Foundation Funded Projects for 2017
Dr. T. Freeman
Dr. M. Stewart
Symptoms and relevant outcomes: SMART
People visit family physicians with sensations (symptoms) which may or may not be due to a disease. Two-thirds of patients visit a family physician for a symptom, of which 35% are not given a disease label at the end of that visit. It is the task of the family physician to figure out which symptoms are associated with a disease or require investigation, and which can be safely cared for without a disease label. The proposed study will provide information to family physicians on 10 common symptoms answering the following questions. For each symptom, what percent are given a new diagnosis at the end of the visit? What percent are connected to an old diagnosis? What percent remain labelled as a symptom and how many future visits are needed before a diagnosis is made? Finally, the study will link patient characteristics (such as age, sex and prior conditions) with whether or not the symptom is diagnosed. This information will help with patients and family physicians to better understand and care for common symptoms.
Dr. K. Kersti
Muskoka Algonquin Healthcare
Postgraduate Diploma in Clinical Dermatology
Dr. F. Mahmud
Dr. M. Marcon
Hospital for Sick Children
Celiac disease and Diabetes Longitudinal Follow-up and Evaluation Study (CD-LiFE): a longitudinal study evaluating dietary factors, metabolic control and complications and, self-perceived health and wellness in type 1 diabetes patients with celiac disease
Celiac Disease (CD) occurs in people with Type 1 Diabetes (T1D) at rates 5-10 times that of the general population with most patients showing no obvious clinical signs or symptoms. Recent research has shown higher rates of diabetes related complications, including eye and kidney disease in patients with both CD and diabetes. Treatment of CD is with a gluten-free diet (GFD), which can make managing diabetes more difficult. It is also not known if the significant dietary and lifestyle change of a GFD is optimal for people to take care of both CD and diabetes while avoiding negative health outcomes.
This study will evaluate children and adults who with both CD and diabetes who have screened as part of a large clinical trial in Ontario. The investigators will examine the impact of dietary choice and adherence with a gluten-free diet on overall diabetes care, quality of life, and self-perceived health. In addition, the investigators will also follow patients for up to 10 years to track longer term health outcomes. This research will help guide care practice for clinics and patients managing two significant chronic health conditions with the overall goal of evaluating health outcomes in this unique group of patients.
Dr. O.N. Pathmanaban
Dr. M.D. Cusimano
St. Michael’s Hospital
Tranexamic acid in the treatment of residual chronic subdural hematoma: a single-centre, observer-blinded, randomized, controlled trial
Chronic subdural hematoma (CSDH) is a common disease after minor head injury in older people. Blood collects on the surface of the brain, causing headaches, confusion, weakness or even coma. The best treatment is surgery, where a small hole is made in the skull and the blood is drained. Patients usually do well, but some of the blood remains after surgery and there is up to 30% chance of more bleeding and the CSDH getting bigger again. A medicine capable of reducing the chance of further bleeding is therefore desirable.
In this study, the investigators will test a drug called Tranexamic Acid (TXA). The body stops unwanted bleeding naturally by forming blood clots; TXA stops these blood clots dissolving (antifibrinolytic), helping to keep bleeding spots plugged. TXA has been shown to decrease hematoma volume in a small group of CSDH patients. The investigators hypothesize that TXA can help reduce the remaining volume of CSDH after surgery and lower the chance of it getting bigger again. Half of the patients in this study will be randomly assigned to take TXA tablets, while the other half will take placebo. Remaining CSDH after burr-hole surgery will be measured over time to quantify treatment success.
Dr. T. L. Roy
Dr. A. D. Dueck
Sunnybrook Health Sciences Centre
Magnetic resonance imaging (MRI) in the assessment of peripheral arterial disease
Peripheral arterial disease (PAD) is a morbid, mortal and prevalent condition that affects over 800,000 Canadians. It is one of the most common cardiovascular diseases. Decreased blood flow to the leg causes exertional pain and is associated with poor quality of life and disability. When PAD is severe it is called “critical limb ischemia”. In this subset of patients, major amputation is required within 1 year in up to 40% of patients.
Current treatment options for PAD involve re-establishing blood flow to the leg through either bypass surgery or percutaneous vascular intervention (PVI). PVI is an attractive, minimally invasive approach with improved morbidity and shorter length of hospital stay compared to surgery. However, not all lesions are amenable to PVI and it has a high failure rate of 20% and high re-intervention rate of 30%. PVI is guided with x-ray fluoroscopy, which offers very limited visualization of the diseased arteries in the leg, making it difficult to predict if PVI would be successful or even possible to treat specific patients. Prompt, definitive revascularization is necessary to avoid major amputation, and appropriate patient selection is critical.
MRI is capable of producing high quality images of the blood flow in the legs. In our study, we will develop and validate MRI methods of visualizing diseased arteries in the leg to facilitate PVI planning. MRI has the potential to significantly advance the treatment of PAD by enabling physicians to make more effective decisions with respect to patient selection to reduce PVI failure rates. MRI also holds significant promise to characterize diseased arteries to facilitate tailored wire and device selection to improve the success rates and durability of PVI. Informed patient, wire and device selection is key to improving amputation rates, disability outcomes and quality of life in this growing patient population.
Dr. J. Yoon
Dr. B. Clarke
University Health Network
DICER1 in uterine rhabdomyosarcoma, adenosarcoma and carcinosarcoma - a potential diagnostic tool for molecular distinction
Study of rare tumours has allowed researchers to identify genes important for cancer formation/progression, as well as identifying potential therapeutic targets. DICER1 is such a gene with numerous roles in the gynaecological tract, including development and fertility, as well as being implicated in uterine cancer. Based on previous works, including works by the collaborator, the investigators propose that a specific gynaecological tract tumour, known as embryonal rhabdomyosarcoma, is associated with mutations in the DICER1 gene. To prove this idea, the investigators are employing the state-of-art sequencing technology to examine for mutations in the DICER1 gene. By comparing features seen under the microscope, DNA sequence data and clinical data, the investigators can test their hypothesis and determine the significance of mutated DICER1. The obtained results will be important for both the patient and their family members, as inherited mutations in DICER1 increase risks for a number of different diseases.