One in five Canadians has high blood pressure, but the condition is often poorly controlled among First Nations people because of challenges in health care access. The Dream Global Study hopes to change that with personalized text messages.
Dr. Sheldon Tobe, a nephrologist at Sunnybrook and a professor of medicine at the University of Toronto and Northern Ontario School of Medicine, along with Nancy Perkins, a Sunnybrook clinical research manager, have been studying northern communities' health-care systems and the impact of social determinants on their health.
"We meet with the members of the community to try and figure out what their needs and realities are and how our study can best meet these needs," says Perkins. "Often, access to fresh fruit and vegetables can be seriously limited in remote areas, and energy-dense foods like potato chips are readily available at a much lower cost, making them an attractive alternative."
Perkins and Dr. Tobe have developed culturally-relevant text messages based on clinical practice guidelines. The messages are sent out twice weekly to cell phones. Simple flip phones are provided for study participants who need them.
"The text messages are short, to the point and hopefully impactful," says Dr. Tobe. "As an example, for those communities who rely on canned foods, it could be as simple as suggesting rinsing food before eating it to reduce the sodium content. Taken together, over time, even small behavioural shifts can dramatically impact one's risk of obesity, diabetes and high blood pressure."
When a participant's blood pressure is too high, they get text messages directing them to their health-care provider, who also receives the measurement data. This helps to close the loop for health care, and it helps patients engage in their own care.
The research will be ongoing for some time. The goal is to show that new and innovative technologies can successfully lower the risk of high blood pressure and the complications of heart disease in First Nations communities.
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Advance in Treating Artery Pain
The pain can come in waves of muscle cramping in the thigh and the upper calf, and sometimes there is discomfort in the feet at night or while sitting: Patients with peripheral artery disease, also known as hardening of the arteries that lead to the extremities, face not only an impaired quality of life, but also a higher risk for heart attack and stroke. While there are surgical treatment options that can improve the condition, there is often a need for a follow-up procedure if the artery becomes blocked again.
Sunnybrook is one of the first centres in Canada to offer a new therapy option that reduces the need for subsequent surgery. Dr. Andrew Dueck, division head of vascular surgery at Sunnybrook, says a new drug-coated balloon angioplasty restores blood flow and delivers a drug directly into the wall of the artery. The drug minimizes scar tissue formation, which can lead to blockage of the artery and a return of symptoms. For patients, this means a reduction in pain and discomfort, a lower risk of heart attack and stroke, and less chance of more surgery.
That's reassuring news for the estimated 800,000 Canadians living with peripheral artery disease.
New knee, old pain
Neuropathic pain is one of the reasons patients continue to experience pain after total knee replacement. This chronic pain is similar in sensation to burning or electric shock and may be caused by something minor such as light touch.
"Our study found that about 14 per cent of patients experience this pain five years after knee replacement," says Helen Razmjou, lead investigator and advanced practice physiotherapist at Sunnybrook. "Considering the large number of joint replacement surgeries performed in Canada, a substantial number of people may be suffering from ongoing severe symptoms."
The study, published in 2015 in the journal Physiotherapy Canada, looked at whether reporting neuropathic pain an average of five years after total knee replacement was related to indicators such as age, sex and disability before surgery. The team looked at data for 64 patients, and findings determined that the pain was no more or less common in men or women, the old or the young. "There was no demographic that was more predisposed to development of neuropathic pain than another," says Razmjou.
Patients who are at a high risk for neuropathic pain are identifiable as early as one year after their operation and could benefit from preventive strategies. Physicians should inquire about the types of pain experienced by their patients. Certain surveys help to determine if neuropathic pain is at the root of the problem, as there is potential for medications that will ease it.
Why Burns are Worse for the Elderly
In spite of the many advances in burn care in the last several decades, low survival rates for elderly burn patients have remained virtually unchanged. In a world-first study, Dr. Marc Jeschke, director of the Ross Tilley Burn Centre at Sunnybrook, and his research team set out to identify the reasons why the elderly are much less likely to survive a burn injury than younger adults.
"We found the elderly did not have the same immune response as younger adults, which is necessary to fight disease and injury. Their bodies lack some of the essential stem cells that are important for skin healing," says Dr. Jeschke.
The researchers found the elderly to have a higher death rate, more complex pre-existing medical conditions, a higher risk of developing multiorgan failure and a significantly longer hospital stay than younger adults.
The study, which analyzed 1,461 patients admitted to Sunnybrook's burn centre between 2006 and 2015, also found that metabolic responses seemed to be reversed. "While younger patients moved into a state of less stress and less hyper metabolism over time, elderly patients showed the exact opposite trajectory," says Dr. Jeschke.
The researchers hope their findings will encourage others to continue studying how outcomes of elderly burn patients can be improved. "By learning the major differences that come with this age group, we will be able to better help elderly people who have been subjected to burn injuries," says Dr. Saeid Amini-Nik, junior scientist at the Sunnybrook Research Institute .
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