Monthly Archives

March 2018

Explorers of hospital to home technology

Ground-breaking project aims to minimize complications after cardiac surgery

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

The SMArTVIEW system uses wireless, wearable technology that monitors a patient’s vital signs in hospital after their surgery, and once they go home. If the technology detects anything unusual, the hospital is alerted. The technology aims to prevent post-surgical complications, including infections and blood clots, and reduce post-surgical emergency room visits and re-admissions to hospital. SMArTVIEW will also link patients directly with nurses at the hospital so they can receive education and support during their recovery.

“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 co-principal investigator for SMArTVIEW. “The rate of complications post-op far exceed those in the operating room, where patients are being closely monitored and the surgical team can act quickly if problems arise.”

“The rate of complications post-op far exceed those in the operating room.”

SMArTVIEW is one of 15 projects that received funding in the first round of Ontario’s $20-million Health Technologies Fund (HTF). The fund is administered by Ontario Centres of Excellence (OCE) on behalf of the Office of the Chief Health Innovation Strategist (OCHIS), and is a part of the OCHIS mandate to strengthen Ontario’s health innovation ecosystem.

“The Health Technologies Fund is already having an impact in the health system because of the collaborations it has created between health service providers, health technology innovators and patients,” says William Charnetski, Ontario’s Chief Health Innovation Strategist. “We are finding new ways to solve our greatest challenges by harnessing the power of innovation to provide better care while creating jobs in Ontario.”

“These digital health projects demonstrate why investment through the Health Technologies Fund is so important. People are more comfortable than ever using digital technology in their everyday lives and they expect the same kind interaction of their health system,” says Eric Hoskins, Minister of Health and Long-Term Care. “With these new tools, health care will become even faster and simpler for patients to use in their homes and communities.

With a proven track record of delivering programs on behalf of the Ontario government, OCE was selected to deliver the HTF and assist in driving the development of made-in-Ontario healthcare technology while supporting economic growth, co-investing to commercialize innovation and fostering partnerships and collaboration in the health system.

“People are more comfortable than ever using digital technology in their everyday lives and they expect the same kind interaction of their health system.”

“Healthcare is a priority sector in Ontario and globally, so it makes sense that OCE works with publicly-funded healthcare service providers, patients, academia and industry to find innovative ways to improve patient outcomes and experience by supporting the demonstration of health tech through the Health Technologies Fund,” says Dr. Tom Corr, OCE’s President and CEO.

“We’re very appreciative of the support for SMArTVIEW and the recognition of its potential to dramatically improve outcomes for patients,” says Dr. Michael McGillion, assistant dean of research at the school of nursing, McMaster University and co-principal investigator for the SMArTVIEW project.

The SMArTVIEW project is in partnership with project contributors Philips Healthcare, QoC Health Inc., ThoughtWire Corp, CloudDX, XAHIVE Inc., Argyle Public Relationships, and Ontario Telemedicine Network.

For more information, please visit the Health Technologies Fund website.

Mike McGillion, Nurse Scientist, Explorer

The technological revolution of healthcare

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By: Dr. Michael McGillion
Nurse scientist, Population Health Research Institute
Associate professor, School of Nursing, McMaster University

Like most health care professionals, I became a nurse to make a difference. Then, I became a scientist to understand how best to make that difference.

We’re in an exciting time of emerging technologies in health care. We’re finding ways to improve the delivery of care so that patients can recover better and get back to their daily lives faster. This is unchartered territory, making it an exciting journey as a researcher.

Today, patients undergoing surgery are going home sooner, with a larger portion of recovery time at home. This, however, means that they’re not monitored as well as when in hospital, and patients can have complications, particularly in the first 30 days at home. At the Population Health Research Institute (PHRI), we’re exploring how to bridge this gap between a patient and their hospital team using remote monitoring technology. The SMArTVIEW project is a unique collaboration that’s looking specifically at improving outcomes for patients who undergo cardiac and vascular surgery, where the risk of complication is relatively high. We’re leveraging the academic and clinical expertise of groups across McMaster University and Hamilton Health Sciences to develop a solution that we hope will make a difference for cardiac patients in Hamilton, Canada, and beyond.

Solutions like SMArTVIEW have the potential to revolutionize how we provide care, in and out of hospital.

We’ve never had access to this kind of technology before. Solutions like SMArTVIEW have the potential to revolutionize how we provide care, in and out of hospital. But the technology can’t stand on its own. The support and expertise of our clinical teams is crucial to success. In SMArTVIEW, for example, registered nurses actively review the monitored health data, and check-in with patients daily via video chat to ensure their recovery is going smoothly. The input and support from our nursing and clinical teams has been imperative. Without them, the technology would serve no purpose.

SMArTVIEW is just one example of how our focus on digital health allows us to go beyond the walls of the hospital and create new care pathways. It’s exciting to think about the global reach we can have with these technologies, and what they can help us achieve in supporting our patients through their recovery.

There remains a lot to discover in the growing field of digital health. Where are the best areas to implement hospital-to-home technologies? How can we use these technologies most effectively to manage early signs of complications after surgery? How do we overcome connectivity issues in such a vast country with remote areas? If we make great strides, how will these systems be distributed and managed? I find these questions compelling, and answering them requires far greater collaboration than ever before – not just among investigators, clinicians and research staff, but IT, biomedical technology, informatics and security as well.

The input and support from our nursing and clinical teams has been imperative.

Being part of this cross-cutting community of explorers has allowed me to become part of a growing network that’s inspired to leverage the opportunities that modern technology presents to improve health for people around the globe. It’s an exciting time to be a health researcher, as we help to lay the groundwork for the digital future of health care.

Michael McGillion, Nurse Scientist, Explorer

Click here for more stories on the explorations at Hamilton Health Sciences.

Dr. Guillaume Pare, medical biochemist, explorer

Discovering a new way to predict early heart disease

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Researchers in Hamilton have developed a genetic test that is five times more accurate than the current standard method in predicting early coronary artery disease (CAD) in young adults.

“This has the potential to save lives,” says principal author Dr. Guillaume Paré. “The more we understand about a person’s risk for early CAD, the better we can help prevent complications – like heart attack – for these patients and their family members.”

Until now, the only way to determine a person’s risk of developing early CAD is to test for a rare genetic defect that is known to be a factor in some cases. However, Paré and his team at the Population Health Research Institute of Hamilton Health Sciences (HHS) and McMaster University have discovered that, by testing for multiple genetic variations, they’re able to predict early CAD in five times as many patients than the current test.

Study results were published today in the American Heart Association’s journal Circulation: Cardiovascular Genetics.

Heart disease is the leading cause of death globally. The most common form is coronary artery disease, which occurs when the blood vessels to the heart narrow or harden. Most people can decrease their risk by not smoking, being physically active, maintaining a healthy diet and body weight, and controlling cholesterol, blood pressure and blood sugar.

In rare instances, however, high blood levels of the so-called bad cholesterol, LDL, result from a genetic defect called familial hypercholesterolemia. Patients with this genetic defect are at increased risk for early-onset heart disease before age 40 in men and age 45 in women, so early diagnosis and treatment are critical. The problem is that many patients with early-onset heart disease do not have the single genetic defect measured by the standard test.

“We believed that the rare mutation couldn’t be the only way that someone becomes susceptible to early CAD,” says Paré, medical biochemist at HHS and associate professor of medicine at McMaster University. “What we found is that there are actually several genetic differences which, combined, can significantly increase a person’s risk, even more so than the single gene mutation.”

Paré and his team at PHRI, along with researchers at Laval University in Quebec City, Quebec, developed the multi-gene – or “polygenic” – risk score based on 182 genetic differences related to CAD.

They then compared polygenic risk scores between study participants with and without early-onset heart disease. They found that the polygenic risk score predicted one out of 53 cases of early-onset heart disease, compared to one in 256 for the single genetic test. Additionally, none of the patients with high polygenic risk scores had the rare genetic defect for familial hypercholesterolemia, meaning the current testing method would not have identified them as at-risk for early CAD.

Study participants included 30 patients from the heart clinic at Hamilton General Hospital, and 96 patients with early-onset heart disease enrolled in the UK Biobank study, a large study in the United Kingdom looking at the relationship between genetics, the environment and disease. As controls, the study also included 111,283 UK Biobank participants without early-onset heart disease. The report may be found here.

The study was funded by the Canadian Institutes of Health Research, a Canada Research Chair in Genetic and Molecular Epidemiology and a CISCO Professorship in Integrated Health Biosystems.

Dr. Guillaume Pare, medical biochemist, explorer

Dr. Rosalyn Juergens, Oncologist, Researcher, Explorer

The new generation of lung cancer treatment

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At age 69, Ed Wand had a heart attack. It came as a surprise – he’d been healthy his entire life. Unfortunately, the trip to the hospital brought about more bad news: Ed had lung cancer.

In his retirement, Ed became an avid walker and was often mistaken for being younger than he was. But, everything changed with the heart attack. The cardiac team at Hamilton General Hospital needed to put three stents in Ed’s heart to re-open blocked arteries. In preparation for the procedure the doctors ordered X-rays of Ed’s chest, but what they found was unexpected. There was a dark spot on one of Ed’s lungs. The diagnosis: stage three lung cancer. Ed was immediately referred to the Juravinski Cancer Centre (JCC) under the care of Dr. Rosalyn Juergens, an oncologist specializing in lung cancer. With the support of Dr. Juergens and her team, Ed started the traditional cancer treatment of chemotherapy and radiation. It was a scary new chapter of life, but he took it in stride.

“Immunotherapy is leading a new wave of cancer treatment.”

“I’ve always supported my wife with her ongoing health concerns, so it was a strange feeling when our roles reversed,” says Ed. “Although there were physical side effects to the treatment, with help from my wife, I felt like I could handle it.”

Ed continued to walk every day to help keep up his physical and mental health. There were good and bad days, but he took them one by one. After treatment came the good news of remission, but the celebrations were short-lived. Six months later, Ed’s cancer returned. This time, it came back quickly.

Making life better for people with lung cancer

More than 28,000 Canadians receive a lung cancer diagnosis each year. It can develop quietly which, unfortunately, means that about 75 per cent of cases are caught in the later stages when the disease is harder to treat.

Dr. Juergens has dedicated her career to improving life for these patients.

She and her team at Hamilton Health Sciences and McMaster University, in partnership with The Ottawa Hospital, are exploring a potentially groundbreaking new treatment that may help people like Ed who have advanced stage lung cancer. The “Sandpiper” trial is exploring whether a combination of two different viruses with a cancer treatment drug can stimulate the immune system to recognize and attack cancerous cells.

“Immunotherapy is leading a new wave of cancer treatment,” says Dr. Juergens. “We’re still in the early stages, but the potential that it offers to patients is exciting.”

Ed became the first patient to participate in the study.

Determined to meet his diagnosis head-on, in March 2017, Ed became the first patient to participate in the study. Today, more than 50 patients are enrolled at JCC and The Ottawa Hospital on trials with the cancer fighting virus. Like Ed, they share the hope of a little more time.

In the meantime, every day, Ed continues to walk, seeing the world in a new light. If it weren’t for his heart attack, he probably wouldn’t be here today. He makes the most of every day, and is hopeful that the immunotherapy treatment will give him a little more time with his wife.

“We’ve come a long way over the years at improving survival and outcomes for people like Ed who receive the devastating diagnosis of lung cancer,” says Dr. Juergens. “But, we can do more.”

Dr. Rosalyn Juergens, Oncologist, Researcher, Explorer

Click here for more stories of our explorations.

 

Research at Hamilton Health Sciences is conducted in partnership with McMaster University.