Our lungs normally work by the diaphragm contracting and pulling air into our lungs. The mechanical ventilator is an amazing invention that blows air into the lungs to inflate them. However, research has shown that this can cause lung, diaphragm, and brain injury. Recently, the intravenous catheter that is used in almost all ICU patients has been modified to have the ability to send a directed pulse of electricity across the blood vessel wall to activate the nerve that travels from the brain to the diaphragm, called the phrenic nerve. By sending a carefully directed electrical pulse, the diaphragm can be activated even in patients who are deeply sedated and critically ill. We have shown in a pig model that when this is used in conjunction with mechanical ventilation, it can protect the lung, diaphragm, and brain from injury. We propose studying patients who have low-oxygen levels and are acutely ill. Our team at Royal Columbian Hospital has extensive experience with this novel intervention and will be partnering with a multi-disciplinary team, including patient partners, to carry out this patient-oriented research. This work has the potential to improve patient outcomes and save the healthcare system valuable resources.
Program: Health Professional-Investigator
Bridging the gap: screening for fontan associated liver disease (FALD)
One in 3,000 children is born with one, instead of two, heart pumps, and as a result of a surgery called the “Fontan”, survive well into into adulthood. This surgery creates an artificial path that collects blood low in oxygen from the veins and sends to the lungs (instead of using a right heart pump) to pick up oxygen; leaving the single pump to send blood with oxygen to the body. We are learning these patients are developing many issues in adulthood including liver disease. The best way of identifying significant liver disease is through a liver biopsy, but it is not reasonable to perform biopsies regularly. We do not know the best way to easily identify and monitor liver disease in the Fontan population, yet this knowledge is critical to maintaining Fontan liver health, reducing co-morbidities ultimately benefiting our health care system. The first part of the study will be undertaken at St.Paul’s Hospital and Mazankowski Heart Center in Edmonton. We will perform a number of liver related blood tests/imaging to determine the best combination that identifies significant liver disease as diagnosed by liver biopsy. The second part will take place at five adult sites across Canada and will confirm our findings from the first part.
Tumour tissue biomarkers to guide personalized lung cancer treatment in British Columbia
Non-small cell lung cancer (NSCLC) is the most common cause of cancer death in BC and worldwide. In 2020, 29,300 Canadians were diagnosed with lung cancer and 21,000 died from it — more than colon, breast, and prostate cancers combined. Patients amenable to surgery have the best prospect of cure, but often cancer returns and is lethal. Only 5 percent of patients benefit from chemotherapy after surgery. Return of cancer is caused by changes in the tumour genes and immune system. It is possible to predict these changes to identify patients who would benefit from targeted gene and immune therapies, but testing for tumour genes and immune biomarkers is not done in Stage I-III NSCLC in BC. We will use novel tests to understand how the immune system and tumour genes predict cancer recurrence after surgery. This will be led by thoracic surgeon Dr. Anna McGuire. Tumour gene analysis will be done at the BC Cancer Genomic Lab and immune system analysis will be led by Drs. MacAulay and Guillaud at the BCCRC. Our results will reveal which features predict cancer recurrence so patients who can benefit from targeted gene or immune therapies can be identified. This is first step to implementing this testing for NSCLC patient in BC to improve survival.
Re-purposing the ordering of ‘routine’ laboratory tests in hospitalized medical patients (RePORT)
Blood tests can help diagnose diseases and monitor health status. However, overuse of blood testing, particularly in hospitals, leads to patient discomfort, loss of sleep, contributes to blood loss leading to blood transfusions, and wastes health care dollars. We previously developed and tested a multi-part healthcare provider (HCP) engagement strategy to safely reduce overuse of six target laboratory tests that make up 40 percent of costs on laboratory testing in hospitalized medical patients. In collaboration with a Patient and Family Advisory Council (PFAC), we have co-designed a patient engagement strategy that includes an infographic, video and website. Our team, made up of clinicians, researchers, patient partners and policy makers, proposes to launch the HCP and patient engagement strategies across 16 hospitals in British Columbia and 14 hospitals in Alberta in a cluster randomized stepped-wedge design. We will evaluate the impact of this strategy on number of laboratory tests done, patient experience, patient safety, costs and HCP experience, using administrative data systems and patient and HCP interviews. We will work with the PFAC to design implementation evaluation, particularly of the patient engagement strategy.
FIRE-Diet: food as an intervention to reduce effects of woodsmoke exposure on respiratory health
Many people in BC are exposed to woodsmoke from woodburning stoves in their homes, controlled burning for farming purposes, and increasingly from wildfires. Exposure to woodsmoke can lead to difficulty breathing, lung disease, hospitalizations, and in some people who have underlying health conditions, even death. Children, whose lungs are actively developing, may be at heightened risk. We don’t yet fully understand how woodsmoke causes health effects nor how to reduce or prevent these effects in people who can’t avoid exposure. We want to find these answers, first by examining symptoms and changes in function and immune activity in the lung with exposure to woodsmoke. We will also study whether and how the impact of woodsmoke may differ by (1) age of exposure, including developmental windows in childhood, (2) female or male sex, and (3) genetic factors, so that we can design strategies to protect and help those with the greatest and most urgent need. Lastly, because of growing evidence that a healthier diet may help the body to protect itself from pollution, we will study whether a person’s diet changes the effects of woodsmoke on the lung. This work will be performed at UBC with partners across BC and Canada.
Clinical impact of 24/7 on-site staff radiologist coverage at a level 1 trauma center in British Columbia
Background: Between 2019 and 2020, the total number of emergency department visits in BC was 1,640,067. On October 1, 2013, Vancouver General Hospital started a program where specialist doctors capable of reading X-ray, ultrasound and computed tomography were available in the hospital around the clock. The mission of this new program was to improve access to diagnostic tests and improve patient care.
Methods: A team of physicians, researchers, patients and community partners are collaborating on this research to assess the impact of this new model of service by comparing time it takes for patients to get diagnostic tests, time it takes for reporting these diagnostic tests, patient length of stay in emergency, and the overall cost of care. We will also study if there are any differences in care and outcomes based on sex and race of the patient. We will review consecutive 10 years of the emergency room and radiology department records.
Importance: Our research results will help us improve timely patient care, efficiency and conserve hospital resources. The results of our proposed research will provide an example for enhanced and culturally fitting patient care which can be applied to emergency department services throughout Canada.
Evaluating a virtual care platform (REACHOUT) that delivers peer-led mental health support to adults with type 1 diabetes in rural and remote communities in British Columbia
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.
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.