weekly schedule to treat emergency patients.
“It’s much more responsive to the community and it has completely transformed outpatient cardiology access,” said Dr. McNamara.
St. Mary’s Hospital, in Kitchener, Ontario, is performing better than most cardiac centres and is among the top three in Canada.
Moving forward, the expanded plan includes developing a “hub and spoke” model for advanced cardiac care delivery, with St. Mary’s Heart Function Clinic as the main resource for guidance, order sets and care of the highest risk and sickest patients in its catchment area.. The “spokes” will be satellite services provided in smaller communities, but under St. Mary’s guidance, he explained.
St. Mary’s regional cardiac program serves over 20 hospitals in a geographic rectangle stretching from Simcoe to Tobermory, along the coast of Lake Huron to Goderich and east to Guelph. One of the goals of the expanded Waterloo Wellington Regional Cardiac Care program – which includes the addition of an electrophysiology lab to treat advanced heart rhythm disturbances as well as remote cardiac rehab – is to develop a comprehensive digital strategy.
Concurrent with its strategic plan to expand regional cardiac care services, St. Mary’s is in the midst of a large Cerner electronic medical record implementation in conjunction with Grand River Hospital. Dr. McNamara expects the new system will enhance the flow of information between satellite sites so that a physician at one location can get an ECG in front of an on-call cardiologist at St. Mary’s in a secure manner that protects patient privacy.
“It’s one of those Tower of Babel situations. The hospitals we work with all use different platforms for diagnostic imaging, records; it’s difficult to talk to each other,” he explained. “The hope is one EMR will enhance the to and fro of information to our partner hospitals in a more seamless way.”