First-in-Canada: CLIMB program helps kids and teens take steps to holistic care for their minds and hearts

For a child or teen struggling with depression, the world can be a dark place. Depression, combined with the daily ups and downs of school, and life, can become overwhelming, or even paralyzing. Accessing the mental health care they need can be challenging at best. Any concerns about their physical health, as well as warning signs for serious future health problems, are often overlooked.

To address this often-disjointed approach to care, and to try to obtain a clearer picture of the health of the whole child, The Hospital for Sick Children (SickKids) has launched a new program that aims to provide holistic care to children and teens with depression. The first of its kind in Canada, the Children’s Integrated Mood and Body (CLIMB) program provides comprehensive mental health care for paediatric depression, while also screening for risk factors that may result in serious heart and related health problems as the patient grows up. The program is funded by the Medical Psychiatry Alliance, an Ontario initiative dedicated to transforming the delivery of mental health services for patients who are living with both physical and mental health conditions.

Cardiovascular disease is known to be a leading cause of death in individuals with depression, and research has shown that teens with depression are at higher risk of dying younger from cardiovascular causes than their non-depressed peers.

“Youth with mood disorders like depression are often not accessing the care they need. By the time they experience symptoms in adulthood, the window of prevention for cardiovascular problems has long passed,” says Dr. Daphne Korczak, Director of the CLIMB program, Child and Adolescent Psychiatrist and Clinician-Researcher at SickKids, who is also a trained general paediatrician.

CLIMB was designed to integrate physical health care and mental health care by an interdisciplinary team, which includes experts in psychiatry, cardiology, endocrinology, obesity and health systems. In addition to addressing the primary diagnosis of depression, the team aims to identify early signs of cardiovascular disease risk in children and teens. Armed with this information, they can determine opportunities for effective intervention early on, with the hope of reducing the severity of future cardiac problems, or eliminating them altogether.

“SickKids is uniquely positioned to do this because we already have the expertise in all of these related areas,” Korczak explains. The program is both a clinical initiative and a three-year research project. A clinical research registry is in development, through which clinical assessments, cardiometabolic markers, treatments and depression outcomes can be examined.  When complete, all CLIMB patients will be invited to participate. This research, Korczak hopes, will be an important step toward addressing a critical gap in scientific knowledge about how and when depression first presents an increased risk of cardiovascular disease. The team is also studying how early treatment of depression can impact cardiovascular risk.

“The CLIMB program will address this important question head-on, and pave the way for us to ensure that youth with mental health issues have excellent physical health as well. Recent research has suggested that youth with mental illness may have a higher chance of having risk factors for adult heart disease,” says CLIMB team Dr. Brian McCrindle, Staff Cardiologist and Section Head of Preventative Cardiology at SickKids and Professor of Paediatrics at the University of Toronto.

One in 15 Canadian children and teens are diagnosed with depression every year. CLIMB began seeing patients in June and feedback from families and clinicians alike has been positive so far.

“By bringing together experts in both mental and physical health, we can look more broadly at what’s going on for the child or youth as a whole, and be better equipped to help them thrive in the future,” says Korczak, who is also Assistant Professor of Psychiatry at the University of Toronto.

CLIMB is one of several innovative pilot programs rolling out at SickKids under the mandate of the Medical Psychiatry Alliance, a collaborative partnership between The Centre for Addiction and Mental Health, SickKids, Trillium Health Partners and the University of Toronto, in conjunction with the Ministry of Health and Long-Term Care and an anonymous donor.

Originally published on the SickKids website, this research story is an example of how SickKids is contributing to making Ontario Healthier, Wealthier and Smarter. www.healthierwealthiersmarter.ca.

 

Related Stories:

 

RESEARCH SPOTLIGHT: St. Michael’s Hospital

LifeVest was born to help babies

LifeVest, a technology being developed at St. Michael’s Hospital to help newborn infants breathe, won the Global Healthcare Innovation Academy’s international competition in Calgary.

Global Healthcare Innovation Academy brought together innovators, entrepreneurs, investors, and industry for its scientific and business innovation competition. The projects involved were recognized for cultural, scientific, technological, and/or social impact.

Premature infants have underdeveloped lungs and weak respiratory muscles, while other newborns may have pneumonia or other lung diseases. Because of such challenges, premature newborns or full-term babies with breathing difficulties may require specialized hospital care in a Neonatal Intensive Care Unit (NICU).

“For such critically ill newborns, breathing support with a mechanical ventilator is a life-saving treatment,” said Dr. Doug Campbell, director of St. Michael’s NICU. “But existing mechanical ventilation leaves much to be desired. Nasal devices can cause skin breakdown and permanent damage to infants’ noses. Current devices and ventilation techniques are imperfect and can interfere with breastfeeding and hinder parent-infant bonding.”

Dr. Campbell’s LifeVest pitch partner, Dr. Jennifer Beck, is with the hospital’s Keenan Research Centre for Biomedical Science. She’s part of a St. Michael’s research group that developed and commercialized neurally adjusted ventilator assist (NAVA). The group continues to develop technologies for mechanical ventilators, including LifeVest.

“In healthy people, the brain sends a signal to the diaphragm, telling the muscles to contract and relax—breathing,” said Dr. Beck. “For critically ill patients, the brain still sends the signal but the body is not able to properly perform the request.”

How LifeVest works

With NAVA technology, electrodes on the patient’s feeding tube pick up the brain’s signal to the diaphragm and tell the ventilator when and how much to breathe for the patient.

An infant would wear a vest (similar to a life jacket), and the ventilator triggered by the NAVA signal would pull gently on the chest by applying negative pressure. This would greatly assist the infant’s breathing. Dr. Beck said the concept has similarities to the old-fashioned iron lung, but the LifeVest is much easier to use. As well the materials will be lightweight and suitable for babies’ sensitive skin.

World-class innovation, international recognition

 ghia2016_209ghia2016_301
Drs. Doug Campbell and Jennifer Beck present LifeVest at the Global Healthcare Innovation Academy’s international competition in Calgary. (Photo by Chris Gee)

Fourteen innovators and start-up entrepreneurs from around the world competed for the Global Healthcare Innovation Academy’s $25,000 top prize. Each team presented a scientific pitch and six projects advanced to the competition’s second day to deliver a business pitch.

LifeVest was selected by the panel of judges based on criteria which included market opportunity and competitive advantage, problem and solution fit, and team and leadership. These judges came from a diverse portfolio of international expertise ranging from research and innovation agencies, to respected entrepreneurs and industry leaders.

St. Mike’s is driving research, clinical innovation and commercialization

LifeVest was born out of a research competition put on by St. Michael’s Foundation. Since 2015, St. Michael’s has run an Angels’ Den competition where teams pairing a researcher and clinician have competed for research funds. LifeVest won St. Michael’s 2015 Angels’ Den contest. MaRS Innovation provided business pitch support to LifeVest and the two 2016 Angels’ Den finalists who also competed at this year’s Global Healthcare Innovation Academy:

“We’re thrilled for Jennifer and Doug,” said Dr. Arthur Slutsky, vice-president of Research for St. Michael’s. “All three St. Michael’s teams represented the hospital well against stiff international competition. Each innovative project is a testament to the calibre of the research taking place in St. Michael’s labs and clinics, as well as the support of our Foundation through the Angel’s Den events.”

 

Related Stories:

 

St. Michael’s 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.

 

Patients + Research: Richard King

Meet Richard

Richard is one of hundreds of patient volunteers who have taken part in respiratory studies over the past 25 years with Dr. Denis O’Donnell, a world renowned researcher in Chronic Obstructive Pulmonary Disease (COPD) at Kingston General Hospital.

 Richard is one of hundreds of patient volunteers who have taken part in respiratory studies over the past 25 years with Dr. Denis O’Donnell, a world renowned researcher in Chronic Obstructive Pulmonary Disease (COPD) at Kingston General Hospital
Rick King at work in the dental lab he has managed for more than 45 years.
Photo: Matthew Manor (Kingston General Hospital)

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

I’m 70 years old and I’ve had lung disorders since I was three. It started as asthma, but now it’s Chronic Obstructive Pulmonary Disorder (COPD), which was diagnosed in 1994. I’ve been under the care of a respirologist since the early 1970s. I’ve gone through different levels of this disease, and it’s gotten worse over time. The problem is, air gets trapped in your lungs and it can’t get out, making it difficult to get new air in.

I’ve been under the care of Dr. Denis O’Donnell at Kingston General Hospital for the past two decades, and I’ve taken part in a number of his studies. He really has revolutionized my life. I’ve been part of a study to try out new inhalers with a new delivery system.

Dr. O’Donnell is a very kind and caring physician, always trying to read behind the lines, trying to find out why things happen. I’ve gone through seven decades of breathing disorders, and now I’m at a point where although I have limitations in my ability to perform physical activities, I still strive to live a normal life. The breathlessness is always with me but I have found that by pushing myself and exercising faithfully (which takes dedication) I can do almost do whatever I want!

Why does health research matter to you?

My belief has always been, we should give back. It’s why I’ve given my time to assist in research. Research matters to me because if there wasn’t research going on, there’d be no drug development, and a lot of people wouldn’t have the quality of life that we have now.

When I was little, many times I’d have to sleep upright in a rocking chair because I couldn’t breathe. Nowadays inhalers give your lungs an opportunity to open up your airways. You’re able to go for a walk or live a relatively normal life. When I see a doctor bending over backwards to find answers to benefit his patients, I recognize that are a lot of positives for us, and it’s our responsibility to help them answer the questions that lead to better treatments and better quality of life.

How does health research contribute to a healthier Ontario?

Research has helped me to have a better quality of life – I’m still going into the dental lab (which I managed for more than 45 years) three days a week as I move toward retirement– but it also helps the lives of all the people in Ontario. And it helps people around the world, so the impact of this Ontario-based research is global.

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

Without the patient volunteers, doctors wouldn’t be able to do the research, so the patient voice is important. The problem is, there’s not a lot of public knowledge about respiratory disease. For example, people with my problem, as long as we’re sitting still, nobody knows we have a problem. But as soon as we become active it’s an issue. You should be able to do all those kinds of things, walking, going up and down stairs, playing football with your grandson… you should be able to enjoy all aspects of life. That’s what the miraculous new drugs are doing for us. So it’s important for patients to give their time to research. It IS our responsibility!

 

Related Stories

 

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

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.

Hamilton Health Sciences Study Gives New Hope to Kids with Inflammatory Bowel Disease

Researchers at Hamilton Health Sciences are conducting a ground-breaking new trial looking at fecal transplants to help treat inflammatory bowel disease (IBD) in children.

Fecal transplant treatments have been found to be beneficial for adults with IBD, but the pediatric fecal transplant for ulcerative colitis trial – or PediFETCh – is the first such study for children with IBD in Canada, and the first randomized controlled trial of its kind in the world.

Dr. Nikhil Pai, principal investigator for the PediFETCh trial, says the study is particularly significant given that rates of IBD in children in Ontario are among the highest in the world and rising steadily. Dr. Pai is also a pediatric gastroenterologist in the Centre for Child & Youth Digestive Health at McMaster Children’s Hospital and assistant professor of pediatrics at McMaster University’s Michael G. DeGroote School of Medicine.

dr-pai-headshot-1
Dr. Nikhil Pai, principal investigator for the PediFETCh trial

“One in 150 Canadians have inflammatory bowel disease,” says Dr. Pai. “About 30 per cent of people with IBD are diagnosed before the age of 20, and Ontario has one of the highest rates of childhood-onset IBD in the entire world. Over the past five years, IBD has increased most rapidly in children under the age of 10 years old.”

Ulcerative colitis (UC) – one of a group of diseases known as inflammatory bowel disease – can have a severe impact on a child’s life, leading to stunted growth; debilitating pain; negative effects on the liver, bones, skin and eyes; and the need for surgery and frequent hospitalizations.

Fecal transplants involve the transfer of fecal material from a healthy donor into a patient’s gastrointestinal tract through an enema, endoscope, or catheter. In adults, repopulating the gut with healthy bacteria has been shown to treat patients with recurrent infections from a common, hospital-acquired bacteria known as C. difficile. A 2015 McMaster University study of adult IBD patients was the first to show that fecal transplants can improve symptoms of ulcerative colitis.

“This is a potentially life-changing treatment option for kids and teens affected by this increasingly common disease,” says Dr. Pai. “The PediFETCh study will help determine – for the first time – whether fecal transplants can be a viable treatment for children with UC who cannot control their disease with their current medications, or who want to avoid moving onto higher doses, different medications, or surgery.”

Patients six to 17 years old who have been diagnosed with ulcerative colitis are eligible for recruitment to the PediFETCh study. For more information, click here.

 

Related Stories

 

Hamilton Health Sciences is one of Ontario’s 24 research hospitals that contribute to a healthier, wealthier, smarter province. Read more stories on our Healthier, Wealthier, Smarter blog or join the conversation about why health research matters for Ontario on Twitter, using the hashtag #onHWS. This story was originally published on HHS Share.

 

 

Patients + Research: Maria Larmon

Meet Maria

Thirty years ago, Maria Larmon was diagnosed with an eye condition that left her legally blind. Researchers at the Hotel Dieu Hospital Low Vision Rehabilitation Clinic have used new accessible technologies, including the iPad, to help Maria regain her independence.

hws-blog-hotel-dieu-hospital-patient
Maria Larmon with Hotel Dieu ophthalmologists/researchers Dr. Mark Bona (left) and Dr. Zale Mednick (right).

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

About 20 years ago, when I was 30 years old, I was diagnosed with retinitis pigmentosa, an eye condition that eventually left me legally blind and unable to read or watch TV.  I stayed in the house more and more.  I tried using magnifiers and other low vision aids but without much success.

Why does health research matter to you?

Health research turned my life around.  Thanks to a study in the Low Vision Rehabilitation Clinic at Hotel Dieu Hospital I learned how to use the really helpful accessibility features on an iPad such as the virtual assistant Siri and voiceover.  Before, I had to hope like heck someone else remembered by medical appointments.  Now I can track them myself, send emails, text, find recipes on the internet and access other applications that support people with low vision.  I have my independence and privacy back, and a lot more hope for the future.

How does health research contribute to a healthier Ontario?

Having low vision can have a huge impact on your life.  You run the risk of falling more or suffering from depression or losing a job.  You could end up with more physical or mental health problems.  Researchers like Dr. Mark Bona and Dr. Zale Mednick at Hotel Dieu Hospital aren’t just trying to help people see print better.  They’re improving the quality of their lives by helping them to function better in society and live healthier, happier and more productive lives.

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

I think patients can help to support research by speaking out about how research has helped them and improved the quality of their lives—good reasons to encourage others to participate in research studies.

 

Related Stories

 

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.

RESEARCH SPOTLIGHT: Providence Care

New Rehab Study at Providence Care gets “Fitbit” Treatment

Feature Photo: Dr. Trier and Dr. DePaul demonstrate some of the technology associated with their study. Photo by Matthew Manor at Kingston General Hospital.

Dr. Jessica Trier of St. Mary’s of the Lake’s Physical Medicine & Rehabilitation Program and Dr. Vincent DePaul, Queen’s University’ Assistant Professor in the School of Rehabilitation Therapy have developed a new research study to benefit patients with Acquired Brain Injury with their rehabilitative care.

Dr. DePaul says the introduction of wearables like the Fitbit have opened doors in terms of measurement of physical behaviour. That is what the study focuses on. Patients will wear an ActiviPal – a small accelerometer (like a Fitbit) – during rehab, for the first seven days post-discharge and three months after discharge. Afterwards, the data is downloaded and analyzed.

Dr. DePaul explains, “This device detects and records the body’s motions in 3 different planes of movement. It’s able to tell us if the person was lying, sitting, standing or walking, and how much time they spent in each activity, and what time of day they performed these activities. We will be looking at how that activity data is associated with their physical status and some of those other factors, their cognitive – ability to think – and do sort of higher level activities and some of their personal, social situations and see if that affects their activity patterns at different points in time.”

Dr. Trier goes into more detail on the purpose of monitoring the patient’s activity, “We have a general idea of what people’s activity patterns are like while they are in the hospital but that’s never been formally studied. We also don’t really know what those people do when they leave rehabilitation and carry on with their exercise programs in the community, particularly in this population with cognitive impairment.”

There are two groups the doctors would like to focus on: those who received funding through motor vehicle insurance and therefore may have a lot of support from a community rehab team, and those who may have had a different cause of brain injury, such as falling down the stairs. The latter group may not have insurance funding and therefore have limited access to community rehabilitation resources.

“We want to know if there is a difference in activity patterns between those two populations that may have more or less funding in terms of their activity patterns,” Dr. Trier confirms.

Dr. DePaul adds, “This is a pilot study, meaning that we hope to be able to collect some initial information and data about the activity patterns of these patients, and try out the research methods with the idea that we’ll be able to do the larger study and ask bigger questions.”

This project is still in the very early days, HSREB approval has been received and Dr. Trier and Dr. DePaul expect to recruit their first participant in early in the fall. Stay tuned!

 

Related Stories:
Patients + Research: Mike Gardner
HWS Field Trip: Kingston
RESEARCH SPOTLIGHT: The Ottawa Hospital

 

Providence Care 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.