Patients First 2011-2012
Article
Date
New Centre for Complex Diabetes Patients
Winter Health: Bronchiolitis Season
Starting now, There’s No Place Like Home
Genetics at North York General Hospital: Top ten facts
Exciting changes coming to North York General
Prenatal Classes and Tours at NYGH
Palliative Care at NYGH receives major gift
Six Simple Truths about Cancer Prevention
Addressing Stigma in Mental Health
In Case of an Emergency...
Helping Prevent Serious Fractures in Higher Risk Patients
Keeping You and Your Family Safe
Helping You Live Through Loss
Facing Alzheimer's Disease
Feeding Difficulties and Children
Culture’s impact on mental health care
Dec. 2012
Nov. 2012
Nov. 2012
July 2012
July 2012
June 2012
May 2012
April 2012
March 2012
Feb. 2012
Feb.2012
Feb. 2012
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Jan. 2012
Jan. 2012
Dec. 2011
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New Centre for Complex Diabetes Patients
December 11, 2012
On Thursday, November 29, the Honourable Deb Matthews, Minister of Health and Long-Term Care,
attended the opening of the Centre for Complex Diabetes Care (CCDC) at the Branson site of North York
General Hospital.
The CCDC is a program for patients with complex diabetes needs, such as unmanaged diabetes
complications, barriers in accessing health care, and recurrent emergency department visits or
hospitalizations.
“Diabetes patients with complex needs now have a single point of access through the CCDC at North
York General,” says Tim Rutledge, President and CEO of NYGH. “The CCDC offers our patients in the
community, and across the Central LHIN, a specialized interprofessional team to provide the support they
need to take control of their disease.”
The CCDC team includes an endocrinologist, nurse practitioners, registered nurses, registered dieticians,
social workers, a pharmacist and a chiropodist. The team works directly with each patient's primary care
provider to maintain continuity of care and avoid service duplication.
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The event was a great success and was attended by staff, members of the provincial government, and
other health care stakeholders. Several patients of the program were also able to attend and take part in
the launch.
“I am so pleased this Centre is now available to people with diabetes,” says Malcom Koss, one of the first
patients admitted into the program. “I know this team will be there for me until I don't need them anymore
and I can care for myself.”
If you, or a loved on, require extra help managing your diabetes and think this program could be right for
you, speak with you health care provider or visit our diabetes page for more information:
www.nygh.on.ca/diabetes.
Winter Health: Bronchiolitis Season
November 19, 2012
Winter is here and with it comes influenza (flu) season. During this time of year viruses are easily spread,
making it difficult to enjoy the winter months if you or your family members are ill. North York General
Hospital (NYGH) is seeing an unexpected number of influenza cases, but has noticed a surge of younger
patients, particularly infants, being admitted due to bronchiolitis.
Bronchiolitis is a common infection of the lungs caused by a virus. The infection causes airways in the
lungs to swell, making airways narrower and breathing difficult. Most cases of the infection are caused by
a virus called Respiratory Syncytial Virus (RSV) which is different than the flu virus.
“In older children and adults, RSV may present itself as a runny nose and cough, but in younger children,
specifically infants, the virus can be much more severe and those are the cases we have been seeing
here at the hospital” explains Dr. Ronik Kanani, Paediatrician at NYGH.
Symptoms parents should look for to detect if their child has the virus include:
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Trouble breathing, including fast, shallow breathing or high pitched breathing that sounds like
wheezing
Cough and nasal congestion
Fever
Increased irritability, crankiness, or tiredness
Eating or drinking less
Usually lethargic or sleepy demeanor
Dehydration
If your child is exhibiting these symptoms, they should be assessed by a physician to determine the most
appropriate method of treatment. Most children have mild symptoms and can be managed at home, but
those with more severe symptoms may require hospitalization. Treatments in hospital may include
oxygen, IV fluids, and sometimes medications that are used to treat asthma.
Dr. Kanani advises that some children are at higher risk of developing RSV than others. “It is important to
be more cautious with infants who were born prematurely, and those who have underlying heart, lung, or
neurological problems. Children who are exposed to smoke, have asthma or other respiratory illnesses
are also at greater risk.”
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Similar to the flu, the viruses that cause bronchiolitis are spread through coughing, sneezing and
touching. In children, the risk of catching a virus increases from playing closely together and sharing toys.
“Similar to the flu, the most effective way to prevent the spread of these viruses is through proper and
frequent hand washing, “says Dr. Kanani.
Some other important prevention methods include: not allowing smokers in your home or near your children, staying
away from others while they are sick, cleaning toys which are being shared between children, and teaching children
to cough and sneeze into their elbows.
NYGH expects to see many more patients with RSV and the flu in the coming weeks. There is still time to significantly
reduce your chances of developing the flu by getting your flu shot. Find more information on upcoming flu shot clinic
from Toronto Public Health.
Starting now, There’s No Place Like Home
November 9, 2012
On October 16, North York General Hospital officially launched There's No Place Like Home, our new
discharge philosophy that supports patients as they return home after their treatment finishes in the
Hospital.
Evidence shows a discharge home, even if it's to make a decision about long-term care, is the best
solution because it:
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Reduces risk for hospital acquired infections
Reduces risk for hospital associated deconditioning
Gives more time/support to wait for preferred long-term care home
Provides time to optimize functioning after hospitalization before making major decisions about
the future
Provides the best environment to experience the significant life transition of moving to (in most
situations) a final residence, a nursing home
Too often, seniors are waiting in hospitals and entering long-term care homes with health care needs that
can be safely met in their homes, with the proper home care support. There's No Place Like Homeis not
meant to replace a hospital stay or an admission to a long-term care home. As always, the type of care
an individual needs is the key factor in any decision about the best place for them to receive the care they
require.
There's No Place Like Home, is part of a broader discharge planning initiative all hospitals in the Central
LHIN are participating in, together with the Central Community Care Access Centre, to ensure all patients
in our LHIN are receiving consistent messaging about supportive care offered in the community.
There's No Place Like Home will help reduce our number of ALC days, decrease waits in the Emergency
Department and ultimately ensure we are providing patients with the right care, at the right time, in the
right place.
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Genetics at North York General Hospital: Top ten facts
July 27, 2012
North York General's Genetics Program meets the needs of people through all stages of life: from
preconception through pregnancy, and from childhood through the adult years. Our program offers
comprehensive diagnostic, counselling and testing services to individuals and families with genetic
concerns. Interested in learning more about Genetics at NYGH? Here are 10 more facts you should
know:
1. The Cytogenetics laboratory opened in 1982 with one technologist. Since then, the Genetics
Program has grown to also include the Molecular Genetics laboratory, Maternal Serum
Screening, laboratory, Clinical Genetics and over 70 staff.
2. The Molecular Genetics laboratory tested over 900 patients for hereditary breast cancer gene
mutations in 2011.
3. The Charlotte and Lewis Steinberg Familial Breast and Ovarian Cancer Clinic began in 1998 with
an interdisciplinary approach to care. The care team includes a clinical geneticist, genetic
counsellors, a gynaecologist and a family physician who provides high risk surveillance for
women attending the clinic. The clinic is recognized by the OBSP (Ontario Breast Screening
Program) High Risk Program.
4. The Maternal Serum Screening laboratory is the largest of its kind in Ontario. Through analysis of
chemical markers in the pregnant woman's blood, it provides prenatal screening for Down
syndrome, spina bifida and Trisomy 18. It tests over 33,000 patients each year.
5. Last year, the Cytogenetics laboratory performed karyotype analysis on 3750 specimens to
detect chromosome abnormalities that can be used to diagnosis genetic syndromes and help
determine the prognosis for certain types of cancer.
6. Clinical Genetics is participating the CIHR sponsored FORGE (Finding of Rare Disease Genes in
Canada) study. This study uses genome-wide sequencing to identifying genes responsible for
causing rare disorders in Canadian children.
7. The Molecular Genetics laboratory is a provincial laboratory offering a wide range of genetic
testing with a special focus in neurological disorders for patients in Ontario and other provinces.
8. The Maternal Serum Screening laboratory is actively involved in research. It has been an
international; leader in incorporating new markers to improve the accuracy of prenatal screening
in order to reduce the number of pregnant women undergoing invasive testing.
9. The Huntington multidisciplinary clinic was created in 1993. Genetics staff, neurologists,
psychiatrists and social workers provide integrated care for patients suffering from this
progressively debilitating inherited neurological disease. The clinic has joined a multi-centre drug
trial to study the effect of Coenzyme Q10 on progression of Huntington symptoms.
10. The Genetics laboratory has been providing microarray services to Genetics Program patients
since the Fall of 2011. Microarray can detect smaller chromosome deletions and duplications
than standard chromosome karyotyping. It is commonly offered to patients with developmental
delay, multiple congenital anomalies and autism in order to investigate the underlying cause of
their symptoms.
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Exciting changes coming to North York General
July 25, 2012
NYGH is pleased to announce a new retail plan. The plan's objective isto make the best possible use of
our hospital space in order to create an outstanding patient, visitor and staff experience. A greater array
of retail services reinforces our strategy of putting patients first by making their stay more comfortable and
convenient. The plan includes revitalizing spaces within our hospital, creating a more welcoming and
warm space with exciting new retail outlets.
Here are some of the amazing changes coming to North York General:
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The south lobby will be revitalized to optimize the atrium and create a welcoming and warm
space with clustered social setting, improved sightlines and visibility to retail, elevators and
overall way-finding.
Retail will continue from the lobby and past our Gift Shop leading our patients and visitors to a
refreshed cafeteria
The Pharmacy will relocate and expand to a new space clustered with the Gift Shop and
Cafeteria on the ground level
A 24-hour Tim Hortons will open close the Emergency Department offering a much-needed food
offering especially after hours. Tim Hortons will also remain in the cafeteria offering two location
options.
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Prenatal Classes and Tours at NYGH
June 7, 2012
North York General Hospital has a wide variety of ways to support families as they prepare for a new
arrival. The hospital offers many classes and tours as parents count down to the big day – here's a list of
what we have to offer:
1. Labour and Delivery class
Designed to prepare you for the birth of your baby, the Labour and Delivery Class will be consistent with
your experience at North York General – something patients have stressed is very important to them.
Labour and Delivery Nurses provide an interactive, informative and engaging class, complete with a tour
of the Labour and Delivery area and the Mother and Baby Unit. Participants usually will have the
opportunity to dialogue with an Obstetrician and Anaesthesiologist during the tour.
2. Caring for Your Baby class
Experienced and enthusiastic Mother and Baby nurses will teach you how to care for your baby during
your hospital stay and once you go home. This informative class is lots of fun and designed to make you
feel better equipped to care for your new baby at home. A bonus: plenty of practice bundling and holding
and a baby bathing demonstration.
3. Breast is Best class
Taught only by Lactation Consultants (LC), this class is a combination of the theory behind breastfeeding,
as well as various activities that allow participants to learn and practice various important breastfeeding
skills. Parents give high praise to our skilled LC teachers, who use a variety of props to enable
participants to practice what they are being taught.
4. New Mandarin classes available
To serve our community better, North York General has recently introduced classes in Mandarin Chinese.
We currently offer Labour and Delivery and Caring for Your Baby classes in Mandarin. In the very near
future, we will also offer the Breast is Best Class in Mandarin in which Mandarin speaking nurses and
Lactation Consultants provide accurate, evidence based information, in a culturally sensitive, interactive
setting. We look forward reviewing patient and family feedback about these classes so that we can best
meet the needs of our Mandarin speaking patients and families.
5. Link to Life Emergency Workshop
This special workshop prepares participants to manage child-related medical emergencies. A variety of
topics are covered from basic first aid and CPR for infants and children to child proofing your home.
6. Prenatal Tours
Prenatal tours are provided twice per week by our wonderful NYGH volunteers. They include a tour of the
Labour and Delivery and Mother and Baby units and provide a general overview of the patient and
family's birth journey from admission to discharge home. These tours are designed for our patients and
family members who do not plan to register for prenatal classes.
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Palliative Care at NYGH receives major gift
May 2, 2012
Palliative care services at North York General Hospital (NYGH) will continue to serve our community well
into the future because of a recent $ 1 million donation to the palliative care program, now called the
Freeman Centre for the Advancement of Palliative Care. This donation will further propel our
educational and academic vision of educating the next generation of palliative care professionals while
providing compassionate and seamless end-of-life care to more patients and families.
Palliative care is philosophy of care with a holistic approach to patients with an incurable disease while
supporting families and loved ones along the journey. Palliative care affirms life and treats death as a
normal human process. Patients and family care goals are supported by an inter-disciplinary team to
ensure patients have the best quality of life possible. Our palliative care program provides relief from pain
and other distressing symptoms with attention to psychological, social and spiritual issues. It is care that
spans a continuum from diagnosis until death and through bereavement.
The vision for the Freeman Centre for Palliative Care was initially inspired by a dedicated group of family
physicianswho identified a need to provide home-based care to dying cancer patients and their families.
The Freeman Outreach Program, along with six inpatient beds dedicated to acute pain and symptom
management, celebrates its 13th anniversary in May 2012. Since its launch, more than a thousand
cancer patients have been able to die with dignity, receiving expert and compassionate care, from the
Freeman Centre for Palliative Care's inter-professional team and many more patients were able to die in
the comfort of their homes, surrounded by loved ones.
The Freeman Centre for Palliative Care's services includes inpatient consultation,six acute pain and
symptom management beds, an outpatient pain and symptom management clinic and an outreach team.
The Centre is supported by three full time palliative care physicians, 12 family practitioners, two
psychiatrists with expertise in psycho-oncology and supportive care, an inpatient and outpatient advance
practice nurse, frontline nurses, social workers, chaplains, occupational therapists, physiotherapists and
pharmacists.
Education is an integral part of the Freeman Centre for Palliative Care. Inter- professional workshops in
pain and symptom management, end-of-life issues, bimonthly Palliative Care Rounds along with training
of family practice residents, physician fellows, nursing and social work students provides the ongoing
development of expertise in palliative care among the health care professionals of today and tomorrow.
Daryl Roitman, MD, FRCPC
Nina Horvath, MD, CCFP, FCFP
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Six Simple Truths about Cancer Prevention
April 4, 2012
In recognition of Cancer Awareness Month, the Cancer Care team at North York General Hospital wants
everyone in our community to know how to reduce their risk of developing cancer. Here’s the good news
– almost 50% of cancers can be prevented by following these six steps:
1. Don’t smoke: Smoking is the single most important cause of cancer; it causes about 90% of lung
cancer deaths in women and almost 80% of lung cancer deaths in men. All forms of tobacco –
smoking, chewing and second-hand tobacco smoke – can cause lung cancer, cancers of the oral
cavity (e.g., larynx, pharynx and esophagus) and urinary tract (bladder and kidney), cervical
cancer, and acute myeloid leukemia, as well as some cancers of the stomach and pancreas.
2. Eat well and be active: More than one-third of cancers can be attributed to poor diet, unhealthy
body weight, and physical inactivity. Eating a well-balanced diet rich in fruits and vegetables,
exercising regularly, and maintaining a healthy body weight can significantly reduce your risk of
developing cancer.The preventative power of a healthy lifestyle can also reduce your risk of
diabetes, heart disease, stroke and other chronic conditions.
3. Limit alcohol: Research shows that drinking any type of alcohol – beer, wine or spirits – raises
your risk of many types of cancers including breast, colon and rectum, esophagus, larynx, liver,
mouth and pharynx.The less alcohol you drink, the more you reduce your risk.If you choose to
drink alcohol, keep it to less than one drink a day for women and less than two drinks a day for
men and be a non-smoker. Tobacco and alcohol together are worse for you than either one on its
own.
4. Limit your exposure to UV rays and never use tanning beds: If you can, plan your outdoor
activities before 11 a.m. or after 4 p.m., when the sun is at its weakest, or any time of the day
when theUV Index is three or less. Wear a hat and sunglasses to protect your eyes and face. If
you are going to be outside for long periods, apply generous amounts of sunscreen 20 minutes
before going outside.You can find your city or town’s daily UV Index by visiting the federal
government’s weather office.
Here are two truths: skin cancer is the most common type of cancer and indoor tanning causes
cancer. Tanning beds and sun lamps release UV raysthat start the tanning process in the skin –
just like the sun. Tanned skin is damaged skin. When a tan fades, the damage is still there.
Exposure to UV rays – whether from the sun, tanning beds or sun lamps – increases your
chances of gettingskin cancer.
5. Get your vitamin D: There is growing evidence that vitamin D may reduce the risk of some types
of cancer, particularly colorectal and breast cancers. You can get vitamin D from exposure to
sunlight, in your diet (especially if you eat foods fortified with vitamin D), or by taking vitamin
supplements.
Experts are now concerned that many people are not getting enough vitamin D due to our
northern latitude and because the sun’s rays are weak in the fall and winter. Talk to your doctor
about taking 1000 international units (IU) a day during fall and winter months.
6. Talk to your primary care provider about screening: Screening tests help find some types of
cancer early, before you have any symptoms. Some screening tests can even help prevent
cancer by finding changes in your body that would become cancer if they were left untreated. In
Ontario, three provincial screening programs exist for breast, cervical and colorectal cancer. As
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well, men who are approaching 50 and should talk to their primary care provider about the risks
and benefits of prostate screening.
Source: Cancer Care Ontario and the Canadian Cancer Society
Addressing Stigma in Mental Health
March 13, 2012
In a 2006 Canadian survey 22 per cent of respondents reported that they had been treated with
disrespect by medical and/or administrative personnel or had a physical ailment ignored because of their
mental illness or addiction. This is the impact of stigma.
The textbook definition of stigma is a mark, or sign of disgrace which distinguishes someone from the rest
of society. When applied to mental illness and addictions, the term describes the stereotyping, prejudice
and discrimination prevalent in the day-to-day lives of those with mental illness. Stigma is a complex idea
that involves attitudes, feelings and behaviour, and most experts agree that two of the main contributing
factors are ignorance and fear.
Stigma can affect how organizations, including social service agencies, employers, health care providers
or schools, respond to a person with a mental illness and their families. People with a mental illness will
often hesitate to seek help for their mental health conditions for fear of being looked down upon,
discriminated against or labelled based on their condition. When help is sought, it is reported that the
urgency or acuity of mental health and addiction crises are often not recognized, and requests for
assistance when symptoms escalate are often ignored. In addition, stigma can also lead to physical
health problems being overlooked when individuals with a history of mental health conditions seek
medical help. This often happens as a result of stigma, as some health care workers may attribute any
health problem to an individual's mental health condition.
Understanding Stigma: Building Organizational Capacity and Driving Sustainable Change is a project
being developed with LOFT Community Services as the lead agency, North York General Hospital
(NYGH) as one of two pilots sites, with the support of the Central LHIN, and funded by the Mental Health
Commission of Canada (MHCC). The goal of the project is to build awareness and provide health care
workers with new strategies for working with mental health and substance abuse patients. The project
focuses on implementing a sustainability process, to ensure attitudes established throughout the project
are then maintained.
“We are very excited that North York General has agreed to be one of our pilot sites,” said Arla Hamer,
project coordinator. “It is a wonderful synergy that our project with the goal of addressing stigma fits so
well with North York General's new Patient Values; which highlight the expectation to be treated fairly and
without discrimination as well as with respect, kindness, compassion and courtesy.”
The Emergency and Mental Health departments, as well as hospital security, will begin training in March.
Contact with individuals with mental illness and who have experienced stigma is vital to the training
experience. As a component of sustainability, booster training sessions will be provided in the months
following the initial training. The MHCC will be evaluating the training and sustainability through a pretest
and voluntary survey to be completed at three and six months, designed to understand the impact of the
project's components.
Dr. Thomas Ungar, Chief and Medical Director of NYGH's Psychiatry program, highlighted the major
concepts of the training at Mental Health Grand Rounds earlier this year on January 27. “Mental illnesses
account for a large percentage of hospital stays every year. In spite of the fact that every Canadian knows
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someone who has been, or will be, affected by mental illness, there remains a general lack of knowledge
around mental health,” Dr. Ungar stated. “By developing awareness of our attitudes and making a
commitment to do things differently, each of us can make a difference in the lives of those who are
struggling with mental health and addiction issues.”
By participating in this project, NYGH is contributing to a body of knowledge about addressing stigma and
is helping to develop a sustainable model that will be replicated in other settings across the country.
In Case of an Emergency...
February 28, 2012
A visit to the emergency department (ED) can be a stressful experience. While many injuries and
illnesses require emergent care; waiting for treatment in a busy emergency facility can be the last thing a
person needs when suffering from a cold or flu.
“Many people who visit the ED don't require emergency treatment, but don't know where else to go,” says
Helen Richard, Interim Program Director, Emergency Department. “While we do treat non-life threatening
injuries and illnesses, our priority is to treat the most seriously ill or injured patients in our Charlotte &
Lewis Steinberg Emergency.”
Helen stresses that NYGH's Urgent Care Centre is designed specifically to manage less serious illnesses
or injuries quickly and efficiently. “Persons with less serious illnesses are more likely to be treated faster
in our Urgent Care Centre,” she says. “Injuries such as broken bones and cuts and illnesses such coughs
and colds are best handled at this centre.”
Still unsure when to visit the Emergency Department versus the Urgent Care Centre? Read the following
symptoms below. (Note: People with worrisome chest pains, signs of stroke or severe breathing
difficulties should call 911 for immediate care.)
For adults:
While not a complete list, the following can best be handled in the Emergency Department.
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chest pain
difficulty breathing, unexpected heavy breathing or shortness of breath
severe bleeding or head trauma/injury
sudden onset of weakness, dizziness
mental health crisis or emergency
Car accident
loss of consciousness
sudden change in speech or vision
any type of severe pain
For children: While not a complete list, in addition to the above, you should bring a child to the
Emergency Department if the child experiences:
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difficulty breathing
high fever
persistent vomiting/diarrhea
will not eat or drink - particularly young children
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inactivity, compared to usual activity levels
While not a complete list, the following are best handled in the Urgent Care Centre:
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Broken bones, sprains, sports injuries
Cuts that may need stitches
Minor burns
Minor abnormal pain (nausea, vomiting, flu)
Ear, nose and throat problems
Coughs and colds
Eye problems
Urgent Care Centre Hours
Monday to Friday:9 a.m. to 7 p.m.
Saturday, Sunday and Statutory Holidays:9 a.m. to 3 p.m.
No appointment is necessary.
Please bring your Ontario Health Insurance card.
For more information visit our website.
Helping Prevent Serious Fractures in Higher Risk Patients
New model one-of-a-kind in Ontario
February 27, 2012
Serious fractures, especially hip fractures, are a consequence of osteoporosis and all too common among
our elderly population in Canada. For an elderly patient, a serious fracture often means a long stay in
hospital and being unable to return to the life they had before being injured.
A new model of care has been developed between Osteoporosis Canada and North York General
Hospital's (NYGH) Elder Care, Medical Imaging and Ambulatory Care programs to help prevent repeat
fractures among high-risk patients.
Most hip fractures occur in people over 70 years of age, and incidence rises exponentially with increasing
age. Hip fractures in elderly people are associated with poor clinical outcomes, including higher mortality
rates (10% to 28% at six months), and functional and walking disabilities. Fewer than half of patients
regain their pre-fracture abilities; with up to 35% of patients, who were living at home, admitted to a
nursing home within one year after a hip fracture.
Led by Dr. Gabriel Chan, the new model was developed after reviewing data that showed 10-15 years
after a minor fracture, patients were much more likely than the rest of the population to suffer a hip
fracture.
“Traditionally, a hip fracture has been the trigger for healthcare providers to explore the reasons why a
patient suffered such a serious fracture, but now that we know earlier minor fractures indicate a risk of
more severe injury in the future, we should focus on prevention and early treatment,” said Dr. Gabriel
Chan, Director of Elder Care at NYGH.
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In this new model of care, NYGH's Orthopaedic Surgeons refer patients over age 50 with a minor fracture
for a bone mineral density scan. After an initial assessment of the patient's fracture risk, a letter is sent to
their primary care provider with instructions for follow-up care. Patients who are determined to be medium
to high risk of a repeat fracture are referred to NYGH's Osteoporosis and Fracture Prevention Clinic,
which provides comprehensive assessment and diagnosis, and determines treatment plans for falls and
osteoporosis. The clinic links day hospital patients with occupational therapists, physiotherapists,
educational programs and home care services.
“This model creates a process where at-risk patients are identified early and creates collaboration
between patients various healthcare providers, improving the continuity of care and early intervention. In
the end, patients will have better long term outcomes,” said Bibi Rampersad, Clinical Team Manager of
Ambulatory Services at NYGH.
“There are many misconceptions about osteoporosis, like only the very elderly and frail could possibly
have the disease,” said Ravi Jain, Director of the Ontario Osteoporosis Strategy. “The new assessment
and prevention model at North York General is unique because it identifies osteoporosis earlier,
increasing a patient's access to treatment options and implementing fracture prevention strategies with all
members of a patient's healthcare team. This model really is the new best practice in preventing future
serious fractures.”
By intervening early, models of care like this one, can prevent patients from suffering a serious fracture in
the future and helps patients maintain a better quality-of-life in their later years.
Keeping You and Your Family Safe
February 9, 2012
Patient safety is everyone's responsibility. While North York General Hospital staff, physicians and
volunteers are committed to providing a safe environment, our patients and visitors play an important role
in creating a culture of patient safety. If you are visiting the hospital or receiving care, make sure to follow
these five tips to keep you or your loved one safe:
1. Help prevent infection. The first step to protect our patients is avoiding the hospital if you feel
unwell. While it's always tempting to visit a loved one being cared for, there's a good chance you
may spread your illness to others. Similarly, whenever you visit the hospital remember to wash
your hands frequently to avoid spreading germs. Feel free to prompt health-care providers to
clean their hands if you feel it is necessary. A kind reminder is helpful.
2. Check for identification. Hospital staff, physicians and volunteers must wear ID badges in
hospital at all times. Do not let anyone care for you who is not wearing a badge. If an ID badge
isn't visible, request to see it.
3. Prevent falls. If you're staying in hospital, there's a chance you will have some mobility issues
and perhaps discomfort. Health-care providers can help you with tasks such as going to the
bathroom or reaching for belongings. It's important to follow their advice on safety – they are best
able to gauge potentially hazardous situations.
4. Make sure you're the right patient. The hospital is a busy place, with many different patients
and needs. Sometimes mistakes can happen. It's important that staff identify you properly before
they provide care. They also must use two methods of identification.Should they fail to do so,
please remind them to check.
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5. Know your medication. It's crucial you understand the reason for all your medications and have
written information about your prescriptions. Always make sure you can read the doctor's writing
– ask for the prescription to be printed legibly if need be.Unsure about a pill? Don't take it unless
you know what it is.
Have a question or comment about patient safety? Feel free to drop us a comment in the box
below. We'd love to hear from you.
For more information, visit “Keeping You and Your Family Safe” on the NYGH website.
Helping You Live Through Loss
February 9, 2012
Leonard and Halina Hart emigrated from England to Canada in February of 1957. Leonard describes the
voyage across the Atlantic Ocean as one of the most memorable times in their relationship. January 1 st,
2012 would have marked 63 years of marital bliss for the couple, but sadly Halina passed away at North
York General Hospital (NYGH)on December 11th, after a six year battle with multiple myeloma.
Losing a loved one can be a lonely, painful experience. For most people, there may be no greater loss
than to be separated from someone who had meaning in, or gave meaning to, your life. The grief
experience challenges us on many different levels — emotional, spiritual, physical, and social. Each loss
experience is as unique as the person going through it and for the recently bereaved coping can be both
difficult and exhausting.
NYGH offers bereavement support for individuals dealing with grief; helping loved ones understand the
meaning of their loss and providing help for moving on with life. Going on from Here: A Guide for Living
Through Loss is a booklet created by an inter-disciplinary Bereavement Support Team (BST) at NYGH.
The BST is available to provide bereavement education to staff, patients and families, in order to ensure
consistent bereavement care is being provided across the organization. High quality compassionate care
and bereavement support for patients and families is part of comprehensive end-of-life care at NYGH.
Going on From Here, not only details the practical activities that must take place after a death (such as
funeral arrangements, entitlement to benefits, etc), but also explains how long the grief may last, what
normal responses to loss are, and how to identify the signs and symptoms of grief.
“Grief is different for each person” says Joan Silcox-Smith, Director of Spiritual and Religious Care at
NYGH and member of the BST. “It is a maze of feelings, reactions and experiences. Your personality,
age and cultural and religious beliefs can all contribute to the way you grieve as well as the length of time
you grieve. The BST and this guide are really about helping people through their journey with grief and
we've seen success with it - Mr. Hart is a testament to that.”
When Halina was diagnosed with multiple myeloma in 2005, Leonard instinctively took on the role of
caregiver. He kept track of her numerous medications and monitored the various dosages that needed to
be administered. He went with her to her many medical appointments, as well as taking on the role of
chef and housekeeper. As Halina's condition progressed, Leonard became overwhelmed.
“Halina was sick for so long and when she passed away I felt a sense of relief that the stress and
pressure of delivering her care was gone” says Leonard. “The book reassured me, it let me know that this
was a common response and I shouldn't feel guilty.”
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Going on from Here helps individuals to understand that the feelings they experience after losing a loved
one are normal. Shock, anger, hostility, sadness, loneliness, guilt – these are all normal reactions to grief.
Many people also feel confused, isolated, preoccupied, depressed, lost or relieved.
At a time that only you can identify, you will begin to feel that things have changed for you and the guide
will provide you with resources to help you move forward with your healing.
Copies of Going on From Here: A Guide for Living Through Loss are available in the NYGH multi-faith
chapel, as well as on the Spiritual & Religious Care Program page of the website, and is printed in nine
different languages, in order to meet the diverse needs of the NYGH community.
For additional resources on bereavement, or bereavement services, please visit the Bereaved Families of
Ontario website.
Facing Alzheimer's Disease
January 23, 2012
It is estimated that over 500,000 Canadians have Alzheimer's disease or a related dementia, and every
five minutes another person will develop the disease. As our population ages, early detection and greater
awareness of the disease is vital.
“One of the biggest misconceptions people have is that they associate poor memory as part of the aging
process and do not inform their physician about this symptom,” says Dr. Gabriel Chan, Director of Elder
Care at North York General Hospital (NYGH). “Without a proper diagnosis during the early stages, brain
cells will continue to degenerate which can impact daily activities and cause behaviour changes.”
Understanding and being aware of the signs and symptoms of Alzheimer's disease can help you and your
loved ones get the best support and treatment as early as possible.
The Alzheimer Society of Canada lists 10 warning signs to watch for:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Memory loss that affects day-to-day function
Difficulty performing familiar tasks
Problems with language
Disorientation of time and place
Poor or decreased judgment
Problems with abstract thinking
Misplacing things
Changes in mood and behaviour
Changes in personality
Loss of initiative
January is Alzheimer's Awareness Month and the Alzheimer Society of Canada launched its “Let's Face
It” campaign to promote the benefits of early diagnosis. Alzheimer's disease is a progressive and
degenerative disease that destroys brain cells. It is the most common form of dementia usually affecting
people over the age of 65. An early diagnosis of Alzheimer's disease can give a person more time to lead
an active and fulfilling life by getting treatments that help delay the progression of the disease.
A recent survey by the Alzheimer Society found that almost 50 per cent of Canadians waited more than a
year after their symptoms began before they consulted a physician; possibly due to stigma associated
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with Alzheimer's disease that prevents people from discussing early signs.
“People often fear that if they have the disease they won't be able to function, have to move into a longterm care facility and believe that their life is coming to an end,” Dr. Chan explains. “It's actually quite the
opposite. If you catch the disease in the very early stages, medication and treatments can help delay the
deterioration, allowing patients to continue living a meaningful life.”
At NYGH, the health-care team works to provide care for the whole person (the physical, psychological
and environmental) and helps patients maintain their life at home. The Memory Clinic provides early
assessment and diagnosis of memory disorders with the aim to support caregivers. This interdisciplinary
service will connect patients with a social worker and occupational therapist for further support and
assessments. For more information about NYGH's Memory Clinic, call the Geriatric Services Line at 416756-6050 ext. 8060 or visit www.nygh.on.ca.
Several community support services are available through NYGH's Memory Clinic, Alzheimer Society of
Canada and your local Community Care Access Centre.
Feeding Difficulties and Children
January 10, 2012
If you've ever struggled at the dinner table with a fussy eater, you're not alone: 50 to 60 per cent of
parents report that they have difficulty feeding their children. Dr. Glenn Berall, Chief of Paediatrics at
North York General Hospital (NYGH), speaks with The Pulse about the complex reasons behind feeding
issues, what parents can do to resolve the problem, and the most important thing to keep in mind during
meal time:
The Pulse: Dr. Berall, thank you for sitting down with us. Could you please explain your role at
NYGH to our readers?
Dr. Berall: Certainly. I am Chief of Paediatrics at North York General, which means I take a leadership
role in paediatrics and ensure we provide quality child- and family-friendly, care. In my clinical practice, I
treat a number of nutrition-related disorders in children. I would say the two most common things I treat as
a physician are feeding difficulties and obesity.
The Pulse: It is surprising that over half of parents report that they have challenges feeding their
children. What are some of the reasons behind these challenges?
Dr. Berall: Feeding difficulties are very complex and there are many different reasons behind them. In the
medical community, the ways in which we categorize feeding difficulties vary and literature tends to report
that 30 per cent of children meet the criteria for medical food refusal and selective eating.
I would break down the two overarching reasons for these difficulties as medically-based and nonmedically based. It's important to note that children can experience a mix of the two. Life often isn't so
clearly defined.
The Pulse: Let's focus on non-medically based reasons…
Dr. Berall: In my practice I see many well-meaning parents who simply need to be assured that their child
is developing as he or she should. Sometimes parents come to me, very worried, believing there is an
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issue when in actual fact their child is eating normally for their weight and height. If this is the case, I am
able to educate parents on the nutritional needs for the child's age. Sometimes, it is simply a matter of
lessening the anxiety of the parent.
There are also cases where children are more interested in playing with toys than feeding. This typically
occurs during the transition from spoon to self-feeding between six months and three years of age. Some
feeding guidelines I give to parents include no grazing, regularly scheduled meals and other principles.
With proper and consistently applied feeding principles, a child's appetite typically returns to normal.
The Pulse: What are the other non-medical reasons behind a child's feeding difficulty?
Dr. Berall: One may be sensory defensiveness. This means that a child refuses to eat based on taste,
texture, smell or appearance. In these cases, the child often has other sensory difficulties such as a
dislike of loud noises or the feel of tags on their clothing. Another reason is a post traumatic-feeding
difficulty, which is rare, and is possibly the result of a frightening experience such as choking.
The big issue is that the medical community doesn't have a common language for describing the medical
reasons behind feeding difficulties. I am part of a group that is working to categorize them so that medical
staff and parents have a definitive guide and can tailor interventions accordingly.
The Pulse: What types of interventions are used for non-medical and medical feeding difficulties?
Dr. Berall: Treatments vary, but one strategy is to make the feeding process more of an interactive
process, one in which the child actively participates. For example, you often see parents feed a child by
putting the spoon directly into the mouth. A better way is to hold the spoon under the child's lip and let him
or her go to the food. This allows the child to access his or her own hunger signals and develop a normal
hunger drive. Coercive feeding methods can worsen the problem.
Another thing I would recommend is that parents turn off any distractions during meal time. It's important
to create a calm environment so that feeding is not associated with the feeling of anxiety. Both the child
and the parent need to feel relaxed and not feel pressured.
The Pulse: What is the one thing that parents should keep in mind when dealing with a fussy
child?
Dr. Berall: Patience. It's easier said than done, admittedly, but the more relaxed you are as a parent and
the more time you allow your child to develop a natural eating rhythm, the easier it will become. Having
said that, if you are feeling anxious about your child's feeding, please seek medical advice. We are here
to help and can provide you with information and a plan of action.
The Pulse: Thank you for this useful information, Dr. Berall.
Dr. Berall: You're welcome. Happy to help!
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Culture’s impact on mental health care
December 5, 2011
On May 31, 2011, the Globe and Mail published an opinion piece by Dr. W.L. Alan Fung, attending
psychiatrist at North York General Hospital, on the role of culture on mental health – specifically, mental
health issues in the Chinese community. Dr. Fung talks to The Pulse about his work at North York
General Hospital, a surprising trend, and the reaction to his editorial.
The Pulse: Dr. Fung, thank you for taking the time to speak with us about your practice. Could
you expand on what you do at the hospital?
AF: My clinical practice is based at both the Branson and General Sites of North York General Hospital
(NYGH). At Branson, my practice focuses on general adult psychiatry and neuropsychiatry, with the
majority of patients being immigrants and/or coming from various ethnic communities. I deal with a wide
range of disorders of the mind and the brain.
At the General Site, I am the psychiatrist for the NYGH Huntington’s Disease Clinic of the Genetics
Program, where I provide neuropsychiatric assessments and treatments to patients. I also work with
families suffering from this devastating disorder in order to enhance their functioning and quality of life. It
is challenging, important and very rewarding work.
The Pulse: Are you involved in non-clinical roles at NYGH?
AF: As an Assistant Professor at the University of Toronto Faculty of Medicine, I am also involved in
academic endeavours at NYGH, including conducting research studies and supervising and teaching
resident physicians pursuing specialist training in psychiatry and family medicine. Earlier this year, I
served on the NYGH Research Strategy Implementation Working Group.
More recently, I have been working with Reverend Joan Silcox-Smith, Director of Spiritual and Religious
Care at NYGH, as well as the NYGH Spiritual & Religious Care Advisory Committee, to devise strategies
in enhancing collaborations between mental health and spiritual/religious care professionals in mental
health care provision.
Pulse: In your opinion piece, your wrote that you get many questions about “koro” (the belief that
one’s genitalia is shrinking) or some other culture-specific condition, but there is comparably less
interest in discussing the prevalent issues in one’s culture. Why do you think that is?
AF: It’s natural to be fascinated by unique and seemingly unusual culture-specific conditions such as
“koro” and it makes for some interesting dialogue on the rationale behind such conditions. I, however, find
discussions about prevalent conditions more interesting and stimulating as they point to widespread
issues in the community.
The Pulse: What type of widespread mental health issues do you mean?
AF: In Chinese, for instance, one such condition is called “shenjing shuairuo” — a condition consisting of
depression, anxiety, insomnia and fatigue. While shenjing shuairuo (also known as "neurasthenia") is not
unique to any one ethnic community – most of us have known someone who has had it or felt it ourselves
– the cultural lens can certainly magnify or distort mental health issues and either hasten or impede
treatment. The challenge is to deliver culturally appropriate services to ensure the best possible care.
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The Pulse: You also wrote about something in the Chinese community that bucks an international
trend...
AF: Yes, suicidality in Chinese Canadian women: Chinese women are more prone to suicide than men.
There is growing evidence that this is true for Chinese immigrants abroad. We believe that this may be
attributable to the rigid gender roles in the Chinese culture, which could lead to conflicts with partners,
families and the community at large.
The stress, as I wrote, is immense and there is a severe lack of Chinese-speaking mental health
professionals in Ontario. Obviously, language is key in expressing mental health issues. In Ontario, some
psychotherapy services in Chinese currently have a waiting list of 1-2 years.
North York General Hospital is working with the University of Toronto, St. Michael’s Hospital and Hong
Fook Mental Health Association to further delineate the gender role stress in our Chinese community.
Through our research, we hope to shed light on a potential health issue going largely ignored.
The Pulse: What was the reaction to the piece in the Globe and Mail?
AF: By and large, it was very positive. I received a lot of positive feedback from my colleagues, friends
and members of the community. I noticed from the comments that some readers thought I was solely
advocating for improved services to the Chinese community. I am advocating for better, culturally
appropriate services for all Canadians. Regardless, I am very glad it sparked a debate. It is important to
me that we bring issues to light and deal with them openly.
The Pulse: What is the one thing you’d like to stress about the role of culture in mental health?
AF: That it is a very, very complex relationship and certainly not limited to the Chinese community. Our
cultural beliefs, values and traditions shape who we are positively, and sometimes negatively. The more
we understand about culture – the more we appreciate and learn about those different from our own – the
more we have an appreciation of the issues our neighbours, friends and other family members face. We
are then better equipped to be supportive and understanding.
The Pulse: Thank you for your time, Dr. Fung.
AF: My pleasure. Thank you for the opportunity!
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