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How the pediatric hospital’s ICU was saved from near collapse

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It’s 1:50 p.m. on a recent weekday at the intensive care unit of Toronto’s Hospital for Sick Children as a trio of women try to solve the latest problem.

There are three children who need to be in SickKids’ ICU but are not.

One is waiting in the emergency department and two others are at community hospitals. There’s currently no space for them at the intensive care unit, so staff need a plan on how to care for them until beds open up.

“At this particular moment, I don’t have physical capacity to admit them,” says Lee-Anne Williams, the charge nurse for the ICU, who is primarily responsible for managing the flow of patients in and out of the unit.

“This is the worst I’ve seen,” she says of her 21 years in the hospital’s intensive care unit.

While they work to open up spots, SickKids has dispatched mobile critical care teams to be with the two children at the other hospitals while another team is closely watching the child in the ER.

For now, all are safe.

“We have SickKids eyes, ears and hands on the patients, and it’s a really good assessment that we can trust,” Williams says. “Hopefully it just buys us a little bit of time so we can then transfer patients out of the ICU to accommodate patients coming in.”

The SickKids ICU is at 120 per cent capacity and has been under immense pressure for weeks.

Pediatric hospitals across the province are in similar situations as they’ve seen a huge surge in children with respiratory illnesses. A severe staffing crunch, especially in highly specialized units such as intensive care, has compounded the problem.

The Canadian Press spent several hours inside SickKids recently to understand the crisis and examine the ways in which the Toronto hospital has worked to ensure it can keep caring for young patients who need its specialized care.

“The big thing right now is staffing and being able to provide safe care for our patients,” says Sandhaya Parekh, the senior clinical manager of the ICU at SickKids.

The hospital has 42 physical pediatric ICU beds – not counting its neonatal intensive care unit – but struggles to staff more than 36 on any given day. The number of patients who can be cared for depends on how many staff might call in sick.

The ICU – currently filled mostly by children under five years old – has been over capacity for the last month. More than half of the respiratory patients are on ventilators as the hospital has seen a huge number of cases of flu and respiratory syncytial virus, or RSV.

Those patients are almost all otherwise healthy kids. The flu is hitting especially hard. The hospital has seen kids with the flu who have gone into heart and other organ failures at a much higher rate.

At the ICU, the unit’s senior clinical manager, the clinical director of the ICU’s cardiac unit and the charge nurse meet daily to figure out staffing.

They first look within the ICU’s staffing pool and then turn to other departments for help. On this day, they put a call out for six nurses to work overnight. Thankfully, enough stepped up.

The hospital has lost a lot of nurses during the pandemic to retirement and other nursing jobs, especially less stressful ones. The departures have hit the ICU hard since it requires nurses with specialized skills.

Over at the front desk of the unit, the chief of critical care takes a deep breath.

“It never ends,” says Dr. Steven Schwartz.

Halls of the department snake off from the front desk, which sits under a blue skylight painted with fluffy clouds. Computers on mobile carts pack the hallways as nurses and doctors go to and fro. Other nurses stand watch outside isolation rooms, eyes on the vitals of little ones.

The situation on this day is at least better than the first week of November.

“We were either on the verge, or maybe slightly past, out of control,” Schwartz says. “Now we’re back to being manageable.”

The hospital’s emergency department began seeing higher-than-normal patient volumes in September that grew through October until daily records kept being broken – more than 300 children were showing up at the ER daily, with another 200 seen through the hospital’s virtual emergency department.

The ICU gradually came under greater pressure, both from SickKids patients and as other hospitals needed to transfer children in for specialized care.

By the first week of November, the SickKids ICU had to do something it’s never done before: it had to say no.

“It very quickly got to a point where we were having to say, ‘We can’t take this person right now,'” Schwartz says.

“That was getting very scary because then we’re asking people, ‘Can you take care of this kid for one more day?’ Maybe they’re not the one who needs the breathing tube right now, but everybody’s worried they will. That’s where it started to feel very unsafe.”

Anxiety and moral distress skyrocketed among staff.

The ICU needed to be saved.

Senior management dusted off a surge plan that was created, but never used, for COVID-19. It meant a seismic shift in patient care, away from its one-nurse-to-one-patient model.

“The only way for us to be able to work within this model is to redeploy resources,” says Jackie Hubbert, the clinical director of the cardiac unit of the ICU. “And the only way to do that is to stop doing something else.”

On Nov. 11, CEO Ronald Cohn sent out an email to staff about cancelling surgeries and redeploying staff to the ICU. A new team-based model that changed nurse-patient ratios would start three days later.

“It literally saved lives,” Schwartz says.

Merit Hayden-Town put up her hand when the hospital called for volunteers to boost ICU staffing under the new model.

“I knew that the situation in our ICU was desperate and I wanted to step up,” she says.

She’s worked at SickKids for 16 years, 15 of those in the pediatric ward. That became a COVID-19 ward during the pandemic. With so much fear about the virus early on, Hayden-Town shipped her then-eight-year-old boy to his grandmother’s for three months.

“It was traumatic,” she says as she plays with her necklace that reads “Mama.”

A year ago, she moved to the post-anesthetic care unit, where she helps children recover from surgeries.

Now, in her new role in the ICU, she teams up with at least one experienced ICU nurse as they care for three or more patients. The hospital says they’ll use the model until the surge abates.

Hayden-Town is learning on the job and takes heart in helping her young patients, although the need for more staff remains.

“To be with a family when their child is sick, at the darkest time of their life, is so meaningful to me,” she says. “We are fighting the fight, but there’s just not enough staff.”

Hayden-Town rubs her necklace again as she leaves to take a nap – the night shift begins in a few hours.

This report by The Canadian Press was first published Dec. 12, 2022.

Health

What’s the greatest holiday gift: lips, hair, skin? Give the gift of great skin this holiday season

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Give the gift of great skin this holiday season

Skinstitut Holiday Gift Kits take the stress out of gifting

Toronto, October 31, 2024 – Beauty gifts are at the top of holiday wish lists this year, and Laser Clinics Canada, a leader in advanced beauty treatments and skincare, is taking the pressure out of seasonal shopping. Today, Laser Clincs Canada announces the arrival of its 2024 Holiday Gift Kits, courtesy of Skinstitut, the exclusive skincare line of Laser Clinics Group.

In time for the busy shopping season, the limited-edition Holiday Gifts Kits are available in Laser Clinics locations in the GTA and Ottawa. Clinics are conveniently located in popular shopping centers, including Hillcrest Mall, Square One, CF Sherway Gardens, Scarborough Town Centre, Rideau Centre, Union Station and CF Markville. These limited-edition Kits are available on a first come, first served basis.

“These kits combine our best-selling products, bundled to address the most relevant skin concerns we’re seeing among our clients,” says Christina Ho, Senior Brand & LAM Manager at Laser Clinics Canada. “With several price points available, the kits offer excellent value and suit a variety of gift-giving needs, from those new to cosmeceuticals to those looking to level up their skincare routine. What’s more, these kits are priced with a savings of up to 33 per cent so gift givers can save during the holiday season.

There are two kits to select from, each designed to address key skin concerns and each with a unique theme — Brightening Basics and Hydration Heroes.

Brightening Basics is a mix of everyday essentials for glowing skin for all skin types. The bundle comes in a sleek pink, reusable case and includes three full-sized products: 200ml gentle cleanser, 50ml Moisture Defence (normal skin) and 30ml1% Hyaluronic Complex Serum. The Brightening Basics kit is available at $129, a saving of 33 per cent.

Hydration Heroes is a mix of hydration essentials and active heroes that cater to a wide variety of clients. A perfect stocking stuffer, this bundle includes four deluxe products: Moisture 15 15 ml Defence for normal skin, 10 ml 1% Hyaluronic Complex Serum, 10 ml Retinol Serum and 50 ml Expert Squalane Cleansing Oil. The kit retails at $59.

In addition to the 2024 Holiday Gifts Kits, gift givers can easily add a Laser Clinic Canada gift card to the mix. Offering flexibility, recipients can choose from a wide range of treatments offered by Laser Clinics Canada, or they can expand their collection of exclusive Skinstitut products.

 

Brightening Basics 2024 Holiday Gift Kit by Skinstitut, available exclusively at Laser Clincs Canada clinics and online at skinstitut.ca.

Hydration Heroes 2024 Holiday Gift Kit by Skinstitut – available exclusively at Laser Clincs Canada clinics and online at skinstitut.ca.

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Here is how to prepare your online accounts for when you die

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LONDON (AP) — Most people have accumulated a pile of data — selfies, emails, videos and more — on their social media and digital accounts over their lifetimes. What happens to it when we die?

It’s wise to draft a will spelling out who inherits your physical assets after you’re gone, but don’t forget to take care of your digital estate too. Friends and family might treasure files and posts you’ve left behind, but they could get lost in digital purgatory after you pass away unless you take some simple steps.

Here’s how you can prepare your digital life for your survivors:

Apple

The iPhone maker lets you nominate a “ legacy contact ” who can access your Apple account’s data after you die. The company says it’s a secure way to give trusted people access to photos, files and messages. To set it up you’ll need an Apple device with a fairly recent operating system — iPhones and iPads need iOS or iPadOS 15.2 and MacBooks needs macOS Monterey 12.1.

For iPhones, go to settings, tap Sign-in & Security and then Legacy Contact. You can name one or more people, and they don’t need an Apple ID or device.

You’ll have to share an access key with your contact. It can be a digital version sent electronically, or you can print a copy or save it as a screenshot or PDF.

Take note that there are some types of files you won’t be able to pass on — including digital rights-protected music, movies and passwords stored in Apple’s password manager. Legacy contacts can only access a deceased user’s account for three years before Apple deletes the account.

Google

Google takes a different approach with its Inactive Account Manager, which allows you to share your data with someone if it notices that you’ve stopped using your account.

When setting it up, you need to decide how long Google should wait — from three to 18 months — before considering your account inactive. Once that time is up, Google can notify up to 10 people.

You can write a message informing them you’ve stopped using the account, and, optionally, include a link to download your data. You can choose what types of data they can access — including emails, photos, calendar entries and YouTube videos.

There’s also an option to automatically delete your account after three months of inactivity, so your contacts will have to download any data before that deadline.

Facebook and Instagram

Some social media platforms can preserve accounts for people who have died so that friends and family can honor their memories.

When users of Facebook or Instagram die, parent company Meta says it can memorialize the account if it gets a “valid request” from a friend or family member. Requests can be submitted through an online form.

The social media company strongly recommends Facebook users add a legacy contact to look after their memorial accounts. Legacy contacts can do things like respond to new friend requests and update pinned posts, but they can’t read private messages or remove or alter previous posts. You can only choose one person, who also has to have a Facebook account.

You can also ask Facebook or Instagram to delete a deceased user’s account if you’re a close family member or an executor. You’ll need to send in documents like a death certificate.

TikTok

The video-sharing platform says that if a user has died, people can submit a request to memorialize the account through the settings menu. Go to the Report a Problem section, then Account and profile, then Manage account, where you can report a deceased user.

Once an account has been memorialized, it will be labeled “Remembering.” No one will be able to log into the account, which prevents anyone from editing the profile or using the account to post new content or send messages.

X

It’s not possible to nominate a legacy contact on Elon Musk’s social media site. But family members or an authorized person can submit a request to deactivate a deceased user’s account.

Passwords

Besides the major online services, you’ll probably have dozens if not hundreds of other digital accounts that your survivors might need to access. You could just write all your login credentials down in a notebook and put it somewhere safe. But making a physical copy presents its own vulnerabilities. What if you lose track of it? What if someone finds it?

Instead, consider a password manager that has an emergency access feature. Password managers are digital vaults that you can use to store all your credentials. Some, like Keeper,Bitwarden and NordPass, allow users to nominate one or more trusted contacts who can access their keys in case of an emergency such as a death.

But there are a few catches: Those contacts also need to use the same password manager and you might have to pay for the service.

___

Is there a tech challenge you need help figuring out? Write to us at onetechtip@ap.org with your questions.

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Pediatric group says doctors should regularly screen kids for reading difficulties

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The Canadian Paediatric Society says doctors should regularly screen children for reading difficulties and dyslexia, calling low literacy a “serious public health concern” that can increase the risk of other problems including anxiety, low self-esteem and behavioural issues, with lifelong consequences.

New guidance issued Wednesday says family doctors, nurses, pediatricians and other medical professionals who care for school-aged kids are in a unique position to help struggling readers access educational and specialty supports, noting that identifying problems early couldhelp kids sooner — when it’s more effective — as well as reveal other possible learning or developmental issues.

The 10 recommendations include regular screening for kids aged four to seven, especially if they belong to groups at higher risk of low literacy, including newcomers to Canada, racialized Canadians and Indigenous Peoples. The society says this can be done in a two-to-three-minute office-based assessment.

Other tips encourage doctors to look for conditions often seen among poor readers such as attention-deficit hyperactivity disorder; to advocate for early literacy training for pediatric and family medicine residents; to liaise with schools on behalf of families seeking help; and to push provincial and territorial education ministries to integrate evidence-based phonics instruction into curriculums, starting in kindergarten.

Dr. Scott McLeod, one of the authors and chair of the society’s mental health and developmental disabilities committee, said a key goal is to catch kids who may be falling through the cracks and to better connect families to resources, including quicker targeted help from schools.

“Collaboration in this area is so key because we need to move away from the silos of: everything educational must exist within the educational portfolio,” McLeod said in an interview from Calgary, where he is a developmental pediatrician at Alberta Children’s Hospital.

“Reading, yes, it’s education, but it’s also health because we know that literacy impacts health. So I think that a statement like this opens the window to say: Yes, parents can come to their health-care provider to get advice, get recommendations, hopefully start a collaboration with school teachers.”

McLeod noted that pediatricians already look for signs of low literacy in young children by way of a commonly used tool known as the Rourke Baby Record, which offers a checklist of key topics, such as nutrition and developmental benchmarks, to cover in a well-child appointment.

But he said questions about reading could be “a standing item” in checkups and he hoped the society’s statement to medical professionals who care for children “enhances their confidence in being a strong advocate for the child” while spurring partnerships with others involved in a child’s life such as teachers and psychologists.

The guidance said pediatricians also play a key role in detecting and monitoring conditions that often coexist with difficulty reading such as attention-deficit hyperactivity disorder, but McLeod noted that getting such specific diagnoses typically involves a referral to a specialist, during which time a child continues to struggle.

He also acknowledged that some schools can be slow to act without a specific diagnosis from a specialist, and even then a child may end up on a wait list for school interventions.

“Evidence-based reading instruction shouldn’t have to wait for some of that access to specialized assessments to occur,” he said.

“My hope is that (by) having an existing statement or document written by the Canadian Paediatric Society … we’re able to skip a few steps or have some of the early interventions present,” he said.

McLeod added that obtaining specific assessments from medical specialists is “definitely beneficial and advantageous” to know where a child is at, “but having that sort of clear, thorough assessment shouldn’t be a barrier to intervention starting.”

McLeod said the society was partly spurred to act by 2022’s “Right to Read Inquiry Report” from the Ontario Human Rights Commission, which made 157 recommendations to address inequities related to reading instruction in that province.

He called the new guidelines “a big reminder” to pediatric providers, family doctors, school teachers and psychologists of the importance of literacy.

“Early identification of reading difficulty can truly change the trajectory of a child’s life.”

This report by The Canadian Press was first published Oct. 23, 2024.

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