Foundation Funded Projects for 2016

October 1 to December 31, 2016

July 1 to September 30, 2016

April 1 to June 30, 2016

January 1 to March 31, 2016

 

October 1 to December 31, 2016

 

 

Dr. R. Aviv
Dr. S. Morrow

Sunnybrook Health Sciences Centre

Longitudinal, multicenter study of cortical perfusion as biomarkers of cortical disease severity and cognitive impairment in multiple sclerosis

Intellectual decline is seen in more than half of people with multiple sclerosis (MS), increasing with disease duration. It is an important cause of reduced quality of life impacting on personal relationships and the ability to work or live independently. There is increasing recognition that lesions in the outer brain layer or cortex are implicated in both physical and intellectual decline. These cortical lesions are however difficult to detect with routine clinical MRI imaging making it difficult to monitor disease progression or assess the efficacy of medical therapies.

The investigators have developed a 2-minute MRI technique that quantitatively measures cortical blood flow and can distinguish between MS patients with and without intellectual decline. Preliminary data demonstrates that the technique is superior to traditional measures such as cortical atrophy and white matter lesion load and may even be present in the absence of any structural brain changes. These findings strongly suggest that cortical blood flow could be used to monitor cortical disease severity without the need for directly identifying cortical lesions. This technique has shown promise in both relapsing remitting and secondary progressive MS.

The current proposal seeks to extend previous work by determining whether the cortical blood flow changes observed are sensitive to disease progression over time. To do this the researchers propose rescanning patients who participated in a prior study 2 years ago to achieve prospective longitudinal follow up.

 

 

Dr. H.M. Cheung
Dr. L. Milot

Sunnybrook Health Sciences Centre

Preoperative gadolinium-enhanced MRI as a predictor of long-term survival in surgical patients with colorectal liver metastases

Colorectal cancer is the second leading cause of cancer deaths in Ontario, with over 3000 deaths in Ontario every year. Many of these deaths are related to cancer that has spread to the liver. Surgery to remove colorectal liver metastases improves survival and offers the possibility of achieving long-term cure in as many as a quarter of patients; however surgery does have risks and determining which patients are most likely to benefit from aggressive treatment remains challenging.

Magnetic resonance imaging (MRI) is a test that is routinely used prior to surgery in order to diagnose colorectal liver metastases. However, it is not used for determining prognosis. In a preliminary study, the researchers have shown that the MRI routinely used prior to surgery for diagnosis may also be used to predict long-term survival; however this was a small preliminary study and needs to be confirmed on a larger patient population.

The goal of the proposed study is to confirm these findings on a larger population involving 4 major cancer centres (Calgary, London, Ottawa, Toronto) across Canada. The investigators will retrospectively analyze data from patients with colorectal liver metastases who received an MRI prior to surgery in the 5-year period between 2008-2012 to determine whether MRI features are associated with long-term survival in these patients. The researchers will work in a multicentre, multidisciplinary team involving abdominal radiologists, liver surgeons, and biomedical engineers in order to complete this project. If successful, the proposed project has the potential to improve the long-term survival outcomes of patients with colorectal liver metastases.

 

 

Dr. J.C. Dionne
Dr. D.J. Cook

McMaster University

Diarrhea, interventions, consequences and epidemiology in the intensive care unit (DICE-ICU)

Diarrhea is common among critically ill patients, however, little is known about why critically ill patients have diarrhea. Some research has shown that diarrhea may be caused by antibiotics, different types of medications such as liquid Tylenol, and different types of nutrition used in patients who are critically ill. Diarrhea can lead to kidney injury, the development of wounds, cause electrolyte abnormalities and could lead to patients needing to be in the Intensive Care Unit (ICU) and hospital longer.

The Diarrhea Interventions Comparison and Epidemiology in the Intensive Care Unit (DICE-ICU) study hopes to identify how often patients are having diarrhea, risk factors for diarrhea including the impact of antibiotics, medications, infections including Clostridium difficile (which can cause diarrhea), and effect types of nutrition have on the occurrence of diarrhea in 3 ICUs over a 10 week period.

The investigators also hope to identify how doctors and members of the ICU team (nurses, dieticians, pharmacists) manage diarrhea. The knowledge gained from the DICE-ICU study will help identify risk factors for diarrhea and help the ICU care team looking after patients develop ways to prevent it.

 

 

Dr. R. Grant
Dr. S. Gallinger

University Health Network

Germline genetic variants influencing survival from pancreatic cancer: results from an exome-wide association study and independent replication

Pancreatic cancer is a common deadly disease. There currently is limited ability to predict the prognosis of individual patients or select patients who will benefit from therapies. In this study, the objective is to identify inherited genetic variants that influence survival from pancreatic cancer.

The investigators have identified candidate variants through an "exome-wide association study". In that preliminary analysis, the researchers combined data from four studies to create a cohort of over 400 patients with pancreatic cancer who underwent sequencing of their exomes, the portion of their genome that encodes proteins. Statistical models were used to identify variants most likely to be associated with survival. In the proposed project, the researchers will take the top candidates from that analysis and additional variants previously identified in the literature and test their association with survival in an independent cohort using next-generation sequencing. The research team have prospectively collected DNA and detailed clinical data on 500 unselected patients at Princess Margaret Hospital.

This project has the potential to identify clinically relevant and biologically important variants that influence survival from pancreatic cancer. Since sequencing technologies are widely available for germline variants, the results may be readily translated into the clinics. Through identifying genetic biomarkers, this study has the potential to bring precision medicine to pancreatic cancer patients.

 

 

Dr. S. Lalani
Dr. I. Chen

The Ottawa Hospital Research Institute

PrOSE Study: pregnancy outcomes in surgically-diagnosed endometriosis study

Preterm birth, fetal growth restriction, pregnancy-associated hypertension and haemorrhage are leading causes of neonatal and maternal disease and death in Canada and worldwide. Recent research suggests such serious pregnancy conditions can be associated with endometriosis, a chronic condition where cells of the inner uterine lining grow outside of the uterine cavity. Due to fertility treatments, the proportion of women with endometriosis who are becoming pregnant is increasing. Women with endometriosis who conceive and carry the pregnancy to later gestation may be at risk of serious adverse pregnancy outcomes for the infant and mother.

The research team has performed a comprehensive and systematic review of the literature, and found significant controversy regarding the relationship between endometriosis and pregnancy outcomes. Furthermore, most studies have not accounted for other factors, such as the use of fertility treatments. Based on the findings, the investigators propose a large, high quality study using Canadian database systems to better explore the relationship between endometriosis and adverse pregnancy outcomes.

By understanding the impact of endometriosis and fertility treatments on adverse pregnancy outcomes, this study has potential to help decrease infant and maternal morbidity and mortality. This study can also help in understanding the reproductive burden of disease among women with endometriosis, and will lead to improved counseling, informed care standards, and appropriate resource allocations, as more frequent maternal and fetal ultrasound monitoring may be warranted. As this research represents novel collaboration between distinct communities of perinatal and gynecologic researchers, this research will help foster novel, innovative, and clinically-relevant research on the common health conditions affecting women everywhere.

 

 

Dr. C.H. Lee
McMaster University

Prospective, open-label trial to evaluate efficacy of lyophilized fecal microbiota transplantation for treatment of recurrent C. difficile infection

Clostridium difficile infection (CDI) is the leading cause of healthcare-associated infection in Canada and the rates of this infection continue to also rise in the community setting. Treatment of a primary episode of CDI with metronidazole, or with oral vancomycin in severe cases, is the standard of care. Recurrence rates following treatment with metronidazole and vancomycin are approximately 20%, increase to 40% following the first recurrence, and to more than 60% after two or more recurrences.

Fecal transplantation, also known as fecal microbiota transplantation (FMT), uses stool from a healthy screened donor to restore the healthy bacteria (microbiota) in the colon, and breaks the cycle of the need to treat with antibiotics which prevent reestablishment of beneficial microbiota in the colon. The investigators have recently reported in the Journal of American Medical Association that the efficacy of frozen or fresh FMT is approximately 85%; however FMT remains unavailable in most healthcare facilities in Canada largely due to lack of suitable donors and laboratory support to manufacture FMT.

Laboratory testing showed that lyophilisation (freeze-and-dried) of FMT allows healthy microbiota to survive for several months stored at 5 degrees Celsius. The use of lyophilized FMT will allow wider and immediate accessibility of FMT across many healthcare facilities in Canada. The researchers’ primary objective is to determine the efficacy of lyophilized FMT compared to the frozen FMT.

 

 

Dr. R.M. Shapiro
Dr. A. Lazo-Langner

London Health Sciences Centre Research Inc.

Methylation study of myelodysplastic syndrome patients treated with azacitidine

Myelodysplastic syndrome (MDS) refers to a group of bone marrow disorders that share the common features of an inefficient bone marrow and a high risk of developing acute myeloid leukemia (AML). Most patients with the disease are too frail to tolerate the only potential cure for the disease, a bone marrow transplant. MDS has a high degree of morbidity, resulting in anemia (low hemoglobin) that makes its sufferers fatigued and short of breath, low white blood cell counts that increase the risk of serious infections, and low platelet counts that increase the risk of serious bleeding.

For those patients who are too frail to tolerate a bone marrow transplant or who have failed a bone marrow transplant, azacitidine is one of a few treatments that offers a benefit in terms of survival and maintenance of stable blood counts. The mystery of azacitidine is that nobody knows how or why it works. There is no explanation for why some patient with MDS can survive a long time on azacitidine with stable blood counts, why others have no response at all, and why others still seem to respond at first but then progress to AML rather quickly. Being able to reliably identify patients who fall into one of the above categories of disease response is critical in not only selecting the right patients in whom to start azacitidine, but also to get a clue as to what actually goes wrong in the bone marrow of MDS patients.

The goals of this project are to try to figure out why azactidine works in some MDS patients and not others, to better identify who would most likely benefit from the drug, and to identify who would most likely fail ongoing treatment with the drug after having started it. Azacitidine works by inhibiting an enzyme (piece of cellular machinery) that puts methylation markers on DNA. The fact that this has a benefit in MDS suggests that understanding the methylation lexicon (or signature) would be a big step forward in understanding how MDS develops and how to treat it. To be able to do this, the investigators propose to use tools that read methylation markers on DNA derived from bone marrow of MDS patients. By comparing methylation patterns of azacitidine responders to nonresponders, the researchers hope to derive a unique distinguishing methylation signature that also points to those parts of the DNA that are critical in the development of MDS.

 

 

Dr. J.L.Y. Tsang
Niagara Health System

Impact of a multifaceted and multidisciplinary approach on pain, agitation and delirium management in a community intensive care unit

Delirium is a common manifestation of acute brain dysfunction in critically ill patients with a prevalence of as high as 80% in mechanically ventilated intensive care unit (ICU) patients. It is associated with multiple complications and adverse outcomes including prolonged hospital stay, increased health care costs, increased mortality and long-term cognitive impairment. In 2013, the American College of Critical Care Medicine published a revised version of the ICU pain, agitation, and delirium (PAD) guidelines. The implementation of various components of the PAD guidelines in academic hospitals has been shown to improve clinical outcomes and to save costs; however its dissemination at Niagara Health (NH) St. Catharines Sites (SCS) ICU, a community hospital, is unclear.

The investigators propose a prospective interventional study in the NH SCS ICU. The aims of the study are 1) to review our PAD management practices and 2) to study the impact of multifaceted and multidisciplinary interventions on PAD management of adult critically ill patients.






July 1 to September 30, 2016

 

 

Dr. M.J. Cecchini
Dr. D.K. Driman

London Health Sciences Centre Research Inc.

Loss of CDX2 as a clinically actionable biomarker in stage II and III colon cancer

Colon cancer is one of the commonest cancers affecting Canadians. The main treatment for colon cancer is surgical removal of the section of the colon involved by the cancer. In the case of early stage colon cancer limited to the colon, chemotherapy improves the survival of some patients only. While there is typically a good prognosis associated with early stage colon cancer, there is a significant number of patients that develop metastatic disease and ultimately die from colon cancer.

The challenge that oncologists face is to identify those patients that would benefit from more aggressive therapy, including chemotherapy after surgery. Recent work has suggested that a biomarker known as CDX2 could be utilized to identify high-risk patients that would benefit from chemotherapy; however significant questions remain about its use to guide treatment decisions in colon cancer.

This proposal holds the promise to define a means by which CDX2 can be utilized in clinical samples to identify high-risk patients that would benefit from adjuvant therapy. Ultimately, this would improve the survival of patients with colon cancer and also limit the unnecessary use of chemotherapy in patients.

 

 

Dr. N. Daneman
Dr. B. Coburn

Sunnybrook Health Sciences Centre

BALANCE of the microbiome

Bloodstream infections are common and potentially fatal, and require early treatment with effective antibiotics to improve patient outcomes. The ideal duration of treatment for these infections is unknown, and in the absence of evidence unnecessarily prolonged treatment lengths are causing avoidable harms to patients. These harms include occasional but severe side effects such as kidney injury and Clostridium difficile infection, and increasing bacterial resistance to our antibiotics, but may also include universal but unseen harm to the gut microbiome (the normal diverse bacterial species present in the human gut).

In the Bacteremia Antibiotic Length Actually Needed for Clinical Effectiveness (BALANCE) randomized controlled trial the investigators are testing whether 7 days of antibiotics are associated with non-inferior survival rates to 14 days of antibiotic treatment. In this BALANCE of the Microbiome sub-study, in a subset of patients in the BALANCE trial, the researchers aim to test whether 7 days of treatment is superior to 14 days of treatment through preservation of the normal microbiome diversity.

Taken together, the results of the BALANCE trial and BALANCE of the Microbiome sub-study will define the appropriate treatment duration for bloodstream infections, and potentially result in major reductions in antibiotic treatments and harms across Ontario.

 

 

Dr. N. Dudek
University of Ottawa

Can we assess trainees, provide written feedback, and improve uptake? A grounded theory study of assessment anchors in postgraduate medical education

Workplace-based assessment (WBA) is considered the best method of assessing professional competence. High quality WBA is a vital component of the successful implementation of competency based medical education. WBA tools typically provide a list of items that detail particular aspects of a clinical activity to be rated on a scale. Traditional anchors for these scales ask educators to quantify a trainee’s ability as compared to their level of training or the quality of the performance.

WBA tools that use traditional anchors have well documented problems. A new generation of WBA tools have used the concept of entrustment by using anchors such as “I would allow this trainee to practice unsupervised”. WBA tools using entrustability scales are more reliable. How and why entrustability scales seem to work and whether residents will accept these scales are complex questions that remain unanswered in the literature. The answers to which are needed to help create and improve the use of new WBA tools.

This study will explore why and how the concept of entrustment as an assessment method resonates with residents and their supervisors. This study will use the qualitative approach of grounded theory, which aims to build theories to explain complex, social phenomena.

 

 

Dr. A.B. Fecso
Dr. T.P. Grantcharov

St. Michael's Hospital

Predictors of short-term patient outcomes in laparoscopic gastrectomies for gastric cancer

Laparoscopic gastrectomy for gastric cancer is a major intra-abdominal operation with significant surgical morbidity and mortality. Factors reported to influence postoperative outcomes include patient related (age greater than 70 years, comorbidities), and disease related factors (extent of the surgery). Surgical factors (technical performance and errors), might play a role as well.

Although this area is under investigated, it is important, since in many operations the technical skill of the operating surgeon may be more important for a successful outcome than the perioperative care the patient receives; therefore, the objective of this study is to determine whether the intraoperative technical performance of the surgeon affects the short-term patient outcomes in minimally invasive (laparoscopic) gastrectomy for gastric cancer.

This is a multi-center, multi-surgeon project. Full length, unedited video recorded operations will be reviewed and evaluated for technical performance, errors and adverse events. Patients’ charts will be also reviewed to collect perioperative patient-, disease- and short-term (within 30 days after the surgery) outcome data. Statistical analysis will be performed to determine the predictors for postoperative complications. This study will demonstrate that higher level of technical performance is associated with lower incidence of short-term postoperative adverse outcomes.

 

 

Dr. K. Gauthier
Dr. M. Rodger

University of Ottawa

Preventing maternal mortality: VTE prophylaxis with LMWH in the postpartum period, a before and after study

Venous thromboembolism (VTE), which can present as blood clots in the legs, lungs or both, is one of the leading causes of maternal mortality in the developed world. Anticoagulation therapy is highly effective at preventing VTE. During and shortly after pregnancy, the recommended agent is low-molecular-weight-heparin (LMWH). LMWH comes with its associated risks such as bleeding, it is expensive, and inconvenient due to the daily injections it requires.

Current guidelines for postpartum VTE prophylaxis are inconsistent and based on poor quality evidence. At the Ottawa Hospital, a tool was developed in 2009 to help identify which women were at higher risk of VTE after childbirth; however, this tool has not been validated.

The current study is a before and after study, looking at the rate of postpartum VTE and bleeding complications in the postpartum period before and after implementation of the postpartum VTE risk stratification tool in 2009. In order to obtain this information, the investigators will conduct a database review and chart reviews. The main objectives are to determine if this tool helped reduce the rate of VTE after childbirth, and if it had an impact on the rate of bleeding complications.

 

 

Dr. B. Girardi
Dr. L. Murnaghan

Hospital for Sick Children

A qualitative assessment of the role of 'bootcamps' in surgical residency

The transition from senior medical student to resident is a period of substantial increase in responsibility. This responsibility includes direct effects on patient care and thus represents a new stressor for junior residents. This transition period has been identified as a timepoint where simulation interventions could provide important benefits for residents and their patients. From this notion, there has been a widespread adoption of “pre-clinical training camps” or “boot-camps” targeting new residents prior to entrance to the hospital environment.

While a plethora of studies have highlighted positive trainee reaction to implementation of pre-clinical training camps, and a limited few have demonstrated learning in pre-post test designs, there is a paucity of data on the theories informing how trainees learn in this environment and how they transfer those new skills to their hospital practice. In order to effectively implement pre-clinical training camps and efficiently maximize benefit to junior residents, a thorough understanding of the resident experience within these camps is needed. Qualitative grounded theory methodology employing semi-structured interviews will be utilized to explore the construct of “boot camps” through the eyes of junior surgical resident trainees, senior resident instructors, staff physician preceptors, and members of the inter-disciplinary health team at the University of Toronto.

Transcribed interviews will be coded and analyzed thematically to inform and develop theory that can subsequently be used to improve future implementations of pre-clinical training camps. In addition, the transfer of knowledge from the pre-clinical camp environment to the real-world hospital environment will be explored to help assess the ultimate impact of these camps on actual practice. In light of the widespread adoption of pre-clinical training camps, and the large amount of resources required to implement them, increasing understanding of their effectiveness and impact is vital to justifying their continued use.

 

 

Dr. J.C. Lauscher
Dr. P. Karanicolas

Sunnybrook Health Sciences Centre

Prediction of postoperative liver function with preoperative primovist (gadoxetate disodium)-enhanced MRI (PROLIVE)

The limits of hepatic resectability are constantly expanding with increased understanding of hepatic anatomy and refinements in surgical technique. Even in hepatobiliary centres with highest expertise, 15% of patients experience liver failure after partial hepatectomy and 3.7% of all patients die from postoperative liver failure. Exact estimation of volume and function of the remaining liver after resection is key to prevent postoperative liver failure.

Clinical scoring systems (Child-Pugh score, MELD score) as well as conventional liver function tests such as Technetium-99m galactosyl human serum albumin (GSA) and inodocyanine green dye retention at 15 min (ICGR-15) have failed to precisely predict postoperative liver failure. Several studies over the recent years have been shown that Primovist-enhanced MRI can estimate liver volume as well as liver fibrosis and cirrhosis. No study thus far has evaluated the capability of Primovist MRI to assess both volume and function of the remaining liver prior to resection and therewith predict postoperative liver function. The investigators believe that Primovist MRI can help predicting postoperative liver failure better.

This multicentre large-scale analysis will substantially improve prediction of post-hepatectomy liver failure and therewith improve patient selection before liver surgery, lower the rate of postoperative liver failure and postoperative deaths; and decrease postoperative hospital stay. This trial will have a substantial impact on improving morbidity, mortality and health care costs after major liver resection.

 

 

Dr. A.A. Mosher
Dr. N. Leyland

McMaster University

Investigating the role of melatonin and prostaglandins in endometriosis

Endometriosis is a condition characterized by uterine tissue located outside the uterine cavity, which results in pelvic pain and infertility. Current treatments for endometriosis include hormonal suppression of menstruation and surgical removal of the ectopic endometrial tissue. Unfortunately, there is a high rate of recurrence for both treatment options.

A recent study has shown that melatonin can reduce the pain associated with endometriosis. The goal of this research project is to investigate the role of melatonin in the molecular mechanism of endometriosis. This will be accomplished by assessing the expression of melatonin receptors in endometriotic tissue and determining the effect of melatonin on inflammatory output from cultured endometriotic cells.

There is a need for effective non-hormonal and non-invasive treatments that don’t interfere with the ability to conceive. Melatonin would be an ideal choice as it has a low side effect profile and does not interfere with conception. The results of this project will provide molecular insight into the mechanisms of a potential fertility sparing treatment for endometriosis.

 

 

Dr. C.M. Ryan
University Health Network

Sleep pediatric transition clinic cohort study - bridging the gap between pediatric and adult sleep medicine

The transition from adolescence to young adulthood is a point of high vulnerability characterized by significant developmental change and increased psychosocial stress for many young people, and more so, for those with chronic health conditions. In particular, this is true for sleep apnea, a disorder which has burgeoned over the last decade, due to the rising obesity rates in the Western world.

The results of many clinical longitudinal studies strongly suggest that sleep apnea is an independent risk factor for heart disease and stroke and that treatment of it alleviates the increased risk. Most of the evidence is based on adult observational studies, with limited data available from short term pediatric studies. As adherence to treatment is of such potential importance to long-term health, this study will investigate the short term impact of transition from the pediatric to adult health care systems on adherence to therapy for sleep apnea in young adults.

 

 

Dr. M. Sey
London Health Sciences Centre Research Inc.

A double blind randomized clinical trial of high volume simethicone to improve visualization during capsule endoscopy

Capsule endoscopy (CE) involves swallowing a pill with a tiny camera built into it to examine the small intestine. Unfortunately, air bubbles inside the bowel can block the view of the camera and lead to missed diagnoses, such as cancers, polyps, abnormal blood vessels, and ulcers.

Simethicone is a liquid medication swallowed 30 minutes before CE that stays inside the bowels to get rid of air bubbles. Prior studies have tried using this medication with mixed success. The investigators believe that simethicone is likely effective but is not being given in a high enough volume to clean the entire small intestine.

In this study, the research team will randomize people to either the standard amount of simethicone (200 ml) or high volume simethicone (750 ml) to determine if the latter will remove air bubbles better and lead to improved views of the small intestine and more diagnoses. The researchers have already conducted a mini pilot study that showed a strong trend supporting the hypothesis that the high volume simethicone works better; however, confirmation of these findings by a rigorous clinical trial is needed.

 

 

Dr. T. Tang
Dr. R. Reid

Trillium Health Partners

Mixed methods evaluation of an interprofessional communication platform’s impact on patient safety, team communication processes, team functioning, allied health utilization, and length of stay

In our aging population, more people are living longer with one or more chronic health conditions. As patients admitted to the hospital become increasingly complex, they often require care from a group of diverse clinicians including physicians, nurses, and allied health professionals. This makes teamwork and effective communication among the care team an important factor for patient safety and discharge planning.

Communication technologies currently used in hospitals are often out dated and have a number of limitations. The investigators developed Care Connector, a web-based and mobile electronic tool to support effective communication across the care team. This study evaluates the impact of Care Connector on the care team’s processes for communication, teamwork, whether or not allied health staff are involved sooner, and on a patient’s length of stay in hospital. If this technology is proven effective, it can be adopted by other hospitals to improve care.

 

 

Dr. A. Thoma
McMaster University

A multi-center, randomized controlled trial comparing the clinical effectiveness and cost-effectiveness of collagenase injection (Xiaflex) and palmar fasciectomy in the management of Dupuytren’s disease - Evaluation of Xiaflex: trial of effectiveness in Dupuytren's (EXTEND)

Dupuytren's disease is an abnormal thickening of tissue beneath the skin of the palm and fingers. Gradually turning into cords, this causes flexion contractures of the fingers pulling them toward the palm. Dupuytren’s can affect activities of daily living; because this is a progressive disease it results in considerable limitation of hand motion and reduced quality of life.

Many surgical approaches have been introduced over the years to treat Dupuytren’s. Limited palmar fasciectomy is a surgery whereby the thickened cord is excised and this has been the most widely accepted treatment. In the last few years a non-surgical solution has been introduced that involves injection of collagenase (enzyme) directly into the cord. This weakens the cord and a few days later the physician stretches the finger(s) straight.

The investigators plan to conduct a prospective, multi-centre, pragmatic randomized controlled trial to compare the clinical and cost-effectiveness of collagenase injections versus limited palmar fasciectomy to determine if collagenase is a superior treatment in terms of improved quality of life and reducing recurrence of the disease without serious complications. Since collagenase injections are costly it is also necessary to assess if this novel intervention is cost-effective from the patient, Ministry of Health and societal perspective.

 

 

Mental Health Research

 

 

Dr. G. Northoff
University of Ottawa

Does brain imaging improve therapy in psychiatric disorders? An imaging-based and individualized approach to stimulation treatment

The enormous socioeconomic impact of psychiatric disorders, such as schizophrenia, bipolar disorder and major depressive disorder, underpins a medical imperative to develop new or enhanced treatments. Brain imaging can decipher processing alterations in the brain's neural activity. It remains unclear how the changes in the brain's spontaneous activity are related to alterations in multisensory processing in psychiatric disorders like schizophrenia and depression.

The present project aims to investigate the neural changes underlying multisensory integration in these disorders and to use these measures to guide therapy in an individualized way. The recent acquisition of a Siemens hybrid PET-MRI brain scanner, with an integrated EEG system, will support this project and offer leading-edge capabilities.

 

 

Dr. R.J. Van Lieshout
McMaster University

Impact of public health nurse delivered group CBT for postpartum depression on maternal relapse, recurrence, attachment, parenting, and offspring emotion regulation: a randomized controlled trial

Postpartum depression (PPD) affects over 14,000 women in Ontario each year, and can have profound effects on mothers and their infants. Indeed, the cost of one case of PPD exceeds $150,000, a significant proportion of which is related to its impact on offspring. Difficulties accessing preferred treatments (e.g., psychotherapy) result in fewer than 15% of women receiving care. While Public Health Units have played an important role in PPD detection in Ontario, Public Health Nurses (PHNs) currently lack the skills to deliver evidence-based treatment to women.

The investigators’ objectives are to determine if: 1. PHNs can effectively treat PPD in the community using group cognitive behavioural therapy (CBT) to prevent depressive relapse and recurrence up to 18 months; 2. Improve mother-infant attachment and parenting; and 3. Prevent the intergenerational transmission of depression risk.

The researchers will conduct a randomized controlled trial comparing group CBT to care as usual in women with PPD. Funding from a previous study will enable us to assess the impact of group CBT on maternal depression immediately post-treatment, while the work proposed here will examine mother-infant attachment, parenting, and infant emotion regulation at 6, 12, and 18 months after group completion using self-report, observational, and physiological measures.






April 1 to June 30, 2016

 

 

Dr. L.D.C.R. Barra
Dr. K. Boutis

Hospital for Sick Children

Home management versus primary care physician follow up of children with distal radius buckle fractures: a randomized control trial

Distal forearm buckle fractures are the most common fracture in childhood. Despite their high frequency, they are very stable injuries and can be safely treated with a removable wrist splint while the fracture heals.

Currently, after emergency department assessment and treatment, these fractures are increasingly being followed by primary care physicians due to the rarity of requiring orthopaedic intervention; however some preliminary evidence also supports that these fractures can be managed at home after assessment and treatment in the ED, without any physician follow up. Thus, the goal of this study is to design a methodologically robust trial that will examine the effectiveness and safety of home management of these injuries after ED discharge.

 

 

Dr. R. Behman
Dr. P. Karanicolas

Sunnybrook Health Sciences Centre

The management of small bowel obstruction: a population-based analysis on practices and outcomes

Small bowel obstruction (SBO) represents one of the most common surgical problems in Western medicine accounting for up to 16% of all surgical admissions. American data has shown that more than 300,000 emergent surgeries are performed per year for this disease at a cost of 850,000 days of inpatient care and $2.3 billion. These figures likely comprise only a fraction of the overall burden of this disease as only 20-35% of patients who present to hospital with this problem are treated operatively.

Existing management guidelines are based on limited high-quality evidence. Prior studies have focused on short-term outcomes; few studies exist with sufficient follow-up to allow for characterization of the long-term consequences of management decisions. The proposed study is a population-based analysis of patients in Ontario presenting with their first admission for small bowel obstruction. The investigators will evaluate the burden of disease of SBO in Ontario and follow the population forward in time to assess how early management patterns affect long-term outcomes.

 

 

Dr. I. Chen
The Ottawa Hospital

Canadian hysterectomy alternatives study

With 40,000 hysterectomies being performed each year, Canada has among the highest hysterectomy rates in the developed world, 2nd only to the US. Most hysterectomies are performed on otherwise healthy women for the treatment of common gynaecologic conditions. Alternatives to hysterectomy exist, and the use of more conservative medical and minor procedural alternatives to hysterectomy can lead to a reduction in unnecessary surgery and associated complications and sequelae. Social inequities exist for hysterectomy practice in Canada, and variation is seen in geographic location, income, and education.

The objectives of this study are to: (1) explore the variation in hysterectomy practice in Canada; (2) determine the effect of First Nations/Inuit/Métis status, neighbourhood income, neighbourhood education, and geographic factors on hysterectomy rate, approach, and use of alternatives to hysterectomy, after taking into consideration the effects of patient clinical factors and identify patient subgroups that may be vulnerable to potentially avoidable hysterectomy; and (3) compare healthcare utilization and cost of care for women who received alternative to hysterectomy compared with hysterectomy without prior use of alternative. A population-based retrospective analysis will be conducted.

This study will provide: (1) a quantified description of disparities in hysterectomy rates, use of minimally invasive approaches, and use of non-hysterectomy alternatives, and (2) quantified measure of the benefits and costs of hysterectomy alternatives compared with hysterectomy in Canada. By identifying subgroups of patients at highest risk of potentially avoidable procedures, the research has potential to lead to practice and policy changes that reduce inappropriate and invasive gynaecologic interventions for vulnerable women in our society.

 

 

Dr. S.A. Crawford
Dr. T.L. Forbes

University Health Network

Determinations of geometric factors that cause rotation of fenestrated aortic stent grafts during deployment

Endovascular aneurysm repair is a minimally-invasive method for the treatment of abdominal aortic aneurysms. This technique involves the insertion of a stent graft to exclude the aneurysm. For complicated aneurysms involving the renal and/or other visceral arteries, a custom-made stent graft is required. These custom-made stent grafts have fenestrations (holes) that need to align precisely with the target arteries to maintain blood flow and organ perfusion; however, stent grafts can rotate unexpectedly upon deployment potentially leading to serious complications (e.g. kidney failure).

In the proposed study, the investigators aim to understand the factors of the arterial system that lead to this unexpected rotation. The researchers hypothesize that regions of torsion, calcification and stenosis cause an accumulation of rotational energy that is released when the stent graft is deployed. A prospective clinical study will evaluate the incidence of stent graft rotation and the specific anatomical variables that lead to rotation. These variables will then be further evaluated using a series of custom, 3Dprinted aortic models. Stent graft rotation is a challenging clinical problem with no currently available tools to predict when it will occur. From the proposed research, a fundamental understanding of the mechanics underlying stent graft rotation will be gained.

 

 

Dr. N.C.J. Filewod
Dr. W. Lee

St. Michael’s Hospital

Discovery of new drugs to treat influenza: high-throughput screening in zebrafish and confirmatory testing in a murine model of infection

Influenza affects a large number of people in Ontario every year. Many of these people are admitted to hospital, and up to 5% will die. As new strains continuously emerge, the influenza vaccine is not always protective, and the drugs that are currently available to treat influenza have not been shown to save lives.

In this paradigm-shifting study the investigators will look for new types of drugs to fight influenza: rather than finding drugs that fight the virus, the researchers will look for drugs that alter how the body responds to infection. Leveraging the considerable investment of public money in the local zebrafish facility, the investigators will screen a library of candidate drugs in both zebrafish and mice to see if they can help the animals survive influenza. Testing drugs in two different animals will allow them to quickly eliminate those with serious side-effects, hastening the time between drug discovery and clinical trials.

Once possible drugs are identified, the researchers will determine how they work by performing experiments in human cells, zebrafish embryos, and mice. Overall, this project is a cost-effective discovery process with a real chance of finding new drugs to fight a common and serious disease.

 

 

Dr. J. Fish
Hospital for Sick Children

A randomized controlled trial investigating the use of ablative fractional carbon dioxide laser therapy to improve pediatric burn scars

Despite improvements in the treatment of pediatric burn injuries, many children develop severe hypertrophic scars. Hypertrophic scars occur when the normal healing process is disrupted. As a result, these scars are typically red, raised, and stiff and often lead to serious morbidity. Ablative fractional Carbon Dioxide laser therapy (AFCL) is the newest form of scar treatment available and early evidence has shown its ability to greatly improve hypertrophic burn scars.

AFCL was first introduced as a scar treatment at the Hospital for Sick Children (SickKids) in 2014. SickKids is the only pediatric center offering AFCL for pediatric burn scars in Canada. A randomized controlled trial (RCT) that compares AFCL to standard scar management (SSM) in pediatric patients has not been published. Thus, the investigators are proposing to conduct an RCT to determine whether treatment with AFCL and SSM is superior to SSM alone for improving the texture and appearance of hypertrophic burn scars in children aged 1 to 18 years from baseline to month 12 as measured by a validated scar assessment scale.

Ultimately, the findings from this study may change how hypertrophic burn scars are treated and may also benefit both children and adults with other types of scars.

 

 

Dr. T.L. Forbes
University Health Network

Determination of geometric factors that cause rotation of fenestrated aortic stent grafts during deployment

Abdominal aortic aneurysms (AAA) are pathological enlargements of the aorta, which are often treated with an endovascular technique utilizing stent grafts to exclude the AAA from the circulation; however when the AAA involves the arteries to the kidneys, these stent grafts require precise fenestrations, or holes, to allow blood flow to this organ. The fenestrated stent graft is placed in a sheath that is delivered though an artery into the aorta. The sheath is then removed, allowing the stent graft to expand. While expanding, the stent graft can rotate, causing fenestration misalignment, which cuts off blood flow to the kidneys and can lead to kidney failure.

The investigators hypothesize that stent grafts rotate when the sheath is removed due to a build-up of rotational energy as the delivery system passes through tortuous, narrow, and stiff arteries. The goals of this project are to understand why this rotation occurs and to develop computer models to predict when it will occur. The researchers will use an experimental apparatus to deliver stent grafts through arterial models and measure rotation upon deployment. This research will use computer models to simulate stent graft passage through arteries and unsheathing to calculate rotation. The findings will predict and prevent the deleterious effects of rotation.

 

 

Dr. B.Y. Kwan
Dr. J.G. Burneo

London Health Sciences Centre

Imaging of non-lesional epilepsy using hybrid PET/MRI: a prospective feasibility study

Patients with epilepsy that is unable to be controlled by medications may be potential candidates for epilepsy surgery. Surgical removal of an epileptic lesion can lead to alleviation or elimination of seizures. Current diagnostic imaging standards are unable to detect a surgical lesion in a significant proportion of these patients. Patients who undergo surgery without a visible lesion on MRI have worse outcomes than those who do.

Recent advances in imaging technology have led to the development of PET/MRI scanners which allow two versatile imaging modalities to be combined into one machine. It is predicted that such technology will allow greater rates of lesion localization in medically refractory epilepsy patients thus leading to improved surgical outcomes. In Ontario, access to PET/MRI scanners will improve from one to three additional scanners by the end of 2016. This project will aim to establish indications for the use of this exciting technology in this patient population and form a starting point for establishing Canadian guidelines.

 

 

Dr. A. Mazine
Dr. B. Yanagawa

St. Michael’s Hospital

The role of the NLRP3 inflammasome in the pathogenesis of rheumatic valve disease

Rheumatic heart disease (RHD) is the leading cause of valvular disease worldwide. The only treatment for end stage RHD is heroic, namely surgical valve replacement. Despite its high prevalence, little is known about the pathogenesis of RHD. The NLRP3 inflammasome is a protein complex that plays an essential role in triggering the innate immune system and has key roles in multiple infectious, inflammatory and autoimmune diseases as well as multiple cancers. Its role in RHD has not been studied.

The purpose of this study is to investigate a potential role for the NLRP3 inflammasome in the pathogenesis of RHD. The investigators hypothesize that auto-inflammatory inflammasome signaling is a critical upstream regulator of innate immunity in RHD. This study will address this hypothesis using a translational approach by studying NLRP3 protein and gene expression in human rheumatic and control valve leaflets explanted at the time of surgery. These proposed studies carry significant discovery potential and may provide new insights into our understanding of the pathogenesis of RHD.

 

 

Dr. C.E. Moulton
Dr. E. Paradis

University Health Network

The Tools and the Trade: an ethnographic study of checklist policy and performance, and implications for patient safety

Patients entering Canadian hospitals have a 7.5% chance of suffering an adverse event (AE), 36% of which are preventable. The most commonly identified AEs occur in the Operating Room (OR). Most errors occur because of gaps in communication. In 2008, the World Health Organization proposed that introducing a new tool into practice, the Surgical Safety Checklist (SSC), could drastically reduce mortality and complications in the OR. Based on initial reports of success and admitted gaps in communication as a predominant source of error, hospitals across the globe mandated the use of the SSC, demanding 100% compliance and achieving it in the majority of cases.

In addition, the checklist model as a tool to facilitate communication and reduce error has been applied to many other points of patient care; however although it appears that checklist implementation into the lives of healthcare workers has been a major success story, frontline workers seem to have a more nihilistic view of checklists, often ‘rolling their eyes’ in cynicism when asked to perform the checklist, and doing so out of obligation for a policy driven from the ‘top-down’. Moreover, a large Ontario study demonstrated no reduction in either mortality or complications despite widespread ‘compliance’ with the SSC, suggesting that simply ‘ticking boxes’ in compliance of the policy may not be sufficient.

To this end, the investigators are proposing a second wave of research that studies the safety culture in the OR. Specifically, the researchers want to study how the OR culture intersects with the use of the SSC in the OR. This study will use an ethnographic lens to identify how checklists are perceived, experienced and practiced by healthcare workers in the OR, and interrogate the relationship between OR culture and team engagement with the SSC. While the SCC and other checklists have been implemented across Canada, Canadian patients have yet to appreciate their full value in terms of reduced mortality and complications. There is a pressing need to understand the underlying mechanisms of cultural resistance embedded in our systems that prevent us from realizing the checklists’ full patient safety potential.

 

 

Dr. M. Seed
Dr. J. Keunen

Hospital for Sick Children

Preliminary investigation of the utility of MRI for measuring the hematocrit in fetal anemia

Fetal anemia is a pregnancy complication where the number of red blood cells in the fetus' blood is reduced. It is usually caused by antibodies from the mother's blood that attack fetal blood cells. If untreated, this can lead to the death of the fetus; however survival rates can exceed 90% if anemia is diagnosed, monitored and treated with intrauterine blood transfusions in a timely manner. The standard test to monitor fetal anemia is middle cerebral artery (MCA) Doppler ultrasound.

MCA Doppler is unreliable after 35 weeks of gestation, especially after prior transfusions, which may lead to unnecessary delivery of the baby by the obstetrician or a risk of serious anemia going unrecognized. A new technique for measuring the severity of the anemia using magnetic resonance imaging (MRI) is likely to perform well in late gestation and could offer an improvement in fetal monitoring in this disease.

This study investigates the accuracy of MRI for measuring the level of anemia in fetuses. In pregnant mothers in whom fetal anemia has been diagnosed with conventional methods, the investigators will perform MRI before and after each transfusion. MRI hematocrit measurements will be compared with direct fetal blood sampling and MCA Doppler assessment.

 

 

Dr. A. Seth
Dr. W. Gofton

The Ottawa Hospital

Learning new skills in practice: how surgeons make a risk assessment and know when and how to implement new procedures

Surgeons regularly make changes in their practice to ensure they are providing high quality patient care. This includes the process of learning and safely integrating new skills, techniques and technologies into practice. Despite evidence that introducing a new surgical technique is associated with a learning curve during which there are reduced surgical and patient outcomes, there are no suggested protocols in place to support a surgeon in safely introducing a new procedure into an established practice.

The goal of this study is to investigate how surgeons experience risk when learning and integrating a new procedure into practice. Surgeons who have recently introduced a new procedure into their practice will be interviewed to explore their approach to learning a new skill, assessing potential risks and managing their learning curve. A conceptual framework will be introduced to understand how surgeons perceive the risk associated with learning and integrating a new procedure into practice.

This framework may lead to the development of systemic guidelines that would facilitate access to resources for surgeons looking to learn and implement new skills, techniques and technologies while maximizing patient safety.

 

 

Dr. S. Shen
Dr. A. Lofters

St. Michael’s Hospital

Non-adherence to colorectal cancer screening among immigrants to Ontario: a population-based study

Colorectal cancer is the second most common type of cancer and cause of death related to cancer in Canada. Ontario has the highest number of new cases of colorectal cancer and related deaths per year in Canada. Colorectal cancer screening aims to catch cancer at early stages and provide treatment in a timely way. A province-wide program has been in place since 2008 for this purpose, which screens people between 50 and 74 years of age who do not have a family history of colorectal cancer with a test that checks for blood in the stool every two years. Alternative methods of screening exist, including colonoscopy every 10 years and sigmoidoscopy every 5 years.

Immigrants appear to have lower screening rates compared to those born in Canada. This is an important issue in Ontario, given its large immigrant population. This study aims to find predictors of non-adherence to recommended colorectal cancer screening, including immigration factors, sociodemographic characteristics, healthcare use, and provider characteristics, among immigrants to Ontario. Data are collected from existing databases and analyzed through statistical programming. Study findings will help support planning of screening programs and improve screening uptake among immigrants.

 

 

Dr. A. Stewart
Dr. J. Werier

University of Ottawa

Smoking cessation intervention within the fracture clinic

Tobacco use is the leading preventable cause of death contributing to more than 5 million estimated deaths per year globally. The long-term negative effects of smoking are well established. Complications due to smoking, from an orthopaedic perspective include impaired bone and wound healing, increased risk of infection, osteomyelitis and intra-operative complications.

The primary outcome of this research is smoking cessation in patients attending the orthopaedic fracture clinic. This is a unique environment whereby previously healthy patients are faced with the impact of disability. This impetus to abstain for the benefit of fracture outcomes provides an opportunity for previously unattained early intervention and thus a greater potential for decreased patient morbidity and mortality. Furthermore it is a high volume clinic that, given the unique nature of traumatic injuries, consists of a high proportion of males, ages 24-34 years old, obliged to follow up - a population traditionally regarded as unattainable from primary prevention smoking cessation strategies.

The investigators hypothesize that The Ottawa Hospital fracture clinic, in collaboration with The Ottawa Heart Institute, will serve as an effective environment to employ established primary prevention smoking cessation interventions and result in greater long-term cessation rates in comparison to other smoking intervention programs.

 

 

Dr. Z. Touma
University Health Network

Improving the assessment of cognitive function in systemic lupus erythematosus: screening and measurement of change in cognitive impairment over time and determination of its implications on patients’ quality of life and productivity

Cognitive Impairment (CI) is common in systemic lupus erythematosus (SLE) patients. CI includes difficulty thinking clearly, trouble with memory and learning, problems with language which may have a significant effect on patient self-esteem, and performance at work. As a result, early detection of CI for these SLE patients can improve patient care.

There is a lack of standardized tests to screen, diagnose and more importantly monitor CI in SLE. The currently recommended 1-2 hour neuropsychological battery by the American College of Rheumatology for the diagnosis of CI may not be covered by health care plans, as well as being time consuming and requiring specialized health care personnel to complete and interpret.

This research will identify and validate the best time and cost effective screening test(s) and diagnostic test(s) for CI assessment in the clinic. Assessing change in CI is complex especially because it can be affected by many factors including anxiety, depression, fatigue, and others. This study will measure these factors to make the results very robust.

 

 

Dr. R. Upshur
Sinai Health System

Validating the frailty and vulnerability evaluation (FAVE) score

Elderly patients with complex medical and social needs are at risk of receiving sub-optimal care as well as becoming high-utilizers of the healthcare system. In order to improve care and reduce the costs associated with population aging, it is necessary to identify those seniors who are at risk of decline. The vast proportion of care provided to this population occurs in primary care so that is the ideal setting for intervention.

This research team developed the FAVE (Frailty and Vulnerability Evaluation) tool drawing upon a literature review of existing tools used in primary care, in consultation with a steering committee/expert panel, and based on a pilot study with a sample of elderly patients. Leveraging this previous work, the investigators are proposing an innovative research project to validate the FAVE tool using a provincial sample of elderly patients living in the community with complex medical and social needs.

This project has four main goals: (i) to validate the FAVE tool among patients in a representative sample of Ontario seniors; (ii) to examine the predictive validity of the FAVE tool by conducting patient chart audits for transitions in health status one year after tool administration; (iii) to compare FAVE tool scores with physician judgements of the patients’ frailty and vulnerability risks; and (iv) to determine the optimal scoring and cut points of the FAVE tool. Ultimately, the aim is to provide a tool that is useful to primary care clinicians to identify and better manage a rapidly growing population of older adults at risk for health deterioration.

 

 

Dr. P.D. Wong
Hospital for Sick Children

The association between total breastfeeding duration and household food insecurity

The main objective of our study is to determine if total breastfeeding duration is associated with household food insecurity in young children. The investigators hypothesize that young children who are never breastfed or breastfed for a short duration are at an increased risk of household food insecurity. The postulated mechanism is that no breastfeeding or short duration of breastfeeding might result in the use of household resources to acquire breast milk substitutes and result in household food insecurity.

The researchers also hypothesize that young children within 48 months of life who are never breastfed or breastfed for a short duration are at an increased risk of becoming household food insecure. The postulated mechanism here is that households that are on the border of household food insecurity might be tipped into food insecurity with the added need to use household resources to acquire breast milk substitutes. In this study, the investigators do not plan to assess the contribution of household food insecurity on breastfeeding duration.






January 1 to March 31, 2016

 

 

Dr. L.E. Chaparro
Dr. A. Perlas

University Health Network

Accuracy of gastric ultrasound to diagnose a “full stomach”. A Bayesian framework

Aspiration of gastric contents into the lungs during anesthesia can lead to serious injury and death; therefore a “full stomach” at the time of anesthesia should be avoided. Ultrasound can evaluate stomach content to help anesthesiologists decide on the best timing and type of anesthesia to prevent aspiration.

This study will be the first to evaluate how accurate gastric ultrasound is to differentiate a “full” from an “empty” stomach. The accuracy of a test is defined as how well the test can “pick up” all subjects with a full stomach (“sensitivity”) and how likely it is that a stomach identified as full on ultrasound, actually is so (“specificity”). To that end, 80 healthy volunteers will be studied. After fasting for 8 hours, the subjects will ingest either a) a cup of coffee, b) a cup of coffee and a muffin, or c) nothing. An anesthesiologist who is unaware of what the subject ingested will examine the stomach content using ultrasound and will conclude if the stomach is empty or full according to pre-established criteria.

The results of the ultrasound test will then be compared with what the subjects actually ingested and the accuracy of the test result will be calculated using standard formulas.

 

 

Dr. K.N. Cowan
Children’s Hospital of Eastern Ontario

Elastase and matrix metalloproteinases in pulmonary hypertension associated with congenital diaphragmatic hernia: potential therapeutic targets?

Congenital diaphragmatic hernia (CDH) is a developmental anomaly of the diaphragm that impairs lung growth in utero. Up to 40% of neonates with CDH die, a large part due to pulmonary hypertension (PH). Existing therapies for controlling PH have met with limited success in these infants, highlighting the need for a novel therapy.

The investigator’s previous studies have demonstrated that a matrix-enzyme pathway is crucial to the progression of primary PH. Blockade of this pathway completely reversed PH and improved survival. The researcher’s laboratory has now shown using a rat model of CDH that a similar pathway is activated in the diseased pulmonary arteries; thus suggesting that the molecular players involved in this pathway may represent novel therapeutic targets to treat the PH associated with CDH. It is now necessary to determine whether these molecular players are also induced in human CDH.

The objective of the current study is to assess the levels of these factors in archived lung tissue from patient's with CDH and compare them to lung tissue from patients that do not have pulmonary disease. This work is a necessary step towards identifying novel therapeutic targets to improve the treatment of PH secondary to CDH.

 

 

Dr. J. Johnstone
Dr. D. Cook

McMaster University

PROSPECT: probiotics: prevention of severe pneumonia and endotracheal colonization trial

Probiotics are commercially available live bacteria thought to have health benefits when ingested. Studies have shown that probiotics may prevent 25% of all pneumonias when patients are on a breathing machine, 18% of all other infections, and 65% of serious bowel infections; however previous studies were small and potentially biased; therefore, whether probiotics are truly helpful remains unclear.

With PSI funding, the investigators completed a randomized controlled pilot trial in critically ill ventilated patients in 14 ICUs to test the feasibility of doing a larger trial. The researchers demonstrated that patients be can enrolled, the protocol can be followed, and that infections in the ICU are common. The investigators are proceeding to investigate whether L. rhamnosus GG (LGG, a common probiotic) prevents infection during critical illness (pneumonia, bowel infection with Clostridum difficile, and other infections). 2650 adults admitted to the ICU who need a breathing machine will be enrolled. Patients will receive either LGG or a placebo, twice daily given down a feeding tube into the stomach.

This trial is very important in the ongoing search for more effective strategies to prevent serious infections in the ICU. Probiotics may be an easy-to-use, readily available, inexpensive approach to help future critically ill patients around the world.

 

 

Dr. R. Murthy
Dr. A.E. McCarthy

The Ottawa Hospital

Screening for Strongyloides stercoralis in high-risk patients undergoing immunosuppressive therapy in association with bone-marrow transplant, solid-organ transplant or rheumatological disorders

Strongyloides stercoralis, a soil transmitted worm (helminth), occurs in tropical and subtropical regions of the world. Increasing migration to Canada from endemic areas means more Canadians are at risk of exposure. Many are often asymptomatic, but may become gravely ill if they became immune suppressed, even decades after moving to Canada. Many chronic illnesses and cancers can be treated with immunosuppression and transplantation of bone marrow or solid organ. This study will investigate whether or not it is valuable to test for Strongyloides in patients that have lived in areas where the disease is common.

The investigators will use a blood test to screen individuals who may be at risk of severe Strongyloides infection because of their underlying diseases or treatments. A standardized screening questionnaire regarding country of origin or country in which a patient has spent more than 1 year will be used to identify potential participants under the care of hematology, nephrology, and rheumatology. All participating patients will have standard blood testing for Strongyloides stercoralis.

This research will allow the investigators to provide descriptive statistics of our patient population as well as the burden of this infection in patient groups at high risk for potentially fatal complications of that infection.

 

 

Dr. S.L. Orr
Dr. R. Zemek

Children’s Hospital of Eastern Ontario

Oral dexamethasone for the treatment of acute migraine recurrence in pediatric patients presenting to the Emergency Department with migraine: a pilot randomized controlled trial

Migraine is common in the pediatric emergency department. Unfortunately, somewhere between one third and two thirds of children and adolescents will have recurrence of their migraine within a week of discharge from the emergency department. Although there is strong evidence from adult studies that dexamethasone can prevent migraine recurrence, there is no evidence on how to prevent recurrence in children and adolescents.

The proposed study will randomly assign children and adolescents visiting the Children’s Hospital of Eastern Ontario emergency department for migraine to receive either one dose of oral dexamethasone or oral placebo. Twenty patients will be recruited to this pilot trial and the aim of the study will be to determine the feasibility and acceptability of the study, in order to inform the design and implementation of a larger, definitive study.

The goal of the larger study will be to determine if oral dexamethasone is superior to placebo for preventing recurrence of migraine after discharge from the pediatric emergency department.

 

 

Dr. C.D. Witiw
Dr. M.G. Fehlings

University Health Network

Impact of surgical approach for cervical spondylotic myelopathy on outcome and resource utilization: a cost-utility comparison based on the combined data from the AOSpine North America and International prospective studies

Degenerative Cervical Myelopathy (DCM) is the leading cause of adult non-traumatic spinal cord impairment worldwide. Age-related changes to the spinal column result in spinal cord compression in the neck and cause a multitude of neurological symptoms including numb and clumsy hands, difficulty walking, weakness and incontinence. Some individuals have a slow, progressive deterioration while others may rapidly worsen.

Surgery has been shown to improve neurological outcomes, functional status, and quality of life in patients with DCM. This type of surgery can be done through 2 approaches; one from the front of the neck and another other from the back. While both are effective, they have different advantages and disadvantages as well as different costs. As concerns rise regarding the sustainability of healthcare delivery, the assessment of quality and value is a priority and it is becoming imperative that the value of treatments are taken into consideration. As such, the investigators plan to conduct a cost-utility analysis on patients undergoing surgery for DCM using the data compiled from two large international studies on surgical intervention for DCM.

This will provide important information on which approach to surgery provides greater outcomes at less cost and thus more value. The researchers will look specifically to see if certain patients gain more value from one approach or the other, with the intent that this information will help optimize care and costs for patients undergoing treatment for this debilitating condition.