Hospital

Drug diversion in health-care facilities, when prescription medications are obtained or used illegally, is on the rise in Canada – and most Canadian hospitals do not have sufficient safeguards in place to detect and deal with the problem.

That's why Patricia Trbovich and her team at the University of Toronto, in partnership with the Institute for Safe Medication Practices Canada, have developed a free, online tool that helps hospitals identify the risk of drugs being lost or stolen within their organization, and offers guidance on how to address those risks.

In developing the tool, the team pinpointed areas that make a hospital vulnerable to diversion as opposed to targeting individuals who lose or steal drugs.

“We saw this as an opportunity to look at it from a system perspective, seeing what is it in terms of the way we’ve configured our technologies, workflow processes and environments that is allowing for diversion to occur?” says Trbovich, an associate professor at the Institute of Health Policy, Management and Evaluation in the Dalla Lana School of Public Health.

The diversion risk assessment tool addresses a huge and complex problem. Nationally, reports of the loss of opioids and other controlled drugs have doubled annually since 2015. When drugs are lost or stolen within hospitals, everyone suffers. Drug diversion compromises the safety of patients and staff, increases health-care costs and contributes to substance abuse in the population.

The most commonly diverted drugs are opioids, which are prescribed to relieve pain. Trbovich and Mark Fan, manager of Trbovich’s research group HumanEra, published a study in CMAJ Open that looked at opioid losses from Canadian health-care facilities from 2012 through 2017. Using Health Canada data, they found there were about 65,000 reports of loss during this period, equating to about 112 kilograms of opioids with a street value of about $136 million.

“What makes this topic challenging is that we think losses and thefts are underdetected, and then potentially underreported. We don’t know the relative contributions of those two things,” says Fan, noting that any medication is at risk of going missing.

Moreover, hospitals don’t seem to know when or how medications are being lost or stolen.

“When we started talking to hospitals about it, they were saying, ‘We know it happens, but we don’t have a good way to track how often it happens,’” says Trbovich, who holds the Badeau Family Research Chair in Patient Safety and Quality Improvement at North York General Hospital. “Opioids might go missing for example, but they don’t necessarily know what led to it going missing. They are mandated to report to Health Canada when opioids go missing; often they report it back as ‘unexplained loss.’”

Organizations can use the tool at no cost, but they must first register. The risk assessment examines how controlled drugs are managed throughout a hospital. Users are asked, for example, how discrepancies in inventory records are detected, how staff access controlled areas and how processes around ordering, storage, transfer and disposal of medications are conducted.

The tool produces a risk score based on the information provided. Users can compare their score against other hospitals. There is also a reference guide that has recommendations to address areas of weakness, which was developed in collaboration with the Institute for Safe Medication Practices Canada and the Ontario Branch of the Canadian Society of Hospital Pharmacists.

Hospitals can re-do the assessment after implementing recommended safeguards, notes Trbovich. “Once they’ve addressed [vulnerabilities], they could then on a regular basis benchmark themselves against others or themselves if they want to see how they’re improving,” she says.

To date, dozens of hospitals have signed up to do the risk assessment. The research team will analyze the aggregated results to provide an overview of the diversion risks in Canadian hospitals. The analysis will highlight differences in risk based on region, hospital size and technologies used, so that organizations can learn from each other, says Fan.

“Having this national ‘snapshot’ is going to help policymakers assess where we need to raise the floor on our safety practices across Canada, and to transfer the learnings,” he says. “If we see some people are doing really well, it’s something to celebrate and bring to other hospitals.”

The project received support from the Canadian Institutes of Health Research.

�鶹��Ƶ researchers lead cancer-fighting Dream Team

sgupta — Thu, 04 Feb 2016 14:40:07 +0000

�鶹��Ƶ researchers lead cancer-fighting Dream Team sgupta Thu, 02/04/2016 - 09:40

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“Every cancer patient is different,” Professor Cheryl Arrowsmith says. “They have different mutations and a lot of drugs will work on some patients but not on others.” (photo by Erin Howe)

Erin Howe

Author legacy

Erin Howe

Topic

Subheadline

“Our knowledge is at a turning point,” says Professor Peter Dirks

When Stand Up To Cancer (SU2C) Canada wanted to assemble a “Dream Team” of researchers to fight brain cancer, they turned to the University of Toronto.

Eight members of the Faculty of Medicine have joined the group, fighting brain cancer by focusing on the stem cells that drive the growth of tumours.

“Our knowledge is at a turning point,” says Peter B. Dirks, a professor in the departments of surgery and molecular genetics. “In the last number of years, there have been important genomics discoveries involving mutations in cancer. We’ve also developed an understanding about the cell types that drive these tumours’ growth.

“Now, we can acquire integrated information about the key cells that drive the disease and that should impact the assessment of the quality and efficacy of new drugs tested for these cancers.”

�鶹��Ƶ to transform regenerative medicine thanks to historic $114-million federal grant

sgupta — Tue, 28 Jul 2015 10:35:46 +0000

�鶹��Ƶ to transform regenerative medicine thanks to historic $114-million federal grant sgupta Tue, 07/28/2015 - 06:35

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University Professor Emeritus James Till and Professor Peter Zandstra (photo by James Poremba)

Terry Lavender

Author legacy

Terry Lavender

Topic

The University of Toronto is set to cement its position as one of the world’s leading centres for the design and manufacture of cells, tissues and organs that can be used to treat degenerative disease, thanks to a $114-million grant from the federal government.

“Our government is investing in research and innovation to create jobs, strengthen the economy and improve the quality of life of Canadians,” said the Honourable Ed Holder, Minister of State (Science and Technology). “This legacy investment in Medicine by Design will harness Canada’s strengths in regenerative medicine to treat and cure serious injuries and diseases that impact every Canadian family while creating new opportunities for Canadian health-related businesses.”

The research grant, the largest in �鶹��Ƶ’s history, is the first to be awarded under the Canada First Research Excellence Fund (CFREF), established by the federal government last year. Spread over seven years, the funding will allow �鶹��Ƶ and its partners, which include the Hospital for Sick Children, the University Health Network, and Mount Sinai Hospital, to deliver a new program called Medicine by Design.The initiative and the new funding build on years of support for �鶹��Ƶ’s regenerative medicine researchers from federal granting councils, the Canada Foundation for Innovation and support from the Canada Research Chairs and Canada Excellence Research Chairs programs.

The mandate of Medicine by Design is to undertake transformative research and clinical translation in regenerative medicine, enhance capability in synthetic biology and computational biology and foster translation, commercialization and clinical impacts.

�鶹��Ƶ President Meric Gertler thanked the government for its support of the university’s Medicine by Design initiative, and for its leadership in the advancement of globally competitive Canadian research and innovation. He also thanked and congratulated all those involved in the project at the university and its partner hospitals. “Our brilliant researchers and clinicians are doing cutting-edge work that is making Canada a world leader in regenerative medicine. I applaud them, and all those who helped prepare �鶹��Ƶ’s successful application for this historic research award.”

Read the story of a patient whose life was saved by regenerative medicine

“This program will allow us to take regenerative medicine to the next level,” said Peter Zandstra, a professor in �鶹��Ƶ’s Institute for Biomaterials and Biomedical Engineering, Canada Research Chair in Stem Cell Engineering and one of the researchers involved with the Medicine by Design project. “We’ll be able to design cells, tissues, and organs from the ground up, hopefully with benefit to patients and benefit to the Canadian economy.

“Stem cells offer avenues to treat – and perhaps cure – devastating and costly illnesses such as cardiovascular disease, diabetes, blindness, lung disease, neurodegenerative disorders, and diseases of the blood and musculoskeletal system,” he added. “Medicine by Design provides a framework to design the cells, the materials and, ultimately, the clinical strategy needed to reach this goal.”

Read Behind the Scenes of Medicine by Design: a Q & A with Peter Zandstra and Molly Shoichet

Medicine by Design will allow Canada to lead the transformation of the global medical industry and become a major international supplier of regenerative medicine technologies – a market that is predicted to grow to $50 billion by 2019. The strategy is expected to generate several new startup companies and to attract established international companies to Canada, eager to take advantage of �鶹��Ƶ’s expertise.

The program will have three divisions, Cells by Design (to create cells whose fate and function can be controlled to ensure safer and more effective therapies), Tissues by Design (to create complex tissues for use in research, drug discovery and replacing lost or damaged tissue in humans) and Organs by Design (create and repair organs outside the body and demonstrate how those organs can be successfully transplanted into human patients). The three divisions will be supported by technology platforms such as genomic engineering, immune engineering and a program to manufacture stem cells on demand.

Medicine by Design builds on a rich legacy of �鶹��Ƶ contributions to regenerative medicine, beginning with the demonstration of the existence of stem cells by biophysicist James Till and hematologist Ernest McCulloch in 1960. As Gertler noted, “Their breakthrough has led to an entirely new field of biomedical research; to the wonders of regenerative medicine; to a global industry responsible for many thousands of high-tech jobs, and ultimately, to better health and new hope for patients and their loved ones, across Canada and around the world.”

Till, who attended the CFERF grant announcement, said he is thrilled by Medicine by Design’s potential. “It's marvellous that the Canada First Research Excellence Fund has chosen to assign a very high priority to regenerative medicine/stem cells. This announcement means that research on stem cells and on regenerative medicine in Canada will move to another level and it will be the University of Toronto that will provide leadership for that.”

See a photo gallery of the event

�鶹��Ƶ has a very long and impressive history of accomplishments, both in biomedical engineering and in stem cell biology, such as the discovery of cancer stem cells, the development of the first artificial endocrine pancreas, and combining living cells with synthetic polymers to create artificial organs and tissues. From 2009-2013, �鶹��Ƶ researchers published more articles than any university in the world except Harvard in top scholarly journals for regenerative medicine and stem cells, biomedical engineering, and cell and tissue engineering.

More than 50 researchers and clinicians from �鶹��Ƶ and its hospital partners are involved in the Medicine by Design program, as well as hundreds of graduate students and postdoctoral fellows. Additional researchers and graduate students will be recruited over the next few years. Medicine by Design’s inaugural international partners include Peking University, Technion Israel Institute of Technology, the UK Regenerative Medicine Program and Sweden’s Karolinska Institutet.

Additional CFREF grants will be announced shortly, noted Ted Hewitt, president, Social Sciences and Humanities Research Council of Canada and chair, Canada First Research Excellence Fund steering committee.

“The Canada First Research Excellence Fund has provided Canadian universities with an unparalleled opportunity to take their leading-edge research and make it the best in the world. This will set them on course to make the ground-breaking discoveries that will enhance prosperity and change the lives of Canadians and millions around the world forever,” Hewitt said.

Kenyan medical resident on �鶹��Ƶ exchange program: “My life will never be the same again”

sgupta — Tue, 14 Jul 2015 12:07:45 +0000

Kenyan medical resident on �鶹��Ƶ exchange program: “My life will never be the same again” sgupta Tue, 07/14/2015 - 08:07

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“At the end of the day patients will receive better care and will live because of what I’ve learned at �鶹��Ƶ,” says medical resident Elizabeth Kagotho

Katie Babcock

Author legacy

Katie Babcock

Topic

Global Lens

Features

St. Michael's Hospital

Subheadline

Elizabeth Kagotho talks about what it's like to train with top pathologists and learn from this city's diverse patient population

It was her first time traveling outside of Africa, and it was an experience that didn’t disappoint. Elizabeth Kagotho, a clinical pathology resident from Aga Khan University Hospital in Kenya, recently completed a two-month observership in hematological pathology at �鶹��Ƶ.

She coordinated her visit through Rumina Musani, a professor in the Faculty of Medicine’s department of laboratory medicine and pathobiology. While working at the University Health Network and St. Michael’s Hospital, Kagotho analyzed blood samples to diagnose diseases.

Upon her arrival, Kagotho hit the ground running and learned how to use flow cytometry, a laser-based technology that characterizes blood cells in different types of diseases. This diagnostic tool is especially useful when distinguishing between different types of blood cancers.

Kagotho spoke with Faculty of Medicine writer Katie Babcock about how her training has helped her to become a better clinician and how her experience will change her work in Kenya.

What was your day-to-day experience like?
When I arrived in Toronto I started by interpreting results from the flow lab, and then I learned how to use the technology to run the samples. Every week I was assigned to a new pathologist. They would create the original report, then I would provide the diagnosis and we would then review my interpretation. It was a great one-on-one learning experience because they could give me immediate feedback on how to improve.

What have you learned from your experience as an observer?
I’ve learned many things, but I’ve really enjoyed learning flow cytometry. Aga Khan is one of the few institutions in Kenya that has a working flow cytometry machine, but we really don’t have a lot of experience with this technology. One of the main issues is that when we’re trouble shooting technical issues, we don’t really know what to do. With my experience here, I now know how to address these problems. Also, in Kenya we see one sample per week and in Toronto I saw 60 samples per day! As a result, I had the opportunity to learn from so many experts and when I go back home I’ll be the expert.

What did you enjoy most about your time in Toronto?
I was impressed with the wide variety of cases. I’ve read books and I know what certain diseases are supposed to look like, but now I’ve seen these cases in real life. Toronto has a diverse population, and it has patients with all sorts of different diseases. It also has an aging population – since my country has a lower life-expectancy, we don’t get to see some of the diseases that arise in older people.

I also enjoyed being trained by top-quality experts. Pathologists around the world use a manual called the WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. One of the pathologists here is an author of this manual, and when I met her it was like meeting a star.

How will this experience change the way you practice medicine?
When I go back home I have a lot of work to do. Most pathologists in Kenya diagnose hematological malignancies, or blood cancers, by looking at a slide under a microscope. But this method isn’t very accurate or specific. It’s important to know exactly what type of cancer you’re dealing with because that could result in a different treatment. I’m excited to use flow cytometry because it’s the gold standard for diagnosis and it can differentiate between different cancers. With the education I have received here I can effectively manage patients better in Kenya.

Why is this type of experience so important?
It’s really a global exchange of ideas. Since this program has empowered me, I will go and empower others in Africa. At the end of the day patients will receive better care and will live because of what I’ve learned at �鶹��Ƶ. This program also counteracts brain drain – I’ll be going back to my country and will be investing in its future.

What are your next steps?
After my experience in Toronto, my life will never be the same again. Since my life has changed, I know that my future patients’ lives will never be the same either. I have a much better grasp of how to use diagnostic tools and I owe this to my time in this program.

In the future I hope to join the one-year hematological pathology fellowship program at �鶹��Ƶ. These past two months have been amazing, and I can only imagine how one year could transform my life even more.

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Building healthier cities and communities, one collaboration at a time

sgupta — Fri, 29 May 2015 14:55:17 +0000

Building healthier cities and communities, one collaboration at a time sgupta Fri, 05/29/2015 - 10:55

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(Bike to School Day photo by San Francisco Bicycle Coalition via Flickr)

Nicole Bodnar

Author legacy

Nicole Bodnar

Topic

Dalla Lana School of Public Health

Community

Collaboration

Cities

They are projects aimed at fostering a sense of community for people in apartment towers, making it safer for kids to bike and walk to school in rush hour – and helping homeless people deal with extreme temperatures while living on the city streets.

On May 29, those initiatives got a boost from �鶹��Ƶ’s Dalla Lana School of Public Health, the Wellesley Institute and Toronto Public Health through a collaboration called the Healthier Cities & Communities Hub.

A total of nine projects by community, public sector and university collaborators received research grants from the Hub to address what are known as the social determinants of health.

“More than half of the world’s population lives in urban areas, and as more people migrate to cities to seek employment, public health professionals must be thinking about ways to ensure that those cities promote health equity for citizens,” said Professor Dan Sellen (pictured at left) associate dean of research at the Dalla Lana School of Public Health.

“Health inequities persist in the GTA. That’s why these partner-based, solutions-focused research projects are so crucial.”

In April 2015, public health and community engagement leaders from the Dalla Lana School of Public Health, the Wellesley Institute and Toronto Public Health reviewed 30 grant applications related to creating resilient cities, the built environment and health and place-based interventions.

“Our innovative grant scheme will bring academics and communities together to improve the health of Torontonians. We need everyone working side by side if we are going to meet the challenges we face,” said Dr. Kwame McKenzie, CEO of Wellesley Institute.

The grants are enabled by the Healthier Cities and Communities Hub as part of its mission to improve urban and community health locally and beyond. Project teams unite experts from diverse fields, including leaders in community based and public service organizations, architecture, business, medicine, engineering and public health who proposed innovative projects that will help generate solutions to health challenges faced by many people in the GTA.

“The healthier cities and communities hub and its seed grant program strengthens connections between community organizations, academics and the public sector,” said Monica Campbell, director of Healthy Public Policy at Toronto Public Health.

“The hub and the seed grant will support research on vital public health policies and programs aimed at improving health and equity in the Toronto region. Toronto Public Health is pleased to contribute funds and in-kind support to this important initiative,” Campbell continued, who is also an assistant professor in the Dalla Lana School of Public Health’s occupational and environmental health division.

A workshop is planned for April 2016 where projects leaders will share and discuss their preliminary findings with a range of stakeholders across the city.

Here are the funded projects and leaders:

Developing a framework to evaluate the health impacts of apartment neighbourhood improvement initiatives such as the Tower Renewal Program in Toronto, led by Roshanak Mehdipanah, Monica Campbell, James Dunn, Graeme Stewart (Urbana Solutions + and Toronto Public Health)
Falling through the Cracks in Employment Services: Improving Social Well-Being through Community-Based Youth Employment Solutions, led by William Sinclair (St. Stephen's Community House)
Green Access Action Research (GreenAAR) Project: Building Local Environmental Leadership to Promote Green Living and Food Security: a place-based pilot initiative in the Taylor Massey neighborhood, led by Yogendra Shakya and Akm Alamgir (Access Alliance Multicultural Health and Community Services)
Creating a 'Town Centre' in a Tower Neighbourhood, led by Nancy Smith Lea and Car Martin (Toronto Centre for Active Transportation / Clean Air Partnership)
Understanding the health impact of extreme temperatures on homeless populations with a view to enhancing Toronto's extreme weather plans and responses: developing a research proposal, led by Kate Bassil and Stephen Hwang (Toronto Public Health and St. Michael's Hospital)
A Guide to Safer Streets near Schools, led by Katie Wittman (Green Communities Canada and Dalla Lana School of Public Health)
Promoting Resilient Relationships among Newcomer Youth, led by Chris Rahim and Lisa Randall (METRAC: Action on Violence)
Building Roads Together: Evaluating, Enhancing, and Expanding a Walk and Roll Peer Support Program, led by Farah Naaz Mawani and Susan Lynn Hardie (Farahway Global, Centre for Social Innovation - Regent Park and Dalla Lana School of Public Health)
Building the economic resiliency of communities: Exploring the acceptability and feasibility of establishing a time bank in St. James Town, led by Andrew Pinto (St. Michael’s Hospital)

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Why this astronaut-turned-surgeon (and hospital CEO) respects science fiction

sgupta — Tue, 12 May 2015 15:03:13 +0000

Why this astronaut-turned-surgeon (and hospital CEO) respects science fiction sgupta Tue, 05/12/2015 - 11:03

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“SciFi is great at getting us to think about biocompatible devices, ” says Dr. Dave Williams

Suniya Kukaswadia

Author legacy

Suniya Kukaswadia

Subheadline

“Science fiction is a driver that challenges us to consider what might be possible. ”

As a former astronaut, now assistant professor in the University of Toronto's department of surgery and hospital chief executive officer, Dr. Dave Williams has a unique perspective on health care.

Today, Williams is using lessons he learned in space to transform care as president and CEO of Southlake Regional Heath Centre. He spoke to writer Suniya Kukaswadia about the promise of Big Data, the future of medicine and the intersection of science and science fiction.

Do you think big data will change medical research in the future?

Big data presents opportunities for using large databases of information to provide diagnostic support to clinicians. The ICU is a good example. We can monitor patients using physiologic sensors to record heart rate, urine output and blood pressure as opposed to relying on one-on-one interactions between the health care professional and patient to gather the data and make decisions.

Imagine if we can use computers to do this in the future instead of people. It sounds like something out of Star Trek or 2001: A Space Odyssey.

In the aerospace world, for example, aircraft have on-board data monitoring systems that help the crew ensure everything is working properly. The clinical data is there but now we have the opportunity through analytics to apply this information to health care.

What inspired you to become an astronaut and a physician?

It goes back to 1961 when Alan Shepard went to space. I remember watching it on TV and thinking ‘that’s incredible! That’s what I want to do.’ But at that time Canada didn’t have an astronaut program. I decided to focus on the underwater world instead, and became passionate about scuba diving.

At age 12 I was considered young for the course and I had to pass both the physical and theoretical tests to get my scuba certificate. The theory involved advanced physics and a lot of physiology. I became interested in looking at how the body adapted to functioning in extreme environments – whether it was underwater or in space. That’s one of the reasons why I became a physician.

While many see me as an astronaut, an aquanaut and a physician, I would actually characterize myself as an exploration scientist who is passionate about how the body performs in a wide-range of environments. My passion is helping people working in those environments optimize their performance.

How does one role inform the other?

Both working in space and in health care requires understanding how teams work together in environments that are intolerant of error. The consequences of a mistake in space can be catastrophic. The same is true in clinical practice. If you were going in for surgery you would want to know that the operating room is a zero-fault-tolerant environment where your clinical team achieves success and avoids errors.

Both careers are also data driven and science-enabled. Our understanding of scientific principles has helped us explore space, and the same is true for medicine. We’re using science and engineering to drive the development of new technology to deliver state-of-the-art health care in space. Similarly, technological innovation is transforming the way in which medical care is delivered on Earth. There have been remarkable changes in the treatment of a number of different diseases over the course of my career, all driven by research and innovation. For instance, it is exciting to see how the application of space robotics to the development of surgical robots is transforming modern surgery.

One of the reasons why I became a hospital CEO was to see whether we could take the lessons learned from aerospace about the importance of innovation, safety and quality and bring them into health care.

Have you been able to apply any of those lessons at Southlake?

Yes, very much so. One of the elements of high reliability organizations is creating a culture of safety. At Southlake we have a very vibrant culture called the Southlake Way. It is defined by our core values of putting patients first, honouring our commitments, pushing the envelope and giving a damn. We just added a new core value called ‘speak up’ which is an extrapolation of what we do in the aerospace program. During a space flight we want crew members to speak up if they see something that they are concerned about. The same applies to health care, where we are seeing the concept integrated into the use of surgical checklists.

How do you think science fiction influences medical devices?

I think science fiction is a driver that challenges us to consider what might be possible. It is based on science portrayed from a fictional perspective. If you think back to the SciFi from the 1960s, you’ll recognize some of the devices that are in use today such as body-worn sensors that collect physiologic data and stream it to hand-held devices. Metaphorically it’s very similar to the Tricorder from Star Trek.

During my first space flight in 1998, I had to take a pill that was actually an AM frequency radio hooked up to a temperature sensor. It was used to monitor my core body temperature. The data was then sent via radio signals to a receiver I wore on the outside of my body and then downloaded to a research team in mission control.

SciFi is great at getting us to think about biocompatible devices. Currently, we’re seeing glimpses of the fictional ‘bionic person’ with people who have artificial implants. Take ventricular assist devices. In the 1950s and 60s those would be considered science fiction, but they are a reality today. I’m interested to see where biocompatible devices will take us in the future.

What are some of the big challenges facing health care today in your opinion?

I think we need to transition from a health and disease model to a wellness model. I trained as a physician when rest and recovery was a routine part of a hospital stay. Patients were admitted to the hospital to be treated and then rest and recover. That’s now evolving into a system where patients are admitted to the hospital when they need access to sophisticated technology to diagnose or treat a condition followed by early mobilization. Where possible I think care needs to be transferred back to the community with supports to help patients return to their optimum level of function.

How can the health care model shift towards a wellness-focused approach?

We’re already seeing the shift in my opinion. Patients and their families are better engaged in individualized care plans developed by interprofessional teams. We’re also creating new technologies to help empower patients to get more involved in their care. Technology will definitely speed up the transition to a more wellness-focused approach. I think this model will also help us confront some of the economic factors we face in health care today.

What are some unique health issues faced by astronauts?

Astronauts in space face the same challenges we face while we age. Their rate of bone loss can be anywhere from one to two per cent per month. This becomes problematic if an astronaut has been in space for an extended period of time. They also face issues with muscle wasting and aerobic deconditioning. We don’t use our legs much while in space. After a space flight it takes some time to adapt to a gravitational environment and regain your terrestrial legs.

NASA uses bed rest when it does research to understand the impact of these changes on an astronaut’s body. When some elderly patients are admitted to the hospital, we may keep them in bed for extended periods of time depending on their condition and need for care in the community. That’s like sending someone to Mars.

On my first space flight we wore a wrist device that monitored our activity levels. Imagine if we monitored activity levels of patients in hospitals, and physicians started prescribing minimum levels of activity to make sure people weren’t becoming deconditioned. We’re much more aware of the need for early mobilization in health care. I’m very excited to see our physiotherapists working together with respiratory therapists to help recovering ICU patients on ventilators walk around.

We know physical activity is crucial in the space program, but that’s something that’s fallen off the radar in the traditional health and disease model of care. Activity, diet and sleep are all critical in the wellness model.

Where do you see health care going?

Our imagination will be the limit, but I think we will use more and more technology in the delivery of innovative community-based care. However, one thing to consider is whether or not humans will remain an earth-living species, or will we be a space faring species. We know people want to go to Mars. Our ability to live on Mars will be based on us developing technology to drive biologic sustainability. Biologic change is measured in centuries whereas technologic growth is much faster. I think health care in the future will be based on technology optimizing physiologic function.

What do you think humans in 100 years will look like?

I think fundamentally the human form will continue to look the way it does today. But I wouldn’t be surprised if people continued to grow taller and have better physical conditioning. I also think we’ll see more bionics. We have some interesting advancements even now. In the past we haven’t been able to do much for adults who lose their sight. But now we’re seeing the emergence of light sensors that interact with the central nervous system to give people a rudimentary pattern of light recognition.

Suniya Kukaswadia is a writer with the Faculty of Medicine at the University of Toronto.

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Risk of suicide remains high even years after failed attempt

sgupta — Thu, 02 Apr 2015 09:01:01 +0000

Risk of suicide remains high even years after failed attempt sgupta Thu, 04/02/2015 - 05:01

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(photo by Ben Harvey via Flickr)

Caitlin McNamee-Lamb

Author legacy

Caitlin McNamee-Lamb

Topic

Hospital for Sick Children

Health

Research

Global

Subheadline

“Most individuals who eventually died by suicide used more violent methods on subsequent attempts"

People who survive a first attempt at suicide by poisoning are 42 times more likely than the general population to kill themselves by poisoning eventually, say the authors of the world's largest suicide-risk study.

“The durable risk of suicide long after the first self-poisoning episode suggests that to save lives we may need ongoing sustained initiatives," said Associate Professor Yaron Finkelstein, lead author of the study. “Most individuals who eventually died by suicide used more violent methods on subsequent attempts, and only seven per cent of them reached hospital alive.”

Researchers at the University of Toronto, The Hospital for Sick Children (SickKids), the Institute for Clinical Evaluative Sciences (ICES) and Sunnybrook Health Sciences Centre, based the study on more than 65,000 people who survived a self-poisoning episode – including adults and children. The results were published in the April 1 online edition of JAMA Psychiatry.

Researchers tracked every person who presented to an emergency department in Ontario for self-poisoning between April 2002 and December 2010. They found that the risk of death from accidents was 10 times higher following self-poisoning.

This suggests that the first episode of deliberate self-poisoning is a strong predictor for subsequent suicide and premature death.

”The hope is that our findings can be used to target this high-risk group and that it may influence suicide-prevention strategies to include long-term follow-up and efforts,” said Dr. Finkelstein, an associate professor of paediatrics, pharmacology and toxicology at �鶹��Ƶ and staff physician in paediatric emergency medicine, and clinical pharmacology and toxicology, and associate scientist at SickKids.

In Canada, suicide is the second leading cause of death in individuals aged 15 to 35 years, yet prevention efforts have remained a challenge, because the long-term outcomes following suicide attempts have not been well characterized. The present study also identified population-level suicide risk factors, which include being male, having engaged in multiple self-poisonings, higher socioeconomic status, a diagnosis of depression and psychiatric care in the year preceding the first self-poisoning episode.

“Previous research has largely focused on short-term studies of patients with known psychiatric conditions in individual health-care centres,” said Finkelstein. “However, no one has looked at the entire population including both patients with diagnosed mental health conditions as well as everyone else in the community.

“Additionally, this is the first study to focus exclusively on individuals with a first presentation for self-poisoning. More research is required, and our multidisciplinary team is working hard to dig deeper, and is focusing on the vulnerable group of teenagers, as well as subsequent self-harm behaviours.”

Dr. David Juurlink, the study's senior author, is professor of medicine, pediatrics, and health policy, management, and evaluation at �鶹��Ƶ, senior scientist at ICES, and head of the division of clinical pharmacology and toxicology at Sunnybrook Health Sciences Centre.

“It’s surprising how little we know about long-term outcomes after a first self-poisoning episode.” said Juurlink. “By following a very large group of patients over a long period of time, this study demonstrates that the risk of suicide remains elevated long after a first attempt. The implication of this is that suicide prevention efforts in these patients must also be sustained.”

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Brain bleeds in newborns and fetuses may be caused by immune system, research shows

sgupta — Wed, 25 Mar 2015 08:52:14 +0000

Brain bleeds in newborns and fetuses may be caused by immune system, research shows sgupta Wed, 03/25/2015 - 04:52

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“What we’ve discovered means that platelet transfusions are necessary to control bleeding after birth but may not be an effective therapy for brain bleeds in fetuses,” says Professor Heyu Ni (photo by Carly Lesser and Art Draggles via Flickr)

Melissa Di Costanzo

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Melissa Di Costanzo

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St. Michael's Hospital

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Study challenges notion that low platelet counts are behind life-threatening condition

A newly-discovered bodily process in mice may explain why some human fetuses who have different antigens than their mothers suffer life-threatening brain bleeds, says a new study.

“Antigens are like the body’s national flag. They’re planted on each cell in the body and tell the immune system whether something in the body, such as a bacteria or virus, is foreign,” said Heyu Ni, a professor in the departments of laboratory medicine and pathobiology, medicine and physiology.

“Because each parent’s DNA is different, a fetus can have different antigens, or flags, on some cells than his or her mom. When a mom’s immune system identifies those cells as foreign to the body it attacks them, which can cause brain bleeds and result in neurological impairment or even death.”

The condition where mothers and fetuses have different antigens is called fetal and neonatal alloimmune thrombocytopenia, or FNAIT. It affects about one in 1,000 live births. Fetuses experience bleeding in the brain in about 10 to 20 per cent of FNAIT cases. The disease can also cause miscarriages, although that has not been well studied.

Platelets – cells in the blood that help form blood clots and stop bleeding – are one of the cell types that commonly have different antigens. Because they are often different in the mother and fetus, they can be targeted by the mother’s immune system. Until now, low amounts of platelets were considered the cause of brain bleeds in fetuses and newborns.

“Our research challenges the idea that low platelet counts are responsible for fetal brain bleeds and instead shows that the immune system’s attack on the new blood vessel cells in the brain is more likely responsible,” said Ni, who is a scientist in the Keenan Research Centre for Biomedical Science of St. Michael’s Hospital as well a Canadian Blood Services scientist. “An antigen, called beta 3 integrin, is found both on platelets and on the cells responsible for developing blood vessel in fetuses.”

Newborn platelet levels are tested at birth since it’s believed a lower platelet count signifies the newborn lacks the ability to stop bleeding. A safe level of platelets for newborns is between 150 million and 450 million cells per ml of blood. Babies with low platelet counts (less than 150 million cells per ml of blood) are usually treated right away with platelet transfusions.

“What we’ve discovered means that platelet transfusions are necessary to control bleeding after birth but may not be an effective therapy for brain bleeds in fetuses since platelets may be not essential to stop fetal bleeding,” said Ni. “We should consider different therapies to prevent brain bleeds and ensure blood vessels in the brain are developed properly before birth.”

Ni’s research team also looked at the potential treatment of intravenous immunoglobulin transfusions. He said IVIG –made of plasma from donated blood – may be an effective therapy to control this devastating disease, although more research is needed to confirm this.

The study was published in The Journal of Clinical Investigation. The project was supported by the Canadian Institutes of Health Research, the Canadian Foundation for Innovation and Canadian Blood Services.

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How to treat a leading cause of potentially fatal hospital-acquired infections?

sgupta — Fri, 06 Feb 2015 10:42:54 +0000

How to treat a leading cause of potentially fatal hospital-acquired infections? sgupta Fri, 02/06/2015 - 05:42

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Professor Leah Cowen, lead researcher on the study and Canada Research Chair in Microbial Genomics and Infectious Disease in �鶹��Ƶ's department of molecular genetics (photo courtesy NSERC)

Jim Oldfield

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Jim Oldfield

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Try combination drug therapy, new research suggests

Researchers at the University of Toronto have discovered that Candida albicans – a leading cause of potentially fatal hospital-acquired infections – rarely develops resistance to combination drug therapy and, when it becomes resistant, it also becomes less dangerous.

The team may also have found a new way to eliminate Candida albicans in humans.

Treating fungal infections through a single drug is increasingly ineffective because fungi quickly evolve drug resistance. Combination therapies have shown great promise in overcoming this problem, but scientists are concerned these combinations will spur even stronger resistance.

By testing combination therapies in Candida albicans, the �鶹��Ƶ researchers found that only a few strains of this fungus became drug-resistant, and that resistance came at a cost to the fungus.

“Drug resistance in fungal infections is a huge problem,” says Professor Leah Cowen, the lead researcher on the study who holds the Canada Research Chair in Microbial Genomics and Infectious Disease in �鶹��Ƶ's department of molecular genetics. “And if we’re going to treat these infections with drug combinations we need to know if they’ll readily become resistant. In Candida albicans we found a trade-off: a few strains gain some resistance but they become less ‘fit’ or functional when the drug is not present.”

The strains of the yeast that became resistant to drug combinations grew poorly in several stress conditions which are connected to human infections. For example, the resistant strains became weaker when they encountered oxidative stress, which happens when people become sick.

The researchers also found that resistant strains were vulnerable to immune cells called macrophages – further evidence that drug combinations may minimize drug resistance.

Cowen and her colleagues used Candida albicans strains they created in the lab, and they compared them to strains that were sensitive to combination therapy. They also confirmed their findings with yeast that had evolved resistance in a patient. “This was an important step, because what you learn in a test tube often doesn’t correspond to what happens in a patient,” says Cowen.

The journal Cell Reports published the findings.

Candida albicans is the third-leading cause of intravascular catheter-related infections, and when acquired from implanted medical devices, it kills one-third of people it infects. The number of fungal bloodstream infections has more than doubled over the last two decades, partly because successful treatments for cancer and AIDS have left many patients immune-compromised and vulnerable to infection.

Cowen and her lab have developed a combination therapy for Candida albicans that inhibits a protein in the yeast called Heat-shock protein 90 (Hsp90). They’re eager to test the therapy in patients, especially given Candida’s limited resistance to it. But a big challenge is that Hsp90 is also an important protein in humans, so they need to develop fungal-selective inhibitors that target it in yeast exclusively.

Recently, they found a way to do that.

Cowen’s team created and compared detailed maps of the drug-binding structure of Hsp90 in Candida albicans and in humans. In the yeast, the Hsp90 protein contains a larger pocket through which drugs can bind to it. So by increasing the size of the drug-like molecules, they engineered a potential therapy that targets Hsp90 only in yeast – the molecules are too big to bind in the Hsp90 drug-binding pocket in people.

“It seems to work,” says Cowen. “We have a handful of structures that preferentially inhibit the fungal protein over the human counterpart. With a little more funding we can improve on these molecules and ultimately test this treatment in patients.”

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Crohn's drug may help treat bone marrow disorder, researchers say

sgupta — Mon, 02 Feb 2015 10:55:29 +0000

Crohn's drug may help treat bone marrow disorder, researchers say sgupta Mon, 02/02/2015 - 05:55

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Award-winning author and filmmaker Nora Ephron (pictured here in 2009) died of acute myeloid leukemia, a complication of myelodysplastic syndrome, in 2012 (photo by John Dalton via Flickr)

Erin Howe

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Erin Howe

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Researchers in the department of medicine may have found a new way to treat a bone marrow disorder.

A drug called adalimumab, which is commonly used to treat Crohn’s disease, may help people who have myelodysplastic syndrome (MDS). The drug is also used to treat other conditions including rheumatoid arthritis, ulcerative colitis, plaque psoriasis and juvenile idiopathic arthritis.

In MDS, a person’s bone marrow doesn’t produce enough healthy blood cells. The stem cells don’t function properly, which results in too few healthy red blood cells, white blood cells and platelets. Red blood cells carry oxygen through the body while white blood cells protect against illness. Platelets help blood to clot.

“Many of these patients depend on transfusions for red blood cells and platelets,” said Anca Prica, assistant professor in the division of haematology and lead author of the study. “They can live like that for a long time, but they still have the disease.”

The study is published in the Journal of Clinical Oncology and is co-authored by Rena Buckstein, an assistant professor in the division of haematology and head of the haematology site group at the Odette Cancer Centre at Sunnybrook Health Sciences Centre. It focused on a 60-year-old man referred to the doctors in 2009 with mild macrocytic anemia and thrombocytopenia. He also had Crohn’s, but was not on active therapy at the time. He was diagnosed with MDS.

The man’s hemoglobin levels increased with the use of a medication called darbepoetin. He also participated for a year in a clinical trial of romiplostim and his hemoglobin levels continued to improve. Meanwhile, the man’s need for the darbepoetin declined, and he was able to stop taking it.

Two months later, the man began a prescription for adalimumab to manage his Crohn’s disease after symptoms returned. Doctors saw a secondary benefit – a slow increase in the man’s platelet counts. A year later, the man’s platelet counts were normal. He remains on adalimumab with normal blood counts and stable Crohn’s disease.

Prica, who is also a staff haemotologist at Mount Sinai Hospital and the University Health Network’s Princess Margaret Cancer Centre, said inflammation is one of many mechanisms involved in MDS. Previous research has shown that a messenger protein called TNF-alpha is impaired in a number of different conditions including Crohn’s as well as in MDS.

“The idea of using an anti-TNF-alpha is certainly not new in MDS,” she says. “A few small studies involving other medications like infliximab, which is used to treat rheumatoid arthritis, revealed some promise, but overall, the results were on the lower end of efficacy.”

About 1,500 cases of MDS are diagnosed each year. Well-known MDS patients have included astrophysicist Carl Sagan and writers Nora Ephron, Susan Sontag and Roald Dahl. The disease affects 0.2 per cent of people with anemia over the age of 65. Few treatment options are known to change the course of the disease in its most common low-risk, slow-moving form. MDS transforms into a form of cancer called acute myelogenous leukemia in nearly a third of people with the condition.

Erin Howe is a writer with the Faculty of Medicine at the University of Toronto.

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Brain bleeds in newborns and fetuses may be caused by immune system, research shows

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