Health

Azrieli Foundation transforms how we treat complex brain disorders

Published

8 months ago

January 3, 2024

Jan 3, 2024

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.”

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.

“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.

“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.”

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.

“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.”

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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Health

Canada to donate up to 200,000 vaccine doses to combat mpox outbreaks in Africa

Published

23 hours ago

September 13, 2024

Anne Joseph

The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.

It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.

Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”

Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.

Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.

A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.

On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.

Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”

But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”

“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.

Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.

Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.

Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.

“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.

“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”

This report by The Canadian Press was first published Sept. 13, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

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Health

How many Nova Scotians are on the doctor wait-list? Number hit 160,000 in June

Published

2 days ago

September 11, 2024

Anne Joseph

HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.

The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.

Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.

“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”

The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.

A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.

Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.

“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.

Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.

The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.

“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.

This report by The Canadian Press was first published Sept. 11, 2024.

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Health

Newfoundland and Labrador monitoring rise in whooping cough cases: medical officer

Published

3 days ago

September 10, 2024

Anne Joseph

ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.

Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.

Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.

Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.

The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.

“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.

Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.

Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.

Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.

A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.

This report by The Canadian Press was first published Sept. 10, 2024.

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