The Physicians’ Services Incorporated Foundation This site is primarily for individuals with an interest in the research programs of the Foundation

Report on Granting Activities

September 1 to November 30, 2008

The Foundation approved grants with a total value of $600,000 in the third quarter of 2008, for the following projects:

Dr. A. Chaput
University of Ottawa

Pregabalin in the prevention of postoperative delirium and pain.

Delirium is a major complication occurring postoperatively, affecting up to 35% of patients. Pain and certain classes of medications represent two common causes of delirium in patients undergoing major surgery. Such medications include opioid analgesics and drugs with anticholinergic effects, which are frequently used to treat opioid-related side effects, such as nausea, vomiting, and itchiness.

An ever growing body of evidence supports the use of gabapentinoids, such as pregabalin, to reduce acute pain after many types of surgical procedures. This investigator hypothesizes that pregabalin use perioperatively will improve overall pain management and result in reduced opioid consumption, thereby reducing the consumption of medications required to treat opioid-related side effects.

Dr. L-N. Hazrati
Dr. C. Hawkins
University of Toronto

Filaminopathy: Unravelling a new paediatric seizure disorder.

Epilepsy is a common neurological disorder in children; even though it can be a relatively benign disease in many patients, it can be "catastrophic", because resulting seizures, and associated cognitive impairment, prove difficult to control. Even though some causes have been identified, only rare causes have a well defined aetiology, allowing specific treatment.

Recently, these investigators described a series of paediatric seizure patients with a novel and unique pathological finding; they propose that these patients represent a new diagnostic category of childhood seizure disorders. These investigators hypothesize that a defect in a protein called filamin causes this specific category of seizure disorder.

With full characterization of the clinical, pathological, and radiological features of this new entity, the investigators expect to facilitate both early recognition and treatment.

Dr. Gupta
St. Michael's Hospital

Online collaboration tool for asthma action plan with usability (OCTAPUS).

Asthma is a common and potentially fatal disease; an asthma action plan (AAP) is a written plan produced by a physician for a patient, to provide education and guidelines for self-medication of worsening symptoms. Studies demonstrate that AAPs effectively improve asthma control, but physicians fail to provide AAPs, due to a lack of time and adequate skill.

This investigator proposes to develop a computerized tool that will automatically generate an electronic version of the AAP, based on patient responses to questions about their current asthma control. Before creating this system however, the content and format of the AAP must be established.

The main objective of this phase of the study is to determine and compare AAP preferences within and between physicians, asthma educators, and patients, to arrive at a collaboratively designed AAP. The results of this study will be tested in future study phases, with the goal of improving asthma care.

Dr. P.J. Devereaux
McMaster University

Perioperative ischemic evaluation-2 (Poise-2) trial: A pilot.

Patients with heart disease are living longer, thus they are commonly developing conditions requiring a wide variety of non-heart surgeries, such as hip replacement. These patients are at risk of suffering a major heart complication around the time of surgery, including a heart attack, stroke, or death. Aspirin has been used for years in people with heart disease, in reducing the risk of such complications,

This investigator believes that aspirin may have the same benefits for patients having surgery; however, a large clinical trial is required to know for certain. The goal of this pilot study is to identify and resolve problems with this protocol, before embarking on the larger study.

Dr. M. Harrison
Dr. C. Parker
Queen's University

Effects of cardiac resynchronization therapy on dyspnea and exercise tolerance in patients with congestive heart failure.

Despite medical treatments, patients with heart failure (HF) may experience disabling symptoms of breathlessness and poor exercise tolerance, which can have profound effects on their quality of life. Some patients with HF develop abnormalities in the electrical conduction system of the heart, such that the ventricles do not contract synchronously.

Cardiac resynchronization therapy (CRT) involves the implantation of a specialized pacemaker device, in an attempt to restore synchronous contraction of the heart muscle. CRT has emerged as an important new therapy for select patients with advanced HF, with many patients noting immediate improvements in exceptional breathlessness and their ability to exercise. However, the physiological mechanisms associated with these improvements remain unclear.

These investigators propose to study the physiological effects of CRT in patients with advanced HF. The results of this study may further current understanding of the mechanisms by which CRT improves shortness of breath, the ability to exercise, and quality of life in HF patients.

Dr. T. Principi
Dr. S. Schuch
Hospital for Sick Children

What happens to oxygen saturation in infants discharged with acute bronchiolitis.

Bronchiolitis is the most common lower respiratory tract infection in infants, characterized by wheezing and breathing difficulties. Oxygen levels in the blood are frequently monitored in the emergency department (ED) through a special skin probe. The decision to admit infants to hospital is often based on decreases in oxygen levels, even if the child looks well. Acceptable levels of oxygen vary by physician and hospital; such levels are not based on evidence.

Research exists showing that children who are not sick will have decreases in oxygen levels while sleeping or sitting in a car seat. Oxygen levels fluctuate in children with bronchiolitis, while they are in the ED and/or admitted to hospital, and do not correlate with a change in condition. There is no information as to what happens to oxygen levels when infants with bronchiolitis are sent home from the ED.

The purpose of this study is to compare the rate of unscheduled medical visits for bronchiolitis between infants, whose oxygen levels decrease to less than 90% for at least one minute while at home, to those whose oxygen levels remain above 90%. This study will provide important details regarding the frequency of decreases in oxygen levels in infants with bronchiolitis at home, and the affect of those decreases on health utilization. More importantly, if there is little difference in medical visits between these two groups, it will put the significance of these events into perspective and deemphasize the importance of oxygen levels in an otherwise well looking infant.