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Alin Danila

Dr. Harriette Van Spall, Explorer, cardiologist at Hamilton Health Sciences

Helping those with heart failure live long healthy lives

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Carol has been an avid clogger for the past 20 years. What’s clogging, you ask? It’s a folk dance similar to tap dancing. Carol is part of a clogging group that travels all over the United States for workshops and conventions. Clogging is about more than exercise and socializing for Carol. It’s part of who she is.

In the fall of 2017 Carol started to notice an unsteadiness in her legs. Despite using her asthma inhalers, she also had a cough that wouldn’t go away. Both issues were starting to affect her life, including her clogging.

“My legs would get wobbly when I was clogging, so I’d sit down and take a break. Then when I stood up they’d be wobbly again and it would take me a minute to reorient myself. I just couldn’t keep up anymore,” she recalls.

As advised by her family doctor, Carol went to the emergency department at Hamilton Health Sciences’ Juravinski Hospital and Cancer Centre. She was in heart failure.

Heart failure is one of the most common causes of hospitalization in older adults.

Heart failure occurs when damage to the heart makes it too weak or stiff to work properly. Common causes include heart attacks, high blood pressure and other conditions that affect the heart. When someone is in heart failure, their heart must work much harder to pump blood through the body.

Carol is not alone. There are about 600,000 Canadians living with heart failure. It’s one of the most common causes of hospitalization in older adults. For about a month after they leave the hospital, these patients have a higher risk of their symptoms becoming worse. One in four patients return to the hospital during this period.

A Hamilton doctor is on a mission to change this.

Exploring heart failure services

Dr. Harriette Van Spall, a cardiologist at Hamilton Health Sciences and researcher at Population Health Research Institute, is exploring how improving services for heart failure patients can benefit their health. She recently led the Patient-centered Care Transitions in Heart Failure (PACT-HF) clinical trial, which investigated how education and access to resources following hospital discharge can help patients like Carol avoid another hospital admission.

Her prior research shows certain services, like regular nurse visits and multidisciplinary clinics, can reduce readmissions in heart failure patients. These services require collaboration among multiple health care settings and professionals, which makes them difficult to implement. The PACT-HF study brought everyone together to set patients up for success.

“Heart failure requires lifelong management,” says Dr. Van Spall. “Supporting these patients when they’re most vulnerable is a key way to ensuring they’re well equipped to manage their condition. And, if managed with appropriate services, they can live long healthy lives.”

“we need to ensure that all Canadians have access to heart failure care regardless of geography”

The goal of the study was to determine if the services would reduce emergency department visits, hospital readmissions, or death. While the results showed no impact on these outcomes, the services had a significant impact on the patient’s quality of life. They felt more prepared for their recovery process and ongoing management once they were home.

“Dr. Van Spall understood how important it was to me to return to clogging. Now, I’m thrilled to be back to clogging three times a week,” says Carol.

“The results indicate that there is merit to providing transitional care services as they improve quality of life. We just need to find which services will also impact readmissions and death,” says Dr. Van Spall.

“Importantly, we need to ensure that all Canadians have access to heart failure care regardless of geography. Access to specialized treatment centers, use of proven-effective medications, and outcomes depend to a large extent on where patients live. We are now developing and testing digital health technologies that will allow us to provide care in remote and rural regions, so that all patients can access optimal treatment. With new technologies that bring specialized services and treatments to where people need them, we will continue to explore how best to tackle the epidemic of heart failure.”

Dr. Van Spall with some of her research team

Dr. Van Spall and her research team

Click here for more stories of our explorations.

 

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

Mother reading book to daughter

Report: Unlocking a healthier future

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We’ve reached an important time for health care in Canada. We’re at a crux. We need total, transformational change to mount some of the big challenges that our health systems are facing country-wide.

But at Hamilton Health Sciences (HHS), in partnership with McMaster University, we’re exploring and implementing innovative solutions to change the tides for the better, and we’re doing it through world-leading health research.

Our research teams are helping us unlock important answers about health and health care so we can bring more value to our patients and their families. For example, our teams are helping patients with heart rhythm issues live better and with fewer complications. They’re finding new treatment options for patients with late-stage cancer so that they can live longer and more comfortably. And, they’re working with various cultural groups to create healthier futures for their children by detecting and mitigating potential health issues earlier on.

Learn more about how research at HHS is making a difference in people’s lives and in our healthcare system, for the better, in our latest report.

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

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.

Many patients with early-onset heart disease don’t have the single genetic defect measured by the standard test.

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.

“There are actually several genetic differences which, combined, can significantly increase a person’s risk, even more so than the single gene mutation.”

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. Sne running a test of the LaparoGuard technology in the operating room

New equipment aims to make surgery safer

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Advancements in technology have greatly aided in making many procedures and surgeries safer for patients. This includes laparoscopic surgery, which has become a common approach over the past 40 years for a variety of surgical procedures.

In laparoscopic surgery, a long, slim tool is inserted through small cuts into the abdomen. The tool is equipped with a very small camera and light on the end. Additional instruments are inserted through a similar technique. Images from the camera are fed to a screen, and the surgeon carries out the procedure by watching their movements on the screen. It’s used for many procedures including gall bladder removal, hernia surgery and colon resection.

Dr. Sne testing the LaparoGuard system

There’s still room for improvement

As a minimally invasive surgery, the incisions are much smaller. This reduces the patient’s risk of infection and significantly reduces the hospital length of stay, overall leading to a faster recovery.

Despite the benefits laparoscopic surgery offers, there is still room for improvement. Since surgeons are working within a much smaller space, it can sometimes be tricky to keep their multiple tools within a clearly defined safe zone. This can result in unintentional minor injury to surrounding tissues. The injury is often recognized and treated when it occurs, but if it goes unnoticed it can eventually cause complications.

Finding solutions with technology

To tackle this problem a local medical device company, Mariner Endosurgery, has developed a new device called LaparoGuard. It allows surgeons to identify and create a safe zone that the surgeon must stay within during laparoscopic procedures. If the instruments unintentionally move out of the safe zone, Laparoguard sends an audio and visual signal to the operating team.

After rigorous testing and approvals, the equipment is ready to pilot in a research trial at Hamilton Health Sciences (HHS).

LaparoGuard uses innovative image-enhancing technology, similar to what’s used in a fighter jet.

“We’ve come a long way in terms of the safety and precision of minimally-invasive surgery in recent years,” says Dr. Niv Sne, trauma surgeon at HHS and principal investigator for the LaparoGuard trial. “Still, no surgery is without its risks. This trial may present surgical teams with a more advanced option to conduct laparoscopic procedures with even fewer risks to the patient.”

LaparoGuard uses innovative image-enhancing technology, similar to what’s used in a fighter jet. It’s described by the makers as augmented reality without a headset. LaparoGuard is installed in one operating room at Hamilton General Hospital for the pilot, which begins in the next few weeks.

LaparoGuard tools being used in a test at the Hamilton General Hospital

“We’re excited to be working alongside Dr. Sne and the surgical teams at Hamilton Health Sciences,” says Mitch Wilson, president & chief operating officer of Mariner. “Their extensive experience conducting laparoscopic procedures and their interest in exploring new technology to improve patient safety and surgical precision is invaluable.”

A collaborative team

This collaboration between HHS and Mariner Endosurgery is one of the projects funded by Health Ecosphere, an innovation pipeline program that assists in commercializing health solutions. This, along with a grant from Hamilton Health Sciences Foundation, helped make this trial possible.

“Now we’ll use feedback from HHS surgeons to ensure it’s efficient for the team that’s using it.”

The surgeons at HHS’ Hamilton General Hospital are excited to explore the new technology.

“At this point we’re confident LaparoGuard can help make laparoscopic surgery safer for patients. Now we’ll use feedback from HHS surgeons to ensure it’s efficient for the team that’s using it,” says Mitch. “We’re looking forward to the results.”

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.