Research led by The Ottawa Hospital could help people with cancer avoid life-threatening blood clots

Patient Harold Black in the middle of his two doctors.

Research led by The Ottawa Hospital could help people with cancer avoid life-threatening blood clots

Harold Black (middle) suffered a life-threatening blood clot soon after being diagnosed with cancer. He survived the clot and today, people like Harold have a much better chance of avoiding blood clots, thanks to research led by Dr. Philip Wells (left) and Dr. Marc Carrier (right) at The Ottawa Hospital.

As a regular member of a church choir, Harold Black was used to standing and singing for long periods. But in September 2018, he had trouble catching his breath while singing in the congregation. Two days later he went to The Ottawa Hospital’s emergency department and was quickly diagnosed with a life-threatening blood clot in his lung, called a pulmonary embolism. The doctors also found a serious clot in his leg.

“It was a scary experience, but I feel very lucky because I was told that the first sign of a pulmonary embolism is often death,” said Harold, 76.

Harold had two days of intensive treatment and monitoring at The Ottawa Hospital. The clots have now cleared up, but he continues to take daily shots in his belly to prevent new ones.

Blood clots can occur in anyone, but they are particularly common in people with cancer, like Harold. In fact, blood clots are the second-leading cause of death in people with cancer, tied with infections.

“Cancer itself may increase the risk of blood clots, but chemotherapy, surgery and other factors can contribute as well,” explained Dr. Marc Carrier, who treated Harold’s blood clots at The Ottawa Hospital.

This problem inspired Dr. Carrier and fellow blood clot specialist Dr. Philip Wells to design a clinical trial to see if a low dose of a blood thinner pill could prevent blood clots in people newly diagnosed with cancer. The results, recently published in the New England Journal of Medicine, are now changing practice around the world.

The study included 563 people newly diagnosed with cancer who had a higher risk of developing blood clots (based on blood test results and other clinical factors). Half received a blood thinner pill twice a day and half received a placebo. Those who received a placebo were more than twice as likely to develop blood clots compared to those who received the blood thinner (10.2 percent with placebo compared to 4.2 percent with the blood thinner).

“Blood thinners are commonly used to prevent blood clots in other high-risk groups, but the traditional thinking has been that these drugs would cause too much bleeding in people with cancer,” said Dr. Carrier, who is also a senior scientist at The Ottawa Hospital and associate professor at the University of Ottawa. “Our study shows that if you select the right patients and use a relatively low dose of a certain blood thinner, the benefits easily outweigh the risks.”

With about 1.9 million people diagnosed with cancer every year in Canada and the U.S., the researchers estimate that about half, or 950,000 could be considered for the blood clot prevention strategy tested in the study. In this population, the strategy would be expected to prevent clots in six percent, or 57,000 people.

“Blood clots are not only life-threatening, but they can also cause pain, reduce quality of life and can be expensive to treat,” said Dr. Wells, who is also senior scientist and Chief of Medicine at The Ottawa Hospital and the University of Ottawa. “We expect that this study will change practice and help many people with cancer avoid blood clots.”

Black continues his cancer treatment, but he is back to singing in his church choir.

“If this research prevents people like me from developing blood clots, that will make a big difference for a lot of people,” he said.

The blood clot (thrombosis) program at The Ottawa Hospital and the University of Ottawa is the largest and the most research-intensive in the world. With four publications in the New England Journal of Medicine since 2015, their research is transforming lives both in Ottawa and around the world.

“I want to thank the outstanding physicians, nurses, research coordinators and other members of our thrombosis team,” said Dr. Wells. “But above all, I want to thank our patients for participating in our research and helping us improve care for them and others around the world.”

The Ottawa Hospital 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.

Lawson explores technology to support youth mental health

Researchers smiling at camera.

Lawson explores technology to support youth mental health

Puneet Seth, Jennifer Moles, Dr. Cheryl Forchuk, Dr. Sandra Fisman and Damon Ramsay spoke at the funding announcement in February 2019.

Imagine having your care team at your fingertips. Picture opening an app on your phone to schedule a virtual visit where you can have a face-to-face meeting, without ever leaving your home. What if you could fill out an online questionnaire and instantly send it to your physician to let them know how you are doing?

As technology advances, the opportunities to connect and empower patients and clients seem endless. Mental health services are rooted in these relationships. For delivery, specifically community-based and outpatient services, connection and communication between an individual and the care provider are a priority focus.

But how do we integrate technology into mental health services, without losing that sense of connection?

While it may seem easy to download an app on a phone or tablet, this can bring issues with privacy and security. Many apps are not proven effective, and some can actually do more harm than good.

In the health care sector, the use of technology needs to be carefully tested and implemented through evidence-based research, to ensure it is not only meeting the needs of those using it but also that it complies with standards for privacy and security.

Through funding from the Government of Ontario’s Health Technologies Fund (HTF), researchers at Lawson Health Research Institute (the Research Institute of London Health Sciences Centre and St. Joseph’s Health Care London) are partnering with industry to develop a unique approach to connect technology and mental health care. TELEPROM-Y is a mobile-based TELEMedicine and Patient-Reported Outcome Measurement Youth study that looks to leverage technology to improve access to specialized services and reduce inpatient mental health admissions for youth.

Technology is a regular form of communication for youth and they are a vulnerable population when it comes to mental health challenges. “Our research team is looking at how technology can assist in the delivery of mental health services for youth in a way that still supports the important components of treatment,” says Dr. Cheryl Forchuk, Assistant Scientific Director at Lawson and lead for the study. “In our work with youth, they’ve talked about wanting the technology they are already using integrated into their care.”

The majority of mental illnesses occur between the ages of 16 to 25 years old. This important transitional period in a youth’s life marks an opportunity for them to be actively engaged in their own care journey.

Researchers will use an electronic Collaborative Health Record (CHR) developed by InputHealth, an innovative Canadian digital health software company. This software allows secure communication between the patient and care team. Patients will have access to virtual visits, prompts and reminders, text or email messages, and educational materials delivered by phone or another device.

The research team is recruiting participants between the ages of 16 to 25 years old who have symptoms of anxiety and/or depression and are receiving outpatient services from a hospital-based mental health care program at London Health Sciences Centre, St. Joseph’s Health Care London, Woodstock General Hospital, or community-based services from partner organizations. A key aspect the research team is investigating is whether the technology is effective and efficient, while acceptable to both the care team and youth.

Two men demonstrating phone app.

“We know from research that remuneration on mood, or focusing deeply on mood, without communication can actually increase depression,” says Dr. Cheryl Forchuk. “We’ve only been interested in technology that supports the relationships necessary for mental health services.”

The mobile software will also be evaluated on its ability to improve access to care; monitor mood and behaviour changes for earlier intervention; enhance information exchange between patient and health care provider; and, support the overall experience for the youth.

“Careful evaluation is essential to make sure we are doing the right things for the people we serve,” adds Dr. Forchuk, who is also the Beryl and Richard Ivey Research Chair in Aging, Mental Health, Rehabilitation and Recovery at Lawson and Western University.

This initiative is one of 11 that received funding from Ontario’s second round of the Health Technologies Fund (HTF), a program of the Ontario Ministry of Health and Long-Term Care administered by Ontario Centres of Excellence. This funding program supports the development of made in Ontario health technologies by accelerating evaluation, procurement, adoption and diffusion within the Ontario health system.

TELEPROM-Y received $395,109 in provincial funding with $494,630 in matching contributions for a total investment of $889,739.

“This collaboration matches financial investment from the province, along with technical tools and expertise from the private sector, with our patient-centred approach,” says Dr. Forchuk. “Together, we can bring solutions to life and translate them quickly to care delivery once shown to be effective.”

Other project contributors include St. Michael’s Hospital Centre for Excellence in Economic Analysis Research, The Forge (McMaster University), Thunder Bay Regional Health Sciences Centre, Western University and Youth Opportunities Unlimited (Y.O.U.).

The TELEPROM-Y study is one example of how dedicated research funding can be used to drive discovery with potential to create a tangible impact on patients. Research-intensive hospitals are improving health care, creating jobs and contributing to the country’s growing knowledge economy.

Lawson 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.

SickKids leading medical breakthroughs in child health

SickKids Lab

SickKids leading medical breakthroughs in child health

Behind the doors of The Hospital for Sick Children’s (SickKids) state-of-the-art Peter Gilgan Centre for Research and Learning (PGCRL), more than 2,000 researchers, trainees and staff are collaborating and conducting cutting-edge research to tackle some of the toughest challenges in child health. This past Fall, the PGCRL celebrated its fifth anniversary; five years of interdisciplinary collaboration, innovation, mentorship, discovery and scientific breakthroughs.

Standing tall at 21 stories and housing over 230 labs, the PGCRL is the largest paediatric research tower in the world. It is designed to promote interaction between research teams from seven different research Programs in order to fuel innovation and accelerate improvements in child health outcomes, both locally and globally. The facility is built to accommodate ‘research neighbourhoods’ where scientists and trainees from a variety of disciplines work side by side, generating out-of-the-box solutions.

“The way people get together to work has been incredible,” says Dr. Michael Salter, Chief of Research. “Even after five years there’s a buzz about it, which means there’s a buzz about research. Usually medical research facilities are housed in low buildings, very spread out. Here it’s so bright. It puts people in a good mood and helps fuel their creativity.”

Exterior of the SickKids Peter Gilgan Centre for Research and Learning. (Photo: SickKids)

Since opening its doors in 2013, the PGCRL has drawn some of the world’s brightest minds and leads the way in paediatric medical breakthroughs. It may not be a coincidence then that SickKids continues to secure more Canadian Institutes of Health Research (CIHR) funding than any hospital in the country. Additionally, for the past few years, SickKids has ranked among the top of RE$EARCH Infosource Inc’s list of Canada’s Top 40 Research Hospitals. Most notable among these rankings, SickKids has been recognized as the most research-intensive hospital in Canada.

“This building has been a crucial enabler over the past five years for Toronto and Canada in attracting and retaining world-class leaders in child health research. Over the next five years and beyond, we will continue to be a forward-looking institution, driven to discover new breakthroughs, achieve new heights and solve new problems,” says Salter.

On the outside, the PGCRL emanates excellence, innovation and grandeur, while on the inside it also gives scientific staff a greater sense of purpose, motivation and togetherness.

Interior of the SickKids Peter Gilgan Centre for Research and Learning. (Photo: SickKids)

As noted, the Research Institute boasts seven distinct research Programs. All seven have reported major breakthroughs over the last five years. Read below for a small sampling of some of these achievements.

 Cell Biology

  • A senior scientist and his team showed that a drug commonly used to treat malaria had the potential to prevent neurodegeneration in cells from newborns affected by Zellweger syndrome, a rare genetic disease that is typically fatal within the first year of a child’s life.

Child Health Evaluative Sciences

  • Researchers are creating “Prenatal Sprinkles”, a supplement of iron and calcium encapsulated in a dissolvable coating, which will enable nutrients to be more easily absorbed in different parts of the maternal digestive tract. This will help to improve maternal and newborn health and reduce morbidity in low-income settings in Africa and South Asia.

Genetics and Genome Biology

  • Scientists from the Toronto Centre for Applied Genomics sequenced the genome of the most iconic Canadian animal species, including the beaver, the lynx and the snowshoe hare.
  • A game-changing study identified for the first time that a significant portion of all human cancers are hypermutant. Hypermutant tumours create distinct footprints that may show researchers important information about how the tumour will behave and how it will respond to treatment, leading to more proactive and targeted care.

Developmental and Stem Cell Biology

  • Medulloblastoma is the most common malignant paediatric brain cancer. A recent study showed that these cancer cells can circulate though the bloodstream when it was previously assumed that metastasis of this brain tumour was through the cerbrospinal fluid. This research can help contribute to improving diagnosis of the disease.

Molecular Medicine 

  • Molecular Medicine is home to the immunologist who first uncovered the symptoms of Roifman Syndrome, a rare congenital condition which bears his name. Later, he also discovered the genetic cause behind this disease, enabling a clear diagnosis and better treatment for children and their families.

Neurosciences and Mental Health

  • Researchers discovered that there are at least two forms of ADHD, one that is caused as a result of genetic risk and the other a result of traumatic brain injury.

Translational Medicine

  • A research team developed an ELISA test to detect antibodies to Stenotrophomonas maltophilia in the sera of cystic fibrosis patients who are susceptible to this increasingly prevalent and hard-to-treat bacterial infection.

 

SickKids 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.

Baycrest announces plans for first-of-its-kind brain health facility in Canada

Rendering of Baycrest promenade.

Baycrest announces plans for first-of-its-kind brain health facility in Canada

Rendering of the promenade at The Kimel Family Centre for Brain Health and Wellness at Baycrest.

Healthcare researchers are in a race against time to seek treatments for Alzheimer’s disease. As the world’s population ages, a new case of dementia is diagnosed every four seconds with 7.7 million new cases per year worldwide, according to the World Health Organization. Currently, about 50 million people around the world live with the neurodegenerative disorder and this number is expected to surge to 75 million in 2030.

The statistics may appear bleak, but there are still opportunities to intervene. “We now know that Alzheimer’s starts to develop in the brain decades before memory loss symptoms become apparent,” says Baycrest President and CEO Dr. William Reichman. “By focusing on ways to prevent the disorder from developing, we stand a chance in stemming this ballooning public health crisis.”

Baycrest researchers remain at the forefront of leading the fight to prevent dementia. During its centennial last year, Baycrest shared its plans on the launch of a unique research and care facility that will be a shining example of what is possible in the realm of brain health and aging.

The Kimel Family Centre for Brain Health and Wellness: Stopping dementia before it develops

Under the direction of Dr. Howard Chertkow, Baycrest’s new Chair in Cognitive Neurology and Innovation, and Senior Scientist at the Rotman Research Institute, this new centre will spearhead the unprecedented convergence of scientific research and evidence-based interventions that will have a measurable impact on the brain health and wellness of older adults in our community, across Canada and worldwide.

The Kimel Family Centre for Brain Health and Wellness builds on nearly 30 years of research leadership in Baycrest’s Rotman Research Institute (RRI) to seamlessly integrate brain health workshops, physical fitness, nutrition, sensory and cognitive training, arts programs, and social engagement for older adults. It also will serve as a testing ground and demonstration centre for new technologies supported by the Centre for Aging and Brain Health Innovation (CABHI), a solution accelerator powered by Baycrest.

The Kimel Family Centre will focus on three areas:

  • Community Wellness Programming
  • Specialized Wellness Clinics
  • Integrated Research to Prevent Cognitive Decline

“The programming we will offer is based on research demonstrating that these activities may be beneficial to everyone,” says Dr. Chertkow, who is also the Scientific Director of Canada’s largest dementia study involving over 400 researchers across the country, the Canadian Consortium on Neurodegeneration on Aging. “The Kimel Family Centre’s one-of-a-kind environment will allow clinicians and researchers to closely track the effectiveness of prevention regimens and bring us closer to answering how we could prevent the onset of dementia and cognitive loss.”
Over the last 30 years, the RRI has made a number of discoveries helping to improve aging brain health and unlock the mysteries of the human brain.

Some of these discoveries include:

  • Uncovering the key differences between the brains of older and younger adults that set brain research in a new direction;
  • Finding the first clear evidence that bilingualism delays the onset of dementia;
  • Identifying anxiety as a risk factor for Alzheimer’s disease, separate from depression

“The Kimel Family Centre is a natural evolution for us – taking our scientists’ discoveries into how the brain changes with age to the next level by working with healthcare professionals across the Baycrest campus to prevent, detect, and treat dementia,” says Dr. Allison Sekuler, Vice-President, Research and the Sandra A. Rotman Chair in Cognitive Neuroscience at Baycrest, and Managing Director of the Rotman Research Institute (RRI) and the Centre for Aging + Brain Health Innovation (CABHI).

Clinical Trials Unit: Exploring promising dementia treatments

To complement this cutting-edge facility, Baycrest also is developing a formal Clinical Trials Unit to continue providing clients and community members access to groundbreaking drug and non-drug interventions.

“The majority of promising therapies have only shown benefits to mice, but some may work on patients,” says Dr. Chertkow. “In fact, these might also be more effective when administered in combination, and individuals deemed to have a higher risk of developing dementia at the Kimel Family Centre will qualify to participate in trials for combination therapy through our Clinical Trial Unit.”

Some of the upcoming clinical trials researchers, clinicians, and industry partners are planning at Baycrest include:

  • Mindfulness meditation training for clients with early cognitive impairment and caregivers for individuals with dementia
  • Real-time fall detection and prevention technology for clients with dementia
  • Combined brain stimulation with group intervention to boost treatment effects
  • Lifestyle interventions to ward off dementia

“Our researchers have explored the prevention and early detection of dementia using many different approaches,” says Dr. Sekuler. “Through the Kimel Family Centre and Clinical Trials Unit, Baycrest staff are further united in creating a world where every older adult enjoys a life of purpose, inspiration, and fulfillment.”

Baycrest 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 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.

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.  

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.