Improving Therapeutic Decision-Making During Active Clinical Practice

The ultimate goal of Laura Esmail’s research is to improve the management of medication use and patient outcomes. Studies estimate that 4.3% of hospital admissions in industrialized countries are due to preventable adverse outcomes of drug therapy. To begin to address this problem, Laura developed and tested a decision-making network aimed to improve physicians’ drug therapy decision-making. The conceptual framework of this network was based on the theory of cognitive apprenticeships: the process of understanding concepts through engaging in authentic activities and actual practice. Through linking family physicians with clinical pharmacists using cellular-telephone instant group conferencing, Laura attempted to create a continuous, contextual, social learning environment in which therapeutic expertise and experience could be shared and acquired at the time of patient care decision-making. This network ultimately aimed to facilitate the collaborative decision-making process that often takes place between health care professionals during hospital medical rounds. Results of her study concluded that cellular-telephone instant group conferencing between family physicians and clinical pharmacists is a useful method for influencing and assisting with drug therapy decisions at the time of patient care decision-making. Further modifications to the network are necessary before feasibility can be fully assessed. This work is an important contribution towards the understanding of decision-making systems that can improve drug related morbidity and mortality and help advance patient care.

Metabolism and Inactivation of Glucagon by Dipeptidyl Peptidase IV (DPIV)

John Pospisilik’s research centres on glucagon, an important hormone involved in regulating blood sugar levels between meals. Glucagon prevents hypoglycemia (low blood sugar) by releasing sugar stored in liver, fat and muscle. While type 1 and type 2 diabetes both involve excessive release of glucagon, until recently, little was known about how the body inactivates and clears glucagons from the blood stream. Pospisilik contributed to research that showed the DP IV enzyme may inactivate glucagon. Now using state-of-the-art and conventional techniques, he is examining the process in which DP IV may inactivate and clear glucagon, and developing tools to measure active glucagon. He hopes this research will lead to novel treatments for diabetes.

Moment-to-Moment: Narratives of Mindfully Living-and-Dying

Anne Bruce’s research focused on the potential for mindfulness meditation to promote a better quality of living and dying by reducing stress and anxiety. Mindfulness meditation, which involves nonjudgmental and moment-to-moment awareness of change within a person’s mind and body, has been researched extensively for the last decade. But little research has been done on the experience of people with life-threatening illness and hospice caregivers who practice this form of meditation. At the Zen Hospice Project in San Francisco, where care is based on mindfulness meditation, Anne conducted extensive fieldwork while working as a volunteer caregiver. Through in-depth unstructured conversations, she gained insights about new ways of understanding death and dying, and their meaning for those holding non-theistic, non-Western perspectives. Anne hopes findings from this research will help enhance understanding of mindfulness meditation as a self-care practice for people with life-threatening illness. Ultimately, she hopes her work will help program planners develop new models of hospice care and support services that address psychological and spiritual needs of people with life-threatening illness and their caregivers.

Domestic violence victims’ appraisals of future risk: The Impact of trauma symptoms on the accuracy of risk appraisals and safety planning

Research suggests spouse abuse victims, particularly those experiencing severe psychological trauma, may underestimate their risk for future violence from their partners and, therefore, be less likely to engage in safety planning. Dr. Tonia Nicholls is advancing that research by examining how psychological, social and environmental factors impact women's appraisals of risk of future abuse and ultimately, their willingness to seek help. Nicholls will contrast the subjective risk appraisals of battered women with objective risk appraisals made with structured risk assessment measures. The goal is to increase awareness among service providers about the factors related to victims' minimization of risk and improve risk management with former batterers at risk for relapsing into abusive behaviour. She also hopes the research will result in effective methods for educating women about their partners' level of risk and encourage victims to engage in safety planning and/or treatment.

Encapsulation based in vitro selection of RNA catalysts

Naturally occurring cellular components such as enzymes are often the only tools available to perform biological research, a limitation that slows the pace of research and hinders the search for cures to human disease. The situation is similar to having your car break down in the middle of the street and having to make repairs using parts scavenged from neighbouring automobiles. A proper toolbox would greatly decrease the time required to perform the repair. My research examines the potential functions of ribonucleic acid (RNA), a cellular component which is vital for the development and functioning of all living things. I am examining the ability of RNA to replicate itself, without the help of protein, because RNA may be capable of important metabolic functions that are currently performed by protein enzymes. I am developing in vitro (in the test tube) techniques to isolate new RNA catalytic molecules. Because these artificially manufactured catalysts perform specific functions, they can be used as tools for conducting medical research. Ultimately, I will examine whether artificial RNA sequences can interact with existing cellular components. Such experiments give us a better understanding of natural processes within cells, perhaps leading to potent new genetic therapies for the treatment of disease.

The role of the hematopoietic progenitor antigen, CD34 on mature mast cells

A study that Erin Drew took part in revealed some surprising insights about the mysterious CD34 protein. Contrary to the predominate belief that this protein is absent on mature blood cells, this study demonstrated that CD34 is present on mature mast cells. These cells play a major role in the development of asthma and allergies by releasing strong chemicals such as histamine into tissues and blood. In her Master’s research, Erin further investigated the role of CD34, and a similar protein CD43, on mast cells. Her research suggests that CD34 blocks inappropriate cell adhesion, and that CD34 and CD43 play an important role in the appropriate migration of cells into tissues. Erin hopes this work could lead to new drug treatments for asthma and allergies, as well as contribute to the emerging use of stem cell transplantation in treatment of diseases.

Social Support Among Patients with Rheumatoid Arthritis: A Daily Progress Study

Because there is no cure for Rheumatoid Arthritis (RA), treatment focuses on alleviating pain symptoms and maintaining function. With that in mind, Susan Holtzman studied the links between pain levels, stress, ways of coping and social supports in patients with RA. The few existing studies in this area indicated that patients with strong social supports experience less pain and disability, but Susan wanted to examine this more closely. In her study she used daily monitoring techniques and collected detailed data from patients and their spouses. Susan used an advanced modelling technique to analyse the findings and concluded that social support decreased pain levels by encouraging and improving coping strategies. Findings from this study highlight the importance of social support. The research may ultimately lead to the development of psychologically-based treatment and individually-tailored pain management for patients with RA.

The role of SHIP in normal and aberrant macrophage and osteoclast development and function

Michael Rauh believes the best approach to health research is to acquire insights from patients, and then to explore those insights in the laboratory. That’s why he’s enrolled in a combined MD/PhD program at UBC to become a clinician-scientist. Rauh’s research focuses on the molecular pathways that lead to the development of cancer cells. His particular interest involves the SHIP gene and its possible use as a therapeutic target in the treatment and prevention of leukemia and other diseases such as osteoporosis. Rauh is investigating whether SHIP can inhibit development of the diseases by preventing inappropriate cell growth. The research will contribute to his ultimate goal of learning how to identify cancer at its earliest, most treatable stages to enable more effective preventative strategies.

Menstrual pain and discomfort in adolescence: Socialization influences

Tina Wang’s interests in health psychology and peer influences prompted her to examine a problem that is a major cause of missed school days among adolescent girls – menstrual pain and discomfort. Most adolescents fail to manage their pain effectively. But virtually no research has been done on how adolescent girls influence each other’s attitudes towards pain. Wang’s study will focus on similarities and differences in the attitudes and coping behaviours of adolescent girls related to menstrual pain. Identifying peer influences could lead to the development of school programs that help adolescent girls manage menstrual pain more effectively, resulting in better health and fewer missed school days. Wang’s long-term goal is to contribute to women’s health by developing a better understanding of the social factors that influence health.

Developing an effective and efficient health care delivery system for Canadians at the end-of-life

In the mid-eighties, while working as a palliative care nurse, Dr. Kelli Stajduhar cared for a young man dying from AIDS. A few years later, her mother was diagnosed with lung cancer and died. Both received less than optimal care at the end of their lives. Stajduhar was profoundly affected by those experiences, which gave her a strong desire to examine ways to improve care and support for people at the end-of-life. Stajduhar’s PhD research focused on the provision of home-based care for people who are dying, and its impact on family caregivers. Her postdoctoral work aims to identify the elements needed for an effective, efficient, comprehensive and coordinated system of health care for Canadians who have come to that point in their lives. Ultimately, Stajduhar would like to advance health policy on end-of-life care.