Out-of-hospital-cardiac arrest (OHCA) affects 40,000 Canadians per year. Cardiac arrest is the sudden loss of heart beating, and can occur in people with or without known heart disease. In British Columbia (BC), only 15% of these patients live (50% die before hospital, 35% die in hospital), less than 50% receive bystander cardiopulmonary resuscitation, and only 3% receive bystander automatic external defibrillation. Due to a lack of connected data, little is known about the effect of treatments on long term survival, brain function and quality of life after leaving hospital.
We are closing this knowledge gap by having recently developed a new provincial database linking BC Ambulance records with hospital charts, prescription data, and post-discharge nursing home and home care information. This is the first database of its kind in North America and includes information for over 16,000 OHCA patients. We can now evaluate the complete 'journey' of each patient from 9-1-1 call, to hospital treatments, to survival and functional status long after discharge. We can now determine if current treatments affect length of survival, brain function, and quality of life, and within this framework, eventually test whether new strategies improve patient outcomes.
Many patients with depression struggle to return to their full level of functioning in work and other areas of life. These poor functional outcomes in depression may be related to cognitive difficulties, as patients demonstrate problems with memory, attention, and problem solving. We however lack treatments for these difficulties. Cognitive training, consisting of tasks to target cognitive deficits, has been tested but shows inconsistent results in depression.
Virtual reality (VR) – which is immersive, interactive and can recreate real world settings – may enhance cognitive training. VR cognitive training has shown benefits in stroke and schizophrenia. However, a full course of VR cognitive training has not been tested in depression.
With the National Research Council Canada, we have designed a VR cognitive training suite, the 'bWell' Cognitive Care Platform for Depression. We plan to pilot bWell in patients. This will determine if bWell is feasible, and will allow us to gather patient feedback to improve the tasks. We will then proceed to a clinical trial comparing bWell to standard cognitive training in depression. Our goal is to determine if VR can improve cognitive and functional outcomes in depression.
Endometriosis is a common condition, affecting 1 in 10 women of reproductive age, or approximately one million women in Canada. Endometriosis occurs when tissue from inside the womb grows outside of the womb, such as in different areas of the pelvis. Half of women with endometriosis experience sexual pain, which is felt as pelvic pain with deep penetration during sexual activity.
Sexual pain in endometriosis can occur when the endometriosis cells show invasive qualities. We recently identified non-inherited gene mutations in this type of invasive endometriosis.
Our team has established a registry of endometriosis patients along with surgical samples from these patients. I will validate the role of gene mutations in endometriosis sexual pain, in particular whether these mutations are associated with invasion of endometriosis, and also with increased nerve growth around endometriosis.
In the future, gene mutation testing could be incorporated into clinical care for endometriosis to identify subgroups and promote more individualized care. These mutations could also be potential novel treatment targets for this common condition in women.
Advanced head and neck cancers involving facial bone often require aggressive removal of diseased bone. Reconstruction of the bone is typically done by cutting and reshaping patient donor bone. This process involves is complex, since the accuracy of the reconstruction significantly impacts cosmetic and functional outcomes. Doing this during surgery is challenging, time-consuming and can be improved with better planning before surgery.
One method of pre-operative planning is to use patient imaging data to perform virtual reconstructions and design 3-D printed cutting guides for use during surgery. Currently, the only way to obtain such guides is through a third party and costs between $2000 – $6000 per case. However, this process has a significant turnaround time and surgeons have limited input on how the actual guides are designed.
My group has developed a software that makes the pre-operative process fast, simple and effective. We currently have the capacity to plan mandible (lower jaw) reconstructions with the fibula (lower leg) and are now validating the process through a clinical trial. We hope to extend the software capability to other surgeries and conduct research to generate supporting evidence.
Today the greatest barrier to optimal health among persons living with HIV (PLWH) is antiretroviral (ART) adherence. The WelTel program uses weekly text-messages to improve ART adherence and HIV viral suppression among PLWH, but does not work for everyone. The literature states that personality traits and sense of purpose (dispositional traits) play a role in HIV-related outcomes. Measuring disposition is simple and rapid, and could be used to personalize adherence supports for clients with relative ease.
We will enrol 300 PLWH from three Vancouver HIV clinics into the WelTel program. Participants will receive a basic cell phone and phone plan if they do not have one, and receive a weekly (two-way) text message for 12 months asking 'How are you?'. Problem responses will be triaged by a nurse.
We will use existing validated tools to measure disposition at baseline/over time to determine whether we can predict who is most likely to benefit from the WelTel program, and how WelTel works to enact behaviour change. In this way we hope to provide a means by which limited resources could be triaged in vulnerable populations struggling with adherence to provide well-suited programs to the greatest number of individuals possible.
Breast cancer is the most common cancer in women. Patients with large breast tumour or palpable lymph nodes often receive chemotherapy first, followed by surgery. During chemotherapy, a doctor performs serial breast exams and occasional imaging to monitor tumour shrinkage, but this is not good enough to capture shrinkage accurately. It is important to develop a better way to measure breast cancer response on chemotherapy before surgery, as it can predict outcomes and change treatment plans.
Diffuse Optical Imaging (DOI) takes advantage of different light scatter properties in different biological tissues (for example, normal tissue, cavities, cancer and blood have different scatter properties in infrared spectrum). Our team has developed a hand-held DOI-Scan probe (optical probe) which has shown promising preliminary findings in patients without prior diagnosis of breast cancer.
We will use this real-time, easy-to-use, point-of-care imaging tool to examine normal breast and breast tumour characteristics in patients with locally advanced early breast cancer prior to and after each cycle of systemic therapy, alongside serial breast examinations and ultrasound imaging, to see how breast cancer appears and responds to chemotherapy given before curative surgery. The results will be compared with the final surgical specimen and patient outcomes.
Medications have transformed the lives of Canadians suffering from many debilitating conditions. However, medications may also cause harm. As medication use has increased, so has the incidence of adverse drug events (ADEs), harmful and unintended events related to medication use. Today, ADEs cause over 2 million emergency department visits across Canada each year, and are a leading cause of admissions.
Preventing ADEs is not easy. Health care providers often unknowingly expose patients to the same or similar medications as ones that previously caused harm. For example:
"I saw a diabetic who was discharged from hospital after being admitted for hypoglycemia [low blood sugar] due to glyburide [a blood sugar lowering drug]. The physician asked him to stop the glyburide and put him on gliclazide which has a lower risk of causing hypoglycemia. But he presented [a different hospital] with an even lower blood sugar. When I looked at his blister pack I discovered that both glyburide and gliclazide had been dispensed. The patient had been given a discharge prescription for gliclazide, but no note was made to discontinue glyburide, and neither his [family] doctor nor his pharmacist were aware of what had happened."
Hospital pharmacist, 2012
Using combined professional and research expertise we will pilot-test, refine, implement and evaluate ActionADE, a new health information technology developed by my team to prevent repeat ADEs.
There are 40,000 patients who suffer a cardiac arrest in Canada each year. When the heart stops beating from a cardiac arrest, blood flow to the brain stops which can lead to large strokes, called ischemic brain injury. Only a small percentage of people who develop ischemic brain injury survive with normal brain function.
The overall goal of this research is to improve the neurologic outcomes of critically ill patients who have suffered a severe brain injury after cardiac arrest by determining how to personalize blood pressure targets for individual patients to ensure adequate cerebral blood flow (CBF). CBF in the first few millimetres of brain tissue can be measured non-invasively by near-infrared spectroscopy (NIRS), using sensors applied to the forehead. I have previously demonstrated that we can use the NIRS to determine the patient-specific blood pressure, but it is unclear if maintaining this individualized blood pressure leads to better outcomes.
To address this gap, my Heart & Stroke Foundation funded study will enroll 60 patients in 3 intensive care units across Canada following cardiac arrest. The objective is to determine the association between the amount of time spent at the patients individualized blood pressure threshold, and neurologic outcomes at 6-months. The results of this study will be used to design a large interventional study of individualized blood pressure management and neurologic outcomes.
Self-compassion refers to an individual's capacity to be mindful, recognize our common humanity in times of hardship, and to practice self-kindness in times of suffering. It has been shown to be beneficial in working with individuals with chronic health conditions, such as HIV/AIDS, diabetes, and eating disorders. However, many individuals have difficulty with this skill and experience barriers to being self-compassionate.
This research will help us understand how self-compassion can benefit individuals with chronic health conditions. We will interview patients in treatment, recovered patients, and clinicians about their experiences with self-compassion. Their responses will be used to design an intervention that aims to increase capacity of individuals with chronic health conditions to benefit from self-compassion. We will also explore self-compassion in family members and clinicians to increase understanding of what gets in the way of a collaborative stance, shown to be most helpful to individuals with chronic health conditions. We will share results of this research with clinicians, patients and families locally at education days and provincial video conferences, and nationally and internationally through workshops, conference presentations and publications.
Cerebral venous thrombosis (CVT) is a rare type of stroke that can cause headaches, vision loss, weakness, seizures and coma. It is most common in young women and causes 1/3 of strokes that occur around pregnancy. Among those affected, up to 15% are left dead or disabled, 25% cannot return to work, and over half have lasting issues with energy, thinking or mood.
As a rare disease, CVT is hard to study in large trials, and treatment decisions are based on clinician opinion. CVT is treated with strong blood thinners, but it is not clear which blood thinner is best or how long people should be treated. We are conducting a national study to determine the best way to treat CVT.
Collaborating with 18 other hospitals we will recruit patients from across the country. People living outside of major cities can participate in the study over video-conference and we will also hold forums to consult with patients and family members about lasting symptoms that affect their quality of life.
Our aim is to improve treatments for CVT, and better understand its long-term effects. We also want to continue to expand our video-conference network so that people with health issues will be able to access research treatments, regardless of where they live.
