HHS experts tackling global issue of complications after heart surgery

A ground-breaking project is underway at Hamilton Health Sciences’ Population Health Research Institute (PHRI) to address a major medical shortcoming in Canada and around the world: too many patients develop complications after having cardiac and vascular surgery, and many are re-admitted to hospital after they’re discharged home.

The SMarTVIEW project uses specially-designed software for patients who have had serious cardiac and vascular surgery to receive continuous vital sign monitoring in the hospital and at home. The technology aims to prevent serious complications post-surgery, including infections and blood clots, and to reduce post-surgical emergency room visits and readmissions to hospital.

“As many as eight per cent of patients will have complications after cardiac or vascular surgery,” says Dr. PJ Devereaux, cardiologist at Hamilton Health Sciences, perioperative research lead at PHRI, and scientific lead for SMarTVIEW. “The rate of complications post-op far exceed those in the OR, where patients are being closely monitored and the surgical team can act quickly if problems arise.”

SMarTVIEW extends this monitoring beyond the OR to the hospital ward and then to the patient’s home for about one week after they’ve been discharged. The remote monitoring software is designed to detect subtle declines in a patient’s condition and alert the healthcare team to intervene. At home, monitoring is further enhanced by virtual visits with a nurse, who patients can see on a tablet computer they receive when they leave the hospital.

The project will launch in Fall 2017 with the first patient cohort, including about 600 patients from HHS as well as the Liverpool Heart and Chest Hospital in the UK. Hamilton Health Sciences has also partnered with Coventry University, where researchers have devised tools for support patient self-management during recovery, which will be incorporated in to the SMarTVIEW software.

HHS researchers discover a simple blood test could save lives after surgery

Researchers at Hamilton Health Sciences’ Population Health Research Institute (PHRI) and McMaster University have determined that a simple blood test can predict and possibly prevent many of the deaths that occur after surgery.

The “VISION” study enrolled nearly 22,000 patients aged 45 years or older from 23 hospitals in 13 countries and found that approximately 18 per cent of them sustained heart damage within 30 days of non-cardiac surgery and that, without enhanced monitoring, the vast majority – as many as 93 per cent – of these complications will go undetected, potentially until it’s too late to intervene.

“The effects of surgery anywhere in the body create a perfect milieu for damage to heart tissue, including bleeding, blood clot formation, and long periods of inflammation,” says Dr. P.J. Devereaux, scientific leader of perioperative medicine at PHRI, director, division of cardiology at McMaster University and principal investigator for the VISION study. “In most cases, this damage occurs within the first 24 to 36 hours after surgery when patients usually receive narcotic painkillers that can mask symptoms of cardiac distress.”

“These discoveries have the potential to save lives.”

After surgery, study patients had a blood test for a protein called high-sensitivity troponin T, which is released into the bloodstream when injury to the heart occurs. Devereaux and his team discovered that patients with troponin T levels beyond a certain threshold had increased risk of death within 30 days of having surgery.

Overall, the study found that 1.4 per cent of patients died within 30 days following non-cardiac surgery.

“One per cent seems like a small number, until you consider that about 200 million surgeries are performed each year around the world,” says Devereaux. “Where we’re letting patients down is in post-operative management. We now know that we need to become more involved in care and monitoring after surgery to ensure that patients at risk have the best chance for a good recovery. These discoveries have the potential to save lives.”

The results of the VISION study were published Tuesday in The Journal of the American Medical Association.

 

BLOG: Our fast-growing Children’s Hospital will need a new home

McMaster Children’s Hospital, emergency department, childrens healthcare, mcmaster university medical centre, hamilton ontario, community, hamilton general hospital, our healthy future, dr. peter fitzgerald

Imagining a new hospital in a new location

By Dr. Peter Fitzgerald, President, McMaster Children’s Hospital

As any parent knows, kids grow up fast. One  minute you’re snapping them into a onesie and the next, they’re asking for the car keys.

I often get the same feeling about our McMaster Children’s Hospital. It seems like yesterday we were celebrating an official designation as Ontario’s newest children’s hospital; now, our 30th anniversary is only a year away. And talk about growing before your eyes: We are the fastest-growing of any children’s hospital in the province and are now second only to the Hospital for Sick Children in size (for number of patients and level of acuity).

During the last five years at our Children’s Hospital, we’ve seen an overall 25 per cent growth in inpatient activity, with a particular growth spurt in the Emergency Department (ED), where the number of visits ballooned by 120 per cent. The McMaster Children’s Hospital ED is now the busiest in our HHS family of hospitals.

As busy as we are today, we’re also thinking ahead to how we’ll serve the next generation of children and youth. Over the last two years we’ve been working on a long-range plan for all of Hamilton Health Sciences, called Our Healthy Future. The plan forecasts the services we’ll provide, and the facilities we’ll need, over the next 20 years.

“It seems like yesterday we were celebrating an official designation as Ontario’s newest children’s hospital; now, our 30th anniversary is only a year away.”

We have a bold and exciting vision for McMaster Children’s Hospital. Over the next 20 years we will see an increase of 1.2 million children in Canada, which equals the current population of Manitoba! So we know the growth we’ve seen will continue as the population of Hamilton and surrounding areas continues to rise. Although our services are by no means limited to inpatient care, let’s look at our projected bed counts as a simple example of predicted growth: today we have 161 Children’s Hospital beds and in 20 years we expect to need 231.

So, when we look down the road, we envision a new facility that is designed specifically for the needs of children and their families, and including women’s health services such as our high-risk obstetrics program. We see this new facility being located adjacent to the Hamilton General Hospital campus.

McMaster Children’s Hospital, emergency department, childrens healthcare, mcmaster university medical centre, hamilton ontario, community, hamilton general hospital, our healthy future, dr. peter fitzgeraldThere are many reasons why this location would be ideal – expectant mothers who need acute care services will have them immediately at hand, while children and their parents will benefit from close proximity to our beautiful new Ron Joyce Children’s Health Centre, with its extensive list of outpatient programs for children and youth with special needs.

“Best of all, we’ll have room to grow and develop.”

Best of all, we’ll have room to grow and develop. Our current location at McMaster University Medical Centre, where we share space with the university, just can’t handle the long term needs we foresee. I’m excited about our vision for the future of our Children’s Hospital and I look forward to sharing more information as planning continues.

We envision a new Children’s Hospital to meet our community’s needs – one designed specifically for kids and their families.

BLOG: Health research in Hamilton – improving lives, today

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Katie Porter, director, Research Administration, Hamilton Health Sciences

By: Katie Porter, Director of Research Administration, Hamilton Health Sciences

“And what do you do at Hamilton Health Sciences?” the woman at the Juravinski Cancer Centre asked politely, pointing at my ID badge. I launched into my usual response – I’m a health care administrator, I support the research mandate at HHS, etc., while she nodded.  I pointed to a poster recruiting patients for a clinical trial and said, “There’s an example of a research study my team supports.”

“Clinical trials!” she exclaimed. “I’m alive right now because of a medication I’m receiving in a clinical trial. Thank you.”

I walked away feeling even more proud of my mission at Hamilton Health Sciences, but also wondering how we – those who work in and support health research – can do a better job of communicating the direct and personal impact that research has on our patients and their families.

Too often, we view research as something that happens behind closed doors in laboratories, or as something that takes decades to improve patients’ lives.

This perception needs to change. Research is not only about unlocking new possibilities for tomorrow’s patients; it is also about improving the health of our patients today, helping them live longer, healthier lives.

Changing lives, today

Examples of this abound across our organization. Hamilton Health Sciences has more than 2000 research studies happening at any one time at our various sites and centres. Right here and now, we’re tackling real-life, close-to-home Hamilton issues that are having a positive effect on our patients, families and our community.

Our researchers are improving health care for patients and families facing life-threatening illness. We’re helping our local patients with heart failure have a safer transition to home. We’re joining forces with our community to raise awareness of intimate partner violence and the recognition of associated injuries, and we’re working with our aging population to prevent, and even reverse, clinical frailty. And, because we know that Hamilton has some unique needs in terms of population health, our “Making the Race Fair” study is engaging families in Hamilton’s highest-needs communities to help prevent child and adolescent behavior problems, supporting our city’s vision to help make Hamilton the best place to raise a child.

Too often, we view research as something that happens behind closed doors in laboratories, or as something that takes decades to improve patients’ lives. This perception needs to change.

And while we know that not every research study results in a better outcome for an individual patient, there are other benefits, including a better understanding of their condition, and finally, the satisfaction of making valuable contributions to medical research that may help others down the road.

For those of us who work in research, these benefits are clear. They’re why we do what we do. We know research makes a difference in people’s lives. But how do we shift the common perception that research is only for the future? How do we help our friends, our family members and our neighbours understand that we have world-class research happening right here in our own backyard, and that that research is affecting health outcomes right here, right now?

Making research relatable

Those of us who work in health research must do a better job of de-mystifying research activity and clearly explaining its value in a way that patients can engage with and respond to. We need to establish research as a joint venture between patients, researchers and the community. We must have regular conversations with our patients about research and the fundamental role it plays in the delivery of their own treatment, and remind them that best care evolves out of research and education.

In Hamilton, research is in our community’s blood – its growth and impact as a key industry in our city is undeniable, and only increasing.

Finally, we must continue to conduct research inspired by the needs of our patients, our health professionals and our community. With this approach, we can make discoveries that improve patient care and quality of life – not just for generations of the future, but also for those of us who are here today.

In Hamilton, research is in our community’s blood – its growth and impact as a key industry in our city is undeniable, and only increasing. We have one of Canada’s most research-intensive communities in our own backyard. Last year alone, Hamilton Health Sciences conducted research valued at over $150 million dollars. We’re on track to exceed this amount in 2016.

The story I shared earlier isn’t a rare case. Research is changing our communities every day, for the better, but it often flies under the radar.

There’s so much more of this story to tell.

To learn more about how health research is contributing to a healthier, wealthier and smarter Ontario, visit healthierwealthiersmarter.ca.

Groundbreaking Hamilton study looking at fecal transplants to treat irritable bowel disease in kids

Dr. Nikhil Pai of McMaster Children's Hospital and McMaster University is leading Canada's first study looking at fecal transplants as treatment for irritable bowel disease in children and youth.

Dr. Nikhil Pai, pediatric gastroenterologist at McMaster Children’s Hospital and assistant professor at McMaster University is leading Canada’s first study looking at fecal transplants to treat irritable bowel disease in children and youth.

Hamilton researchers are conducting a ground-breaking new trial looking at fecal transplants to help treat inflammatory bowel disease (IBD) in children.

Fecal transplant treatments have been found to be beneficial for adults with IBD, but the pediatric fecal transplant for ulcerative colitis trial – or PediFETCh – is the first such study for children with IBD in Canada, and the first randomized controlled trial of its kind in the world.

Dr. Nikhil Pai, principal investigator for the PediFETCh trial, says the study is particularly significant given that rates of IBD in children in Ontario are among the highest in the world and rising steadily. Dr. Pai is also a pediatric gastroenterologist in the Centre for Child & Youth Digestive Health at McMaster Children’s Hospital and assistant professor of pediatrics at McMaster University’s Michael G. DeGroote School of Medicine.

“One in 150 Canadians have inflammatory bowel disease,” says Dr. Pai. “About 30 per cent of people with IBD are diagnosed before the age of 20, and Ontario has one of the highest rates of childhood-onset IBD in the entire world. Over the past five years, IBD has increased most rapidly in children under the age of 10 years old.”

Ulcerative colitis (UC) – one of a group of diseases known as inflammatory bowel disease – can have a severe impact on a child’s life, leading to stunted growth; debilitating pain; negative effects on the liver, bones, skin and eyes; and the need for surgery and frequent hospitalizations.

Fecal transplants involve the transfer of fecal material from a healthy donor into a patient’s gastrointestinal tract through an enema, endoscope, or catheter. In adults, repopulating the gut with healthy bacteria has been shown to treat patients with recurrent infections from a common, hospital-acquired bacteria known as C. difficile. A 2015 McMaster University study of adult IBD patients was the first to show that fecal transplants can improve symptoms of ulcerative colitis.

“This is a potentially life-changing treatment option for kids and teens affected by this increasingly common disease.”

“The PediFETCh study will help determine – for the first time – whether fecal transplants can be a viable treatment for children with UC who cannot control their disease with their current medications, or who want to avoid moving onto higher doses, different medications, or surgery.”

“This is a potentially life-changing treatment option for kids and teens affected by this increasingly common disease.”

Patients six to 17 years old who have been diagnosed with ulcerative colitis are eligible for recruitment to the PediFETCh study. For more information, click here.

 

PediFETCH, with Dr. Nikhil Pai from Hamilton Health Sciences on Vimeo.