Cesarean section rates have been considered too high in North America for a number of years, and the rate appears to be rising. My research will assess whether a different approach to early labour care lowers the rate and is cost-effective. Currently, women who phone British Columbia’s Women’s Hospital and Health Centre in labour, wondering whether they should come in to the hospital, receive telephone advice only. My research study will focus on women having their first baby who call the hospital for advice. Women who agree to participate in the study will be randomly assigned either the current method of telephone care or a visit from a delivery suite nurse, who will conduct an assessment in the woman’s home. This is the same assessment that takes place when women arrive at the hospital. The nurse will call the woman’s physician from her home, and the three of them will plan what to do next. In this study, I will compare the outcomes of home visits to telephone advice to determine whether the cesarean rate is lowered. We anticipate that early labour support and assessment at home will enable women to delay admission to hospital until labour is well established, reducing the use of cesarean sections and other interventions. We know from a small pilot project that babies seemed less likely to have problems at birth with this approach to maternity care. In addition, we will compare the cost of the two methods. We expect early labour support at home to reduce the costs associated with cesarean section and longer hospital stays.
Research Location: University of British Columbia
Primary deafferetation of the spinal cord: consequences and repair strategies
Excessive force on the brachial plexus – the network of nerves in the shoulder that carry information to and from the arm and hand – can tear sensory nerve roots from the spinal cord. Traffic accidents, complications during childbirth and other situations can cause this common condition. As a result, people lose sensation and, paradoxically, develop a severe and untreatable condition called deafferentation pain. Sensation loss is permanent because sensory nerve fibres cannot regenerate into the spinal cord. However, recent studies have shown that groups of naturally occurring proteins called neurotrophic factors have the potential to promote re-growth of damaged sensory neurons, the nerve cells that carry information about touch and pain from sense organs like the skin to the cord. Some of these proteins can also prevent or reverse the deafferentation pain that results from the interruption of sensory input to the spinal cord. My research will examine the therapeutic potential of neurotrophins on regeneration in spinal cord injury and deafferentation pain. We will also assess the consequences of brachial plexus injury in the spinal cord and develop methods for assessing the resulting pain. This work will help explain why regeneration fails, and identify new therapies for treating brachial plexus and other spinal cord injuries.
Expanding and exploiting the catalytic repertoire of combinatorial nucleic acid selections for medical applications
Synthetic DNA can potentially be used to develop new drugs that target infectious diseases and cancer. I am studying how to create new molecules based on DNA. My research team is examining billions of molecules at a time and selecting synthetic DNA that may have therapeutic properties or act as catalysts. Part of developing new catalysts involves developing building blocks of synthetic DNA with particular properties that regular DNA doesn’t have. For example, we have been able to modify synthetic DNA to enhance its catalytic activity. I am examining whether the catalytic activity can be used to target the RNA sequence involved in the development of cancer. I am also studying a DNA catalyst with the potential to cut viral RNA sequences in HIV. In addition, we are screening molecules to find DNA that can stimulate or inhibit activity on a cell surface or in proteins. In particular, I am examining the proteins involved in cancer. Our goal for this research is to support the development of potent anti-viral and anti-cancer therapies.
Origin and evolution of intracellular parasites apicomplexa and microsporidia
Apicomplexa and microsporidia are two groups of parasites that infect a broad range of animals, including humans. Apicomplexa cause serious diseases such as malaria and encephalitis. Traditionally, microsporidia were not prevalent among humans. However, microsporidia are increasingly becoming a problem in people with impaired immune systems. The relationships of these parasites to other organisms and how they evolved are not clearly understood. Yet recent molecular studies have revealed surprising evolutionary histories for both groups of parasites. Apicomplexa evolved from an alga, an unusual origin for a parasite. Microsporidia were originally believed to be simple, single-celled organisms that were not highly evolved. But we now know that microsporidia have evolved from fungi. I am studying the evolution and biology of apicomplexa and microsporidia to learn how they developed into parasites and how they function. This research may uncover weaknesses in the parasites that can be exploited to develop new treatments for disease involving herbicides or fungicides that would not have been considered earlier.
Patient-focused care over time: issues related to measurement, prevalence, and strategies for improvement among patient populations in B.C.
Patients often see multiple health professionals in a variety of places for the care of their health problems. Linking care from different providers over time is challenging, with the risk that some care may be missed, duplicated or ill-timed. Concern about this fragmentation of care is growing in Canada and worldwide. Continuity of care, which is accomplished when the connections between care are seamless, is thought to improve patient outcomes, patient satisfaction with their care and physician and health providers’ satisfaction as well. I am studying the impact of continuity of care on costs and quality of care. A common way to connect care over time is to have one central person, usually a primary care physician, responsible for providing the majority of services and linking a patient to specialists. I am examining a variety of data to measure the concentration of care in this type of sustained relationship. A growing trend is team care provided at a clinic, where patients see any one of the physicians working there. My study will compare outcomes for patients who use health care teams to those who primarily see one physician, and I will look at the way walk-in clinic care affects continuity and patient outcomes. I will also examine how continuity of care affects patient health over time for people with severe and persistent mental illness, individuals with workplace injuries, and patients with HIV/AIDS.