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Alin Danila

Michael McGillion, Nurse Scientist, Explorer

From hospital to home

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Imagine having a major surgery and being able to go home only days later. We know that people recover better in their own surroundings, where they’re most comfortable. But, there’s also a higher risk of complications in the first month after surgery. How do we reduce this risk to ensure people don’t end up back in the hospital, while encouraging a better recovery process?

Technology has made its way into every aspect of our lives. Now, it’s helping healthcare professionals answer important questions like this one.

Researchers at the Population Health Research Institute of Hamilton Health Sciences (HHS) and McMaster University have developed a potential solution to bridge the gap between hospital and home for patients who undergo major surgery. The SMArTVIEW project utilizes unique Philips’ technology to wirelessly monitor patients vital signs on the ward, as well as a hospital-to-home system to track a patient’s vital signs once they’ve gone home and alert the hospital team to any patient flags. The system is currently being tested in a formal research trial to determine whether it could help prevent hospital readmissions and the many complications and, in some cases, deaths that can happen in the weeks after heart surgery.

“We’re empowering the patients to take control of their recovery and help them every step of the way.”

“In the operating room and intensive care unit (ICU), patients are closely monitored and the surgical team can act quickly if problems arise.” says Dr. Michael McGillion, principal investigator for SMArTVIEW. “We also need systems that can monitor patients closely on the surgical ward and at home, beyond the operating room and ICU. We still need the ability to monitor closely and intervene before serious complications occur.”

A crucial aspect of the SMArTVIEW model is the team of registered nurses who follow patients through the entire recovery process and, with the support of the mobile technology, ensure that any issues are addressed quickly. As the SMArTVIEW system collects patient data, it identifies abnormalities that could be the first warning sign of a complication and prioritizes patients accordingly for the nursing team’s review. It’s exciting for the SMArTVIEW nurses. Typically their relationship with the patients ends when they leave the hospital, but with SMArTVIEW, they can continue to help the patients once they’re home.

“We get to use the full scope of nursing practices and are more involved in the patients’ recovery than ever before,” says Natalia Worek, registered nurse, SMArTVIEW project. “It’s so rewarding to be part of the entire process and reach recovery milestones with them.”

“It’s so rewarding to be part of the entire process and reach recovery milestones with them.”

“We’re empowering the patients to take control of their recovery and help them every step of the way. We’re not only reviewing their vitals, but helping them set and achieve goals, no matter how big or small. We want to ensure they can get back to their regular lives,” says Filomena Toito, registered nurse, SMArTVIEW project.

The SMArTVIEW system goes beyond tracking vitals: it’s also a self-management system that includes information on what to expect in recovery, healthy practices for best recovery, goal setting, a messaging system with the nurses and an open forum to have dialogue with other patients in recovery. Also, part of the SMArTVIEW trial includes a daily video chat with one of the nurses to ensure patients are on track.

“It’s a more holistic approach. We talk to them about their sleep, nutrition, pain management, physical activity and well-being. These all play a part in the recovery process,” says Karyn Barrett, registered nurse, SMArTVIEW project. “On top of that patients can ask questions that may have otherwise caused them to go see a doctor.”

Successful integration of new technology in to healthcare practice requires the support and expertise of a large team that extends beyond healthcare providers and includes IT, biomedical technology and informatics professionals.

“As nurses, we have no idea how to develop this kind of technology. Likewise, developers aren’t experts in caring for patients,” says Carley Ouellette, registered nurse, SMArTVIEW project. “But working together, we can have a real impact on people’s lives.”

Acknowledgements:
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. The project is funded by the Canadian Institutes of Health Research, the Ontario Centres of Excellence, and the Hamilton Health Sciences Research Strategic Initiative (RFA).

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

Dr. Terry Bennett, child psychiatrist, Explorer, making the race fair lead researcher

Making the Race Fair

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In 2015 Sonja Baker’s family grew from three to five when she gave birth to twin girls. Even as newborns the twins, August and Violet, had very different personalities, but both were outgoing, happy little girls.

“Of course all three of our girls have their own unique personalities, but it’s amazing how much you see the differences with the twins,” says Sonja.

But, when the twins approached age two, Sonja became concerned about some of the differences between them. Violet was cooperative, easy going and learning quickly, while August started to become less vocal and have more temper tantrums.

“When you have two that are going in opposite directions,” says Sonja. “It can be challenging to figure out how to get both to respond positively. I was starting to feel like I needed some help.”

“As healthcare professionals, can we influence kids towards a more positive path in development to set them up for success as early as we can.”

That’s when Sonja learned about a research study in Hamilton called “Making the Race Fair”. The study is exploring whether a program called the Family Check-Up can help decrease challenging behaviours and emotions in young children. The Family Check-Up program has proven to be successful in the United States, and this is the first time it’s being tested in Canada.

“Sometimes challenging behaviours can lead to greater problems as children get older,” says Dr. Terry Bennett, child psychiatrist at Hamilton Health Sciences and lead investigator of the study. “The idea of ‘Making the Race Fair’ comes from the concept that, as healthcare professionals, can we influence kids towards a more positive path in development to set them up for success as early as we can.”

Dr. Terry Bennett and her team at the Offord Centre for Child Studies of McMaster Children’s Hospital and McMaster University, have set out to enroll 280 families like Sonja’s who have kids between the age of two and four and are struggling “beyond the terrible two’s”. The Family Check-Up program works with parents on setting family goals and developing the path to achieve them. The study team follows up with families at 6 and 12 months to gauge their progress.

“Ultimately, we hope to follow the participants longer to see if early intervention benefits the kids well into their school age years,” says Dr. Bennett. “We know that early parenting practices influence kids’ ability to learn emotional self-regulation. If we’ve been able to assist in this area by the time they’re entering kindergarten, it should have spillover effects as they progress in to their youth.”

Any parent will agree that some days are more challenging than others. Dr. Bennett and her team hope that their work will help those kids who struggle more than others to be able to flourish just the same.

“Even if I have to guide my girls differently, I want to ensure they have the same opportunities in life,” says Sonja. “I want to see them grow up together as equals, as best friends.”

Dr. Terry Bennett, explorer, child psychiatrist

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

lab assistant removing research samples from a nitrogen tank

HHS ranks in the top three research hospitals in Canada

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Canada's Top 40 Research Hospitals 2018

Hamilton Health Sciences (HHS) has been ranked among the top three research hospitals in Canada, as announced today by Research Infosource Inc..

Research Infosource Inc. is an independent, leading source of ranking information on research universities, corporations, hospitals and colleges in Canada. Each year, it releases results on the top 40 research hospitals in the country, based on total research revenue.

In 2017, Hamilton Health Sciences generated $207 million in research revenue, a 20 per cent increase over the previous year.

“As an academic teaching hospital with a mandate to improve patient care and our healthcare system through research, we take great pride in our achievement of this high ranking among some of Canada’s most accomplished health research communities,” says Ted Scott, vice president of research at HHS.

More than one million participants from across the six inhabited continents have enrolled in research led by HHS.

In partnership with McMaster University, Hamilton Health Sciences conducts research through five research institutes and centres, with expertise across the spectrum of care. To date, more than one million participants from across the six inhabited continents have enrolled in research led by HHS, and its experts have made discoveries around some of the world’s biggest health challenges.

Click here for more information on research at HHS.

Dr. Andrew Mente in the produce aisle of a grocery store

The evolving relationship between diet and health

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By Dr. Andrew Mente
Principal Investigator, Population Health Program, Population Health Research Institute
Associate Professor, Health Research Methods, Evidence and Impact, McMaster University

Understanding how food affects our health is not a new journey, but as our societies change and evolve, so must our explorations.

In the early 1900s, researchers were focused on the role of vitamins and minerals in human health, since common conditions like scurvy were a result of nutritional deficiency. By the 1950s, Western countries saw a major increase in heart disease, so attention shifted to the “heart-healthy diet”. While this concept is still in focus today, it’s being examined through many new and different lenses.

Early Western-led studies on the effects of nutrition on health focused only on Western countries, and it was these studies that provided the evidence that informed global dietary guidelines. Since then, we’ve learned much more about nutrition around the world and we know now that we can’t take a ‘one-size-fits-all’ approach to educating people about nutrition. Increasingly, as researchers, we need to look from a global perspective as we continue to explore the relationship between diet and health. Because health concerns like heart disease are now a global issue, broadening our scope can have a greater impact and help people around the world live healthy lives.

Broadening our scope can help people around the world live healthy lives.

In 2002, myself and a team of researchers at Population Health Research Institute began the challenge of capturing dietary patterns on a global scale. This is ongoing, but we’re analyzing data from over 50 countries on six continents to explore how food intake affects the health of people all over the world from all walks of life.

So far we’ve learned that, contrary to popular belief, a higher intake of fat is actually linked to lower health risks. By contrast, a diet higher in carbohydrates is associated with a higher health risks. This means that a moderate amount of fat and lower intake of carbohydrates is best for our overall health.

As expected, a high intake of salt increases a person’s risk of health problems such as heart disease. However, we also found that a very low intake can be detrimental, too. This means that a moderate intake is salt is the healthiest option – an amount that the majority of people already consume.

Our work is already challenging common nutritional wisdom.

We also believe a strong case can be made for increasing the consumption of potassium-rich foods since we’ve found that it contributes to decreased rates of stroke in people from all countries. Since fruit, vegetables and certain dairy foods are high in potassium and consumption is low worldwide, this may be a good place to start.

These are only a few observations so far. However, our work is already challenging common nutritional wisdom and will hopefully begin to influence public health recommendations.

Since one of the largest research biobank’s in the country is onsite, we’re lucky to continually have access to the samples collected. This means the opportunities are endless on our nutritional explorations. We hope to venture into finding out why we’ve found these results – what the foods or nutrients are doing within our bodies to cause heath issues like heart disease and stroke.

For now, regardless of our dietary guidelines, “everything in moderation” is the key.

Dr. Andrew Mente, explorer

Stelios Georgiades, autism researcher, explorer

Autism research should be based on individual strengths

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By: Dr. Stelios Georgiades
Co-Director, McMaster Autism Research Team (MacART)
Scientist, Offord Centre for Child Studies
Assistant Professor, Psychiatry and Behavioural Neurosciences, McMaster University

Autism is challenging and complex. It impacts different aspects of life in different ways. It changes throughout development and over time. It touches no two people the same.

However, traditional research approaches to autism tend to “lump” children into large groups based on their symptoms and behaviours at any given point in time. These approaches are too simplistic and don’t capture the complexity and diversity we see across the spectrum and the lifespan. Bottom line – much of our research efforts to date have had limited success in advancing autism care.

We hope to inform the development of more individualized and adaptive, family-centred services and supports.

In my opinion, autism is about diverse perspectives and how these are communicated. How do children with autism see the world? How do they see themselves in the world? How does the world see them? These perspectives shape how each child interacts differently with their family, peers, teachers, care providers, and community. If we can better understand these interactions and the perspectives that influence them, we can help support the child along the most appropriate developmental path.

So, my colleagues and I at the McMaster Autism Research Team (MacART) and the Offord Centre for Child Studies are exploring autism using a strengths-based approach to understand how children grow and develop within their surroundings. Ultimately, we hope to inform the development of more individualized and adaptive, family-centred services and supports.

Our new Pediatric Autism Research Collaborative (PARC) project is embedded within the autism clinic at the Ron Joyce Children’s Health Centre of McMaster Children’s Hospital. Our research team is working alongside clinicians to gain a better understanding of which services, or combinations of services, contribute to healthier outcomes for children with autism. Of course, there is no one answer for this, so we’re hoping to find some positive trends that can help parents and care teams navigate the system effectively for each child.

An optimal outcome should be based on each child’s personal characteristics and individual growth over time.

As autism researchers, we’re not striving for a single discovery. Instead, we aim to ensure that every child with autism has an “optimal outcome”. But first, we want to re-define what that means.

In my 15 years as an autism researcher, I have had the opportunity to work with some of the world’s best clinicians and scientists. But, the most valuable lessons I’ve learned are from my interactions with children with autism and their families. Based on this, my team and I believe that an optimal outcome should be based on each child’s personal characteristics and individual growth over time, within a system of care that adapts to their changing needs. That’s the vision we’re working toward.

Katie Porter, Explorer, HHS Research Administration

Exploring a healthier community together

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

At Hamilton Health Sciences (HHS), research isn’t something that happens on the outskirts of health care. Health care and research come together to provide the best care for our patients. Our researchers are our health care professionals – doctors, nurses, therapists, even students. The patients and families we serve aren’t just at the heart of the care we provide, they’re at the heart of our research explorations.

Our desire to discover runs deep. Many of us live in the communities we serve. We understand the unique health challenges we face and recognize that we all have a vested interested in discovering alternative treatments and therapies. The vision that together, we can create a healthier future for our families, friends and neighbours inspires us. We are finding ways to change health outcomes in our community from child and youth mental health to mobility in older adults. Here are two examples.

The vision that together, we can create a healthier future for our families, friends and neighbours inspires us.

For the first time our researchers are working with clinical staff and physicians, patients, families and care givers to explore ways to improve the delivery of Autism Spectrum Disorder (ASD) services. We’re trying to gain a better understanding of what contributes to healthier outcomes for patients with ASD by utilizing the data already collected. Determining how best to navigate ASD services leads to improved care and ultimately provides these kids with more opportunities to become active members of our community in the future.

We’re also exploring ways to ensure our older patients stay healthier longer as our population ages. We’re bringing our best minds into their homes to make their lives better from day one. Our researchers are providing one-on-one support on medication management, nutritional coaching, and physical activity as well as moral support. Patients speak highly of the relationships they form with the research team, and the positive impact they’ve had on their daily lives. For one patient, the study helped him return to his love of skating.

Research is not about numbers, it’s about people.

Research is not about numbers, it’s about people. We’re looking for answers to the questions our patients and our communities are asking. Working with our patients to explore a healthier future for all of us is what makes it to rewarding.

Dr. Stacey Marjerrison

Improving care for Indigenous children with cancer

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Written By: Dr. Stacey Marjerrison, pediatric oncologist at McMaster Children’s Hospital and assistant professor at McMaster University.

Treating childhood cancer is an incredible privilege. Most days, I get to meet families facing their worst nightmare, and have the honour of watching them find strength they didn’t know they had. I get to giggle with kids who somehow manage to find joy and humour in the most trying circumstances. I get to say the words: “the cancer is in remission” and see parents’ faces light up with relief. But, that isn’t every day.

One in five children with cancer will not survive. We do not yet have the tools to save every child’s life. We do, however, have the tools to make their cancer journey better. When days get tough, being able to take a step back and think about how I can improve the cancer journey for all of the families that I help care for makes those awful days easier.

We know that for marginalized families, the cancer journey is tougher than average. Families from low-income neighbourhoods and low-income countries face additional hurdles to those of an average family. Among them are Indigenous families living in Canada. Improving care for marginalized families, including Indigenous families, is the major focus of my research.

I noticed early in my career the differences in survival that Indigenous kids with cancer were facing.

I’m a childhood cancer doctor and a researcher, but I am not an expert on Indigenous health. I noticed early in my career the differences in survival that Indigenous kids with cancer were facing across American studies. Working with experts in Indigenous health, I set about trying to answer the question being asked by many of our Indigenous patients: does this difference also exist in Canada? Our analysis in Ontario showed that First Nations, Inuit and Métis kids diagnosed with childhood cancer had about a 15 per cent lower survival rate than the general population. But, we noted that this difference doesn’t seem to be due to factors such as the time it took for a child to be diagnosed, their adherence to treatment, individual characteristics (age, gender, nutritional status), the severity of the disease, or the strength of the treatment. Our findings differed from a study from Manitoba (which showed no worse outcomes for First Nations children), so we’re now working together on a Canadian-wide analysis. We hope this will help us discover if outcomes have been worse for Indigenous kids with cancer, and if so, why this difference exists and how we can close the gap.

Research is an opportunity for us  to learn how we can make the cancer journey easier for our patients and their families.

Beyond survival, we must also improve the health journey for families. We know that Indigenous Canadians often face systemic racism when interacting with the healthcare system, and when participating in healthcare research. Working with Dr. Chelsea Gabel – an expert in Indigenous well-being – my colleagues and I published a review of ways to improve Indigenous health research in Canada. Ensuring meaningful partnership with Indigenous communities and scholars, considering Indigenous methods and methodologies, and making sure that research findings are considered within the context of Colonial history and current inequities are some of the ways forward.

We also need to ensure that healthcare providers are educated to provide culturally safe and informed care to Indigenous patients. As such, I’m helping to develop new curricula for post-graduate students under the umbrella of the McMaster University Faculty of Health Sciences Indigenous Health Initiative. We hope to build on the lessons we’re learning through a qualitative evaluation of the pediatric residency curriculum this past year, applying our findings across the programs at McMaster.

Inside the hospital, we also hope that the recent opening of Mkoonhs Zhongehgii Iako’nikonhrahnira:ton, our Indigenous family room at the McMaster Children’s Hospital, creates a space where all our Indigenous families feel welcome.

Finally, on an international scale, I’m working with global experts to evaluate how to safely integrate Traditional and complementary medicines into childhood cancer care; a priority for many Indigenous Peoples.

Walking with families through their childhood cancer journey is an honour. Research is an opportunity for us – as healthcare providers – to learn how we can make that journey easier for our patients and their families.

researcher and lab technician in the lab

Leading thrombosis care

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Hamilton Health Sciences and McMaster University are the epicenter of thrombosis research in Canada and the world. Through their ground breaking discoveries, our experts have set the global standards for the prevention and treatment of thrombosis, a common threat that causes one in six deaths worldwide.

Setting the standard for treatment

Thrombosis – or the “bad” kind of blood clotting – causes heart attack and stroke. Our scientists lead many important global projects that have set the standard on how and which drugs are most effective in preventing thrombosis-related issues in those at risk.

People with atrial fibrillation (AF), a common heart rhythm disorder, are especially susceptible to blood clotting and often live with the fear of stroke looming over their heads. In the past, a drug called warfarin was used to reduce the risk of blood clots and stroke in people with AF. But, Dr. Stuart Connolly and his colleagues have proven that the new, blood-thinning drugs are safer and far more effective, meaning those with AF can live with a lower risk of stroke and greater peace of mind.

People who have had a heart attack, stroke or arterial disease share the concern of blood clotting and the complications it brings. Dr. Salim Yusuf (pictured, p. 3), Dr. John Eikelboom and their colleagues have led the charge on a series of studies that have proven that combinations of certain drugs with aspirin, commonly used to prevent blood clotting, are more effective in preventing clotting-related issues than aspirin alone. Their findings can change how we treat these patients in Canada as well as in other parts of the world. Ultimately, fewer lives lost to the very real threat of thrombosis-related disease.

Safer treatment, at home

Our scientists have pioneered discoveries that have made thrombosis care safer and more effective. So effective, that many patients can now benefit from receiving treatment from home instead of a hospital bed.

Previously, those with venous thromboembolism (VTE) – a blood clotting disease affecting the veins – required specialized treatment in hospital to help keep potential problems like stroke and heart attack at bay. But, Dr. Jeffrey Weitz and his team have focused on advancing treatment of VTE so that, in most cases, the disease can be safely managed at home using medication. For hospitals, it means more room to care for the patients who really need it, and for those with VTE, it means a better quality of life.

 

This article is featured in the latest Explorers publication.

Hamilton researchers’ discovery challenges global dietary guidelines

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Researchers at the Hamilton Health Sciences (HHS) & McMaster University Population Health Research Institute (PHRI) have made a discovery that challenges standard nutritional guidelines worldwide.

The PURE study, which involved more than 135,000 people across five continents, examined the relationship between the intake of certain nutrients and the risk of death.

Contrary to popular belief, the study showed that people who consumed a higher amount of fat (about 35 per cent of total energy consumed) had a lower risk of death compared to lower intake. The study also confirmed that a diet high in carbohydrates (more than 60 per cent of total energy consumed) is associated with a higher risk of death, although not with the risk of cardiovascular disease.

“The current recommendations say that we should consume less than 10 per cent of our energy from saturated fat, but we found that lowering intake to currently recommended levels is actually associated with higher risk of mortality”, says Andrew Mente, co-principal investigator for the PURE study.

In other words, when it comes to fat and carbohydrate intake, moderation is key.

Researchers also looked at daily intake of fruits, vegetables and legumes and found that the lowest risk of death was in people who consumed about three to four servings (total) per day, with little additional benefit from consuming more. Current global guidelines suggest five or more servings per day.

The PURE study is the first of its kind based on the size and scope of the participant group. While other similar studies have focused primarily on Western populations, PURE involved people from from 18 low-income, middle-income and high-income countries across five continents. The study’s investigators say that its findings are most significant for lower-income countries where carb consumption tends to be higher while fat intake is lower. In addition, the high cost of fresh produce in some areas around the world makes it difficult for individuals to meet the current recommendation of five servings of fruits, vegetables or legumes each day, whereas three to four is more attainable.

“We’re questioning current global dietary guidelines which have focused mostly on European and North American populations,” says Mashid Dehghan, co-principal investigator. “In light of our findings, we’re suggesting changes to these guidelines.”

John Eikelboom, explorer, co-principal investigator of COMPASS

Cancer and heart disease: An unexpected discovery

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Hamilton Health Sciences researchers have discovered that patients with heart disease who develop major internal bleeding are much more likely to be diagnosed with cancer.

Patients with gastrointestinal (GI) bleeding are 18 times more likely to be diagnosed with GI tract cancer, and those who major genitourinary (GU) tract bleeding are 80-fold more likely to be diagnosed with GU cancer, than patients without internal GI or GU bleeding.

The clinical study, called Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS), is led by the Population Health Research Institute (PHRI), of Hamilton Health Sciences and McMaster University.

The COMPASS study involves more than 27,000 patients with coronary or peripheral artery disease in 33 countries.

“This startling insight should stimulate a search for cancer in patients with cardiovascular disease who develop bleeding.”

Previously, COMPASS found that the combination of a blood thinning drug (rivaroxaban) combined with aspirin reduces cardiovascular death, stroke or heart attack by 24 per cent compared with aspirin alone. Increased bleeding was found to be an unwanted side effect of the drug combination, although there was no significant increase in fatal or critical organ bleeding in patients who took both.

The newest findings show that patients who developed internal bleeding were more likely to be diagnosed with cancer, particularly when the bleeding occurred in the GI or GU tracts. One in five of all new cancer diagnoses during the trial were in patients who had experienced bleeding.

“This startling insight should stimulate a search for cancer in patients with cardiovascular disease who develop bleeding,” said John Eikelboom, co-principal investigator of COMPASS and hematologist at HHS.

“Most of our efforts have been focused on discovering better ways to prevent and treat bleeding, but if bleeding allows us to diagnose cancer earlier, it may lead to an unexpected benefit,” says Dr. Stuart Connolly, co-principal investigator of the COMPASS study and cardiac electrophysiologist at HHS.

Explorer, Dr. John Eikelboom