July to Dec 2018 Kudos

Dr. Erin Keely and Family Medicine colleague, Dr. Claire Liddy received $1,129,141.00 from CIHR for their project entitled, “Improving Access to Specialist Care through eConsult for Patients Living with Chronic Pain.”

Dr. Valerie Gratton received two Montfort innovation grants that her colleague Dr. Kwadwo Kyeremanteng will also be part of:

  • Early palliative care interventions in the ICU – “Criteria Based Palliative Care Consults in ICU: Outcomes and Costs”
  • Advanced care planning clinics for patients at high risk within a year (mainly non-malignant diseases): “An Advance Care Planning clinic for high-risk patients: A feasibility study”

In addition to these projects Dr. Peter Tanuseputro is co-leading a project at McMaster that will investigate how physicians provide care at the end of life, and link this to outcomes.

Dr. Chris Kennedy’s team found that the nervous system controls how quickly the kidneys filter blood, and one protein is essential to this process. In the first study of its kind, the team found that a lack of the protein ubiquitin C-terminal hydrolase L1 (UCHL1) can significantly change the structure of nerve cells in the kidney, having a dramatic effect on kidney function.

Dr. Tiago Mestre led an international research project which found that close relatives of people with a rare inherited form of Parkinson’s disease (PD) were more likely to have neurological problems, even if they did not have symptoms of the disease or carry an associated genetic mutation. Most cases of Parkinson’s disease happen out of the blue, but overall one to two percent are caused by mutations in the LRRK2 gene. This percentage is higher for people of certain ethnic backgrounds. In a paper published in Movement Disorders, the research team looked at healthy relatives of individuals with Parkinson’s disease caused by the LRRK2 mutation, regardless of whether they carried a LRRK2 mutation or not. They found that individuals in this group were more likely to experience neurological symptoms including anxiety, less daytime sleepiness, and worse motor skills when compared with healthy non-related individuals. The fact that there was no difference between these individuals with or without a LRRK2 mutation suggests that additional genetic or environmental factors are at play. Future studies may involve observing these groups over longer periods of time to see who develops PD, and using MRI as a marker to predict the onset of PD.

Rashmi Kothary received $50,000 from Cure SMA as Principle Investigator for “The shifting landscape of SMA research: towards a better understanding for a role for SMN in aging.”

Four research groups at The Ottawa Hospital have been awarded $1.7 million in the most recent project grant competition from the Canadian Institutes of Health Research (CIHR):

  • Drs Lauralyn McIntyre, Dean Fergusson and colleague will lead the first rigorous multi-centre trial to compare two commonly-used salt solutions for rehydrating hospitalized patients.
  • Dr. Sanjay Murthy and Dean Fergusson as leads will pilot test a new colon cancer screening strategy for people with inflammatory bowel disease.
  • Dr. David Picketts will shed light on brain development and intellectual disability by studying a protein called PHF6.
  • Dr. Deborah Zimmerman and colleague will see if a simple exercise program can improve health for people with end-stage kidney disease and reduce health care costs.

Several Department members received additional CIHR grants:

  • Principal Investigator: Curtis Cooper – The Many Faces of HIV Co-Infection ($20,000)
  • Principal Investigators: Jonathan Angel, Michael Grant – HIV Vaccines: Progress, Failures and New Directions ($19,000)
  • Principal Investigator: Bill Cameron – Nowhere to publish: Homeless HIV Research ($18,500)
  • Principal Investigator: Curtis Cooper – Training Workshop: Professional Development for Canadian Virologists ($7,500)
  • Principal Investigators: Marjorie Brand, Jean-Francois Couture – Novel approach to destabilize protein interactions in T-ALL ($588,000)
  • Principal Investigators: Lauralyn McIntyre, Dean Fergusson – Cellular Immunotherapy in Septic Shock: A Meeting to Develop a Stem Cell in Sepsis International Collaborative Network ($10,000)

Dr. Jean-Francois Marquis received the Outstanding Achievement Award from the Canadian Association of Interventional Cardiology.

Dr. Sharon Chih received the Canadian Cardiovascular Society Young Investigator Award.

Dr. David Harnett received the Dr. Charles Kerr Award, given to a resident who embodies Charlie Kerr’s humanitarianism and his legacy of encouraging and advocating for those in need of assistance or support from the Canadian Cardiovascular Society.

Dr. Dean Fergusson and colleagues led a massive study which found that using lower hemoglobin thresholds to transfuse red blood cells during and after heart surgery is just as safe as using traditional thresholds. Hemoglobin is a protein that delivers oxygen to the body’s tissues. Some physicians give blood transfusions during or after surgery to keep a patient’s hemoglobin levels from falling, while others wait to see if the hemoglobin levels remain stable. In the study published in the New England Journal of Medicine, over 5,200 heart surgery patients were randomized to receive transfusions based on either a lower or higher hemoglobin threshold. There was no significant difference in the outcomes between the groups six months after surgery. The lower threshold also reduced the number of patients who received transfusions by 28 percent. This paper expands on the primary results at 28 days after surgery, previously published in the same journal.

Dr. Derek Jonker led an international study which found that a drug that targets cancer stem cells improved survival in patients with a specific form of colorectal cancer. Cancer stem cells make up a very small part of some tumours. However, they can repeatedly duplicate and give rise to all the cell types in a tumour, and may help cancer spread to other parts of the body or resist treatment. 282 patients with advanced colorectal cancer were recruited from 68 centres around the world. They were randomly assigned to take either the drug napabucasin, which targets multiple pathways in cancer stem cells, or a placebo. The study published in The Lancet Gastroenterology and Hepatology showed that while the drug did not improve survival among the general population of patients, it did improve survival (from 3.0 months to 5.1 months) in people with a molecular marker called pSTAT3 in their cancer. Further studies will examine STAT3 as a target for treating this kind of colorectal cancer.

New research led by Dr. Fraser Scott showed that cellular stress is linked to decreased insulin and increased glucagon production in the pancreas of prediabetic animals. The study involved a rat model in which about two thirds of the animals spontaneously develop T1D by adolescence. The team found that diabetes-prone animals displayed a specific pattern of gene expression in their pancreas as early as eight days after birth. The pattern suggests that cells in the pre-diabetic pancreas may have trouble processing new proteins, and this may lead to cell death and inflammation long before the characteristic immune attack on the pancreas. Surprisingly, the liver showed similar patterns of gene expression, with some changes apparent even earlier than in pancreas. This suggests the liver could be a new target for diabetes research.

Additional Grants:

  • Principal Investigator: Dylan Burger – Microparticles in Diabetes ($140,000 Ontario Early Researcher Award + $50,000 match raised through fundraising events such as THE RIDE)
  • Principal Investigator: Edward Clark – Predicting Renal Recovery in Patients Requiring Outpatient Dialysis After Acute Kidney Injury ($147,000, Cancer Care Ontario)
  • Principal Investigator: Marjorie Brand – Targeted Proteomic Analysis of Epigenetic Factors in Leukemia ($120,000, Cancer Research Society)
  • Principal Investigator: Mark Clemons – Expanding the REthinking clinical trials (ReACT) Program to other sites in Ontario – a prospective study ($100,000, Cancer Care Ontario)
  • Principal Investigator: Rashmi Kothary – Abnormal fatty acid metabolism is a feature of spinal muscular atrophy. $300,000, Muscular Dystrophy Association.

Dr. Andrew Pipe was recognized as an Honorary Fellow by the Royal College Council. The Royal College Council may bestow Honorary Fellowship on exceptional physicians, surgeons and lay persons who are not eligible for Fellowship. These individuals have demonstrated outstanding performance in a particular vocation or a specific area of professional activity directly or indirectly related to the field of medicine. Honorary Fellows may use the designation FRCPSC (Hon). Up to four Honorary Fellows can be appointed per year by the Royal College Council. Honorary Fellows typically receive their Fellowship diploma at Convocation, at a meeting of Council or at another appropriate Royal College event.

Three groups from the Department of Medicine were successful in the Heart and Stroke Foundation’s recent grant competition:

  • Dr. Dar Dowlatshahi and colleagues were awarded $290,000* to test whether a tablet-based speech therapy that stroke patients use from their beds in between appointments can help them recover their ability to speak. Dr. Dowlatshahi also received a $240,000 clinician-scientist phase 2 award to support his acute stroke recovery research program.
  • Dr. Michel Shamy was awarded a national new investigator award ($260,000) for his research program on the ethics of clinical trials, and a seed catalyst grant ($100,000) to support a study of women-only trials in stroke.
  • Dr. Alexander Sorisky and colleagues were awarded $263,000 to study how high levels of thyroid-stimulating hormone increase an individual’s risk of heart attack.

Dr. Michael Schlossmacher has been appointed as the interim Director of the University of Ottawa’s Brain and Mind Research Institute (uOBMRI) for up to a one-year period, effective September 1, 2018. uOBMRI brings researchers, clinicians, trainees and community members in Ottawa together to advance nervous system-related research, develop new treatments, improve brain health and share emerging insights. The Ottawa Hospital and its Research Institute are key partners, along with other hospitals, institutes and centres across Ottawa.

New research led by Dr. Xiaohui Zha shows that lipid rafts probably don’t exist in most real cells. Originally described in the 1980s, lipid rafts were thought to be semi-rigid blocks of cholesterol, sphingolipids and proteins that floated around in the sea of membrane that surrounds cells. But lipid rafts have never been observed in real cells – only in artificial membrane models called liposomes. In a new paper published in Cell Reports, Dr. Zha and her team created liposomes that were much more similar to true cell membranes and showed that they didn’t have lipid rafts. They also discovered the artificial conditions that could make lipid rafts in real cells. In the real world, these conditions only exist in people with certain genetic diseases. Thus, this research will not only re-write biology textbooks, but also spur new disease-related research.

Dr. Kwadwo Kyeremanteng’s interest in using ICU resources more efficiently and improving access to palliative care in the ICU led him to found the Resource Optimization Network, a multidisciplinary research group working to reduce health spending in this area without compromising care.

A recent study led by Dr. Kyeremanteng, together with Dr. Peter Tanuseputro, suggests that direct transfer to the ICU from the emergency department could reduce the death rate and hospital costs for some people with serious infections. Further research could lead to better tools to help physicians make these kinds of decisions.

Dr. Pietro Di Santo’s study involving a smartphone application which used the phone’s camera function performed better than traditional physical examination to assess blood flow in a wrist artery for patients undergoing coronary angiography, according to a randomized trial published in CMAJ and prompted an accompanying editorial and a cover reference. It was also featured on CBC (http://www.cbc.ca/player/play/1201432131964). The app is available through the App Store and Google Play Store free of charge (Instant Heart Rate by Azumio). A protocol is currently being developed for a follow up study in patient’s pre-CABG as an alternative to the Allen’s test as well which should be interesting to see if we can have impact on the use of the radial artery as a graft.

Dr. Tiago Mestre and colleagues kicked off the MDS-PAS 1st Summer School on Neuromodulation for Movement Disorders with great success!

Dr. Dylan Burger received an Ontario Early Researcher Award (ERA) of $140,000 to help understand how diabetes damages blood vessels and increasing the risk of heart attacks, stroke and kidney disease. Dr. Burger’s lab studies microparticles, tiny pieces of cells that are shed by injured or dying cells. His lab and others have previously found that people living with diabetes have high levels of microparticles in their blood. These microparticles damage the blood vessels, but researchers don’t know how exactly how. Dr. Burger’s team will investigate how microparticles are formed in people with diabetes and exactly how they damage blood vessels. A better understanding of this process could help develop new drugs to reduce the risk of heart and kidney problems in people with diabetes. Microparticles might also be used as an early warning of cardiovascular disease for this population. The Ottawa Hospital Research Institute can provide the required matching funds for ERAs ($50,000 each) because of community support for Ottawa Hospital Foundation-led initiatives such as THE RIDE.

Dr. Douglas McKim was chosen by the American College of Chest Physicians to give the Margaret Pfrommer Memorial Lecture in Long-term Mechanical Ventilation on October 8, 2018. This honour is awarded to a clinician or ventilator-dependent professional or advocate who has advanced mechanical ventilation and fostered partnerships between physicians and patients.

Dr. Jeremy Grimshaw was interviewed on Cochrane Australia’s The Recommended Dose podcast about his many pursuits in health, social science, and implementation science research.

Dr. Richard van der Jagt appeared in Ground War, a documentary that explores the links between pesticides, cancer, golf courses and environmental degradation. This follows their recent appearance in Dad and the Dandelions on CBC’s The Nature of Things.

Dr. Dar Dowlatshahi co-authored an international study in JAMA that could help predict which ischemic stroke patients would benefit the most from a clot-busting drug. This kind of stroke can be treated with the drug alteplase or by running a long thin tube through the blood vessels to break up the clot. The second treatment is only available at specialized stroke centers that may be hours away from where a patient lives. The researchers found that patients who had “leaky” clots that let some blood through and were further away from the center of the brain were the most likely to benefit from the drug. This suggests that patients with these characteristics may have their clots cleared just as quickly with alteplase, and do not need to be transported to a specialized center. The Ottawa Hospital enrolled 54 patients, the second-highest number of all the study sites.

Dr. William Stanford and his colleagues, including Dr. Caryn Ito and Dr. Mitchell Sabloff, and developed a possible new strategy to treat chemotherapy-resistant acute myeloid leukemia (AML). The research focuses on a protein called MTF2, which places chemical tags near certain genes to help control their expression (called epigenetics). Using AML samples from patients treated at The Ottawa Hospital, the team found that MTF2 activity was strongly associated with resistance to chemotherapy and lower survival. They then linked this to how MTF2 controls a gene called MDM2. Mice with patient-derived AML treated with MDM2 inhibitors plus chemotherapy all survived with no evidence of cancer, while those treated with chemotherapy alone all died. Since MDM2 inhibitors are already in clinical trials for other cancers, the researchers hope to start trials in AML patients relatively soon. They are also developing a test to determine which patients could benefit. Dr. Stanford will receive the Chrétien Researcher of the Year Award for this discovery, which was published in Cancer Discovery.

Dr. Fraser Scott received the Grimes Research Career Achievement Award, not only for his outstanding contributions to diabetes research, but also for his mentorship, leadership, collaboration and numerous contributions to the Ottawa research environment. In the early 1980’s, Dr. Scott was conducting nutritional studies on rats that were supposed to develop type 1 diabetes—except they didn’t. He discovered that changing the diet of these diabetes-prone rodents had prevented the disease. Making this connection between diet and diabetes was a ground-breaking discovery. His team then discovered that diabetes-prone rats had abnormally strong immune reactions to wheat proteins, as did a majority of people with type 1 diabetes whom they tested. Additional studies identified a wheat protein that can stimulate an abnormal immune response in some individuals, and revealed links between type 1 diabetes, the gut immune system and gut bacteria. Dr. Scott’s most recent work focuses on how very early life challenges in the pancreas and liver precede and promote the development of diabetes.

Dr. Natash Kekre is leading the charge to bring CAR-T cell therapy to Canada. She’s part of a national team that has designed a “made-in-Canada” version of CAR-T therapy, which will provide Canadian patients with access to CAR-T cells using Canadian science and expertise. This trial could begin recruiting patients in 2019.

CMAJ’s new supplement on engaging patients in health research features commentaries led by Dr. Dean Fergusson. As co-Scientific Director of OSSU, Dr. Fergusson’s piece reflects on overall successes and lessons learned.

Dr. Tetyana Kendzerska was awarded a Grant-In-Aid (GIA) for her research proposal entitled, “Obstructive sleep apnea and cancer development and progression: evidence from clinical and health administrative data.”

Dr. Susan Humphrey- Murto received an AMEE Research Grant award for 8,444 Euros (announced in August at the AMEE conference in Basel, Switzerland) for her project entitled, “Learner Handover: How does it influence assessment?” co-authors: Tammy Shaw, Claire Touchie, Debra Pugh & Timothy Wood.

Jason Bau (PGY-2 in Internal Medicine) took home the prize for best oral at CSIM for the Ted Giles Clinical Vignette competition at the annual meeting for the Canadian Society of Internal Medicine for his oral presentation on ” Multi-system presentation of primary Sjogren’s system’.

Dr. Nancy Dudek’s paper, “A grounded theory study of assessment anchors in postgraduate medical education: Forthcoming opportunities and ongoing tensions,” received national recognition for top paper in Residency Education Research at this year’s conference in Halifax.

Dr. Debra Pugh received a PSI Grant for $45,000 over two years for her health research project entitled, “The importance of testing: using test-enhanced learning to teach point-of-care ultrasound.

Irena Druce (PGY5 Endo & Metab) won the Canadian Society of Endocrinology and Metabolism Dr John Dupré Award for her poster presentation “Patient-Driven Quality Improvement for Pituitary Adenoma Management”.

Erin Miller (PGY5 Endo & Metab) won the Canadian Society of Endocrinology and Metabolism Sonia Salisbury Resident Oral Clinical Vignette Award for her presentation entitled “Fetal Goiter and Profound Hypothyroidism Due to Treatment of Maternal Graves’ Disease.”

Dr. Andrew Pipe was announced as Chair of the Board at the Heart and Stroke Foundation of Canada.

Drs Marc Carrier and Phil Wells led a cross-Canada clinical trial published in the New England Journal of Medicine that provides the first approach for safely preventing blood clots (or venous thromboembolism) in people with cancer. Blood clots are the second-leading cause of death in cancer patients. They can also cause pain, reduce quality of life and delay cancer treatment. The trial showed that a low dose of the drug apixaban could reduce the rate of blood clots from 10.2 percent to 4.2 percent in cancer patients with a higher risk of clots. The rate of bleeding was only slightly increased. The researchers estimate that about half of all people newly diagnosed with a solid cancer could be candidates for the strategy, and if fully implemented it would prevent clots in more than 50,000 people per year in Canada and the U.S.

Dr. Jeremy Grimshaw has once again been ranked among the world’s top scientists. According to Clarivate Analytics, he is among the most highly cited scientist in the world in the field of Social Sciences, with tens of thousands of citations each. A total of 6,000 researchers made Clarivate’s list this year, out of a total of nearly eight million around the world. Dr. Grimshaw is a world-renowned expert in systematic reviews, clinical guidelines and knowledge translation. His research has reduced the use of inappropriate lab testing among family physicians and improved the management of chronic diseases like asthma, angina and stroke.

Dr. Kevin Burns and his team previously found that “exosomes” released from progenitor cells in human umbilical cord blood can prevent kidney cells from dying during this kind of acute injury. Their latest research, published in Scientific Reports, helps explain how. They found that injured kidney cells release a protein called SDF-1alpha, which attracts the exosomes through a protein called CXCR4. So, when the exosomes are injected intravenously into mice with acute kidney injury, they target just the kidney and deliver certain healing factors. This research may offer new ways to repair acute kidney injury, which affects one in 20 hospitalized patients.

Dr. Tetyana Kendzerska published a study in Chest showing that severe sleep apnea increases the risk of hospitalization for new atrial fibrillation, or irregular heartbeat. The study followed more than 8,000 people who were originally free of any irregular heartbeat for a median of 10 years. Over this time, 173 (2.1 percent) were hospitalized with new atrial fibrillation. Very severe sleep apnea (where blood oxygen levels fall below 90 percent for a third of the sleep time) was associated with a 77 percent increased risk of hospitalization with new atrial fibrillation, after controlling for traditional risk factors. The rate of hospitalization with atrial fibrillation was 7.8 percent for patients with these low blood oxygen levels in sleep compared to 1.7 percent for patients with normal oxygen levels. These findings can help identify those patients with sleep apnea who are at greatest risk of developing atrial fibrillation and may need more aggressive treatment.

Dr. Erin Kelly received a TOHAMO Quality and Patient Safety Grants for her project: Exploring the Perspectives of Patients and Caregivers Navigating End-Stage Cirrhosis.

MEDIA

Dr. Shawn Marshall was interviewed by the Ottawa Citizen about updated Ontario concussion recovery guidelines for healthcare providers and a new user-friendly version for patients. Dr. Marshall was also interviewed by CTV Morning Live.

Drs Dean Fergusson and Raphael Saginur were interviewed by Healthy Debate about the REthinking Clinical Trials (REaCT) program. Dr. Fergusson discussed REaCT’s innovative integrated consent model, which allows physicians to efficiently enroll patients in clinical trials that compare standard treatments. Dr. was also interviewed, along with a trial participant.

Drs. Clare Liddy and Erin Keely were interviewed for the Royal College of Physicians and Surgeons of Canada’s newsletter about the growth of the eConsult program, a web-based platform that connects primary care physicians and nurse practitioners with specialists to discuss non-urgent patient cases .

Dr. Jonathan Angel was interviewed by the Huffington Post about the risk of HIV transmission through blood donations.

Dr. Paul MacPherson was interviewed by CFRA Radio about The Ottawa Hospital’s Research Chair in Gay Men’s Health.

Dr. Jennifer Beecker provided expert advice on sunscreen in Hello! Canada magazine.

Dr. Kumanan Wilson was interviewed by CBC News about vaccine hesitancy and the possibility of holding parents liable for not immunizing their children.

Dr. Swapnil Hiremath was interviewed by the American Heart Association News about drug-resistant hypertension. His new research suggests that some people who apparently have this condition are simply not taking their medication.

Dr. Hiremath was also interviewed by Consumer Reports about home blood pressure monitors.

Dr. Kumanan Wilson was interviewed by LinkedIn for a feature story on health apps, including the need to rigorously evaluate them.

Dr. Peter Tanuseputro was interviewed by CBC Radio Ottawa, the Ottawa Citizen and other media across the country about a research project that aims to improve end-of-life care in the community. The RESPECT End-of-Life calculator, developed by Dr. Tanuseputro and Dr. Doug Manuel, is meant to help people start having discussions about what to expect as the end of life approaches.

Dr. Shawn Marshall was interviewed by the CBC Radio’s The Current about how Canadian diplomats posted in Cuba who are suffering from “Havana syndrome” have symptoms similar to chronic post-concussion syndrome.

Dr. Guy Trudel’s project studying the bone marrow health of astronauts in space was mentioned in the Globe and Mail, Radio Canada and in Le Journal de Montréal. Canadian astronaut David Saint-Jacques is participating in the study.

A clinical trial led by Drs. Marc Carrier and Phil Wells that provides the first approach for safely preventing blood clots in people with cancer was featured in the Ottawa Citizen and CBC Ottawa Morning.

Dr. Swapnil Hiremath was interviewed by Cardiology News about research he co-led with Drs. Manish Sood and Marcel Ruzicka that found alpha-blockers are still widely used to treat hypertension despite being associated with an increased risk of heart failure and stroke.

Drs. John Bell and Michael Rudnicki were interviewed by the Ottawa Citizen about the impact of the cancellation of the Networks of Centres of Excellence Program.

Dr. Shirley Huang and Taryn Mackenzie (manager for Geriatric Medicine Ambulatory Services & Day Hospital) were interviewed by former Redblacks quarterback and now TV host Henry Burris on CTV Morning Live on Nov 16, 2018, concerning falls in older people, since November was Falls Prevention Month. Dr. Huang and Taryn along with Dr. Frank Molnar developed and implemented the Champlain Falls Assessment and Streamlined Treatment (C-FAST) clinic at the Civic Hospital. This innovative clinic has grown exponentially and the service had won the 2017 TOH Excellence Award in the category of Improving Population Health.

The Nov 2018 TOH  featured an article describing the MedSafer research project, involving Drs. Allen Huang (Geriatric Medicine) and Babak Rashidi and Alan Forster (General Internal Medicine).