Cancer is one of the leading causes of death in Canada. As a pathologist, Dr. Torsten Nielsen’s job is to accurately diagnose cancer and determine its type from more than 200 possibilities. For more than 50 years, these diagnoses have been made using a light microscope to examine tissue biopsies. However, this can be subjective, requiring the pathologist to make a judgment call in certain cases. Recent new technologies help determine the genetic profile of each type of cancer. This profile can be used to distinguish between cancers that otherwise appear almost identical under the microscope. The ability to detect subtle differences among cancers can be enormously important because the exact diagnosis determines what combination of surgery, radiation, hormone treatment or chemotherapy is the best treatment plan.
Using advanced genetic tools, Dr. Nielsen aims to develop clinical tests that more accurately identify difficult subtypes of cancer, and to then determine which treatments will work best for each subtype. Previously supported by an MSFHR Scholar award, he works with two cancer types in particular: breast cancer and sarcomas (tumours of muscle and bone). With breast cancer, he is working to develop inexpensive and easy-to-conduct clinical tests that accurately diagnose four types not easily distinguished under the microscope. With sarcomas, he is using new molecular tools to develop diagnostic tests and treatments that target specific molecular changes, to see if new drugs can cure these cancers with minimal side effects. His research could lead to simple, effective, and widely available diagnostic tools and personalized treatment strategies that will improve survival for cancer patients.
Every year, more than 20,000 people in Canada sustain a hip fracture. Of these, up to 20% die within 12 months and 50% do not return to their pre-fracture level of mobility. People who have a hip fracture have a higher risk of falling and an increased risk of a subsequent hip fracture compared with those of the same age who have never had a hip fracture. After a hip fracture, relative immobility initiates a vicious cycle where deteriorating balance and muscle weakness increases risk of falls and diminished bone health contributes to fracture risk. Although exercise is key to reversing this pattern, there have been relatively few clinical trials aimed at improving muscle strength, balance and enhancing bone health following hip fracture.
Dr. Maureen Ashe is conducting a randomized controlled trial to evaluate the impact of a targeted exercise program on the rate of falls, functional mobility and bone micro-architecture among older adults who have sustained a hip fracture. If successful, this intervention will result in fewer falls and improved bone health in a vulnerable senior population. Data from the research will inform recommendations for rehabilitation and contribute to the knowledge base for health-professionals, both in hospital and in the community, who manage care after hip fracture.
Adverse Drug Related Events (ADREs) are the most common type of preventable non-surgical adverse event related to medical care, and represent a leading cause of death. Each year, in BC alone, Emergency Departments treat an estimated 130,000 patients for ADREs, most of which are caused by medications prescribed in community settings. Unfortunately, community-based programs aimed at detecting and reducing drug-related problems have not led to a significant decline in morbidity, mortality or health services utilization. Emergency Department practitioners are well situated to play a pivotal role in the timely recognition and treatment of community-based ADREs. Unfortunately, Emergency Physicians currently detect only 50% of ADREs, missing opportunities to intervene.
Continue reading “Development of a screening strategy for community-based adverse drug related events in the emergency department”
Social pediatrics is a model of practice that places specific emphasis on the importance of the relationship between the practitioner and the child as well as focuses on family and community engagement as vital to the ways in which care is provided. Moreover, it is located in the child’s community and seeks to ensure care is accessible and responsive to the child and family’s health needs. To date, little is known about the processes needed to implement a social pediatrics model of practice within the current structure of the health system.
Continue reading “Social Pediatrics: A Responsive Interdisciplinary Coordinated Health [RICH] Model for Timely Accessible Services for At-Risk Families”
The Canadian Academic Detailing collaboration (CADC) includes academic detailing (AD) programs that routinely reach over 1,000 physicians in six provinces. They deliver evidence-based, independent information on optimal prescribing practices to physicians through one-on-one or small group visits. As the health system continues to face drug safety controversies and escalating costs of chronic disease, AD holds promise for providing physicians timely access to information and tools for better prescribing and case management. While there is evidence of AD effectiveness in special research projects, rigorous evidence is lacking of real-world impacts of ongoing AD programs.
Continue reading “Partnership for Ongoing Impact Assessment of Academic Detailing”
Influenza is a major cause of morbidity and mortality in Canada. Community attack rates range from 10 to 20 percent, but can be more than 50 percent in closed settings such as residential care facilities or schools. In BC, influenza vaccine is provided free to hose at increased risk of severe disease and/or death from influenza infection, including the elderly and people with chronic health conditions. Despite access to free vaccine, adult immunization rates in the eligible population remain too low.
Continue reading “Pharmacy Immunization Community Strategy”
Tuberculosis kills more than two million people worldwide every year. More than one-third of the world’s population is currently infected with Mycobacterium tuberculosis (Mtb), the bacterium that causes tuberculosis. Because of its synergy with HIV infection, TB is the leading cause of death in HIV-infected individuals. Contributing to this global health crisis is the emergence of multi-drug resistant strains (MDR-TB), including extensive drug resistant strains (XDR-TB). The drug course to clear MDR-TB lasts up to two years, and XDR-TB is virtually untreatable with current therapies. These factors, combined with the high toxicities of current drugs, underline the urgent need for novel therapeutics to combat this disease. One of the major contributing factors to the prevalence and persistence of the disease is the bacterium’s ability to survive within the human macrophage, a type of scavenger cell that normally combats disease-causing bacteria. The mechanisms by which Mtb survives inside the macrophage in the immune system are largely unknown. However, a set of genes that encode (produce) a series of cholesterol-degrading enzymes in Mtb has recently been discovered as essential to the bacterium’s survival. Compounds that inhibit Mtb’s cholesterol-degrading enzymes might be useful starting points for the design of novel therapeutics. Jenna Capyk is focusing on one of these cholesterol-degrading enzymes, known as KshA. She is studying how this enzyme works and how it is inhibited by small molecules. Her work also involves determining KshA’s three-dimensional structure and synthesizing potential inhibitors for the enzyme. By investigating the mechanisms of this promising new enzyme target in tuberculosis, Capyk’s studies may help lay the foundation for the development of new classes of therapeutics to treat this deadly disease.
With an estimated 159,900 new cancer cases and 72,200 deaths from cancer predicted to occur this year alone in Canada, the need for new cancer therapies with unique mechanisms of action is urgent. Researchers are finding a promising resource among the ocean’s estimated one to two million structurally diverse microbial species. Compounds derived from marine organisms offer great potential in the fight against cancer; in the past decade, more than 30 natural products from the ocean have entered preclinical and clinical trials as potential treatments for cancer. However, it is often not ecologically or economically feasible to extract the active ingredient by harvesting natural sources in the ocean. Synthetic organic chemistry – where molecules are engineered in the laboratory – serves as an alternative source of these compounds. Inhee Cho is focusing on the synthesis of imbricatine, a chemical originally isolated from the Pacific sea star that shows significant anti-tumour properties. The structural core of imbricatine includes tetrahydroisoquinoline, a molecular structure that is also found in many biologically active agents, including anti-tumour antibiotics and drugs that treat diseases such as asthma, Parkinson’s and other nervous system diseases. Cho is developing an efficient way to synthesize tetrahydroisoquinoine, allowing rapid access to this important class of natural products in order to obtain enough material for biological testing and chemotherapy. Cho’s work may facilitate the discovery of new lead compounds with useful pharmacological properties, potentially leading to new therapies for treating cancer
Ubiquitin is a small protein found in all cells containing a nucleus. A key function for this protein is ubiquitylation, the process by which ubiquitin attaches to target proteins to “mark” them for degradation (breaking down) and removal from the cell. Ubiquitylation is an important process for maintaining proper levels of cellular proteins and removing mis-folded proteins to ensure proper cellular function and to prevent disease. E3 Ub ligases are important regulators of the ubiquitylation process because they select the specific proteins (substrates) that are to be degraded. Itch is an E3 Ub ligase that is important in the immune system, as mice deficient in Itch (Itchy mice) develop a fatal autoimmune-like disease. The Jun transcription factors, c-Jun and JunB, are found to be deregulated in the T cells of these mice, and this is believed to contribute to the disease. These proteins are also important for the proper function of B cells and their deregulation has been implicated in some B cell cancers, such as Hodgkin lymphoma. Joel Pearson is determining whether Itch also regulates the Jun proteins in B cells, and how this may contribute to the autoimmune-like disease of Itchy mice. He is also investigating whether Itch regulates the Jun proteins in B and T cell lymphomas where these proteins are expressed at unusually high levels. His hypothesis is that Itch is an important regulator of the Jun proteins in B cells. Furthermore, he believes that Itch is also an important regulator of the Jun proteins in B and T cell lymphomas where these proteins are over-expressed. Understanding how the Jun proteins are regulated in these cells is important for understanding how the autoimmune-like disease of Itch-deficient mice may arise. Deregulation of the Jun proteins also contributes to the pathogenesis of some types of B and T cell lymphomas. Because of this, understanding how they are regulated is important for understanding how these cancers arise and persist. It could also lead to the development of novel ways to treat these cancers.
Borderline personality disorder is a serious mental health problem characterized by heightened emotional vulnerability and difficulty modulating emotional responses. Individuals with BPD have high rates of health risk behaviours, such as suicide attempts (75 per cent), self-harm (69-80 per cent), and substance abuse (60 per cent). Despite frequent intense emotional reactions to stressful events, people with BPD lack the skills to reduce their distress through adaptive coping methods. In an effort to reduce these unpleasant emotions and feel better, persons with BPD features often resort to maladaptive coping strategies that are quick and easy to execute (e.g., self-harm, substance abuse) but have negative long-term consequences. However, not everyone with BPD engages in these risky behaviours in response to every stressor, and the specific triggers for these behaviours are largely unknown. Certain types of emotional states (e.g., shame) and life stressors (e.g., being rejected) may be particularly linked with self-destructive coping behaviours. Kristy Walters is examining the specific negative emotions or particular stressful triggers that may be strongly associated with maladaptive behaviours such as self-harm, substance abuse, or suicide. This research will also examine whether or not these relationships among emotions, stressors, and maladaptive behaviours is unique among individuals with borderline personality disorder (BPD). A better understanding of which specific emotions constitute cause for concern, or which types of negative events are more likely to result in self-destructive behaviour, will considerably improve clinicians’ ability to evaluate their client’s level of risk and better identify those clients who are in urgent need of life-saving interventions.
