Hamilton Health Sciences: We Are Explorers

Redefining “Research”

By Ted Scott, Acting Vice President Research & Chief Innovation Officer, @Chief_Innovator 

The dictionary definition of “researcher” is painfully self-explanatory: “someone who conducts research.” Based on my experience at Hamilton Health Sciences over the last few years, this description does no justice.

The word “research” itself has attracted a certain connotation that invokes images of anonymous individuals in lab coats analyzing samples in whitewashed, sterile rooms in the pursuit of some far-off, seemingly impossible discovery. Sure, some discovery happens that way. But, so often, it’s so much more than that.

At HHS, our researchers are so much more than people in lab coats. They are innovative, strategic, highly creative minds who translate complex data into new knowledge. Many of our researchers are also healthcare providers. Every day, they work alongside the patients who are the inspiration for their research pursuits. Their “labs” are patients’ rooms, clinics, and operating theatres. Every day, they’re on the front lines of our healthcare system, asking questions and solving problems. Their roles span the entire spectrum of healthcare professions: they’re surgeons, pediatricians, physiotherapists, nurses, students. They’re also our neighbours, friends, family members and, sometimes, they’re patients, too.

In my short time at HHS, I’ve learned that our researchers are also some of our community’s top innovators and collaborators. They’re forming networks across our city and region that are aimed at improving the way we provide healthcare, applying technology and expertise to make our healthcare system better. And, most importantly, their work has immense, tangible impact. Beyond the lab and the computer database, our nearly 2,000 researchers and research staff are discovering and implementing new knowledge that’s changing the way we care for people, in real-time.

For example, they’re testing in-home technology that our nurses and doctors can use to monitor patients once they go home after heart surgery. They’re working with tech innovators to find better ways of predicting outcomes for cancer therapies, so patients can make better decisions around their treatment options. They’re trialling the latest therapies to help make life easier for kids with chronic diseases, like IBD.

This is just a sampling of the research happening at our hospitals, right now. It wouldn’t be possible without our researchers and research staff who are unwavering in their pursuit of making life better for people in our community, across our country, and around the world.

I admire their persistence, their patience, and their will to keep exploring, even when the answers aren’t clear. And especially when competing commitments – of being doctors, nurses, allied health professionals, students – are as demanding as they are in our very busy health system.

It’s this insatiable drive to know the unknown that I believe better defines a researcher, no matter how big or small the issue at hand.

At HHS, we’re redefining what “research” means to our community, and to the world.

We’re not just researchers. We are explorers. It’s in our DNA.

Read about Explorers at Hamilton Health Sciences:

BLOG: Creating a new treatment option

 

BLOG: The stubborn pursuit of “Why”

      

For more, visit WeAreExplorers.ca 

#WeAreExplorers #onHWS

 

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Hamilton Health Sciences 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.

 

 

Canadian First: SickKids and Sinai Health System repair spina bifida in-utero

In a Canadian first, a team from Mount Sinai Hospital and The Hospital for Sick Children (SickKids) has repaired a form of spina bifida in a fetus at 25 weeks gestation. The baby’s mother, Romeila Son, recovered very well from surgery, and a bouncing baby girl, Eiko, weighing 2.45 kg, was born on August 19 at 36 weeks gestation at Mount Sinai Hospital. Since her birth, Eiko has needed no further intervention for this usually debilitating condition. This is the first case in Canada where the mother has not had to travel to the United States for this specialized surgery.

Dr. Greg Ryan heads Canada’s largest and most experienced fetal therapy program at Mount Sinai Hospital and Dr. James Drake heads Canada’s largest and most established neurosurgical centre for the postnatal repair of spina bifida at SickKids. Working in collaboration with colleagues from Vanderbilt University in Nashville who pioneered the procedure, a team of 24 clinicians led by Drs. Ryan and Drake successfully carried out the 2.5 hour in-utero procedure at Mount Sinai on June 4, 2017.


From left: Dr. Michael Apkon, President & Chief Executive Officer, SickKids; Dr. Paige Church, Head of spina bifida clinic at Holland Bloorview Kids Rehabilitation Hospital; Dr. James Drake, Head of Neurosurgery, SickKids;  Premier of Ontario, Kathleen Wynne; Dr. Greg Ryan, Head of Fetal Medicine program, Mount Sinai Hospital; Romeo Crisostomo, Eiko’s dad; Romeila Son, Eiko’s mom; baby Eiko Crisostomo; Dr. Mathew Sermer, Obstetrician and Gynaecologist-in-Chief, Sinai Health System; Dr. Gary Newton, President and Chief Executive Officer, Sinai Health System.

What is spina bifida?

Myelomeningocele is a form of spina bifida, affecting approximately 120-150 babies in Canada each year. It is caused when the spinal column fails to close early in fetal development, causing permanent damage to the baby’s spinal cord and nervous system.

Babies with spina bifida can have varying degrees of paralysis of their lower limbs and many will need mobility supports such as leg braces, crutches or wheelchairs. Over 80 per cent of children with spina bifida will require a shunt to be inserted to relieve pressure on their brain, which must remain in place for their entire life, and some affected children will have a negative neurocognitive outcome. Between 15-30 per cent of children with spina bifida do not survive into adulthood and less than 50 per cent live independently as adults. A third of adults with spina bifida require substantial lifelong daily support. The emotional, social and financial impact for these affected individuals, their families and society as a whole, is enormous.

Better treatment option for babies

The Management of Myelomeningocele Study (MOMS), a groundbreaking trial published by Vanderbilt University, Children’s Hospital of Philadelphia and the University of California, San Francisco, in the New England Journal of Medicine in 2011, showed that, in babies who underwent the in-utero procedure:

  • Brain malformations were reversed by one-third
  • The need for walking aids or a wheelchair was halved
  • Their need for brain shunts was reduced by half

Consequently, the Society of Obstetrics and Gynaecologists of Canada (SOGC) now mandates that any pregnant woman whose fetus has spina bifida must be counselled about this treatment option.

“Although fetal surgery will not be appropriate for all fetuses with spina bifida, it is extremely encouraging that, for some, it may preserve neuromotor function, reverse brain herniation and reduce their need for a brain shunt,” said Dr. Greg Ryan, head of the fetal medicine program at Mount Sinai Hospital, part of the Frances Bloomberg Centre for Women’s and Infants’ Health. “However, it also entails some maternal and fetal risks, particularly that of premature labour, which must be carefully balanced.”

“We regularly see children who have been affected by spina bifida at SickKids,” said Dr. James Drake, head of the division of neurosurgery and senior associate scientist at SickKids. “It is my hope that our capacity to perform this in-utero surgery here in Toronto will mean that we can optimize their clinical outcomes, and reduce the degree of medical challenges these children will face.”

Collaboration counts

“I am extremely proud of the collaboration between Mount Sinai Hospital and SickKids – which has resulted in a terrific outcome for this baby girl,” said Dr. Ryan.”Having this kind of clinical capacity here in Ontario will really change the range of options available to parents who have been given a diagnosis of spina bifida during pregnancy.”

“I would like to congratulate everyone at Mount Sinai Hospital and SickKids who teamed up to perform Canada’s first in-utero spina bifida surgery,” said the Honourable Kathleen Wynne, Premier of Ontario. “The incredible story of baby Eiko’s journey into this world shines a bright light on our world-class health care professionals. They’re talented, innovative, and making life better for people in this province — starting even before they’re born. Congratulations to little Eiko and her family. I wish them a healthy, happy future.”

Mount Sinai Hospital and SickKids recently collaborated on another in-utero surgical first, repairing a congenital heart defect called transposition of the great arteries, in May, 2017. The team from SickKids and Mount Sinai Hospital is Canada’s only provider of fetal surgery.

Read the original press release of this Canadian First here.

*Feature photo: From left: Premier of Ontario, Kathleen Wynne; Dr. James Drake, Head of Neurosurgery, SickKids; Romeo Crisostomo, Eiko’s dad; baby Eiko Crisostomo; Romeila Son, Eiko’s mom; ; Dr. Greg Ryan, Head of Fetal Medicine program, Mount Sinai Hospital.

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SickKids and Sinai Health System are two 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.

HIV care that’s made for women

Women are one of the fastest growing populations at risk for HIV infection and they have worse clinical outcomes than men do.

Dr. Mona Loutfy, a senior scientist at Women’s College Research Institute, is developing HIV care designed especially for women’s needs to close the health gaps they experience.

Dr. Loutfy leads the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS), a national study funded by the Canadian Institutes of Health Research. The study’s goal is to help women with HIV be as healthy as they can be in every way.

Study findings have shown that women in Canada receive good treatment for their HIV but their overall women’s health needs — including pregnancy planning, Pap testing, mammograms and mental health care — are often overlooked. To find and address these gaps, Dr. Loutfy engages women with HIV and their communities to ensure their concerns drive her research questions.

“When we set out to look at what we thought as researchers, were the most important topics, we thought it was going to be all about delivery of HIV care. What came out was actually a bit different.”

The study found that 64 per cent of the women had experienced violence in childhood and 80 per cent had experienced violence in adulthood. Half of the women had depressive symptoms. Isolation and poverty were also significant issues in the community.

“I feel that the care needs to be a little bit different,” Dr. Loutfy says.

She is working to create a new model of care that is women-centred, meaning focused on optimizing the overall health of women with HIV in Canada, particularly those at a higher risk, such as Indigenous women and trans women.

For women like Evana Ortigoza, a Community Advocate with Dr. Loutfy’s Trans Women HIV Research Initiative, the effort is very important. Evana is a trans woman who has lived with HIV for 17 years.

“The research they’re doing here is for trans and women, women with kids and women in all their diversity; it’s amazing. We are not alone,” she says. “Everywhere I go, Women’s College is there to make sure that women are protected.”

Watch the video above to learn more about Evana and Dr. Loutfy’s research, and visit report2017.womensresearch.ca to learn more about research at Women’s College Research Institute at Women’s College Hospital.

 

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Women’s College 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.

Research Spotlight: North York General Hospital

Research Chairs Poised to Ask the Right Questions 

As a leading community academic hospital, North York General Hospital (NYGH) is uniquely positioned to transform and enhance patient care through continuous evolution. In 2011, the hospital released Strategy 2015-2018, which envisioned the achievement of excellence in integrated patient-centred care through learning, innovation and partnership. To achieve this stratagem, research and innovation plays a central role assuring the necessary evolution contributing to quality, efficiency and excellence in patient-centred care. The creation of the first-ever research chairs was a key part of building on the academic foundation.

“We know the majority of hospital care in Canada is provided in community hospitals, so the scholarly work we do will make a difference well beyond our catchment areas,” says Dr. Donna McRitchie, Vice President, Medical & Academic Affairs. “Our strategy for research and innovation is built around our research chairs, who will explore new ways to improve processes for delivering care.”

To date, North York General has recruited four research chairs, beginning with the recruitment of the Gordon F. Cheesbrough Research Chair in Family and Community Medicine, named after one of North York General’s greatest leaders and champions, and the first of its kind in Canada. The Chair’s purpose is to drive interdisciplinary, interprofessional and crossinstitutional research investigations, with the goal of enhancing the quality and outcomes of care provided at the individual and system level. Until recently the position was held by Dr. Frank Sullivan. NYGH is currently recruiting for the role.

Dr. Monika Kastner NYGK

Monika Kastner joined NYGH in February 2016 as the Research Chair in Knowledge Translation and Implementation. Knowledge translation is regarded as a bridge between the creation and implementation of knowledge and as such, it is highly relevant to NYGH strategic objectives.

“There is so much important work in health care research that is underutilized simply because we do not have adequate processes and channels for implementation and dissemination,” Monika says. “I’m interested in bridging that gap to help enhance the uptake of services and products for patients and families.”

North York General Hospital (NYGH) recently welcomed Patricia Trbovich

Patricia Trbovich joined the hospital in August 2016 as the Badeau Family Research Chair in Patient Safety and Quality Improvement. In her role, she focuses on reducing preventable medical errors and creating innovative solutions in a community academic hospital setting to enhance patient safety and quality of care.

“We have to proactively identify risks and mitigate them before they cause harm, as opposed to solely reacting once adverse events have already occurred,” Patricia says. “We have to embrace complexity and figure out where it’s needed and where we can reduce it.”

As the newest member recruited in August 2017, Katie Dainty, PhD, is the hospital’s Research Chair in Patient-Centred Outcomes. Katie is interested in finding new ways to enhance this experience by applying an often-ignored lens: the patient’s perspective.

NYGH Katie Dainty

“It’s important to remember that even if the care was clinically perfect, a patient’s life may be changed dramatically and they have to deal with after effects, both physically and psychologically,” Katie says. “The question is: what can we do leading up to, during and after hospital care to ensure there is the best possible long-term outcome for the patient and their family?”

The appointment of hospital research chairs is part of NYGH’s overall strategy to transform care through applied research and innovation. The hospital is immensely grateful to the North York General Foundation for their support in establishing these Research Chairs.

North York General Hospital is one of Ontario’s 23 research hospitals that contribute to a healthier, wealthier, smarter province. Read more Research Spotlight posts and other patient and researcher stories on our Healthier, Wealthier, Smarter blog or join the conversation about why health research matters for Ontario on Twitter, using the hashtag #onHWS.

 

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RESEARCH SPOTLIGHT: Hamilton Health Sciences

Hamilton researchers discover a simple blood test could save lives after surgery

Researchers at Hamilton Health Sciences’ Population Health Research Institute (PHRI) and McMaster University have determined that a simple blood test can predict and possibly prevent many of the deaths that occur after surgery.

“If death after surgery within the first 30 days was made its own category of death, it would be in the top 5 leading causes of death within North America,” explained Dr. P.J. Devereaux, principal investigator for the “VISION” study.

The VISION study enrolled nearly 22,000 patients aged 45 years or older from 23 hospitals in 13 countries and found that approximately 18 per cent of them sustained heart damage within 30 days of non-cardiac surgery and that, without enhanced monitoring, the vast majority – as many as 93 per cent – of these complications will go undetected, potentially until it’s too late to intervene.

Putting pressure on the heart

“The effects of surgery anywhere in the body create a perfect milieu for damage to heart tissue, including bleeding, blood clot formation, and long periods of inflammation,” says Dr. Devereaux, scientific leader of perioperative medicine at PHRI, director, division of cardiology at McMaster University. “In most cases, this damage occurs within the first 24 to 36 hours after surgery when patients usually receive narcotic painkillers that can mask symptoms of cardiac distress.”

“These discoveries have the potential to save lives.”

After surgery, study patients had a blood test for a protein called high-sensitivity troponin T, which is released into the bloodstream when injury to the heart occurs. Devereaux and his team discovered that patients with troponin T levels beyond a certain threshold had increased risk of death within 30 days of having surgery.

Overall, the study found that 1.4 per cent of patients died within 30 days following non-cardiac surgery.

“One per cent seems like a small number, until you consider that about 200 million surgeries are performed each year around the world,” says Devereaux. “Where we’re letting patients down is in post-operative management. We now know that we need to become more involved in care and monitoring after surgery to ensure that patients at risk have the best chance for a good recovery. These discoveries have the potential to save lives.”

The results of the VISION study were published in The Journal of the American Medical Association.

 

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Hamilton Health Sciences is one of Ontario’s 23 research hospitals that contribute to a healthier, wealthier, smarter province. Read more Research Spotlight posts on our Healthier, Wealthier, Smarter blog or join the conversation about why health research matters for Ontario on Twitter, using the hashtag #onHWS.

Research Spotlight: Providence Care Hospital

What does the new Providence Care Hospital (PCH) in Kingston mean for health research in Ontario and the CAHO community?

Providence Care is a proud member of the Council of Academic Hospitals of Ontario, and our new space is an asset to the research community in southeastern Ontario. The PCH design provided dedicated space for health research in a prime location: Kingston is within easy distance of both Ottawa and Toronto, and our hospital itself overlooks local parks and Lake Ontario.

Researchers have open areas suitable for collaboration at PCH and just steps from our in-house Health Sciences Library, which is an academic library accessed by health care providers across the region. In addition, each of the nine inpatient units has space on the unit for researchers and care teams to work together with patients and families.

What is the focus of research at Providence Care?

The top three areas of focus for researchers at Providence Care align with our Mission to enhance the quality of life for the people we serve.  Working hand-in-hand with our health care partners, Providence Care offers programs and services in the areas of ‘Aging, Mental Health and Rehabilitative Care.’ Our research streams are aligned to these themes as well.

From a strategic perspective, our focus areas are also aligned to the Queen’s University Faculty of Health Services, and in particular they are supported by the Division of Geriatric Medicine, Department of Psychiatry and Divisions of Geriatric and Forensic Psychiatry, Department of Physical Medicine and Rehabilitation, and the Schools of Rehabilitation Therapy and Nursing.

When you look at the full spectrum of research, from knowledge generation to translation and exchange, there is quite a lot going on at PCH.

First, with respect to knowledge generation, currently in Psychiatry and its subspecialties at PCH there are 37 active studies totaling $8.2 million. These include:

  • 3 CIHR studies (2.7m) – dementia, CT evaluation, drug efficacy in seniors
  • 6 OBI studies (2.2m) neurodegenerative disease and biomarkers in depression
  • 4 CAN-BIND studies (800K) biomarkers in depression
  • 11 pharma drug evaluation studies (600K)

When it comes to Knowledge Translation and Exchange, the Centre for Studies in Aging & Health at Providence Care focuses on education and training, capacity building, development of partnerships and linkages and the use of online education and information.

The Centre is supported by success in grant applications from agencies such as Health Force Ontario, The Ontario Research Coalition, and Ontario Senior’s Secretariat and the South East Local Health Integration Network.  Important current initiatives include continued involvement as one of three funded sites involved in the provincial Age Friendly Communities initiative and for the Ministry of Corrections, the development and dissemination of materials on Aging for the inmates and institutional care providers, staff and administration.

What’s next for research at Providence Care Hospital?

Looking ahead, since moving into the new hospital, we see health research activities growing in Southeastern Ontario.  This relates to the previously mentioned new space and expanded partnerships. These provide new opportunities for our research supporters to grow and develop on-site and with our acute care academic hospital partners contributing substantially to the development of an Integrated Research Institute comprised of the Queen’s University Faculty of Health Sciences, the Kingston Health Sciences Centre and Providence Care. We also are working hard to attract new researchers into contributing to developments  in care for seniors, people living with mental illness and people living with and/or recovering from illness or injury.  

 

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Providence Care Hospital is one of Ontario’s 23 research hospitals that contribute to a healthier, wealthier, smarter province. Read more Research Spotlight posts on our Healthier, Wealthier, Smarter blog or join the conversation about why health research matters for Ontario on Twitter, using the hashtag #onHWS.

 

Research Spotlight: CAMH

The brain, mental health and therapeutics
A new dietary kit, developed as a result of brain imaging research, reduced the baby blues in women after giving birth

Why is brain research so important in mental illness and addictions?

The story behind a new dietary therapeutic kit shows how a better understanding of the brain can lead to health benefits.

In a CAMH study by Dr. Jeffrey Meyer, published earlier this year, this dietary kit led to a dramatic drop in “baby blues” among women after giving birth. Postpartum blues are common among women, but when severe, substantially increase the risk of clinically diagnosed postpartum depression (PPD). Overall, PPD affects 13 per cent of new mothers and is the most common complication of child-bearing.

As with other forms of depression and mental illness in general, postpartum depression is caused by a combination of factors such as a person’s genetics, environment and experiences. Specific symptoms are due to biological changes in the brain’s complex networks and chemical neurotransmitters.

Brain imaging is one way to help unravel how these networks and chemicals are linked to mental health and illness. Dr. Meyer, a psychiatrist and neuroscientist, has led a number of major studies in this area. Dr. Meyer heads the Neuroimaging Program in Mood & Anxiety, part of the Research Imaging Centre in CAMH’s Campbell Family Mental Health Research Institute.

In an earlier study, Dr. Meyer’s group had shown a surge in the brain protein MAO-A in the early postpartum phase. MAO-A breaks down three brain chemicals that help maintain mood: serotonin, norepinephrine and dopamine. When these chemicals are depleted, it can lead to feelings of sadness. MAO-A levels peak five days after giving birth, the same time when postpartum blues are most pronounced. In another previous study, Dr. Meyer showed that this also resembles brain changes that last for longer periods in clinical depression.

Based on these findings, Dr. Meyer developed a nutritional kit with three supplements carefully selected to compensate for a surge in the brain protein MAO-A.

The kit includes tryptophan and tyrosine, which compensate for the loss of the three mood-regulating chemicals, as well as a blueberry extract with blueberry juice for anti-oxidant effects.  Dr. Meyer’s team had also tested and confirmed that the tryptophan and tyrosine supplements, given in higher amounts than people would normally get in their diet, did not affect the overall concentrations in breast milk.

The current study, administered by research fellow Dr. Yekta Dowlati, included 21 women who received the supplements and a comparison group of 20 mothers who did not. It was an open-label study, meaning the women knew they were receiving nutritional supplements. The supplements were taken over three days, starting on the third day after giving birth.

On day five after giving birth – when the baby blues peak – the women underwent tests to assess the kit’s effect on mood.  The testing included sad mood induction, which measured the ability to be resilient against sad events. The women read and reflected on statements with sentiments that expressed pessimism, dissatisfaction and lethargy, and then listened to a sad piece of classical music. Before and after this test, researchers measured depressive symptoms.

The results were dramatic. Women who were not taking the supplements had a significant increase in depression scores. In contrast, women taking the dietary supplements did not experience any depressed mood. The study was published in the Proceedings of the National Academy of Sciences (PNAS).

“We believe this is the first study to show such a strong, beneficial effect of an intervention in reducing the baby blues at a time when postpartum sadness peaks,” says Dr. Meyer, who holds a Canada Research Chair in the Neurochemistry of Major Depression. “Postpartum blues are common and usually resolves 10 days after giving birth, but when they are intense, the risk of postpartum depression increases four-fold.”

These effects need to be replicated in a larger sample in a randomized, controlled trial. Further study could assess the kit’s ability to reduce both the postpartum blues as well as clinically diagnosed postpartum depression.

While the potential will take time to be fully realized, the kit is an important example of how brain imaging studies have led to a new therapeutic method that has potential to help women after giving birth, and perhaps even prevent PPD.

“Developing successful nutrition-based treatments, based on neurobiology, is rare in psychiatry,” says Dr. Meyer. “We believe our approach also represents a promising new avenue for creating other new dietary supplements for medicinal use.”

 

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CAMH is one of Ontario’s 23 research hospitals that contribute to a healthier, wealthier, smarter province. Read more Research Spotlight posts on our Healthier, Wealthier, Smarter blog or join the conversation about why health research matters for Ontario on Twitter, using the hashtag #onHWS.

 

 

 

Research Spotlight: SickKids

A new review at SickKids suggests paediatricians should think twice before routinely testing for respiratory viruses

In 2014, more than 2,000 kids who visited SickKids Emergency Department with respiratory symptoms were given an invasive and uncomfortable nasopharyngeal swab test. This is when a doctor or nurse inserts a long swab into the nostril to the back part of the nose to collect a sample of cells. The swabs are sent to the lab to test for six common respiratory viruses, but the results come back the next day, often after patients have already been discharged from the Emergency Department. With no set process for communicating positive or negative results for this test, the results generally did not impact the child’s care.

With an increased emphasis on ‘choosing wisely’ and reducing unnecessary medical tests and therapies across the medical field, paediatricians at The Hospital for Sick Children (SickKids) say it is not good enough to ‘do’ these tests just because we ‘can’. The team examined the benefits and limitations for this specific type of test and reviewed the scientific evidence as to when it is actually helpful in improving patient care. The review, including their recommendations, is published in the July 3 advance online edition of JAMA Pediatrics.

“Just because a test is available doesn’t mean we should automatically order one.”

Most viral respiratory illnesses can be diagnosed clinically based on the child’s symptoms (for example, runny nose, cough, nasal and chest congestion), but with more sophisticated and sensitive tests available, frontline clinicians frequently order tests to identify the specific offending virus.

“While the number of testing options has grown rapidly, the same attention has not been given to deciding how and when these tests can add value to the care of our patients. Just because the test is available, doesn’t mean we should automatically order one, especially since we know that for the majority of healthy children the result will have no impact on their care,” says Dr. Jeremy Friedman, senior investigator of the review and Associate Paediatrician-in-Chief at SickKids.

The review describes some of the common rationales used to justify respiratory viral testing but found poor evidence to support these rationales. Unsupported rationale includes:

  • to reduce the number of lab blood tests and chest x-rays performed, as well as unnecessary antibiotic use
  • to reduce the length of hospital stay
  • to offer prognostic information on length of the illness, and a confirmed diagnostic label for the physician and the family
  • to reduce health care costs

The team emphasized that there are clinical scenarios where respiratory viral testing can inform treatment decisions and improve overall patient care and therefore should be seriously considered. These examples include children with compromised immune systems, those at risk for influenza-related complications, children admitted to intensive care units, and infants with fever younger than three months old.

Healthier, Wealthier, Smarter results

“We hope this review helps health care providers make better decisions and think twice before ‘checking the box’ for a nasopharyngeal swab on the list of possible investigations,” Dr. Peter Gill, lead author of the review and senior paediatric resident at SickKids.

As part of SickKids Choosing Wisely initiatives, SickKids has reduced nasopharyngeal testing for typical respiratory viruses in the Emergency Department by greater than 80 per cent since 2014.

 

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SickKids is one of Ontario’s 23 research hospitals that contribute to a healthier, wealthier, smarter province. Read more Research Spotlight posts on our Healthier, Wealthier, Smarter blog or join the conversation about why health research matters for Ontario on Twitter, using the hashtag #onHWS.

 

Research Spotlight: Kingston Health Sciences Centre

Kingston Health Sciences researchers tackling health equity issues world-wide

Four Kingston Health Sciences Centre researchers are combining their experience with disadvantaged populations, their relationships with institutions on three continents, and a novel approach to evidence-gathering to tackle health equity issues world-wide.

ARCH, a research collaborative for global health equity, grew out of the diverse yet complementary research interests of Kingston General Health Research Institute and Queen’s University researchers Drs. Heather Aldersey (Rehabilitation Therapy), Susan Bartels (Emergency Medicine), Colleen Davison (Public Health Sciences) and Eva Purkey (Family Medicine).

“Global health isn’t just international,” explains Dr. Davison, “it’s about advantage and disadvantage, and unequal access, and working at the structural and community level on things that can benefit the vulnerable in Canada, and around the world.”

In March, the ARCH group was awarded $449,000 from the Queen Elizabeth II Scholars Program (QES) to establish The Queen Elizabeth Scholars Network for Equity in Maternal and Child Health.

“The most vulnerable mothers and children are rarely prioritized in health research or health policy, especially outside the immediate delivery and neonatal period,” Dr. Purkey says. The network aims to address the inequities in access to health services in low- and middle-income countries, where six million children die before the age of five, and where maternal death rates are still 14 times higher than in developed regions.

To do this, the project will support the research, learning and advocacy skills of 17 PhD, postdoctoral and early career researchers from the University of Kinshasa (Democratic Republic of Congo), Institute of Social work and Social Science (Haiti), the Mongolian National University of Medical Sciences (Ulaanbaatar, Mongolia), and Queen’s University (Kingston). The trainees will take part in international exchanges to conduct research and community outreach aimed at understanding and reducing disparities in maternal and child health.

“We want to develop engaged, ethical and innovative global health researchers who can advocate for these vulnerable populations, and address these real-world issues,” says Dr. Aldersey.

To build their collective experience, the group will also contribute to a common, multi-country study looking at the factors that contribute to maternal and child health inequities. This research has the potential to be boundary-breaking through its use of SenseMaker®, an innovative data-collection tool for mobile phones and tablets.

“It’s an efficient tool that enables us to get a quick picture of people’s experiences and perceptions,” says Bartels, who recently led a team using the tool to study child marriage in Syrian refugee camps across Lebanon. “It allows people to tell their stories without feeling judged or guilty, and then use the tool to interpret their stories for us without the filter of our own biases.” (Using SenseMaker, the researchers captured 1400 stories from Syrian refugees in hard-to-reach places in just eight weeks.)

Algorithms within the tool enable both qualitative and quantitative analysis of these anonymous stories, providing researchers with data patterns and contextual factors to capture common themes and identify inequities, quickly, so that researchers can go back to the communities within weeks or a few months to gain further information and begin to find solutions to these problems.

“QES is just the beginning for ARCH,” say the four researchers. “We’ll be seeking other funding opportunities to continue this kind of research.”

 

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Kingston Health Sciences Centre is one of Ontario’s 23 research hospitals that contribute to a healthier, wealthier, smarter province. Read more Research Spotlight posts on our Healthier, Wealthier, Smarter blog or join the conversation about why health research matters for Ontario on Twitter, using the hashtag #onHWS.

RESEARCH SPOTLIGHT: St. Michael’s Hospital

St. Michael’s scientists get down to business

Up on the 5th floor of the Keenan Research Centre for Biomedical Science, Dr. Richard Gilbert, head of the Division of Endocrinology and Metabolism for St. Michael’s Hospital, and Dr. Darren Yuen, a nephrologist with the hospital, work together on cases where diabetes and kidney disease intersect.

On top of stethoscopes and microscopes, the pair has added business scope to their frequent discussions—with the launch of a company called Fibrocor.

Drs. Gilbert and Yuen are two of the three scientific co-founders of Fibrocor, who will work to identify targets and develop therapies to prevent, slow and ultimately reverse organ scarring.

Read more about how research hospitals are driving Ontario’s knowledge and innovation economy.

“Scarring, or fibrosis, can help people in the short-term—such as healing after a cut or sealing off an infection so that it does not spread—but when an injury is chronic, such as with diabetes, the amount of scar tissue formed can cause organ malfunction,” said Dr. Gilbert, who also holds the Canada Research Chair in Diabetes Complications.

The researchers and fellow co-founder Dr. Jeff Wrana, senior investigator at Sinai Health System’s Lunenfeld-Tanenbaum Research Institute, will test biopsy samples of scarred human tissue. They will measure which genes the body activates when scarring begins.

“Once we know what pathways are involved in activating the body’s scarring response, we’re well on our way to understanding how to block it,” said Dr. Yuen. “And because we’ll identify these pathways using human tissue samples, we think they’ll have a much better chance of being effective in future clinical trials.”

Although scarring underlies the development of liver failure, heart failure and certain type of lung disease, the company’s initial focus will be on kidney disease—reflecting Dr. Gilbert’s and Dr. Yuen’s clinical backgrounds and the tremendous unmet need.

By 2018, Fibrocor expects to have developed a new anti-scarring drug that will be ready for testing, not only in kidney disease but also in other diseases that involve fibrosis, the doctors said. The world-class academic team is complemented by management and business development from MaRS Innovation and drug discovery and development services from Evotec AG, which together launched the company with $2M USD financing.

“Because drug development is incredibly expensive and most granting agencies don’t fund this sort of activity, forming the company was a necessity,” said Dr. Yuen. “With Fibrocor, we’ll be part of the developmental strategy, taking our knowledge from the clinic, to the lab, to the boardroom and, hopefully, all the way back to the bedside.”

Written by Geoff Koehler at St. Michael’s Hospital

 

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