Cytomegalovirus (CMV) remains one of the most common infections after transplant and despite medical advances, still poses significant challenges. Currently, transplant patients at risk of developing CMV infection are either given antiviral medications or are monitored by blood tests that detect CMV. However, these medications can have serious side effects and may only delay but not eliminate CMV infection. Furthermore, monitoring the blood for CMV ideally requires weekly blood draws.
We are designing a blood test, the CMV-AIM assay, as a personalized approach to monitoring the immune system against CMV after transplant. This test will not require additional blood collections as it will be done concurrently with routine blood tests, and not more frequently than once monthly. We have previously shown in kidney transplant patients that the CMV-AIM assay done early after transplant can predict those patients that later go on to develop CMV infection requiring treatment. The goal of this study is to trial and expand the CMV-AIM assay to all solid organ transplant patients, including lung, heart, liver, and kidney transplant patients and to validate this test in the clinical immunology laboratory to incorporate it into patient care.
Research Location: Vancouver Coastal Health Research Institute
Tele health for Emergency-Community Continuity of Care Connectivity via Home Telemonitoring Blood Pressure (TEC4HOME-BP)-a Randomized Controlled Trial
Around one in four Canadians have high blood pressure (BP), also known as hypertension. High BP is a major risk factor stroke, heart attack, and kidney disease. Lowering BP levels by a small amount, can reduce risk of heart disease and stroke. Hypertension control rates in Canada are the lowest that they have been in a decade. Patients with hypertension frequently need to visit the emergency department (ED) due to high BP. Hypertension is one of the chronic diseases that can be managed effectively with digital health technology. We do not know the best way to manage BP after people are discharged from the ED. Many doctors worry that their BP may go too high or low if we treat or do not treat their BP. We do not know if digital health technologies can be used to safely monitor these people as they transition from the hospital to home and help control their BP. We will test to see if home blood pressure telemonitoring (HBPT) plus pharmacist case management will result in better BP control for participants who are discharged from the ED with uncontrolled high BP compared to standard care. We hope to create a toolkit on how to implement a HBPT program for people discharged from the ED with high BP and inform guidelines on high BP.
Engaging ethnocultural communities in health-promoting programs: the role of trust
There is a pressing need to find effective ways to promote health and well-being of ethnoculturally-diverse older adults. To do so, it is important to foster trust between researchers and ethnocultural communities; yet our understanding of how to do so is limited. Therefore, we propose to convene scholars from implementation science, ethno-gerontology and healthy aging; community partners that serve diverse groups of older adults; and older adults themselves to explore the idea of trust and how to foster trust between researchers and ethnocultural communities in Canada. Using a “Café Scientifique” approach that encourages ‘deep’ discussion these groups will get together to: i. explore the role of trust in health-promoting programs for older adults from ethnocultural communities and identify effective approaches that foster trust; ii. co-create a ‘Trusted Partnership Roadmap’ with guidelines for research and practice, that identifies culturally appropriate trust-building strategies, and iii. plan for a CIHR Project Grant in cultural adaptation of Choose to Move-an effective health-promoting program for older adults.
Indigenous, community and research partnership to collaboratively explore environmental justice, unconventional gas development (UGD), wildfires, and health in Northeast British Columbia
UGD is taking place in Northeast BC, close to traditional territories of First Nations who rely on the land for food, water, ceremonial practices and cultural identity. People living in the region have also faced unprecedented wildfires. Health concerns about UGD include carcinogenic and endocrine-disrupting chemicals, and asthma triggers while the negative health impacts of wildfires are only beginning to be understood. To our knowledge, there is almost no research into the combined effects of both UGD and wildfire exposures. Furthermore, neither UGD nor wildfires are distributed or experienced equally across Indigenous and non-Indigenous populations. Indigenous communities in Canada are more likely to be evacuated due to wildfires and face disproportionately greater negative health impacts from UGD. Applying a lens of environmental justice and Indigenous Ecological Knowledge, our goal is to partner with the Saulteau First Nation and local health providers to review the current research on the health impacts of UGD while understanding the lived experiences and priorities of research users. We will work together to review and co-design the best approaches to studying the dual health impacts of UGD and wildfires in Northeastern BC.
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.
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.
Digital health to guide the transition to menopause: Recognizing normal and abnormal changes during reproductive aging
During the years leading up to menopause, women often experience menstrual cycle and flow changes. This is usually part of normal aging, but can also be the first symptom of endometrial cancer, the most common gynecological cancer in Canada. Few women are aware of the risk factors for endometrial cancer, can recognize abnormal bleeding, and/or seek medical help. Predicting cancer risk and determining which abnormal bleeding is associated with endometrial cancer is a top priority for clinicians and women alike, because if detected early, this cancer is curable and has exceptional outcomes. Digital health technology (e.g. mobile phones apps) and analytics can help women track and monitor risk factors and symptoms and be alerted when suspicious patterns arise. In this project, we will collaborate with women in the community, patients, clinicians, and women’s health researchers to co-design digital health tools that can help women learn about and assess their risk factors for endometrial cancer, discern symptoms of cancer from those of normal aging, and provide opportunities for education, prevention, and early detection, especially among women at high-risk for cancer.
Team members: Jerilynn Prior (UBC); Lauren Tindale (UBC); Malak Ibrahim (UBC); Lori Brotto (UBC); Gurm Dhugga (UBC); Shirley Weir (Community Partner); Ali Zentner (Revolution Medical Clinic); Elise Abi Khalil (UBC); Shanzhao Wang (OVCARE, BC Cancer Agency); Sabrina Wong (UBC); Candice Taguibao (Women’s Health Research Institute); Nicole Prestley (Women’s Health Research Institute)
Reimagining gynecologic cancer survivorship: Creating a provincial strategy for survivorship research and care in British Columbia
In Canada, two-thirds of people diagnosed with cancer today will be long-term cancer survivors. With advances in early detection and improved treatment, and an ageing population, this number is expected to continue to rise highlighting the urgency for improved strategies to enhance the well-being of individuals, and their families, living with and beyond cancer. In partnership with patients and families, and the clinical and scientific community in BC, we plan to hold a series of stakeholder events and surveys that will address the impact of a gynecologic cancer diagnosis and treatment on the mental health, cognition, financial burden, and sexual health of those affected. We will also examine the impact of hereditary cancers and patient education/navigation to improve upon a patient’s journey through their cancer diagnosis and treatment. Through this work, we will map out the clinical and research resources available across the province to support a long-term research strategy and plan. By putting patient and family voices and experiences at the centre of the strategy, it will enable our research team to develop a provincial strategy that is biologically-relevant and socio-culturally informed.
Team members: Siv Klausen (UBC); Nancy Cleveland (Gynecologic Cancer Initiative); Nicole Keay (Gynecologic Cancer Initiative); Stephanie Lam (UBC); Jocelle Refol (Simon Fraser University); Gavin Stuart (UBC); Michelle Woo (UBC); Nicole Prestley (Women’s Health Research Institute); Lori Brotto (Women’s Health Research Institute); Janice Kwon (UBC)
Mobilizing falls prevention knowledge with patients and clinicians in British Columbia
Effective approaches to prevent falls exist, yet barriers to their uptake exist. These barriers include: 1) patient knowledge of best-practices for falls prevention; 2) geriatrician time and a geriatrician shortage in British Columbia (BC); and 3) access to Otago Exercise Program (OEP) training across BC. To mitigate some of these barriers, we propose a series of videos guided by patient, clinician and physiotherapist champions. The Falls Prevention Clinic team includes patient partners, geriatricians, and physiotherapist champions who deliver the OEP. A primary goal of this video series will be to: 1) increase awareness using accessible language of best practices for falls prevention; 2) increase referrals to physiotherapists for falls risk assessment from geriatricians; and 3) provide access to resources for physiotherapists who would like training in the delivery of the OEP. The intent of these videos is to prevent falls and thus promote healthy aging by: 1) facilitate improved patient understanding of how to prevent falls; 2) address the geriatricians capacity burden through increased physiotherapist referrals for falls risk assessment; and 3) foster translation of the OEP to physiotherapists across BC.
Team members: Tracy Dignum (UBC); Teresa Liu-Ambrose (UBC); Linda Li (UBC); Kenneth Madden (UBC); Naaz Parmar (UBC); Larry Dian (UBC); Catherine Chan (UBC); Alison Chan (UBC); Lillian Morishita (Retired); Cassandra Adjetey (UBC); Eleanor (“Jean”) Ko (Retired); Mohammed Esfahaad (Retired)
An iKT, interpretivist, feminist, multi-method study examining the experience of, and models of treatment for, acute postpartum mental illness
Postpartum depression is common, affecting 10-15% of women, and increases risk for suicide. Postpartum psychosis is rarer (approximately 1/1000 women), but is a psychiatric emergency. Women with postpartum psychosis or severe postpartum depression need care in hospital to protect their health, and the health of their families. Currently in Canada, these hospital stays separate women from their babies, which can be traumatic for mother and baby. In other countries, Mother-Baby Psychiatric Units (MBUs) admit both mother and infant for care. This study will investigate whether MBUs are suitable for Canada, or whether another model of care would be better for Canadian families. To do this, we will conduct three sub-studies. Sub-study 1 will amplify women’s stories of the experience of a hospital stay for postpartum mental illness in Canada. Sub-study 2 will describe the frequency and predictors of hospitalization for postpartum mental illness. Sub-study 3 will provide a rich picture of the MBU model of care through a case study of five international MBUs. By understanding how to best meet the needs of women and families living with serious postpartum mental illness, we aim to improve mental health outcomes across generations.