RESEARCH SPOTLIGHT: The Ottawa Hospital

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By Dr. Duncan Stewart, Executive Vice-President of Research, The Ottawa Hospital, Professor of Medicine, University of Ottawa

Ten years ago, The Ottawa Hospital opened its Sprott Centre for Stem Cell Research with a promise that one day its scientists would play a lead role in harnessing the power of stem cells to develop new treatments for devastating diseases.

Today that promise is being realized, but we still have a long way to go. We now have more than 250 scientists, investigators, trainees and staff working in our Regenerative Medicine Program, which includes the Sprott Centre as well as the Sinclair Centre for Regenerative Medicine. We also provide leadership for Canada’s Stem Cell Network and the Ontario Institute of Regenerative Medicine. We are a key player in Canada’s thriving stem cell research community.

More importantly, patients are benefitting from our research. Just this year, Dr. Harold Atkins and Dr. Mark Freedman published the results of a ground-breaking clinical trial in top medical journal The Lancet. They found that strong chemotherapy followed by blood stem cell transplantation could completely reset the immune system of patients with aggressive multiple sclerosis (MS), with striking results. There was no further evidence of inflammation or relapses in any of the patients for up to 13 years after treatment. In addition, 70 percent of patients did not develop new disabilities and many had improvements in pre-existing disabilities.

Learn more about this clinical trial from a patient’s perspective. Read Heather Harris’s Patients + Research blog post. 

Today, The Ottawa Hospital offers this as a treatment option for appropriate MS patients. Dr. Atkins has also pioneered a similar therapy for other autoimmune diseases, with equally remarkable results. Not only is this research making our citizens healthier, it is also making us wealthier, because although the transplants are expensive, they eliminate the need for even more expensive medications and hospitalizations.

This research is just the tip of the iceberg in terms of the potential of regenerative medicine. Here at The Ottawa Hospital and the University of Ottawa, Dr. Michael Rudnicki has developed a protein therapy that can stimulate muscle stem cells and double muscle strength in mice with Duchenne muscular dystrophy. Dr. Jing Wang discovered that a common diabetes drug can promote brain regeneration in mice, and human clinical trials are already underway. Dr. Lauralyn McIntyre is leading the first clinical trial in the world of a stem cell therapy for septic shock. And my own research team has pioneered the first trial in the world of a genetically-enhanced stem cell therapy for heart attack. We’ve also recently published promising results of a similar therapy for pulmonary hypertension, and we have plans to start a larger trial within the year.

All of this reflects our overall focus on translational research – moving results from the lab to the clinic and beyond.  Our success in this area has been possible because of a strong culture of collaboration, with basic scientists, clinicians and experts from our Methods Centre working closely together. Thanks to this approach, we now rank as one of the top research hospitals in the country.

Of course, translational research is fraught with challenges, particularly in regenerative medicine. We need to be realistic in our expectations because the first generation of stem cell therapies will likely have fairly modest effects. The key is to be persistent. Increased support for health research, and for our research hospitals, will make all of us healthier, wealthier and smarter.

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Recherche en vedette : L’Hôpital d’Ottawa

Par le Dr Duncan Stewart, vice-président exécutif, Recherche, L’Hôpital d’Ottawa, Professeur de médecine, Université d’Ottawa

Il y a dix ans, l’Hôpital ouvrait son Centre de recherche sur les cellules souches Sprott dans l’espoir que ses scientifiques seraient des chefs de file dans l’exploitation du potentiel des cellules souches pour créer des traitements contre des maladies dévastatrices.

Aujourd’hui, cet espoir s’est transformé en réalité, mais il reste encore du chemin à parcourir. En tout, plus de 250 scientifiques, chercheurs, stagiaires et employés font partie du Programme de médecine régénératrice, qui comprend le Centre Sprott et le Centre de médecine régénératrice Sinclair. Nous jouons aussi un rôle déterminant au sein du Réseau de cellules souches canadien et de l’Institut ontarien de médecine régénératrice. Nous nous sommes taillé une place de choix dans le domaine de la recherche sur les cellules souches, en plein essor au Canada.

Mais ce qui compte le plus, c’est que des patients bénéficient de notre recherche. Cette année, les Drs Harold Atkins et Mark Freedman ont publié les résultats d’un essai clinique révolutionnaire dans la prestigieuse revue médicale The Lancet. Ils ont découvert qu’une forte chimiothérapie suivie d’une greffe de cellules souches sanguines permet de remplacer le système immunitaire de patients atteints de sclérose en plaques agressive, ce qui donne des résultats extraordinaires. Aucun signe d’inflammation ou de rechute n’a été décelé chez les patients suivis pendant jusqu’à 13 ans après leur traitement. De plus, 70 % des participants n’ont acquis aucune nouvelle incapacité et beaucoup ont même vu des incapacités préexistantes se résorber.

Pour en savoir plus sur cet essai clinique, lisez les propos de la patiente Heather Harris dans le blogue Patients + Research (en anglais).

Aujourd’hui, L’Hôpital d’Ottawa offre cette option de traitement aux patients qui ont la sclérose en plaques et qui y sont admissibles. Le Dr Atkins a également mis à l’essai un traitement similaire pour d’autres maladies auto-immunes et a obtenu des résultats tout aussi remarquables. En plus de procurer à nos patients une meilleure santé, cette recherche nous rend plus riches, car avec ces greffes, même si elles coûtent cher, il n’est plus nécessaire de prendre des médicaments ni d’être hospitalisé, ce qui est encore plus coûteux.

Ces travaux ne révèlent que la pointe de l’iceberg du potentiel de la médecine régénératrice. À L’Hôpital d’Ottawa et à l’Université d’Ottawa, Michael Rudnicki, Ph.D., a mis au point une thérapie à base de protéines qui peut stimuler les cellules souches musculaires et doubler la force des muscles de souris ayant la dystrophie musculaire de Duchenne. Jing Wang, Ph.D., a découvert qu’un médicament utilisé couramment contre le diabète peut favoriser la régénération du cerveau de souris; des essais cliniques chez des sujets humains sont en cours. La Dre Lauralyn McIntyre dirige le premier essai clinique au monde sur le traitement du choc septique à base de cellules souches, tandis que ma propre équipe de recherche a fait de même pour un traitement par cellules souches génétiquement modifiées administrées à la suite d’un infarctus du myocarde. Enfin, nous avons récemment publié des résultats prometteurs d’une thérapie semblable pour l’hypertension artérielle pulmonaire et avons l’intention de lancer un essai plus vaste d’ici un an.

Voilà qui illustre l’importance que nous accordons à la recherche translationnelle, qui consiste à traduire en résultats concrets les résultats obtenus en laboratoire. Nos réussites dans ce domaine tiennent à la culture de collaboration qui unit les chercheurs en science fondamentale, les cliniciens et les experts du Centre de méthodologie. Grâce à cette collaboration, nous sommes l’un des meilleurs centres hospitaliers de recherche au pays.

Certes, la recherche translationnelle est chargée de défis, surtout en médecine régénératrice. Nos attentes doivent rester réalistes, car la première génération de traitements à base de cellules souches aura probablement des résultats modestes. Quoi qu’il en soit, la persistance portera ses fruits, surtout si la recherche en santé et les hôpitaux où elle se poursuit reçoivent plus de soutien. Ainsi, notre population sera plus en santé, plus riche et plus informée.

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The Ottawa Hospital is one of Ontario’s 24 research hospitals that contribute to a healthier, wealthier, smarter province. Read more RESEARCH SPOTLIGHT posts on our Healthier, Wealthier, Smarter blog or join the conversation about why health research matters for Ontario on Twitter, using the hashtag #onHWS.

L’Hôpital d’Ottawa est l’un des 24 hôpitaux de recherche qui contribuent à faire de l’Ontario une province plus en santé, plus riche et plus informée. Vous pouvez lire d’autres articles (en anglais) sur la recherche dans le blogue Healthier, Wealthier, Smarter ou participer au débat sur Twitter au sujet de l’importance de la recherche en santé en Ontario (mot-clic #onHWS).

Patients + Research: Jan Magee

Meet Jan:

Jan’s youngest son, Wesley, was born with cerebral palsy. She decided to get involved with the research that would make a difference for her son and her family, and today, she is the vice-chair of the Research Family Engagement Committee at Holland Bloorview Kids Rehabilitation Hospital.

Jan Magee, Member of the Research and Family Engagement Committee at Holland Bloorview Kids Rehabilitation Hospital
Jan and her son Wesley

Can you tell us a bit about yourself and your health story?

I am a proud mother of two wonderful boys. My youngest, Wesley (now 16 years old), was born 2 ½ months premature and diagnosed with cerebral palsy. The health care ‘journey’ from his birth has been a roller coaster. My son was hospitalized for almost three months after his birth, during which we spent time in three different hospitals. My son had an operation during that time as well, before he could come home.

He started occupational- and physio-therapy interventions shortly after, with many other therapies occurring throughout the years including Botox injections for his spasticity (when muscles are continuously contracted). He had surgery again when he was just 2 ½ years old and major orthopedic surgery at Sick Kids when he was 9. Following that surgery, he went through a three-month rehabilitation as an inpatient at Holland Bloorview Kids Rehabilitation Hospital and then as an outpatient for about a year. My son’s current health is stable, but we have many ongoing health concerns and appointments to ensure he is as healthy and pain-free as possible. Our biggest challenge now in our health care ‘journey’ is transitioning from pediatric to adult care and rehabilitation.

I also decided to become directly involved in the work of Holland Bloorview and got involved in the research family engagement committee (RFEC) as a family leader. My goal was to support and make recommendations on research to help make a difference in the lives of children with disabilities and their families based on my lived experiences. I am currently the vice-chair of the RFEC.

Why does health research matter to you?

Health research is critically important for all people with disabilities and it gives me hope that in the future, there will be new therapies, equipment and interventions that will allow people like my son to have the best quality of life possible and allow him to reach his full potential. Wesley has dreams of going to university, getting a job, getting married and travelling the world. With the research currently being done and plans for future research, these goals become more and more achievable for him.

How does health research contribute to a healthier Ontario?

There are so many ways that health research contributes to a healthier Ontario. For example, it leads to therapies and/or interventions that help people with physical disabilities live with less chronic pain and support them in reaching their full potential. Health research can also improve how life skills are taught and inform the design of equipment for non-verbal people to communicate.  It can also help reduce health system costs if research is conducted with the goal of helping people with disabilities reach their personal goals, create more equitable opportunities (employment, housing, etc.) for all persons with disabilities, and help people with disabilities live more independently.  Health research in Ontario enables better community integration for people with disabilities and creates a rich and fulfilling environment for everyone.

How can patients and families support, improve or empower health research?

It is not only important for the patient to participate in research, but to also have input into what is being researched and provide meaningful consult based on their individual lived experiences. Patients and families also benefit from having access to results from research.

When researchers, patients and families collaborate, from the initial research concept right through to the end result, it allows them to combine their experiences and knowledge to shape research in meaningful ways that help to improve the lives of people with disabilities. Collaboration is essential.

 

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Add your voice to the Patients + Research blog series. Email or call Elise Bradt at ebradt@caho-hospitals.com, 416-205-1469, or direct message or tweet at us on Twitter at @CAHOhospitals.

Read more Patients + Research posts and share your own insights on Twitter with the hashtag #onHWS. To learn more about how health research makes Ontario healthier, wealthier and smarter, visit our impact page, and check out our other blog posts and videos.

 

Health & Community Leaders Talk: Peter Pisters

Safer, Smarter Care for a Healthier Ontario

Peter Pisters, President and CEO of University Health Network, shares the value of research evidence in improving patient safety, generating smarter care and a healthier Ontario.

 Peter Pisters, CEO of University Health Network

Almost every person who works in health care has seen or heard about a terrifying event where a patient was hurt or was almost hurt because something went wrong.  Nobody who works in health care wants errors to happen.  Trust has been placed in us and we do everything we can to live up to that trust.

Notwithstanding the noble intentions of health care workers, preventable harm does happen and these events occur far more often than industry insiders or the general public understand.   Indeed, by our estimates – and there isn’t reliable data in Canada so we must extrapolate from U.S. data – more than 30,000 Canadians die each year as a result of preventable harm in health care settings.

The causes are many and familiar – wrong medication or medication given in the wrong dose, an infection acquired in the hospital because proper protocols for handwashing or sterilization of equipment are not followed, complications which arise from a fall that could have been prevented, foreign objects accidentally being left inside patients during surgery.  The list of types of preventable harm is a very long one and, in complex, dynamic environments that have high reliance on technology and where patients move from one setting to another being handed off to different care teams, the opportunities for errors grow.

I’m proud to be the leader of Canada’s most research-intensive hospital, where we apply research findings into improving clinical care and outcomes.  I see wonderful care and a commitment from everyone to heal and help our patients.  I also see the enormous possibilities of using our clinical teams and researchers to help us understand how errors occur and how we can make our hospital a much safer place to receive care.  Our efforts, in partnership with the Hospital for Sick Children, are going forward under a shared program that we call Caring Safely. Many other organizations including Sinai Health System, Women’s College Hospital, Health Quality Ontario, the Canadian Medical Protective Association, the Ontario Hospital Association and others have all expressed great interest in our efforts to drive preventable harm to zero. Through smarter, safer care, University Health Network, along with its partners, will help to build a healthier Ontario.

For critical insights on improving safety, we are looking to other industries that have made extraordinary safety improvements over the past 30 years.  These industries include aviation, nuclear power, and chemical manufacturing — industries that have a relative complexity of the work environment similar to healthcare and where reliability and resilience have been hard wired into the workforce. Collectively, these industries have adopted practices known as high reliability. In high reliability industries safety is a core value and employees are supported and trained to spot problems before they happen and take immediate action. The lessons learned from success in other industries are applicable to healthcare.

I believe that safety is an implicit expectation that Ontarians have of our hospitals. For those who would like to read more about High Reliability Organizations I recommend two books – Why Hospitals Should Fly by J.D. Nance and Managing the Unexpected by Karl Weick and Karen Sutcliffe of the University of Michigan. The first is written in novel form and imagines what it would be like to work in a hospital that has adopted the principles of reliability and resilience.  The second book is a seminal academic work that outlines the principles that define high reliability organizations.

At UHN, we started this journey with an organization-wide survey from the Agency for Healthcare Research and Quality (AHRQ) that has given us rich data about attitudes to safety on our units, in our clinics and throughout the organization.  The response was overwhelming with two of our sites achieving 100% participation, and a third at 98%.  This extraordinary response to administrative efforts to measure our safety culture clearly demonstrates the deep interest that the UHN community has in our safety transformation and our shared commitment to safety for each other and for the patients we serve.  One major benefit of the AHRQ safety survey is that it is used throughout North America, enabling us to benchmark ourselves with over 700 hospitals.

You can learn more about the work Canada is doing to address patient safety here.

Toronto Rehabilitation Institute has been using the AHRQ safety culture survey for many years and has used their data to identify issues that can then be worked on by the manager and the team on the unit.  They have seen changes to their safety culture year over year and all of UHN will learn from their experience with the survey and with the ways they have worked with their staff to make Toronto Rehab a safer organization.

The Institute of Medicine once noted that “errors… are costly in terms of loss of trust in the health care system by patients and diminished satisfaction by both patients and health professionals”. By decreasing incidents of preventable harm and increasing a focus on patient safety we can create a healthier and smarter environment for everyone that comes through our doors.

UHN is a proud member of CAHO, which supports the health research enterprise that makes Ontario Healthier, Wealthier and Smarter.  We’re determined to also make it safer, and I thank CAHO for allowing me to write about the start of this journey and welcome your thoughts and questions.

 

Read more Health and Community Leaders Talk posts here, and share your own insights about the value of health research on Twitter with our hashtag, #onHWS.

To learn more about how health research makes Ontario healthier, wealthier, and smarter, check out our website and our other blog posts and videos.

 

Research Spotlight: Sinai Health System

Short-term insulin therapy successfully induces remission in Type 2 diabetes

A new study lead by researchers at Mount Sinai Hospital, part of Sinai Health System, has shown that early intervention with short-term intensive insulin therapy for four weeks can successfully induce a remission of Type 2 diabetes that lasts for up to one year thereafter.

The study was led by Dr. Ravi Retnakaran, an endocrinologist with Leadership Sinai Centre for Diabetes at Mount Sinai Hospital, and has just been published in BMJ Open Diabetes Research and Care. The findings of Dr. Retnakaran and his team show that the earlier that short-term intensive insulin therapy was administered after the diagnosis of diabetes, the more successful it was in sustaining a 48 week remission.

Dr. Ravi Retnakaran, Mount Sinai Hospital
Dr. Ravi Retnakaran, endocrinologist with Leadership Sinai Centre for Diabetes at Mount Sinai Hospital

Short-term intensive insulin therapy is typically administered for a period of two to four weeks and can decrease insulin resistance, reduce glucagonemia, improve pancreatic beta-cell function and induce a remission that can last up to one year in just under 50% of patients. The study showed that those who had been diagnosed within the preceding two years and then undergone the treatment had the longest sustained remission. Patients who had sustained remission had better baseline beta-cell function that was preserved across the one year after stopping the treatment.

On the road to longer term remission

“This study points us in a very important direction in our quest to address one of the most prevalent chronic diseases today. The first point is the clear benefit of short-term intensive insulin therapy, and the second is the importance of early intervention within the first few years after diagnosis.   Our quest is to better understand the factors that determine remission so that we can offer long term solutions for our patients. The current study tells us that one key factor is early intervention with short-term insulin therapy during a window of opportunity that only exists in the first few years after diagnosis,” said Dr. Retnakaran.

Home to world-class diabetes researchers and research centres

Dr. Retnakaran, an endocrinologist with Leadership Sinai Centre for Diabetes at Mount Sinai Hospital and an investigator with the Lunenfeld-Tanenbaum Research Institute, collaborated with Drs. Bernard Zinman and Caroline K. Kramer, both of Leadership Sinai Centre for Diabetes at Mount Sinai Hospital and Lunenfeld-Tanenbaum Research Institute, in conducting a major clinical trial known as RESET-IT that aims to induce remission of Type 2 diabetes. The institute ranks amongst the top diabetes research centres in the world.

More than three million Canadians have Type 2 diabetes and the World Health Organization recently warned that rates have quadrupled since 1980, with 422 million people worldwide living with diabetes. The rate is expected to double in the next 20 years.

Patients interested in participating in the RESET IT trial should contact: Ms. Haysook Choi at Mount Sinai Hospital at (416) 586-8778 or haysook.choi@sinaihealthsystem.ca.

 

Sinai Health System is one of Ontario’s 24 research hospitals that contribute to a healthier, wealthier, smarter province. Look for other RESEARCH SPOTLIGHT posts on our Healthier, Wealthier, Smarter blog or join the conversation about why health research matters for Ontario on Twitter, using the hashtag #onHWS.

Health & Community Leaders Talk: George Weber

By George Weber, President and CEO of The Royal Ottawa Health Care Group

Weber, George_The Royal

What does health research mean to you?

Research is vitally important in the mental health field because of a growing gap between the number of available specialized clinicians and the significant increases in people with treatment-resistant mental illnesses who require care that is both more effective and more efficient.

Mental health receives only about five per cent of medical research dollars, despite the fact mental illness is the No. 1 medical condition in terms of the years lost to disability, economic and social costs confronting Canadians; costing more than heart disease, pulmonary diseases and cancers combined.

Research plays a key role in discovering how to better manage symptoms of those with significant and/or chronic mental illness. For example, I am confident The Royal’s Brain Imaging Centre, which features a new PET/fMRI scanner, will help us understand how the brain works and ultimately move toward more accurate diagnoses, new treatment protocols and more personalized treatments to help these individuals improve.

The work being done by researchers and clinicians can only lead to a deeper understanding of the brain, and what happens when brain circuits go awry.

The goal, ultimately, is helping people with mental illness to return to productive and fulfilling lives.

Read Rachel Scott-Mignon’s Patients + Research blog post on The Royal’s new PET/fMRI scanner to learn more.

 

How does health research contribute to a healthier, wealthier, smarter Ontario?

It is estimated that the direct and indirect cost of mental illness to the Canadian economy is approximately $51 billion. Some put it at $38 billion for Ontario alone. Contributing to that is that in any given week, at least 500,000 Canadians are unable to work due to mental health problems and one in three Canadians will experience a mental health problem during their life.

As one of Canada’s foremost mental health teaching and research hospitals, The Royal combines the delivery of specialized mental health care, advocacy, research and education to improve the lives of people with complex and treatment-resistant mental illness.

Mental health research being done here and in other centres will help improve treatments rates, and will have a profound impact on creating a healthier, wealthier and smarter Ontario.

We have seen progress but there is still a long way to go. While advances have been made in the treatment of mental illness, it is still a matter of trial and error in many cases, with clinicians trying one approach after the other until something works. Research will take us to the next level, allowing for new, personalized treatment to help people manage symptoms sooner.

And, simply put, that means people can lead more productive lives, working and taking an active role in the community, all of which contributes to the prosperity of Ontario.

 

 

Read more Health and Community Leaders Talk posts here, and share your own insights about the value of health research on Twitter with our hashtag, #onHWS.

To learn more about how health research makes Ontario healthier, wealthier, and smarter, check out our website and our other blog posts and videos.