Celebrate Canada’s Healthy Workplace Month!

This month at Iridia, we want to make a real, healthy difference. We are aligning ourselves with the goals of Canada’s Healthy Workplace Month by improving and building upon healthy lifestyle practices, workplace culture, occupational health and safety here in the office.

Healthy Workplace Month!

As a healthy lifestyle is a core focus of Canada’s Healthy Workplace month we wanted to help spread awareness for a local event called Jog4Joy; a 5K walk/run to raise awareness for mental and emotional wellness.

healthy workplace month

Click for larger view.

The Cause

“Jog4Joy is a JOYFUL and EMPOWERING COMMUNITY EVENT raising awareness for mental and emotional wellness. Mental illness/mental health has a large umbrella that includes but not exclusive to: depression, anxiety, bipolar, schizophrenia, eating disorders, addictions, trauma, abuse, grief, poverty, postpartum, bullying and suicide.
It also reaches people suffering with other illnesses such as cancer, arthritis or chronic pain. This affects our community in a BIG way. It knows NO BOUNDARIES affecting people of all race, culture, age, gender and financial circumstances.”

For more information or to register, please visit: http://jog4joy.com/wp/

If you’d like more information about Canada’s Healthy Workplace Month, visit: http://healthyworkplacemonth.ca/en/

Sudden Cardiac Arrest Prevention

Sudden Cardiac Arrest Prevention

Sudden Cardiac Arrest Prevention

At this time there is no definite way to gauge the likelihood of suffering a Sudden Cardiac Arrest (SCA), so reducing the risk is your best strategy. Steps to take include regular checkups, screening for heart disease, and living a heart-healthy lifestyle with the following approaches:

  • Don’t smoke
  • Only use alcohol in moderation
  • Eat a nutritious, balanced diet
  • Stay physically active

Dietary Prevention

A growing body of research supports the role of lifestyle measures in protecting against this sudden, silent killer. Given the serious outcome of this disease, scientists are now looking to diet as one of the most promising primary prevention strategy.

The most important line of defense is adopting heart-healthy lifestyles that can guard against heart disease in the first place.

The urgency of preventive approaches takes on even more meaning when you consider that most victims of SCA weren’t identified as being at risk in the first place.

The results of a study published in a 2011 issue of The Journal of the American Medical Association concluded that 81 percent of cases of SCA were due to unhealthy lifestyles.

The study, funded by the National Institutes of Health, found that a Mediterranean-style diet, when combined with other healthful habits, such as maintaining a healthy weight, not smoking, and exercising, provided a 92 percent reduced risk of SCA.

The researchers evaluated data from the Nurses’ Health Study, which included information from more than 81,000 women over 26 years.

healthy food

Key findings:

  • Women who ate a diet closest to the Mediterranean diet, which is rich in vegetables, fruits, nuts, omega-3 fats, and fish; moderate in alcohol; and light in red meat, had a 40 percent lower risk than women whose diets least resembled the Mediterranean diet
  • Normal-weight women had a 56 percent reduced risk compared with obese women
  • The more the women exercised, the smaller their risk; at least 30 minutes of exercise per day lowered the risk by 28 percent
  • Smoking was the biggest factor: Women who had never smoked had a 75 percent decreased risk than women who smoked at least 25 cigarettes per day

The American Heart Association stresses the following approaches for the general population to achieve ideal cardiovascular health:

  • Fruits and vegetables: at least 4.5 cups per day
  • Fish (preferably oily fish): at least two 3.5-oz servings per week
  • Fiber-rich whole grains: at least three 1-oz-equivalent servings per day
  • Sodium: less than 1,500 mg per day
  • Sugar-sweetened beverages: no more than 450 kcal (36oz) per week
  • Nuts, legumes, and seeds: at least four servings per week
  • Processed meats: no more than two servings per week
  • Saturated fat: less than 7 percent of total energy intake.

We hope we have shed some light on the risks and prevention of SCA. At Iridia, our goal is to fight SCA and the damage it does to our society. Now get out there and start your heart-healthy lifestyle!

All About Airway – Endotracheal Tubes

This week I want to highlight two airway discussion points which have recently come to my attention: cuffed vs. non-cuffed endotracheal tubes (ETTs) in pediatric patients and the possible, negative side effects of supraglottic airways.

Endotracheal Tubes: Cuffed vs non-cuffed

In June, 2012, a memo was released by the BC Children’s Trauma Program advising the use of cuffed ETTs over non-cuffed. I copied the wording below, click the link to see the memo.

“BC Children’s Hospital’s Trauma Program and Pediatric Intensive Care Physicians are requesting that all pediatric trauma and burn patients who require intubation at another facility, be intubated with a CUFFED endotracheal tube. This is currently the standard in the BCCH Emergency Room, Pediatric ICU, and Operating Room.”
 endotracheal tubes
 
“Uncuffed endotracheal tubes run the risk of large air leaks which make effective ventilation difficult, and may require reintubation with a cuffed tube. The risk of reintubating these patients can be of particular concern in the burn population.”

What does this mean to me? I understand how critical airway management and ventilation is to the unstable pediatric patient. The memo specifies pediatric burn and trauma patients. I wonder how this recommendation applies to a primary respiratory or cardiac arrest pediatric patient?

I look forward to your thoughts and discussions.

Stay tuned for tomorrow’s post on supraglottic airways. 

Bath Salts – Medical Director Update

Dr. Allan Holmes & Dr. Erik Vu
Clinical Snapshot: Bath Salts
Subject: Synthetic cathinones
Street name: “Bath Salts”, “Plant Food”, “Cloud Nine”, “Rave”.

What are “Bath Salts”?

Psychoactive drugs containing MDPV1 have entered the recreational drug market, with a recent surge in the United States (US) and Canada. These products are often labeled as “bath salts” or “plant food,” and have been used legally for decades in parts of the US and Europe. These products are also available for online purchase and may be sold under such names as “Cloud Nine” or “Rave.”

What do “Bath Salts” look like?

MDPV and other analogues (e.g. Mephedrone) are often supplied as white powders. Users can snort or ingest these white or brown amorphous or crystalline powders, but since they are soluble in water, these substances can also be injected.

Bath Salts

What are the effects of “Bath Salts”?

MDPV has a chemical structure similar to MDMA2 or “Ecstasy”. The intended effects are improved attention, energy, and euphoria. Clinical features include altered mental status, agitation, delusions, hallucinations, psychosis, fast heart rate, high blood pressure, chest pain and elevated core body temperature, amongst others.

Why are “Bath Salts” dangerous?

MDPV is used as substitute for other stimulants such as amphetamines, cocaine or ecstasy because it can produce the same effects on the brain. MDPV toxicity can present as excited or agitated delirium. Mainstream media have reported bizarre suicides and homicides. Drug-induced psychosis and aggression appear to be more severe than with other amphetamine-like stimulants.

How do you manage patients high on “Bath Salts”?

Agitated patients require urgent medical assessment. Caution should be used when restraining these patients due to the potential of cardiac arrest in patients with excited delirium.

Summary of Key Points

  • MDPV (i.e. “Bath Salts”), has strong stimulant effects similar to cocaine and amphetamines. This compound can be considered an emerging designer drug of abuse.
  • The psychoactive profile of these drugs has gained popularity with widespread use of this compound as recreational drug, particularly among young people.
  • The marketing of MDPV as “bath salts” or “plants fertilizer” provided false assurances on the safety of this substance as drug of abuse.
  • Current case reports show the potential for severe cardiovascular and central nervous system toxicity.
  • Excited delirium is characterized by delirium with agitation, elevated temperature, elevated heart rate and breathing pattern, and can be followed by a period of “giving up,” or cessation of struggle, followed by cardiac arrest.
  • Use caution when engaging a patient exhibiting these signs or symptoms. Use caution if/when restraining these patients.
  • Considering the limited information about the clinical, pharmacological and toxicological effects of this substance in combination with the potential health risks, the alertness of the medical and law-enforcement community is of great importance in order to mitigate the downstream effects of MDPV use.

Best Regards,

Allan Holmes

Medical Director, Iridia

13,4-methylenedioxypyrovalerone, or MDPV
2methylenedioxymethamphetamine, or MDMA

How to Implement Clinical Care Protocols

At Iridia, we have a strong team of subject matter experts who are well versed in the facilitation, project management, and overall coordination of resources. With our background, we have become successful at implementing clinical care protocols.

Clinical Care Protocols

What are clinical care protocols? They are what health care organizations around the world call “best practice” protocols.

These protocols are “tools to improve hospital services” and are synonymous with improving patient care. However, to benefit from these scientific advances, a health care organization must first overcome the challenge of taking an abstract protocol and ingraining it into day-to-day operations. 

Clinical Care Protocols

Currently, there is a substantial amount of inconsistency in the both the process and the success of implementing care protocols. This variability wastes financial and human resources, both of which are already under heavy strain.

The solution is to consistently be able to convert “best evidence” to “real practice.” Health care organizations must employ a proven and practical standardized process that meets the needs of all stakeholders involved.

For example, a recent study of hospitals in the U.S. found that patients who are discharged during the busiest times for hospitals are 50 percent more likely to come back in within three days. The study looked at occupancy rates, day of the week, staffing levels and surgical and concluded that readmissions come from poor planning.

Cutting back on hospital readmissions is a hotly debated topic in the health care industry and there isn’t one simple answer. But the study authors are recommending a few changing for the hospitals; such as using checklists before discharge to avoid infections and moving patients to units with empty beds rather than sending patients home prematurely.

Read the original study here

Now, if a hospital decided they wanted to cut patient readmissions through an infection checklist, they would need to implement a clinical care protocol for doing so.

Who would be responsible for educating and engaging patients? How will the hospital track readmission? How will the protocol be evaluated? What is the timeline for implementation? These are just a few of the many questions to be answered, and that’s where Iridia steps in.

We follow formal project management techniques and in consultation with our clients we develop a coordinated strategy consisting of three phases:

We give hospital staff the tools to manage the protocol so they can answer the key question, “how does this apply?”

Since 2004, Iridia has worked with B.C.’s Provincial Health Service Authority Emergency Department Protocol Working Group to improve the quality care in the province. This has allowed Iridia the opportunity to successfully manage the implementation of both the Acute Asthma Management Protocol and the High-Risk Stroke/TIA Guidelines.

Please visit our website to see other projects we have worked on.

 

 

Fighting Sudden Cardiac Arrest with a Chill

The chances of surviving SCA can be as little as 3 percent, depending on your location and access to EMS. In most cases early defibrillation is the only treatment.

Even if an individual survives a trip to the hospital, their bodies are still in a very critical state. “After we start the heart again, about 60 per cent of people who get admitted to hospital will end up dying as a complication of the cardiac arrest. That’s because other important organs are injured when blood flow stops,” says Steven Brooks, at Toronto’s Sunnybrook Hospital.

Fighting Sudden Cardiac Arrest

For this reason, two hospitals in Toronto are experimenting with therapeutic hypothermia, a deep freeze medical treatment aimed at increasing a patient’s chance of retaining neurological function after suffering SCA.

The goal is to lower the patients’ temperature by roughly five degrees Celsius for a 24-hour period. The cooling is achieved through a combination of ice packs placed around major arteries, a chilled saline solution and temperature controlled blankets.

Fighting Sudden Cardiac Arrest

Dr. Brooks said this cooling treatment is significantly more effective than some other traditional treatments.

One study published in 2002, in the New England Journal of Medicine has demonstrated improved neurological outcomes for the use of therapeutic hypothermia on survivors of cardiac arrest. The study shows a decrease in the mortality rate with patients who have been cooled (41 percent) compared to patients who were not cooled (55 percent).

Despite the positive results, therapeutic hypothermia currently still isn’t a very popular option in Canadian hospitals. It is fairly easy to establish, but takes a very coordinated effort to make it happen.

Fortunately, in Dr. Brooks’ opinion, the effort is well worth it. He has created a dedicated on-call Post Arrest Consult Team (PACT) that will be able to manage therapeutic hypothermia services. Eligible patients who are brought into both Sunnybrook and St. Michael’s hospitals in Toronto will receive a potentially lifesaving deep freeze.

Kelvin Au is one individual who credits therapeutic hypothermia with his survival. In 2009, the 33-year-old was rushed to a hospital after collapsing on a basketball court. The doctors were able to re-start his heart, but he did not regain consciousness. Afraid that his neurological functions were deteriorating, the doctors transferred him to St. Michaels for experimental hypothermia treatment. At that time very few were practicing therapeutic hypothermia at St. Michaels, and the PACT team had not yet been created.

“The doctors had been pessimistic, but they said this cold treatment was the best shot at his recovery,” said his wife, Liz Au.

Fighting Sudden Cardiac Arrest

The treatment ended up saving Mr. Au’s life, but he still suffers side effects of his collapse. “This is definitely one of the things that saved my life,” Mr. Au said. “I now have my life almost back to normal, but I still can’t remember about two weeks of my life around when the heart attack happened and I have short-term amnesia.”

With the recent successes, Dr. Brooks hopes therapeutic hypothermia will eventually lead to application at more hospitals throughout Canada.

Tackling Hospital Readmission

Hospitals have a problem. Frequently, when a patient is discharged, they are readmitted again within a month. Hospital readmission is a huge drain on resources. In North America hospitals spend billions of dollars a year on patients’ return visits.

For example, one in 20 Canadians who has a heart attack — a common cause of rehospitalisation — is urgently readmitted within a month of being discharged, according to the Canadian Institute for Health Information. An analysis published last year in the New England Journal of Medicine showed the chances of rehospitalisation only increase over time.

Tackling Hospital Readmission

Now, obviously, the goal isn’t to prevent individuals from returning to hospital if the need arises. The goal is to provide high-risk patients with the necessary information and tools upon discharge to limit their chances of return.

Hospital Readmission

As times change, hospitals have undergone many transformations to the way care is delivered. From the development of outpatient facilities such as the Jim Pattison Outpatient Care and Surgery Centre here in British Columbia, to the state of the art St. Josef Hospital and Pediatric Clinic in Neunkirchen, Germany, Hospitals are entering an era of change.

So how are hospitals tackling the problem of readmission? The answer is to give patients better follow-up care.

One solution getting growing attention is Project Red — for Re-Engineered Discharge — developed by Boston University. It includes the use of a “virtual discharge advocate” named Louise, who appears as an animated character on an interactive screen rolled up to a patient’s bedside to help in the discharge process.

Facilities in Florida and New Jersey have found another successful tool: nurse intervention and communication. For instance, focusing on nursing education, and have nurses explain discharge plans before patients are discharged.

Medication-related side effects and misunderstandings about what and when to take medicine is a leading cause of readmissions. Nurses, therefore can explain in detail to patients about the medicine they have been prescribed to avoid future complications.

One hospital in Florida devotes a nurse practitioner (NP) to provide transitional care for heart failure patients. The heart failure NP not only provides one-on-one training to the patient in the hospital but also ensures that patients are seen within 7 days of leaving the hospital and receive a follow-up phone call within 48 hours and 10 days of discharge.

For a full overview of hospital readmission challenges and solutions , have a look at this video created by the United States National Health Policy Institute.

[youtube=http://www.youtube.com/watch?v=dRUvsv5V1Pg]

 

Follow-up care is extremely important in reducing hospital readmission rates. All too often, patients are sent out the door without enough information in hand. However, with intervention, an onsite nurse or visiting coach can help cut the rate of readmission’s. 

Heart and Stroke 2011 Annual Report

Year after year the Heart and Stroke Foundation, with support from 130,000 Canadians around the country, is able to invest in ground-breaking research, prevention efforts and advocates healthy change across Canada.

heart and stroke

In British Columbia alone:

  • 24 Foundation funded researchers are investigating new treatments against heart disease and stroke
  • 33 new research projects have been funded
  • A BC Stroke Strategy has been developed
  • A provincial awareness campaign for improved recognition of stroke has been launched

In the 59 years of the Foundation’s existence, the mortality rate for cardiovascular disease has decreased by 25%. And yet, still, close to 250,000 potential years of life are lost every year heart disease. Heart disease and stroke still take 1 in 3 Canadians before their time.

A 25% decrease is very impressive, but there is always more we can do as early onset of heart disease and stroke is 80% preventable.

Even one campaign can leave a lasting impression. For example, in 2011 The Heart Truth campaign helped make Canadian women aware of their leading cause of death; heart disease and stroke. Awareness grew by 12 percentage points among women 35 and older.

Stroke Strategy

After working with the Heart and Stroke Foundation on various stroke related projects, we at Iridia understand their importance. Research funded by the Heart and Stroke Foundation can lead to various projects that that aim to deliver better health care to Canadians. 

Mentioned above, the new British Columbia Stroke Strategy is a key initiative to hit a major milestone in 2011. For the past few years, Iridia has been working with the Heart and Stroke foundation on the development of BC’s Stroke Strategy.

BC stroke strategy - Heart and Stroke

The care stroke survivors received within forty-eight hours after their stroke has a tremendous impact on the length and quality of their recovery. The immediate recognition and treatment of stroke is imperative.

For the first time, a province-wide strategy is in place to improve the prevention and treatment of stroke in BC’s health care system.

According to Pam Aikman, Provincial Director of Stroke Services BC at the Provincial Health Services Authority, “This is a milestone year for stroke care in BC. Thanks to the tireless work by the Heart and Stroke Foundation, we have been able to launch Stroke Services BC, and have a solid plan for implementing ongoing improvements to stroke care here in BC.”

Iridia is proud to have worked with the Heart and Stroke Foundation in the development of the BC Stroke Strategy. We will stand alongside the Foundation in the step-by-step fight against heart disease and stroke.

Learn more about the stoke care strategy: signsofstroke

View the annual report: H&S2011

Visit the Heart and Stroke Foundation: HeartandStroke

An Innovative Look at Fitness

So, it’s a month past Christmas and if you’re like me you’re still feeling a little sluggish post-eggnog, turkey and chocolate, and perhaps not quite into the habit of those resolutions you made to make fitness a priority in 2012. I’m guessing a lot of people are in the same boat, so this year, Global is inviting its staff into participating in a 90-Day fitness challenge.

innovative fitness

The conversation around implementing some kind of fitness program for our staff came out of an indicator from our staff satisfaction survey that 60% were interested in a fitness initiative of some kind. We spent a lot of time researching the types of things companies are doing to promote fitness in the workplace, and went the gamut on ideas from as simple as offering an annual subsidy to individuals for a fitness initiative (gym membership or equipment, personal trainer, etc.) to signing on to a comprehensive online program that offered biometric screening, customized fitness programs, life-change programs (weight loss, smoking cessation, etc.), online tracking, education, individual health and fitness coaching, etc.

In the end, we decided on a program that was more collaborative and team-oriented than simply offering a lump some of money, and that wouldn’t break the bank with the expensive online programs designed for much larger companies. We found a Vancouver-based company called Innovative Fitness (IF) that has provided the best of both worlds for us.

They will run a 90 Day Challenge in which a beginner and advanced walk/run program are developed for those who want to participate, with the goal being participation in three walk/runs per week, with specified goals in terms of heart rate and length of time, depending on the program level. Staff will submit their daily fitness activities by email to the IF coach, who will track each individual’s progress. Innovative Fitness will also provide weekly education updates and fitness tips and provide individual coaching whenever staff need it to modify their programs (MJ in Fort St. John isn’t likely to do a walk/run at -34). At the beginning of the challenge, the team from IF came to our office to do a biometric assessment of all participants (measuring height/weight, BMI, etc.) to provide a starting point. All activities are tracked according to a points system (so many points for submitting your daily log, plus additional points for every 15 minutes of exercise), and every certain number of points gains an entry to a prize to be drawn at the end of the challenge. In addition, everyone doing the challenge will participate in a fun closing event at the end of the challenge to celebrate the achievement of 90 days of increased physical activity.

innovative fitness

When we first talked about the concept, we had no idea what kind of participation we might expect from our staff. To our surprise, we have 100% participation – even our two staff who work remotely from other locations are participating! We are excited about the impact this initiative will have in each person’s health and life, and are looking forward to swapping war stories along the way.

They say it takes 40 days to develop a new habit – we’re hoping that after more than twice that many days, physical activity will become a part of everyone’s life in a new and exciting way. It’s just another way we are investing in keeping our staff healthy and fit (we also provide fresh fruit and healthy snacks in the office), so they can be at their best at work and in life.