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… Commission in 1997, SJHC provides four major services and many more sub-services. Each of our acute/ambulatory, … of: – Oncology Program to LHSC and LRCC – July 1999 – Diabetes to SJHC – May 2000 – Cardiology to LHSC – June 2000 … Phase 2 to SJHC – Oct. 2001 – ENT, Cardiology, and Endocrinology moves – Dec. 2001 – Rehabilitation move to …
FINANCIAL STATEMENTS OF ST. JOSEPHS HEALTH CARE, LONDON | Year ended March 31, 2003 Visit our web site: www.sjhc.london.on.ca Financial Statements of St. Josephs Health Care, London Year ended March 31, 2003 St. Josephs Health Care, London (SJHC) is a very complex organization. Reflective of the sig...
… G:\COMMDEPT\CLINICAL & PROGRAM SUPPORT\Diabetes\Website - Division - citywide list of physician 2012 06 22.docx DIVISION OF ENDOCRINOLOGY & METABOLISM Physician Secretary Phone # Fax # … Disorders Yes Hramiak, Irene Marty Brouwer (clinical) Wanda McBeth (administrative & research) 519-646-6353 …
G:\COMMDEPT\CLINICAL & PROGRAM SUPPORT\Diabetes\Website - Division - citywide list of physician 2012 06 22.docx DIVISION OF ENDOCRINOLOGY & METABOLISM Physician Secretary Phone # Fax # Special Interest Accepting Referrals Clarson, Cheril Cathy Belegris 519-685-8138 519-685-8105 Pediatric Endocrinolo...
London researchers part of a federal funding boost to enhance transition in care research
How can we improve health care for Canadians experiencing “transitions in care” to ensure they don’t fall through the cracks as they move through the health care system?
That’s the question two London researchers are aiming to answer, with the support of nearly $1.5 million in federal funding announced today at Western University's Schulich School of Medicine & Dentistry.
Peter Fragiskatos, MP for London North Centre, announced the funding boost on behalf of Federal Health Minister Jean-Yves Duclos, alongside Dr. Jane Rylett, Scientific Director of the Institute of Aging with the Canadian Institutes of Health Research (CIHR).
“When a person experiences a transition in care, whether moving from surgery to rehabilitation or aging out of pediatric care, the quality of their care and their health can be at risk,” said Bryan Neff, Western’s acting vice president of research, who hosted the funding announcement. “With federal investments like this, Western will continue to lead the way in identifying how to provide the best possible care for Canadians while improving efficiency in the health-care system.”
Transitions in care happen when responsibility for a person’s care shifts between providers, institutions or sectors. Some groups, such as patients with complex medical conditions, Indigenous peoples, and new immigrants, are particularly vulnerable to poor outcomes during transitions.
People with diabetes – a complex, typically life-long condition – fall into this category, which is why London’s Primary Care Diabetes Support Program (PCDSP) was developed. The clinic, which is part of the Centre for Diabetes, Endocrinology and Metabolism at St. Joseph’s Health Care London, is based at St. Joseph’s Family Medical and Dental Centre. The program provides diabetes support and management for individuals with type 2 diabetes who don’t have a family doctor or who may have additional medical and social issues that make diabetes management particularly challenging.
Maria Mathews, PhD, and her team at Schulich Medicine will evaluate the program to determine its impact on patient health, and on health-care providers, diabetes-related complications, and health system costs.
“While this program has already been shown to deliver high-quality care, my team is examining its overall impact to determine whether this model could be expanded to other sites and to support other chronic conditions,” said Mathews, a professor in the department of family medicine. With the $895,000 investment in her research, Mathews will determine “how we can best provide high- quality care for people with chronic conditions in a way that supports their health, eases strain on family doctors, and creates efficiencies in the health care system.”
Laura Brunton, PhD, an assistant professor at the School of Physical Therapy in Western’s Faculty of Health Sciences, received more than half a million dollars in CIHR funding.
Her team will examine a local program based at St. Joseph’s Parkwood Institute – called the Transitional and Lifelong Care Program (TLC) – that supports people with childhood-onset disabilities as they transition to adult care. This includes many patients with brain-based, neurodevelopmental conditions, such as cerebral palsy, spina bifida and developmental disabilities, as they move into adult care.
“Many of these patients have experienced severe health inequities because of the gaps in care when transitioning from pediatric care to the adult sector,” said Brunton, also a physiotherapist at St. Joseph’s Health Care London and affiliate scientist at Lawson Health Research Institute. “We’re going to evaluate the TLC model as an intervention that provides transitional, lifelong care and reduces the barriers experienced.”
Roy Butler, president of St. Joseph’s Health Care London, said today’s announcement highlights the synergy and collaboration among these organizations.
“We are happy to hear that work being done by both Laura Brunton and Maria Mathews to improve patient care is being recognized through this funding announcement. The two areas these talented researchers will be studying are innovative and ground-breaking with compassionate, forward-thinking teams who provide highly acclaimed care to vulnerable patients.”
Fragiskatos emphasized the vital importance of funding this field of research, given that most Canadians will experience a ‘transition in care’ at some point.
“People living in Canada routinely experience transitions in care as they navigate the health system. The important research that will be done here in London and at institutions across the country will help develop meaningful approaches to make these transitions easier for patients and caregivers,” he said.
Local researchers were among 14 groups across Canada that received approximately $12 million in federal funding to improve continuity of care for Canadians through the “Transitions in Care” initiative, which is provided in partnership with the Azrieli Foundation, Mitacs, and the Rossy Family Foundation.
… next phase underway at St. Joseph’s Health Care, London and London Health Sciences Centre (LONDON, ON) – London … Throat (ENT) clinic, Ambulatory Gynaecology, Endoscopy, Diabetes/Endocrinology, Respiratory Therapy as well as a renovated … Throat (ENT) clinic, Ambulatory Gynaecology, Endoscopy, Diabetes/Endocrinology, Respiratory Therapy as well as a …
MEDIA RELEASE For Immediate Release: March 23, 2009 Hospital redevelopment next phase underway at St. Josephs Health Care, London and London Health Sciences Centre (LONDON, ON) London Health Sciences Centre (LHSC) and St. Josephs Health Care, London (SJHC) are now well into the next phase of redeve...
… Newly Diagnosed Type1 Diabetes DERIC MORRISON ASSOCIATE PROFESSOR OF ENDOCRINOLOGY WESTERN UNIVERSITY Resources 2018 Diabetes … its content suppliers or its licensors as the case may be, and is protected by Canadian and international copyright, … Newly Diagnosed Type1 Diabetes DERIC MORRISON ASSOCIATE PROFESSOR OF ENDOCRINOLOGY …
Newly Diagnosed Type1 Diabetes DERIC MORRISON ASSOCIATE PROFESSOR OF ENDOCRINOLOGY WESTERN UNIVERSITY Resources 2018 Diabetes Canada Clinical Practice Guidelines Evidence-based; largely outpatient focused http://www.diabetes.ca (look under For Professionals) http://www.diabetes.ca/ http://www.diabet...
… notified \\lhdat12\vol5\Users\BRUCEDA\Windows\Desktop\Diabetes Endocrinology OPD Referral Form 2017 03 01cv2.docx OUTPATIENT DIABETES & ENDOCRINOLOGY REFERRAL FORM Copies of this form … notified \\lhdat12\vol5\Users\BRUCEDA\Windows\Desktop\Diabetes Endocrinology OPD Referral Form 2017 03 01cv2.docx …
FOR OFFICE USE ONLY Date received Appointment with Appointment date Appointment time Patient notified Referring physician notified \\lhdat12\vol5\Users\BRUCEDA\Windows\Desktop\Diabetes Endocrinology OPD Referral Form 2017 03 01cv2.docx OUTPATIENT DIABETES & ENDOCRINOLOGY REFERRAL FORM Copies of this...
… -referral form - Diabetes Endocrinology OPD Referral Form 2017 03 01c.docx OUTPATIENT … problems Please attach any relevant laboratory, pathology, and imaging results. URGENT ENDO CONSULTANT ON-CALL REFERRAL … -referral form - Diabetes Endocrinology OPD Referral Form 2017 03 01c.docx …
FOR OFFICE USE ONLY Date received Appointment with Appointment date Appointment time Patient notified Referring physician notified \\lhdat12\vol5\users\BRUCEDA\Windows\Desktop\DIA -referral form - Diabetes Endocrinology OPD Referral Form 2017 03 01c.docx OUTPATIENT DIABETES & ENDOCRINOLOGY REFERRAL ...
… of this form available at: http://www.sjhc.london.on.ca/diabetes-endocrinology-centre/referral-forms Revised: March 13, 2019 … Please attach any relevant laboratory, pathology, and imaging results. URGENT ENDO CLINIC REFERRAL – Please … of this form available at: http://www.sjhc.london.on.ca/diabetes-endocrinology-centre/referral-forms Revised: March …
Copies of this form available at: http://www.sjhc.london.on.ca/diabetes-endocrinology-centre/referral-forms Revised: March 13, 2019 OUTPATIENT DIABETES & ENDOCRINOLOGY REFERRAL FORM Please complete all sections of this form for all elective referrals (complete URGENT section only if indicated). You ...
Specialized diabetes care may help prevent recurrent emergency department visits
One in three Canadians is living with diabetes or prediabetes. When they experience complications like severe hyperglycemia (high blood sugar), they require emergency care. For many, one emergency department (ED) visit leads to multiple others.
“There’s an increasing prevalence of diabetes in our population. It’s imperative that we support patients in managing the disease to prevent adverse outcomes and optimize health,” says Dr. Justin Yan, Associate Scientist at Lawson Health Research Institute and Emergency Department Physician at London Health Sciences Centre (LHSC). “In our research, we wanted to see whether specialized diabetes care was associated with a reduction in recurrent ED visits and hospitalizations.”
Dr. Yan and his colleagues studied de-identified data from patients who presented with hyperglycemia to the EDs at LHSC’s Victoria and University Hospitals over a one-year period. They compared those patients who had been followed by specialized diabetes care at St. Joseph’s Health Care London (250 patients) to those who had not (206 patients).
At St. Joseph’s Centre for Diabetes, Endocrinology and Metabolism, patients with diabetes are supported by a dedicated team of endocrinologists, family physician diabetologists, certified diabetes educators (registered nurses and dietitians), nurse practitioners, pharmacists, social workers and social service workers. The multidisciplinary team provides specialized care and comprehensive teaching which includes diet and lifestyle management advice, exercise programs, help with medications and more.
“Our team provides patient-centered multidisciplinary support to patients with diabetes” says Dr. Selina Liu, Associate Scientist at Lawson, Endocrinologist at St. Joseph’s and co-investigator on the study. “We work with patients to empower them to manage their diabetes with a goal of preventing serious complications, both acute and chronic, including those that can lead to ambulance calls, ED visits and hospitalizations.”
The research team found that patients who had received specialized diabetes care were less likely to revisit the ED due to hyperglycemia (9.6 per cent versus 32.5 per cent) and to be hospitalized due to hyperglycemia (5.2 per cent versus 14.1 per cent) within 30 days of their initial ED visit.
“While further research is needed, our findings are important for a number of reasons,” notes Dr. Yan. “They suggest that follow-up with specialized diabetes care may prevent recurrent ED visits and hospitalizations. In addition to improving patient outcomes, this could equate to significant cost savings for the health care system.”
The team hopes this knowledge can be used to develop targeted interventions for patients who are at higher risk of returning to hospital for hyperglycemia. They are planning future studies to look at what factors contribute to a patient being at higher risk of adverse outcomes and what interventions are most effective in preventing them.
The study, “Do adult patients with type 1 or 2 diabetes who present to the emergency department with hyperglycemia have improved outcomes if they have access to specialized diabetes care?,” is published in the Canadian Journal of Diabetes. It was funded by Lawson Health Research Institute’s Internal Research Fund.
Scientist
Study offers hope for hard-to-treat type 2 diabetes
A landmark international study involving patients and researchers at St. Joseph’s Health Care London shows automated insulin pump delivery can be ‘life-changing’ for people with type 2 diabetes
Lisa Mercer had tried just about everything to regulate the ups and downs of her blood sugars, from a strict diet to medication to four-a-day-day insulin shots.
But her busy life with type 2 diabetes finally started to feel better when she enrolled in a clinical trial at St. Joseph’s Health Care London to test the effectiveness of a system that combined glucose monitoring with an automated insulin pump.
“It was life-changing for me. I was diagnosed with type 2 diabetes 25 years ago and my blood sugars have always been all over the map. I felt sort of helpless. I said yes to this clinical trial because I hoped it would return some normalcy to my life,” she says. Now that study, with results newly published in the prestigious New England Journal of Medicine, is being heralded as a big step forward for patients with hard-to-treat type 2 diabetes.
“This is an exciting finding because it shows we can improve patients’ blood sugars and hopefully prevent long-term negative consequences of high sugars while at the same time making it easier for patients to manage the disease,” says Dr. Tamara Spaic, Medical Director of St. Joseph’s Diabetes Education Centre and the lead Canadian researcher for the multi-site international study based at the Jaeb Center for Health Research in Tampa, Fla.
Study participants were placed either in a group testing the effectiveness of a new system called Control IQ+ or a control group continuing their existing diabetes management regimen.
The intervention group wore glucose monitors that electronically talked with high-tech pumps that delivered insulin – automatically, in the right dose and at the right time – with minimal patient input.
While the device was approved about five years ago for people with type 1 diabetes, this is the first examination of its effectiveness managing the complexities of type 2 diabetes.
“The biggest burden in diabetes control is that it’s 24/7 vigilance: did I eat or not; what did I eat and how much; did I exercise; do I need to wake up for an insulin shot in the middle of the night? This system largely removes those variables to bring blood sugars to target levels,” says Spaic, who is also a Lawson Research Institute scientist and professor of endocrinology and metabolism at Western University’s Schulich School of Medicine & Dentistry.
“What surprised us was that this worked so well across all populations regardless of duration of the disease, amount of insulin needed, whether they used other medications or not, whether they were tech-savvy or not. It worked for everyone regardless of their ethnicity, socioeconomics, and whether they were male or female, old or young,” she adds.
Researchers even asked participants in the intervention group to skip insulin with meals on occasion – generally a no-no in the highly regimented life of someone with insulin-managed diabetes – and the automated system responded appropriately and quickly to adjust blood sugars.
Mercer found improvement within a couple of weeks: “Before the pump, I felt awful. When my sugars were too low, I got the shakes, I had trouble communicating and thinking clearly and I got extremely tired. When my sugars were too high, I was exhausted. It dominated every day and was tough on my job as a police officer. Now I feel better. I feel more in control.
“Is it perfect? No. But my sugars are stable and consistent more often than not.”
Not yet approved in Canada
In February, the US Food and Drug Administration cleared the use of the Control IQ+ system in adults with type 2 diabetes – approval that also meant the expense could be covered through health insurance.
However, it has not yet been brought to Health Canada regulators for approval, Spaic says.
Even so, several of her patients, including Foster, decided to continue using the system after the 13-week trial, paying out-of-pocket or through private insurance.
Spaic and St. Joseph’s colleagues, endocrinologist Dr. Selina Liu and nurse coordinator Marsha Driscoll, were extensively involved in the design of the study, recruiting and monitoring participants and reporting results.
Diabetes type 2 usually develops in adulthood and is a condition in which body cannot make enough insulin or does not properly use the insulin it makes to regulate the amount of glucose (sugar) in the blood.
While most people with type 2 diabetes can control their blood sugars through lifestyle changes or with new treatments such as non-insulin glucose-lowering medications, the sub-set of North Americans who require insulin still numbers in the millions.
THE STUDY:
What: 13-week, large-scale clinical trial to test the effectiveness of a system combining automated insulin delivery with continuous glucose monitoring for people with type 2 diabetes.
Who: 319 study participants – including 13 at Lawson Research Institute of St. Joseph’s Health Care London – all needing multiple daily insulin doses. Age range 19 to 87, from 21 centres across the U.S. and Canada. Study led by Jaeb Centre for Health Research in Tampa, Fla., and funded by Tandem Diabetes Care, which also provided the automated insulin-delivery systems
How: Two-thirds of patients received an automated insulin pump, continuous glucose monitor and transmitter to track and automatically administer insulin to regulate their blood sugars. A control group continued their existing insulin-delivery method and also received glucose monitors.
Results: The intervention group had more stable blood sugar levels – with 3.4 more hours per day in the target glucose range – than the control group. Use of automated insulin devices was successful and safe even for patients without previous experience with an insulin pump
Why it matters: Automated insulin delivery can help insulin-dependent patients manage their type 2 diabetes better than before. Better management means improved quality of life and may result in fewer diabetes complications such as heart disease and damage to the eyes, kidneys and nerves.
Third clinical trial launched to study whether type 2 diabetes can go into remission
Since launching two years ago, an innovative study that aims to induce remission of type 2 diabetes has captured the attention of hundreds of Londoners. For those with type 2 diabetes like Greg Ackland and Jocelyne Chauvin, the idea of stopping all medications has translated from a dream to a reality through participation in the REMIT study at Lawson Health Research Institute (Lawson).
With a family history of type 2 diabetes, Greg Ackland was first diagnosed over six years ago when he underwent an operation for a hernia. He developed a mild infection and, while being treated, his care team discovered his blood sugar levels were high.
Ackland started treatment and was eventually taking four pills per day. “I watched the progression of my medications and thought ‘I’m losing this battle,’” says 51 year-old Ackland.
Image
Above: Greg Ackland, research participant in the REMIT study
He saw information about the REMIT study on the local news and after meeting the criteria he was enrolled. The outcomes have been incredible. Ackland has now stopped all medications and his blood sugar levels are good. He has recommitted to exercise which has resulted in weight loss and muscle gain.
“I’m glad I jumped at the opportunity to participate in this trial,” says Ackland. “I’ve reset myself.”
Lawson is one of seven Canadian sites taking part in the REMIT study, which is considered a significant departure in strategy in the care of people with type 2 diabetes. The study consists of a series of clinical trials that tests an aggressive approach in recently diagnosed patients. The first two trials in London saw significant interest in participation from those with type 2 diabetes. A third REMIT trial is now being launched providing another opportunity for individuals with type 2 diabetes to take part.
“The goal of the REMIT study is to take a proactive approach to help people early in the disease, normalize their blood sugars for a period of 12 weeks and then slow the progression of the disease and the need for additional medications,” says Dr. Irene Hramiak, Lawson researcher, endocrinologist, and Chief of the Centre for Diabetes, Endocrinology and Metabolism at St. Joseph’s Health Care London. “We want to know if we can induce remission, for how long and whether it matters what combination of medications we use.”
The standard treatment for people with type 2 diabetes is to start on a single medication, which is then followed by the addition of more drugs and insulin as the disease progresses. In the REMIT study, patients receive intensive treatment early in their care journey that consists of two diabetes medications plus insulin at bedtime for three months to see if remission can be induced. In addition, patients are supported to make lifestyle changes with a diet and 30 minutes of exercise each day.
“When I saw a gentleman on the news talking about the REMIT study and how it allowed him to stop taking all medications, I thought ‘cool!’” says Jocelyne Chauvin. The 62 year-old Londoner was first diagnosed with type 2 diabetes three years ago after a regular checkup. While it was difficult news, she had a family history of the disease and health issues before her diagnosis.
Image
Above: Jocelyne Chauvin, research participant in the REMIT study
“I started taking one pill a day and was told I’d be up to four pills a day within six months,” says Chauvin. “But with good nutrition and exercise I worked hard to stay on one pill a day for three years.”
After hearing about the study, she contacted the research team and, after meeting the criteria, was enrolled in April 2017. Chauvin has now stopped all medications and says she feels much better. She exercises more and her blood sugar levels are close to normal.
“This is my first time participating in a clinical trial and I’m very excited about my experience,” says Chauvin.
REMIT is being led by the Population Health Research Institute (PIHR), a joint institute of McMaster University and Hamilton Health Sciences. The study follows a PHRI pilot study of early aggressive treatment that resulted in up to 40 per cent of intervention group participants with type 2 diabetes going into remission and not needing any diabetes treatment for at least three months.
“The idea of putting type 2 diabetes into remission is changing the way we think about the disease. It has a strong appeal to both those with type 2 diabetes and clinicians,” says Dr. Hramiak. “It’s changing the paradigm of when and how to use medication for type 2 diabetes.”
Those who would like more information about the trial can call 519-646-6100 ext. 65373.
… Endocrinology Thyroid Cancer Clinic Referral Centre for Diabetes, Endocrinology and Metabolism St. Joseph’s Hospital, 5th floor 268 … Endocrinology Thyroid Cancer Clinic Referral Centre for Diabetes, Endocrinology and Metabolism St. Joseph’s Hospital, 5th floor 268 …
Endocrinology Thyroid Cancer Clinic Referral Centre for Diabetes, Endocrinology and Metabolism St. Josephs Hospital, 5th floor 268 Grosvenor Street, London, ON N6A 4V2 Phone 519-646-6000 ext. 61294 Fax: 519-646-6043 Name: DOB: Address: HC#: PIN#: Phone: Email: Interpreter required? Yes what languag...
… Use of Language in Diabetes Dickinson et al 551 Jane K. Dickinson, RN, PhD, CDE … (Dr Jackson); Ascension St John Providence Hospital and Medical Center, Detroit, Michigan (Ms D’Hondt); Astra … outcomes. 2016. Endocr Today. https://www .healio.com/endocrinology/diabetes/news/print/endocrine- …
Use of Language in Diabetes Dickinson et al 551 Jane K. Dickinson, RN, PhD, CDE Susan J. Guzman, PhD Melinda D. Maryniuk, MEd, RD, CDE Catherine A. OBrian, PhD Jane K. Kadohiro, DrPH, APRN, CDE, FAADE Richard A. Jackson, MD Nancy DHondt, RPh, CDE, FAADE Brenda Montgomery, RN, MSHS, CDE Kelly L. Clos...