London Health Sciences Centre (LHSC), London Health Sciences Foundation (LHSF) and Children’s Health Foundation have announced new recipients of LHSC’s Academic Realignment Initiative Awards. The awards will support 15 research and quality improvement initiatives over the next two years.
CLINICIAN-SCIENTIST AWARDS:
Improving detection and treatment of non-resolving inflammation and persistent pain in knee osteoarthritis
Clinician Scientist: Hayden Atkinson
Clinical Program Area: Orthopaedics (Physiotherapy)
Knee osteoarthritis (OA) is one of the most commonly treated conditions at LHSC and across Canada. It is a major cause of disability, work absenteeism and reduced quality of life, and there is currently no cure. Many patients with OA experience persistent pain and symptoms despite their best efforts to address risk factors. This pain and joint damage results in reduced participation in enjoyable and healthy activities, with many eventually requiring a joint replacement. While some patients experience relief from reducing excessive load on the joint, many patients don’t share this response. This may be a result of unaddressed inflammation within the joint. This research program aims to better understand the role of inflammation and its relationship with OA symptoms in response to reducing knee joint loads. By studying patients with knee OA undergoing high tibial osteotomy (HTO) – a surgery that reliably restores balanced joint loads by realigning the leg – the research team will measure the effect of persistent inflammation on OA symptoms and progression while importantly teasing out the role of excess load. This will allow the research team to identify the mechanisms that contribute to non-resolving inflammation in OA and associated symptoms and conduct further research to evaluate comprehensive treatment options.
Advancing patient safety and enhancing diagnostic utility of contrast-enhanced computed tomography through implementation of personalized patient
Clinician Scientist: Mary Castle & Taylor Ongena
Clinical Program Area: Medical Imaging
Computerized tomography (CT) acquires high-resolution images to guide clinical decision making and appropriate patient care. The CT medical radiation technologist (MRT) modifies the scan protocol to achieve the best image quality and minimize radiation dose by adjusting for patient body size. The image quality and diagnostic utility of CT scans also depends upon use of intravenous iodinated contrast medium (ICM), which is used in approximately 90 per cent of cardiovascular CT, 80 per cent of body CT and 45 per cent of thoracic CT. Although MRTs optimize the CT scan parameters to the individual patient, the use of ICM is not typically based on specific patient parameters. Optimized ICM protocols would deliver the lowest volume of ICM, injected at an optimal rate for each patient to achieve high-quality images. This approach would help minimize damage to patients’ kidneys and veins and help address the recent global shortage of ICM. LHSC’s Department of Medical Imaging is creating an academic partnership with Bayer Medical – a global leader in the development and supply of ICM injector pumps – to establish a centre of excellence in CT image quality. This project team will develop a multi-phased research and clinical translation program that will evaluate, validate and then deliver optimized ICM protocols for patients who require enhanced CT scans.
Implementing 3D printing for individualized care in gynecological brachytherapy
Clinician Scientist: Donna Murrell
Clinical Program Area: Radiation Oncology
Brachytherapy is a critical component of treatment for cervical cancer where special applicators and hollow needles are used to place a radioactive source into the tumour for short periods of time. Implanting needles in ideal positions allows for better plan quality and improved outcomes; however, it is technically challenging to do this in a way that uniquely conforms to each person’s anatomy. Innovative 3D-printed needle guides offer a low-cost, customizable, and evidence-based strategy to address this problem. Despite successful translation to clinical situations, implementation of 3D-printed needle guides into routine practice has not occurred. This program seeks to understand constraints to implementation and produce strategies to promote uptake of 3D-printed needle guides into routine brachytherapy procedures at the London Regional Cancer Program (LRCP) at LHSC.
Inclusive family care: Tending to ethical implications of family treatment in paediatric mental health
Clinician Scientist: Daniel Wyzynski
Clinical Program Area: Office of Health Ethics
Supporting the mental health concerns of parents is often in the best interests of our paediatric patients, but this becomes ethically challenging due to policy limitations, charting restrictions, and issues with current legislation. This project will examine how consent, privacy, parental obligations, provider duties, and documentation standards intersect with treatment outcomes, and will establish ethical guidelines and recommendations for future practices. This research will explore the opportunities and barriers for caregiver treatment where children are receiving care in paediatric mental health settings. The goal is to support inclusive family care, acknowledging that paediatric patients are often highly dependent on and impacted by their caregivers.
FELLOWSHIPS:
Advanced Practice Fellowships
A program to develop the capacity and capability to provide bispecific T-cell engager (BiTE) therapies for cancer patients at LHSC
Fellow: Morgan Black
Supervisor: Dr. Daniel Breadner
Clinical Program Area: Oncology
The recent introduction of immunotherapy has transformed cancer treatments and outcomes. The development of a new generation of immunotherapy, called bispecific T-cell engagers (BiTE), brings immune cells called T-cells to cancer cells and activates those immune cells to kill the cancer. BiTE therapies have demonstrated clinical benefit in treating multiple types of cancer. Currently, an increasing number of BiTE compounds are in development and being evaluated in multiple solid tumour types. Although BiTE therapies display promising efficacy, they can cause immune-related side effects that can occasionally be quite severe. At the beginning of treatment, patients require admission for 48 hours for monitoring for these reactions, which require immediate treatment, and some patients may require intensive care unit (ICU) support. The goal of this project is to design and implement a BiTE treatment care path which would facilitate the safe administration of these novel and exciting compounds. In the immediate future, BiTE treatments will largely be administered in the context of clinical trials for solid tumour malignancy, but we envision these regimens becoming a standard of care for cancer patients with a variety of tumours in the future.
Canadian National Obstetrical Centre of Excellence – Best Practices Fellowship
Fellow: Natasha Quin
Supervisors: Paula Merini / Dr. Narinder Paul
Clinical Program Area: Medical Imaging
Congenital anomalies affect approximately 1 in 25 babies and can have profound implications for the health of the baby and mother. Early, accurate diagnosis is essential to inform decision making and appropriate management. LHSC is the perinatal referral centre for southwestern Ontario and as such, it is crucial that the obstetrical ultrasound imaging, teaching, research and patient care provided at LHSC remains at the highest level. The Medical Imaging department, in conjunction with the Obstetrical Maternal Fetal Medicine (MFM) division, specializes in providing subspecialty care and access to ultrasound imaging and antenatal care for the region’s high-risk patients throughout their pregnancy. LHSC has recently committed to a significant investment in the latest generation of ultrasound equipment to meet the growing demands for access to high-resolution imaging in this complex patient population. Alongside technological advancements, there is a pressing need for comprehensive education and training to optimize the clinical benefits of these systems. The purpose of this project is to support the development of an advanced training and education program in MFM ultrasound. Through groundbreaking research, machine training for superusers, education program development, imaging program updates and academic collaboration, the initiative aims to align with LHSC’s strategic priority of advancing excellence and elevate its MFM ultrasound program to create a Canadian National Obstetrical Centre of Excellence.
The implementation of a comprehensive clinical neurophysiology program in paediatric neurosciences
Fellow: Anastasiia Skovronska
Supervisors: Drs. Andrea Andrade and Sandrine deRibaupierre
Department: Department of Clinical Neurological Sciences and Department of Paediatrics
Epilepsy is a common condition affecting approximately 15,000 children in Ontario. Approximately 5,000 of those children will develop epilepsies that do not respond to medications. This group of children faces major challenges related to their epilepsy and seizure burden, which may include side effects of multiple medications and other conditions such as behavioral or cognitive problems. Children’s Hospital at LHSC is one of two provincially-designated regional paediatric epilepsy surgical centres of excellence. This fellowship opportunity will help Children’s Hospital further strengthen clinical and research productivity in paediatric epilepsy and beyond. It will also offer a unique opportunity for Children’s Hospital’s clinical neurophysiologist to implement new innovations that will position Children Hospital as a leader in this field.
Enhancing dysphagia care practices in head and neck cancer
Fellow: Kendra Thouless
Supervisors: Julie Theurer
Clinical Program: Health Disciplines – Speech Language Pathology
Healthy swallow function supports efficient intake of nutrition and hydration, minimizes the risk of pneumonia and contributes to one’s quality of life. Meanwhile, difficulty with swallowing, also called dysphagia, can significantly and adversely affect an individual’s health and wellbeing. While many health conditions increase risk for dysphagia, patients with head and neck cancer are particularly vulnerable since dysphagia can be present before cancer treatment and also arise as an immediate and/or long-term side effect of treatment. With improved survival rates in head and neck cancer, preventing the consequences associated with dysphagia has become one of the most important challenges of speech-language pathology care for these patients. Best practices for dysphagia intervention are not established and care varies between clinicians and across institutions. This research will focus on determining the usefulness of a swallowing assessment for head and neck cancer patients prior to starting treatment, establishing evidence to support delivery of the right intervention to the right patient at the right time – with a goal of improving health and quality of life outcomes for patients.
Clinical Fellowships:
Genetic and epigenetic diagnostics in epilepsy: Utility and impact of advanced genetic testing in childhood epilepsy
Fellow: TBD
Supervisors: Drs. Tugce Balci and Maryam Nouri
Clinical Program Area: Paediatric Epilepsy Program and Medical Genetics (Department of Paediatrics)
Epilepsy is the most common serious neurological disorder in children. It is a heterogeneous condition with many different genetic and environmental causes. Genetic testing has had an increasingly important role in the epilepsy diagnostic process with recent work suggesting a genetic reason is found in ~30 per cent of patients. Even with optimized access to genetic testing, many patients with epilepsy have an “inconclusive” genetic testing result. This proposal offers a unique opportunity to harness existing areas of specialization, expertise and collaboration in genetics and epilepsy at LHSC to analyze the utility of a novel epigenetic diagnostic test for children with epilepsy. This research aims to use episignature analysis to reach a diagnosis. The researchers will leverage this novel genetic technology developed at LHSC to improve the detection rate in paediatric patients with epilepsy. This work aims to ultimately improve clinical care and quality of life for children and families living with the condition.
Complex aortic surgery clinical fellowship
Fellow: TBD
Supervisor: Dr. Michael Chu
Clinical Program Area: Cardiac Surgery
The complex aortic surgery fellowship will set the stage for groundbreaking advancements in the field of thoracic aortic surgery with an emphasis on advanced techniques and innovative approaches. What makes the fellowship unique is its focus on aortic reconstructive surgery of the aortic root, ascending aorta, aortic arch and descending aorta, where trainees will learn highly specialized techniques that are only available in a handful of health-care centres across the country. This program has attracted applicants from around the globe because of LHSC’s unique combination of clinical expertise and state-of-the-art operating room facilities. This fellowship will encompass all aspects of patient care – fellows will master pre-operative assessment, interoperative repair, and postoperative management, ensuring comprehensive and seamless care throughout the patient’s journey. They will also become champions of research, undertaking at least two major projects during the year. By pushing the boundaries of aortic surgery, fellows will contribute to the creation of new knowledge, the development of best practices, and the improvement of patient care.
Minimally invasive, robotic, and transcatheter cardiac surgery fellowship
Fellow: TBD
Supervisor: Dr. Michael Chu
Clinical Program Area: Cardiac Surgery
The minimally invasive, robotic, and transcatheter surgery fellowship aims to equip trainees with advanced skills in treating complex heart diseases using cutting-edge minimally invasive techniques. This fellowship stands out due to its focus on endoscopic, robotic, and transcatheter approaches, offering a unique opportunity for fellows to learn innovative methods of cardiac surgery. By emphasizing advanced techniques, the program strives to improve patient outcomes and revolutionize the field. These procedures offer several advantages, including shorter hospital stays, faster recovery times, and improved overall quality of life for patients. By immersing fellows in various stages of patient care, the program ensures a well-rounded learning experience that encompasses the entire treatment process and prepares the fellows to launch a career in minimally invasive cardiac surgery. Fellows are mentored through at least two major research projects during the year, and these research endeavors will contribute to the growing body of knowledge in cardiac surgery, further refining treatment approaches and enhancing patient outcomes. This fellowship is unique in its commitment to guiding fellows to learn how to establish their own programs or practices, gaining the necessary skills and knowledge to drive innovation and disseminate best practices in cardiac surgery.
Stroke neurology fellowship: Implementing Canada’s first heart and brain program
Fellow: Arturo Gonzalez-Lara
Supervisor: Dr. Lauren Mai
Clinical Program Area: Stroke Program / Clinical Neurological Sciences
Cardioembolic strokes can have devastating effects and account for a significant portion of ischemic strokes, when a vessel supplying blood to the brain is obstructed. Fortunately, new minimally-invasive cardiac technologies and improved medications have provided the means to reduce recurrent stroke risks. Implementing best practice guidelines and utilizing these state-of-the-art advances in stroke care requires the involvement of both cardiologists and stroke physicians. To improve the management and prevention of cardioembolic strokes, this fellowship will formalize a clinical and academic partnership between stroke neurologists and cardiologists at LHSC in a heart and brain initiative that aims to enhance patient care, reduce stroke recurrence and improve cardiovascular health. This initiative will contribute to improved stroke care, attract skilled professionals and position LHSC as a leader in the field.
Establishing role of functional near infrared spectroscopy (fNIRS) in pediatric epilepsy surgery
Fellow: Marcelo Oppermann
Supervisor: Dr. Victor Yang
Clinical Program Area: Clinical Neurological Sciences
Spinal metastasis, a condition involving cancerous tumours of the spine, poses challenges to accurate diagnosis and effective treatment. Separation surgery, involving tumour resection to create a tumour-free zone around the spinal cord, is critical for postoperative radiotherapy treatment. While these surgical attempts to create a tumour-free zone around the spinal cord can cause additional neurological damage, robotic systems can offer enhanced precision, visualization and control, improving surgical outcomes.
An autonomous robotic system developed by the research group utilizes advanced imaging and surgical planning, and preclinical studies have demonstrated the reliability and feasibility of the system. During this research, the investigators plan to use the same robotic system to make the separation surgery more effective. By implementing this autonomous robotic system, standardizing the procedure and replicating it across surgeons, the aim is to redefine spinal metastasis surgery by improving surgical accuracy and optimizing disease control.
Stroke neurology fellowship: Improving outcomes in ischemic stroke in patients with atrial fibrillation while on anticoagulation
Fellow: Jaime Eduardo Rodriguez-Orozco
Supervisor: Dr. Lauren Mai
Clinical Program Area: Stroke Program/Clinical Neurological Sciences
Atrial fibrillation (AF) is one of the most common causes of ischemic stroke (IS), which occurs when a vessel supplying blood to the brain is obstructed. It is usually treated with blood thinners called anticoagulants to reduce the risk of new blood clots. However, there are patients that experience a new IS even while on anticoagulants and there are currently no clear recommendations on how to treat those patients.
LHSC is a national leader in the delivery of high-quality stroke care and is home to the London Ontario Stroke Registry. Using this unique and robust local registry, which includes over 5000 patients, the clinical fellow will identify patients with known atrial fibrillation and recurrent stroke events, investigate reasons for recurrent stroke, and survey those affected to understand why treatment failed. Characterizing this population and determining the reasons for treatment failure will help create better strategies for treating these patients. The knowledge gained will inform a quality improvement initiative that will be implemented to reduce stroke recurrence in atrial fibrillation.
Does distance from treating tertiary care hospital impact post-operative anxiety in parents of paediatric surgical patients: A prospective cohort study to assess quantitative and qualitative outcomes
Fellow: Leandra Stringer
Supervisors: Drs. Sumit Dave and Dr. Peter Wang
Clinical Program Area: Paediatric Urology
The goal of this study is to understand the impact of distance from treating hospital on parental anxiety and outcomes following day surgery for paediatric urologic conditions. A prospective study will compare post-operative parental anxiety and overall outcomes for children who reside close to an academic hospital with those who reside in more rural locations. Through a qualitative approach, parental input will be sought in order to identify factors which lead to this additional stress and identify potential solutions. By identifying areas for improvement, the research team hopes to make care more equitable and improve outcomes for all patients.
