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Dr. Tea Rosic: 2023 PSI Graham Farquharson Knowledge Translation Fellowship Recipient

 “As a Child Psychiatrist, I see firsthand the impact of the COVID-19 pandemic on youth mental health and the gaps that currently exist in mental health service delivery. Youth experience the highest rates of co-occurring substance health and mental health problems (“concurrent disorders”) compared to other age groups, yet many do not receive the integrated services they need. Through knowledge mobilization and capacity-building, my program of research aims to bridge these gaps. I will work with community organizations in Eastern Ontario to identify needs and disseminate knowledge to improve concurrent disorders care, develop an integrated substance health and mental health program at the Children’s Hospital of Eastern Ontario, and lead and contribute to national standards implementation for paediatric concurrent disorders. Most importantly, my time will be spent mobilizing and translating research evidence, moving knowledge into our daily practice to improve health outcomes for children and youth. I am delighted to receive this PSI Knowledge Translation Fellowship to start my early research career dedicated to improving services in child mental health.” – Dr. Tea Rosic

PSI Foundation is pleased to announce Dr. Tea Rosic as the recipient of the 2023 PSI Graham Farquharson Knowledge Translation Fellowship.

About Dr. Tea Rosic

Dr. Tea Rosic is a Child and Adolescent Psychiatrist at the Children’s Hospital of Eastern Ontario (CHEO) and Lecturer in the Department of Psychiatry at the University of Ottawa. Her research examines the impact and management of co-occurring mental health and substance use disorders (concurrent disorders). She has published 30 peer-reviewed manuscripts (11 first-authored) since 2016 and given 16 oral presentations in national and international settings.

Dr. Rosic has won numerous awards for her research, including several best poster and best paper awards, and additionally won awards for her clinical work (2019 Outstanding Resident Award, Hamilton Health Sciences) and for student mentorship (2018 Resident Mentor Award, McMaster). At CHEO, she was ranked first in the Children’s Hospital Academic Medical Organization (CHAMO) Fellowship Competition in 2020.

Dr. Rosic completed her medical training and Psychiatry residency at McMaster University, followed by a fellowship in Child and Adolescent Psychiatry at the University of Ottawa. She is in her final year of PhD training in Health Research Methodology and in the Clinician Investigator Program at McMaster.

About the PSI Graham Farquharson Knowledge Translation Fellowship

Knowledge translation research aims at transitioning research discoveries to the real world to improve health outcomes. The PSI Graham Farquharson Knowledge Translation Fellowship – valued at $300,000 for over two or three years – helps protect a promising new clinician investigator’s research time, allowing the Fellow to undertake high-impact translational research in Ontario.

Fellowship Funds to be Used for Synthesis, Dissemination, and Application of Evidence to Improve the Care of Youth with Concurrent Disorders

This Fellowship will allow Dr. Rosic, a Child Psychiatrist and researcher, to synthesize, disseminate and apply evidence to improve the care of youth who have both substance use and other mental health disorders.

Compared to other age groups, youth have the highest rates of co-occurring addiction and mental health problems, also known as “concurrent disorders.” Substance use is related to higher severity of other mental health symptoms and lower chances of receiving treatment. When concurrent disorders go untreated, youth are at risk of dropping out of school, having family conflicts, engaging in risky activities, and dying. There are gaps in our healthcare services in Ontario and in Canada that can be addressed through knowledge translation and capacity-building.

Dr. Rosic will work to mobilize knowledge and build capacity for assessment and treatment of youth concurrent disorders within Eastern Ontario and beyond. Her research program includes working with community organizations to identify needs and disseminate knowledge, developing a specialized child concurrent disorders program at the Children’s Hospital of Eastern Ontario, and leading and contributing to guideline development and national standards implementation for concurrent disorders care.

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Dr. Krishan Yadav: 2023 PSI Graham Farquharson Knowledge Translation Fellowship Recipient

“Skin and soft tissue infections (SSTIs) are one of the top 10 reasons to visit a Canadian emergency department. Despite being so common, care is not standardized which has resulted in high treatment failure rates, overuse of intravenous antibiotics and unnecessary hospitalization. As a PSI Graham Farquharson Knowledge Translation Fellow, I will be afforded the critical support necessary to use multimethod, multidisciplinary approaches to develop and implement a best practices checklist for the diagnosis and management of SSTIs in the emergency department setting. This will standardize management of these common infections with the potential to reduce treatment failure, intravenous antibiotic use, and hospitalization. With support from the PSI Foundation, Ontario will be positioned as a leader in improving the care of Canadians with SSTIs.” – Dr. Krishan Yadav

PSI Foundation is pleased to announce Dr. Krishan Yadav as the recipient of the 2023 PSI Graham Farquharson Knowledge Translation Fellowship.

About Dr. Krishan Yadav

Dr. Krishan Yadav is an Associate Scientist at the Ottawa Hospital Research Institute with a focused area of expertise in the management of skin and soft tissue infections (SSTIs; cellulitis; abscess) in the emergency department. He is an Assistant Professor with the Department of Emergency Medicine at the University of Ottawa. His research has been recognized nationally twice (in 2018 and 2022) with the Top New Investigator Abstract Award at the Canadian Association of Emergency Physicians Annual Meeting. In 2020, he received the Junior Clinical Research Chair in Skin and Soft Tissue Infections at the University of Ottawa. To date, he has 52 publications in peer reviewed journals (12 as first author, 5 as senior author) and has 35 published abstracts at conference proceedings.

About the PSI Graham Farquharson Knowledge Translation Fellowship

Knowledge translation research aims at transitioning research discoveries to the real world to improve health outcomes. The PSI Graham Farquharson Knowledge Translation Fellowship – valued at $300,000 for over two or three years – helps protect a promising new clinician investigator’s research time, allowing the Fellow to undertake high-impact translational research in Ontario.

Fellowship Funds to be Used for Development and Implementation of a Best Practices Checklist for Emergency Department Management of Skin and Soft Tissue Infections

Skin and soft tissue infections (SSTIs) are bacterial infections affecting the skin and underlying tissues. SSTIs are one of the top 10 most common reasons to visit an emergency department in Canada. Patients with SSTIs have pain, redness and swelling (i.e., cellulitis) or boggy painful red skin due to underlying pus (i.e., abscess). For abscesses, the treatment is a bedside surgical drainage procedure, and some patients are prescribed antibiotics. For cellulitis, patients are treated with antibiotics.

The current treatment of SSTIs in emergency departments is not standardized and up to 20% fail treatment. Existing guidelines are not designed for use in the emergency department setting. Dr. Yadav’s overall goal is to design and implement an evidence-based, user-friendly best practices checklist for diagnosis and management of SSTIs in the emergency department. He will use robust KT approaches to: (1) Create a best practices checklist with engagement of key stakeholders; (2) Assess barriers and facilitators to checklist use in the emergency department; and (3) Conduct a pilot implementation trial in three Ontario emergency departments. This work has the potential to improve patient outcomes and reduce costs by standardizing care and reducing unnecessary intravenous antibiotic use, minimizing treatment failures, and lowering hospitalization.

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Dr. Daniel McIsaac: 2023 PSI Mid-Career Knowledge Translation Fellowship Recipient

“As an anesthesiologist, I care for hundreds of patients preparing for, having, and recovering from surgery each year. While most benefit from their operation, many experience complications and struggle to recover their strength and function after surgery. Prehabilitation is an approach where we use the wait time before surgery to a patient’s advantage. We support them in completing evidence-based exercises, help to improve their nutrition and manage the stress of preparing for a major operation. The idea is that because they go to the operating room in better health, they are less likely to experience a complication and will have better recovery after surgery. With the support of the PSI Mid-Career Knowledge Translation Fellowship, I will be able to work with my team, our patient partners, and collaborators to understand the most effective approaches to prehabilitation, and how to implement prehabilitation into routine care to the benefit of the hundreds of thousands of Ontarians who need surgery each year.” – Dr. Daniel McIsaac

PSI Foundation is pleased to announce Dr. Daniel McIsaac as the recipient of the 2023 PSI Mid-Career Knowledge Translation Fellowship.

About Dr. Daniel McIsaac

Dr. Daniel McIsaac is an Associate Professor and Anesthesiologist in the Department of Anesthesiology and Pain Medicine at the University of Ottawa. He is also a Scientist at the Clinical Epidemiology Program of Ottawa Hospital Research Institute, and an Adjunct Scientist at the Institute for Clinical Evaluative Sciences (ICES). To date, Dr. McIsaac has published more than 160 peer-reviewed papers and secured over $10 million in peer-reviewed research funding. He currently holds six Canadian Institutes of Health Research (CIHR) grants as principal applicant, four of which focus on prehabilitation.

Dr. Daniel McIsaac’s Research Program

More than 300,000 Ontarians have major surgery each year. These patients, their physicians, and health system leaders have made it clear that they desire access to effective prehabilitation so that Ontarians who need surgery can improve their health before their operation to avoid complications and enhance recovery after surgery. Dr. McIsaac’s research aims to implement routine prehabilitation, an approach that supports and motivates patients in exercising and improving their nutrition in preparation for surgery, in Ontario’s healthcare system. Working with his team, patient partners, and collaborators, Dr. McIsaac’s program focuses on developing practical and effective prehabilitation programs and evaluating them in real-world settings. His overarching objective is to translate the findings of these real-world experiments into routine care to the benefit of surgical patients in Ontario.

About the PSI Mid-Career Knowledge Translation Fellowship

The PSI Mid-Career Knowledge Translation Fellowship is intended to provide salary support for a mid-career clinician investigator in Ontario, who has demonstrated the ability to successfully complete high impact knowledge translation research. The total amount of the award is $400,000 over two or three years, with the sponsoring institution providing matching funding, contributing to 50% of the total award.

PSI acknowledges that mid-career can be a challenging time for physician researchers. During this phase, there are often additional academic roles and responsibilities including committee work, leadership positions, and mentoring of junior investigators, while clinical work continues. PSI recognizes the importance in supporting this phase of an investigator’s trajectory.

Fellowship Funds to be Used for Translating Prehabilitation Evidence into Practice to Improve Surgical Recovery in Ontario

In Ontario, more than 300,000 people have major surgery each year, such as joint replacement, heart bypass, or cancer operations. While more than 98 of every 100 patients survive their operation, recovery after surgery can be very difficult. This is because major complications such as bleeding, infections, heart attacks, weakness and/or loss of one’s ability to complete day-to-day activities happen to about 1 in 5 people who have surgery.

Prehabilitation means doing exercise, improving diet, and receiving structured motivational care before surgery to improve a person’s recovery after surgery. Patients in Ontario and across the world are keen to have access to prehabilitation, as it makes sense that this approach would lead to better recovery after surgery.

Unfortunately, the science supporting prehabilitation’s impact is still at an early stage. For Ontarians to benefit from prehabilitation, patients, clinicians, and scientists must work in partnership to understand what types of prehabilitation work best, test strategies to deliver prehabilitation across the province, and develop plans to move prehabilitation into day-to-day care for all Ontario surgical patients. Dr. McIsaac proposes to lead such work, building on partnerships and expertise already in place to deliver effective prehabilitation to Ontarians.

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Dr. Matt Sibbald: Using Technology to Reduce Diagnostic Errors

A novice physician working in a busy emergency department in the middle of the night may be challenged to diagnose a patient presenting undifferentiated symptoms.

An electronic differential diagnostic (EDS) support system could assist by providing diagnostic hypotheses for the physician to consider – but only if the system is easy to use and fits into the clinician’s workflow.

Dr. Matt Sibbald, associate professor of medicine at McMaster University and cardiologist at Hamilton Health Sciences and Niagara Health System, led PSI Foundation–funded research to examine whether technology and artificial intelligence could improve diagnostic accuracy and when it should be used.

“With the challenge of busy clinical environments, technology might have something to offer to make our lives simpler as clinicians and bring more value and be more effective for patients,” says Dr. Sibbald. “Technology and artificial intelligence could leverage clinicians’ expertise and extend their cognitive capacity. But it needs to be accessible at the point of care without physicians having to modify their workflow.”

EDS support systems have been available for decades and have the potential to reduce diagnostic errors by providing a list of diagnostic hypotheses for the physician to consider. However, the value of the technology has always been limited by the amount of time that physicians needed to spend inputting data into the system – ranging from 20 minutes to even hours per patient.

A platform called Isabel may have greater potential to fit within clinicians’ workflows. After the clinician inputs the patient’s age and just a couple of key symptoms, taking only a minute or two – though Dr. Sibbald notes that this still represents a significant amount of a typical seven-minute emergency department triage visit – the system provides a list of the most common diagnosis differentials.

“It helps with quick decision-making around undifferentiated illness to make sure that you’ve at least thought about the different possibilities,” says Dr. Sibbald. “Some of these hypotheses might not be relevant to the patient in front of you, but that’s for the clinician to dismiss. A system like this is expected to diagnose, but to suggest.”

In 2020, Dr. Sibbald and his team received PSI funding to examine the Isabel EDS system under “sterile” conditions, not a working clinic, as a first step to gauge whether the system could improve the diagnostic process. Clinicians with different levels of experience completed cases through an online platform, with half using EDS early in the process, when only the main patient complaint was available, and half using EDS later, when all patient information including medical history and a physical, was available.

The research team found that the system increased the number of diagnostic hypotheses and the likelihood of the correct diagnosis being included in the list. When Isabel was used early, it generated significantly more diagnostic hypotheses, and when it was used later, the correct diagnosis was included more often in the list of hypotheses. But, ultimately, the researchers found that the system improved the diagnostic process regardless of when it was used and who was using it, though novices benefited the most.

“Electronic differential diagnosis does contribute to physician diagnosis. It adds rigor and length to the differential, and it adds different things for a physician to consider,” says Dr. Sibbald. “We actually saw the most benefit with simplest diagnoses for relatively novice clinicians. We expected that the system would be most helpful with the complex cases, but it helps by pointing to things that you know but haven’t necessarily thought of in the moment.”

Following these positive results, published in BMJ Quality and Safety, Dr. Sibbald and his team have continued to examine how EDS could be used in real-life clinical settings where physicians see patients with undifferentiated illness, such as primary care and the emergency department. They recently published a follow-up study that examined EDS in the context of the emergency room, with a research associate using the technology to simulate how the system could be integrated into the workflow. The results of this study, published in JMIR Human Factors, suggested that the technology needs to be customized to account for the scope and context of the emergency department and the clinician’s experience.

Though there is still a lot of work to be done before EDS is routinely used in clinical settings, Dr. Sibbald says that the potential value of these systems in reducing diagnostic errors is worth the effort. And funding from PSI has been key to the work they have done so far.

“It’s important for PSI to have a broad mandate and scope and to support this type of research that might not be top of mind on the needs spectrum but is still vital for our health care system to grow and adapt,” says Dr. Sibbald. “We can’t keep doing things the same way we’ve been doing them. There’s so much to challenge and to change, and this field can be a key part of that change management. But it needs to be driven by scholarship, research and understanding.”

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Alice Cavanagh: Understanding How Physicians Learn About Intimate Partner Violence

As a volunteer at a sexual assault crisis centre before starting medical school, Alice Cavanagh would occasionally accompany people who had experienced sexual violence to access emergency health care. While health care professionals’ roles include the important and difficult tasks of collecting samples and evidence, their interactions with the survivor were very different from hers as a volunteer trained primarily to listen and be supportive.

“I became interested in what physicians are actually learning in the course of their professional training about intimate partner violence and sexual violence, and how that shapes their practice,” says Cavanagh. “There is research that quantifies how much education Canadian medical students get on intimate partner violence, but I was really interested in looking at the impact of that education. How are physicians experiencing that training and what are they taking from it?”

When Cavanagh started the MD/PhD program at McMaster University a short time later, she was able to examine these questions, receiving a PSI Research Trainee Award to support her research. With supervision from Dr. Meredith Vanstone and mentorship from Dr. Harriet MacMillan, she led research on how physicians learn about intimate partner violence (IPV) and how that affects the support they provide to patients, and recently defended her dissertation.

In the first part of the study, Cavanagh examined policy and training materials for physicians related to IPV. She then collaborated with the RISE project, a study funded by the Public Health Agency of Canada examining the family violence learning needs and preferences of Canadian social workers and physicians, interviewing physicians and residents across Canada from five medical specialties (emergency medicine, family medicine, obstetrics and gynecology, psychiatry and pediatrics) about their IPV education and the support they provide to patients. She also interviewed health and social service providers outside of medicine about their perceptions of the IPV training that physicians receive.

Physicians often feel unprepared to support people experiencing violence

Cavanagh’s analysis of physician’s training materials found that IPV has become increasingly medicalized, where it is often viewed solely as a health issue, instead of a structural issue with many facets, including poverty, racism, ablism and other forms of oppression. She also found that physicians are taught to identify patients experiencing IPV, provide them with support, and direct them to resources.

At the same time, physicians and residents revealed during the interviews that, while they understood IPV is important to their patients’ health, they largely felt unprepared to support their patients. However, they also spoke about how much they valued experiential learning, which Cavanagh says may offer opportunities to collaborate with IPV experts in other fields to learn directly from patients and other IPV experts.

Interviews with experts outside of medicine confirmed that physicians need to understand IPV and be prepared to support their patients. But they also highlighted that physicians need to be more aware of power dynamics in intimate partner violence, both in terms of the power dynamics between the person who is enacting violence and the person experiencing violence, but also the power that physicians hold in society to make a difference for individual patients and in dismantling the structures that uphold violence.

“It’s not just about understanding, it’s also about engaging with power to move from knowledge to action,” says Cavanagh. “This is a problem that can’t only be addressed by the health care system. By creating opportunities for health care providers to learn about IPV as an issue that is complex and connected to lots of different facets of people’s lives, my hope is health care providers will have opportunities to engage with the type of collective action that is critical to address complex, structural issues like IPV.”

PSI support was instrumental to kickstarting research career

With her dissertation complete and one more year of medical school remaining, Cavanagh is looking forward to continuing research that will improve health policy.

“My goal for my career is to be able to use my clinical work to look at questions about policy and health and to be able to use my research skill set to answer and think through those questions,” she says. “I really believe in the value of clinician-scientists, including those who work outside traditional bench-to-bedside research, and funding from PSI was really instrumental to me in being able to do my work and kickstart my career.”

Cavanagh says the PSI Research Trainee Award provided important financial support during her studies, and PSI meetings gave her important opportunities to connect and collaborate with other researchers.

“In very practical ways, being a part of the community has been really helpful to me in finding and developing new opportunities to grow, which is so important at this stage of my career,” she says.

Cavanagh hopes that the results from her research will help to inform medical education about IPV, particularly in developing opportunities to collaborate with experts from other fields and fostering physicians’ connections with community resources and services to support people experiencing IPV. With more than one quarter of women worldwide having experienced violence, she emphasizes that this issue affects people from all communities, including physicians.

“Violence and structural oppression are pervasive and touch every corner of our lives,” she says. “In health care, if we can have more sensitive conversations about these issues that acknowledge that this isn’t an issue that only affects ‘other’ people, that it affects everyone, I think that we can come toward creating safer places for both patients and providers.”

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PSI Profiles: Meet the PSI Team 

Behind the scenes and beyond the hardworking committees and volunteers who contribute to our organization, PSI Foundation is currently run by a tight-knit team of five staff.

Here is a glimpse into each of our team members’ roles, and what we do to deliver funding opportunities to our grantees who contribute their expertise in order to better the health of Ontarians.

Samuel Moore: Executive Director

How long have you worked at PSI?

I have been working at PSI since 2010, so 12 years.

What are the main responsibilities for your job?

To keep staff, physicians, and happy, and to keep everyone (e.g. Board, all Committees, and staff) pulling in the same direction, all working towards meeting PSI’s goals. I focus on both big picture small details, which is always a new challenge. I am expected to evolve in my role as Executive Director.

What is your favourite part of your job as Executive Director at PSI?

My favourite part is working with great people, and working in a wide variety of areas at PSI. For example, I’ll focus on finance one day, then move on to grants the next, then on to governance. Working to make a difference and constantly learning and innovating is another favourite.

What are the most memorable moments from your career?

The most memorable moments are getting PSI to be the first non-American member to join the Health Research Alliance (HRA) , and launching our Knowledge Translation (KT) fellowships.

What did you study in post-secondary?

History, with an emphasis on the history of medicine in Canada.

What are your future plans for PSI as Executive Director?

To see our new PSI strategic plan executed and implemented, as well as to enhance physician-researcher involvement to create an even deeper pool of experts. We are constantly innovating PSI’s current grants programs to meet our goals. Seeing PSI evolve from a smaller regional organization to a larger funder is my ultimate goal.

Jessica Haxton: Grants Coordinator

How long have you been working at PSI?

I have worked at PSI for 11 years.

What are the main responsibilities for your job?

My responsibilities include screening applications, finding external peer reviewers, and getting application ready for internal Grants Committee review.

What did you study in post-secondary?

I studied Molecular Biology and Art History.

 

Heather Bruder: Administrative Coordinator

How long have you worked at PSI?

I have been working at PSI for 4 years.

What are the main responsibilities for your job?

Representing business as first point of contact for all enquiries, support grants funding program activities, by managing external peer review requests, tracking and processing peer reviews. Manage grant payments, including following up with grantees and maintaining payment schedule. Providing administrative support to the Executive Director, Board and Committee members. Organize and coordinate and facilitate several annual meetings and other events with internal/external stakeholders.

What did you study in post-secondary?

History

 

Asumi Matsumoto: Programs Coordinator

How long have you worked at PSI?

I’ve been working at PSI at since September 2016 – so 6 years!

What are the main responsibilities for your job?

My responsibilities adapt depending on the needs of PSI, however, my current ones include:

  • Coordinate the application process for salary support awards
  • Manage the post-award process for all funding streams
  • Maintain PSI’s communication channels
  • Prepare committee meeting material, including dashboards and reports
  • Assist with special projects as assigned

What did you study in post-secondary?

I received my undergraduate degree in Nutritional Sciences and Psychology at the University of Toronto.

Eunice Lee: Administrative and Communications Assistant

How long have you worked at PSI?

I worked at PSI since May 2019, so for 3.5 years.

What are the main responsibilities for your job?

My job involves designing visuals and writing for PSI through reports, infographics, and social media management, as well as administrative tasks for post-meeting cleanup and our grants system (SmartSimple).

What did you study in post-secondary?

I majored in Journalism with a minor in English.

To read more about PSI’s history, funding, Board of Directors and Management, click here.

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Dr. Aaron Gazendam: Helping Patients Manage Pain Without Excess Opioids

Over the past several years, and particularly during the COVID-19 pandemic, opioid use disorder has been taking a significant toll on Canadians. According to the Public Health Agency of Canada, between January 2016 and December 2021, more than 29,000 people in Canada died from apparent opioid toxicity, and more than 30,000 hospitalizations were related to opioids.

As evidence has grown in recent years about the risk of opioid use, health care providers are being more careful and deliberate in prescribing opioids to reduce the risk that patients will become long-term opioid users. But this has been a particular challenge in orthopedic surgery.

Research has found that orthopedic surgeons prescribe more opioids than any other surgical specialty. Most patients receive an opioid prescription after surgery, often for more than they need.

“Recovery from these surgeries can be very painful, and as surgeons, there’s a fear that you’re sending patients home with not enough pain control and that they may end up in a pain crisis,” says Dr. Aaron Gazendam, an orthopedic surgery resident at McMaster University. “There’s also been a lack of high-quality research to prove that we can manage this pain without a lot of opioids.”

While working on a Master of Science in Health Research Methodology at McMaster during his residency, he co-led a clinical trial to examine the effectiveness of an opioid-sparing post-operative pain protocol following arthroscopic shoulder and knee surgery.

“Previous research has shown that there is a pretty strong correlation with that initial opioid prescription and the proportion of people who go on to develop chronic use,” says Dr. Gazendam. “We wanted to do an impactful study, and we felt that the results could be implemented after the study to support patients beyond those enrolled in trial.”

In 2021, Dr. Gazendam received a PSI Resident Research Grant to support the Non-Opioid Prescriptions after Arthroscopic Surgery in Canada (NO PAin) randomized controlled trial.

The research team, which included orthopedic surgeons and residents, enrolled 200 patients from three clinical sites in Canada who were undergoing outpatient shoulder or knee arthroscopic surgery. The patients were randomly assigned to one of two groups: the control group received the same prescriptions for opioids that they would typically receive outside of a trial, while the experimental, or “opioid-sparing,” group received a prescription for non-steroidal anti-inflammatories (NSAIDs) and acetaminophen, a “rescue prescription” for a small number of opioid pills they could fill if needed, and education about the risks of opioid medications.

At two and six weeks after the surgeries, the research team asked the patients how many opioid pills they used, how much pain they had, and how satisfied they were with their pain control.

They found that patients in the opioid-sparing group were prescribed and consumed significantly fewer opioids than the control group, yet patient-reported pain and patient satisfaction with pain control were not significantly different between the two groups. Importantly, only two people in the opioid-sparing group needed a refill on their opioid prescription, demonstrating that the opioid-sparing protocol was an effective way to manage pain.

“We included patients who were having major surgeries like ACL reconstruction and rotator cuff repairs, so we were in uncharted territory and unsure of how many refills we were going to get during the study,” says Dr. Gazendam. “Leaving patients without access to adequate pain control is a major concern for surgeons, so the fact that only a couple of people needed to refill their opioid prescription was a pleasant surprise.”

The research team now plans to publish the results and work with orthopedic and arthroscopy associations to develop guidelines and position statements that provide evidence-based information about pain management.

As Dr. Gazendam finishes his residency, he plans to specialize in orthopedic oncology and continue studying opioid use in oncology patients, who have very different medication needs and opioid use.

“The question for this project came directly out of our clinical experiences with patients. Being able to investigate questions that come up clinically that have little or no evidence is very rewarding,” says Dr. Gazendam. “The funding from PSI for the NO PAin trial has given me the opportunity to do meaningful and hopefully impactful research that I wouldn’t have had the opportunity to do otherwise.”

 

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Dr. Tavis Apramian: Resident’s Research Highlights Barriers Residents Face in Learning Advanced Care Conversations

“Learner-directed funding is critical to build skills in team leadership and direction and to create unique projects that tackle issues that learners themselves experience. I’m grateful to PSI for having the foresight to develop the next generation of scientists and education scientists in a deliberate way through the Resident Research Grants.” – Dr. Tavis Apramian

As both a learner and a researcher examining medical education, Dr. Tavis Apramian says he sometime felt as though he was navigating two worlds. During his residency in family medicine at McMaster University, he led research investigating how family medicine residents learn how to advance care planning conversations, with the goal of eventually improving education and training around this skill set.

“Studying medical education while acting as a learner is a little bit like living two lives at once,” says Dr. Apramian, now a palliative care fellow at the University of Toronto. “It helps me put some of the challenges I face into a broader systemic perspective, but it can also be challenging when I know that more evidence-based educational practices are available, but they might not be applied in a given situation.”

Dr. Apramian has long been interested in learning patient and physician stories and using storytelling to improve patient care. He studied English and biology at Carleton University and Narrative Medicine at Columbia University. He then focused his career on research and medicine, completing a PhD and MD at Western University.

When Dr. Apramian started his family medicine residency at McMaster University in 2019, he wanted to undertake research on medical education to try to affect positive change in how medicine is taught. He was specifically interested in how learners gain skills in advance care planning conversations, which require a complex skill set and are not typically taught in medical school.

Advance care planning conversations are often iterative conversations meant to help patients, typically with serious illness, understand the course of their disease, consider their values as they relate health care and make decisions about their future care.

Research has shown that fewer than 40% of family doctors regularly have these conversations with their patients with life-limiting illness, which suggests that residents may have limited opportunities to observe or participate in these conversations during a family medicine residency.

In 2020, Dr. Apramian received a PSI Resident Research Grant to investigate how family medicine residents learn to approach advance care planning. Working with Dr. Erin Gallagher as mentor and Dr. Michelle Howard as senior author, Dr. Apramian and the research team interviewed residents about their experiences to better understand if and how residents are learning these skills during their training and the factors that shape how they are taught these skills.

Residents face unique barriers to learning advanced care planning skills

Previous research has found that advance care planning conversations are challenging even for experienced physicians. These conversations are time-consuming and may take place over several appointments, and physicians often lack the time or flexibility in their schedules or access to clinical records to have these conversations effectively. In addition, physicians and patients often have cultural aversions to conversations about death and dying.

In the interviews led by Dr. Apramian’s team, residents described facing these same barriers, plus some specific to residency: lack of authority to shape clinic flow and schedules, short-term relationships with patients, navigating their preceptors’ clinical priorities, lack of encouragement from their preceptors, and limited opportunities to practice.

“The interviews demonstrated that the preferences and principles of family medicine preceptors affected how much time, energy, willingness and supervision that family medicine residents had to practice this skill set,” says Dr. Apramian. “These are really complex skills that require iterative and adaptive conversations. There’s certainly no training on advance care planning in medical schools, and little didactic or deliberate practice in the workplace once medical students reach residency, which is concerning.”

Importantly, the research team noted that, without this training in the primary care setting, many residents shifted to learning related skills during emergency department or internal medicine rotations through practising goals of care conversations, which are focused on an immediate clinical decision in a time of acute crisis.

“You can’t have conversations about values when patients are scared and uncomfortable and with physicians they don’t know or trust,” says Dr. Apramian. “I hope that what we found in our study will lead to more deliberate thinking about how to help residents practice the skill of building illness understanding and eliciting patients’ values in a family medicine setting.”

With the team now publishing and presenting the results, Dr. Apramian hopes that more awareness of the gaps in education will lead to changes in training that dedicate more time to practising this skill to increase future physicians’ comfort in leading these conversations and ultimately helping patients experience health care more aligned with their values. In his fellowship at the University of Toronto, he is planning to continue this research to examine advanced care planning in other clinical domains, including pain management.

Dr. Apramian says that the funding from PSI Foundation was critical to his research and has helped him to build a research program focused on medical education and the dynamics between learners and their supervisors.

“Having my own funding allowed me to hire team members to move the research forward while doing my residency,” he says. “Getting this grant allowed the research to continue and improve over the course of my residency in a way that wouldn’t have otherwise been possible.”

 

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2022 PSI Symposium Recap – Improving the Health of Ontarians: Past, Present, and Future

After two years of pandemic push back, PSI opportunely welcomed back our grantees, committees, and doctors to the 2022 PSI Symposium. This year’s symposium included a full day of PSI activities, including a resident presentation by Dr. Raed Joundi, open-floor and roundtable discussions, and three certified and accredited educational presentations* by Dr. P.J. Devereaux, Dr. Deborah Cook, and Dr. John Marshall. 

The day commenced with PSI president Dr. Robin Walker giving his opening remarks for the first ever in-person symposium since 2019, updating attendees on PSI’s 2021 impact report and activities during the COVID-19 pandemic. Notably, PSI began a COVID-19 funding stream to maintain support for our researchers during the pandemic, all the while giving a one-year blanket extension on all research funded during that period. PSI also increased grants funding support salaries through the PSI Graham Farquharson Knowledge Translation (KT) Fellowship award. 

PSI’s focus on Equity, Diversity and Inclusion (EDI) was discussed by Ms. Giselle Bodkin. Commenting on the state of EDI at PSI, Ms. Bodkin stated: “if you don’t consciously include people, you unconsciously exclude them” – our slogan to intentional inclusion as a research grants provider in the Ontario healthcare space. Ms. Bodkin walked us over the steps PSI has taken so far, including having grantees self-identify in order to analyze the statistics and fill in any missing diversity gaps with such data. With the newly instated EDI committee, PSI hopes to create a more inclusive, diverse space for our grantees.  

PSI Governance Committee Chair Dr. John Drover presented a governance update, including what the committee will be focusing on for the next year. Dr. Drover’s focus is on revitalizing the governance committee to be more effective in support of research in Ontario. In regards to revitalization, Dr. Drover told the symposium that “we’ve been focusing on [next steps] to move us into the future.” This will be achieved in partnership with external firm Overlap Associates by utilizing strategic planning exercises in the upcoming months.

Our first presenter, Dr. P.J. Devereaux of McMaster University, focused on his Perioperative Care Program. 

Dr. Devereaux discussed perioperative cover (silent) stroke and its association with perioperative and 1-year outcomes, understanding the effects of perioperative aspirin, and research for the relevance of atrial fibrillation and chronic incisional pain. 

Our second presenter, Dr. Deborah Cook of McMaster University, gave a heartfelt presentation on how opportunities for early career investigators make a difference in their career: including how PSI helped to fund one of Dr. Cook’s studies early on in her career. “In most studies, the same senior investigators do the work. PSI focuses on enabling new investigators – I was one of them. It was the first validating grant I’ve received,” she noted. 

Dr. Cook commented on PSI’s support for her over the years, stating that groups have an organizational culture. “I think of the way a personality is to an individual, organizational culture is to a group,” she said. “I was struck early on by the open-minded, communicative approach of [Executive Director] Sam Moore through PSI, and learned a little more of the organizational culture beyond the myth and the vision that is being actively refreshed.” 

Dr. Cook then focused on three women physician-led PSI funded studies that made impactful changes in the critical care realm: including Dr. Jennifer Johnson’s study on probiotics in the immunocompromised, Dr. Joanna Dionne’s study on diarrhea, and Dr. Brittany Dennis’ study on end-of-life care during the pandemic. 

PSI Resident Research grantee, Dr. Raed Joundi, presented his 15-year study on temporal trends in stroke incidence and outcomes in Ontario. Dr. Joundi thanked PSI for the support he received, which he ascribed as vital to establishing his career early on. 

Presenter Dr. John Marshall of University of Toronto spoke about PSI’s three decades of support in his research, and how, as he stated: “support from PSI Foundation has been critical to allow [him] to move forward” in his research since the early 1990s. His presentation included the topic of how biomedical research in critical care can change medical practice and patient lives. Dr. Marshall’s first funded research project looked into the role of gut liver axis in the pathogensis of Multiple Organ Failure. “I see PSI as the seed that can allow grant visions to take shape…my first funding came from PSI Foundation,” he said. 

Dr. Marshall spoke of the importance and “extraordinary power” of collaboration; especially that of PSI’s collaboration with grantees, peer reviewers, and researchers; and how it is vital to furthering the world of medical research. With the analogy of the Hubble Space telescope and an “unprecedented collaboration of scientists,” Dr. Marshall connected PSI’s grants funding streams to how PSI has helped further research – especially during the COVID-19 pandemic. 

A panel discussion was then hosted by panelists Dr. John Marshall, Dr. Andrea Gershon, Dr. Naana Jumah, Dr. Ishrat Husain, and Dr. Deborah Cook. This discussion was based on key guiding questions, such as ‘what the future of physician-led medical research should look like,’ ‘what role physicians should play in shaping the future of medical research,’ and ‘what the greatest challenges and opportunities facing clinician researchers are now and moving forward.’ PSI has taken into account the feedback provided to us from these needed discussions, and plan to integrate it into our organization moving forward.

We thank all who attended our symposium this year. PSI will continue striving towards fulfilling our mission of improving the health of Ontarians, through the support of physician-led research and education in the years to come.

Check out our YouTube playlist for exclusive video content from the PSI 2022 Symposium.

*This event is an Accredited Group Learning Activity as defined by the Maintenance of Certification Program of the Royal College of Physicians and Surgeons of Canada, and approved by the Continuing Education and Professional Development Office at the Northern Ontario School of Medicine. 

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Dr. Laureen Hachem: Clinical Experience in Neurosurgery Provides Valuable Perspective for Lab-based Research

Dr. Laureen Hachem has long been interested in neurosurgery and the potential of endogenous stem cells to repair spinal cord injuries. She started her research career in her last year of high school, volunteering in the lab of Dr. Charles Tator, a researcher and neurosurgeon at Toronto Western Hospital, and she continued working in Dr. Tator’s lab throughout her undergraduate and medical school education at the University of Toronto.

In 2017, she graduated from medical school and started the Toronto Neurosurgery Residency Program, which combines clinical and lab-based research training.

“When I’m on clinical service, I see questions or problems that I can critically analyze and think about how I would address them in a systematic, hypothesis-generating way,” says Dr. Hachem. “When I go back to the lab, I have an important perspective because I’ve seen what is relevant and feasible in the clinic, and the patient is always top of mind.”

In 2020, she started her PhD research, supervised by Dr. Tator and Dr. Michael Fehlings, continuing her studies of endogenous stem cell regeneration, with the aim of identifying therapies for spinal cord injury.

She had previously found that high levels of the neurotransmitter glutamate activate the AMPA receptor, which stimulates a response from endogenous stem cells. With a PSI Resident Research Grant, she began to look for clinically relevant methods to therapeutically activate AMPA receptors to stimulate endogenous stem cell regeneration, focusing on a class of drug called ampakines.

Ampakines bind to AMPA receptors to improve neuron signalling and have been used in neurodegenerative diseases, such as Alzheimer’s disease and Parkinson’s disease and in the setting of opioid-induced respiratory depression, and have been tested in clinical trials for some neuropsychiatric conditions. But until Dr. Hachem’s research, ampakines had not been examined for their potential in enhancing endogenous spinal cord stem cell regeneration.

Dr. Hachem says that PSI’s Resident Research Grant is a valuable tool for residents to develop their own research program and gain valuable skills early in their career.

“Because this grant funds residents as principal investigators who are asking the questions and leading the work, it gives residents ownership over the project,” she says. “It sets you up for the future in developing your career as a scientist and your own research program.”

Repurposed drug shows promise for neural stem cell regeneration

With PSI funding, Dr. Hachem used a clinically relevant rodent model of spinal cord injury to test whether an ampakine drug could stimulate the AMPA receptor to regenerate endogenous stem cells and restore function.

She found that the treatment increased the growth and division of endogenous neural stem cells and the production of beneficial growth factors, which was associated with increased neuron survival, reduced inflammation and improved functional recovery.

Dr. Hachem notes that other more invasive strategies – including stem cell transplantation – have been studied to repair spinal cord injuries, and while they show promise, her research is the first to show that ampakines have potential as a less invasive approach to regenerate neural stem cells.

“With this work, we’re trying to harness the body’s own regenerative potential with these stem cells. Since the discovery of these cells, it’s been a long-standing question of how we can actually use them to repair the spinal cord after injury, and this study is a critical step in answering that,” she says. “The relevance of the therapy and translation to the clinic is always top of mind, and ultimately the goal is to translate this drug and this approach of positively modulating these cells to patients in a clinical trial.”

With these first results, Dr. Hachem is continuing her research to understand the mechanisms at work, as well as examining the use of ampakines in chronic spinal cord injury. She plans to continue pursuing lab-based research along with clinical care to build a career that ultimately improves care for patients with spinal cord injury.

“Funding from PSI Foundation allowed me to do this first critical experiment to show the feasibility and efficacy of the drug, as well as optimize drug dosing, timing and duration, and this work paves the way for larger scale studies and ultimately clinical translation to patients,” says Dr. Hachem. “This line of research has really grown with me throughout my medical education. Looking forward in the future, I aim to have a career where I can integrate my research interests with my surgical practice.”

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