May/June 2016 Kudos

Publications and Quality

Mark Clemons (and Kednapa Thavorn) led a new study which shows that unnecessary imaging has a big financial impact on Canada’s health-care system: at least $4.4M over five years in Ontario alone. The analysis published in Current Oncology is an extension of previous research by this group in CMAJ. One of the greatest fears upon cancer diagnosis is that the cancer may have spread and the instinct among patients and physicians is often to look for more cancer using a multitude of scans. But for people with early stage breast cancer, the chance of finding a distant metastasis is incredibly small (0.2-1.2%), especially compared to the risks of all the extra testing, which include anxiety, radiation exposure and treatment delays. Dr. Angel Arnaout, who is also part of the team, is now working with Dr. Janet Squires to develop strategies to reduce this unnecessary imaging. Authors: Thavorn K, Wang Z, Fergusson D, van Katwyk S, Arnaout A, Clemons M.

Jim Dimitroulakos and his team discovered that pairing high doses of cholesterol-lowering statins with cancer drug erlotinib enhanced its anti-cancer activity. They then partnered with Dr. Glen Goss on a clinical trial to test the combination’s safety and efficacy. Their Phase I trial was published in the Journal of Translational Medicine, involved 24 cancer patients at TOH. For a subset, their cancer did not progress for more than six months, however, many of the participants suffered statin-induced muscle pains and weakness. These insights spurred further laboratory studies to identify ways to improve the therapy and reduce toxicity. This team is currently performing pre-clinical evaluations that may lead to a future clinical trial. Authors: Goss GD, Jonker DJ, Laurie SA, Weberpals JI, Oza AM, Spaans JN, la Porte C, Dimitroulakos J.

Michael Rudnicki (Arezu Jahani-Asl and Azad Bonni) has revealed a key player in brain tumour formation that may lead to new therapies for a deadly and incurable cancer. The study, published in Nature Neuroscience, is the first to show that a protein called OSMR (Oncostatin M Receptor) is required for glioblastoma tumours to form. Glioblastoma is one of the most deadly cancers, resistant to radiation, chemotherapy and difficult to remove with surgery. The team found that blocking OSMR activity in brain tumour stem cells prevented them from forming tumours in mouse brains. This new understanding could pave the way for more effective treatments for glioblastoma. Authors: Arezu Jahani-Asl, Hang Yin, Vahab D. Soleimani, Takrima Haque, H. Artee Luchman, Natasha C. Chang, Marie-Claude Sincennes, Sidharth V. Puram, Andrew M Scott, Ian A.J. Lorimer, Theodore J. Perkins, Keith L. Ligon, Samuel Weiss, Michael A. Rudnicki, and Azad Bonni.

Daniel Kobewka, lead author of Quality Gaps Identified through Mortality Review, published in BMJ Quality and Safety was quoted in The Hospitalist regarding hospital wide mortality review benefits. The major issue the study identified was an inadequate discussion of goals of care. “This was often a patient who was dying, and in retrospect, it was clear that they were at high risk for death, but there had been no discussion with the patient about prognosis or about symptom management,” Dr. Kobewka says. “It seemed that care was directed at prolonging life. When we looked back at the case, that wasn’t realistic. That accounted for 25% of the quality issues that we identified: The discussion of prognosis and goals of care was inadequate or even absent all together. I think every hospital needs to think about those discussions and how and where and when we have them.” Authors: Kobewka DM, van Walraven C, Turnbull J, Worthington J, Calder L, Forster A.

Marc Rodger recently published in Thrombosis Research on the long-term risk of venous thrombosis after stopping anticoagulants for a first unprovoked event: A multi-national cohort. The findings will be presented at the European Society of Cardiology in August.

 

Media

More than 100 members of the public came out to in a recent panel discussion at TOH with Harold Atkins and Jeff Blackmer (and Bill Stanford), on behalf of the Ontario Institute for Regenerative Medicine (OIRM). CBC Ottawa attended and interviewed the researchers, noting that Ottawa is becoming a major hub for stem cell research – on par with California – thanks to a collaborative approach. The Stem Cell Foundation also wrote a blog about the event and wrote about Ottawa’s strength in stem cell research in its recent newsletter (which also includes interviews with Drs. Bernard Thébaud and Lauralyn McIntyre).

Erin Keely and Clare Liddy were featured on CTV Ottawa News at 6 regarding an e-consult program for patients who need specialist care. The program started with five specialties, but has grown to 84 in the last four years. Over 200 specialists in the region are available to respond to primary care providers when called on. “I can say that it’s been the most satisfying thing in my career to see the difference we’ve made to patients and primary care providers” says Dr. Keely. Since 2011, more than 14,000 patients have had e-consults, only one-third have needed a face-to-face referral. Often, it doesn’t take long to get answers.

Shawn Aaron was interviewed on CTV National News about his research showing that asthma misdiagnosis is common, and can cause physicians to miss serious underlying conditions. More than 2.5 million Canadians have been told they have asthma, but research suggests that as many as 30 per cent of them may have been misdiagnosed. Dr. Aaron published a study in the Canadian Medical Association Journal in 2008, that found many Canadians who believe they have asthma have never been properly tested for the condition. Dr. Aaron, is now in the process of updating those findings as he says he believes the problem of overdiagnosis persists.

Kumanan Wilson and Ian Stiell were interviewed on CBC Radio Ottawa Morning about a free mobile health app that was created by the new mHealth Research Team for Dr. Ian Stiell’s Ottawa Rules. The app will include the Ottawa Ankle Rules, the Ottawa Knee Rule and the Canadian C-Spine Rule (further rules are expected in the future). “Studies have repeatedly shown that the Ottawa Rules reduce unnecessary use of x-rays and CT scans, reduce wait times and save money for the health-care system,” said Dr. Stiell.

Announcements:

Kumanan Wilson and his mHealth Research Team have received a $3.5M investment from the Public Health Agency of Canada. The new funding will support a new mobile immunization app available with a number of new features, including a secure portal for family record-sharing and customized vaccination schedules for newcomers to Canada and people with special health conditions. The app will also be accessible via desktop computer and the goal will be to integrate with provincial immunization records.

Duncan Stewart has been appointed as the President and Scientific Director of The Ontario Institute for Regenerative Medicine (OIRM), which brings 180 scientists across the province together to advance stem cell research and develop new therapies. Dr. Stewart will assume this new role on June 1, while continuing to lead the research activities at TOH as well as his own laboratory.

Michael Rudnicki has received $1.35M US from the National Institutes of Health to continue his research into the biological mechanisms behind Duchenne Muscular Dystrophy. His research team recently made the surprising discovery that the lethal muscle-wasting disease directly affects muscle stem cells. Patients with this disease lack the dystrophin protein, and without this protein muscle stem cells are unable to orient themselves relative to the muscle fibre. This means they cannot divide properly and generate enough precursor cells to properly repair the damaged muscle. The new grant will help the team delve into the molecular mechanisms behind this phenomenon. They will also investigate ways to restore proper cell division in these stem cells, which could potentially lead to new therapies. The disease affects approximately one in 3,600 boys, and leads to death by the second or third decade of life.

Michael Rudnicki – The Stem Cell Network (SCN) has become Canada’s foremost research organization dedicated to enabling the translation of stem cell research into clinical applications, commercial products and public policy. Dr. Rudnicki is the Stem Cell Network (SCN) Lead and co-host by TOH and the uOttawa. In March 2016 the Government of Canada provided SCN with an additional $12M over two years to fund outstanding translational research in the stem cell research and regenerative medicine fields. As a result, SCN has quickly moved to launch three new funding programs and hopes to see funds flow to the research community before the year is out. Over the last 15 years, SCN has catalyzed more than 12 clinical trials, enabled 11 start-up companies and provided training to more than 2,000 researchers across the country.

Gonzalo Alvarez, Jeremy Grimshaw and George Wells are among a group of local collaborators to receive a $3.3M foundation grant from the CIHR . The award will be used to create a program that will help research play a more prominent role in health policy, health systems and clinical decision making. The team wants to optimize collaborations between researchers and people who use their research as well as create conditions where the results will be more likely to influence policy and clinical decision-making. This is one of 22 CIHR grants awarded to researchers at The Ottawa Hospital / uOttawa in the last competition.

Several Department of Medicine Scientists from the OHRI were successful in the Heart and Stroke Foundation’s recent grant-in-aid grant competition. The following are some of the areas where funding will be supported:

  • Vicente Corrales-Medina with coPI Girish Dwivedi – Effect of pneumonia on blood vessel inflammation
  • Marc Rodge and Lynn Megeney – Clinical trial of statins in venous thromboembolism.

PARO Award Recipients 2016 – The Clinical Teaching Awards acknowledge the essential role that clinical teachers play in the training of physicians. Residents are asked to outline the qualities that make their nominee an excellent teacher including: patient care, quality of bedside teaching, and interest in the trainees’ personal development and well-being. The following were recipients:

  • Steven Glassman from the division of Dermatology recently received the Excellence in Clinical Teaching Award. Since qualifying as a dermatologist in 1997, Dr. Glassman worked in both public and private health sectors in South Africa, supervising the training of 24 dermatology residents over ten years. Dr. Glassman is the Medical Director of the Phototherapy Service at the Riverside and Bruyere hopsitals. Dr. Glassman is also the Program Director for Dermatology, managing the training of 16 residents in Ottawa.
  • Steven Promislow a PGY 6 from the division of Cardiology recently received the Resident Teaching Award.  Dr. Promislow, a graduating adult cardiology resident from the University of Ottawa, is a leading example of the excellence in teaching that is done every day by resident physicians. He has many strengths and attributes that constitute a strong clinical teacher. Dr. Promislow served as chief resident in his final year and has received much praise and appreciation from fellow trainees at all levels on his approachable personality and for his ability to make complicated material understandable.

Promotions:Scientist Promotions in the Clinical Epidemiology and Chronic Disease Programs:Congratulations are in order for a number of scientists who been promoted over the last year. In the Department of Medicine Clinical Epidemiology Program, they include:

  • Drs.  Lauralyn McIntyre (Senior Scientist) and Tim Ramsay (Senior Scientist). Promotions at the University of Ottawa, as well as new Scientist appointments, will be covered in a future edition.

Professorial Promotions and Awards from uOttawa Faculty of MedicineCongratulations are in order for a number of scientists and investigators who recently received promotions from the University of Ottawa’s Faculty of Medicine.

New Full Professors in the Department of Medicine include:

  • Christopher Kennedy
  • Lynn Megeney.

New Associate Professors in the Department of Medicine include:

  • Alan Tinmouth
  • Jim Dimitroulakos.

Special honours in the Department of Medicine were awarded to:

  • Dr. Susan Humphrey-Murto (Faculty of Medicine Award of Distinction and Service).

 

Weekly Research News from TOH (affiliated with the University of Ottawa)

Rashmi Kothary has been awarded $140,000 from Families of SMA Canada to study how Spinal Muscular Atrophy, or SMA, affects muscle stem cells. SMA is the number one genetic cause of death in infants and impacts 1 in 10,000 babies. Individuals with SMA have a genetic mutation which prevents their body from producing enough of a protein called SMN. The lack of this protein causes motor neurons to shrink and die, but little is known about how it affects other cells in the body. Dr. Kothary’s previous studies in cell culture have shown that low levels of SMN make it harder for muscle cells to form fibers, impacting muscle growth. His current study looks even further back to see if lack of this protein causes problems in muscle stem cells. The team will also study mouse models to see how the progression of the condition changes the ability of muscles to regenerate.

News in brief:

  • Rachel Goodwin received the Dr. Elizabeth Eisenhauer Early Drug Development Young Investigator Award from the Canadian Cancer Trials Group for her contributions to the development and evaluation of new cancer treatments.
  • Sunita Mulpuru was awarded a $50,000 Ontario Lung Association-Pfizer Canada Research Award for her work on how viral infections affect patients with chronic obstructive lung disease. See video for details.
  • Smita Pakhale was interviewed by CBC and Radio-Canada about a project that engages vulnerable people in downtown Ottawa to participate in research aimed at reducing smoking, drug use and homelessness.