Photo by Cindy Cui / Photo Editor

A new study led by McMaster researchers may change the medical treatment of heart attack survivors.

The COMPLETE study, led by Dr. Shamir Mehta, staff cardiologist at Hamilton Health Sciences and professor with the Population Health Research Institute at McMaster University, investigates reducing survivor’s risk of future heart attacks.

Heart attacks occur when arteries supplying the heart with blood are blocked. Doctors typically open up the artery responsible for the heart attack and treatment proceeds with medications such as blood thinners, beta blockers and low-dose aspirin. The COMPLETE study, however, aims to investigate whether opening up more potentially problematic arteries is preferable to medication-focused treatment options.

“Given its large size, international scope and focus on patient-centered outcomes, the COMPLETE trial will change how doctors treat this condition and prevent many thousands of recurrent heart attacks globally every year,” said Mehta in a McMaster press release regarding the study. 

Arteries are “opened up” through a procedure known as percutaneous coronary intervention, a non-surgical procedure in which  a small structure known as a stent is put in place to widen blood vessels supplying blood to the heart. Blood vessels that require this procedure are usually narrow due to a buildup of plaque.

Beginning in 2013, the COMPLETE study has enrolled over four thousand patients with acute heart attacks from 31 countries. Upon arriving at collaborating hospitals, patients are quickly installed with a stent to widen the narrowed artery. If cardiologists discover one or more arteries that are more than 70 per cent blocked during the procedure, that patient becomes eligible for the COMPLETE study.

Patients are randomized to one of two groups: one returns 45 days later to install more stents while the other heads home with normal medication centered treatment. 

The study found that 7.8 per cent of patients that had additional stents installed either had another heart attack or died. By contrast, 10.5 per cent of patients receiving conventional care experienced these outcomes.

“This study clearly showed that there is a long term benefit in preventing serious heart-related events by clearing all of the arteries. There was also no major downside to the additional procedure,” said Mehta.

The COMPLETE trial earned international attention after being published in the New England Journal of Medicine early last week, and was presented at the World Congress of Cardiology in Paris. Whether the study’s findings will convince more doctors that partially occluded arteries should also be opened up, or result in a change in medical practices remains to be seen.

The study may prove to be of special importance to Canadians. Heart disease is the second leading cause of death in Canada and cardiovascular diseases account for approximately 30 per cent of all deaths worldwide. Making changes to improve the treatment of patients with multivessel disease may help to save lives in the future.

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Hamilton is a city of stark inequalities. As the city’s economy booms, many Hamiltonians are swept to the sidelines as a result of a housing crisis and employment insecurity. Compared to other cities in Ontario, Hamilton also has a high proportion of working class people, disabled people and refugees, who are often the first to feel the brunt of these changes.

Health outcomes over the past decade have been bleak, and according to many disability justice and healthcare advocates, show no signs of changing unless bold steps are taken to support Hamilton’s marginalized populations.

 

The Code Red Project

In 2010, the Hamilton Spectator released Code Red, a project that mapped the connections between income and health across Hamilton to explore the social determinants of health. Using census and hospital data from 2006 and 2007, the report showed strong disparities in health outcomes between the Hamilton’s wealthiest and poorest neighbourhoods.

The Code Red project shows that social and economic inequalities lead to health inequalities. The lower city, which experiences disproportionately higher rates of poverty, also has significantly poorer health outcomes.

In February 2019, an updated Code Red project was released using data from 2016 and 2017. The updated Code Red project found that in general, health outcomes in Hamilton have declined and inequalities have grown.

Since the first Code Red project in 2010, the average lifespan in parts of the lower city has declined by 1.5 years. Furthermore, the gap in lifespan between Hamilton neighbourhoods has grown from 21 to 23 years.

 

Hamilton: the past 10 years

These results come as no surprise to Sarah Jama, an organizer with the disability justice network of Ontario. According to Jama, given the lack of political change coupled with changes in the city of Hamilton, it was inevitable that poverty would worsen and inequalities would deepen.

Jama notes that health care and social services tend to be compacted into the downtown core, which has tended to have a higher concentration of people who rely on these services.

However, rising costs of living within the downtown core has meant that the people who access these services are being priced out. According to a report by the Hamilton Social Planning and Research Council, eviction rates have skyrocketed in the past decade. As a result, the people who rely on these services have to make compromises about whether to live in a place with supports available close by, or a place that is affordable.

“The more compromises you have to meet with regard to your ability to live freely and safely in the city the harder it is to survive,” said Jama.

Denise Brooks, the executive director for Hamilton Urban Core, works directly with people at the margins of Hamilton’s healthcare system. Brooks noted that the 2010 Code Red project was a wake up call for many.  

“For me one of the biggest takeaways [from the first Code Red project] was even greater resolve that this really is a political issue and that it hasn't been looked at and is not being looked at as a crisis,” stated Brooks.

The 2010 Code Red project sparked projects including the Hamilton neighbourhood action strategy and pathways to education program. According to Brooks, while these initiatives were beneficial, more robust policy is needed to substantially address poverty.

“... [C]an we see any change in policy orientation? Did we see a reallocation of resources? Did we see a redistribution of priorities in any way? I would have to say no,” said Brooks.

 

Looking ahead

The updated Code Red project calls for a restructuring of the traditional health care system to include social and economic programs that contribute to people’s overall health.

However, recent political changes have led many health advocates to worry that the coming years will see change for the worse. Matthew Ing, a member of the DJNO research committee, notes that provincial cuts to a slew social assistance programs threaten to further exacerbate the existing inequalities in Hamilton.

In November 2018, the provincial government announced reforms to Ontario Works and the Ontario Disability Support Program that aimed to streamline social assistance and incentivize people to return to work. Among many changes, this includes aligning the definition of disability to align with the more narrow definition used the federal government.

According to Jama, narrowing the eligibility requirements for disability support makes it likely that people will slip through the cracks. They will put the responsibility on the municipality to provide services, meaning that care is likely to differ between providers.

“The onus is going to be on individual service providers on all these people to really decide who really fits this idea of being disabled enough to be on the service versus it being like sort of supervised by the province,” stated Jama.

Additionally, in February 2019 the provincial government announced plans to streamline and centralize the health care process. Under the proposed model, Ontario Health teams led by a central provincial agency will replace the existing 14 local health integration networks across the province.

Brooks noted that this has not been the first time that the province sought out to reform healthcare. Having worked in community health for years, Brooks remarks that the changes that are made to healthcare frequently exclude people on the margins.

“It's always the people who are the most marginalized, the most vulnerable, the socially isolated and historically excluded that remain on those margins all the time regardless of the change that go through,” said Brooks.

Currently, patient and family advisory committees work to inform the work of LHINs. The government has not announced whether PFACs will be retained under the new model, but Ing worries that a centralized model would leave patients and families out of the decision making process.

However, Ing recognizes that the current system is far from perfect, noting that disabled communities were not adequately represented on PFACs. According to Ing, this speaks to the much larger problem of political erasure of people with disabilities.

“Disability justice means that we must organize across movements, and we must be led by the people who are most impacted,” writes Ing.

The DJNO was created in order to mobilize disabled communities and demand a holistic approach to healthcare reform. According to Jama, this includes seeing race, income, and disability as fundamentally interconnected.

However as social assistance measures are cut at the provincial level, the future for disability justice is murky. The results of the updated Code Red project paint a sobering picture of the state of health inequality in Hamilton. Given the direction that healthcare reform is taking on the provincial level, health and poverty advocates worry about the future of healthcare equality in Hamilton.

 

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A new bistro at the St. Joseph’s Hospital is hoping to bring some colour to the monotony of hospital life. The bistro is an expansion of the services of Colours Café which has been serving St Joe’s for two and a half years. The café, located on the second floor of the West Fifth campus of the hospital, is a brightly lit space surrounded by artwork and high tables. In-patients say that café is a haven. In the early morning, the steaming coffee pot and the sunlight filtering in through the large windows provides a warm wake up call to patients and visitors alike.

The café is administered by Rainbow’s End, a social enterprise looking to provide employment opportunities for people who have struggled with mental health issues and addiction. When St. Joe’s approached Rainbow’s End to see if they would run a store out of their building, Rainbow’s End saw it as the perfect opportunity to open up jobs and train employees. At first, the café opened with just coffee and cold counters, but it didn’t take long for sales to pick up.

“It’s gone from success to success,” said David Williams, the Executive Director of Rainbow’s End.

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The café currently employs 11 people and is also open on weekends, when most places have closed their doors.

As of early February, Rainbow’s End was able to expand into a full kitchen in the first floor cafeteria, made possible by donations from the recent MSU Charity Ball. Workers at the new bistro have access to full commercial equipment that allows for expanded food prep training. Costumers are lining up for the hot breakfast and lunch plates, capitalizing on the opportunity for warm food in a building that serves most food in cold counters.

Williams hopes that the great food and service produced by his employees will contribute towards breaking the stigma of mental health.

Maribeth Chabot, the food services and manager chef for Rainbow’s End, said that she hopes Colours Café will provide the employees with skills to succeed in other jobs as well.

“Hopefully when I am done, these guys can move on and be a line cook in someone else’s restaurant. They will know all the things that a line cook needs to know, and the procedures of how a restaurant is run. You get a crowd of 50 people lining up for lunch. That kind of demand is reality. It gives them really good exposure to that and good skills in today’s market. And we laugh, we have too much fun.”

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Williams hopes that the great food and service produced by his employees will contribute towards breaking the stigma of mental health.

“What excites me most is really the opportunity to offer training and a real job to people that would like to get back to work and have to face certain hurdles such as mental health and addiction. The most important thing for us was to get it open, employ the right people and establish the business and credibility. I think we have done that,” says Williams.

Expectations for people working at the café or bistro are no different from other restaurants. In fact, employees are expected to already have or be planning to get their food handling certification.

As for the physical layout of the space, the bistro has a similarly airy feel as the café. The food is prepared right in front of the customers, with the stoves in plain sight of the cash register. The employees are not only learning to prepare food, but they are doing so in an environment where the people they are hoping to please are watching them work. So far the challenge has been met with enthusiasm.

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Williams knows this may not be the most comfortable of situations for staff. “It’s challenging. It would be challenging for anybody to prepare food that way.”

He also recognizes that perhaps his employees also have an edge others may not.

“We actually like to think that many of our team members, because they have experienced mental health challenges, have a lot of empathy with people who do have the same conditions. We feel that there is a degree of communication there that they can establish with other team members, with patients in hospital, with friends of patients who are coming to visit them.”

“I have a brother who has problems; I have a nephew I lost to suicide. I have been a chef all my life, I have made good money. I owned a restaurant. At this point in my life it’s time to give back.”

Chabot has nothing but praise for Rainbow’s End and their work at St. Joe’s. “I can tell you that working for Rainbows End has been one of the most rewarding jobs of my career. I mean, we can’t have a meeting where I don’t cry. They are a fabulous organization with people who care and with huge hearts. I am privileged to be a part of it and I get choked up. I have a brother who has problems; I have a nephew I lost to suicide. I have been a chef all my life, I have made good money. I owned a restaurant. At this point in my life it’s time to give back.”

Photo Credit: Alex Florescu

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McMaster's Health Science Faculty Loses Mass Funding

Jaslyn English

McMaster University has lost more than 15 per cent of its research dollars in the past year, totaling up to a $100 million loss of funding within the city of Hamilton.

The research in the Faculty of Health Sciences relies on pharmaceutical companies for the majority of its funding and in recent years, the companies’ interest in the University’s research has plummeted.

Since the pharmaceutical industry provides approximately 90 per cent of research funding for this sector of the University, this is a huge setback for McMaster’s research capabilities.

Joel Lexchin, a professor of Health Policy and Management at York University, was quoted in the Hamilton Spectator saying that pharmaceutical companies have halved the dollars going to research and development in Canada.

The Spectator quoted Dr. Salim Yusuf, a professor in the Department of Medicine at McMaster as saying, “We’ve had one of our worst years financially,”

The main reason for the drop in funds, besides a steadily decreasing investment from pharmaceutical companies in general, is that three multi-million dollar Hamilton-led drug studies have been shut down for safety concerns.

It would appear that McMaster and the Health Sciences Faculty have been adversely affected by the funding cuts, considering it was the only university in the top six national research earners to lose funding.

Though McMaster still maintains its rank as sixth nationally on Re$earch Infosource Inc, a reporting site that tracks research and development dollars in universities across Canada, it was also the only university in the top six to lose any funding.

Similarly, four of the five top hospitals lost money, but Hamilton Health Sciences was hit the hardest.

In Jan. 2012, the provincial Liberal government scrapped $42 million in university research grants, which halted research progress across Ontario even before the lack of pharmaceutical companies’ interest was realized this year.

Although the cuts to research grants may be significant, it takes constant long-term depreciation before a loss in funding is felt by research institutions such as those housed in Health Sciences.

“If this were to be a longer term trend over two to four years, then yes, it would have an impact,” said Marvin Ryder, an assistant professor of marketing at McMaster.

A potential loss of student research jobs and a diminished interest in the research done by the Health Sciences faculty can mean lack of funding which has further repercussions for students and faculty.

Dr. Yusuf  stated with confidence that it is “a temporary blip” and that the university will “bounce back.”

Despite the optimistic climate, it is clear that next year’s research, coupled with results of the impending provincial election, will have a significant impact on Health Sciences research capabilities and the overall research intensity of the institution.

Bushra Habib

Silhouette Staff

 

To those passing by the Ronald McDonald House, at the corner of Cootes Drive and Main Street West,  the building looks complete. Though construction is not yet finalized, it is drawing closer to its  much-anticipated completion date of March 31.

When the expansion is finished, the facility will have the capacity to house up to 40 out-of-town families whose children who are patients at the McMaster Children’s Hospital. In addition, the facility will offer family-centered support programs, as it is located just steps away from the hospital.

The Ronald McDonald House has received $8.6 million in federal and provincial infrastructure grants, and has relied on community fundraising for an additional $5 million to complete the project.

McMaster contributed  by donating a charitable portion of $9,500 from 2011 Charity Ball for the initiative.

“Our mission is to provide support and accommodations for families who are out of town, with children who are very sick being treated at the McMaster Children’s Hospital,” said Chantell Tunney, the executive director of the Ronald McDonald House.

The House, which previously had 15 rooms, is open to families of inpatients, including those in neonatal, oncology or pediatric critical care. They also serve outpatients and their families, such as children receiving cancer treatments and those participating in day clinics.

“We help families that are staying at Mac, and McMaster helps families that are staying with us,” said Tunney. “Some of this will be new territory for us, but we really view our relationship with Mac to be symbiotic because we’re all taking care of the same families. It is to really make sure that the entire circle of care is looked at.”

More than doubling in size to 56,000 square feet, the House primarily aims to meet family needs. Included in the new renovations are a larger kitchen, a quiet café-like dining area, dedicated breastfeeding rooms with breast pump sterilizers and private washrooms in every room.

In addition to the necessities, the renovated House will have more common rooms, quiet lounges, a Games Room pool table and gaming consoles, an underwater-themed playroom and an inbuilt movie theater, which includes a generous donation from La-Z-Boy Furniture for theater seating.

There are 13 Ronald McDonald Houses in Canada, and Hamilton’s has been around since 1933.

“Our location is one of the biggest benefits that we have. When you consider that families are leaving their children at the hospital to come and sleep here, the closer you can be, the better.

Families love the fact that when they’re in one of our upstairs rooms that are facing the Cootes side, they can actually see the hospital, and there is a comfort level knowing that the staff is right there.”

McMaster students have also been a big part of the House’s success. “Our volunteerism is fantastic,” said Tunney. “We have so many student volunteers, and we are a very youthful House … we are lucky to be at the position we are in.”

Kacper Niburski

Assistant News Editor

Watermelons. Helium balloons. Cookies with pink icing.

While such novelties could very well describe the perfect picnic, these instead were present at the Children’s Emergency Department open house on Nov. 5.

Having closed their doors to anyone older than eighteen years of age since Apr. 4, the open house served as an invitation from the hospital to the broader community to showcase both what has been built and what currently goes on in the Children’s Emergency Department at McMaster Children’s Hospital.

Visitors were given a look into various areas of the Emergency Department, from the trauma rooms to the casting areas for broken bones. Additionally, demonstrations of IVs and cast moldings were performed for children.

The entire emergency has been tailored to meet the needs of children. Waiting and treatment areas are more spacious to accommodate family comfort, from bulky strollers to worrisome grandparents. Separated ambulances and walk-in entrances, as well as an isolated trauma bay and treatment room, serve to minimize a child’s exposure to the more gruesome aspects of medicine.

Dona Teles, Clinical Manager for the Children’s Emergency Department, stressed this design layout, saying “the point of the Children’s Emergency Department’s infrastructure was to limit the experience with needless trauma.”

Unique to the hospital is an overwhelmingly child-friendly environment. Bright colours highlight an otherwise bleak hospital exterior. Areas have been designed as to mirror the urban landscape. Interactive screens with a variety of games function as apt distractions. Together, these unique features further assist the children and families during the stressful time of a hospital emergency.

“We did not want it [the Emergency Department] to look so medicalized, with equipment right when you entire the room. We didn’t want people to be looking at it as a hospital, but as a welcoming playland,” said Teles.

But not all was gumdrops and lollipops, despite the fact that the current infrastructure and infantile atmosphere may remind some of exactly that.

Teles noted that, “The ER change was very controversial in the beginning, when we were separating the hospitals and putting them into their centres of excellence. We became the centre of excellence for children.

“It wasn’t that we were building a centre for children. It was that we were taking something away from the adult population; and in a sense we did,” said Teles.

Plans to do just that began in 2008 when Hamilton Health Sciences (HHS) introduced the “Access to Best Care” (ABC) plan, which served to ensure healthcare was coordinated to be at the highest quality possible.

To do this, the hospital planned to strengthen its centre of excellence in Pediatrics, which culminated in a pediatric Emergency Department, Pediatric Critical Care Unit, and an inpatient mental health unit.

Last summer saw the application of this plan for the Hamilton Health Sciences began construction of a new Children’s Emergency Department. The opening of the Emergency Department represented the very butt-end of nearly $650-million in investments.

Despite this, controversy swelled. Ward 14 Councillor Robert Pastua was worried that besides some people being unaware of the change, others would have to drive further to receive the same care.

Other politicians chimed in, including Flamborough Ward 15 Councillor, Judi Partridge, who went so far to say that, “The pressure on the system created by this closing appears to be ill thought out – the risk is someone may die.”

“The days of every hospital being exactly the same as the others are long gone. Modern medicine and the need to have high technologies in places means you can’t have one of everything in every place,” said Jeff Vallentin, Vice President of HHS in charge of Communications and Stakeholder Relations, in response.

While both sides boomed their voices of concern, lost in the verbal fireworks was that the switch not only altered the way in which immediate care was carried out, but implicitly refashioned the entire hospital’s method of care, from how it operates to how it delivers various services.

To this point, the 270 staff members, 102 beds, and numerous departmental changes were observed. Much of the staff and medical equipment was partitioned between other Hamiltonian hospitals such as the Juravinski Hospital, which received 185 of the staff members, or Hamilton General Hospital, which received six of the beds.

Irrespective of these changes, the explicit benefits of whether or not the move has been advantageous remains to be seen. Certainly, the youngest of the population are being cared for. But lingering questions still remain to those left behind, especially considering that the hospital is situated in a University with some 20,000 students that are not eligible for immediate care.

Perhaps in an attempt to answer the enduring concerns, or perhaps to appease the bitterness some community members may still hold, Teles boldly concluded with, “It is the best and only place we should be bringing our children to for care.”

And with an entire emergency department retrofitted for children and familial needs, from distracting games to a child-friendly environment, this may certainly be true.

Children may not want to just be brought to the hospital. Instead, they may want to stay there too.

 

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