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Issue No.4 February 2011
World-first dual-site centre uses sound waves instead of scalpels to perform surgeryOpens in Toronto and Thunder Bay
Sunnybrook in partnership with Thunder Bay Regional Health Sciences Centre have launched a unique dual-site Centre that stands to revolutionize surgery through non-invasive treatments for complex health concerns including cancers.
“Congratulations to Sunnybrook and to their partners in Thunder Bay on yet another example of leadership in health-care innovations. New technologies like this will not only put Ontario on the world stage as an innova-tor, but also will improve the quality of health services for patients,” says Deb Matthews, Minister of Health and Long-Term Care.
Teams of clinicians and scientists at both sites of the Centre are developing new treatments using MRI (mag-netic resonance imaging)-guided, focused ultrasound. MRI-guided focused ultrasound therapy uses heat gen-erated from high intensity ultrasound waves, focused to the target tissue and guided by MRI.
Patients with complex health concerns would benefit greatly from surgery but in many cases traditional op-erations pose high risks. With MRI-guided focused ul-
trasound therapy, many of these risks can be overcome. Procedures are performed without ever making a surgical incision and without the use of needles.
In the Centre’s first patient trials for this new approach, teams have chosen to apply the novel therapy to uterine fibroids. Uterine fibroids are non-cancer-ous tumours that most often affect women in their 40s and early 50s. Early trial results show the treatment to be safe and effective with no serious side effects.
The researchers will expand their new therapy team with trials with clinicians at Sunnybrook’s Odette Cancer Centre and at Thunder Bay Regional Health Sciences Centre, for the treatment of patients with bone metas-tases, recurrent breast tumours, head and neck tumours, and rectal tumours. Research will also involve use of the technology to potentially increase the effectiveness of chemotherapy and to enhance the effects of radiation therapy.
Dr. Kullervo Hynynen, director of imaging at Sunnybrook Research Institute pioneered the MRI-guided focused ultrasound technology. He is a co-investigator on the fibroid trials in Toronto being led by Dr. Elizabeth David, an interventional radiologist at Sunnybrook.
Funding from FedNor, Natural Sciences and Engineering Research Council of Canada - Discovery Grant for HIFU Guidance, the Ontario Ministry of Research and Innovation – ORF grant and Philips Healthcare have been fundamental to the success of this leading-edge procedure. Natalie Chung-Sayers
Psychological tests help doctors predict dementia accurately Two neuropsychological tests have been shown to ac-curately predict dementia from all causes, in patients up to 10 years in advance of its diagnosis, says a new study. “This will be helpful for clinicians concerned about the risk of progression to dementia in patients who may be healthy or present with a variety of medical and neurological conditions such as stroke,” says Dr. Mary Tierney, principal investigator of a new study and direc-tor of the Geriatric Research Unit at Sunnybrook.
“Enhancing the long-term prediction of dementia could have important implications for clinicians who are concerned about whether their aging patients will progress to dementia or remain dementia-free within a
five or 10 year period, and offer a route to early de-tection of cognitive decline. This may also help us to identify patients early on who may benefit from clinical trials or treatments as they become available, as well as researching the longer-term effects of the disease so we can better understand its progression in the brain and how best to approach it.” The two tests that accurately predicted dementia within 10 years of diagnosis were a test of word recall memory after a short delay and a test requiring the participant to match digits and symbols. These tests require special-ized training to properly administer and interpret. Continued inside
New less invasive heart procedure transforms patient’s life A gift of gratitude
When 76-year-old George Bilikopoulos had trouble breathing, he thought he was having a heart attack. After being rushed to his local hospital and then trans-ferred by ambulance to Sunnybrook, it was discovered that George had a leaky heart valve and needed a replacement.
Traditionally, such a procedure involves having open-heart surgery. Luckily for George, he was a candidate for a new minimally invasive procedure at the Schulich Heart Centre.
With the introduction of the Transcatheter Aortic Valve Implantation (TAVI) initiative at the Schulich Heart Centre, patients like George who are considered too high risk for conventional open-heart surgery to replace the aortic valve may be candidates for a substantially less invasive procedure.
The minimally invasive procedure involves a team of health-care workers working together to implant a new valve percutaneously (without opening the chest). Minimally invasive interventions offer many benefits to patients including:•reducedpain•lessneedforpostoperativepainmedication•smallerscars•ashorterstayinthehospital•afasterrecovery
People who undergo a transcatheter valve implantation can often return home after only a few days and resume many normal activities within a couple of weeks rather than a couple of months.
Nine days after his procedure, George was back at work and feeling like a new man. On October 19, 2010, he and his wife Mary paid a visit to the TAVI team at the Schulich Heart Centre, where Mary presented them with a hand-made needlework creation she made to show her gratitude for the wonderful care the team provided for George.
“I am so grateful,” says George. The incredible staff at Sunnybrook have given me my life back and I’ll never forget what they did.” Laurie Legere
From left to right: Dr. Eric Cohen. Michelle Porter, Dr. Sam Radhakrishnan, Dr. Steve Fremes, Dr. Brad Strauss, Mary Bilikopoulos, George Bilikopoulos
Dr. Hynynen (far right) explains how the focused ultrasound beam is delivered through a glass area on the MRI table. Looking on are, from left to right: Minister Matthews; Kathleen Wynne, Minister of Transportation and MPP Don Valley West; and Bill Mauro, MPP, Thunder Bay Atikoken. In the background: Sunnybrook CEO, Dr. Barry McLellan
Skyrocketing costs of Alzheimer disease in Canada The cost of treating and caring for an outpatient (non-hospitalized) in Canada with Alzheimer Disease (AD) increases dramatically as it progresses in severity, con-firms a new study.
“Delaying the progression of AD will not only signifi-cantly improve quality of life for patients and families, but will also reduce the indirect costs and burden to caregivers and society, as the costs of caring for patients living in the community are staggering,” says Dr. Nathan Herrmann, principal investigator of the study and geriatric psychiatrist at Sunnybrook. “This is par-ticularly relevant when we consider that AD is growing in prevalence in Canada, as the number of patients with AD is increasing as the Canadian population ages.”
The costs for treating a patient with AD in the com-munity (those not institutionalized) range from $367 per month for very mild Alzheimer patients to $4,063 a month for patients with severe AD.
The total cost of treating women with the disease is about 86 per cent higher than men.
Contributing factors include more difficulty in ac-complishing activities of daily living and symptoms of mental illness.
The research was published in the December 2010 issue of The Canadian Journal of Psychiatry. Direct medical costs include hospitalization, physician visits, and medication. Indirect medical costs include home care by informal caregivers, such as family and friends, and loss of productivity by both the patient and the caregiver.
“The greatest changes in cost were observed in the most severe group of AD patients,” says Dr. Krista Lanctôt, co-investigator of the study and neuropharmacologist at Sunnybrook. “For patients with severe or very severe AD, the cost is close to $50,000 yearly. The largest com-ponent of total cost was indirect costs such as caregiver burden and productivity loss at higher severity levels, though medication costs contributed the most in very mild cases. For patients with very mild AD, the cost is under $5,000 yearly.”
The study was conducted between August 2000 and March 2003 in five major regions across Canada: British Columbia, the Prairies, Ontario, Quebec, and the Atlantic provinces. Nadia Radovini
Beloved Canadian Tenor pledges gift for Sunnybrook Palliative CareThrough his new foundation, McDermott House Canada (MHC), Canadian singer John McDermott has committed to making a difference for veterans, first responders, military, and community members who have a terminal illness.
In December, , John McDermott and friends officially launched McDermott House Canada, pledging a gift of $3.6 million dollars to increase the number of beds and enhance the current space of the palliative care unit at the Sunnybrook Veterans Centre.
“The care you receive at the end of life is as important as the care you receive at the beginning of your life. I es-pecially want to ensure that we meet the needs of those who risk their lives for us on daily basis. Our motto at MHC is “Serving Those Who Serve”, said McDermott. “We are thrilled to have General (Ret’d) Rick Hillier, CMM, MSC, CD (former Chief of the Defence Staff of the Canadian Forces) as our Honorary Chair.”
McDermott House Canada will be the touchstone of excellence in palliative care in Canada. The unit will offer a warm homelike space with single rooms and ad-ditional accommodation for family members who wish to stay overnight. Along with a leading-edge interpro-fessional care team, patients and family members will have enhanced amenities to ensure there is an enriched quality of life during their stay on the unit.
“We are honoured to partner with McDermott House Canada and join this unique initiative. Together we will create a premier palliative care unit that will signifi-cantly change the end-of-life experience for our patients and their families,” said Dr. Jocelyn Charles, medical director of the Sunnybrook Veterans Centre.
Throughout his cross-Canada holiday concert tour, McDermott has been raising awareness and funds, com-mitting a portion of the proceeds from his CD, entitiled Journeys to the cause. “It is inspiring to see so many people share our vision. Everyone we talk to becomes immediately enthusiastic and wants to know how they can help out.” For more information check out www. mcdermotthousecanada.org. Sally Fur
Alzheimer Neuroimaging Initiative seeks volunteers
The National Institute of Health (NIH) is expanding the Alzheimer’s Disease Neuroimaging Initiative (ADNI), a groundbreaking study that will recruit hundreds of new volunteers across North America to help define the subtle changes that may take place in the brains of older people many years before overt symptoms of AD appear.
ADNI is the largest public-private partnership to date in AD research. It is led by the National Institute on Aging at NIH. Sunnybrook is one of the participating sites. For more information, please call Ms. Joanne Lawrence or Mr. Kamshad Touri, the clinical trial coordinators, at: 416-480-6108 or email [email protected] or [email protected].
According to the Alzheimer Society of Canada, half a million Canadians currently have AD or a related dementia, and this year alone, more than 103,000 Canadians will develop dementia. If nothing changes, the number of people living with AD or a related dementia is expected to more than double, reaching 1.1 million Canadians within 25 years. (Alzheimer Society of Canada)
Several of the tests had previously been identified for the early prediction of AD by Dr. Tierney and her colleagues, including the tests of word recall, category names and long-term memory, but these new results indicate that a test of matching digits and symbols is an important predictor of dementia due to all causes, not just AD.
John McDermott announces his pledge of $3.6 million dollars to Sunnybrook. John’s recent CD entitled, Journeys, is a work he has attributed to the cause of veterans, and includes the classic historical song “Danny Boy.”
From left to right: Jordan Paris and Wayne Everett, Brampton Fire Department Honour Guard; Sunnybrook Foundation’s CEO Jeff O’Hagan; event MC and former Canadian Olympic Alpine Skier, Brian Stemmle; Mike McDonell, Inspector Ontario Provincial Police, Commander Stormont Dundas/Glengarry Detachment and McDermott House Canada board member (shaking hands with John) and Deputy Chief EMS Norm Lambert.
The digit symbol test measures sustained attention and the ability to change mental set, which are thought to reflect functioning of the frontal lobes of the brain. Thus a combination of tests that measure functioning of both the temporal and frontal lobes of the brain appear to be important for accurate prediction of all causes of dementia. Efforts such as those in this Canada-wide study must be made to identify AD and related causes of dementia early in the disease process, so that appropriate care and treatments can be provided as soon as possible. Early identification of dementia risk also allows individuals to be included in clinical trials before disease diagnosis. The study is published in the January 2011 issue of the Journal of Alzheimer’s Disease. Nadia Radovini
Dementia continued
Get your game on!
We are excited to announce a new initiative dedicated solely to the staff of Sunnybrook. The I Love Sunnybrook Campaign is a two-week fundraising campaign that will run from February 28 to March 10. During the two-week campaign period we will raise funds for the equipment, space and research we need to invent the future of health care here at Sunnybrook. If you are an employee and wish to participate in this year’s I Love Sunnybrook Campaign please visit us at sunnybrook.ca/family.
February is heart awareness month
Heart healthy recipe Split pea and barley soup From: Healthy Helpings/MealLeaniYumm!
For a delicious smoky flavor, add the cut-up carcass of a smoked turkey along with the barley!
2 cups green split peas, rinsed and drained3 carrots, chopped3 or 4 stalks celery, chopped1 medium onion, chopped12 cups water, chicken or vegetable broth1/2 cup pearl barley, rinsed and drained1 bay leafSalt and pepper, to taste2 cloves crushed garlic, if desired2 tsp. canola oil2 medium onions, chopped1/4 cup chopped fresh dill
1. In a large soup pot, combine split peas, carrots, celery and 1 onion with water. Bring to a boil. Stir in barley, bay leaf and garlic, if using. Reduce heat and simmer partly covered for 1 1/2 to 2 hours. Stir occasionally. Add salt and pepper to taste.
2. In a nonstick skillet, heat oil. Saute the remaining 2 onions on medium heat until well-browned, about 6 to 8 minutes. Add onions to soup along with dill. Simmer soup 5 to 10 minutes longer. Discard bay leaf (and turkey carcass, if using).
Yield: 12 servings. Reheats and/or freezes well. If soup gets thick, add a little water or broth.
Nutritional Information152 calories per serving, 1.3 g fat (0.1 g saturated), 0 mg cholesterol, 8 g protein, 28 g carbohydrate, 31 mg sodium, 427 mg potassium, 2 mg iron, 9 g fibre, 34 mg calcium. Norene Gilletz
Brandon Quigley was enjoying a game of volleyball three years ago when an ordinary day suddenly turned south. He felt a tearing sensation in his chest, and over-whelmingly unwell. He had the good sense to sit out the rest of the game, and follow up on his wife’s advice to see a doctor right away.
Good thing he did. No one at the beach that sunny day could have predicted what this 32-year-old-father was up against. After extensive testing at Sunnybrook’s Schulich Heart Centre, a big problem was detected. Brandon had an aortic dissection, a tear in the big vessel coming off his heart and supplying blood to his entire body. It kills some instantly, and most within two weeks.
Brandon’s surgery was done by heart surgeon Dr. Gideon Cohen, who says aortic dissections are com-monly missed or misdiagnosed. Because this condition causes chest pain, it can be easily mistaken for a heart attack, which is treated with blood thinners. But that’s the worst thing you can do for an aortic dissection, as the risk for bleeding is already high. He says an astute medical team and CT scan are essential to pinpointing the problem.
But there are many things you can do, like knowing the risk factors and red flags. Symptoms of aortic dissection include a tearing feeling or pain in your chest, abdomi-nal discomfort, back pain or even paralysis. Conditions like high blood pressure, pregnancy, angiograms and even acute trauma, like a fall, can cause a tear. You’re also at higher risk if you are male or if a blood relative has had the condition, meaning you should talk to your doctor about being screened with a chest MRI.
Brandon has been through cardiac rehab, which is recommended for all patients who have experienced an aortic dissection. After his own experience, and losing his mother to an aortic dissection, he’s now being pro-active about screening his daughters. He’s also hopeful that others will learn about his story and come away knowing more. That includes recognizing the signs of trouble, and of course, how important it is to take your wife’s advice. Monica Matys
Health tip of the month
Your heart is in good hands
If you are referred to Sunnybrook for a test to inves-tigate how well your heart is functioning, chances are you will have an appointment in our Echocardiography Laboratory (Echo Lab).
There, our sonographers and Echo Lab cardiologists will perform a diagnostic test called an echocardiogram, or “echo.” This painless, non-invasive procedure uses ultrasound to record moving images of your heart and investigate your blood flow. The images taken provide valuable information about how your heart valves and chambers are working so that your cardiologist can de-tect any irregularities with your heart and get you the treatment you need.
No day at the beach…
Brandon with his daughters Sara and Emma (birthday girl) and wife Lucia.
After extensive testing at Sunnybrook’s Schulich Heart Centre, a big problem was detected. Brandon had an aortic dissection, a tear in the big vessel coming off his heart and supplying blood to his entire body.
Sunnybrook’s Echo Lab was recently re-accredited by the Intersocietal Commission for the Accreditation of Echocardiography Laboratories (ICAEL). Our Echo Lab is one of only three laboratories in Canada to be accredited by the ICAEL, and one of only two accred-ited in transthoracic echocardiogram, transesophageal echocardiogram and stress testing disciplines.
Congratulations and thank you to all of our expert so-nographers and Echo Lab cardiologists at the Schulich Heart Centre for their hard work and dedication to making our Echo Lab one of the very best in the coun-try. Laurie Legere
Above: Paul McMullin, Chief Cardiac Sonographer performing an echocardiogram.
Sunnybrook Speaker Series
Innovations in Cardiology:The Newest Lifesaving Techniques
Join us for a heart healthy eveningTuesday, February 22, 2011 6:30 – 8:30 P.M.
Leading Sunnybrook experts will discuss:
• UpdateonMitralValveSurgery:Dr. Gideon Cohen, Cardiovascular Surgeon
• RoboticsintheTreatmentofCardiacArrhythmia:Dr. Eugene Crystal, Director, Arrhythmia Services
• CoronaryArteryDisease:HowtoStayOutofTrouble:Dr. Shaheeda Ahmed, Cardiologist
• ARecipeforHeartHealth:Daphna Steinberg, Registered Dietitian
Moderator: Dr. Bradley Strauss, Chief, Schulich Heart Centre
Please RSVP your attendance by February 21, 2011 Phone: 416.480.4117 E-mail: [email protected]
Free Admission Free Parking, Garage One
Tuesday, February 22, 2011 6:30-8:30 p.m.McLaughlin Auditorium, Bayview CampusE Wing Ground Floor, 2075 Bayview Avenue
How to reach us:Your Health MattersSunnybrook Health Sciences Centre2075 Bayview Avenue, Suite D1 00Toronto, ON M4N 3M5 P: 416.480.4040E: [email protected]
Your Health Matters is published monthly by the Communications & Stakeholder Relations Department and the Sunnybrook Foundation. Submissions to Your Health Matters are welcome, however, they are subject to space availability and editorial discretion.
Sunnybrook Health Sciences Centre is inventing the future of health care for the one million patients the hospital cares for each year through the dedication of its more than 10,000 staff and volunteers. Internationally recognized leadership in research and education and a full affiliation with the University of Toronto distinguish Sunnybrook as one of Canada’s premier academic health sciences centres. Sunnybrook specializes in caring for Canada’s war veterans, high-risk pregnancies, critically-ill newborns, adults and the elderly, and treating and preventing cancer, cardiovascular disease, neurological and psychiatric disorders, orthopaedic and arthritic conditions and traumatic injuries.
$470MCAMPAIGN GOAL
69%RAISED TO DATE
Campaign spotlight
The community has invested $325 million in Sunnybrook as of January 31, 2011. Learn how the Campaign for Sunnybrook is saving lives at sunnybrook.ca.
Risky businessAs a patient coming to the hospital, you may worry about things like making sure your surgery is on time, or not acquiring an infection during your stay. You’re probably not even considering that an information system could shut down, impacting the ability of your nurses and doctors to order the tests needed for your treatment. This risk, and dozens of others, are realities in all hospitals. But now, Sunnybrook has implemented a program that does the worrying for you.
It’s called the Enterprise Risk Management (ERM) Program, a big title for a simple idea: stopping trouble in its tracks. The program identifies what the risks are across the hospital, and then does something to either fix or prevent each one according to priority. For exam-ple, making sure all areas are connected to automated, and not manual, back up systems should a blackout occur is a high priority. Other issues, like reducing er-rors from manual processing of some payroll codes, are on the radar but not as urgent.
“A reality in life is that risk doesn’t entirely go away,” says Ru Taggar, director of Quality and Patient Safety at Sunnybrook. “You take a risk every time you drive your car. But you can do things to mitigate that risk, like not being sleepy while driving and wearing your seatbelt.”
Historically, hospitals have focused on things like pre-venting hospital acquired infections and medication er-rors. Now, in addition to focusing on everyday patient safety, Sunnybrook is also documenting and managing the bigger picture risks that could negatively impact the efficient and effective operation of the hospital. Many hospital Board members now come from private sector
backgrounds, like banking, industries that have long taken a big lens approach to figuring out what problems could paralyze their organizations. These hospital Board members are beginning to ask this same very important governance question of hospital management.
“Management teams are also asking the questions,” says Michael Young, executive vice president at Sunnybrook. “I’m responsible for a third of the hospital, and I know the risks in my portfolio. But as a part of the Senior Leadership Team, I should understand the risks in total to the organization. That helps enhance our ability to work as a team.”
Knowing more means you can do better. Sunnybrook’s ERM Program makes that happen, making clear the se-verity of each risk should it occur, the likelihood it will happen and how to play defense (known as “mitigation strategies”). While a number of Canadian hospitals have begun to implement ERM, what differentiates the Sunnybrook program is that it’s been implemented without hiring new positions or using external consul-tants. Sunnybrook has leveraged existing resources and created a very cost effective solution.
“That’s so important at a time when hospitals are trying to minimize their administrative expenses and maxi-mize the amount of our limited resources going towards patient care,” says Young.
The ERM reports are reviewed and updated several times a year, governed by the appropriate board com-mittees for action, and presented to the Board annually.
“I sleep better at night knowing what the issues are,” Young says. “I lose sleep over the issues I don’t know about.”
He says this is a key message for other hospitals and or-ganizations. Young hopes Sunnybrook’s ERM Program will serve as an efficient and cost-effective model, be-cause you can’t manage what you don’t know. Monica Matys
Pre-hospital care team wins first place in international competition!
Recently, a pre-hospital care team comprised of Toronto EMS and Sunnybrook staff competed in and won the Dutch Open Ambulance Competition. Twenty-four Dutch teams as well as one team each from Belgium, Germany, Canada, Israel and Norway completed a day-long test of their pre-hospital skills and at the end of a long day of competition Canada’s entry was the overall winner!
Canada’s team was comprised of: Jennifer Shield, su-pervisor and advanced care paramedic (ACP) with
Toronto EMS (TEMS), John Klich, ACP with TEMS, Dr. Michael Feldman, medical director of Sunnybrook-Osler Centre for Prehospital Care (SOCPC), and Don Reid, ACP with TEMS.
Says Dr. Feldman, who is also a Sunnybrook Emergency Department physician: “We were all very honoured to be able to represent Canada at this international event. It is very valuable to have an independent objective evaluation performed of our practice at an international level, and it is even better to know that we placed first!”
The scenarios the teams had to complete were: •team work/physical skills (e.g. blindfolded stretcher
carry through obstacle course, tightrope walk)•blunt trauma with a severe head injury•penetrating abdominal trauma with an agitated by-
stander interfering with crew•paediatric drowning•trench rescue of a patient with an underlying medical
condition•precision driving skills
Toronto and Ambulancezorg Nederland have had a relationship for over five years in which a lot of informa-
tion has been shared. When they decided to host their first ever ambulance competition, a team from Toronto was invited to attend.
“The group got together several times prior to the trip,” says Maud Huiskamp, senior manager at SOCPC and team coach during the competition, “and we focused on communication, team building, skill training, sce-narios, creative problem solving, and more communi-cations approaches.”
The teams all met in Harderwijk (central Holland) in an industrial park used for construction education and where their national ambulance academy is located. All teams were briefed the evening before the event regard-ing the rules, and were oriented to the terrain. Each international team was assigned a Dutch facilitator who oriented the team to the ambulance, explained equip-ment, and gave direction when needed.
Two parallel tracks were setup to accommodate all 29 teams. There were a large number of volunteers and professionals involved, from actors posing as patients, to traffic control, and evaluators (two per scenario).Laura Bristow
Upcoming eventsTuesday, February 22, 2011, 6:30 – 8:30 P.M.
Innovations in Cardiology:The Newest Lifesaving TechniquesMcLaughlin Auditorium, Bayview CampusE Wing Ground Floor, 2075 Bayview Avenue
Please RSVP your attendance by February 21, 2011 Phone: 416.480.4117 E-mail: [email protected]
Tuesday, March 29, 2011, 6:30 – 8:30 P.M.
Preventing Blood Clots in Women: From Pre-pregnancy to PostmenopauseMcLaughlin Auditorium, Bayview CampusE Wing Ground Floor, 2075 Bayview Avenue
Please RSVP your attendance by March 28, 2011
Phone: 416.480.4117, E-mail: [email protected]
“...stopping trouble in its tracks. The program identifies what the risks are across the hospital, and then does something to either fix or prevent each one...”
