Open Board Forum Island Health Board of Directors November 2019 - - PowerPoint PPT Presentation

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Open Board Forum Island Health Board of Directors November 2019 - - PowerPoint PPT Presentation

Feb 10, 2024 173 likes •1.21k views

Open Board Forum Island Health Board of Directors November 2019 Excellent health and care for everyone, everywhere, every time. islandhealth.ca Open Board Forum Leah Hollins, Chair Island Health Board of Directors November 2019 Excellent

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islandhealth.ca

Open Board Forum

Island Health Board of Directors

November 2019

Excellent health and care for everyone, everywhere, every time.

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islandhealth.ca

Open Board Forum

Leah Hollins, Chair Island Health Board of Directors

November 2019

Excellent health and care for everyone, everywhere, every time.

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Agenda

  • Welcome

– Kathy MacNeil, CEO & President, Island Health – Murray Fyfe, Medical Health Officer – Lucia Bartleman and Jane Fox, W’SANEC Partnership Projects with Island Health – Shawna Walker and Andrea Lewis, Shoreline Medical Clinic – Dr. Paul Winston, Rehabilitative care at the Victoria Peripheral Nerve and Spasticity Clinic

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islandhealth.ca

Kathy MacNeil

President & CEO

Excellent health and care for everyone, everywhere, every time.

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W’SÁNEĆ First Nations

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islandhealth.ca

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islandhealth.ca

Thank you

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Saanich Penin insula

Population Health Overview

  • Monday, February 03, 2020
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BC Statistics P.E.O.P.L.E. 2019

Population Estimates by Age Groups

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Estimated 2019 Population: 70,356 Estimated 2039 Population: 70,319

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Social Determinants of Health

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Economic Status

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Statistics Canada, Census 2016

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Education

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BC Statistics and Ministry of Education (2017); Statistics Canada, Census 2016

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Housing

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Statistics Canada, Census 2016

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Early Development In Instrument

Percent Children Vulnerable in One or More Domains

  • Measures vulnerability in

Kindergarten in five child development areas (domains):

  • Physical
  • Social
  • Emotional
  • Language and Cognitive
  • Communication skills

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Perinatal Service BC (2016); Human Early Learning Partnership (2017)

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Healthy Behaviours & Built Environment

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Alcohol and Other Drug Monitoring Project (2017); Statistics Canada, Census 2016

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Health Status

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Li Life Expectancy (y (years)

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Ministry of Health Primary Care Chronic Disease Registries (2017)

Prevalence of Chronic Conditions, 2017

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In Inju jury Hospitalizations – Saanich Peninsula

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Other

74%

4% 4% 3% 2% 2% 10%

Traffic Injuries

9.1%

0.0% 1.0% 2.0% 3.0% 4.0% 5.0% 6.0% 7.0% 8.0% 9.0% 10.0%

Percent of All Hospitalizations Cause of Injuries

F a l l s

Other Land Transport

Injuries

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Hospit italiz ization Rate for Fall lls by Age and Sex

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0.0 500.0 1000.0 1500.0 2000.0 2500.0 3000.0 3500.0 4000.0 < 15 15 to 24 25 to 44 45 to 64 65 to 74 75 + Hospitalization Rate per 100,000 Female Male

Saanich Peninsula, 2014-2018

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Fall lls Preventio ion

Strength and Balance Exercises

  • Shoal Centre
  • Panorama Recreation Centre
  • Greenglade Community Centre
  • Saanich Commonwealth Place

Primary Care team

  • Assess: past falls, medications,

vision, health, balance, fitness

  • Recommend “interventions” to

reduce fall risk

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Hospitalizations for Traffic Injuries 2009-2018

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10 20 30 40 50 60 70 80 90 100 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Hospitalization Rate per 100,000

Year

Saanich Peninsula

Motor vehicle occupant- MVT, 60% Motorcyclist- MVT, 15% Pedestrian-MVT,

13%

Pedal cyclist- MVT,

12%

Unspecified motor vehicle-…

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Source: ICBC online map tool

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  • Safe road designs
  • Safe vehicles
  • Safe speeds
  • Educated road users

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30 Clipart: clipart-library.com

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W’SANEC Nation Partnership Projects with Island Health

Lucia Bartleman & Jane Fox

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W’SANEC Nation Partnership Projects with Island Health

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TOWARDS A WORLD LEADING SPASTICITY AND PERIPHERAL NERVE CLINIC ON VANCOUVER ISLAND.

The Victoria Combined Peripheral Nerve and Spasticity Clinic Paul Winston, Emily Krauss, Dan Vincent And Dr. Mike Berger

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Do you like tales of Serendipity?

  • Kismet?
  • What is for you won’t
  • go by you?
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Spasticity ABC’s A = All together

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B=Break Free. Clench your arms tight.

  • Don’t stop gripping
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We do a fantastic job on early intervention

  • Go team Victoria.
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  • Initiate physiotherapy and consult with the

MDT for advice9,10

  • If the patient is still under your care and

symptoms do not resolve, refer them to a spasticity specialist and request that they assess the patient and decide if additional intervention is needed8

Consult with the multidisciplinary team (MDT)

In the presence of mildlya increased muscle tone across one joint and involuntary muscle contractions in the affected limb*c,1 plus one or more of the following: 1. Reduced sensitivity on one side of the body and / or visual inattentiond,1,5 2. Weakness of the limbs and problems with function that cause difficulties with active range of motion and / or daily livinge,1,2,6,7 3. Lesion load in the corticospinal tract*, as seen on CT and /

  • r MRI scan1

Refer to a spasticity specialist

If both of the following criteria are met: 1. Moderately, markedly or severely increased muscle stiffness across two or more jointsa,1,2 2. Severe loss of sensorimotor function (e.g., severe decrease in surface sensation, impaired proprioception and severe motor dysfunction)b,3,4

  • Urgently initiate physiotherapy (evaluation

and treatment)

  • Immediately refer the patient to a physician or
  • ther healthcare professional who is a

spasticity specialist8,9

Monitor periodically

Monitor periodically (re-evaluate in three to six months) if the patient has persistent dexterity problems in the absence of increased tone*

  • Refer to a general physiotherapist or
  • ccupational therapist

for treatment and / or a self-stretching programme8

  • Patient should be evaluated within three

months, and monitored by a physiotherapist

  • r occupational therapist with experience in

stroke management*

  • Provide the patient and caregivers with

information about post-stroke management and relevant contacts9

Possible e add dditional risk k factors for the develo elopmen ent of PSS include: e: Smoking (defined as current and past smokers)1,11 | Left-sided stroke1 | Enhanced manual activities prior to the stroke1 *Based on the clinical expertise of Dr Rhoda Allison, Dr Ganesh Bavikatte, Professor Philippe Marque, Associate Professor Barry Rawicki, Dr Maria Matilde de Mello Sposito, Dr Paul Winston & Professor Jörg Wissel.

Post-Stroke Spasticity (PSS) Risk Classification System

This tool is recommended by experts in the field of stroke rehabilitation and neurorehabilitation to be used when evaluating patients who have had a stroke, ideally within the first 12 weeks post stroke. However, it can still be used at other timepoints. It is recommended that this screening tool is used during regular follow-up visits following a stroke, to identify and manage symptoms of PSS.

Ur Urge nt nt referr al al Routi ne ne referr al al Per erio iodic ic mo monitori ng ng

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C = Cinematically

  • It’s boring

without a picture ZZZZZZZZZZZZZZZ!

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How we got from here

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Before intervention 10 days after toxin

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Ongoing Reaction

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DOH

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RE - A Crash of Versailles Light Francois Genet

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Mi – Me, I, We can do this

  • 6 PMR doctors from three cities.
  • 2 anesthesiologists with experience in nerve

blocks.

  • Two neurophysiotherapists.
  • One orthotist with expertise in measurement

and analysis.

  • 4 patients 2 hours. A light flight from

Vancouver

  • 1 US machine –
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Musculocutaneous to increase elbow extension active and passively.

Non spastic limb Spastic limb, poor localization

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Tib Post with US and E-stim

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Adult with Cerebral Palsy, painful hand.

At baseline After median nerve block.

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Baseline 16 months post stroke

Fast Catch Slow Maximum

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Post Nerve Block

Fast Slow

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Cryoneurotomy longer duration effect on the spastic elbow

  • Ice ball at -600 C through a cryoprobe to cause a

myelin disruption and Wallerian degeneration. With potential to regrow

  • The “tube” serves as

A track to guide nerve generation.

www.iovera.com

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Westco Lloyd SL 2000 Neurostat Console using CO2

  • Dr. Daniel Vincent

Anesthesiology

Incorporated neurostimulator e-stim ground Digital Timer Gas flow control E cylinder CO2 tank High pressure line for CO2 delivery and exhaust

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CRYONEUROTOMY ICE BALL: 4 minutes at -60 C = 8 mm L X 6 mm

W

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2.3 mm Cryoneurotomy needle passing through 16 G thermoinsulating catheter

Cryo tip at 8 mm 16 G catheter Insulated hand piece

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Our first nerve block

Pre-Fast Post Fast

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Our first MSCN Cryoneurotomy

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6 Months

6 months

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1 year out –BoTNA q 3 months

  • 1 year
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Lidocaine MSCN Block

Passive Before Passive After

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3 months post cryo

Clonus from what?

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Hand

Before median nerve block After

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Add Botulinum Toxin to fingers and wrist

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Fa – A long long way to gain Pectoral Nerve Block little capsulitis

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30 year incomplete Para – was not sure if he wanted any procedures, thus we simulated effect.

Gait at baseline

Bilateral Obturator Lidocaine block at 5 minutes post block

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Tib post Pregnant woman

Before Four weeks post CryoN

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Still doing great after ten months

With brace. Gait has improved.

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So - Dr. Vincent performs our novel Victoria pioneered cryoneurotomy

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9 Days post Bilateral Pectoral Cryo

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La- Oh-La-La Note one year ago had a nerve transfer to triceps by Dr. Krauss.

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Left hand before – Ulnar nerve block

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  • 5 Minutes of a $37

TENS machine to extensors.

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Ti - is for TEAM

We can do it

  • It takes a team

You can do it

  • We can all learn together
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Left Pre DNB Left Post DNB

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The fantastic Emily Krauss. Plastic and Nerve Surgeon.

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A Nerve Transfer for all qualifiers?

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  • Dr. Mike Berger MD/PHD
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Surgical Candidate? Dr. Krauss.

Pre Block Post

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THE SURGERY – MSCN to brachialis neurectomy with upper arm selective dissection of median fascicles to FDS and FCR. Sparing FDP and AIN and sensory branches – Dr. Emily Krauss

Pre-op Post

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Role of Plasticity?

Learning to plan What about grip strength?

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Telehealth after 1st Toxin injection 3 X OT – more planned

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Cookies for firefighters

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Pec tone Photo Consent

  • Dr. Krauss performs surgical

neurectomy

Before Treatment One month Post neurectomy Much better, some capsulitis

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Should we go wearable?

  • Strong partnership with
  • University of Victoria
  • Department of

Biomedical Engineering

  • Strong partnership with

Island Medical Program

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UVIC Bioengineering

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Better Together

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The fairy tale continues….

  • The world has invited us in and we are ready
  • But Do Re Mi Fa So La Ti Do
  • We must go back to the beginning. Do.
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Three months after video

Ongoing PT, OT, Doctor, Botulinum Toxin, Orthotist + Hard working Patient

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THANK YOU

Make this a reality To date we have had no access for funding for equipment, patient therapy or relearning. Join our dream to build the most innovating clinic in Canada.

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  • Dr. Paul Winston
  • Dreamers only please:nston@viha.ca
  • 250-727-4221
  • paul.winston@viha.ca
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Q & A’s

For more information contact Louise.carlow@viha.ca