Mental health is often overlooked in diabetes care. In fact, BC’s provincial health plan does not cover psychological services for patients with chronic illness. Studies have found that, of psychological stressors, diabetes distress (DD) is the most closely associated with poor blood sugar control and worse health consequences. DD refers to the unique and often hidden emotional burdens, and relentless frustrations and worries that patients experience when trying to manage this condition. In 2027, almost 35,000 British Columbians diagnosed with type 1 diabetes (T1D) will report clinically significant levels of DD. Unfortunately, T1D adults living in rural and remote regions will have the least access to mental health services. I seek to address three major gaps in BC’s diabetes care: the availability, affordability, and accessibility of mental health support for T1D patients living in settings with limited resources. In collaboration with T1D patients, clinical psychologists, digital health specialists, and biomedical engineers, I will use digital health strategies to “drive” a peer-led mental health support intervention (REACHOUT) to adults with T1D living in geographically isolated communities.
Program: Health Professional-Investigator
Improving clinical practice guidelines for antenatal corticosteroids: Incorporating a decision support tool to impact clinical counselling
Antenatal corticosteroids are a medication given to women who are at risk of an early delivery to reduce the chance of breathing problems for their baby after birth. Current guidelines recommend giving antenatal corticosteroids to pregnant women who might have their baby before 34 weeks of pregnancy. This medication may also help those at risk of an early delivery at 34-36 weeks of pregnancy but the balance between the benefits and harms of this treatment is less clear at these ages. Guidelines for giving this medication at 34-36 weeks of pregnancy are also unclear, making it difficult for doctors and patients to decide whether to use it. We will find out if including a decision support tool in clinical guidelines will improve how doctors discuss antenatal corticosteroids with patients at 34-36 weeks of pregnancy. We will ask patients whether they had better discussions with their doctor about this treatment after their doctor had access to the decision support tool within the clinical guideline, and we will ask doctors how this decision support tool impacted their counselling. This project could improve communication between doctors and patients, especially when it is unclear whether a treatment’s benefits outweigh its harms.
Exploring the experiences of racialized learners to understand and dismantle racist structures in our healthcare system
Racism is experienced by learners, professionals, and patients in our healthcare system and contributes to well-documented health inequities. However, patient care and health outcomes are improved through a diverse physician workforce. Medical schools have attempted to support diversity through the admissions process, including increased racial diversity in their programs. Yet we know little about the experiences of racialized learners once admitted. This study will explore the impact of existing policies, processes and practices on learners’ sense of agency, attending to their perspectives on how their experiences of racism impact patient care.
This study focuses on racialized learners’ experiences in their clinical education over time through the use of diaries and interviews. Engaging with learners across four medical schools, we will attend to the impact of important differences in their identities such as race, gender, and sexual orientation.
Through this study, we will identify concrete ways in which our healthcare (and clinical education) systems perpetuate racism. From this, I will work with clinicians, educators and policy makers to enact systems changes that will ultimately reduce health inequities.
Economic evaluation of the use of expanded criteria donor kidneys pre-emptively to improve the critical organ shortage
Kidney transplantation can be life saving for people with end-stage kidney disease at a lower cost than the only other alternative which is dialysis treatments. Unfortunately, there are not enough kidneys available for transplant. This means that until we can improve the kidney supply, patients will continue to have to wait on a waiting list and may die in the process.
Kidneys from older donors have been successfully used for transplant, but at a higher risk. This higher risk discourages some patients and physicians from accepting these kidneys for transplant. This results in kidneys being discarded that could otherwise have saved lives.
However, these kidneys will have better outcomes if they are given to patients before they ever need to start dialysis, instead of our current practice which is to wait until someone is at the top of the waitlist after years of dialysis. This research project will use economic models to study how allocating kidneys from older donors to some patients before they ever need dialysis might impact the overall kidney supply and patient outcomes. This research will help inform future health care policy which may improve organ supply for patients waiting for a life-saving transplant.
The DISCO study: Rethinking STI prevention
Syphilis, chlamydia and gonorrhea are three of the most common sexually transmitted infections (STI). Over the last decade, these STIs have seen a resurgence in many parts of Canada, with most infections seen in major urban centres. These infections have primarily affected gay, bisexual, and other men who have sex with men (gbMSM). Recently, a small pilot study found that doxycycline — an inexpensive, well-tolerated antibiotic — given daily may prevent new STIs in gbMSM. Another study looked at the use of doxycycline given after a sexual encounter for prevention of STIs, and the results of this study showed protection against STIs as well. Based on these promising data, along with the concerning increases in STIs seen in Canada, the current study will examine the use of doxycycline as either a daily prevention therapy (preexposure prophylaxis, or PrEP) or an ‘after sex’ prevention tool (postexposure prophylaxis, or PEP) for STIs in gbMSM. While examining for efficacy as its primary goal, this study will also do an examination of some of the potential challenges and concerns associated with the use of a daily antibiotic: drug resistance, tolerability and side effects, and how acceptable this drug is for people to take regularly.
Perioperative stroke screening and outcomes in high-risk surgical patients
Up to two percent of patients will experience a stroke during or after surgery and these patients have a high chance of disability and death. Currently, we don’t understand clearly how to prevent, detect, and treat stroke after surgery. Although risk factors have been identified including older age and cardiac surgery, high risk surgical patients are not usually identified and strokes can be missed, leading to fewer treatment options and more complications. My previous pilot study showed that anesthesia and surgery can limit the accuracy of standard screening tools for stroke. We urgently needed a screening tool and protocol specifically for surgical patients. We also don’t understand well how patients recover after perioperative stroke, such as which patients survive, and whether they can stay in their homes. Building on our prior research, this multiphase study aims to: (1) Understanding which patients do poorly after perioperative stroke and whether those factors can be changed; (2) Compare mortality and other complications after stroke between those who had recent surgery and those who did not; and (3) Identify a useful perioperative stroke screening tool to quickly and accurately detect stroke after surgery.
Neuropsychological functioning in treatment resistant schizophrenia
Schizophrenia is a severe and disabling psychiatric illness involving primary symptoms of psychosis (hallucinations, delusions, disordered thinking and behavior). Unfortunately, as many as 30% of patients respond poorly to standard antipsychotic medications and are considered to have treatment resistant schizophrenia (TRS). Neuropsychological impairment is an important clinical feature of schizophrenia, as cognitive deficits predict poor treatment response, daily functioning, and disability. However, very little is known about cognitive functioning in the clinically complex subset of patients with TRS. The aims of this project are therefore to investigate the severity, pattern, and variation in cognitive functioning among individuals with TRS, and to determine whether cognitive difficulties predict treatment response and functioning. This will be achieved by analyzing clinical and neuropsychological data that has been collected on TRS patients who have been treated within the BC Psychosis Program since 2012. Findings using this unique dataset will have a direct impact on shaping assessment and treatment strategies, improving prognosis and ability to predict functioning, and improving clinical decision-making and planning.
Design and pilot of a culturally resonant intervention to treat substance use disorder among South Asian men
Substance use disorder is a growing problem affecting racialized men in Canada. There is increased awareness and understanding about why and how racialized men use substances, yet little is known about effective treatments and interventions. The project will use anti-racist research methods to design and study an intervention to support a racialized group, South Asian men who use substances. The team will consist of Punjabi men who use substances, community organization members, health care providers, and researchers. Using a rigorous facilitated approach that highlights evidence from literature and draws upon members’ life experiences, the team will design an intervention to support South Asian men who use substances in the Lower Mainland. Once the design is complete, the intervention will be studied in a feasibility study and pilot randomized controlled trial (RCT) in preparation and justification for a full scale RCT.
Exploring oxidative phosphorylation as therapeutic vulnerability in high risk acute myeloid leukemia
The standard of care for AML patients was introduced in the 1970s and has not significantly changed since then. Patients suffering from acute myeloid leukemia (AML) with unfavourable genetics are characterized by dismal overall survival due to poor treatment response to standard chemotherapy. In this research proposal, I aim to better understand the energy metabolism of high-risk AML cells and explore this as a novel treatment avenue. My research will create a rational for future clinical trials to improve patient care and develop novel treatment perspectives for a patient collective with a bleak prognosis.
Leveraging computational modelling and 3D bioprinting in pursuit of a regenerative therapeutic approach for male infertility
A desperate need exists to develop technology to regenerate sperm that can be used for in vitro fertilization (IVF) among men who lack sperm production, such as pediatric cancer survivors. In Canada, approximately 2,440 boys aged less than 15 will be diagnosed with cancer each year. Fortunately, the field of oncology has made significant improvements in survival rates, which are estimated to be 83%. However, treatments will render up to 97% of paediatric cancer survivors infertile with no sperm production, despite over 75% eventually desiring to have biological children. While stem cells (sperm precursors) can be retrieved prior to cancer therapies, no technology currently exists to regenerate sperm, which is required to achieve a pregnancy. This project proposes to utilize single cell sequencing and along with state-of-the-art computational modelling to reveal molecules and pathways that are key regulators of developing sperm from stem cells. These findings will be screened and tested to identify critical molecules that help generate sperm in 3D bioprinted structures. Results from this study will contribute to developing the understanding and technology to regenerate sperm for men lacking any ability to father biological children.