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Azrieli Foundation transforms how we treat complex brain disorders

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Jan 3, 2024
Photo by Morsa Images/Getty Images

People living with complex brain disorders – defined by their combined impact on how a patient thinks, feels and behaves – typically require coordinated care from multiple medical specialists. But all too often, these patients can struggle to access and navigate the multilayered care they need.

Long-persisting siloes in medical education and practice are a major contributor to this gap. While the medical specialties that diagnose and treat complex brain disorders (including neurology, psychiatry, neurosurgery, rehabilitation medicine and geriatrics) have made great advances in recent years, they are not designed to collaborate or even share the same language – tending to train and work in isolation from one another.

Since 2020, U of T’s Temerty Faculty of Medicine has been working to break down these barriers through innovative brain medicine training opportunities that look at symptoms arising from brain dysfunction in a holistic way. Now, with generous support from the Azrieli Foundation, the Azrieli Brain Medicine Fellowship Program is accelerating efforts even further — building capacity to train new brain medicine practitioners and, ultimately, transforming the way we treat patients with complex brain disorders in Canada and around the world.

“The Azrieli Foundation has long enabled innovative research and care to improve the health of individuals and communities, with a particular focus on brain health,” says Naomi Azrieli, chair and CEO of the Azrieli Foundation. “But at the very core of our mission, is an imperative to harness the power of education. Through the Azrieli Brain Medicine Fellowship Program at Temerty Medicine, we are doing both: supporting the next generation of exceptional clinicians and investing in a future where complex brain disorders can be identified and managed effectively.”

From specialized to holistic care

The training program is being spearheaded by Sara Mitchell, an assistant professor of neurology at Temerty Medicine and a neurologist in the Sunnybrook Health Sciences Centre’s Hurvitz Brain Sciences Program.

“Traditionally in medicine, the longer you train, the more narrow and hyperspecialized your focus gets,” says Mitchell, who is also the director of the Azrieli Brain Medicine Fellowship Program. “With these fellowships, we’re turning that model on its head — broadening trainees’ experiences so they can provide enhanced care for patients with complex brain disorders.”

Sara Mitchell smilingSara Mitchell smiling

Dr. Sara Mitchell, Director, Azrieli Brain Medicine Fellowship Program

Mitchell goes on to explain that the unique, competency-based program, which initially launched in 2019 as a pilot in Sunnybrook’s Hurvitz Brain Sciences Program, is helping develop well-rounded brain medicine experts who can help steward people through the health-care system — and find the care they need.

Sara Mitchell smilingSara Mitchell smiling

Dr. Sara Mitchell, Director, Azrieli Brain Medicine Fellowship Program

“For example, now a patient with a complex disorder will be able tell their story to a brain medicine fellow who can then hold a single case conference with a psychiatrist and a neurologist and get their different perspectives,” says Mitchell. “This integrated approach takes the burden off the patient and their family — which could help shorten the patient’s journey through the health-care system by months or years, and improve their quality of life while reducing costs.”

She also points to the long-term value of addressing this gap via medical education. “Training fundamentally shapes health professionals and the work they do throughout their entire careers,” she says. “The goal of the Azrieli Brain Medicine Fellowships is to have an immediate, but also a lasting, impact on patient care and research that will continue to grow for decades to come.”

Building connections

Sarah Levitt was the program’s inaugural fellow in 2020 and has experienced the difference the fellowship training has made on her psychiatric practice.

“The experience provided me with countless clinical opportunities and research connections across specialties that are now benefitting my patients,” says Levitt, an assistant professor of psychiatry at Temerty Medicine and a general adult psychiatrist with the University Health Network.

Sarah Levitt smilingSarah Levitt smiling

Dr. Sarah Levitt

“For example, by training alongside neurologists, I’ve gained a much better understanding of how to identify and treat conditions of cognition. I now use this knowledge when caring for patients experiencing severe and persistent mental illness – many of whom also exhibit cognitive impairment.”

Levitt is also now helping lead the Azrieli Brain Medicine Fellowship Program as its associate director – working to ensure future fellows receive the same value in their training. “This fellowship mirrors the kind of care we’re trying to provide,” says Levitt. “We’re looking at brain dysfunction and its many symptoms from every angle, and providing the most holistic care possible.”

Sarah Levitt smilingSarah Levitt smiling

Dr. Sarah Levitt

Learning from peers and advancing science

Current Azrieli Brain Medicine Fellow, Carl Leochico, is also already seeing the training program’s impact on his work. “A patient’s behavior and affect (i.e., their emotions and moods) can have a huge positive or negative impact on their response to rehabilitation,” says Leochico, who originally trained as a physiatrist in his native Philippines.

With these fellowships, we’re broadening trainees’ experiences so they can provide enhanced care for patients with complex brain disorders.

“Through the Azrieli Fellowship, I’m being trained by neurologists, psychiatrists and physiatrists and am learning to detect neuropsychological disturbances in my patients – helping them maximize the benefits they gain from physiotherapy, occupational therapy and speech and language therapy.”

With these fellowships, we’re broadening trainees’ experiences so they can provide enhanced care for patients with complex brain disorders.

Looking ahead to impact

Incoming Azrieli Fellow Mike DeDominicis, currently a fifth-year neurology resident, is eager to follow in Levitt and Leochico’s footsteps beginning in 2024 – and is already looking ahead to the impact the training will have in shaping his future contributions to patient care and research.

One area of focus is his work developing a reference guide that combines neurological and psychiatric lenses for clinical assessments to facilitate the diagnosis of brain diseases.

Michael DeDominicis smilingMichael DeDominicis smiling

Dr. Michael DeDominicis

“Symptoms may seem to belong solely to the field of neurology or psychiatry – for example, numbness or depressed mood, respectively – but there is often an interplay between the two,” he says. “Incorporating a holistic brain medicine approach to this work makes a lot of sense.”

Michael DeDominicis smilingMichael DeDominicis smiling

Dr. Michael DeDominicis

DeDominicis also points out that U of T’s size and breadth helped to draw him to the Azrieli Brain Medicine Fellowship Program.

“There’s such a high concentration of different experts working at U of T, so if you really want to learn more about a new or specialized area, or explore the intersection between fields, Toronto is an ideal place to do that.”

What’s next

While the Azrieli Brain Medicine Fellowship Program is still officially a pilot, ambitions for the program’s future are high.

“Our plan is to leverage this successful proof-of-concept so that brain medicine can eventually become a recognized training program in Canada and abroad,” says Mitchell. “We want to build a model that can be replicated and expanded at different institutions across the country and around the world. We’re already seeing the impact here in Toronto and are laying the groundwork to transform how patients with complex brain disorders are treated everywhere.”

Thanks to the Azrieli Foundation’s gift, we’ve expanded the number of fellowship opportunities we offer and are building a network of people who’ve been trained in this unique way.

Mitchell also notes the central role the Azrieli Foundation’s support is having in enabling this larger vision.

“The foundation’s support has made it possible to accelerate the program’s development significantly,” says Mitchell. “Thanks to their gift, we’ve expanded the number of fellowship opportunities we offer and are building a network of people who’ve been trained in this unique way. In turn, they will go on to share their newfound expertise with their peers and colleagues. We’re also disseminating what we learn from the program to other institutions through a new Azrieli Brain Medicine Conference – laying the foundation for similar programs, based on our own, to develop elsewhere.”

Thanks to the Azrieli Foundation’s gift, we’ve expanded the number of fellowship opportunities we offer and are building a network of people who’ve been trained in this unique way.

 

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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.

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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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