Kudos January 2015

Publications and Quality

Marc Carrier and colleagues (Drs. L. Castellucci, C Cameron, G. Le Gal, M. A. Rodger, D. Coyle, P. Wells, T. Clifford, E. Gandara, G. Wells and M. Carrier) posted a JAMA publication on Healio www.healio.com about a systematic review and meta-analysis of eight anticoagulation options to compare their efficacy and safety outcomes for the treatment of VTE. Clinicians and patients have several anticoagulant options in the treatment of venous thromboembolism, and results from a Canadian study showed there are no significant differences in clinical and safety outcomes among most of them.

Swapnil Hiremath was quoted in MedPage Today. Dr. Hiremath said he believes metformin is underused in the diabetic population. “Metformin-induced lactic acidosis, seen in new patients started on metformin, is exceedingly rare. Metformin-associated lactic acidosis is more common, but it usually accompanies a sick patient — someone who has decreased tissue perfusion and shock (hypotension, sepsis, etc.),” he told MedPage Today. “In that acute situation, metformin should be stopped promptly. I have used metformin, albeit in lower, adjusted doses (500 mg/day with CKD stage 4) in CKD patients without complications.”

Kumanan Wilson, Steven Hawken and their co-authors published a paper in CDC’s Emerging Infectious Diseases journal that examines whether the flu shot increases or decreases the risk of getting Guillain-Barré Syndrome (GBS). The possible association of GBS with vaccination is frequently cited by health-care workers as a reason not to have a flu shot, even though chances of acquiring GBS after contracting the flu are far greater. This study is the first to use a model that accounts simultaneously for incidence of flu in the community and effectiveness of the flu vaccine. In most scenarios the authors found an overall decreased risk of GBS associated with vaccination, an important message for flu shot campaigns.

Marc Rodger recently received the Canadian Hematology Society’s clinical paper of the year award for his international clinical trial of blood thinners in pregnant women, published in The Lancet. The trial showed that daily blood thinner injections, which have been commonly given to pregnant women at high risk of developing clots, don’t actually do any good. The Hematology Society noted that this paper has “exceptional impact and represent(s) the best of Canadian hematology”. A summary of the paper is available in this media release.

Grants

John Bell has been awarded $25M from the Government of Canada, with an additional $35M from partners, to create the first Network of Centres of Excellence (NCE) devoted to cancer research. Called Biotherapeutics for Cancer Treatment (BioCanRx), the network will focus on oncolytic viruses, immune cells, synthetic antibodies and other promising biotherapeutics. The network includes more than 40 researchers from 17 academic institutions, as well as 24 non-profit and industry partners. Other members from the Ottawa Hospital Research Institute and uOttawa include Drs. Harry Atkins, Rebecca Auer, Jean-Simon Diallo, Dean Fergusson and Derek Jonker.

Dean Fergusson and his team have received $103,000 from Canadian Blood Services (CBS) to examine if donor characteristics such as age, sex and blood match have an effect on the outcomes for patients receiving red blood cells. This will be determined by using data from CBS, the Institute for Clinical Evaluative Sciences (ICES) and four major academic hospitals in Ontario. Understanding this relationship could allow for better use of a limited resource and improve patient care. Co-investigators: Michaël Chassé, Alan Tinmouth, Shane English, Jason Acker, Alan Forster, Greg Knoll, Lauralyn McIntyre, Nadine Shehata, Carl van Walraven and Kumanan Wilson.

Media

Curtis Cooper was interviewed by the Ottawa Citizen regarding the high cost of Hepatitis C treatments. Holkira pak, which had a 97 per cent cure rate in clinical trials, including for patients with cirrhosis, is not yet on the market, and its price is not public. But other new drug regimes that treats and cures hepatitis C (genotype 1) cause difficult side effects, are less effective and priced well out of range for most patients. Although Health Canada approved Holkira pak on Dec 22nd the Ontario drug plan or many private plans still do not cover the cost.

Duncan Stewart was interviewed by the Ottawa Citizen about the research he is conducting using genetically enhanced stem cells to repair damaged heart muscle after a heart attack. It is related to the kind of experimental treatment Gordie Howe received in Mexico, technology that Stewart says is in its infancy. The technology has huge potential, but it will take a long period of refinement and testing to get to that point. Stem-cell tourism creates unrealistic expectations that could “deflate the whole field,” Stewart said, leading companies to pull money out of stem-cell development because the results are not what they expected.

Andrew Pipe was interviewed by CTV news about the risks of shovelling, it can be harder on the heart than we realize. “If you’ve got cardiac risk factors, if you’ve got known cardiac disease – particularly if you’re a smoker -and you’re over 45 years old make a local teenager wealthy,” says Dr. Pipe. “They will benefit from the exercise. You won’t put yourself at risk.”

Mark Clemons was interviewed by the Ottawa Citizen about treatment options for women facing a cancer diagnosis during pregnancy. Dr. Clemons is internationally recognized for his expertise in treating pregnant women with breast cancer. Dr. Clemons treats about two pregnant women with breast cancer a year — not exactly an epidemic, but a trend that requires a new kind of expertise. As more women have children later, though, Clemons said doctors are seeing more pregnant women with breast cancer. In the past, and even now in some cases, oncologists would have recommended terminating the pregnancy under this circumstance.

Alan Forster was featured in the Ottawa Citizen about the Ottawa Hospital’s goal to improve patient care. The Ottawa Hospital is changing the way patients receive care, one phone call at a time. Last May, the Post-Discharge Phone Call Program began and has proven to be so successful in patients’ continuity of care, that the hospital has extended the pilot program through to next year. “When patients leave the hospital it’s often difficult for them and we want to make that easier,” said Dr. Forster.

Curtis Cooper and his team reviewed patients with sudden or long-term infections who went to a local clinic where they had a secure and private telemedicine video link to specialists, instead of an in-person appointment. Patients were more likely to stick to their medications, respond well to antiretroviral therapy and felt more satisfied and involved in their care. Cost-effectiveness is another proposed advantage of telemedicine, but is still debatable, there needs to be more analysis to prove what everybody believes to be true,” Dr. Cooper said. Another drawback is that doctors can’t perform physical exams via video chat, but new technology could help overcome that. Dr. Cooper stated “This review demonstrates that you can safely and effectively provide consultation services for patients with telemedicine. There is great potential with telemedicine to streamline health care”.

Gonzalo Alvarez is co-leading a research study that uses mathematical modelling to compare different approaches for preventing tuberculosis (TB) among aboriginal people in Canada’s north. The mathematical model will compare the costs and benefits of a TB-specific prevention program (that focuses on enhanced diagnosis and treatment) with a more general prevention program (that focuses on reducing TB risk factors such as smoking, heavy alcohol use, diabetes and overcrowded housing).