Motor vehicle crashes result in 78 million injuries worldwide each year. Some crashes might be prevented by restricting driving for individuals with medical conditions that might cause sudden incapacitation while diving (eg. epilepsy, sleep apnea).
About 4,000 Canadians will have an implantable cardiac defibrillator (ICD) implanted this year. ICDs treat life-threatening cardiac rhythm abnormalities and prevent cardiac arrest. A heart rhythm problem or device malfunction in the weeks after implantation might result in a crash, so patients are warned not to drive for 4 weeks after ICD implantation.
Do driving restrictions after ICD implantation prevent crashes? Would driving restrictions be more effective if they were modified? The answers to these questions aren't known.
British Columbia's health and driving databases provide a unique opportunity to examine crash risk after ICD implantation. The MVC-ICD study will use health and driving records to compare crash risk among 9,000 ICD patients to crash risk among control patients. Results will provide an immediate opportunity to improve clinical practice, licensing policy and road safety in Canada and abroad.
Each year, more than 18,000 British Columbians have joint replacement surgery for hip or knee osteoarthritis. Many face challenges in getting timely, quality rehabilitation before, and especially after surgery. I have developed quality indicators that set minimum standards of rehabilitation care for joint replacements. Focusing on 10 of these quality indicators for care after surgery, my team of clinicians, patients and researchers have created online toolkits to help make these indicators available to patients and clinicians who provide joint replacement rehabilitation in BC. The toolkits contain resources such as checklists, videos, and posters. After first testing our study procedures, I will run a study to see if the toolkits make a difference in overall quality of rehabilitation care and lead to better experiences and results for patients. Patients, clinicians and those who make decisions about healthcare services, will be part of every stage of this work. I will share my findings widely to researchers, clinicians and patients locally and across Canada. This research will lead to better, more consistent care for patients and improve the joint replacement rehabilitation services available in BC.
Single-use plastic medical tubing is widely used in hospitals. Although practical, plastic tubing has a potentially life-threatening problem in that blood cells and proteins can deposit on the tubing to form clots. There are also problems with being unable to dispose of the plastic tubing in an environmentally-friendly manner. Commercially available plastic tubing has seen little change over the last 30 years.
We propose replacing plastic tubing with a 3D printed tube made from compostable materials. Our tubes are based on a substance called a hydrogel, have excellent mechanical and fluid movement properties, and are bio-compatible (do not cause reactions in people). Our approach is technically and economically feasible for scale-up. We target MSFHR health priority #3. We will provide on-demand printing of hydrogel tubing, replacing existing plastic tubing used, e.g. dialysis, to allow clinicians to rapidly customize tubing shape, size, and composition to adapt specific treatment needs. At the end of its life-cycle, our tubing is compostable, which will reduce single-use plastic and open up new pathways for environmentally-friendly disposal.
Over 80% of patients who are treated in the intensive care unit (ICU) for a life-threatening illness face reduced physical health, emotional wellbeing and quality of life. Up to half of patients discharged from the ICU are readmitted to hospital within a year with complex medical conditions. This is a tremendous cost of cure for survivors and their family caregivers. Services for patients with complex medical conditions and/or frail patients is a BC Health System Priority.
This research aims to identify patient- and family-perspectives for designing healthcare services that meet their needs. The primary study will involve interviewing ICU patient survivors, their family members and healthcare providers to map the causes of hospital readmission.
These results will inform the design of services to reduce hospital readmissions. The results of these studies will be shared with national and international researchers and clinicians to benefit patients across Canada.
Indigenous people who use drugs in BC are facing two public health emergencies: COVID-19 and the ongoing overdose crisis. One likely creates additional risk for the other. On one hand, COVID-19 and its response may affect access to clean smoking/injection equipment, safe supply of illicit drugs, income, and health and social services. Pandemic fears and restrictions may also impact mental wellbeing. On the other hand, substance use may increase COVID-19 risk through sharing smoking/injection equipment; barriers to physical distancing; and housing instability. Our study assesses impact of COVID-19 and the pandemic response, as well as its domino effects, among Indigenous people who use drugs. The study will inform a culturally-safe, trauma informed response for this population.
Half of Canada’s COVID-19 deaths are linked to long-term care (LTC) settings. In BC, 24 LTC settings have had COVID-19 outbreaks. In response to COVID-19, LTC settings have introduced rapid changes to resident care delivery. This study will track outcomes from these rapid changes.
How have these changes affected
- the quality and safety of care delivery and
- staff, residents and their families? Researchers will use a variety of methods, including statistical analyses of administrative and survey data and interviews.
Key stakeholders (leadership, staff, Family and Resident Councils) will be represented on a steering committee who will be involved in all phases of the research. The goal is to produce evidence-based LTC practices and policies for pandemic management as soon as possible.
Health Research BC is providing match funds for this research project, which is funded by CIHR’s Strategy for Patient Oriented Research (SPOR) Primary and Integrated Health Care Innovations (PIHCI) Network – Knowledge Synthesis Grants.
Jason Sutherland is Professor in UBC’s Centre for Health Services and Policy Research in the School of Population and Public Health. He is also a Scholar of the Michael Smith Foundation for Health Research.
This is a two-province research team, though the scope of the project is examining integrated funding models across the globe. Little is known regarding how other countries have developed and implemented policies for supporting integrated healthcare. This study will conduct an extensive review of the literature and synthesize the evidence regarding the scope and breadth of policies and their effectiveness to improve integration of healthcare across sectors of the delivery system.
Knowledge translation activities:
- Policy roundtable to disseminate findings to knowledge users in Calgary, Alberta
- Policy roundtable to disseminate findings to knowledge users in Vancouver, British Columbia
- Patient Groups Compensation (honorarium, travel cost, parking) in Calgary, Alberta
- Patient Groups Compensation (honorarium, travel cost, parking) in Vancouver, British Columbia
- Open Access Publication jointly by University of Calgary and University of British Columbia
- Webinar and YouTube video preparation by the University of British Columbia
The team expects to share findings of the project with key public stakeholders regarding attributes of policy and delivery systems that integrate sectors of the healthcare delivery system to improve care and outcomes.
End of Award Update – April 2022
Most exciting outputs
In my opinion, the most exciting outputs from this project include the development of a multi-institution collaborative to collect surgical patients’ health and health outcome information. The information that this project has generated has led to innovative insights into the value of operative treatment for the patient, health system and government. This information has led to creative ways of re-configuring access to elective surgery, improving mental health in addition to physical health, and training students on the importance of patients’ perceptions of their health.
Impact so far
The impact of this project is local, national and international. Locally, operative patients, the health system and the province are benefiting from understanding the gain in health attributable to surgery. Nationally, this work is garnering significant attention from outcomes researchers and health systems seeking to understand variability in health and healthcare outcomes from surgical care. Internationally, this work is attracting interest from countries with public health systems with similar problems in accessing surgical care and cost-efficiency of healthcare delivery, international agencies, such as the International Consortium for Health Outcomes Measurement (ICHOM), and academic institutions.
Potential future influence
The project is continuing to expand with financial and in-kind support from new organizations. In 2021, PHSA and the Heart and Stroke Foundation (B.C.) began funding the expansion of the project.
Next steps
- Continued expansion with existing and new collaborators.
- Renewed knowledge translation with government and healthcare organizations.
- Attract new funding from national and provincial research organizations.
Useful links
There are 2.6 million Canadians with Chronic Obstructive Pulmonary Disease (COPD), representing 17% of adults between 35 and 80 years of age. COPD is a disease characterized by progressive loss of lung function that leads to shortness of breath, poor quality of life, reduced productivity, emergency visits, hospitalizations and deaths. The World Health Organization estimates that COPD will be the 3rd leading cause of death worldwide by 2030, accounting for more than 7 million deaths/year and 11,000 deaths/year in Canada. Most of the deaths and suffering occur during 'lung attacks', when patients' COPD flares-up, in response to a respiratory tract infection. Lung attacks cost the Canadian health care system nearly $3 billion each year in direct expenditures.
There are no tests that doctors can use to diagnose lung attacks and no tests that can guide doctors on how these lung attacks should be treated. In this project, we will develop lab tests to enable rapid and accurate diagnosis of lung attacks and to help doctors figure out who will have another lung attack in the near future, so pre-emptive therapies can be implemented to avoid future attacks. These tests will prevent hospitalizations and deaths from COPD and help patients to receive the right therapies at the most appropriate times.
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Research co-leads:
- Dr. Lianping Ti
University of British Columbia, British Columbia Centre on Substance Use
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Research user co-lead:
- Sampath Satti
Brave Technology Cooperate
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Team members:
- Shawna Blomskog
Brave Technology Cooperate
- Jenna van Draanen
British Columbia Centre on Substance Use, UBC
- Rod Knight
British Columbia Centre on Substance Use, UBC
- Jeffrey Morgan
British Columbia Centre on Substance Use, Community-Based Research Centre
- Oona Krieg
Brave Technology Cooperate
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The proposed activities include two workshops aimed at the collaborative development of a community-informed research agenda at the intersection of applied ethics and the use of technology to combat the overdose crisis. Brave Technology Coop (Brave) is currently piloting a new technology -a sensor that can detect changes in breathing- to aid in monitoring bathrooms for overdose intervention in commercial buildings in Vancouver's downtown eastside, with research support from the BC Centre on Substance Use.
While this intervention has the potential to make spaces safer, it also introduces privacy concerns for people accessing these spaces, particularly people who use drugs (PWUD) who face stigmatization and criminalization. Our aim is to convene stakeholders in Vancouver in November 2019 and February 2020 to discuss the ethical implications of surveillance in spaces where people may be using drugs, including how consent should be obtained with the use of passive overdose detection devices, and how to maintain privacy of sensitive data collected.
We will ultimately develop a collaborative research agenda that will facilitate PWUD, researchers, research users, and community stakeholders to co-develop systems of overdose response.
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Research co-leads:
- Laura Sauve
University of British Columbia
- Dr. Alison Gerlach
University of Victoria
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Research user co-lead:
- Matthew Carwana
BC Children's Hospital, University of British Columbia
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Team members:
- Diana Elliott
Aboriginal Infant Development Program
- Amanda Tallio
YouthCo
- Elder Roberta Price Vancouver Coastal Health, University of British Columbia
- Jenny Morgan
C&W Indigenous Health Programme
- Rochelle Lesueur
C&W Indigenous Health Programme
- Dr. Ariane Alimenti
- Dr. Tatiana Sotindjo
- Nicci Stein
Teresa Group, Aids Service Organization in Ontario
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The aim of this project is to mobilize knowledge on supporting maternal wellbeing and the early health and development of infants in British Columbia (BC) who are affected by human immunodeficiency virus (HIV) and social marginalization. The health and wellbeing of women living with HIV is impacted by social marginalization that can influence their engagement with healthcare and social services for themselves and their children. Children born to mothers living with HIV, are 'HIV exposed but uninfected' (HEU) and have an increased risk of developmental delays compared to the general child population
Children's health and health equity is inseparable from the wellbeing of their primary caregiver(s) and family as a whole. Children's equitable access to health and early years services during the critical early years can improve their long term neurodevelopmental and health trajectory. However, quality assurance and anecdotal evidence suggest that few HEU infants connect with services outside of their HIV care.
Through this project we will engage with mothers with lived experiences, frontline service delivery stakeholders from various community-based organizations that support maternal and infant wellbeing, Elders, HIV advocacy organizations, involved pediatricians and health authority and provincial policymakers
