CAHO Webinar Expert Panel Members Discuss The Art of the Possible: Debunking Common Procurement Myths in Ontario’s Broader Public Sector

CAHO Webinar Expert Panel Members Discuss The Art of the Possible: Debunking Common Procurement Myths in Ontario’s Broader Public Sector

The Council of Academic Hospitals of Ontario (CAHO) held a webcast on Monday, November 26 on The Art of the Possible: Debunking Common Procurement Myths in Ontario’s Broader Public Sector.

Stemming from CAHO’s reference guide titled, The Art of the Possible: A Quick Reference Guide to Ontario Broader Public Sector Procurement Myths, the expert panel members examine well-known barriers to innovation adoption in Ontario and strategies to address them.

If you are involved in hospital procurement in Ontario, this webcast can be a valuable educational tool to help you confront barriers or misconceptions associated with the Broader Public Sector Procurement Directive. Additionally, if you are considering an innovation to pilot and/or adopt at your organization this webcast will also act as an informative tool.

A few of the myths addressed in the webcast include:

  • Organizations must pick the lowest cost option to be consistent with the Value for Money principle of the Directive
  • The Directive forces organizations to go to market for all procurements
  • Health Service Providers are not allowed to talk to vendors

A survey conducted by CAHO across its member hospitals in 2016 helped identify the major hurdles to innovation adoption within their own organizations. 76% of respondents identified policies, directives, and procurement rules as their biggest barriers.

The Art of the Possible Quick Reference Guide and webcast are meant to empower you and your organization by making clear what can be done, what resources are available, and by encouraging you to take a value-based approach to procurement.

This webcast is part of CAHO’s work as an Innovation Broker for the Ministry of Health and Long-Term Care. CAHO was appointed as an Innovation Broker in 2017 to address barriers to innovation adoption.

CAHO represents Ontario’s 23 research hospitals that play a unique and vital role in the province’s health care system. Collectively, we provide advanced patient care services, train the next generation of health care professionals, and conduct leading-edge research to discover tomorrow’s care today. On the foundation of this work, we generate the expertise and evidence to drive change as system leaders, building a healthier, wealthier, smarter Ontario.

Physicians and researchers partnering to improve care in Northern Ontario

Health Sciences North Research in Sudbury and Northern Ontario

Physicians and researchers partnering to improve care in Northern Ontario

Dr. Robert Ohle, Emergency Physician with Health Sciences North, also conducts research at Health Sciences North Research Institute 

Physicians at Health Sciences North (HSN) are collaborating with researchers at the Health Sciences North Research Institute (HSNRI) to improve care for patients and families in Northern Ontario and across the province.

With new funding from the Northern Ontario Academic Medical Association (NOAMA), more than 14 physicians are working with 10 researchers on a number of new projects that include supporting Indigenous families in end of life care, developing a pre-habilitation program for colon surgery patients, and measuring the outcomes of comprehensive palliative care in Northeastern Ontario.

Dr. Robert Ohle, an Emergency Physician with HSN, is one of many physicians who conducts research at HSNRI and who received funding from NOAMA this year. He is adapting and improving current national guidelines for Acute Aortic Dissection (AAD), a rare, but life-threatening condition that results from a tear in the inner wall of the aorta, the body’s main blood vessel. AAD can present with a variety of symptoms that makes it difficult to diagnose. There are no widely accepted guidelines that are both safe and efficient to help guide physicians.

“We expect that an evidence-based clinical practice guideline for ADD will reduce practice variation, improve efficiency of advanced imaging, lead to a reduction in missed cases and ultimately improve patient care,” said Dr. Ohle. “We plan to use a multidisciplinary collaborative process to adapt and improve the current guidelines. It’s important that the unique practice environment of Northern Ontario is represented in any national guideline. We will include remote rural physicians, surgeons and patients from both Northern Ontario and across Canada.”

Dr. Janet McElhaney, Vice President and Scientific Director of HSNRI, also received a NOAMA grant to support her work collaborating with Indigenous communities in Northern Ontario to improve health care. “This year’s NOAMA grants are enabling physicians to begin new research projects and investigate health outcomes for patients in Northern Ontario. It is providing an opportunity for collaboration between researchers and physicians,” says Dr. Janet McElhaney, Vice President and Scientific Director, HSNRI. “As a NOAMA recipient, these grants are crucial to assist physician researchers such as myself to help improve patient care.”

Physicians and researchers from HSN and HSNRI received more than than $700,000 from two NOAMA grants, the Alternative Funding Plan Innovation Fund and Clinical Innovation Opportunities Fund. These grants support the development of new and innovative approaches in health care delivery and enable clinician scientists to develop and implement of new evidence-based enhancements within their clinical practices.

Health Sciences North is one of Ontario’s 23 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.

Using Kingston-made technology to uncover the brain effects of kidney disease

Dr. Gord Boyd, a critical care doctor, neurologist at KHSC and Associate Professor of Medicine at Queen’s University and Jessica Vanderlinden, PhD candidate at Queen’s University who is working with Dr. Boyd

Using Kingston-made technology to uncover the brain effects of kidney disease

Kidney disease doesn’t just affect a patient’s body, it’s hard on their brain too – but no one really knows to what extent.

New research at Kingston Health Sciences Centre (KHSC) is offering intriguing insights into the kidney-brain connection that could change the way that kidney disease is assessed and treated in future.

For the first time, patients on dialysis are being assessed by the KINARM™ to measure the brain effects of kidney disease. KINARM, a state-of-the-art robotic system developed by neuroscientist Dr. Stephen Scott at Queen’s University, precisely measures what’s happening in an individual’s brain or nervous system by testing their ability to perform ordinary movements and tasks.

KINARM was commercialized by Queen’s spin-off, BKIN Technologies, which employs eight people and has sold the KINARM in nearly 60 countries around the world. The system is now in use at all of Kingston’s hospitals to study a wide variety of neurological conditions.

Leading this research is Dr. Gord Boyd, a neurologist and critical care doctor at KHSC who looks at the links between oxygen levels and brain injury in intensive care patients. He says the project was sparked by a casual conversation with Dr. Rachel Holden, a kidney disease specialist at KHSC whose patients are often in intensive care.

“One of the benefits of being in an academic health science centre is that we can collaborate with other specialists to find solutions to the health challenges in our own hospital. In this case, Dr. Holden and I were talking about how to identify oxygenation in the brain, and she suggested that her patients would greatly benefit from this research,” says Dr. Boyd, who is also an Associate Professor of Medicine at Queen’s University.

“While there is some evidence showing that kidney disease, especially in its later stages, can affect some brain functions such as attention and memory, the conventional pen-and-paper tests used to track these effects produce variable and subjective results – and they can’t diagnose the motor effects of brain injury,” says Dr. Boyd.

“There’s no gold-standard test for the effects of kidney disease on brain function, so it’s hard to know the patient’s degree of cognitive impairment,” says Jessica Vanderlinden, a PhD candidate who is working with Dr. Boyd on the project.

Over the past two years Boyd and Vanderlinden have been studying patients on hemodialysis, a four-hour procedure usually done in hospital, and patients on home peritoneal dialysis, a less intensive process that cleanses the blood of the body’s toxins overnight. The patients come to KHSC to participate in KINARM tests before beginning dialysis, then follow-up testing in the KINARM lab at three months and one year.

The researchers will compare patients’ test scores and oxygenation data to study which procedure – hemodialysis or home dialysis – has the better effect on patients’ cognitive function.

They’ve now expanded the scope of their research to include patients at all stages of kidney disease – from mild to moderate, chronic and end stage, which requires dialysis.

They’re also collaborating with Dr. Sam Silver, a nephrologist at KHSC, to include patients with a single episode of acute kidney injury. “No one has ever looked at the brains of this specific group of patients,” Boyd says.

“We’re hoping to come up with a really good description of the neurological complications of kidney disease,” says Ms. Vanderlinden.

This research could provide new insights on treating patients, the researchers say. For example, it could show that hemodialysis itself may need to be re-examined. “If hemodialysis patients have accumulated impairments, how can we make dialysis gentler on the brain? Or it may suggest that we start dialysis sooner, or do transplants sooner,” says Dr. Boyd.

This data can also point to the need for end-of-life conversations. “If we know how much they are impaired, we can develop a plan to start these conversations with them, or if they’re very impaired, with their substitute decision-makers,” Boyd says.

Their work has been sponsored by the Queen’s Department of Medicine Innovation Fund and through equipment donated by the University Hospitals Kingston Foundation.

Feature photo: Dr. Gord Boyd, a critical care doctor, neurologist at KHSC and Associate Professor of Medicine at Queen’s University and Jessica Vanderlinden, PhD candidate at Queen’s University who is working with Dr. Boyd. Photo by M. Manor, KHSC.

 

Kingston Health Sciences Centre is one of Ontario’s 23 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.

CAHO hospitals are driving safer prescribing practices for Ontarians

Research hospitals are driving safer prescribing practices for Ontarians

CAHO hospitals are driving safer prescribing practices for Ontarians

As the population ages, older Canadians are living with multiple chronic conditions and research shows that they are taking many medications.

About a quarter of Canadians over 65 take ten or more prescription drugs, according to a report by the Canadian Institute of Health Information. Some medications can become unnecessary – or even harmful – over time, with age and sometimes because of drug interactions. This can lead to unnecessary hospitalizations and health system costs. One study estimated that Canadians spend $1.4 billion each year in health care costs to treat harmful effects from medications, including fainting, falls, fractures and hospitalizations.

Patients don’t want to be overmedicated either. Another study found that Canadian seniors are prepared to reduce their medications or stop them entirely if their doctors advise it is safe.

Ontario research hospitals are helping physicians and health care professionals change prescribing practices to help patients take only the medications they need, reducing the medication burden in Ontario while improving the quality of life for seniors.

Dr. Paula Rochon at Women’s College Hospital identifies the problem of prescribing cascades

Dr. Paula RochonA prescribing cascade occurs when a doctor misinterprets a patient’s adverse drug reaction as a new medical condition and responds by prescribing another medication.

This issue was first described in 1995 by Dr. Paula Rochon, now the Vice President of Research at Women’s College Hospital, and co-author Dr. Jerry Gurwitz. Since then, there has been increasing focus on smarter prescribing practices and Drs. Rochon and Gurwitz recently revisited their two-decades-old article to see how far we’ve come.

“Since we first described prescribing cascades, they have made an important impact on medication safety in Canada and abroad,” Dr. Rochon says. “I am greatly encouraged by the work happening today across CAHO hospitals and by organizations including the Canadian Deprescribing Network.”

Dr. Barb Farrell at Bruyère Research Institute is developing guidelines to help doctors deprescribe

Dr. Barb FarrellDr. Barb Farrell is a lead researcher with the Bruyère Research Institute and a founding member of the Canadian Deprescribing Network. Together with her research team, she is developing evidence-based guidelines to help guide Canadian healthcare practitioners on when and how to deprescribe medications to improve patient care. The goal is to help clinicians evaluate, reduce and stop medications that may no longer benefit a patient or may cause them harm.

“Our hope is that these guidelines will provide the framework necessary for clinicians around the world to make the best decisions possible for their patients,” said Farrell.

Evidence-Based Deprescribing Guideline Symposium at Bruyere Hospital

The Evidence-Based Deprescribing Guideline Symposium, hosted by the Bruyère Deprescribing Research team, brought together 130 participants from ten countries to share best practices and develop tools.

Dr. Michelle Greiver at North York General Hospital is using data to improve prescribing patterns

Dr. Michelle GreiverDr. Michelle Greiver is a practicing Family Physician and Research Scientist at North York General Hospital (NYGH). She is working to decrease the number of drugs prescribed to seniors and optimize care for patients with complex needs through a new research project called SPIDER (Structured Process Informed by Data, Evidence and Research).  

SPIDER leverages electronic medical record data to identify seniors taking multiple medications and improves prescribing patterns by bringing together a broad range of health care players, each with a specific role. Hospital health planners and quality improvement coaches work closely with family physicians and patient advisors to implement practice changes and improve care for complex seniors taking multiple medications. Meanwhile, researchers use the electronic medical record data to measure overall changes in the types and number of drugs prescribed. The researchers also interview patients and physicians to find out what worked and what didn’t. This is all being done while preserving the privacy and confidentiality of patient information.

“Reducing medications that are not benefiting seniors could help reduce side effects like dizziness and confusion,” says Dr. Greiver. “This could lead to a decrease in falls and an improvement in patients’ ability to manage at home. Consequently, this could impact some areas of NYGH such as the emergency department (fewer visits due to falls and fractures) and the geriatric inpatient unit (fewer admissions).”

Led by Dr. Greiver, a team of more than 50 investigators will roll out SPIDER in five provinces across Canada.

 

North York General Hospital, Bruyere Continuing Care and Women’s College Hospital are three of Ontario’s 23 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.

 

 

Feature photo: Simone van der Koelen on Unsplash

 

Inaugural Research Day Focuses on Smart Health in Northern Ontario

Inaugural Research Day Focuses on Smart Health in Northern Ontario

Thunder Bay Regional Health Sciences Centre (the Hospital) and its research arm, the Thunder Bay Regional Health Research Institute, are teaming up to host their first ‘Research Day’ on September 6, 2018.

Focused on “smart health” and technology as a driver of health care, the fullday event is open to the public and designed to showcase how health research is improving care for people in Northern Ontario.

“Technology can assist in overcoming several of Northwestern Ontario’s geographical and cultural barriers to care,” said Jean Bartkowiak, President and CEO of the Hospital and CEO of the Health Research Institute. “It can help us streamline and improve access to care so that we are able to provide the right care to the right person at the right time, no matter where they live in the region.”

That’s where “smart health” comes in. Smart health is an umbrella term for connected and interconnected health solutions for diagnosing, monitoring, treating and advising patients. It uses technologies such as smart phone apps, internet and even video technology in innovative ways to overcome those barriers and improve patient care.

The Health Research Institute is currently exploring how technology can bring smart health solutions to the region and to achieve the objectives of the Hospital’s Strategic Plan 2020 to contribute to a healthier, wealthier and smarter Ontario.

Healthier

Indigenous health has been identified as one of the Hospital’s five key directions and is one of the directions in the Health Research Institute’s 2020 Strategic Plan. The Health Research Institute will be working with Hospital staff and others to engage Indigenous leaders and communities to learn more about the communities that the Hospital serves and their health needs. The goal is to research and develop programs and services that can be adapted to each community need and capacity. Smart health can help achieve that goal, providing opportunities to overcome the specific geographical, cultural, language and other barriers to care.

Wealthier

The Health Research Institute was founded on the understanding that homegrown solutions work best for a unique region such as Northwestern Ontario, where health care delivery faces a unique set of challenges. The Research Institute’s scientists and researchers attract research funding that supports homegrown projects. For example, Dr. Naana Jumah and Dr. Chris Mushquash are developing prenatal services for Indigenous mothers and increased health education for Indigenous high school students in Thunder Bay.

Smarter

One of the Institute’s first steps in 2018 is to hire a smart health technology scientist with a joint appointment at Lakehead University. Many digital tools can enhance distance health and indeed most areas of health care – perhaps an overwhelming number of tools. The Institute plans to bring in an expert who can determine the best tools for the Hospital and its partners in health, and investigate how smart health technologies such as apps, sensors and other software-based solutions can be used to improve care.

Driving innovation through collaboration

While it’s still early days for smart health technology, the Research Institute plans to implement new technology over the next several years that will significantly improve patient care in the region, keeping patients closer to home.

The new venture into smart health relies on other research programs as well as academic, clinical, and community affiliates. The Institute is looking to partner with Mohawk College in Hamilton and their mHealth & eHealth Development and Innovation Centre (MEDIC) – which is itself a partnership with McMaster University – to assist in finding the right digital health solutions. By sharing resources and expertise, researchers in Thunder Bay can focus on how technology can improve health care delivery in Northwestern Ontario rather than learning to use the technology from scratch.

The Health Research Institute is also expanding its partnerships with innovators. As a member of the Council of Academic Hospitals of Ontario (CAHO), the Institute participates in CAHO’s role as an Innovation Broker, appointed by the Ministry of Health and Long-Term Care in 2017. Through this role, CAHO connects innovators with its member hospitals to remove barriers and bring innovations into hospitals faster, benefiting the Ontario economy and improving patient care.

These partnerships will support the Hospital’s Strategic Plan 2020 and will assist the Health Research Institute to meet its 2020 Strategic Plan Directions to fuel a Healthier, Wealthier, and Smarter future.

 

Thunder Bay Regional Health Science Centres is one of Ontario’s 23 academic 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 tech developed in Hamilton is bridging the gap between hospital and home

Health tech developed in Hamilton is bridging the gap between hospital and home

Imagine having a major surgery and being able to go home only days later.

We know that people recover better in their own surroundings, where they’re most comfortable. But, there’s also a higher risk of complications in the first month after surgery. How do we reduce this risk to ensure people don’t end up back in the hospital, while encouraging a better recovery process?

Technology has made its way into every aspect of our lives. Now, it’s helping healthcare professionals answer important questions like this one.

Researchers at the Population Health Research Institute of Hamilton Health Sciences (HHS) and McMaster University have developed a potential solution to bridge the gap between hospital and home for patients who undergo major surgery. The SMArTVIEW project utilizes unique Philips’ technology to wirelessly monitor patients vital signs on the ward, as well as a hospital-to-home system to track a patient’s vital signs once they’ve gone home and alert the hospital team to any patient flags. The system is currently being tested in a formal research trial to determine whether it could help prevent hospital readmissions and the many complications and, in some cases, deaths that can happen in the weeks after heart surgery.

“In the operating room and intensive care unit (ICU), patients are closely monitored and the surgical team can act quickly if problems arise.” says Dr. Michael McGillion, principal investigator for SMArTVIEW. “We also need systems that can monitor patients closely on the surgical ward and at home, beyond the operating room and ICU. We still need the ability to monitor closely and intervene before serious complications occur.”

A crucial aspect of the SMArTVIEW model is the team of registered nurses who follow patients through the entire recovery process and, with the support of the mobile technology, ensure that any issues are addressed quickly. As the SMArTVIEW system collects patient data, it identifies abnormalities that could be the first warning sign of a complication and prioritizes patients accordingly for the nursing team’s review. It’s exciting for the SMArTVIEW nurses. Typically their relationship with the patients ends when they leave the hospital, but with SMArTVIEW, they can continue to help the patients once they’re home.

“We get to use the full scope of nursing practices and are more involved in the patients’ recovery than ever before,” says Natalia Worek, registered nurse, SMArTVIEW project. “It’s so rewarding to be part of the entire process and reach recovery milestones with them.”

“We’re empowering the patients to take control of their recovery and help them every step of the way. We’re not only reviewing their vitals, but helping them set and achieve goals, no matter how big or small. We want to ensure they can get back to their regular lives,” says Filomena Toito, registered nurse, SMArTVIEW project.

The SMArTVIEW system goes beyond tracking vitals: it’s also a self-management system that includes information on what to expect in recovery, healthy practices for best recovery, goal setting, a messaging system with the nurses and an open forum to have dialogue with other patients in recovery. Also, part of the SMArTVIEW trial includes a daily video chat with one of the nurses to ensure patients are on track.

“It’s a more holistic approach. We talk to them about their sleep, nutrition, pain management, physical activity and well-being. These all play a part in the recovery process,” says Karyn Barrett, registered nurse, SMArTVIEW project. “On top of that patients can ask questions that may have otherwise caused them to go see a doctor.”

Successful integration of new technology in to healthcare practice requires the support and expertise of a large team that extends beyond healthcare providers and includes IT, biomedical technology and informatics professionals.

“As nurses, we have no idea how to develop this kind of technology. Likewise, developers aren’t experts in caring for patients,” says Carley Ouellette, registered nurse, SMArTVIEW project. “But working together, we can have a real impact on people’s lives.”

The SMArTVIEW project is in partnership with project contributors Philips Healthcare, QoC Health Inc., ThoughtWire Corp, CloudDX, XAHIVE Inc., Argyle Public Relationships, and Ontario Telemedicine Network. The project is funded by the Canadian Institutes of Health Research, the Ontario Centres of Excellence, and the Hamilton Health Sciences Research Strategic Initiative (RFA).

Hamilton Health Sciences is one of Ontario’s 23 academic 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.

This story originally appeared on www.weareexplorers.ca.  

New tool tackles major barrier to health innovation adoption in Ontario

The Art of the Possible: A Quick Reference Guide to Ontario Broader Public Sector Procurement Myths

New tool tackles major barrier to health innovation adoption in Ontario

Procurement myths are well-known barriers to innovation adoption in Ontario. A new tool is available to help hospitals pull innovation into Ontario’s health care system faster, improving patient care and health system efficiency.

The Art of the Possible: A Quick Reference Guide to Ontario Broader Public Sector Procurement Myths, created by the Council of Academic Hospitals of Ontario (CAHO), offers straightforward explanations and supporting resources to facilitate hospital procurement of new health technologies or innovations.

In a 2016 survey across CAHO members, Ontario’s 23 academic research hospitals, 76 per cent of respondents identified policies, directives and procurement rules as major hurdles to innovation adoption within their organizations. Aiming to address this challenge, CAHO convened a small panel of experts to develop a quick reference guide with the goal of dispelling myths and identifying what’s really possible when it comes to procurement in Ontario.

“Health care organizations are risk averse by nature, and this also permeates approaches to procurement,” said Sarah Friesen, President of Friesen Concepts and procurement expert on The Art of the Possible development panel. “By debunking some of the more prevalent myths, this guide will increase confidence in exploring innovation procurement opportunities that can improve patient outcomes and deliver value for money.”

The Art of the Possible: A Quick Reference Guide to Ontario Broader Public Sector Procurement Myths

The Art of the Possible guide is part of CAHO’s ongoing efforts to remove barriers to business and promote innovation adoption within Ontario’s health care system through its work as an Innovation Broker with the Office of the Chief Health Innovation Strategist.

CAHO has made significant contributions to Ontario’s innovation ecosystem during its first year as an Innovation Broker, including the following accomplishments:

  • Published a list of critical problems within CAHO hospitals that require innovative solutions
  • Established a streamlined intake process for testing innovative technologies that gives innovators simultaneous access to CAHO members
  • Made over 40 connections between innovators and CAHO hospitals to pursue opportunities for validation testing of new technologies within clinical settings
  • Fostered a culture of innovation adoption within CAHO hospitals by providing tools and resources to address barriers, including The Art of the Possible guide

“Our Innovation Broker work is motivated by our commitment to provide patients with the best available care and to help build the health system of the future,” said Brian Mackie, co-chair of CAHO’s Innovation Broker Task Force and Vice President of Finance and Chief Financial Officer at Baycrest. “Ontario’s sickest and most complex patients depend on the specialized care that academic research hospitals provide and this work is helping us pull new technologies into our hospitals faster so that we can do a better job delivering on that promise.”

CAHO hospitals play a unique and vital role in the province’s health care system. Collectively, they provide specialized patient care services, train the next generation of health care professionals and conduct leading-edge research to discover tomorrow’s care today.

“The Innovation Broker work provides an opportunity for CAHO hospitals to strengthen the business side of Ontario’s health care system by facilitating connections between innovators and our members,” said Michelle Noble, Executive Director of CAHO. “This work exemplifies the role of academic research hospitals in building a healthier, wealthier and smarter Ontario.”

CAHO is calling all innovators with an innovation that will help improve care and increase efficiency in Ontario’s health system to submit a request for a validation test site. Visit CAHO’s Innovation Broker webpage for more information.

 

Donor lungs with hepatitis C safely transplanted to patients at UHN

Donor lungs with hepatitis C safely transplanted to patients at UHN

Donor lungs from individuals infected with hepatitis C have been successfully transplanted into 10 patients at Toronto General Hospital (TG), University Health Network (UHN).

All patients have recovered from their transplant surgery. Eight of them have already tested negative for the virus and the last two patients have recently started taking the drug regimen.

The transplants are part of a clinical trial that is the first to assess the safety of transplanting hepatitis positive organs to non-infected patients using the ex vivo technology. Developed at TG in 2008, the Toronto Ex Vivo Lung Perfusion System (EVLP) perfuses organs outside of the body, allowing doctors to assess the organ and predict how well it will do before transplantation.

The use of hepatitis C infected organs to help deal with the shortage in organ donors will be discussed by experts at the Global Hepatitis Summit, which starts in Toronto on June 14.

“With the opioids crisis and persistent high rates of intravenous drug use, we have a great number of potential lung donors who are hepatitis C positive – many of whom didn’t even know they were sick when they were alive,” says Dr. Marcelo Cypel, thoracic surgeon at TG, UHN, scientist at Toronto General Hospital Research Institute (TGRI) and principal investigator in the study.

“The current protocol is to not use these organs, but we started to question if that still made sense in an era when direct anti-viral agents (DAAs) can cure hepatitis C,” he says.

The study is led by Drs. Cypel, Atul Humar, Medical Director of UHN Transplant, and Jordan Feld, specialist from the Toronto Centre for Liver Disease, TG, UHN.

Dr. Marcelo Cypel estimates there could be 1,000 more lungs available for transplant every year in North America by using hepatitis C positive organs (Photo: UHN)

In recent years, the latest drug regimen of sofosbuvir-velpatasvir for a 12-week period has been used to cure patients with hepatitis C around the world. However, there were still concerns around how this could impact transplants.

The questions researchers want to answer are: if hepatitis C negative patients can be safely transplanted with infected donor organs, and whether they can clear the virus after their surgery.

For this study, lungs were placed in the EVLP circuit in a sterile dome for six hours. The surgical team was able to evaluate the lung function and be certain that the organs were suitable for transplant, despite being infected with hepatitis C.

After six hours, EVLP reduced the hepatitis C virus count to very low levels. As expected, patients still contracted the disease. However, they tested negative for hepatitis within only three weeks of treatment with DAAs, in average.

Developed at UHN, the Toronto Ex Vivo Lung Perfusion System (EVLP) perfuses organs outside of the body. (Photo: UHN)

“This is an initial study, but it shows positive results,” says Dr. Feld. “It suggests that it is safe to use these organs which otherwise we could not have used. This could eventually be a big boost for organ donation.”

“We have a long standing tradition of excellence and pushing boundaries in transplant research and we are pleased that we were able to pioneer this study,” Dr. Humar says.

Dr. Cypel estimates that accepting hepatitis C positive donors would increase the number of lungs available for transplant by 1,000 per year in North America. Currently, approximately 2,600 lung transplants are done per year in Canada and the United States combined.

As of 2016, there were more than 240 patients waiting for a lung transplant in Canada alone and the estimate is that 20 per cent of patients die while waiting for lungs to become available.

Patient experience

As important as the fight against the virus, is the fight against stigma. As studies start to show that it is safe to transplant organs from hepatitis C positive donors, doctors are educating patients about the disease and on how effective DAAs are in curing it.

Stanley De Freitas, 73, is one of the patients who received lungs as part of the study. He suffered from pulmonary fibrosis and agreed to receive hepatitis positive lungs in October, 2017.

“People take breathing for granted and don’t realize the limitations of having a pulmonary disease,” says De Freitas.

“Now, every breath I take I think of my donor and it doesn’t matter that the donor had hepatitis C. I didn’t even have any symptoms of the disease. I recovered well and now I can enjoy life with my two daughters, four grandchildren and my two great-grandchildren.”

De Freitas says at first he was worried about contracting hepatitis C, but after receiving information about the disease, he didn’t think twice and gladly accepted the life-saving lung transplant. He urges other patients to do the same.

“If these lungs or other organs are available, go for it! The treatment is effective and you will have your life back.”

Eva Runciman, 52, suffered from Chronic Obstructive Pulmonary Disease (COPD). Before her transplant, in February, she couldn’t walk because she had difficulty breathing.

“I would tell everyone waiting for a transplant not to be afraid of accepting organs with hepatitis C, trust the treatment,” she says. “The change in life quality is just amazing. I now can walk, I can drive and play with my grandkids.”

(Photo: UHN)

About the clinical trial

The first phase of the study was comprised of the 10 surgeries – performed between October, 2017 and May, 2018. The average age of the organ donors was 33 and the average age of the recipients was 64. The study will be followed by a second phase that will further assess techniques to use organs carrying the virus.

This work is supported by the Canadian Institutes of Health Research, Medicine by Design, Toronto General & Western Hospital Foundation, Gilead Sciences and Xvivo Perfusion. Dr. Cypel also praised the efforts and support of Trillium Gift of Life, which co-ordinates organ and tissue donation across Ontario and without whom this trial would not have been possible.

“We are very grateful to our donors and to Trillium for coordinating the organ donor lists and making it possible for us to conduct this study.”

The Global Hepatitis Summit, 2018 is being held at Metro Toronto Convention Centre from June 14 to 17.

“The advent of DAAs has really created a dramatic shift in how we treat hepatitis C. This study is a perfect example of the latest developments in this exciting rapidly moving field that we will be discussing during this week’s Global Hepatitis Summit,” says Dr. Feld.

The summit will bring together top clinicians and researchers from around the world to Toronto to discuss the remarkable therapeutic developments in recent years and the prospect of disease elimination. The Global Hepatitis Summit 2018 is chaired by UHN’s physicians and researchers Drs. Harry Janssen, Jordan Feld and Adam Gehring.

 

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University Health Network is one of Ontario’s 23 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.

 

 

Patients + Research: Andra Fawcett

Andra Fawcett Kingston Health Sciences Centre CAHO photo by Matthew Manor

Patients + Research: Andra Fawcett

Meet Andra

Andra survived a major stroke in her early 50s. She continues her progress to full mobility, but she’s also keen to help others by taking part in research. She was excited to participate in a study using the KINARM, a game-changing robotic technology used in all three Kingston academic research hospitals to assess the neurological impact of a wide range of injuries and diseases. The reams of data produced by the KINARM are used to help researchers and clinicians better understand the effects of brain injuries such as stroke.

Can you tell us a bit about your family and your family’s health story?

I had my first stroke when I was 49. It was a mini-stroke (or TIA) and I lost the use of my left arm and hand for about a month. Two years and two months later, I had a major stroke.  I was at home and I was feeling tired, nauseous, weak, and dizzy. I was stumbling and my left foot felt heavy, but light at the same time.  I realized this was not normal. My daughter-drove me to hospital. While I was waiting in the ER, I didn’t have any of the classic stroke symptoms – my face wasn’t drooping, I didn’t have trouble speaking, I never really felt anything. But when I woke up the next day, I had lost all my mobility on my left side.

I was in Kingston Health Sciences Centre’s Kingston General Hospital for two weeks and then six weeks in rehab at Providence Care. After my TIA, my stroke doctor connected me with the KINARM. It’s a robotic system that assesses how brain injuries affect our ability to move and function. After my second stroke I started doing more testing with the KINARM group. I’d go every six months or so, and I’ve done it for the last couple of years.

The KINARM collects detailed data about how the stroke has affected me, and how I’m gradually recovering. This information is valuable to researchers because I’m younger than the average stroke patient. Everyone’s stroke is different, and everyone recovers differently, so I’m hoping the information that they’re getting from me will help them better understand stroke.

Andra Fawcett Kingston Health Sciences Centre CAHO
Andra sitting in KINARM, a robotic system that assesses how brain injuries affect motor function

What does health research mean to you?

Research is how doctors are going to find new ways to prevent or treat strokes. When I was in hospital, I was a lot younger than the other stroke patients, but they were up and walking while I was staggering around like a toddler. I’m hoping that the KINARM can gather enough data from me to tell them why it takes a 50-year-old longer to recover than an 80-year-old. That’s what research is about – it can determine the hows and whys.

How can the patient voice support, improve or empower health research?

The more patients share their experiences, the more we can all learn. It’s about getting involved, because stroke patients get a lot more from people who have gone through it. I give talks at our hospitals and I use social media to share stories.

Why does health research matter to you and your family?

I’m thankful for the health care I received, because without it I wouldn’t be here today. It takes patients like me, and others, participating in research, providing feedback, it’s how we learn. It’s important to me to do what I can and give back, because that could help someone down the road. If my test results are helping in this research, I’m proud to be a part of it.

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

Research is important and we can all do our part by taking a little bit of effort to help researchers find out the “whys”, like why do strokes happen to young people, and why does it take some of us longer to recover than others? How can we change this? You do that by getting involved.

 

Top photo by M. Manor, Kingston Health Sciences Centre; KINARM photo by Ethan Heming, BKIN Technologies

 

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Ontario research hospitals, including Kingston Health Sciences Centre, make our province healthier, wealthier and smarter. Read more Patients + Research posts and share your own insights on Twitter with the hashtag #onHWS. Learn more about how hospital-based research makes Ontario healthier, wealthier and smarter.

 

 

Patients + Research: Dr. David Gray

Patients + Research is a platform for patients to discuss their relationship and experience with the research that leads to new cures, cares and treatments.

Patients + Research: Dr. David Gray

Economics professor Dr. David Gray took part in a clinical trial at The Ottawa Hospital to see whether an immunotherapy drug could keep his high-risk skin cancer from coming back. Four years later, he’s still cancer-free.

Dr. David Gray’s cancer was hiding in plain sight.

“It was a blemish on my cheek that just wouldn’t heal,” said the University of Ottawa economics professor and father of two. “My dermatologist didn’t like it, so he had it tested.”

When his dermatologist removed the pea-sized tumour from Dr. Gray’s face, further tests revealed that it was Stage 3c melanoma. He was at high risk of the cancer spreading to other parts of his body.

“During the initial visit, the surgeon told me that the five-year survival was below 40 per cent,” he said.

Faced with those odds, Dr. Gray decided to join a clinical trial that compared an immunotherapy drug called ipilimumab to interferon, the currently publicly-funded treatment used to keep melanoma from returning.

Ipilimumab helps the immune system attack cancer cells anywhere in the body. However, it can have serious side effects. After Dr. Gray’s fourth treatment, his hormonal (endocrine) system went into crisis, and he was hospitalized for four days. He continues to take hormone replacement medication today.

These kinds of side effects have motivated researchers to look for more effective and safer options, said his oncologist at The Ottawa Hospital, Dr. Xinni Song.

“Physicians treating melanoma are looking for something better to keep the cancer from coming back,” said Dr. Song, who is also an assistant professor at the University of Ottawa. “Our patients are very keen to take part in clinical trials, which can not only help them, but future patients as well.”

Four years after taking part in the trial, Dr. Gray is still cancer-free. The results of the trial are still to be published.

“You can’t attribute my survival 100 per cent to the treatment. But my wife certainly does,” said Dr. Gray.

“For me, it was very meaningful that he can enjoy his life with his family and go back to work and continue to teach,” said Dr. Song. “He’s remained cancer-free, and the hope is that he is cured from the disease.”

To spot melanoma early, Dr. Song recommended that you tell your doctor if you notice any changes in your skin, such as new spots or marks that grow or change in colour.

The Ottawa Hospital is a major centre for cancer immunotherapy clinical trials. Researchers at the hospital are also developing new kinds of immunotherapy, such as cancer-fighting viruses and genetically-engineered immune cells. Dr. Gray’s story was originally published on The Ottawa Hospital website.

 

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Ontario research hospitals, including The Ottawa Hospital, make our province healthier, wealthier and smarter. Read more Patients + Research posts and share your own insights on Twitter with the hashtag #onHWS. Learn more about how hospital-based research makes Ontario healthier, wealthier and smarter.