Southlake Regional Health Centre Research Articles

Cardiovascular Disease Risk in SMI Across Various Settings in a Semirural Area – a Study During COVID-19 Pandemic

AimsThe risk for cardiovascular-related death is predicted to be higher in individuals with Serious Mental Illness (SMI) due to increased prevalence of common cardiac risk factors like smoking, physical inactivity, poor diet, substance use and hyperlipidemia among them.MethodsThe aim of this retrospective study was to evaluate the physical health of patients with SMI in various settings- acute inpatient, tertiary care hospital and community.We estimated the cardiovascular disease risk of schizophrenia patients with the aid of Framingham Risk Score (FRS) assessment tool, which can quantitatively predict both the heart age and 10-year CVD Risk percentage of patients aged ≥ 30 years. The clozapine to norclozapine ratio was compared with triglyceride levels, body weight, BMI, and fasting blood glucose in patients after treatment with clozapine. Southlake Regional Health Center's practice was compared with the national standards set by Diabetes Canada 2018 guidelines by conducting a clinical audit.68 non-diabetic, patients aged ≥ 30 years with all the risk factor records for FRS assessment were selected from a cohort of 183 patients registered in the schizophrenia clinic of Southlake Regional Health Centre. The data were collected from patient records from the 75 patients registered with Assertive Community Treatment Team in Georgina, Ontario.The sample size of the study on inpatients was 49 participants from the acute psychiatry ward consisting of 28 females and 21 males during the month of November 2021.ResultsMales, on average, were found to have an intermediate 10-year CVD risk (~11.2%; FRS total points: 11.27) in comparison to females who, on average, had a low 10-year CVD risk (~7.3%; FRS total points: 11.19). 26% of the patients using FRS were calculated to be at high risk and 28% with intermediate risk of developing a CVD. The average heart age of the sample patients was 60 years, which was 9 years higher than the total average age (51 years). The investigated biomarkers of Hemoglobin A1C, triglycerides, and glucose serum concentration were examined graphically, separated into categories of the ratio measurements of 0–2, 2–3, and 3+. For all biomarkers, lower values were more desirable. Triglycerides were the lowest in the 3+ ratio category. Hemoglobin A1C and glucose serum concentration were lowest in the 0–2 ratio category.100% of patients with diabetes had their blood sugar levels measured and 66.67% were referred to an endocrinologist. In patients without diabetes, 91.30% had their blood sugar levels measured, 39.13% had their HbA1C levels measured, and 6.52% had neither their HbA1C, nor their blood sugar levels measured.ConclusionCardiovascular complication can be one of the leading causes of death in the next 10 years among schizophrenia patients due to age, poor lifestyle choices, and current estimations via the FRS assessment tool. Further studies need to be conducted with a larger sample size and more recent data to examine any adverse lifestyle changes in schizophrenia patients during the pandemic, which could have negatively influenced their cardiovascular health. It is recommended that doctors weigh the risks vs benefits of prescribing clozapine to patients with high triglyceride levels.

What older adults and their caregivers need for making better health-related decisions at home: a participatory mixed methods protocol

IntroductionShared decision making is an interpersonal process whereby healthcare providers collaborate with and support patients in decision-making. Older adults receiving home care need support with decision-making. We will explore what...

Referral Bias in Coronary Micro vascular Dysfunction: a Retrospective Study

Obstructive coronary artery disease (CAD) is a well-defned condition and a signifcant cause of myocardial ischemia. Patients with angina typically undergo non-invasive cardiac investigations initially as a means of risk-stratifying. Coronary angiography is the diagnostic test of choice for patients with chest pain (angina) and signs of myocardial ischemia on noninvasive testing. Typically CAD is diagnosed based on the patency of the epicardial coronary arteries [1]. Approximately 30% of patients with angina have non-obstructive arteries on coronary angiogram and area diagnostic and management challenge for clinicians, contributing to signifcant social and economic burden [2]. They undergo multiple angiograms, experience a hospitalization rate 80% greater than patients with single vessel CAD and up to 50% have persistent symptoms leading to functional disability [3]. Historically, this population was given reassurance as long-term prognosis was believed to be benign [4]. We now know that a subset of these patients sui¬Â€er from coronary micro vascular dysfunction (MVD) [1] and are at increased risk for adverse cardiac events including congestive heart failure (CHF), myocardial infarction (MI), left ventricular (LV) dysfunction, and death [1,5]. The Cardiovascular Integrated Physiology (CVIP) program at Southlake Regional Health Centre (SRHC) investigates and manages patients with MVD. CVIP has received referrals for only a small fraction of patients with angina and non-obstructive angiograms at SRHC. It is unclear what factors promote referral. We hypothesized that referrals were not random and that the clinical characteristics of the referred patients dii¬Â€ered from the larger population of patients with angina and nonobstructive CAD. The primary objective of this study was to determine whether the patients referred to CVIP are an accurate representation of the overall population of patients with angina and non-obstructive coronary arteries.

Using Lean to Improve Wait Time Performance in Diagnostic Assessment for Lung Cancer.

Cancer Care Ontario developed a diagnostic assessment program (DAP) to improve patients' experience in the diagnostic phase of their cancer journey and improve health system efficiency and effectiveness. The Stronach Regional Cancer Centre Lung DAP (at Southlake Regional Health Centre) used learnings from a Lean improvement event to increase capacity to meet patient demand for service and to achieve/improve upon the provincial wait time target from consultation to diagnosis for lung cancer patients (65% within 28 days), improving overall patient experience of care. Monthly patient volumes have increased by 65%, and wait time has improved by 60%.

Group format rehabilitation is equally effective as individual therapy in patients with surgically repaired rotator cuff tears.

Does group physiotherapy methods produce different results when compared with individual physiotherapy in persons with surgically repaired rotator cuff tears? No studies to date have examined the feasibility or effectiveness of such therapy formats. Given the prevalence of rotator cuff tears, a study examining group format therapy is warranted and can produce evidence to transform care for rotator cuff tear rehabilitation. We analyzed the electronic medical records of persons that underwent rotator cuff repair surgery followed by the prescribedpost-surgical physiotherapy at Southlake Regional Health Centre. Both groups were provided standard physiotherapy intervention protocol for post-operative rotator cuff tear. Active range of motion (AROM), quick disabilities of the arm, shoulder and hand (Q-DASH) measures, and efficiency measures were examined for differences between groups. No significant differences between AROM (abduction p=.92, lateral rotation p=.64, and flexion p=1.00) and Q-DASH (p=.62) measures between groups were observed at discharge. Overall, group therapy participants required a greater number of visits (p=.000); however, when separated by age groups, only the 60- to 69-year-old participants significantly differed in number of visits between groups (p=.000), whereas no difference was observed in the 50- to 59-year-old participants (p=.14). Group format physiotherapy may be equally effective as individual formats in improving AROM and functional outcomes of participants with surgically repaired rotator cuff tears. Further research is needed to determine the optimal age range for group therapy interventions in this population.

Comparison of Non‐Invasive Peripheral Vascular Function to Invasive Measures of Coronary Function in Patients with Suspected Coronary Microvascular Dysfunction

IntroductionThe purpose of this study is to compare non‐invasive vascular assessments to invasive gold standard measures of coronary flow and resistance in patients with suspected coronary microvascular dysfunction (CMD), a condition driven by systemic endothelial dysfunction. We hypothesize that non‐invasive measures will be associated with both coronary flow and resistance following pharmacological hyperemia.MethodsForty‐one patients with suspected CMD attended the Cardiovascular Integrative Physiology Clinic at Southlake Regional Health Centre. Patients underwent finger‐based arterial tonometry (RHPAT) to non‐invasively quantify microvascular endothelial function (EndoPAT). A subset of participants (n=15) also concurrently completed flow mediated dilation (FMD) of the brachial artery to assess conduit artery endothelial function. Briefly, a standard blood pressure cuff was positioned on the right arm of patients, distal to the elbow joint. Baseline recordings preceded 5 minutes of forearm ischemia, and was followed by cuff deflation, eliciting reperfusion. Within 4 months, patients underwent coronary reactivity testing using the Doppler guidewire method. Specifically, the coronary flow reserve (CFR), and the index of microvascular resistance (IMR) were calculated during pharmacologically‐induced hyperemia using adenosine, then acetylcholine, then dobutamine. Prior to each stimuli, baseline measures were obtained to ensure hemodynamics results to baseline.ResultsRHPAT was negatively correlated to the IMR during dobutamine (r=−0.39, p=0.04), but not the CFR (r=0.14, p=0.49). FMD was negatively correlated to the IMR during adenosine (r=−0.64, p=0.01), but not the CFR (r=0.29, p=0.30). RHPAT and FMD were not correlated to the IMR or CFR during acetylcholine.ConclusionThese preliminary results suggest that measures of non‐invasive peripheral vascular function can predict pharmacologically induced changes in coronary resistance, but not coronary flow.Support or Funding InformationSt. Jude MedicalThe Heart of Gold Cardiac Research FundYork UniversityThis abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Improving patient access and streamlining processes through enterprise intelligence systems

This article demonstrates how enterprise intelligence systems can be used to improve operational efficiency in hospitals. Enterprise intelligence systems mine raw data from disparate systems and transform the data into actionable information, which when used appropriately, support streamlined processes, optimize resources, and positively affect staff efficiency and the quality of patient care. Case studies on the implementation of McKesson Performance Visibility and Capacity Planner enterprise intelligence solutions at the Southlake Regional Health Centre and Lions Gate and Richmond Hospitals are provided.

A training program designed to improve interprofessional knowledge, skills and attitudes in chronic disease settings

For over 25 years, The Arthritis Program (TAP) at Southlake Regional Health Centre has worked within a successful interprofessional model. TAP recognized the need to teach its model and developed The Arthritis Program – Interprofessional Training Program (TAP-ITP). This pilot study evaluated perceptions of 22 TAP-ITP participants related to effectiveness and satisfaction. The study employed a longitudinal survey design and data were collected at the baseline (T1), post-program (T2), and at one year (T3) by use of the following instruments: W(e)Learn Program Assessment; Interprofessional (IP) Learner and Team Contracts; Interprofessional Collaborative Competencies Attainment Survey (ICCAS); Bruyère Clinical Team Self Assessment Scale; and Attitudes Toward Health Care Teams (ATHCT). Data analysis included descriptive, non-parametric and parametric tests. Results indicated participants were very satisfied with TAP-ITP. ICCAS scores revealed statistically significant differences (Wilcoxon rank sum tests) from T1 to T2 in perceptions of IPC competencies (p < 0.05). Paired t-tests for each T1 to post (T2 and T3) scores were all significant (p < 0.05) for each Bruyère subscale and overall scores. For ATHCT, paired t-tests for each T1 to T2 were significant for Quality of Care/Process (p = 0.04) and borderline significant for Physician Centrality scale (p = 0.06). At T3, improvement in both scales was maintained. This pilot study suggests that TAP-ITP improves self-assessed scores of knowledge and skills, as well as attitudes in interprofessional care post-program and sustained at one year.

Development of Anticoagulation Guidelines for Postoperative Cardiac Surgery Patients

Oral anticoagulants are widely used for prevention of stroke and valve thrombosis in the postoperative cardiovascular surgery (CVS) setting. The recent advent of novel oral anticoagulants prompted a process review of treatment modalities within the CVS Program at Southlake Regional Health Centre (SRHC). A treatment gap was identified in that there were no standardized treatment modalities for the use of the novel and existing anticoagulants. In addition, the management of the patients that required anticoagulation was not cohesive amongst all the practitioners throughout the CVS program.

Clinical utility of the Hospital Anxiety and Depression Scale (HADS) for an Outpatient Fibromyalgia Education Program

This paper examines the clinical utility of the Hospital Anxiety and Depression Scale (HADS) in the context of evaluating the Fibromyalgia Outpatient Education Program at Southlake Regional Health Centre (Newmarket, Canada). A pre-test/post-test design was implemented for data analysis. A total of 232 patients' data were obtained through retrospective patient chart review. Complete pre-post data were available for 70 patients and qualitative analysis was done for 12 patients. Main outcome measures included HADS and Arthritis Self-Efficacy (ASE) scores. At the end of the education program, subgroups of patients (high attendance, high exercise habit, low medication) experienced significant improvement on HADS-depression and ASE scores. Linear regression analysis found that HADS pre-program scores explain far more variance in HADS post-test scores than ASE pre-program scores explain in ASE post-program scores; more variance in ASE post-program scores was explained by other variables. In contrast to the quantitative analysis of the Anxiety subscale of HADS, patients in the focus group indicated that their anxiety level decreased through attending the education program. These findings suggest that HADS is an appropriate tool for evaluating fibromyalgia and related patient education programs. Moreover, patient education programs have positive effects on enhancing patients' psychological well-being and self-confidence in controlling fibromyalgia-related symptoms.

NP013 Optimizing Bed Utilization in a Regional Cardiac Program With Cost Savings March 2012

The demand for acute care hospital beds is a constant pressure for most hospitals in Canada today. Health care centres must optimize the supply of open beds to accommodate the daily pressures that are presented each day. Southlake Regional Health Centre is located within the Central LHIN in Ontario and is the only centre providing advanced cardiac services for this region. The population of men and women aged 50-69 in this region is expected to increase anywhere by 27-69% between 2007 and 2016. As a Regional Cardiac Centre, Southlake responds to the needs of eleven parterner hospitals, for patients requiring angiogram/angioplasty. The Interventional Cardiology Program has developed a “Same Day Discharge” strategy and a post angioplasty (PCI) repatriation process with five referring centres. Despite these initiatives, our open door policy for acute ST elevation myocardial infarctions, (STEMI) patients, began developing delays in timely access to acute care beds within the region. This presentation will outline the initiative to optimize bed flow within the region. A select patient group, referred non ST elevation myocardial infarction (NSTEMI) was identified to stay in the CSSU for discharge the following morning. This was done in collaboration with our referring/repatriation hospitals. This presentation will provide the dimensions of a collaborative inter hospital team approach, to improve inter hospital bed flow, patient satisfaction and significant cost savings, while still providing timely access to advanced cardiac care.

Electrograms During AF: What Are They Telling Us?

Journal of Cardiovascular ElectrophysiologyVolume 22, Issue 4 p. 411-413 Electrograms During AF: What Are They Telling Us? ATUL VERMA M.D., F.R.C.P.C., ATUL VERMA M.D., F.R.C.P.C. Southlake Regional Health Centre, Newmarket, Ontario, CanadaSearch for more papers by this author ATUL VERMA M.D., F.R.C.P.C., ATUL VERMA M.D., F.R.C.P.C. Southlake Regional Health Centre, Newmarket, Ontario, CanadaSearch for more papers by this author First published: 29 November 2010 https://doi.org/10.1111/j.1540-8167.2010.01966.x Address for correspondence: Atul Verma, M.D., F.R.C.P.C., Suite 105-712 Davis Drive, Newmarket, Ontario L3Y 8C3, Canada. Fax: 905-953-0046; E-mail: [email protected] No disclosures. J Cardiovasc Electrophysiol, Vol. 22, pp. 411-413. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Volume22, Issue4April 2011Pages 411-413 RelatedInformation

Practice Spotlight: Marie Craig and The Arthritis Program (TAP) at Southlake Regional Health Centre

Care for patients with arthritis has improved greatly over the past 20 years. As a pharmacist working in rheumatology, Marie Craig (known previously as Marie Chambers) has been an active participant in this evolution. Joining the rheumatology team at Southlake Regional Health Centre, Newmarket, Ontario, in 1986, she has made the transition from educating patients about gold injections in the 1980s to educating them about self-injection of methotrexate in the 1990s and the use of biologics in the new millennium. Ms Craig started her career in arthritis care after 16 years at St Michael’s Hospital in Toronto. Joining the Pharmacy Department of Southlake Regional Health Centre in 1986, she soon became involved with the rheumatology team. In 1991, Southlake received funding from the Ontario Ministry of Health and Long-Term Care to establish a rheumatology outpatient program, officially known as The Arthritis Program or TAP. Through this funding Ms Craig formally joined The Arthritis Program, where her new colleagues became the program’s coordinator, 2 occupational therapists, 2 physical therapists, a social worker, and 2 rheumatologists. TAP, which provides care for patients with 135 types of arthritis, not only services the York Region but also draws 2000 new patient referrals per year from a much larger geographic area. The TAP pharmacist’s practice is integrated with the program’s vision of central coordination of all health care disciplines during any patient’s visit. This centralization of care includes documenting the activities of all disciplines in a single health care record, which contributes to more comprehensive care and reduces duplication of not only charting but also patient visits. The one-site, one-chart (including rheumatologists’ notes and health professionals’ charting) vision eliminates the need for each discipline to ask the same questions, while offering the patient easy and continuous access to integrated care. Guided by the Registered Health Professions Act, each health care professional is educated experientially in rheumatology and encouraged to fine-tune his or her discipline-specific skills while thinking “outside the box”. Working together at one site in the Tannery Mall in Newmarket, TAP staff members offer arthritis assessment, education, and treatment by individual appointment, group sessions (for inflammatory arthritis, osteoarthritis, fibromyalgia, and osteoporosis), Rheumatology Clinic appointments (with urgent access to the rheumatologist and other members of the team), and telephone consultation. Through interactions with patients, the TAP pharmacist and other team members frequently identify medication issues requiring intervention. The TAP pharmacist intervenes on behalf of the patient either through the Rheumatology Clinic or through an individual appointment for medication review and education. A large component of the TAP pharmacist’s practice involves assessing medication tolerance and ensuring appropriate education to prepare patients to self-manage their disease. This work environment and role allowed Ms Craig to practise according to the philosophy of pharmaceutical care, even before this philosophy had been firmly defined or taught. After 20 years of exposure to patient medication concerns, Ms Craig developed a medication decision model that asks patients to balance the probable side effects of the arthritis (if untreated) against the benefit of the medication and its possible side effects. The medication information is presented to the patient in an unbiased manner, with the ultimate understanding that it is the patient who will make an informed decision about his or her care. At times, the TAP pharmacist acts as a mediator, advocating on behalf of both the patient and the rheumatologist to find a medication management strategy agreeable to both. Ms Craig and the TAP team document clinical activities in the patient chart and track workload statistics for the

Terapia de ponte com heparina ou cumarínico continuo para cirurgia de implante de estimulador/desfibrilador cardíaco

a University of Ottawa Heart Institute, Ottawa, b Hamilton Health Sciences-General Site, Hamilton, c London Health Sciences Centre-University Hospital, London, d McGill Univeristy Health Centre, Montreal, f Western Cardiology, Victoria and g Kingston General Hospital, Kingston, Canada. e Southlake Regional Health Centre, Newmarket, Ontario. h Instituto de Cardiologia do Rio Grande do Sul Fundacao Universitaria de Cardiologia, Porto Alegre, Brasil, *recipient of a Clinician Scientist award from the Canadian Institutes of Health Research (CIHR).

Developing a Feminist-Informed Model for Decision Making in the Treatment of Adolescent Eating Disorders

In 1997 the Child and Family Clinic treatment team at SouthlakeRegional Health Centre (SLRHC) in Newmarket Ontario, Canadacreated the Eating Disorders Program, which included a day treatmentprogram for adolescents with eating disorders. When firstconceived, this day treatment program was the first of its kind inOntario. The multi-disciplinary team created a feminist-informedmodel centered on developing joint decision making relationshipsamong team, client, and family through sustained and transparentcommunication and negotiation. This model for decision makinghas evolved through careful deliberation and ethical reflectionin the planning and provision of care.