University Health Network Archives | Research & Innovation

CIHR-funded nursing study finds specialized senior care delivers best hospital outcomes

fmaquito — Mon, 11 Apr 2011 08:00:00 +0000

Seniors receiving hospital care in acute care for elders units have shorter hospital stays, experience fewer declines in physical functioning and are less likely to be discharged to a nursing home than when treated in regular hospital units. This is one of the preliminary findings of a -funded study led at 91��ɫ.

The researchers systematically screened more than 50,000 articles on existing studies of acute care for elders interventions, and included 63 different studies in either a narrative or meta-analysis.

91��ɫ nursing Professor Mary Fox, the study's principal investigator, unveiled the preliminary findings at 91��ɫ Central Hospital recently, while Michael Johnny of the Knowledge Mobilization (KM) unit provided KMb strategies to help the hospital determine how to disseminate the information.

Above: Mary Fox with participants at the unveiling at 91��ɫ Central Hospital

The goal of the research is to develop senior-friendly hospitals by informing and engaging decision makers about the best interventions to prevent functional cognitive, social and physical decline in older adults when they are hospitalized. Seventy-five per cent of people age 65 and older have two chronic illnesses and that can lead to a sudden worsening of their condition requiring hospitalization, says Fox.

Right: Mary Fox

“Sixty-two per cent of all day beds in acute care are filled with people 65 years of age and older and they make up only 13 per cent of the population. They really are the core care customer for acute care hospitals,” she says. “My role is to get the evidence and engage the decision makers and researchers in interpreting it for their context. We’re not just rolling it out, but engaging them from the very beginning so the information will be more useful.”

Left: Deborah Tregunno

The study also looked at what the system needs to provide and what interventions are needed to best serve seniors in acute care hospitals.

“I was interested in the study because there is really a lot of evidence that says when older people visit hospitals, they are at risk of experiencing bad outcomes,” says Fox. “The poor outcomes are not related to their illness, but to other things, like not getting up and walking around while in the hospital or not eating well. There are things that fall through the cracks.”

91��ɫ Central Hospital is interested in knowing what those things are so they can provide even better care for older adults.

Professor Deborah Tregunno and Professor Malini Persaud, a former post-doctoral fellow, both of 91��ɫ's School of Nursing in the Faculty of Health, along with 91��ɫ librarian IIo-Katryn Maimets and researchers from Ryerson University and the University of Toronto, were co-investigators of the study.

The team also included Michael Johnny, Andrea England, director of research and partnerships in the Faculty of Health, 91��ɫ adjunct librarian Angela Hamiton and decision-making partners Tiziana Rivera, chief practice officer at 91��ɫ Central Hospital, and Dr. Mary Ferguson-Paré, former vice-president of professional affairs and chief nurse executive at University Health Network.

By Sandra McLean, YFile writer

Republished courtesy of YFile– 91��ɫ’s daily e-bulletin.

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Professor Sherry Grace's study shows positive benefits of cardiac rehab participation

fmaquito — Tue, 15 Feb 2011 10:00:00 +0000

Health care practitioners can increase the number of patients referred to a cardiac rehabilitation program by more than 40 per cent, helping them to reduce their risk of dying and improve their quality of life, say researchers at the Peter Munk Cardiac Centre.

Researchers explored multiple strategies to increase referrals to cardiac rehabilitation programs at 11 hospitals across Ontario, including using a discharge checklist for doctors, electronic referral in medical records and talking with patients at the bedside.

According to the study, “Effect of Cardiac Rehabilitation Referral Strategies on Utilization Rates”, published in the Feb. 14 edition of the journal , a combined approach – a checklist or electronic referral and talking with patients – can increase referrals by 45 per cent. By targeting both health care providers and patients, more than 70 per cent of patients enrol in cardiac rehab.

“Every patient discharged from the hospital with a heart condition should be referred to a cardiac rehab program,” says 91��ɫ kinesiology & health science Professor Sherry Grace, principal investigator and director of research for the Cardiovascular Rehabilitation & Prevention Program at the Peter Munk Cardiac Centre, which is part of the University Health Network in Toronto.

“Cardiac rehab is a key component of the continuum of cardiac care. We shouldn’t just discharge patients from the hospital without ensuring there is a link to these proven rehab services to support patients in their recovery,” says Grace.

Cardiac rehabilitation offers a comprehensive approach to health by combining medical treatments and lifestyle modification. Patients are able to benefit from a variety of services, including: education sessions, nutritional assessment with a dietitian, risk factor treatment (hypertension, cholesterol and smoking cessation) by physicians and nurse practitioners, medication review with a pharmacist, targeted exercise prescription by an exercise physiologist, nurse or kinesiologist and supervised exercise.

indicate that participating in cardiac rehab after a cardiac illness, such as a heart attack, can reduce the risk of death by approximately 25 per cent, a reduction similar to that of other standard therapies such as cholesterol-lowering medications (statins) and aspirin. In spite of this evidence, only 20 to 30 per cent of patients are referred to a cardiac rehabilitation program after hospital discharge, a phenomenon observed in many countries.

Joe Walters, 55, lost 30 pounds through the centre’s Cardiac Rehabilitation Program at Toronto Western Hospital (TWH) after having being diagnosed with an irregular heartbeat in August 2009.

“The cardiac rehab program was truly motivational. It opened my eyes to the number of people who have heart problems like me, and it was refreshing to know it came with a built-in support network,” says Walters, who notes work-related stress contributed to his weight gain and heart trouble. “I highly recommend a cardiac rehab program for anyone with a heart condition.”

Walters graduated from the program in April 2010, but continues to attend classes to keep the weight off.

Dr. Caroline Chessex, medical doctor and clinical director of the Cardiovascular Rehabilitation & Prevention Program at the centre, is part of a multidisciplinary team who treats patients like Walters by developing a personalized exercise program tailored to each patient's cardiac risk profile.

“Our goal is to develop strategies for patients to reduce or eliminate their risk of coronary artery disease, prevent or minimize hospitalization, decrease mortality and improve quality of life,” says Chessex, noting that patients can prolong their life and reduce their risk of having a second heart attack, or needing a second heart surgery.

Beyond the physical and psychological benefits, cardiac rehabilitation saves money. Cardiac bypass surgery, the most common type of open-heart surgery, costs approximately $23,000 for each patient, but rehabilitation costs $1,000 to 1,500 per patient.

“The return on investment is obvious. Focusing on expensive cardiac interventions and then discharging patients without a systematic approach for support just doesn’t make sense,” says Grace. “Cardiac rehab is the right step towards prevention and it saves money.”

The (CIHR) and the funded this study.

Republished courtesy of YFile– 91��ɫ’s daily e-bulletin

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Nursing researchers collaborate with Department of Theatre to highlight patient safety issues on stage

fmaquito — Fri, 29 Oct 2010 08:00:00 +0000

When it comes to Canadian Patient Safety Week, the play’s the thing.

Researchers at 91��ɫ’s have come up with a pioneering way to convey their evidence-based research on what can happen when health-care mistakes are made – they’re putting on a play about it.

Seeing the Forest, inspired by a true story about what happens when a patient is not heard, will be staged as part of , Nov. 1 to 5.

Directed by 91��ɫ theatre studies PhD candidate Laura Jayne Nelles (BA Spec. Hons. ’84, MFA ’07) and presented by 91��ɫ's Faculty of Health and the 91��ɫ – UHN (University Health Network) Nursing Academy, the play will take place Monday, Nov. 1 at 1pm in 152 Founders Assembly Hall, Founders College, Keele campus. The event is free and open to everyone.

It will also be performed as part of a symposium at various health-care sites across the Greater Toronto Area.

91��ɫ Professors Deborah Tregunno and Liane Ginsburg of the School of Nursing, are leaders in the field of patient safety culture. They collaborated with 91��ɫ nursing Professor Gail Mitchell, who has experience with conveying research findings through the arts. This dramatic approach presents research from their studies conducted in four provinces, in cooperation with the Canadian Patient Safety Institute.

The play’s development was financially supported by the 91��ɫ’s Faculty of Health Interprofessional Education Fund (IPE). IPE programming is shared with the health-care community through the Faculty’s innovative .

Co-written by professional playwright Julia Gray (BFA Spec. Hons. ’98, MA ’07) and Mitchell, Seeing the Forest is being performed in collaboration with six organizations, including the Central Community Care Access Centre, the , , , and Unionville Home Society.

“By dramatizing research using the arts, the findings become more meaningful,” says Mitchell. “The play presents the complexity of real life from the perspective of the patient and health care professionals. The impact is much stronger than it would be if you were just reading words off the page of a research report.”

The key character in the play, Healther, goes to the hospital for routine surgery and tries to communicate specific concerns to different health-care providers, yet things go awry. Research suggests that 2.9 to 16.6 percent of patients in acute care hospitals experience one or more adverse events.

“Health care providers work hard to keep patients safe every day. However, there are often systemic issues that contribute to errors. This play is valuable because it strikes an emotional chord and engages people in conversations about improving safety,” says Tregunno.

“This play is a great example of the innovative and interdisciplinary approaches to health care led by 91��ɫ’s Faculty of Health,” adds Professor Lesley Beagrie, associate dean, professional & global programs. “Instead of tailoring health-care programs to individual silos within the health profession, we aim to keep the focus on the end user – the patient.”

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Professor Yvonne Bohr to direct LaMarsh Centre for Research on Violence & Conflict Resolution

fmaquito — Fri, 24 Sep 2010 08:00:00 +0000

The Faculty of Health has appoointed 91��ɫ psychology Professor as the director of the LaMarsh Centre for Research on Violence & Conflict Resolution.

Right: Yvonne Bohr

As the new director of the LaMarsh Centre for Research on Violence & Conflict Resolution, Bohr is on familiar ground. As an executive member of the LaMarsh Centre since 2004, she has actively participated in the redevelopment of the centre’s mission and vision. Her research encompasses issues of mental health and well-being among young children, and she actively engages the community both as collaborators in the research and for the mobilization of knowledge.

"A real strength of Dr. Bohr’s work experience, in light of the vision and mission of the LaMarsh Centre, is the breadth of her experience in both international and local partnership, both with other academics and with community members,” says Harvey Skinner, dean of the Faculty of Health. “Her existing partnerships, and her knowledge of how to build and sustain partnerships, is consistent with the LaMarsh Centre's goals to influence policy, engage the community, and build local and global learning networks.”

A clinical psychologist and psychology professor, Bohr is engaged in academic collaborations with colleagues at the Sapienza University of Rome and several centres in Canada and the United States. She also continues to lead an infant and child mental health team at , a community treatment clinic in East Toronto.

Other Faculty of Health Appointments

Claire Mallette has also been appointed the new director of 91��ɫ’s School of Nursing and Angelo Belcastro is now chair of the School of Kinesiology & Health Science.

Left: Claire Mallette

Prior to becoming director of the School of Nursing, Mallette was director of nursing education, placement & development at the University Health Network in Toronto, while holding an adjunct appointment in the Faculty of Nursing at 91��ɫ and at the University of Toronto. Mallette was also the chief nursing officer and director of professional practice at the Workplace Safety & Insurance Board of Ontario from 2002 to 2006. She has held various teaching positions at the University of Toronto, McMaster University, Sheridan College, John Abbott College and the University of Alberta Hospital School of Nursing, from 1987 to 2002, as well as staff nurse positions in hospitals in Montreal, Ontario and Alberta.

In addition, Mallette has been the principal or co-investigator of six funded grants or programs totalling approximately $1.4 million dollars for research examining educational methodologies, virtual worlds, simulation, and new nursing graduate competencies and decision-making.

“Mallette has extensive experience and strengths as an academic nurse leader, educator and researcher,” says Skinner.

Right: Angelo Belcastro

Prior to joining 91��ɫ as the new chair of the School of Kinesiology & Health Science, Belcastro was the research director in the Faculty of Kinesiology at the University of New Brunswick, Fredericton. He has taken over the position from Professor Ira Jacobs.

“Dr. Belcastro is internationally recognized for his scholarship, is an effective educator and has outstanding leadership qualities and experience,” says Skinner.

In addition, Belcastro has held senior administrative roles in a variety of academic settings, including as director of the School of Rehabilitation Sciences at the University of British Columbia, founding dean of the Faculty of Health Sciences at the University of Western Ontario, vice-president academic at the University of New Brunswick, Fredericton, and vice-president academic & provost at Royal Roads University. He also has extensive experience in academic planning, visioning and program execution, says Skinner.

Republished courtesy of YFile– 91��ɫ’s daily e-bulletin.

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Professor Joel Lexchin: Some Canadian drugs are overpriced before they are patented

fmaquito — Wed, 28 Jul 2010 08:00:00 +0000

Canada needs a new system for controlling drug prices that does not depend on whether or not a drug has received a patent, according to an article by 91��ɫ Professor Dr. Joel Lexchin.

Drug prices in Canada can be unregulated for years, a period during which companies may overprice the drugs and market them, says Lexchin, a professor in the School of Health Policy & Management in 91��ɫ’s and an emergency physician at the in Toronto.

Left: Dr. Joel Lexchin.

His commentary, “”, appears in the journal Open Medicine. It is based on new research which examined how many drugs in Canada are marketed before they are patented, whose prices are therefore not controlled by the federal Patented Medicine Prices Review Board. He also looked at the time period between marketing and patenting, and any excess revenue generated before those drug prices were regulated.

In total, 42 drugs were marketed between 2000 and 2008 before being patented, and complete data was available for 33 of those.

“Some of these drugs were potentially being marketed for weeks before they came under the jurisdiction of the review board and had their prices controlled, but some of them may have been marketed for years,” says Lexchin. “Only three of the 33 drugs were found to be overpriced, but the fact that one of the 33 drugs may have been marketed without price controls for more than seven years is troublesome.”

When drugs are finally patented, their prices are reviewed and if a drug is deemed to be overpriced, the review board can order a company to repay any excess revenue to the federal government. The problem is that if companies overprice their drugs, the drugs may not be added to provincial formularies such as the Ontario Drug Benefit Formulary. In Ontario, the government covers most drugs listed on the formulary for people who are eligible, so if a drug is not on the list, the cost will not be covered.

In addition, although excess revenue from the drugs is eventually recovered, it is paid to the federal government, not the provincial governments which fund drugs through their drug benefit schemes, or to private insurers or people who are paying the cost out-of-pocket, says Lexchin.

The best remedy for various problems caused by using patent status to regulate prices is simply to treat all drugs on the market equally and regulate all prices, he concludes.

More about Joel Lexchin

Dr. Joel Lexchin received his doctor of medicine from the University of Toronto in 1977 and for the past 22 years has been an emergency physician at the University Health Network. He is currently a professor in the School of Health Policy & Management at 91��ɫ and an associate professor in the Department of Family & Community Medicine at the University of Toronto.

From 1992 to 1994 he was a member of the Ontario Drug Quality & Therapeutics Committee and he was the chair of the Drugs & Pharmacotherapy Committee of the Ontario Medical Association from 1997-1999. He has been a consultant for the province of Ontario, various arms of the Canadian federal government, the World Health Organization, the government of New Zealand and the Australian National Prescribing Service.

He is the author or co-author of more than 90 peer-reviewed articles on topics such as physician prescribing behaviour, pharmaceutical patent issues, the drug approval process and prescription drug promotion. He is a co-author of and author of Drug Therapy for Emergency Physicians.

Republished courtesy of YFile– 91��ɫ’s daily e-bulletin.

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Video: Health policy prof who should benefit from Ontario's plan to cut drug costs

fmaquito — Fri, 16 Apr 2010 08:00:00 +0000

, professor in 91��ɫ’s School of Health Policy & Management in the Faculty of Health, spoke to BNN on April 14 about the Ontario government’s latest plan to reduce the cost of generic drugs and whether the plan should benefit drug manufacturers, pharmacies, or people paying for drug prescriptions.

Lexchin, has worked as an emergency physician at the since 1988. His research interests include: physician prescribing behaviour, pharmaceutical promotion and the drug approval process. He has been a consultant on pharmaceutical issues to the Ontario government, the federal Auditor General, the government of New Zealand, the Australian National Prescribing Service, and the .

The interview runs approximately nine minutes and is .

Lexchin was also interviewed by CBC's .

Posted by Elizabeth Monier-Williams, with files courtesy of YFile– 91��ɫ’s daily e-bulletin.

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Audio: Health policy and management prof on Ontario's plan to cut generic drug costs

fmaquito — Wed, 14 Apr 2010 08:00:00 +0000

, professor in 91��ɫ’s School of Health Policy & Management in the Faculty of Health, spoke to CBC Radio's "The Current" April 12 about the Ontario government's latest plan to reduce the cost of generic drugs.

ran in The Current's second segment, "Drug Store Wars." It starts at the 12-minute mark and runs for approximately 12 minutes.

Posted by Elizabeth Monier-Williams, with files courtesy of YFile– 91��ɫ’s daily e-bulletin.

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Biomarkers hold promise of a blood test for endometrial cancer

fmaquito — Tue, 19 Jan 2010 10:00:00 +0000

Researchers at 91��ɫ’s Centre for Research in Mass Spectrometry (CRMS), Mount Sinai Hospital and the University Health Network have identified protein biomarkers that may aid in the diagnosis and prognosis of endometrial cancer, which affects the lining of the uterus. The researchers hope that a partnership with the private sector will expedite clinical testing and eventually move their discovery from the research bench to patients’ bedsides.

Endometrial cancer is the most common form of cancer in the female reproductive tract. In 2009, 4,400 Canadian women were diagnosed with endometrial cancer, making it the fourth-most-common cancer among Canadian women after breast, lung and colorectal cancers.

Although 85 per cent of diagnosed women show a five-year survival rate from endometrial cancer, and the overall survival rate is 79 per cent, those numbers have remained static for the last 20 years. Currently, endometrial cancer is often detected when unusual uterine blood discharges prompt a diagnostic investigation. These discharges can sometimes be the first signal that cancer is present, yet they may appear after the cancer has already progressed to a more advanced stage. Hysterectomies, with or without lymph node dissections, are currently the primary treatment; patients may also receive adjuvant therapy (radiation or chemotherapy), depending on the disease’s type, stage and grade.

Enter protein biomarkers – biological substances associated with a particular disease that can ideally be detected in the blood to aid the disease’s diagnosis and/or prognosis.

“We have identified several proteins that are present in much higher concentrations in endometrial cancer cells compared to normal cells,” says Professor Michael Siu (right), director of the , 91��ɫ’s associate vice-president research, science & technology, and professor in the Department of Chemistry in the Faculty of Science & Engineering. “These differences in protein expression have been verified in the lab on a couple of hundred patient samples; early results for testing in blood are very encouraging. By working with the private sector, we hope to be able to expedite clinical testing of the panel of biomarkers and develop a diagnostic kit for endometrial cancer.”

Siu’s research team includes Dr. Terry Colgan, head of gynecological pathology and cytopathology at , and Alex Romaschin, formerly with the and now a scientist with the Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital.

Over the last five years, the team has published eight papers on endometrial cancer biomarkers in prestigious international journals and a number of additional articles are in various editorial and reviewing stages. Siu’s team has attracted over $1.3 million in external research funding for this endometrial cancer research, as well as an additional $1.8 million in funding for biomarkers of other cancers.

Siracor, a private-sector company founded by biotechnology entrepreneur Joel Cheng, has licensed the intellectual properties of the endometrial cancer biomarkers. Siracor is 100 per cent Canadian-owned, but has a global view and reach. “Endometrial cancer affects women all over the world,” says Cheng. “By developing kits that will expedite the detection of the disease and at an earlier stage, Siracor hopes to be a part of the scientific solution that will lessen this cancer’s impact worldwide.”

91��ɫ’s technology transfer service leads the patenting and licensing of the endometrial cancer biomarkers in collaboration with its counterparts at Mount Sinai Hospital and the University Health Network. It’s part of ongoing efforts to make sure research is not kept on the shelf.

“Technology transfer is a specialized service 91��ɫ offers to all researchers whose findings have commercial potential,” says Stan Shapson, 91��ɫ's vice-president research & innovation. “Strong basic research discoveries can lead to important applications, as we hope will be the case in this instance by improving endometrial cancer detection and treatment options. Through careful collaboration with industry, 91��ɫ is using initiatives such as this to maximize the benefit of our research findings to patients and their families.”

By David Phipps, director, Research Services and Knowledge Exchange, and Elizabeth Monier-Williams, Research Communications Officer

Republished courtesy of YFile – 91��ɫ’s daily e-bulletin.

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91��ɫ scientist elected to the Royal Society of Canada

fmaquito — Thu, 08 Oct 2009 08:00:00 +0000

91��ɫ Professor K.W. Michael Siu has been elected a Fellow of the Royal Society of Canada, the highest honour a Canadian scholar can achieve in the arts, humanities and sciences.

This year’s new Fellows will be inducted at a ceremony to be held Nov. 28 in Gatineau, Que.

A specialist in mass spectrometry whose work is highly regarded by researchers around the world, Siu is also known for service to his field in a number of professional organizations, including president of the Canadian Society for Mass Spectrometry and chair of the Canadian National Proteomics Network Board of Directors.

Right: Professor K.W. Michael Siu

"We are tremendously proud that Professor Michael Siu is elected as a Fellow to the Royal Society," said Stan Shapson, 91��ɫ vice-president research & innovation. "Michael Siu is a pioneering scientist who has made significant contributions to advance research in chemistry, and especially in mass spectrometry, and has made great strides in establishing collaborations and partnerships regionally and internationally."

The citation for his election as a Fellow to the Division of Mathematical and Physical Sciences reads:

“Professor K.W. Michael Siu is one of Canada's foremost bioanalytical and biophysical chemists and an exceptional mass spectrometrist with an outstanding record of innovation and accomplishment. He has made most-significant contributions to understanding the structures, energetics, and ionization and gas-phase chemistries of protonated and metalated peptides as well as peptide radical ions, developing new mass spectrometry (MS) instrumentation in collaboration with Canadian industry, and developing innovative MS technologies and methodologies for proteomics, especially in the discovery, identification, verification and quantification of protein biomarkers for better diagnostics and prognostics of cancers.”

Siu is a Distinguished Research Professor (see YFile May 8, 2007) who did his PhD at Nova Scotia’s Dalhousie University and arrived at 91��ɫ in 1998 after a successful career at the National Research Council Canada (NRC) where he first developed some of the pioneering techniques that he uses to help other scientists in their investigations as well as his own. He is director of 91��ɫ's , holds an Industrial Research Chair funded by the Natural Sciences & Engineering Research Council and MDS Analytical Technologies (formerly Sciex), and is developing new instrumentation and methodologies in mass spectrometry in collaboration with the industrial partner.

He is also collaborating with researchers from Mount Sinai Hospital, St. Michael’s Hospital, University Health Network and the Hospital for Sick Children on discovering and verifying protein biomarkers for endometrial, head and neck, brain, and renal cancers. Siu also has extensive collaboration within and outside of 91��ɫ on proteomics and fundamental chemistry relevant to mass spectrometry.

Since 2005, Siu has also been 91��ɫ's associate vice-president research, science & technology.

He is the recipient of numerous distinctions, including a New Pioneers Award (see YFile, Jan. 22, 2007), the Maxxam Award for distinguished contribution in the field of analytical chemistry (see YFile Aug. 2, 2006), the 2005 Lossing Award (see YFile Jan. 20, 2006) and the Gerhard Herzberg Award from the Canadian Society for Analytical Sciences and Spectroscopy (see YFile, Sept. 13, 2004).

In an article first published in 91��ɫU ��Ա�’s 2007 Special Research Edition, Siu said he was “in the right place at the right time” to ride the technological revolution in biomolecular analysis: electrospray ionization – a Nobel Prize-winning discovery that made it possible to analyze and measure proteins with hitherto unheard of sensitivity and accuracy. “The concept of moving proteins from the solution to the gas phase in order to weigh them accurately was completely revolutionary. This was entirely virgin territory,” Siu explained. He and his colleagues at NRC quickly modified an existing mass spectrometer and began exploring the new technology’s capabilities. As the technique opened up new possibilities, Siu’s work earned him recognition as an innovator and much sought-after collaborator.

Published in 91��ɫ's e-newsletter YFile.

Republished courtesy of YFile – 91��ɫ’s daily e-bulletin.

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