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

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

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 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.

 

 

North American first: Sunnybrook studies scalpel-free brain surgery to treat depression

For the first time in North America, researchers at Sunnybrook Health Sciences Centre are investigating the safety and effectiveness of using MRI-guided focused ultrasound to help patients with treatment-resistant major depression.

Focused ultrasound is an incision-free, image-guided technology that targets specific areas of the brain using high frequency ultrasound waves.

In this trial, focused ultrasound will be used to cause a lesion in a region of the brain (the anterior limb of the internal capsule) to disrupt a pathway of the brain that has been established as being active in depression. This pathway is considered to be a “highway” connecting the frontal lobes to the emotional centres of the brain, including the amygdala and hippocampus.

“Although we are in the early stages of investigating the safety and efficacy of focused ultrasound in patients with depression, it has the potential to be another treatment option,” says Dr. Nir Lipsman, principal investigator of the trial, and Director of the Harquail Centre for Neuromodulation at Sunnybrook.

Each year, 1 in 5 Canadians will experience a mental health problem or illness, and at some point in their lives, about 24 per cent of adults will experience an episode of major depression.

“I’ve struggled with depression for 30 years and tried just about every treatment in existence,” says Linda Bohnen, the first patient in North America to be treated with focused ultrasound for depression. “What I’m hoping will happen is a slow but steady improvement in my mood and functioning.”

“For patients with major depression who aren’t responding to existing standard treatment therapies, circuit disruption techniques, such as focused ultrasound, make it possible to treat areas deep in the brain noninvasively, without surgical incisions,” says Dr. Anthony Levitt, co-investigator and Chief of the Hurvitz Brain Sciences Program at Sunnybrook.

Focused ultrasound was successfully tested in a world first trial at Sunnybrook and other medical centres for use with patients with essential tremor, which led to Health Canada and FDA approval in 2016. Philanthropic investment has been a major catalyst behind Sunnybrook’s advances in focused ultrasound technology and research. Leading donors to this work are the Weston Brain Institute, The Beamish Family Foundation, FDC Foundation, Slaight Family Foundation, Harquail family through the Midas Touch Foundation and the Connor and Robinson families.

Dr. Kullervo Hynynen, Director of Physical Sciences at Sunnybrook Research Institute, worked with industry partner INSIGHTEC for almost two decades to develop the technology.

“This is innovation, medicine and science coming together to go beyond existing treatments for patients with depression,” says Maurice R. Ferré MD, INSIGHTEC’S CEO and Chairman of the Board of Directors.

“Focused ultrasound is a noninvasive alternative to surgery or radiation that offers the potential to treat more patients with major depression, as well as other psychiatric disorders,” says Dr. Neal Kassell, Chairman of the Focused Ultrasound Foundation. “Sunnybrook has become a leader in focused ultrasound research for brain disorders, and the Foundation is pleased to support this innovative trial.”

Phase I of the trial will involve six patients, ages 25-80 years old, over a one-year period who will undergo one round of focused ultrasound, and then assessed for severity of depression and level of functioning at one month, three months, six months and 12 months.

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Sunnybrook 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.

Can computers help unlock the mysteries of the brain?

This story was originally published by Sean O’Malley, Senior Media Relations Specialist and co-host of the CAMH Podcast, on the CAMH website

There is perhaps no better way to illustrate how much the world of mental health research has changed in the 20-year history of CAMH than to look at the work being done today by Dr. Sean Hill’s team at the Krembil Centre for Neuroinformatics.

Consider what happened in 1997, the year before CAMH was created. That was when Deep Blue, a supercomputer created by IBM, defeated the world’s best chess player Gary Kasparov, marking a seminal event in the history of our relationship with technology. Today, the free chess app on my smart phone could probably beat Deep Blue.

For fans of the dystopian Terminator movie franchise, Deep Blue’s victory over Team Human signaled the beginning of the end for humanity as we know it.

But for young scientists like Dr. Hill, it raised the same question he had been asking since he tried his first PC at the age of eight: how much smarter could we make these machines? Could we make them smart enough to unlock the mysteries of the brains of the people who created them?

CAMH podcast with Dr. Sean Hill neuroinformatics
Dr. Sean Hill, Director of CAMH’s Krembil Centre for Neuroinformatics and CAMH podcast co-hosts Dr. David Goldbloom and Sean O’Malley discuss the past, present and future of neuroinformatics.

Yes, Dr. Hill began coding when he was eight, inspired by something called a TRS-80 that his older brother’s high school had purchased at a local Radio Shack and let his brother bring home to their family farm in rural Maine.

“In the winter when it was cold and dark…there was this whole new world you could discover in a box,” says Hill. “To me it was an opportunity to be incredibly creative.”

From a neuroscience perspective, the answer to 8-year-old Sean Hill’s question about computers and the brain increasingly appears to be ‘yes’ in a way we could only have imagined in CAMH’s early days. And that could have profound implications for how we diagnose and treat mental illness in the future.

“We saw in 2005 that by 2025, a supercomputer would be built that could simulate brain circuitry the scale of the human brain,” says Dr. Hill in the latest episode of the CAMH Podcast.

That prediction ended up being off but not by much – that supercomputer is now expected to be ready in the next two years.

Just in time for Dr. Hill to apply that technology breakthrough to his work at CAMH.

After devoting much of his career to this intersection between computers and neuroscience, most recently at the prestigious Blue Brain Project in Switzerland, what most excites Dr. Hill about coming to CAMH is that he can now apply the theoretical power of big data to the flesh and blood world of patient care.

 

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CAMH 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.

Healthy Aging: 100 Years of Research and Care at Baycrest

“I just plough through, that’s something I learned from my mom. Just plough through,” says Barbara Schechter, a young caregiver featured in CBC’s recent documentary, The Caregivers Club, which takes an intimate and compassionate look at the lives of four caregivers and their loved ones living with dementia. The families are also part of the Baycrest Health Sciences community in Toronto.

With three young children and a full time job, Barbara is also a caregiver for her mother. “The only thing that gets you through the day is how you’re going to manage and how you’re going to make your mom safe,” says Barbara in the documentary.

There are currently 564,000 Canadians living with dementia, and that number is expected to double by 2031. As Canada’s population ages, more and better care is needed.

Baycrest Health SciencesThat’s what drives the researchers at Baycrest Health Sciences.

Baycrest is ranked as one of the most research-intensive hospitals in Canada and is a member of the Council of Academic Hospitals of Ontario, which represents Ontario’s research hospitals. Research hospitals play a unique and vital role in Ontario’s health system, providing advanced patient care services, training the healthcare workforce, and conducting leading-edge research to discover tomorrow’s care today. They generate the expertise and evidence to drive change as system leaders, building a healthier, wealthier, smarter Ontario.

And Baycrest is doing just that. Its Rotman Research Institute is among the world’s top research institutes in cognitive neuroscience.  The Centre for Aging and Brain Health Innovation, led by Baycrest Health Sciences, helps to accelerate brain health and aging solutions. Together, Baycrest is advancing dementia care for patients locally and globally, discovering better ways to diagnose, prevent and treat dementia and other brain disorders.

Research at Baycrest is part of a continuous cycle, where foundational brain research leads to clinical testing, which leads to innovations supporting healthy aging, which leads to more questions about the fundamental mechanisms of the brain.

Is my memory normal? At-home assessments and iPad apps  

Early detection and prevention of memory problems and cognitive impairment is a major area of focus at Baycrest. Cogniciti, a digital health company led by Baycrest researchers, is empowering adults to assess their memory in the comfort of their own homes. Free, private and clinically researched, the digital brain health assessment has helped more than 60,000 adults answer the question, “Is my memory normal or should I see my doctor?”

Test-takers age 40 and up solve a series of evidence-based puzzles, including shape matching, face and name matching, and a number-letter alternating test. Based on performance, they receive a memory report and may be advised to connect with their family doctor for next steps in care.  Through the brain health assessment, Cogniciti provides researchers access to a rich pool of interested volunteers to help advance memory research.

Another initiative accelerating research into Alzheimer’s and dementia treatments is Baycrest’s work with the Toronto Dementia Research Alliance (TDRA). The Sam and Ida Ross Memory Clinic at Baycrest is the initial pilot site for the newly developed Toronto Cognitive Assessment (TorCA), which utilizes an iPad to capture anonymous patient information and pools it onto a secure, research recruitment database that will be shared amongst TDRA memory clinics. This data will allow scientists to widen their pool of research subjects and easily identify and recruit consenting subjects who match the criteria for their dementia studies.

The TorCA is a sensitive tool that can identify patients at risk of dementia earlier. The assessment not only informs research on detection of memory-related conditions, it also saves costs for the health system and saves patients from having to pursue unnecessary cognitive tests.

Currently, Ontario patients concerned with cognitive impairment receive assessments from specialists. The TorCA iPad app is a game changer, allowing any health care professional to assess patients upfront and determine whether they need to pursue a more lengthy and resource intensive neuropsychology exam. The hope is that this tool will soon be clinically available across TDRA hospital sites within Toronto – and beyond— free of charge.

Getting a glimpse into a brain with dementia

What if you could detect the minute changes that occur in the brain Alzheimer's transcranial stimulationover the course of a person’s life? Researchers at Baycrest are getting the chance to do just that by using magnetic resonance imaging (MRI) to study the aging brain, including brains with very early dementia.

Cognitive tests, similar to the Toronto Cognitive Assessment, led Dr. Rosanna Olsen and her team to wonder whether physical differences could be detected in the brains of healthy adults who scored poorly compared to those who scored well.

Her cross-sectional study found that people who scored lower on cognitive tests had a smaller “memory region” of the brain – the same region that is first affected in Alzheimer’s disease. This finding has allowed researchers to use both memory region brain measures and low cognitive test scores as biomarkers (a biological flag) for Alzheimer’s disease, which is a big step forward for the detection and prevention of dementia.

Innovative treatment for older adults with depression and Alzheimer’s disease

Up to 70% of people living with Alzheimer’s disease also suffer from depression, which does not typically respond to standard antidepressant treatments. Dr. Linda Mah and Dr. Jed Meltzer are using a non-invasive procedure called transcranial magnetic stimulation (TMS) to reduce symptoms of depression in older adults with Alzheimer’s.

TMS uses magnetic fields to stimulate or inhibit neurons in the brain. Although TMS is approved as a treatment for depression, researchers are aiming to treat other neurologic and psychiatric conditions. Drs. Mah and Meltzer will evaluate the effects of TMS on both mood and memory in Alzheimer’s patients who also suffer from clinical depression. For Alzheimer’s patients, this could mean tapping into brain stimulation to treat their symptoms.

Patient and family care driving research

Research at Baycrest goes both ways. Not only is evidence informing how clinicians, occupational therapists, personal support workers and volunteers care for Baycrest clients, but researchers are also evaluating services to ensure high quality care and support.

Baycrest dementia arts therapyThe Road to Connection program is a great example of this. It’s an arts-based program that brings together caregivers and their partners with dementia for creative sessions and discussion. The program empowers dementia patients to tap into their creative skills while serving as a support group for caregivers.  On top of that, the program gives caregivers an opportunity to celebrate their partners through the art they have created and come away with a shared, meaningful experience.

“We could come back together at the end of the day with something for both of us,” said one caregiver participating in the program. “There aren’t many programs like this one that allow caregivers to meet and share without leaving loved ones behind.”

Baycrest researchers are evaluating the Road to Connection program with the hope of duplicating it across other sites within the Baycrest community and in Ontario.

Baycrest researchers have evaluated and helped redesign volunteer programs to improve resident engagement in Baycrest’s long-term care facility, the Apotex Centre. The Program for Leisure Engagement for Active and Spontaneous Experiences (PLEASE) is an evidence-based model that trains volunteers to work one-on-one and in small groups with residents, when they ask the simple question, “What do you want to do today?” The evaluation found that the PLEASE program enhanced the abilities and personhood of residents – more smiling, talking and engagement. Researchers are also exploring the use of volunteer visits to help older adults with dementia preserve or improve their thinking abilities.

This work helps long-term care homes incorporate cost-effective programs to improve care for residents with dementia and create new roles for volunteers working with older adults.

A century of excellence in complex care, research and training

The world’s population is aging rapidly, and Baycrest has the expertise to deliver proactive solutions. Now in its centennial year, Baycrest has spent 100 years pioneering the science of health and aging.

Baycrest provides compassionate, specialized care, conducts cutting-edge cognitive neuroscience research, commercializes innovative solutions, and trains the next generation of health care professionals with the skills needed to support and respond to the diverse and complex needs of older adults.

As a global leader, Baycrest’s work is contributing to a healthier, wealthier, and smarter future for Ontario and beyond.

 

Why does health research matter to us? We know that it generates new discoveries, better care, and greater efficiency all while contributing to our knowledge-based economy. That’s how it makes Ontario healthier, wealthier and smarter today. Investing in research hospitals will help us continue building a healthier, wealthier, smarter Ontario. Discover more health research and patient stories by signing up for our monthly newsletter or joining the #onHWS conversation on Twitter.

Group feature photo was taken during CAHO’s Healthier, Wealthier, Smarter Field Trip to Baycrest Health Sciences. Read our other Healthier, Wealthier, Smarter Field Trips here.

 

Research shows that preemie babies do better when families are involved in care

Dr. Karel O’Brien, with mother, Amy, whose twins were born at 23 weeks, 5 days.

An international study led by Sinai Health System researchers shows that a Family Integrated Care model of treating the tiniest and most fragile babies helps improve the wellbeing of both children and parents.

Neonatal intensive care units (NICU) in Canada, Australia and New Zealand adopted the Family Integrated Care model, developed at Mount Sinai Hospital by Dr. Shoo Lee, and found that it improved the wellbeing of both preemie babies and their parents compared to standard care:

  • Improved weight gain among preterm infants
  • Better breastfeeding
  • Reduced parental stress and anxiety

When Amy, a new mother of twins found herself in the Mount Sinai NICU with babies born at 23 weeks and 5 days, she felt scared and overwhelmed by how fragile the babies were. Still in the NICU after almost three months, she has found comfort in being part of the Family Integrated Care model. “It really allowed me to feel like a mother. Being with my babies all day, I know instinctively if something is wrong or what they need, and can report that to the doctors and nurses. They are getting stronger and stronger every day, and this model of care has made me believe that when I bring them home, I’ll be able to confidently care for them.”

The study was led by Mount Sinai Hospital researchers Dr. Karel O’Brien, neonatologist, and Dr. Shoo Lee, Chief of Pediatrics. Recently published in the prestigious journal, The Lancet Child & Adolescent Health, it involved nearly 1,800 infants born at 33 weeks gestation or earlier across 26 NICU units.

What is Family Integrated Care?

Family Integrated Care actively involves parents in the care of their newborns, including giving oral medicine, feeding, taking their temperate and taking part in ward rounds.

Mount Sinai supports parents in spending six hours a day, at least five days a week with their babies by providing them with a rest space and sleeping room, comfortable reclining chairs at the bedside and nurses trained in family support.

“Parents are too often perceived as visitors to the intensive care unit. Our findings challenge this approach and show the benefits to both infants and their families of incorporating parents as key members of the infant’s health care team, and helping parents to assume the role of primary caregiver as soon as possible,” says Dr. Karel O’Brien, who leads the Family Integrated Care Program at Mount Sinai.

Real impact for preemies and parents

“How care is provided to the family, not just the infant, has a positive effect on the wellbeing of both infant and family,” says Dr O’Brien. “Weight gain, breastfeeding and reduced parental stress and anxiety are all associated with positive neurodevelopmental outcomes, suggesting that integrating parents into the care of infants at this early stage could potentially have longer-term benefits.”

At 21 days, infants in the Family Integrated Care group had put on more weight and had higher average daily weight gain (26.7g vs 24.8g), compared to the standard care group. Additionally, parents in the Family Integrated Care group had lower levels of stress and anxiety, compared to the standard care group. Once discharged, mothers were more likely to breastfeed frequently (more than 6 feeds a day), compared to the standard care group (70% vs 63% ).There were no differences in rates of mortality, duration of oxygen therapy or hospital stay.

“The results of this trial are encouraging indeed. Not only is this an example of innovative care developed here in our hospital, it is an exceptional example of how a good idea can be shared across the country and around the world,” says Dr. Lee.  “This was truly a collaborative effort with participating NICU’s, parents, and the whole care team.”

Read more about this story in the media.

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Sinai Health System 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.

The Next Generation of Top Research Talent

Ontario Research Hospitals make our province and our health system smarter by attracting, training and retaining the next generation of health care professionals. Carley Richards, a trainee at The Royal, shares her experience diving into mental health research.

Meet Carley Richards

Throughout her teenage years, Carley Richards struggled with feeling depressed.

It wasn’t until her second year of university that she was actually diagnosed with depression and attention deficit hyperactivity disorder (ADHD). She finally had a piece of paper, with a diagnosis, that proved it wasn’t just “in her head.”

It was a change that would have a huge impact on her academic career.

“The brain is like a big unknown body of water that we’re only just dipping our toes into,” says Richards. “I realized the more we learn about and understand the brain, the more we’ll be able to help people like me.”

The Gut and the Brain

Now working toward a master’s degree in neuroscience at Carleton University, Richards is a research trainee under the supervision of Dr. Marie-Claude Audet, a researcher at The Royal’s Institute of Mental Health Research (IMHR). She recently won a Graduate Student Research Award from the IMHR.

“Recent research has shown that people with depression have different bacteria in their digestive system than people without depression,” says Richards.

The goal of her research is to look at the microbiome of two different groups of people — those who have depressive symptoms and those who do not. She’s hoping to link trauma in a person’s life to changes in gut bacteria, and explore whether changes in gut bacteria are associated with depressive symptoms.

Life as a Young Researcher

“As a young researcher paying for my own education, I need funding to conduct my research, which means I need to apply for grants and scholarships,” she says.

“It can take a lot of time, and unfortunately for young researchers, there’s a lot of competition and rejection. It can be really tough to stay in research.”

The funding from the IMHR Graduate Student Research Award is helping Richards push her research project forward.

“When you’re stressed, your body releases certain chemicals,” she says. “I’m using this funding to purchase a lab kit that measures a specific binding agent that connects those stress chemicals to the bacteria in the gut.” By using this lab kit, it will be possible for Richards to measure those connections.

“We’re a long way from understanding the brain, but imagine if we could treat symptoms of depression by treating specific bacteria in your gut,” says Richards. “We’re not there yet, but it’s exciting to know I’m contributing to that possibility.”

The Graduate Student Research Awards are funded by The Royal’s Foundation. They fund research and education experiences for young researchers as they work to make a difference in the lives of people living with mental illness.

 

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

Research Spotlight: Health Sciences North

Dr. Janet McElhaney and her team at Health Sciences North Research Institute (HSNRI) are working with Indigenous communities to promote healthy aging of Indigenous People in Canada.

On December 4th, 2017, MP Paul Lefebvre announced on behalf of Health Minister Ginette Petitpas Taylor and CIHR-IAPH, a $1.4 million funding investment for improving the health of Indigenous seniors.

This funding will support a project titled “Aging in Place: Promoting Healthy Aging for Indigenous People with Multiple Chronic Conditions”, led by HSNRI’S Dr. Janet McElhaney, Vice President of Research & Scientific Director and Dr. Jennifer Walker, Canada Research Chair of Indigenous Health at Laurentian University. Using Indigenous research methods, the project will explore caregiving experiences and patterns to better understand how communities can support Indigenous families living with multiple chronic conditions.

“The funding from CIHR will provide an opportunity for collaborative community-based research that will identify the needs of Indigenous older persons and develop interventions to address the health issues and barriers to care for older adults. It will allow us to work with communities and find innovative solutions while working to develop the next generation of researchers,” says Dr. Janet McElhaney, HSNRI’s Vice President of Research and Scientific Director.

This project is funded in partnership with First Nation communities in Northern Ontario and Saskatchewan to identify the needs of Indigenous older persons living with multi-morbidity; develop interventions to address health issues and barriers to caring for older adults; and evaluate the effectiveness of community-specific interventions to enhance “holistic health”.

The goal is to create a legacy of sustained partnerships that promote true reconciliation and together cultivate a way forward from colonization and intergenerational trauma to healthier aging.

 

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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.