March 2014 Edition

NURSING

HEROAWARDS!

9th Annual

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

Ethics ..................................................13

Nursing Pulse .....................................19

From the CEO's desk ..........................24

Travel ...................................................30

Careers ...............................................31

New! Monthly Healthcare Technology Section

Nominate a Nurse!See page 9for details

28

FOCUS IN THIS ISSUEPAIN CONTROL/COMPLEMENTARY HEALTH/HEALTH PROMOTION:Pain management interventions. Advancements in complementary treatment approaches to various diseases and conditions. Innovative health promotion programs that focus on disease prevention.

MARCH 2014 | VOLUME 27 ISSUE 3 | www.hospitalnews.com

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Be their link to accessing the right care.Be the health professional that clients know will champion their unique needs and guide them through a complex health care system, promoting their health and planning their care – at home and in the community. RNs, MSWs, OTs, PTs, RDs and SLPs are invited to apply. For details, locations and staff videos, and to apply for a Care Coordinator, Nursing or other role, visit ccacjobs.ca.Most 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.

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The vaccinecontroversyBy Tania Haas

ixty years ago an average of 400 Canadi-ans contracted polio per year. Those who survived were left with a paralyzed nervous system and permanently maimed limbs.

Today, polio is prevalent in only a handful of countries and eradicated in Canada thanks to routine immuni-zations against it and 12 other potentially fatal condi-tions. Along with fl ush toilets and clean water, routine immunizations, or vaccines, are considered the world’s most important defence against preventable diseases.

Surprisingly, while vaccines are free and readily available in Canada, cases of infectious diseases, like measles and pertussis (also called whoop-ing cough), are on the rise. The resurgence is a result of Canada’s falling child vaccination rates – resulting from parental complacency and hesitancy, widespread misinformation, socioeconomic factors, cultural miscommunication, a fragmented national strategy and passive public health efforts.

Continued on page 14

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9

www.hospitalnews.comHOSPITAL NEWS MARCH 2014

2 Focus PAIN CONTROL/COMPLEMENTARY HEALTH/HEALTH PROMOTION

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MARCH 2014 HOSPITAL NEWSwww.hospitalnews.com

3 In Brief

NOW AVAILABLENew Edition of Standard on Plume Scavenging

Surgical smoke plume poses a real threat to the health and safety of health care workers. It is not only found in traditional acute care settings but also in vision correction, dental offices and other health care settings.

The 2nd edition of Z305.13 - Plume Scavenging in Surgical, Diagnostic, Therapeutic, and Aesthetic Settings - contains key updates that help plume-generators ensurethat preventative measures are in place and current best practices are met.

The Canadian Medical Association (CMA) will be travelling across the country over the next three months to find out what Canadians think about end-of-life issues in a national dialogue. The first of five town hall was held in St. John's, Nfld., in February. Dr. Louis Hugo Francescutti, CMA President, says the goal is to engage and hear Ca-nadians' thoughts on physician-assisted dying, palliative care and advance care

planning. "Most of the attention has been focused on the question of physi-cian-assisted dying and we're concerned the end-of-life debate is being oversim-plified. We need to hear more from Ca-nadians about how their health care sys-tem can ensure not only a long, healthy life but also a good death.'' In addition to the town hall meeting in St. John's the other public town halls, in associa-tion with the Canadian Society of Pallia-

tive Care Physicians and the Canadian Hospice Palliative Care Association, will be held in:

• Vancouver, March 24 • Whitehorse, April 16• Regina, May 7 • Mississauga, May 27Following the town halls, the CMA

will release a summary report on how the public views end-of-life issues to provide guidance in future policy decisions. ■H

A new report, System Performance Spe-cial Focus Report: Examining Disparities in Cancer Control, uncovers potentially im-portant disparities in the cancer care re-ceived by Canadians based on how much they earn, where they live, and if they are recent immigrants or Canadian-born. Led by the Canadian Partnership Against Cancer, the report shows that people from the poorest urban neighbourhoods are less likely to survive cancer compared with ur-ban residents from the richest neighbour-hoods and that this might be related to inequities in access to diagnosis and treat-ment services.

The new report shows that the wealthi-est urban residents have a 73-per-cent chance of surviving their cancers fi ve years after a diagnosis (relative to others in the general population of their age, sex and income level) compared with 61-per-cent for people living in the poorest urban neighbourhoods.

Earlier research has established that, with higher rates of smoking and obesity, lower income and rural Canadians have a greater risk of getting some cancers and dying from them. However, gaps in surviv-al tend to refl ect differences in diagnosis and treatment as opposed to differences in the risk of getting cancer. In this context, the report reveals for the fi rst time at a pan-Canadian level that people living in lower income and rural and remote com-munities may not be accessing the best cancer care as compared to their wealthier urban neighbours. For example, although fi nding cancers early can often offer a bet-ter chance of surviving the disease, the re-port's results suggest that Canadians from lower income households are less likely to report being screened for cancer than those from higher-income households. The report provides indicators that sug-gest that across the diagnosis and treat-ment pathway from screening and early detection, to radiation therapy, surgery, and enrolment in clinical trials – at every step of the cancer-care journey, these low-er income and more rural-dwelling seg-ments of the Canadian population could be falling behind. ■H

Examining disparities in cancer control

An antidepressant medication has shown potential in treating symptoms of agitation that occur with Alzheimer's dis-ease and in alleviating caregivers' stress, according to a multi-site U.S.-Canada study. "Up to 90 per cent of people with dementia experience symptoms of agita-tion such as emotional distress, restless-ness, aggression or irritability, which is upsetting for patients and places a huge burden on their caregivers," says Dr. Bruce G. Pollock, Vice President of Research at the Centre for Addiction and Mental Health (CAMH), who directed research at the CAMH site. "These symptoms are a major reason why people go into long-term care prematurely."

The antidepressant citalopram, sold un-der the brand names Celexa and Cipramil, signifi cantly relieved agitation in a group of Alzheimer's disease (AD) patients as reported in the February 19 issue of the Journal of the American Medical Association. "When agitation occurs, it's paramount to try non-medication approaches fi rst, such as looking for underlying physical discomfort in a patient, reducing external triggers such as noise or overstimulation, and encouraging light exercise," says Dr. Pollock, Director of CAMH's Campbell Family Mental Health Research Institute. When these approaches don't work, anti-

psychotic medications are commonly used to treat agitation. "Antipsychotics are not an ideal therapy and signifi cantly increase the risk of strokes, heart attacks and sud-den death," he adds.

Based on promising early fi ndings from Europe, Dr. Pollock began conducting studies on citalopram, which suggested it

might be a viable treatment alternative to antipsychotics. To provide stronger evidence, the Citalopram for Agitation in Alzheimer's Disease Study (CitAD) was initiated with eight leading Alzheimer's research centres across the United States and Canada, including the Geriatric Pro-gram at CAMH. ■H

CMA hitting the road to sound out Canadians on end-of-life issues

Antidepressant holds promise in treating Alzheimer's agitation

Safety concerns with new drugsA York University study of drug safety

shows that new drugs are often on the market in Canada for more than three years before they are withdrawn as un-safe, raising concerns about turning to the newest drugs available. The study by Joel Lexchin, an emergency room physician and professor of the School of Healthy Policy and Management in York’s Faculty of Health was published in Open Medi-cine. “As a doctor my policy is not to pre-scribe new drugs until they have been on the market for at least three or four years since I don’t know how safe they will be for my patients,” says Lexchin. “Based on the fi ndings in this study, doctors should not prescribe drugs during this period and patients should not take them, unless they are substantially better than existing

medications.” Lexchin found that 4.2 per cent of the 528 new drugs approved in Canada in a 20-year period (Jan. 1, 1990 to Dec. 31, 2009) were later withdrawn. Of the 22 drugs withdrawn, 11 fi rst had a serious safety warning and 11 did not. The median time between approval and withdrawal was almost three-and-a-half years. The study examined four 5-year periods and found no difference in the percentage of approved drugs that were eventually withdrawn from the market. This shows that the drug review system’s ability to detect serious safety issues and keep those drugs off the market did not change over the 20-year period, he says, but also raises questions about the rigour of the surveillance system once drugs are on the market. ■H

HOSPITAL NEWS MARCH 2014 www.hospitalnews.com

4 Editorial

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APRIL 2014 ISSUEEDITORIAL MARCH 7ADVERTISING: DISPLAY MARCH 28 | CAREER APRIL 1MONTHLY FOCUS: Gerontology/Palliative Care/Home Care/Rural and Remote:Geriatric medicine and aging-related health issues. Innovative approaches tohome care and palliative care delivery. Care in rural and remote settings: enablers, barriers and approaches.

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Is your life affected

by someone’s drinking?

Being a parent is hard – probably the most diffi cult job those of us with children will ever have. Don’t get me wrong, it’s also one of the best jobs – but it doesn’t come easy.

Should you formula or breast-feed? Use cloth or disposable diapers? The questions are never-ending. In the early sleep-deprived days it’s astound-ing that new parents are able to make decisions on the most trivial of par-enting issues – let alone deciding on whether or not to vaccinate their new baby.

Regardless of opinions on feeding, diapering, sleeping, schooling – one thing most parents have in common is that we want the best for our children and will do anything we can to keep them safe.

Prior to becoming a mom I didn’t give vaccination a second-thought. I accepted and supported that vacci-nations protect humans from terrible, highly infectious, potentially fatal dis-eases. I was vaccinated. Without ques-tion, my children would be too.

Then I actually became a mom. And people aren’t lying when they say that changes everything. I had a new purpose and it was to protect this amazing little human from everything I possibly could. It’s a tremendous re-sponsibility – one that comes with a lot of pressure and second-guessing.

We are fortunate that we live in an information age – basically any-thing we want to know is just a few keystrokes away. We can educate our-selves on any topic, fi nd a wealth of parenting advice and even join forums to discuss issues with other parents. Before bringing my baby to receive the fi rst round of vaccinations I looked up possible side-effects and what to look for to detect adverse reactions.

There is some terrifying informa-tion about vaccinations online. It’s no wonder the anti-vaccination move-ment has made such headway. Being

a strong supporter of vaccination, it wasn’t hard for me to research and fi nd credible information refuting the wealth of misinformation and reasons I shouldn’t vaccinate my baby. But I can completely understand how some parents buy into it.

Back in 2011 I penned a column entitled “Immunization is not a bad word.” Not surprisingly, I received a lot of feedback. One letter I received from a family physician in Ontario was quite disheartening. In the column I stressed the role health care profes-sionals have in educating parents and dispelling the myths about the dangers of vaccination. This family physician disagreed and believed it was not his job to educate parents saying he did not have time to spend with parents – they should be able to sort through what is reliable information and what is not.

If it’s not the job of our doctor to help us make decisions about our health, and the health of our children then whose job is it? In many aspects of healthcare patients are expected and encouraged to actively participate and manage their own care – if we want engaged and informed patients we can’t then turn our backs when they have questions about informa-tion they found online – no matter how misinformed. Who can blame a parent for seeking out information when their own doctor is not able or too busy to provide them with the in-formation?

Recently, Public Health Ontario released a fi rst-of-its-kind comprehen-sive assessment of vaccine safety in Ontario. The report aims to encour-age ongoing assessment of vaccine safety and provide relevant and timely information for health professionals and the public about the safety of vac-cines administered in Ontario.

In 2012 approximately 7.8 million publicly funded vaccine doses were

distributed in Ontario. Of those, only 631 adverse events following vaccina-tions were reported. Of the 631 ad-verse events reported, most were mild. Only 56 serious events were reported – which represents 7.2 in every million doses distributed. Serious events after vaccines are extremely rare.

Are there risks associated with vac-cines? Of course. There are risks asso-ciated with leaving your house in the morning. There are risks with every single medical procedure. It’s about weighing the risks and benefi ts. Many scientifi c studies have demonstrated that the benefi ts of vaccines far out-weigh the risks. Not one death was reported as a result of the 7.8 million vaccines distributed in Ontario. Not one. The same can’t be said for the diseases these vaccines prevent.

Many experts are warning Canada’s falling vaccination rates could lead to a public health crisis as once nearly eradicated diseases are reappearing. This month Hospital News takes an in depth look at the vaccine controversy in our cover story that examines why vaccination rates are falling and what can be done about it. Hospital News ethicist provides an ethical analysis of a new and disturbing trend among pe-diatricians – discharging patients who refuse to immunize their children. On page 16 we provide a brief history of vaccines and Canadian innovation with highlights from an exhibit on dis-play at the Museum of Health Care.

Vaccination is arguably the most ef-fective health promotion tool we have in our arsenal. While the report on ad-verse events in Ontario is a good start, this information needs to be com-municated to patients through their health care professional. We need to work harder to dispel the myths of the dangers of vaccines and it is most defi nitely the job of our doctors and health professionals to educate their patients. ■H

Vaccines are safe– time to communicate it

Kristie Jones, Editor


5 PAIN CONTROL/COMPLEMENTARY HEALTH/HEALTH PROMOTION Focus


6 Evidence Matters

Together, we’re better.

Find out why 30,000 health care workers are proud to call OPSEU my union.www.joinopseu.org [email protected] 1-800-268-7376 facebook/joinopseu

raditional non-steroidal anti-infl ammatory drugs (NSAIDs) include ibuprofen (Advil, Motrin), diclofenac (Voltar-

en), naproxen (Naprosyn), and others. These drugs are widely available in many dosage forms and most hospitals have sev-eral on formulary. NSAIDs are fi rst-line options for many types of pain, but they can cause stomach upset and occasionally gastrointestinal (GI) bleeding.

When cyclooxygenase-2 (COX-2) inhib-itors such as celecoxib (Celebrex) became available, they were expected to cause less GI bleeding. Some studies did indeed show less GI bleeding, but some didn’t – and then some studies showed an increased risk of cardiovascular events such as heart attacks and strokes. The COX-2 inhibitor rofecoxib (Vioxx) was removed from the Canadian market in 2004 for this reason. Several confl icting studies led to a COX-2 controversy. Were they safe?

Then studies began to emerge show-ing that traditional NSAIDs might carry cardiovascular risk as well. How big is this risk? Is it the same for all NSAIDs? With so much confl icting data, what informa-tion can a clinician trust, and which drugs should hospitals have on hand for treating mild to moderate pain?

Systematic reviewsThis situation demonstrates the value

of a systematic review. Systematic reviews of the medical literature capture all stud-ies available on a given topic. As more studies become available on a given topic, we can have more confi dence when we see conclusions repeated, or when a more mature data set is presented in one paper with a critical appraisal of all the included studies.

When the design of the studies is simi-lar, the data from different studies can be pooled and re-analyzed together; this is called a meta-analysis. With more data comes more power to detect differences between treatments or to identify rare side effects.

The hierarchy of evidenceFor all these reasons, systematic re-

view and meta-analysis sit at the top of the “hierarchy of evidence.” This hier-archy is a way of ranking different types of clinical studies. In general, systematic reviews and meta-analyses are more reli-able than a single randomized controlled trial (RCT), which in turn is more reli-able than non-randomized studies such as cohort studies and case reports. Qual-ity is important, though; a well-done

study at the bottom of the hierarchy may be more reliable than a poorly-done sys-tematic review.

Hallmarks of a high-quality systematic review include: a clearly formulated re-search question, a structured literature search strategy that others can repro-duce, explicit methods for selecting and critically appraising studies, and a clear reproducible description of the methods used to analyze the data.

CADTH evidence reviewCADTH recently critically appraised

six systematic reviews and meta-anal-yses on COX-2 and NSAID safety. Two systematic reviews of RCTs reported no differences in cardiovascular or GI out-comes between celecoxib and high dose diclofenac, but one systematic review of non-randomized studies reported a slightly higher cardiovascular risk with diclofenac. For celecoxib vs. ibuprofen, celecoxib was associated with fewer GI complications without any statistically signifi cant differences in major cardio-vascular events. For celecoxib vs. naprox-en, the risk of cardiovascular events was higher with celecoxib, but there were more GI complications with naproxen.

The bottom line is that:

• naproxen seems to have lower cardio-vascular risk than celecoxib• diclofenac and ibuprofen seem to have the same cardiovascular risk as celecoxib •celecoxib and diclofenac seem to have lower GI risk than ibuprofen and naproxen• clinicians may need to beware of underestimating the risks of these drugs

These results show the value of using systematic reviews, not only for contro-versial drugs such as COX-2 inhibitors, but also for commonly used drugs such as NSAIDs.

It’s also important to remember that a systematic review has the same limi-tations as the studies feeding into it. For example, most of the studies in these reviews lasted for three months or less, so by extension, the systematic reviews can only answer questions about short-term use. Systematic reviews and meta-analyses have more power and preci-sion than individual clinical trials, but their quality and relevance will always depend on the quality and relevance of the original studies. ■H

Sarah Jennings, PharmD, is a Knowledge Mobilization Offi cer at CADTH.

Side effects of anti-infl ammatory drugs:

By Sarah Jennings

T

What’s the evidence?



hen you think about reliev-ing the aches and pains in your muscles and joints, the last thing most people want is

surgery. The thought of being on an operating

table is the exact reason Toronto resident George Danylkiw avoided surgery on his shoulder for so long – even though it was fi lled with pain. “Over the last year or so, the pain became so bad, I couldn’t sleep at night, sitting down was painful and moving my arm above my head was impossible,” he recalls.

But thanks to an innovative approach to the positioning which facilitates ar-throscopic shoulder surgery, developed by Dr. Amr Elmaraghy, an upper extrem-ity Orthopaedic surgeon at St. Joseph’s Health Centre (St. Joe’s), Danylkiw knew he could overcome his apprehension to surgery for the benefi t of his health.

Arthroscopic shoulder surgery tech-niques are less invasive than the tradition-al open surgery method, and uses a tiny camera called an arthroscope and various instruments to repair the tissues inside or around the shoulder joint. The camera and tools are inserted through small incisions in the skin. In Danylkiw’s case, surgery was needed to remove a bone spur and repair the rotator cuff tendons in his right shoulder.

To enhance the procedure in a way that benefi ts both himself as a surgeon and pa-tients like Danylkiw, Dr. Elmaraghy sits his patients up in the “beach chair” position during the surgery – then applies traction and leverage to their arm to open up spac-es within the shoulder. This innovative ap-proach to creating space makes it easier to use the necessary hand and power tools to repair damage in the shoulder, while ensur-ing that no additional damage is done to the surrounding cartilage and tissue.

Two months after surgery George says he

feels “like a million bucks”. The only proof of his surgery are the fi ve tiny marks left from the incisions made by Dr. Elmaraghy to repair his rotator cuff. His shoulder pain is completely gone.

Danylkiw believes his shoulder pain is a result from his days as a body builder. “Body building is great for you but if you don’t do it correctly it causes more damage than good,” he says.

As a young adult he was also dedicated to weight training and gymnastics. Today at 68 years old, he’s a semi-retired contrac-tor who still loves to stay active especially through cross country bicycling and sever-al cycling accidents over the last two years have also taken a toll on his shoulders.

A number of MRI scans revealed ex-tensive damage to Danylkiw’s shoulder – a bone spur and rotator cuff tears - which were causing him so much pain. He tried everything short of surgery to relieve the pain – physical therapy, cortisone shots, and medication – but nothing helped, ex-plains Dr. Elmaraghy, who initially met Da-nylkiw fi ve years ago.

Sleepless nights, constant pain and the inability to lift his arm properly left Danyl-kiw with one more choice – surgery.

“Beach Chair Traction positioning is an innovation that’s really behind the scenes, meaning patients may not realize the ben-efi t of this technique, to open up spaces while (clinicians are) doing the procedures – but they will see the results,” says Dr. El-maraghy. “What this means for patients is a surgery that is quicker, safer and more ef-fi cient, allowing them to get back to their day-to-day life and be pain free, and to do those sporting activities with better func-tion and range of motion.”

All surgeons face the need to work within spaces that don’t normally exist, especially around the shoulder joint and shoulder tendons, Dr. Elmaraghy explains.

“Your assistants (in the operating room)

can’t provide that kind of holding force throughout the entire length of the pro-cedure that is stable, predictable and ef-fective as far as opening up space around cartilage and tendons. So that was the need that I faced and the beach chair trac-tion positioning method was the solution I came up with,” he says.

When Danylkiw fi rst heard of Dr. Elma-raghy’s approach to arthroscopic surgery he was excited to benefi t from this ap-proach and fi nally fi nd the right solution to relieve his pain. He was even more thank-

ful to receive this level of innovative care close to home at his local hospital.

“I really believe that innovation is the wave of future for everything, not just medicine,” says Danylkiw. “Innovation overall is positive especially coming from a community hospital like St. Joe’s, it’s unbe-lievable. I can’t say enough about all of the doctors, nurses and staff there.” ■H

Michelle Tadique is a communications associate at St. Joseph’s Health Centre Toronto.

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Innovation in arthroscopic shoulder surgery positioning decreases painBy Michelle Tadique

Surgery patient George Danylkiw, pictured in the physiotherapy clinic at St. Joe’s. Two months after his shoulder surgery, Danylkiw is pain free.

W



The May 2014 issue of Hospital News will be celebrating National Nursing Week in Canada (May 12th – 18th) with a special pull-out feature showcasing our “Nursing Heroes” contest winners as well as highlighting outstanding leadership and stories from the nursing frontlines!

ADVERTISERS: Don’t miss this opportunity to celebrate and acknowledge the outstanding contributions of our hard working nurses with your own THANK YOU ad!

Inquire about our reduced rate advertising package,contact Denise Hodgson at

905-532-2600 ext [email protected]

COMMITMENTDEDICATIONEXCELLENCE

COMPASSION

Inquire about our specialadvertising package!

NATIONALNURSING WEEK

9th Annual SupplementBooking Deadline: Friday, April 25th

Material Deadline: Tuesday, April 29th

new program implemented at Rouge Valley Health System (RVHS) is helping to reduce readmission rates for patients

once they are discharged. Studies have shown that inadequate discharge support contributes to a longer hospital stay, higher risk of negative health outcomes, and re-admissions. The Care After The Care in Hospital – or CATCH – program hopes to fi x that.

“CATCH focuses on fully understand-ing and addressing patient needs upon discharge to more adequately respond to the challenge of readmissions rates,” says Amber Curry, manager of the ambulatory care unit, and pre-op clinic, Rouge Valley Ajax & Pickering (RVAP), and fracture clinic, RVHS.

The CATCH program was implemented in November at both Rouge Valley hospi-tal campuses – Rouge Valley Centenary (RVC) and RVAP. It works to improve patient fl ow by using physicians, nurses and rehabilitation therapists, who work together to help reduce the patient’s chances of being readmitted for the same medical issue. Their goal is to, ultimately, help the patient return home sooner, and to remain within the community. Patients are referred to CATCH when they are dis-charged from hospital.

“CATCH helps our patients to better manage their own conditions at home, and to be aware of the supports available to them right here in the community,” ex-plains Aaisha Savvas, manager, complex continuing care, RVC, and outpatient re-hab services, RVHS. “We’re empowering our patients by giving them the tools they need to self-manage their conditions, help-ing to reduce readmissions.”

Interdisciplinary approach One important element of the program

is the interdisciplinary approach between the physician, nurse and physiotherapist in helping to provide the patient with a bet-ter ability to manage their condition from in the community. “The physician, nurse and the therapist play a very important and complementary role in ensuring the

patient’s needs get addressed in a more ho-listic way,” explains Curry.

Physician participation ensures that there is appropriate medical follow-up once the patient is discharged. A general internist, based in the hospital’s general internal medicine clinic, can address any medication concerns or additional testing needs, if required.

Both the nurse and physiotherapist play a role in helping to educate the patient about their condition, so that they will be able to effectively self-manage in the com-munity.

The nurse will assess the patient for dif-ferent risk factors, including falls, medica-tion, cognition, nutrition and even incon-tinence. With each of these risk factors, the nurse can develop interventions for individual patient needs. By helping to ed-ucate the patient on factors such as proper diet and medication administration, they can teach the patient how these factors can improve their ability to self-manage their condition.

By assessing the patient, the physiother-apist can prescribe an individualized re-conditioning program. They can also help to educate the patient on preventing falls and deconditioning, and how to maintain good physical activity in the community.

“After being assessed by the physiothera-

pist, patients are assisted to achieve their physical and functional goals by a therapy assistant in an individualized, small group format,” says Curry.

The physiotherapist sees patients bi-weekly and can later assess if more therapy is required, or if they can be referred to less intensive community programs, such as ex-ercise classes.

“We’re beginning to see improve-ments in the outcomes of our patients in the CATCH program,” explains Savvas. “Patients are able to return to the commu-nity in a much better condition, and with improved function.” ■HAkilah Dressekie is a Senior Communications Specialist at Rouge Valley Health System.

New program helps to reduce readmission ratesBy Akilah Dressekie

Occupational Therapy/Physiotherapy Assistant Carol Hylton-Ehlers gives physiotherapy to a patient. Rouge Valley's new CATCH program will target specifi c patients once they are discharged, providing improved support, and helping to prevent future readmissions.Studies have shown that

inadequate discharge support contributes to a longer hospital stay, higher risk of negative health outcomes, and readmissions.

A



Look around you. Have you been inspired, encouraged or empowered by an employee or a colleague? Have you or your loved one been touched by the care and compassion of an outstanding nurse? Do you know a nurse who has gone above and beyond the call of duty? Now is your chance to acknowledge and recognize the nursing heroes in your facility or community.

Hospital News will once again salute nursing heroes through our annual National Nursing Week (May 12th to 18th) contest. We hope you will share your stories with us so that we can highlight the exceptional work that our nurses are doing and how they touch our lives.

Nominations can be submitted by patients or patients’ family members, colleagues or managers. Please submit by April 15th and make sure that your entry contains the following information:

Full name of the nurse Facility where he/she worked at the time Your contact information Your nursing hero story

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1ST PRIZE:$1,000 Cash Prize

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know exactly the moment that I decided to become a music therapist. That moment was at a hospital, where I was

the patient.I was diagnosed with Type 1 diabetes

when I was 26 years old. At the time I was working as a musician and freelance writer. After experiencing many weeks of debili-tating fatigue, dizziness, and weight loss, I had visited my family doctor. A quick blood test revealed that I had dangerously high blood sugar, and needed to get to an ER at once. It was there that I learned that I had Type 1, and would be on insulin shots for the rest of my life.

Being diagnosed with a life-changing illness can trigger a host of overwhelm-ing emotions. For me, numbness was the strongest thing I felt. Lying in a hospital bed for two days, hooked up to machines and getting shots every hour, I tried to ab-sorb information about my new disease, and what my life would look like from now on. There was no ER social worker that came to visit, no clear moment where any health care provider asked me how I was doing with my diagnosis.

It was that fi rst night in the hospital where something dramatically changed for me. I had just been woken up for my hourly blood-draw, and couldn’t fall back asleep.

The person next to me was experiencing some sort of pain crisis, and the ER was generally a busy, noisy place to have a good night’s sleep. Out of habit (being a lifelong musician and singer), I began humming a song under my breath, “Basement Apart-ment” by Sarah Harmer.

Suddenly, I felt the tide of tears build up inside of me. My whole body, it seemed, was fi nally experiencing emotion. It was as if the deeper breathing and bodily vi-brations of just this simple humming was enough to release all the fear, sadness, grief, and shock of my new diagnosis. Sing-ing, even so softly and for just a moment, made me feel human again.

It was too much. I knew instantly that I had to stop singing. The depth of emo-tion I was accessing was too big for this ER. If I opened that fl oodgate of feeling, there would be no one there to help me through

it. And I could not go through this swamp-land of feelings alone.

That’s when something crystalized for me: this hospital needs more music thera-pists, I thought to myself with clarity un-common for 2am. It needs more music therapists so that people can safely fall apart when they need to.

Several years later, I now have a mas-ter’s in music therapy, and a growing clini-cal practice in inpatient and outpatient oncology. As the new music therapist at Grand River Regional Cancer Centre in Kitchener, I am a daily witness to how music can transform patients’ experience of their pain, provide comfort, create rela-tionships, ease family dynamics, and even soften the whole hospital environment for patients and staff alike. Be it offering a pa-tient a chance to express themselves on an instrument, facilitating a drum circle with a family around a patient’s bed, helping a patient write a song to their loved ones, or just quietly singing at a patient’s bed-side, music never seems to fail at making an impact.

One of the mandates of McGill Univer-sity’s Programs on Whole Person Care is to “create a space where healing may oc-cur,” regardless of whether changing dis-ease outcomes is possible. Music creates this kind of healing space, and it is often

the smallest music that makes the biggest impact. It took only a few notes of a Sarah Harmer song, hummed under my breath in an ER, to unleash the fl ood of emotion the night of my diagnosis. On the inpatient on-cology unit, working with some of the hos-pital’s sickest patients, often it is just quiet, barely-audible singing or humming by the patient’s side that can create the strongest connection. While around them machines beep, equipment clatters and nurses rush in and out attending to endless interven-tions, just breathing and humming with a patient can provide a simple thread of con-nection, focus, and beauty.

It is a privilege to be part of a multidisci-plinary team committed to supporting the whole patient through their cancer jour-ney, and to be using music to help meet this goal. My diagnosis story reminds me of how easy it is to lose one’s identity in a hospital bed, and the importance of mu-sic in delivering person-centred care. It reminds me of what a powerful gift music can be in the most vulnerable moments of our lives. ■H

Sarah Pearson MMT, is the Program Development Coordinator of the Room 217 Foundation, a registered charity dedicated to caring for the whole person with music. www.room217.ca

Music therapy and patient-centred care By Sarah Pearson

music can transform patients’ experience of their pain, provide comfort, create relationships, and even soften the whole hospital environment

I



here is a quiet revolution going on at Hamilton Health Sci-ences. The weapon of choice? Stopping and breathing.

Health care workers are extraordinary–they embrace those who suffer, while the rest of our culture denies the reality of illness and death. However, extending mind, body and spirit everyday to support patients and families in heart wrenching situations, and working to improve care in a complex and chaotic system, takes its toll. Studies confi rm that many helping professionals experience high levels of compassion fatigue. Compas-sion fatigue refers to the profound emotional and physical exhaustion that occurs over the course of a career when workers are not ad-equately refueled or recharged to meet the needs of their roles, colleagues and patients.

Over the past three years, Hamilton Health Sciences has partnered with the McMaster University Program for Faculty Development (PFD) to offer staff, physi-cians, students and faculty access to courses designed to alleviate compassion fatigue and promote the resilience of people who work in healthcare. Since its inception in 2011, over 200 staff and physicians at HHS have participated in the “Discovering Resilience” program.

“The fi rst step to alleviating compas-sion fatigue is awareness of one’s physical and mental state. Awareness is cultivated through mindfulness, which means bring-ing one’s full attention to the present mo-ment, in a non-judgemental way,” says Dr. Andrea Frolic, director of the offi ce of clin-ical & organizational ethics at HHS. “It sounds simple, but our energies are pulled in so many directions, it is often hard to focus on the here and now. Mindfulness requires practice, and these courses are de-signed to support frontline care providers and leaders at HHS to develop a repertoire of practices to reduce stress and enhance resilience.”

Through funds provided through HHS’ new strategic plan, one goal of which is to “Be the organization of choice for talented people”, various mindfulness courses are offered at signifi cantly discounted rates to HHS staff and physicians. One such course, Mindfulness Based Stress Reduc-tion (MBSR), provides an in-depth intro-duction to mindfulness practices and how they can be applied in the clinical setting. In addition, staff and physicians are wel-come to attend free weekly drop-in, 30 minute sessions called “Mindfulness for Lunch” offered across HHS’ hospital sites.

“MBSR is an evidence-based therapeu-tic protocol that has been demonstrated to enhance mental health and well-being, and relieve many physical conditions, such as chronic pain,” says Dr. Frolic. “It teaches participants a range of practic-es, such as breathing meditation, gentle stretching and mindful listening, designed to enhance one’s connection to self and others. Past participants report signifi cant benefi ts, including better sleep, less anxi-ety, greater enjoyment of work and im-proved relationships. These practices are simple, anyone can learn them, but they are truly revolutionary in turning the tide from burn-out to resilience.”

Bonnie Buchko, a physiotherapist on the clinical neurosciences unit at Hamil-

ton General Hospital has completed the MBSR program and says it covered many concepts that have supported her day-to-day work.

“Even when there isn’t time for a for-mal break, being mindful allows me to take a break from the sometimes cha-otic ward by stopping my mind, even for half a minute,” says Bonnie. “This helps me recharge and be able to enter my next patient encounter with greater fo-cus and presence. I’m more able to give my patients the opportunity to express what is important to them and what will help them.” ■H

Calyn Pettit is a public relations specialist at Hamilton Health Sciences.

The quiet revolution at Hamilton Health SciencesBy: Calyn Pettit

Andrea Frolic, director of the offi ce of clinical & organizational ethics at Hamilton Health Sciences, leads a group of staff members through a lunchtime mindfulness meditation session at HHS’ St. Peter’s Hospital site.

T

Mindfulness:



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othing can ever prepare one for a diagnosis of cancer. The emo-tional, psychological and physi-cal impact is often overwhelm-

ing. Not only are the effects of treatment punishing on the body, but the toll from the shock followed by uncontrollable fear often leaves patients reeling. Some say their world stops. They feel isolated from what is normal, cut off from their lives and very much alone.

As many as 40 per cent of Canadians will be diagnosed with cancer and embark on similar journeys at some point in their lives. While they are fortunate to have access to medical care that rivals any in the world, the medical intervention they receive is only one part of the healing process. Re-search shows that approximately 85 per cent of patients are affected by the often devastating non-medical consequences of cancer – the anxiety, depression, confusion, fatigue, nausea and pain. But, when medi-cal care is complemented with emotional, rehabilitative and practical support, cancer patients not only improve their quality of life but have been proven to experience an increase in longevity. It is in this area

of psychosocial healthcare that Wellspring Cancer Support Network excels, and plays a unique and crucial role in Canada.

A wealth of innovative programs

Wellspring is a warm and welcoming network of community-based centres in Southern Ontario and Calgary, providing a comprehensive range of supportive care programs and services for anyone living with any type of cancer, at any stage.

Led by qualifi ed and experienced profes-sionals including psychotherapists, phys-iotherapists, art therapists, dietitians and more, Wellspring’s 40 programs span a wide range of categories, from individual and group support to rehabilitation services, to practical guidance in areas such as nutri-tion, fi nance management and workplace issues. The entire continuum of program-ming opportunities offered at Wellspring is evidence-based, professionally evaluated and developed and piloted through the Wellspring Centre of Innovation.

Some of the innovative offerings at Well-spring include the Nourish series of twelve nutritional education and demonstration programs for people with site-specifi c can-cers; for individuals in the treatment phase of their illness who are challenged by palate changes, medical interactions and loss of appetite; or for those who have completed treatment looking to ensure ongoing well-ness and recurrence prevention.

Exercise is another critical tool in the healing process with evidence showing that benefi ts are gained when exercise is incor-porated into treatment plans right from the

point of diagnosis. Exercise helps improve physical functioning, fatigue management and overall quality of life; it reduces pain, the side-effects of treatment, improves self-esteem, aids in better treatment com-pliance and even secondary prevention for some types of cancer.

The award-winning Money Matters pro-gram helps patients work through the fi -nancial consequences of cancer, which for many can be equally as harrowing as the diagnosis. By curtailing the ability to work, coupled with the host of unplanned ex-penses, cancer drastically affects a patient’s livelihood. Patients concerned about their fi nances are able to meet privately with

a Money Matters case manager who will assess their personal circumstances, pro-vide options to help make the most of available resources, and will identify any government programs for which the patient might be eligible.

Beyond the door: telling one’s story

Every person who visits a Wellspring cen-tre has a unique set of needs. While some seek out single items of support, others im-merse themselves in an array of programs and activities. Those who fi nd it diffi cult to acknowledge that they need help fi nd that being surrounded by a community of peers, who are survivors, is a very powerful fi rst step on the road toward healing.

Wellspring has helped tens of thousands of men, women and children who have been touched by cancer, as well as their caregivers and loved ones. Beyond the ben-efi ts that they offer in the moment, Well-spring’s programs have the ultimate objec-tive of building, in an unrushed manner, a patient’s capacity to manage their own care.

Wellspring Centres are places of safety, comfort, ease and confi dentiality. Wellspring charges no fees, and requires no medical referral. For more information about a Well-spring centre near you, visit wellspring.ca or call 416-921-1928. Wellspring receives no government or other core funding, and is funded exclusively by independent donors and corporate partners. ■H

Margaret Valois is Director of Communications, Wellspring Cancer Support Network.

A new dimension in cancer hopeBy Margaret Valois

approximately 85 per cent of patients are affected by the often devastating non-medical consequences of cancer

The personalized Cancer Exercise program at Wellspring improves physical functioning, fatigue management and overall quality of life for people living with cancer.

N



n 2011, Deborah Finbow’s hand was bitten by an agitated dog. The wound was treated by her local emergency depart-

ment, and she was sent home with antibi-otics to prevent infection. However, after the wound had healed, Finbow began to experience very painful infl ammation not in her hand, but in her left foot. Her foot would periodically swell, become discol-oured, and burn and tingle with incessant pain. The symptoms worsened with each bout of infl ammation. She was diagnosed with osteomyelitis, a bone infection.

Despite a surgical intervention in March 2012 to relieve the now severe infl amma-tion, the pain would not diminish. It was determined that the infection had also damaged the nerve in her foot which was now causing the unbearable pain. This time, she was diagnosed with Complex Re-gional Pain Syndrome (CRPS).

A married mother of four from Collin-gwood, Ont., Finbow could no longer put any pressure on her foot and relied on a walker and a cane to stand and get around – if she could fi nd the motivation to get out and do anything. She couldn’t stay warm, even in summer, because her body assumed the same temperature as her foot and leg: ice cold.

“Chronic pain takes everything out of you,” she says. “The pain and discomfort was so intense that I just wanted to stay home in bed and sleep.”

Doctors didn’t think there was anything they could do for her. She was told to get a wheelchair and do her best to manage the pain. But one physician thought it might be worthwhile to see if any of the special-ists at Toronto Western Hospital’s Krembil Neuroscience Centre could help.

Finbow was fi rst referred to Dr. Anuj Bhatia, an anesthesiologist and pain spe-cialist to determine whether other pain medications might alleviate her CRPS. It was the fi rst time in a year that Finbow felt

any hope her condition might improve. Unfortunately the medication wasn’t effec-tive, leaving Finbow sluggish, groggy, and unable to participate in family life.

It was time to consider a fi nal alterna-tive: surgery. Finbow was referred to Dr. Mohammed F. Shamji, a neurosurgeon who specializes in minimally-invasive and complex spine surgery as well as neuro-modulation for neuropathic pain in hands and feet. Conditions caused by neuropath-ic pain – damage to a complex sensory sys-tem responsible for how we perceive things like touch and temperature – often have

symptoms of amplifying normal sensations to the point of unrelenting discomfort. Pa-tients can feel very hot or very cold, “pins and needles” sensations, numbness, and itching; much like what Finbow was expe-riencing.

Shamji is trying to organize a program at Toronto Western Hospital especially for treating patients with neurostimulation, a surgically implanted device about the size of a stopwatch in the epidural space around the spine that delivers a controlled electri-cal signal to the spinal cord. The electri-cal impulses deliver a tingling sensation to

the brain while also blocking pain signals that the patient experiences, essentially overriding the pain sensation. The patient is taught how to operate a remote control that can change the intensity and patterns of stimulation at any time, adjusting them for different activities such as sleeping or walking.

Although the technology has existed for a few decades, it is not as well-known as a treatment option for patients with severe, chronic pain.

“Neuorstimulation is not for everyone. Some patients don’t receive any benefi t from the device and others aren’t comfort-able with the tingling sensation it gener-ates,” explains Shamji. “However, we are working on a system to get the right patients to our program so they can be evaluated and treated quickly since this technology is underutilized, but can be ex-tremely effi cient in enhancing the quality of life for these patients.”

Finbow was assessed as a candidate for such a procedure, in her case called a spi-nal cord stimulator, but she was advised that it might only lessen her pain by 50 per cent. She decided to go ahead with the surgery.

The procedure more than exceeded Fin-bow’s expectations. Just two weeks after the surgery, with her stimulator properly programmed, Finbow no longer felt any pain and could not only put weight on her foot, but also walk around unassisted. She is now getting back to the activities she thought were lost to her forever such as travelling and riding a bike.

“This whole ordeal started the year I turned 50,” she says. “Thanks to Dr. Sham-ji, Dr. Bhatia and their whole team, I feel like I’m restarting my 50s and resuming the life I had.” ■H

Alexa Giorgi is a Senior Public Affairs Advisor, University Health Network.

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Spine stimulation tingles the pain awayBy Alexa Giorgi

Dr. Mohammed Shamji demonstrates how a spinal cord stimulator alleviates pain. Implanted wires deliver a controlled electrical signal to the spinal cord, sending a tingling sensation to the brain while also blocking pain signals that the patient experiences

I


13 Ethics

s an ethicist I try to always be as balanced as possible when I write columns like this one. This is not because I don’t have

opinions or I’m afraid to express them. It’s because an important part being an ethi-cist is to facilitate good decision making by highlighting all the ethical considerations with respect to the relevant issue. I also tend to avoid statements like, “x is the right thing to do,” or “y is morally wrong,” largely because ethical issues tend to be more complex than they appear on the sur-face, and there can often be more than one reasonable response to an issue. But when it comes to parents who refuse to vaccinate their children, I have a hard time being bal-anced. I do believe that vaccinating one’s children is clearly the morally right thing to do.

There are two reasons I believe this. One is that vaccinations are a very low risk way to prevent one’s children from being infect-ed with a debilitating or fatal illness. There are literally dozens of studies published in a wide range of academic journals that have debunked all of the misconceptions related to vaccine risk, including the proposed link between vaccines and autism.

But don’t take my word for it – down-load the American Academy of Pediatrics document, “Vaccine Safety: Examine the Evidence,” a 21-page summary of all the published evidence related to vaccine safety (recently updated in April 2013). Some people even question the benefi t of vaccines, despite the fact that the intro-duction of vaccines virtually eradicated diseases like polio from the human race. And now, unfortunately, we’re seeing a re-surgence of many of these illnesses around the world, coinciding with dropping vac-cination rates.

The second reason I believe that vac-cinating one’s children is the right thing to do is because it helps to prevent harm to others from contracting debilitating or fatal illnesses. As the Canadian Paediatric Society points out, a healthy unvaccinated child can spread a vaccine-preventable disease to more vulnerable individuals, such as infecting an infant sibling with per-tussis or a pregnant woman with rubella. Not only that, but many of the infections can only remain controlled if a critical

mass of the population is vaccinated (herd immunity). If too many parents refrain from vaccinating their children, illnesses like measles can make a resurgence and spread around the world.

With that said, I want to shift to anoth-er aspect of the issue: the ethical respon-sibilities of paediatricians towards parents who refuse to vaccinate their children. A paediatrician by the name of Russel Saun-ders recently wrote a column that circu-lated through social media entitled, “Vac-cinate your kids – or get out of my offi ce.” He asks new parents in his practice if their children are vaccinated, or if they plan to vaccinate, as part of his intake process. If they say no, he tells them to fi nd another paediatrician. His rationale for doing so is that the physician-patient (parent) re-lationship is founded upon trust, which means the parents of his patients must be able to trust his judgment and expertise. If they can’t trust his judgment recommend-ing vaccines, something that he believes is so clearly the unambiguous standard of care, how will they trust his judgment if the medical issues become more compli-cated? While he raises some valid points, the question is whether discharging such parents from his practice is an ethically ap-propriate response.

Both the American Academy of Pediat-rics and the Canadian Paediatric Society recommend against discharging vaccine-refusing parents from practice, for several reasons. First, evidence shows that coun-seling does change the minds of many parents who initially refuse vaccines (or are at least reluctant to consent to vac-cines). Scott Halperin categorizes vaccine-refusing parents into fi ve groups, most of which can be counseled or reasoned with (though it can take time). Only a very small percentage of parents are so commit-ted to the anti-vaccine position that they can’t be convinced otherwise. Thus, it is important for paediatricians to understand which group the parents belong to. (The Canadian Paediatric society refers to these parents as “vaccine-hesitant” to refl ect the fact that not all of them are adamant about refusing vaccines).

Second, discharging vaccine-hesitant parents certainly does not further the paediatrician’s goal of promoting child health. Discharge risks further alienating such parents and may fuel their distrust in the health care system, which can end up having detrimental effects on their children. Discharge from practice cuts off all lines of communication and eliminates any chance for the paediatrician to build a trusting therapeutic alliance for the good of the child(ren). Additionally, if there are too many paediatricians who refuse to ac-cept vaccine-hesitant parents into their practice, these parents may have diffi culty fi nding primary health care for their chil-

dren. Not only does this increase the risk of potential harm to the children, but it also denies these parents equitable access to healthcare (especially in smaller communi-ties with few paediatricians available).

In some extreme cases, if all efforts to work with the parents have failed, paedia-tricians may be justifi ed in discharging such parents from their practice. The College of Physicians and Surgeons of Ontario policy states that physicians are not justifi ed in ending a therapeutic relationship merely because the physician disagrees with the patient or because the patient refuses to follow the physician’s advice. There must be a “breakdown of trust and respect” in the relationship for discharge to be justi-fi ed, and even then the physician is ob-ligated to ensure that the patient has ar-ranged (or has been given reasonable time to arrange) alternative services. Simply dis-charging them and sending them on their way is not an ethically appropriate way to respond to vaccine-hesitant parents. ■H

Jonathan Breslin, PhD is Assistant Professor, Institute of Health Policy, Management and Evaluation, University of Toronto Ethicist Member, University of Toronto Joint Centre for Bioethics.

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The ethics of discharging

By Jonathan Breslin, PhD

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patients with vaccine hesitant parents

A paediatrician by the name of Russel Saunders recently wrote a column that circulated through social media entitled, “Vaccinate your kids – or get out of my offi ce.”



“I feel this is a looming public health crisis,” explains Dr. Jane Finlay, a Van-couver-based practitioner who counsels vaccine-hesitant parents. Dr. Finlay is also a member of the Canadian Paediatric Society’s (CPS) Infectious Diseases and Immunization Committee. “I often hear concerns about formaldehyde in vaccines – but there is more in a peach than any of the vaccines,” explains Dr. Finlay, who tries to get parents to understand the seri-ous risks associated with refusing vaccina-tion. “When you are crossing the street are you looking up at the sky for an airplane to fall on you or are you going to watch for traffi c?”

In July 2013, the Public Health Agency of Canada identifi ed 30 cases of measles in six different provinces – fi ve times the number of cases confi rmed by the same point in 2012. By the fall, Alberta con-fi rmed 42 cases of measles. The province declared the outbreak over this past Janu-ary – only to reissue a warning a few weeks later when new cases resurfaced. Measles is the leading cause of death in children worldwide and can cause pneumonia, deafness and brain damage. The vaccine has been available in Canada since 1963.

At least 13 children have died from pertussis in the past 10 years. The major-ity of deaths occurred in infants less than two months – they were too young to be vaccinated – highlighting society’s role in vaccinating to protect others. From Octo-ber 2011 to April 2013, Ontario experi-enced a large outbreak with 441 cases. As Hospital News went to press, at least six people in Prince Edward Island had per-tussis in 2014. That number seems certain to rise across the country.

How vaccines workVaccines expose the patient to a very

small, safe amount of viruses or bacteria. The patient’s immune system learns to recognize and attack the infection in case of future exposure. As a result, the patient will not become ill or will suffer only a milder infection.

More importantly, vaccines protect society’s most vulnerable like newborns, the elderly, the immunocompromised,

the pregnant or those who cannot be vac-cinated because of medical reasons. By preventing contagion, vaccines shield the entire community. It’s harder to catch an illness, if those around you have already fought it off. This is also known as herd immunity. Collective resistance fl uctuates by disease, but usually falls between 85 and 95 per cent. That’s why Canada’s fall-ing child vaccination rate is so alarming.

A UNICEF study published last year found that only 84 per cent of Canadian children were immunized for measles, po-lio and DPT3, placing Canada in second-last place out of 29 of the world’s richest countries. (In contrast, Greece topped the list with a 99 per cent immunization rate –in spite of its instability and economic crisis.) Canada’s low childhood immuniza-tion rate makes it easier for these highly contagious diseases to fi nd holes in our collective barrier.

The Public Health Agency of Canada (PHAC) contests the UNICEF study and says that the current vaccine coverage es-timate for DTP, measles and polio, is over 95 per cent coverage. Even still, experts in the fi eld say Canada could be doing a lot better.

“I am deeply embarrassed when I go outside of Canada to immunization meet-ings to come from an OECD country with such a poor immunization uptake rate,” says Dr. Noni MacDonald, professor of paediatrics at Dalhousie University, IWK Health Centre and Canadian Centre for Vaccinology.

Complacency and ambivalence fuel vaccine hesitancy

One reason Canadians are hesitant to vaccinate is the absence of imminently threatening disease. Without a visible present danger it’s easy for parents to grow complacent.

“Canadians are privileged to live at a time when people no longer remember the severity and how common these illnesses were. Eighty years ago, it was common for children to pre-decease parents in their fi rst fi ve years,” explains Dr. James Talbot, Alberta’s chief medical offi cer.

It’s because of the generations before us, he says, that we live in a time when in-fant mortality is considered a tragedy, and not a common occurrence.

“A slide show of the average pediatric ward from the 1950's and 1960's would il-lustrate what catastrophes await,” warns Dr. Hirotaka Yamashiro, chair of the pe-diatrics section of the Ontario Medical Association and president of the Pediatri-cians Alliance of Ontario. “There is no doubt that the easy access to information, good and bad, has accelerated this process with misinformed or maliciously-inclined individuals given the same credibility as those who have expertise.”

This leaves the need to stress vigilance on the shoulders of practitioners – many who are struggling to have quality time with each patient. “The fee schedule encourages a higher volume practice so many can’t spend a half hour discussing vaccination,” says Dr. Finlay.

Physicians urged to be patient, persistent

“There are few downright refusers for all vaccines, but there are many who are hesi-

tant,” says MacDonald. Finlay and Mac-Donald encourage health care workers to be patient with parents. They urge doctors to fi nd out what’s behind the parent’s am-bivalence. And while many doctors are tempted to dismiss the patient from their practice, Finlay and MacDonald argue it’s in the child’s best interest to be respect-fully persistent with the parents – even if it takes multiple visits.

“One of the most effective interven-tions with parents is to be a good listener. It is important to engage parents in a pro-active, honest discussion, rather than lec-turing. We also must address unfounded allegations about vaccines, refute misin-formation and provide credible sites and resources,” says Shelly Landsburg, director of the communicable disease control with the offi ce of chief medical offi cer of health in New Brunswick.

Alberta’s Chief Medical Offi cer of Health says every health encounter – even in social settings – is a valuable opportu-nity to improve outcomes. “The decision to get immunized is heavily infl uenced by health care professionals in personal and professional relationships. Never underes-timate how you will affect a parent’s deci-sion,” says Dr. Talbot.

The side effects of vaccines are minor when compared to the possible effects of not vaccinating: death, brain damage or permanent disability. The benefi ts, however, are overwhelming: less antibi-otic use; fewer hospitalizations and in-vasive treatments and tests; fewer long-term disabilities and diminished risk of childhood strokes.

Misinformation messages online

Despite the overwhelming scientifi c evidence in support of vaccine safety, a quick Google search will reveal an ac-tive opposition. Purported ‘experts’ use fl awed logic and science to contribute to parental confusion.

“Parents have access to a wealth of information and many sources of misin-formation, including television documen-taries, magazines, and hundreds of anti-vaccine web site links,” says Landsburg. “The diffi culty for parents lies in trying to fi gure out which information to believe.”

Those parents who don’t vaccinate their children base their decisions on what they believe is sound research. One mother told Hospital News that she read an article on the negative side effects, which confi rmed her intuition against vaccines. Another parent said scientifi c articles defend his

choice not to vaccinate his 15-month-old son, citing a recent study that found vac-cinated baboons infected others with the illness. The study justifi ed his belief that vaccines are dangerous; meanwhile, the scientists who led the study believe their results will help improve vaccines.

“We need to teach the difference be-tween one anecdotal case and high-quality scientifi c studies,” says Dr. Joan Robinson, a Pediatric Infectious Diseases specialist in Alberta.

“Vaccines are still the most cost effec-tive way to ensure that you see your child graduate from high school or attend their wedding,” says Dr. Talbot.

Admittedly vaccines are not 100 per cent effective all the time. Three Calgar-ians diagnosed with measles this year were immunized for the illness. “We are still in-vestigating those cases,” explains Dr. Tal-bot. “But even then, they were only mildly affected by measles. Compare that to the outbreak we had in south Alberta, where the community was not immunized. The spread was much faster.”

Still, Dr. Talbot’s assurances frequently fall on deaf ears.

“The anti-vaccine movement is small, but has a very large voice. Canadians are not immune to their messaging,” says Dr. Flanders, director of Kindercare Pediatrics and staff physician at North York General Hospital in Toronto.

Pediatricians and emergency room phy-sicians confront the consequences of on-line misinformation every day. One emer-gency physician told Hospital News of an intentionally unvaccinated toddler who was admitted with fever and a sore neck. The young child had to undergo blood tests and a spinal tap to rule out menin-gitis. The doctor says the child’s suffer-ing and expensive procedures were both avoidable.

Unvaccinated adults are also at risk. “A patient came into our emergency depart-ment with weakness and couldn't breathe properly. This patient was diagnosed with tetanus and almost died. Routine vaccina-tions and boosters could have easily pre-vented this,” says Dr. Glen Bandiera, chief of emergency medicine at Toronto’s St. Michael’s Hospital.

Many unvaccinated patients’ parents base their decision-making on a move-ment which grew from an infamous, now refuted, study published 16 years ago.

Debunking mythsIn 1998, The Lancet published a study

claiming a link between autism and the vaccines that prevent measles, mumps and rubella (MMR). The study was quickly called into question. The results could not be replicated by other scientists and subse-quent research cleared the MMR vaccine of any connection to autism. The medical journal retracted the study and the lead researcher was stripped of his medical li-cence, and charged with acting “dishon-estly and irresponsibly” in his research.

Other common concerns include that vaccines overload the immune system, and undermine the body’s natural ability to protect. Babies are born with antibod-ies but they are temporary, and leave the child vulnerable to deadly illnesses. There is no evidence that vaccines overload or overwhelm the system.

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Vaccine controversyContinued from cover

The anti-vaccine movement is small, but has a very large voice

On weighing the risks of vaccination one expert says: “When you are crossing the street are you looking up at the sky for an airplane to fall on you (risks of vaccines) or are you going to watch for traffi c?”




There’s also no scientifi c evidence that vaccines or their ingredients, cause mul-tiple sclerosis, brain damage, increase risk of asthma, or SIDS. Patients are encour-aged to sit with a trusted health care pro-fessional and address all their concerns.

Other obstacles to vaccination

There are some parents, however, who don’t even know which questions to ask. Often these parents are new Canadians or struggle to meet basic needs because of low-income issues. “Our studies show that new immigrants, for whom language may be a bit of a barrier (…) they may not know that these things are available or that they are free,” explains Dr. Talbot.

Poverty is another factor according to studies out of Manitoba and Ontario.

“A number of factors infl uence child-hood immunization rates. The most im-portant ones appear to be mother’s age at child’s birth (>24 years old), higher family income, continuity of care, primary care physician, and having fewer than four siblings,” says Dr. Alan Katz, professor of Family Medicine and Community Health Sciences at the University of Manitoba, and associate director of the Manitoba Centre for Health Policy.

Collective protection vs. Individual choice

“Canadians respect the rights of indi-viduals to make choices. In many coun-tries childhood immunization is not a

choice but is required by law. Others, like Australia, provide fi nancial incentives to parents who have their children vaccinat-ed,” says Katz.

While Canadian law protects the right of the individual – ethically – vaccine ad-vocates argue for the collective protection over individual choice. “If we can’t over-come vaccine hesitancy with education and supportive strategies, it may be time to consider making vaccination manda-tory for a child to be enrolled in activities which bring them into contact with other children,” suggests Dr. Finlay.

One medical ethicist agrees. “It is ethi-cally irresponsible to refuse vaccinations and put other children at risk,” says Maya Goldenberg, associate professor at the University of Guelph. “Your willfully un-vaccinated child might spread the disease

to a baby that hasn’t been vaccinated yet (too young) or someone who is immune-compromised and therefore unable to be vaccinated. Our public health system also needs to pay for those intentionally un-vaccinated children that become ill and require care.”

Improving outcomes Where Canada goes next in our efforts

to improve vaccination rates is contested. Public health advocate and Globe and Mail Columnist André Picard has some suggestions.

“We need a single, coherent childhood immunization schedule (not 13 different ones in each province/territory); harmo-nized funding so the same essential vac-cines are available to all Canadians; and a national immunization registry to link data across the country,” says Picard.

Alberta’s Dr. Talbot thinks a registry will do little to increase rates, but agrees that federal funding could help provincial initiatives. Both men agree that public health offi cials and health care providers need to amp up public health education and communicating vaccines’ benefi ts.

“Misinformation is widespread and public health offi cials are passive and timid,” says Picard. Picard also argues that we need to move beyond our exclu-sive focus on childhood vaccination and pay more attention to young adults. “The outbreaks of measles are in college-age kids who have no idea they’re not vac-cinated; the mumps and pertussis out-

breaks are in young adults who require boosters but we make no effort to reach out to them. And then there are seniors who could benefi t from shingles vaccine,” says Picard.

CPS co-authors MacDonald and Fin-lay would like to see a national commit-tee to examine vaccine hesitancy and de-velop strategies. “We are already seeing some provinces moving in this direction but we need to learn from each other and work together. Not fragment our talents and resources,” says MacDonald.

“There are already so-called national standards like NACI, but the problem is implementation,” explains Dr. Yamashiro. “The way federal funding of healthcare is decentralized makes it harder to create cohesiveness across the country. Unless there is a universal will to implement any such strategy, it would likely not be suc-cessful.”

All the health care advocates agree on one aspect: public education. They urge all health care workers to embrace the re-sponsibility to debunk myths and be loud-er than the voices muddying the waters.

“I think the vast majority of par-ents want what is best for their chil-dren,” says Flanders. “Armed with the right information, and protected from false anti-vaccine propaganda, they will inevitably make the right choices for their children.” ■H

Tania Haas is a freelance journalist. www.taniahaas.com

A UNICEF study found that only 84 per cent of Canadian children were immunized for measles, polio and DPT3, placing Canada in second-last place out of 29 of the world’s richest countries.

Vaccine controversyContinued from page 14



accines save lives. The his-tory of disease, epidemics, and public health clearly demon-strates this. And yet, there

has always been a very vocal opposition to vaccines, an opposition that continues to rage in very public forums. More public education about the benefi ts and poten-tial risks of vaccines – which are typically quite minimal as vaccines are a highly tested and regulated product – is needed to enable people to make educated, con-

sidered choices about whether they vac-cinate themselves and their children.

The exhibit, Vaccines & Immunization: Epidemics, Prevention and Canadian In-novation, which opened at the Museum of Health Care in November and will re-main as a semi-permanent exhibit for the next several years, attempts to do just this.

Developed with Guest Curator Dr. Christopher Rutty, and funded in part by the Kingston and United Way Com-munity Fund, the Coalition of Canadian

Healthcare Museums and Archives, and Sanofi Pasteur, the exhibit uses case studies of diseases that saw signifi cant decreases in the twentieth century be-cause of immunization – smallpox, diph-theria, polio, and whooping cough – to identify the cost of epidemics to society and explore the search for adequate treat-ment and preventative measures, such as vaccines.

By discussing the impact of epidem-ics on individuals and society in the

short- and long-term, and showing how drastically vaccines affected incidence and mortality rates, the exhibit strives to make people think not only of the risks (perceived or real) of vaccines but also why they were celebrated discoveries.

Let us look more closely at the case of polio, which is a focal point of the exhibit.

Polio presents initially much like the fl u.

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Vaccines & Immunization:Epidemics, Prevention and Canadian InnovationBy Pamela Peacock

V

rt m-

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as vaccines. By discussing the impact of epidem-

ics on individuals and society in the

Three members of a family brought to the hospital with the mother who was suffering from small pox. The child in the center was unvaccinated. The other two had been vaccinated the previous year because of school vaccination requirements. These two children remained in the small pox wards several weeks and did not contract small pox. Image courtesy of Sanofi Pasteur Canada (Connaught Campus) Archives.


A 1937 Iron Lung from the Museum’s collection restored at the Canadian Conservation Institute in 2013, is a centre-

piece of the exhibition. This iron lung is one of 28

constructed at Toronto’s Hospital for Sick Children

during the polio epidemic of 1937. So many cases were admitted to hospital that an

‘emergency’ crew of engineers and tradesmen ran an

assembly line in the basement of the hospital to construct

the iron lungs. The iron lungs were paid for by the Ontario government and shipped to parts of the province where

they were needed during the epidemic. This one was used in Kingston General Hospital

for several decades.



Throughout much of history, most peo-ple were exposed to polio in their youth creating adult immunity; however, by the early twentieth century improvements in hygiene meant that more and more adults had never been exposed to polio and were vulnerable to the disease. Many people are able to fi ght off the disease with only minor symptoms, but in others the viral infection affects the nerves causing mus-cle weakness and paralysis. In the most life-threatening cases, paralysis affects the tongue, throat muscles and diaphragm, leaving the patient at great risk of suffoca-tion.

How was the disease treated in the past? For some, paralysis was temporary and with rehabilitation therapy full mo-bility could be restored. Others required braces, canes, or wheelchairs for the rest of their lives. Similarly, for those who suf-fered through bulbar polio – affecting the respiratory system – the primary treatment was an iron lung. Iron lungs use negative pressure to infl ate and defl ate the lungs of the patient inside, helping them to get ox-ygen. The patient’s body is placed inside the iron lung while the head and neck pro-trude onto a canvas stretcher at one end. When the motor is running, pressure will alternatively build up inside the machine, causing the lungs to become smaller, and then decrease inside the machine, causing the lungs to expand and fi ll with air.

Since cases of polio seemed to increase in the warmer months, fear and anxiety settled over many communities in the summer and early fall. Parents would keep their children close to home and forbid activities, such as swimming in the local pool, that were associated with contract-ing of polio.

The polio virus was fi rst isolated in 1908, but the search for a polio vaccine made great strides in the 1940s and 1950s thanks to innovations by a number of re-

searchers. Connaught Laboratories made critical contributions when its scientists discovered a synthetic medium in which to grow the virus and a way to effectively grow large amounts of virus by rocking the cultures. This enabled enough vaccine to be produced to conduct fi eld trials of an inactivated polio vaccine developed by Dr. Jonas Salk in 1954. North America waited on tenterhooks to hear the results, broad-casted on 12 April 1955. The vaccine was successful at protecting against polio! It should not be underestimated how excit-

ing this news was. From a peak rate of 60 cases per 100,000 in the early 1950s, inci-dence dropped to nearly zero by 1962.

With a vaccine for polio only discovered in 1954, many Canadians can still recall the fear of polio and remember friends and family members who were stricken with the disease; yet, younger generations have little personal connection to the disease and less understanding about what its con-sequences can be.

Without being educated about the dan-gers of polio – which is still endemic in

several countries – and other infectious and contagious diseases it is possible that the much publicized “risks” of vaccines will have no counter-balance. It is impor-tant to provide balanced, well supported evidence to people so that they can make informed decisions. We hope that this ex-hibit will contribute to critical refl ection and much needed discussions around the family dinner table. ■H

Pamela Peacock is the former Curator, Museum of Health Care in Kingston.

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Franklin Delano Roosevelt contracted polio in 1921 while vacationing in New Brunswick. He later spearheaded the foundation of the March of Dimes, which raised much needed funds to support polio research. Image courtesy of the March of Dimes.

Dr. Jonas Salk discovered the fi rst polio vaccine in 1954. Image originally published in Health, April-May 1955.

Continued from page 16

Vaccines & Immunization



early 225,000 Ontarians have helped advance the public health of future generations right from their computers by

taking the Ontario Health Study’s (OHS) online questionnaire. The OHS continues to recruit participants to provide important health data and samples. This information will help researchers understand the risk factors and causes of chronic diseases and to develop new prevention strategies and treatments.

Getting involved in the OHS is a simple, straightforward process. Anyone who is 18 years of age or older and a resident of On-tario can take part in the Study. They just need to go to www.ontariohealthstudy.ca, register and then take the survey, which takes about 45 minutes. The OHS follows strict privacy practices that govern how personal information is collected, who can see it and how it can be used.

The OHS recently celebrated its third anniversary, and is already one of the larg-est long-term health studies in Canada. The OHS continues to enrol new volun-teer participants to take the online ques-tionnaire. Some participants have taken their involvement further with 5,800 pro-viding a sample through the Blood Collec-tion Program and 3,600 have paid a visit to the Toronto Assessment Centre to provide other physical measures.

“Long-term health studies like the OHS are essential to our understanding of chron-ic diseases,” says Dr. Vivek Goel, Principal Investigator of the OHS and President and CEO of Public Health Ontario. “With only a small investment of your time you can make a real and lasting difference in the health of future generations. We appreci-ate the participation of so many Ontarians,

and if you haven’t yet joined the study, I encourage you to sign up today.”

The OHS is just one piece of an even larger national effort called the Canadian Partnership for Tomorrow Project (CPTP). The CPTP consists of the OHS and four other regional studies: The BC Genera-tions Project, Alberta’s Tomorrow Project, Quebec’s CARTaGENE and the Atlantic PATH. Nationally, the CPTP has more than 289,000 participants aged 35 to 69 and more than 100,000 have provided a blood sample.

“By joining this landmark study, Cana-dians have contributed to the creation of a rich national bank of health information to help researchers answer fundamental questions about the causes of cancer and chronic disease for future generations. This platform will be available for research-ers beginning in 2015 and will serve as an important resource for decades to come," says Dr. Heather Bryant, Vice President, Cancer Control, Canadian Partnership Against Cancer.

Those who want to contribute even more to the Ontario Health Study can add their name to a pool of participants who are interested in providing a blood sample or visiting the Toronto Assessment Centre.

The OHS Blood Collection Program is run in partnership with LifeLabs, which operates a number of Patient Service Cen-tres located around the province. Those invited to provide a blood sample simply fi ll out a fi ve-minute questionnaire online and then take their requisition form to the nearest LifeLabs Patient Service Cen-tre. Not all those who express interest in providing a blood sample or visiting the Toronto Assessment Centre will be chosen to participate.

“The information provided in the initial online questionnaire provides us with an overall snapshot of the health of Ontar-ians as well as their exposure to chronic disease risk factors,” says Dr. Karen Me-nard, Chief Planning and Administrative Offi cer of the OHS. “By providing a blood sample or visiting the Toronto Assessment Centre, participants allow us to get a more detailed look at their health. We can then compile this data to draw broader conclu-sions about the health of the overall popu-lation.”

Menard says that although the Study has grown quickly over its fi rst three years it is important for Ontarians to keep par-ticipating. “In three years we have had

more than 200,000 people complete the questionnaire and the Study has gained the endorsement of Ontario’s universities, research teaching hospitals and other rel-evant organizations,” she says. “But this is just the beginning of a very long-term proj-ect. Now we are working on taking this great opportunity to as many communities as possible to keep this momentum going.”

The Study is currently focusing on face-to-face outreach with community groups and hospitals. If you would like someone from OHS to visit your organization to dis-cuss the Study, contact Jocelyn Garrett at [email protected]. ■H

Hal Costie is a Senior Communications Offi cer at The Ontario Institute for Cancer Research.

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Ontario Health Study gives everyday people a chance to

improve public healthBy Hal Costie

A health study participant has blood drawn at the assessment centre.

N

How to get started:• Visit www.ontariohealthstudy.ca to register for the Study and complete the online questionnaire. It only takes about 45 minutes. You have six weeks to complete the questionnaire from the time you start it;• After you have completed the questionnaire you will be able to volunteer to provide a blood sample and/or visit the Toronto Assessment Centre by clicking on the appropriate “Express Your Interest” button. Not all those who volunteer for this portion of the Study will be selected;• If you are selected for blood collection or a visit to the Toronto Assessment Centre you will receive an email invitation;• Once you receive this email, log into your OHS account and click on the orange “Next Step” button to proceed with arranging your participation;• If you have any questions you can speak to an OHS staff member by emailing [email protected] or calling 1-866-606-0686.

Photo JP Moczulski, CP Images.


19 Nursing Pulse

large section of the Moosonee Health Centre was smoulder-ing. The charts of nearly 9,000 patients were covered in soot.

It was December 2012, and the Weenee-bayko Area Health Authority (WAHA) had no choice but to send out an alert that read: “To all residents of Moosonee: Please be advised that due to fi re and smoke damage…Moosonee Health Centre is closed for all medical treatment effective immediately.”

The small town near the southern tip of James Bay, inaccessible by road, was with-out a health-care facility. The nearest hos-pital is a 10-minute helicopter fl ight away on Moose Factory Island. No one was in-jured in the blaze, caused by an electrical fi re that ignited in a storage room, but 70 per cent of the centre’s supplies and equip-ment was lost.

The nurse-led Moosonee Health Cen-tre employed 12 RNs and an NP work-ing on rotation. They provided primary care, emergency services and dispensed medication, but were now without a roof over their heads. “We’re thinking ‘what happens next? What if we have an emer-gency, what are we going to do?’” says RN Weena Saunders, director of patient care. “We wanted to get (re)established quickly, so people would feel safe and have a place to go.”

Fire may have destroyed the centre, but the solution would soon come on ice.

With the help of the close-knit Moosonee community and Ontario’s Emergency Medical Assistance Team (EMAT), Saunders and her colleagues now provide care in the unlikeliest of ven-ues – the town’s curling rink.

Mike Merko and his eight-member EMAT deployment team, specially trained in disaster management for all kinds of medical emergencies, put boots on the ground in Moosonee roughly 24-hours after the fi re. They boarded a plane in Toronto on a mild, late-autumn day, and stepped off into a bone-chilling minus 32 degrees in Moosonee, proclaimed The Gateway to the Arctic by its railway station sign. “The cold was the fi rst shock,” re-calls Merko, EMAT incident commander. He would soon discover that cold would be a constant challenge throughout this deployment.

The team found patients temporarily diverted to the ORNGE helicopter hangar 10 minutes outside of town, where nurses performed triage, and some patients were airlifted to Moose Factory Island. Other lo-cal nurses had started the process of setting up shop in Moosonee’s curling rink, part of a larger facility which includes a skat-ing rink and community hall. It was cho-sen because it already served as the town’s emergency meeting point.

Though it hadn’t been used for years and the ice was gone, the rink was de-signed for temperatures barely above the

freezing mark. “Our biggest challenge was to take something that was designed to be cold and make it hot,” Merko says. EMAT is trained in everything from fi ghting out-breaks to resuscitating critically injured patients, but heating and cooling was out-side of its expertise.

At fi rst, they could only raise the tem-perature to 14 degrees despite an arsenal of heaters. “You can’t expose and assess a patient in that environment,” Merko says. When the team realized the heat was ris-ing to the top of the rink’s seven-metre-high ceilings, they strategically placed six rotating fans to push the warm air down, and the temperature climbed to 24 degrees.

Merko says he admires the Moosonee nurses for their tenacity despite many constraints, including the town’s isola-tion. When the team needed an electrical breaker, they couldn’t just pop in to the local big-box hardware store. Everything had to be sourced and brought in by air or train. “They’re an amazing group of peo-ple,” he says. “We probably learned more from them and how they deal with logis-tical issues.” The nurses, with help from community members, wired the rink for electricity, built accessibility ramps, and addressed plumbing challenges.

The next major issues were infec-tion control and privacy. EMAT came equipped with seven large positive/nega-tive pressure tents, capable of refreshing a room’s air supply 15 times per minute. The light, plastic tents can be set up in less than 30 seconds, and served as the centre’s makeshift ER and examination rooms, providing much-needed visual barriers.

“It was like rebuilding a clinic from the ground up,” Saunders says. “You im-provise and compromise; you try to make things happen.”

More than a year after the fi re, nurses are still providing care in Moosonee’s old curling rink. Work to rebuild the old loca-tion has stalled, and it won’t be ready for months. Inside the arena, the huge blue and white EMAT tents are still dwarfed by the massive room. Medical supplies and equipment line all four walls. A makeshift staff lounge is cordoned off in a corner with drapes held up by PVC pipes and buckets. During the day, the crash of hockey pucks and slash of skates can be heard beyond one wall. Some evenings, music blares in from community dances held beyond another.

“You feel like you’re in a different world,” Saunders says. “(But) it’s business as usual.”

Saunders says nurses and patients are getting used to their unusual sur-roundings. The number of patient visits, which dipped following the fi re, is back to normal. The temporary centre is now equipped for nearly every procedure avail-able at the old centre. Nurses are forever

thankful for EMAT, who Saunders calls their guardian angels.

“They were like our drill sergeants, but in a good way,” Saunders says of EMAT. “They pumped (us) up and gave (us) something to look forward to.”

Sadly, the fi re wasn’t the only tragedy to strike Moosonee that year. The attention of the country turned on the small town after the May 31, 2012 ORNGE air am-bulance crash that killed four people. The helicopter took off from the Moosonee airport carrying two pilots and two para-medics and went down just 850 metres away.

“It really hit hard because we work closely with the paramedics,” says Saun-ders. “But the community came to-gether. We put an orange ribbon on the

door (of the health centre) so when ev-erybody walks in the clinic, they think about ORNGE.”

Through it all, the Moosonee Health Centre hasn’t lost a single staff member. In a region where the average turnover rate is about a year, this is impressive. “It shows the staff is dedicated to the patients and the people of the region,” says Nicole Blackman, an RN and director of profes-sional practice for WAHA. “To not give up and keep persevering and fi nding new options and working well with the options they were given, this staff is resilient.” ■HDaniel Punch is editorial assistant for the Registered Nurses’ Association of Ontario (RNAO), which represents registered nurses wherever they practise in Ontario.

A story offi re and iceBy Daniel Punch

A

A group of northern nurses had to ‘hurry hard’ to transform a curling rink into a health centre following a devastating fi re.

nge was ed to be . EMAT ing out-injured

was out-

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lternative medicine and espe-cially Natural Health Products (NHPs) are growing in use, but when people visit hospitals and

ask about such things, most health care practitioners they encounter have little knowledge in this area.

The NHP Products Regulations came into effect in 2004 and defi ne the category as vitamins and minerals, herbal remedies, homeopathic medicines, traditional medi-cines such as traditional Chinese medi-cines, as well as probiotics, and other prod-ucts like amino acids and essential fatty acids. Why is this important? According to a 2010 Ipsos-Reid survey, 73 per cent of Canadians regularly take vitamins and minerals, herbal products, and homeo-pathic medicine.

The role of the NHP Directorate – it’s part of the Health Products and Food Branch of Health Canada – is to ensure that we have ready access to NHPs that are safe, effective and of high quality. But NHPs are over-the-counter products and don’t require prescriptions, and keeping tabs on their sale and distribution isn’t easy.

Consider the retailer who faced re-peated Health Canada recalls because of selling products found to contain hidden ingredients and unauthorized substances similar to the prescription drugs sildenafi l and tadalafi l. There was nothing on the product labels or packaging to indicate such ingredients.

Another retailer who manufactures and distributes NHPs also got a recall order,

but refused to comply, despite the fact that one of its nutritional shakes contained the prescription drug chloramphenicol. Health Canada says this is an antibiotic associated with the risk of a potentially fatal blood disorder.

The retailer said contamination wasn’t a health risk because of low concentration in its shakes. Nevertheless, an NHP product for sale containing a known pharmaceuti-cal is against the law. Enforcing the law is something else again.

Health Canada has a major challenge because of a lack of resources. While most players involved in the NHP industry are ethical, there are unscrupulous retail-ers, manufacturers and distributors who are less than honest with the consumer. The industry is not subjected to audits, and even when problems arise, the pro-cess in dealing with them is bureaucratic and time-consuming. Also, it’s easy to get around loopholes.

For example, a U.S. company shipping product to Canada must deal with added levels of security at the border, but if the company establishes a manufacturing facil-ity in Canada, the same level of security no longer exists. The company can make what it wants and sell it, even if the information on the label or packaging is less than ac-curate.

Health Canada reacts when a complaint is lodged, but there is very little that is proactive in the process. Even though the NHP world is regulated, the rules are not enforced, giving an unfair advantage to unscrupulous players who can make any claims about their products.

The federal government recently an-nounced new legislation called The Pro-tecting Canadians from Unsafe Drugs Act. The Act, which could become law this year, applies to prescription and over-the-counter drugs, as well as medical devices, vaccines, gene therapies, cells, tissues and organs. The Act:• Imposes stiff penalties for unsafe prod-ucts with fi nes up to $5 million a day and two years in prison for those who do not comply with orders;• Speeds up product recalls or label chang-es when a problem is identifi ed; and,• Increases patient safety by improving Health Canada’s ability to collect safety information on products sold for therapeu-tic use.

While this legislation does not spe-cifi cally address NHPs, it would deal with those who defy a Health Canada order to

recall product found to contain a prescrip-tion drug, or a product similar to a pre-scription drug. Thus, a business that defi es a Health Canada recall could face severe penalties.

A University of Guelph study published in the journal BMC Medicine should serve as a wake-up call about the potential dan-gers of some NHPs. The study used DNA barcoding technology to test 44 herbal products sold by 12 manufacturers, and showed that most of the NHPs surveyed contained fi llers and plant ingredients not listed on the label. One ginkgo prod-uct was contaminated with Juglans nigra (black walnut), which can be fatal for any-one with a nut allergy. Almost 60 per cent of the herbal products contained plant spe-cies not listed on the label, and more than 20 per cent included such fi llers as rice, soybeans and wheat which, again, were not on the label.

There is virtually no enforcement of quality control for the manufacture and la-belling of Natural Health Products in Can-ada, and while the University of Guelph study concluded that we need more regu-lations, in fact, we don’t. But existing regu-lations should be better enforced. People who suffer from plant allergies or seek glu-ten-free products should not to be exposed to these hazards because they buy NHP products that are improperly labelled. ■H

Deborah A. Campbell is, an advisor to the Natural Health Products Directorate of Health Canada.

By Deborah A. Campbell

Enforcement of Natural Health Products

A

73 per cent of Canadians regularly take vitamins and minerals, herbal products, and homeopathic medicine.



hild life specialists at Holland Bloorview Kids Rehabilita-tion Hospital are empowering young patients to take control

of their pain and helping parents develop strategies to support their kids.

The response to pain is not simply a re-sult of tissue or nerve damage, but rather a combination of both physical and psycho-logical variables. “Literature shows that the best approach to pain management is a blend of pharmacological and non-phar-macological interventions,” says Breanne Mathers, child life specialist at Holland Bloorview. “With this in mind, we create individual plans to proactively manage pain rather than chasing it.”

While strategies are patient-directed, families can also play an important role in pain management. This is especially true when a patient has communication challenges since parents can often rec-ognize subtle pain indicators. Mathers says that patients and families should not resign themselves to a certain level of expected pain since patients as youngas four years old can be taught pain management strategies.

“Parents often report that they feel there is nothing they can do about watch-ing their child in pain. When parents are taught non-pharmacological pain man-agement techniques, they can proactively coach their child to manage pain. Parents are then empowered when hospital staff is not at the bedside or when the child is at home.”

Mathers and other child life specialists at Holland Bloorview run a group for pa-tients and families to teach them about pain management. Patients and families attend 30 minute sessions to become fa-miliar with a variety of non-pharmacolog-ical techniques to reduce acute, chronic or recurrent pain. Session topics include humour, multisensory environments like Snoezelen, distraction boxes and advo-cacy. Feedback from the sessions shows it has been an effective way to provide information to patients and their families while helping them learn how to support each other.

Patients can experiment with a variety of techniques to fi nd those best suited to their needs. Some patients may fi nd cogni-tive techniques like distraction and imag-ery to be most effective while others may prefer behavioural techniques like medi-tation or deep breathing. There are also a range of biophysical techniques like heat therapy and massage as well as emotional expression strategies such as art. Once learned, pain management strategies have also been shown to be effective tools for managing stress, anxiety and nausea.

Successful pain management requires a plan that outlines personalized goals that can be assessed and adjusted regularly. Communication both ways between the health care team and the patient and fam-ily is paramount to the success of the plan. Honest explanations from clinicians about procedures that may cause pain can go a long way in reducing the patient’s anxiety. In fact, the act of developing a plan in it-self helps to minimize fear and can give pa-tients a sense of control over the situation.

The individualized plan should also in-clude an outline of which medications will be used and an explanation of how each works. Explaining to patients the type of pain a medication will target, along with an understanding of how it works, will complement non-pharmacological strategies.

Clients at Holland Bloorview generally have stays that are long enough to trial dif-ferent techniques and master skills, how-ever, patients experiencing shorter stays can quickly learn certain pain manage-ment techniques.

Simpler strategies like therapeutic touch, deep breathing and management of physical space can be implemented with little instruction. In all cases, patients should be encouraged to have a dialogue about pain management rather than sim-ply accepting pharmacological strategies as the total plan.

Ideas for a patient distraction box:

•Party blowers and pinwheels that encourage deep breathing•Bubbles for deep-breathing and thera-peutic popping•Squishy items like stressballs for thera-peutic touch and massage•Toys like dinky cars can bring attention to or away from pain area•CDs with calming music•Joke book or other items that employ hu-mour• Hot or cold packs ■HMichelle Halsey is a Senior Communications Associate at Holland Bloorview Kids Rehabilitation Hospital.

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Taking control of painBy Michelle Halsey

A Holland Bloorview client receives Snoezelen therapy.

Successful pain management requires a plan that outlines personalized goals that can be assessed and adjusted regularly

C



“It’s my pleasure to say ‘thank you.’ Your knowledge

-

– A.W.

he November 2013 “Pain in Canada fact sheet” published by the Canadian Pain Society states some hard facts sum-

marized under the heading Pain is Poorly Managed in Canada. These facts include:• Canadians are left in pain after surgery even in our top hospitals•Surgery itself is the cause of almost 10 per cent of chronic pain in Canada•Pain is the most common reason for seeking healthcare (78 per cent ER visits)•One in fi ve Canadian adults suffer from chronic pain•One in fi ve Canadian children have weekly or more frequent chronic pain•Chronic pain is associated with the worst quality of life as compared with other chronic diseases•The annual cost of chronic pain in Can-ada is $56-60 billion dollars

If we are [offi cially] practicing “Evi-dence-Based Medicine” in Canada, why is the “empirical evidence” presented above showing that we are seriously fail-ing to treat pain? One answer, based on the hard data that shows where money is spent in the medical systems of devel-oped countries, is that… even though “pain is a puzzle” with many pieces, we are approaching its treatment in an over-

simplifi ed manner, favoring pharmaco-logical and surgical interventions over any other approach.

For many years, scientifi c knowledge of pain has been providing new clues to help us understand “the pain puzzle.” Perhaps the most important scientifi c fact regarding pain is that the experience of pain is paradoxical: while pain is per-ceived “as if” occurring in the body, in actuality, pain is the result of the brain’s integration of complex neurological ac-tivity involving cognitive, affective and sensory dimensions, what Dr. Melzack termed years ago “the neuromatrix.” The immediate corollary is that if “pain is in the brain”, there is where we need to start solving the pain puzzle.

In addition to the brain dimensions, there are other contributors to the “pain puzzle” also identifi ed by science, such as the peripheral nerve pathways involved in the transmission and processing of “unpleasant sensory information”, as well as the many spinal cord processes that in-fl uence the fi nal passage of these signals to the brain.

As a refl ection of its phenomenal com-plexity, the physiology of the pain experi-ence involves all our important levels of function: neurological, metabolic, hor-

monal, immune, visceral, biomechanical and psycho-emotional.

With this picture, it’s not surprising that chronic pain research has proven the most effective approach to the man-agement of pain is the bio-psycho-social model. This model proposes that health is best understood in terms of a combi-nation of biological, psychological, and social factors rather than purely in bio-logical terms.

Why then are we are still treating pain in daily practice armed mainly with pills, injections and surgical scalps? Well, that is a $60 billion dollar question for Canadians ($600 billion for the USA).

The answer? Self evident: consumers of healthcare are extremely naïve expect-ing that a system dominated by multibil-lion dollars interests (pharmaceuticals, diagnostics, etc.) would care to change a working model that produces phenom-enal profi ts year after year. Really?

Well, ponder this undeniable fact, based on hard cold data from the Organ-isation for Economic Co-operation and Development: pharmaceutical expendi-ture and diagnostics are bankrupting the medical systems of developed countries without providing any additional value to our health.

Solving the pain puzzle?By Dr. Alejandro Elorriaga Claraco

T




s parents, we want our chil-dren to eat a well-balanced and healthy diet, but when your child doesn’t eat his or

her vegetables or more than a few selected food items – ensuring your child’s growth can become a constant cause for concern. A feeding disorder is defi ned as a child or infant who has the inability to take in nu-trition in order to meet their needs. For some children the smell and texture of food causes them signifi cant distress which can lead to low growth rates and serious health issues or a failure to thrive diagnosis.

Since 2009, the Peterborough Regional Health Centre’s (PRHC) Family and Youth Clinic has offered a focused intervention for young children and their families deal-ing with signifi cant food refusal. More re-cently the service has been a collaborative partnership between the hospital’s Fam-ily and Youth, and Paediatric Outpatient Clinic. The clinic treats approximately 60 patients per year for feeding disorders and sees another 60 patients for picky or selec-tive eating concerns.

Most have said or heard the classic mealtime tug of war ‘you can’t leave the table until you fi nish your dinner’, but this tactic can actually cause more harm than good for children with feeding disorders. “Negative mealtime experiences can be a trigger for children who struggle to eat enough to stay healthy,” says Lise Leahy, Registered Dietitian at PRHC’s Pediatric Outpatient Clinic and Feeding Disorders Clinic. “It’s hard to feel hungry when you are stressed because it’s time to eat.”

The team’s multidisciplinary assessment includes psychology, nutrition, social work and medical providers. The fi rst appoint-ment focuses on getting to know the fam-ily and child. “Our goal is to listen to the family’s story and learn when the problems emerged, what the child eats or doesn’t, is there a time of day they eat more, and review the child or infant’s growth and development,” explains Connie Oates, Psychological Associate at PRHC’s Family and Youth Clinic.

The clinic’s family based approach takes a holistic view of the infant or child. The clinic’s team carefully considers all issues that may interfere with healthy eating and contribute to the disorder such as medical complications, hypersensitivities, atypi-cal neurodevelopment such as Autism, stress around feeding or food, anxiety in child or caregiver or gastroesophageal re-fl ux disease(GERD). “Our fi rst task is to remove stress at meal time,” says Leahy. “Through coaching, we teach parents to reduce their own level of stress through deep breaths and positive statements. Once parents believe that their child will eat and that they have a role in helping, we are well on the way to creating a positive meal time experience.”

For example if you are making a stir fry for the family and your child will only eat bread and cheese, then make sure that bread and cheese are on the table for the child to select. “If the bread and cheese are the only items your child eats in a non-stressed situation then it was a positive and successful interaction,” adds Leahy.

The child was also exposed to the sight and smell of a stir fry and watched other people enjoy it.

For the Howting family, this advice was instrumental in their 13-month-old daughter Evelyn’s success. Evelyn was six weeks old when she was diagnosed with a slow rate of growth. After numerous ap-pointments it was determined that there was nothing physically wrong with her – Evelyn continued to eat, but growth was slow.

Then in October 2013, Evelyn came down with the fl u and high fever and re-fused to eat. “Evelyn stopped going into her high chair, or sleeping in her crib,” says Tammara Howting, Evelyn’s mother. “We went to Emergency, but after a week of no sleep and little feeding – it was clear that we needed help.”

In November, the Howting family was referred to PRHC’s Feeding Disorder clinic. After gathering Evelyn’s story, clinic staff members determined that Evelyn’s ill-ness caused stomach pain which contrib-uted to Evelyn’s refusal to eat and sleep. For Evelyn, she associated her stomach pain to eating in her highchair and sleep-ing in her crib. “Connie and Lise taught us to give Evelyn foods that she always liked eating,” notes Howting. “We now give her a ‘mum’s cookie’ on her highchair to signal that it’s time to eat and Evelyn now sits in her chair again.” After three months of clinic appointments, Tammara and Evelyn are seeing progress. “Evelyn now sleeps in her crib again,” says Howting. “Another strategy the clinic taught us was to never leave her bedroom when she was upset. This teaches Evelyn that her room is a happy and safe place.”

Now at 16.5 lbs, Evelyn is still small for her age, but the Howting family has tools and strategies to help their daughter grow. “We still get the odd ‘your child weighs how much comment’, but it’s wonderful to know we have people on our team sup-porting us,” says Howting. “PRHC’s Feed-ing Disorders Clinic provides compassion-ate care – in the beginning they met with us weekly, answered all our questions, and reassured us that we were not to blame for Evelyn’s slow growth.”

Another strategy used at the clinic in-volves parents packing a picnic or snack to bring to their second appointment made up of food that their child usually eats. “With the parents’ permission we video tape these sessions, and use the footage to identify opportunities and tactics to use when trying to introduce a new food or getting a child to eat more of the same food that he/she enjoys,” notes Leahy.

“One of the biggest challenges fac-ing families attending the clinic is that change will not happen overnight,” adds Oates. “The ongoing medical monitoring of growth and liaison with the infant or child’s physician is a key to easing parental anxiety. Families are encouraged to keep a mealtime journal and document informa-

tion like what mealtime was easier than others, what worked well, what your child ate, touched, or smelled.”

It’s important to remember that chil-dren are curious by nature and will start to show signs that they are interested in other types of food. Parents are encouraged to provide opportunities for their child to interact with food such as going to the grocery store, helping to prepare snacks, growing a garden or even using food for art projects. Listen for key phases such as ‘that smells good or what is it?’ and watch for your child noticing where you place food during meals to gauge his/her interest and reaction.

If you think your child has a feeding dis-order or if you have concerns regarding his/her picky or selective eating habits, speak to your family doctor or Nurse Practitio-ner. Some symptoms to look for include highly restrictive food choices, signifi cant confl ict involving meal times or feeding, frequent refusal to approach the table for meals, gastrointestinal distress, and failure to grow or slow growth rate. ■H

Amanda Roffey is a Communications Advisor at Peterborough Regional Health Centre.

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Feeding Disorders Clinic sets table for successful eatingBy: Amanda Roffey

Tammara Howting (left) and daughter Evelyn Howting enjoy a cookie thanks to the help of Peterborough Regional Health Centre's Feeding Disorders Clinic.

A

A feeding disorder is defi ned as a child or infant who has the inability to take in nutrition in order to meet their needs.


24 From the CEO's Desk

ike every other hospital across the province, William Osler Health System (Osler) is con-tinuously striving to make life

better for patients and their families. With thousands of patients walking through our doors each and every day, we are stead-fastly committed to ensuring that each and every one of them has positive interactions with our staff, physicians and volunteers.

I think my hospital colleagues would agree that while this sounds like a reason-able goal, it is unbelievably challenging to put into practice. A negative impression can be formed even if the care that was provided at the bedside during a stay was excellent. This impression may form in any number of places away from the inpatient fl oor – locations like the parking lot, the cafeteria, or even in the elevator. These impressions can also be extremely diffi -cult to identify and address if mechanisms aren’t in place to capture the information.

As one of Ontario’s largest hospitals, we serve a population of over 1.3 million peo-ple living in one of the fastest growing and most culturally diverse regions in Canada. Osler’s emergency departments (ED) are among the busiest in the province and our labour and delivery program is one of the largest in Ontario.

With our growing and diverse commu-nity always top of mind, we have made ser-vice excellence a key driver behind every-thing we do. At Osler, service excellence represents the softer side of healthcare – the human touch that makes a signifi cant difference to patients and families during a hospital stay. Service excellence was made a signifi cant component of our 2013-2018 Strategic Plan and called out as our fi rst strategic direction – stating that we will improve how we communicate with pa-tients and families, listen to what they are telling us, and take action so that we can better serve their needs.

Long before the launch of our Strategic Plan and following a period of time when patient satisfaction scores were at an all-time low, Osler identifi ed the need for more timely information about a patient’s stay in order to better understand where it needed to improve – and to then be able to feed that information back to our clinical units for quick action.

Recognizing the tremendous opportu-nity to make a difference for our patients and their families, we launched a ‘Ser-vice Excellence Call Centre’ in 2011 that conducts outbound calls to inpatients 48 hours after discharge for the purpose of gathering feedback on their hospital stay.

The call centre is staffed by modifi ed work-ers (nurses who may need to be off their feet), college students (who need practi-cum hours to complete their diplomas) and volunteers, and is able to collect rich feedback through what we like to call, ‘the voice of the patient’.

Over the course of the call, patients are asked a few short questions about their satisfaction with their stay, if they were treated with respect and dignity, if they would recommend the hospital to family and friends, and if they have any sugges-tions for ways we could improve. All com-ments are immediately documented and stored within a secured hospital database.

This feedback is then shared with hos-pital staff on the front-lines where it is used immediately to help us better under-stand and evaluate each patient’s experi-ence, celebrate success stories and identify where staff and physicians can focus their energies to further improve the patient experience.

With establishment of the call cen-tre, we soon recognized that we needed a means of feeding information back to the front-lines where it could be used immedi-ately to infl uence behaviours and improve-ment strategies. As a result, we imple-mented daily ‘performance huddles’ across all clinical areas in the hospital in early 2012. These huddles are short, 10-minute sessions where managers and front-line staff come together to discuss their perfor-mance against four key metrics.

It has also been extremely effective in identifying outstanding services and giving us an opportunity to recognize good work. The ability to immediately collaborate on solutions and share patient stories has pos-itively infl uenced staff satisfaction. Recent survey results show a 10 per cent improve-ment year over year.

In just three years, our call centre has provided us with more robust knowledge to better inform the care we deliver, im-pact decision-making, identify areas for improvements, and acknowledge our high-performing areas. Given the diversity of our community, it also helps to ensure that we continue to deliver quality care that respects the traditions, religion and culture of our patients and their families.

With such a diverse community, we in-corporate our interpretation services pro-gram into the operations of the call centre to ensure staff are able to communication effectively with every patient. A number of call centre staff are also multi-lingual, so they are encouraged to speak in differ-ent languages to ensure we are being as inclusive as possible.

Some of our successes to date have come in the form of an award from Accreditation Canada and even national and international attention with requests to speak about our call centre and ser-vice excellence program at a number of conferences. In April, we will be present-ing at the Beryl Institute’s Patient Experi-ence Conference, and in May, we will be speaking at the Cleveland Clinic’s Patient Experience Summit.

While it’s safe to say we still have some work to do on improving the patient expe-rience, we are enthusiastic that the tools we have put in place will guide us on this journey. ■H

Matthew Anderson is the President and CEO of William Osler Health System – comprised of Brampton Civic Hospital, Etobicoke General Hospital and the new Peel Memorial Centre for Integrated Health and Wellness.

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Osler launched a ‘Service Excellence Call Centre’ in 2011 that conducts outbound calls to inpatients 48 hours after discharge for the purpose of gathering feedback on their hospital stay.

service excellenceOsler’s journey toward

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orothy Masih was visiting Tril-lium Health Partners for a rou-tine appointment when she suffered a fall walking through

the hospital corridors. She was quickly as-sisted by a hospital volunteer and taken to the emergency department where she was screened by the attending physician who determined that she was at risk for future falls. Her name was then entered into a da-tabase as part of Trillium Health Partners’ falls prevention strategy.

Dorothy was treated for cuts and bruises suffered in her fall, and released. A few weeks later, Dorothy received a phone call asking if she would be interested in com-ing to the hospital to take part in a falls prevention program where she and other participants would learn how to better pro-tect themselves from another painful fall. Dorothy agreed, and says what she gained from that clinic has changed her life.

According to a report from the Ontario Injury Prevention Resource Centre, falls are the second leading cause of injury-re-lated hospitalizations for all ages. Seniors 65 and older are nine times more likely to suffer fall injuries than younger persons.

Falls are a huge problem. They can be life altering for many people and in the worst cases can result in death. Falls often result in psychological harm. Victims become frightened of falling again and as a result limit activities, which can lead to other is-sues, such as isolation and immobility is-sues. The fact of the matter is that falls are often preventable.

Understanding this reality, Trillium Heath Partners recognized an opportu-nity to promote health and safety within the community by helping to prevent falls for those who are particularly prone to

them. While there had always been a falls prevention strategy in place, there was a chance to really address this problem in a more strategic manner.

The new program is an initiative of the internationally-recognized Best Practice Guideline in falls prevention, which the hospital has committed to achieving as part of its candidacy for the Registered Nurses Association of Ontario’s (RNAO) Best Practice Spotlight Organizations (BPSO) designation.

“Our fall rate was above where we want-ed to it to be so we were very driven to

reduce it and improve outcomes for pa-tients,” says Chris Zettler, Manager, Profes-sional Practice Portfolio,Trillium Health Partners. “In addition to that, we have a large seniors’ population in our community so it was important for us to create pro-grams that addressed their needs.”

The hospital introduced a post-fall hud-dle across all sites for in- and out-patients. This tool promotes team discussion and analysis of the event in an effort to prevent it from happening again. The hospital im-plemented a trial use of low beds to prevent injuries in patients who are prone to repeat falls. A number of visual cues are also now in use, including screening information that appears on status and electronic white boards, as well as “fall precaution” stickers on patients’ armbands, charts alert sheets and other relevant areas.

Trillium Health Partners has also begun screening out-patients at registration to identify whether or not they are at high risk for falls. If patients are at risk staff will make sure they have the proper assistance from volunteer escorts while visiting the hospital and will follow up with them once they are home to see if they are interested in participating in a falls prevention clinic.

While the initiative is nurse-led and driven, Trillium Health Partners broad-ened the program to include all allied health staff, physicians and volunteers from across the organization; it is a truly interdisciplinary approach.

“It takes a village,” says Zettler. “Our professional service team attains informa-tion from our patients in order to assess whether or not they are prone to falls, our volunteers utilize wheelchairs set up by their stations to help patients get from one part of the hospital to another and our por-ters help get patients and their information from one unit to another.”

Trillium Health Partners’ goal for the in-patient program is to achieve the industry standard of four falls per thousand patient days. For our outpatient program, we really wanted to see a reduction in the number of falls and fall-related injuries while people are visiting our facilities.

Trillium Health Partners has experi-enced great success with a number of its falls prevention tactics. The trial use of low beds resulted in an 80 per cent reduction of falls and there were no injuries for the pa-tients who used low beds. Furthermore, the implementation of visual cues has played a signifi cant role in raising awareness amongst staff, physicians and volunteers.

“We are very pleased with our progress to date. The falls prevention strategy has increased the overall awareness of falls and the need to prevent them both within the hospital and outside its walls,” says Zettler. “As a result of this program and the ef-forts of all those involved, we have seen our inpatient fall rates decrease steadily. The outpatient program is a more recent initiative and we are continuing to moni-tor the data on a quarterly basis but we are encouraged by the preliminary results for people like Dorothy.” ■H

Catherine Pringle is a Senior Communications Advisor at Trillium Health Partners.

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Falls prevention program aims to empower those at riskBy Catherine Pringle

D

According to a report from the Ontario Injury Prevention Resource Centre, falls are the second leading cause of injury-related hospitalizations for all ages

Sabina Sobota, rehabilitation assistant, Trillium Health Partners with Viscilsa Alexander.

Photo Sandra Tavares



d Dowdell can’t remember a time when he wasn’t on something.

He started drinking at the age of seven and then added drugs into the mix as a young adult. His life was a vicious cycle of abuse and addictions. The addic-tions helped numb the pain of his Post-Trau-matic Stress Disorder (PTSD), but caused his mind to race and his hands to shake. Sleeping was never easy and relaxing was out of the question. He became a worka-holic – a man always running at full speed.

And so when his addictions counselor at Barrie’s Royal Victoria Regional Health Centre (RVH) suggested he try acupunc-ture as a way to relax, he just had to laugh. “I thought it would be a waste of time. I actually thought it was joke. I was so skep-tical,” says Dowdell.

And so with his arms crossed and a scowl on his face, the 51-year-old Bar-rie man sat against the wall in the group therapy room. He didn’t really want to be there, but he had no place else to be, so the frowning cynic stayed. And all it took was one session to make a believer out of this ‘Doubting Thomas’.

“Once Brian put the music on, and put the acupuncture needles in my ear, I shut my mouth, put my head back, closed my eyes and for the fi rst time in as long as I can remember I relaxed,” says Dowdell. “I have never felt so at peace. I felt like I was fl oat-ing down a river - so safe and calm. That night I had the best sleep in 36 years.”

Dowdell was among the fi rst group of patients at RVH to be offered auricular acupuncture as an alternative therapy for addictions or mental health issues. The service began in May 2013 and since then almost 1,700 such therapies have been administered in RVH’s Inpatient Mental Health program. The program has been so successful that an additional fi ve staff members have been trained to deliver acu-puncture treatments.

“Adding an alternative therapy, such as acupuncture, into a client’s treatment plan is part of RVH’s ongoing commit-ment to deliver safe, quality, patient-cen-tred care with a focus on individualized treatment plans that best meet the unique needs of our clients,” says Chris Nichols, manager, Mental Health and Addiction Services. “This alternative therapy is an

innovative practice in an inpatient set-ting. It promotes a holistic approach to recovery and teaches patients techniques for relaxation, other than substance or prescription medication.”

According to Nichols, more than 75 per cent of RVH mental health clients suffer from both addiction and mental ill-ness, which are chronic in nature and can be very debilitating. “That is why it is so important to teach people how to manage their symptoms with more natural meth-ods and ones they can do at home or at work,” says Nichols.

Brian Irving, RVH addictions coun-selor, has witnessed fi rst-hand the benefi t of using acupuncture. “People fi nd it very calming and are more open and relaxed. Acupuncture is a way to build trust with clients who, after the treatment, are more willing to open up and talk about their other issues during counseling,” says Ir-ving. “I know many people view acu-puncture as holistic, but it is actually very complementary to modern science. Acu-puncture won’t cure anyone, but it can ease the symptoms of substance use, with-drawal and various mental health issues, including depression, anxiety and PTSD.”

Typically, an acupuncture session at RVH is done in a group setting. Irving inserts fi ve needles in the ears of each

client, dims the lights, puts on calming music and lets the group relax. Acupunc-ture is being utilized in RVH’s inpatient mental health unit, the outpatient mental health program and more recently it has been offered to patients in the withdrawal management program and 21-Day resi-dential treatment program.

“Part of the purpose of acupuncture is to learn to relax. When people are stressed they sometimes turn to addictive behaviours as a way to escape and cope,” says Irving.

Dowdell knows all about that. “I was tense all the time and when I fi rst came here my hands were shaking so badly I couldn’t hold a glass. My mind was rac-ing so fast I couldn’t think straight,” says Dowdell. “It has calmed me down – I’ve never felt this way before. I couldn’t wait for the next session.”

Dowdell has since been discharged from RVH to a community-based 90-day treatment program where he is looking forward to cleaning up and get back to en-joying his family. “I’m defi nitely a believ-er now. And I hate needles – really do,” he laughs. ■H

Donna Danyluk works in communications at Royal Victoria Regional Health Centre in Barrie.

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By Donna Danyluk

Ed Dowdall was one of fi rst patients at Royal Victoria Regional Health Centre to be offered auricular acupuncture as an alternative therapy for addictions or mental health issues.

E

ver the next three years, new Canadian law will come into force regulating commercial electronic messaging (CEM).

Known as Canada’s Anti-Spam Legisla-tion (CASL), and widely considered the toughest law of its kind in the world, it will require express or implied consent to email and other electronic communica-tions caught by the law’s broad defi nition of ‘commercial’ unless they fi t within one of the law’s specifi c exceptions. Unfortu-nately, the defi nition of CEM casts a very wide net: electronic messaging is consid-ered commercial if one of its purposes is “to encourage participation in a commercial activity”. Commercial activity includes transactions, acts or conduct of a “com-mercial character” regardless of whether making a profi t is the expectation. Mak-ing hospitals spend scarce public resources to comply with CASL given their trivial contribution to the propagation of spam is akin to using a sledgehammer to crack a nut. However, despite this seemingly obvious fact, hospitals are not exempt from this law.

Application to hospitalsIn order to apply CASL to the health

care context, hospitals must look at their email traffi c and consider whether elec-tronic communications are commercial in

nature. While hospitals might expect that revenue-generating activities would be caught by CASL, one would have hoped that the regulator would at least acknowl-edge, ideally in writing, that core activities of hospitals (i.e. the provision of health care services) are not commercial, as was done with the federal privacy legislation. Without such direction, hospitals are left to grapple with such questions as whether electronic messaging relating to uninsured services and products or programs offered to patients for a fee would be considered commercial. Similarly, would electronic messaging relating to pharmacy sales or the leasing of space to Canada’s favorite coffee franchise be considered commer-cial in nature? If the electronic messaging is determined to be commercial, does it fi t within one of the exemptions or implied consent provisions (which are detailed and specifi c) or will express consent be re-quired? Note that even if there is implied consent under CASL, certain form and content requirements may apply.

The range of electronic communica-tions sent by hospitals is incredibly broad and diverse, including everything from communication with patients and other health care providers, to research insti-tutes and academic partners, vendors and other commercial entities.


OBy Patricia North, LL.B., LL.M.

Acupunctureturns addict into a believer

‘Hospital Spam’ an Oxymoron?Not according to the new Canadian Anti-Spam Law


28 Healthcare Technology

he health care industry has been more cautious in adapt-ing new technology trends than other sectors, and rightly

so. Personal health information must be confi dential and secure, and is closely gov-erned by regulation – PIPEDA in Canada. Any changes to how this information is stored, secured or shared would likely re-quire regulatory revision. Further, the ac-curacy and authenticity of information used by health care professionals in treat-ing a patient is literally a matter of life and death. When so much is at stake, it is clear why the medical community is slow to change and still relies heavily on handwrit-ten notes and documents.

Nonetheless, healthcare has reached a tipping point in terms of adapting new technology. The mobile revolution contin-ues, and patient involvement in their own treatment is an unstoppable force. There is tremendous pressure on health care fa-cilities to improve not only patient health and wellbeing, but also the caregiver ex-perience. The opportunity to improve pa-tient outcomes while reducing wait times and lowering costs to the system – in other words, to enhance the productivity of health care delivery – is so great that adaptation of the enabling technology is inevitable.

Here are fi ve trends that will continue to impact the health care industry in 2014 and beyond.

1. BYOD is becoming mainstream

Employees today want to be connected to everything, and increasingly they want that connectivity on their personal mobile devices. Faced with an infl ux of personal smartphones and tablets brought to work by their medical staff, hospitals are begin-ning to embrace the BYOD (Bring Your Own Device) trend and are looking at the support requirements and protocols need-ed to manage confi dentiality and privacy requirements.

Does your hospital have a BYOD policy that includes an enabling IT infrastruc-ture, and governance and compliance is-sues? The good news is that there are now tools available to securely support the multitude of mobile devices your staff are already bringing to work.

The return on investment for BYOD in a hospital setting is still not easy to com-pute, but the payoff in terms of employee satisfaction and the potential for produc-tivity gains in delivering patient care can no longer be ignored. BYOD is here to stay, and 2014 may be the year to fully embrace it.

2. Big Data plays a vital role in patient care

With advanced technologies, we are now able to analyze and retrieve valuable information from collections of large and complex data sets (known as “Big Data”) that until recently were too diffi cult to pro-cess with traditional data processing appli-

cations. In the health care world, this is a huge benefi t for individual patient care, research into diseases, and overall produc-tivity in the delivery of services.

As Electronic Health Records evolve and are capable of working with outside apps, critical information is being captured and recorded by both caregivers and pa-tients themselves. Data from all sources needs to be integrated to provide a holistic view of patient diagnosis and treatment. Patients can also access their information from almost any device at any location.

With this new capability to manage and analyze Big Data, and the reality that in-formation is increasingly being stored on and retrieved from mobile devices, the era of Big Data in patient care has arrived. Access to comprehensive health data enables more accurate prognosis and treat-ment decisions. Health care providers are realizing the benefi t of Big Data to deliver better care at lower costs as well as more customized treatment plans.

EHR systems have become more afford-able and information can be exchanged more easily than ever before.

3. Telemedicine will deliver cost-effective care for the future

Technology is continuing to push the en-velope of treatment options available to all patients. With video conferencing through laptops, smartphones and tablets, patients can easily connect with their medical staff. Self-monitoring devices make it easier for patients to monitor and report their vital signs without a trip to the doctor or hospi-tal. Post hospitalization, patients can check in and upload their data, and medical staff can videoconference with the patient or with other members of their team.

Such ‘virtual’ care will continue to in-crease through 2014 and beyond.

4. Data security solutions are at hand

Personal health information must always be encrypted, and ensuring patient confi -dentiality and compliance with regulatory requirements has become more challeng-ing as the IT environment becomes in-creasingly complex. At the same time, the platforms that provide data security con-tinue to evolve to meet these challenges.

A great backup tool is the ability to track and erase information from devices that have been stolen or compromised.

This security solution is now readily avail able, as well as products that provide se-cure leads for email, texting, fi le sharing and videoconferencing.

5. Mobile apps are on the rise

Medical staff access mobile apps to quickly gather many types of information. Patients use mobile apps to count their cal-orie intake or measure heart rate, to assist with more complex regimens like manag-ing chronic disease, or to be reminded to take their medication.

EHRs are also evolving to work better with outside apps for data input and moni-toring. Health systems are developing and implementing their own apps to help im-prove the patient experience. Finally, apps are being developed to span many different devices, and will play a vital role in health-care now and in the future.

Technology continues to develop at a dramatic pace. Tablets, servers, cloud com-puting, smart machines and smart printers will all encourage a major work shift – and less use of paper – in hospitals and medi-cal facilities throughout the world. The potential for new technologies to improve patient outcomes while reducing costs is swiftly becoming a reality. ■H

Ken Jarvis is Healthcare Industry Practice Manager, Printing Personal Systems-Americas, HP.

hen treating patients requiring mental healthcare, caregivers need compassion, understand-ing and quick, complete and

accurate access to previous treatment and health records.

“Time is of the essence,” says Thomas Jones, Manager of the Mental Health Pro-gram at Mackenzie Health. He knows that medical decisions on how best to treat a patient need must be made quickly and correctly. If a patient comes into the hos-pital in need of urgent mental health care, having the most up-to-date information can help staff make clear and informed care decisions.

Until this past July, staff treating mental health patients in the Emergency Depart-ment and other outpatient clinics faced a number of challenges in accessing patient histories in an effi cient and timely manner, Mr. Jones says.

“Up until that time, if a patient came to the Emergency Department in crisis, his or her complete mental health record was not always readily available,” he says.

To overcome these challenges, Mack-enzie Health in Richmond Hill, Ontario and Southlake Regional Health Centre in nearby Newmarket, collaborated to improve care for patients seeking mental

health services at the hospitals with a new Ambulatory Electronic Mental Health Re-cord (AEMHR). This software, provided by B Sharp Technologies and McKesson Canada is enabling the hospitals to create, view and update existing mental health records for patients in real time, providing instant access to previous records and bet-ter coordination and integration of care for adult mental health encounters.

With funding from Canada Health In-foway, the system gives mental health pro-fessionals from both facilities secure access to their patients’ entire inpatient and out-

patient encounter history within their hos-pital network, providing seamless mental healthcare across the entire organization.

The new AEMHR is improving access to information for more than 200 clini-cians resulting in improved care for thou-sands of patients at Mackenzie Health and Southlake. The system went live at Mack-enzie Health in July 2013 and Southlake Regional Health Centre in November 2013 providing enhanced care for patients who visit outpatient clinics and improve safety for those receiving prescriptions for mental health.

In addition, as part of this project, pa-tient assessments are being sent to the provincial Integrated Assessment Record (IAR) Portal using the B Care Mental Health Solution, so other authorized clini-cians involved in patient care can access appropriate information to optimize care coordination and treatment.

With this innovative approach, Mack-enzie Health and Southlake are working together to help simplify the journey that many mental health patients face by creat-ing a comprehensive record that more ef-fectively communicates their story, in the event the patient cannot. ■H

Stefanie Kreibe is a Consultant in Communications and Public Affairs at Mackenzie Health.

The tipping point for healthcare technologyBy Ken Jarvis

By Stefanie Kreibe

Electronic record transforms care

Melissa Petriglia, and Thomas Jones, use the new single electronic mental health record.

Photo Jim Craigmyle

W

T

Personal health information must be confi dential and secure, and is closely governed by regulation


29 Healthcare Technology

hen a migraine brought Sara Hampel to Thunder Bay Re-gional Health Sciences Centre (TBRHSC) earlier this year,

she had no idea that she would have ac-cess to one of the country’s leading neuro-surgeons, based in Toronto, without even stepping into an airplane.

Thunder Bay neurosurgeon Dr. Ste-phen McCluskey saw Hampel and rec-ommended a minimally invasive surgery for the treatment of hydrocephalus called Endoscopic Third Ventriculostomy (ETV). In an ETV, the surgeon uses a small video camera to “see” inside the brain and makes a hole in the bottom of one of the ven-tricles or between the ventricles to enable cerebrospinal fl uid to fl ow out of the brain.

“It’s not appropriate for everyone but she was an excellent candidate for ETV,” says Dr. McCluskey. The only obstacle – a signifi cant one – was accessing the neces-sary equipment. Dr. McCluskey was able to rent the equipment, which took several weeks to arrive. Because he had not had access to a ventriloscope for a number of years, Dr. McCluskey had also not per-formed an ETV since his training. For that reason, he wanted an expert present dur-ing the operation. “It’s always good to have mentoring when you haven’t performed a specifi c procedure in a long time,” he says.

He contacted Dr. James Drake, a neuro-surgeon in the Division of Paediatric Neu-rosurgery at the Hospital for Sick Children (SickKids) in Toronto and an expert in the science and surgery of hydrocephalus. Dr. Drake agreed to be present via Telemedi-cine.

TBRHSC’s Telemedicine Department worked to make sure the connection with SickKids would work and then scheduled the surgery via the Ontario Telemedicine Network, with a studio at SickKids and the TBRHSC’s Operating Room, which is equipped with Telemedicine cameras that allow off-site surgeons and/or students to see the surgery.

Dr. McCluskey says that the operation went very smoothly under Dr. Drake’s tele-mentoring. “As a physician, it’s very satis-fying to be able to provide that service, rather than send a patient to Winnipeg or Toronto,” says Dr. McCluskey. “Eventually we would do this without mentoring.”

Hampel says she feels great and was glad she didn’t have to travel to Toronto. “Tele-mentoring is wonderful for people living in isolated communities like Thunder Bay and other towns in Northwestern Ontario. I think it’s wonderful that we have tech-nology that allows us to access out-of-town specialists.”

Trina Diner, Manager of Palliative Care and Telemedicine, says there are plenty of opportunities for health care providers, including physicians, dietitians, pharma-cists, social workers to take advantage of Telemedicine. “Even if the appointment or consult is only 15 minutes, we can re-duce stress for patients and families hav-ing to take time off work to travel. This

saves time and money, as well as separa-tion from their support network of family and friends.” ■H

Donna Faye works in communications at Thunder Bay Regional Health Sciences Centre

416-868-3100 | 1-888-223-0448www.thomsonrogers.com

YOUR ADVANTAGE, in and out of the courtroom

Danny McCoy was rendered a paraplegic in a terrible car accident at the age of 43. Before the accident he was an avid sailor. After the accident, Danny became one of the top ranked competitive disabled sailors in the world. He’s also the founder of the Disabled Sailing Association of Ontario and one of the sport’s foremost international ambassadors.

Thomson, Rogers is a proud supporter of The Disabled Sailing Association of Ontario. We are honoured to have represented Danny McCoy in his lawsuit and to count Danny as a friend and one of the many everyday heroes we have been able to help.

Focus on the things you can do, not

just like I did, that life is fantastic.”– Danny McCoy

“

Tele-mentoring brings specialists close to homeBy Donna Faye

I think it’s wonderful that we have technology that allows us to access out-of-town specialists,” says Sara Hampel (centre), seen here with Telemedicine Nurse, Karen McPhail (left) and Director of Supportive Care and Cancer Care, Dr. Scott Sellick (right).

W


30 Travel: The Best Medicine

Educational & Industry Events

March 5, 2014 Islamic perspectives on End-of-Life Issues and Death University of St.Michael’s College, Toronto Website: www.ccbi-utoronto.ca

March 11–12, 2014 The National Forum on Patient Experience West Hyatt Regency Hotel, Vancouver Website: www.patientexperiencewest.com

April 1–2, 2014 National Patient Relations Conference Hyatt Regency, Vancouver Website: www.healthcareconferences.ca

April 10–11, 2014 National Telemedicine Conference Metro Toronto Convention Centre Website: www.healthcareconferences.ca

April 27–29, 2014 Hospice Palliative Care Ontario (HPCO) 2014 Annual Conference Sheraton parkway Toronto North Hotel & Conference Centre, Richmond Hill Website: www.hpco.ca

May 12–15, 2014 CAHSPR Conference 2014 Hilton, Toronto Website: www.cahspr.ca

May 13–14, 2014 Human Resource Strategies For Healthcare Toronto, Ontario Website: www.healthhrcanada.com

May 20–23, 2014

Quebec Convention Centre, Quebec City Website: www.canadianpainsociety.ca

May 23–24, 2014 International CT Symposium Fairmont Hotel, Vancouver Website: www.toshiba-medical.ca

May 25–28, 2014 Prevention – A Port in Any Storm 2014 National Education Conference on Infection Prevention and Control Halifax World Trade and Convention Centre Website: www.ipac-canada.org

May 29–30, 2014 e-Medication Management Conference Metro Toronto Convention Centre Website: www.healthcareconferences.ca

May 29–June 1, 2014 CAMRT Annual General Conference Shaw Conference Centre, Edmonton Website: www.camrt.ca

June 2–3, 2014 2014 National Health Leadership Conference Banff, Alberta Website: www.cha.ca

June 12–13, 2014 Emergency Department Management Conference Metro Toronto Convention Centre Website: www.healthcareconferences.ca

To list your event, send information to “[email protected]”.

We try to list all events and information but due to space constraints and demand, we cannot guarantee it. To promote your event in a larger, customized format please send enquiries to “[email protected]”

To see even more healthcare industry events, please visit our website

www.hospitalnews.com/events

y heart tells me that I WANT adventure but my head tells me I NEED clean bedding, comfy pillows and a good

night’s sleep. Where is that perfect balance between living life a little more fully and enjoying the comforts of life that make the experience enjoyable?

Island hopping around the Greek Islands is for me that perfect balance between the two – the thrill of exploring new places and meeting new people while enjoying some of the best quality accommodation and food in the beautiful Mediterranean.

When deciding on a route, a good map of the ferry routes is essential. Remember that in high summer there are many extra routes and scheduled ferries running.

If you are starting from Athens then head down to the ferry port at Piraeus har-bour and hop on a boat headed for Myko-nos – a large island with a great history, a warm welcome for visitors and some of the fi nest bays and beaches in Europe. The Mykonos Blu resort is a defi nite star choice for somewhere to stay if you want to ease into your Greek adventure with some real fi rst class pampering.

A few days exploring the island or zon-ing out on the beaches of the impossibly pretty Psarou bay may be all you need be-fore the wanderlust kicks in. One thing not to miss before leaving Mykonos is a day trip to neighbouring Delos, the ‘Island of the Gods’. This was a cult centre and pilgrim-age site in Classical times. Rules imposed on earlier visitors to Delos included a law forbidding anybody from dying on the island.

If you want to get to Santorini (and you really should want to see this beautiful is-land created when a volcano blew apart the island of Thera between three and four thousand years ago) you will need to take a ferry to Naxos and then swap to a Santorini bound boat. Once you get there you will be faced with a wall of rock rising from the ferry port with one switchback road taking you to the top of the cliff for your fi rst of many heartbreakingly beauti-ful views. If you want a suggestion of where to stay, the Grace Santorini in Imerovigli (just a few miles north) has an entrancing combination of luxury rooms, great service and possibly the most perfect infi nity pool on the planet.

If you fi nd the pace just right, then just spend whatever time you have left wander-ing from island to island as you see fi t. You are now au fait with the ferries and can look after yourselves.

If you want to up the excitement, keep going south to the huge island of Crete. If you are in a hurry to get there the Hel-lenic Seaways-Flying Cat can get you to Heraklion in just 1 hour and 45 minutes. Once there the island is big enough to of-fer pretty much anything you could wish for. Between May and October the sixteen kilometre long Samaria Gorge hike is fa-mous for amazing views, wild goats and the deep dark sections where the walls rise vertically on either side of you. At the end of the Gorge the quiet seaside village of Aghia Roumelli can only be reached on foot down the Gorge or by boat.

This is just one suggested route for a little luxury island hopping, but with hun-dreds of inhabited islands the options are legion. Wherever in the Greek islands you choose to explore you will be rewarded with new experiences and memories to last a lifetime.■H

Victoria Brenner is Director at The Couture Travel Company. This article appeared on www.aluxurytravelblog.com and is reprinted with permission.

Greek island hopping in style

MBy Victoria Brenner

Crete, a large island in Greece offers pretty much anything a traveller could wish for.

One thing not to miss before leaving Mykonos is a day trip to neighbouring Delos, the ‘Island of the Gods’



This, coupled with the fact that elec-tronic communications within hospitals are generally quite decentralized, will make for a fairly detailed and onerous in-ternal administrative compliance exercise, particularly in larger facilities with re-search institutes and revenue-generating groups and programs.

Beginning the CASL Compliance Process

In order to comply with CASL, hospi-tals should start by:1. Reviewing the organization’s elec-tronic messaging traffi c; noting that electronic messaging includes email, text,

instant and social media messaging;2. Determining which electronic messag-ing falls under CASL’s defi nition of CEM, and identify situations where exemptions or implied consent apply; 3. Conduct audits of the organization’s current electronic communications poli-cies and practices with respect to CEM and computer programs to ensure compli-ance with CASL; 4. Ensure that appropriate consent is in place prior to July 1, 2014 for CEM; and5. Put procedures in place to ensure on-going compliance with CASL, including form and content requirements, consent tracking and the scrubbing of implied con-sents in accordance with CASL’s specifi ed time frames (as applicable).

Fortunately for hospital foundations, CEM sent by charities with the primary

objective of ‘raising funds’ for the char-ity have the benefi t of an exemption from CASL. However, even this exemption has left some scratching their heads regard-ing electronic messaging sent by hospital foundations for purposes other than fun-draising given the broad defi nition of the term ‘commercial’.

Grandfathering and transition

One element of relief comes from FAQ’s published by the CRTC which state that valid express consents obtained prior to CASL coming into force will be grand-fathered even if they didn’t meet CASL’s identifi cation and contact information requirements, although opt-out consents obtained under the federal privacy leg-islation will not be grandfathered. There is also deemed implied consent for 36 months where there is an existing business or non-business relationship.

PenaltiesThe maximum penalties for non-com-

pliance with CASL are very steep: up to $10 million for corporations, $1 million for individuals. As well, a private right of ac-tion will allow consumers and businesses to commence enforcement proceedings

and recover damages (mercifully, the pri-vate right of action will not be in force until July 1, 2017). Also important to note is that offi cers, directors and agents are liable, and can be subject to a private right of action, if they directed, authorized or participated in a contravention, unless they can establish that they exercised due diligence to prevent the commission of the violation. The computer programming provisions (the subject of a future article) will not be in force until January 15, 2015.

With the exceptions noted above, the rest of CASL will come into force on July 1, 2014. In light of the short timelines, hospitals would be best served by working together, and with the OHA and HIROC, to make sense of this new legislation in the health care context. Develop a standard-ized approach to CASL would help hospi-tals become compliant and reign in all of those rogue hospital spammers.

*This article is a summary of a current legal issue and is not meant as legal opin-ion or advice. Readers are cautioned not to rely or act upon the information provided in this article without seeking legal advice relating to their specifi c circumstances. ■H

Patricia North, LL.B., LL.M. is Legal Counsel, University Health Network.

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What could then be the solution to the pain puzzle? Evident too, all true solutions start with ourselves.

If we want the Canadian medical system to provide a true science based approach to the treatment of pain, we have to start by giving ourselves a better education in this and other health related topics (becoming responsible consumers), so we can then question the clinical models that are fail-ing to provide pain relief to so many of us. Otherwise, like in physics, things will just keep moving in the direction where forces push them.

For practitioners, we now know enough to start using a more refi ned diagnostic and treatment model that favors interven-

tions that modulate neurofunction at all relevant levels. Interventions such as elec-troacupuncture and manual techniques, complemented then with appropriate interventions, including pharmaceutical agents when they have a well-defi ned role to play. If evidence-based medicine tells us that only a minority of chronic pain is as-sociated with infl ammation, why are anti-infl ammatories one of the most prescribed drugs to chronic pain patients?

Perhaps we can fi nd an explanation from the same “Pain in Canada fact sheet” men-tioned before: Veterinarians receive fi ve times more training in pain management than people doctors. ■HDr. Alejandro Elorriaga Claraco, Sports Medicine Specialist (Spain) is Director, McMaster University Contemporary Medical Acupuncture Program.

Hospital spamContinued from page 27

Pain puzzleContinued from page 22



Keynote Speakers

May 31 - June 4, 2014 Ottawa Convention Centre

For more information visit caep.ca/Conference

EARLY REGISTRATION DEADLINE: APRIL 7TH

Dr. Samantha NuttSunday June 1

Mr. Ray ZahabMonday June 2 Wednesday June 4Wednesday June 4

Dr. Mel HerbertTuesday June 3

Dr. Ian StiellTuesday June 3

Dr. Jeffrey TurnbullMr. Jeffrey Simpson

Documents

March 2014 Edition