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Alin Danila

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

salted pretzels

Pass the salt: Average sodium intake proven safe, after all

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When it comes to salt consumption – an ever-controversial topic in the world of nutrition and health – the old adage “everything in moderation” has proven to be true. Researchers at the Population Health Research Institute (PHRI) of Hamilton Health Sciences and McMaster University have discovered that, for most people, sodium (a.k.a. salt) consumption does not increase the risk of health problems except for those who eat more than five grams a day, the equivalent of 2.5 teaspoons of salt.

Andrew Mente, an author of the study, and his colleagues at PHRI along with researchers from across countries found that salt intake above five grams, equal to 2.5 teaspoons, per day can increase a person’s risk of health problems like cardiovascular disease. But, fewer than five per cent of people who live in developed countries, including Canada, exceed that level. The average sodium consumption is between 3 to 5 grams – or 1.5 to 2.5 teaspoons – of salt per day.

The findings are part of a larger, long-term study led by PHRI looking at how nutrition impacts health in populations around the world. Last year, the same team found that a higher versus lower intake of fat can also reduce the risk of health problems and death. The findings are challenging global dietary guidelines, which Andrew and his team argue need to be revisited.

There’s only an associated risk of heart disease and stroke when a person’s average daily salt is greater than five grams.

“The World Health Organization recommends consumption of less than two grams of sodium – one teaspoon of salt – a day as a preventative measure against heart disease, but there is little evidence in terms of improved health outcomes that individuals ever achieve at such a low level,” says Andrew.

The study followed 94,000 people aged 35 to 70 from 18 countries around the world for an average of eight years. The results show that there’s only an associated risk of heart disease and stroke when a person’s average daily salt is greater than five grams. When the average intake is less than five grams, the evidence shows that there is no correlation between salt intake and risk of heart disease and death.

“Our findings show that community-level interventions to reduce salt intake should only target communities with high salt consumption, and should be embedded within approaches to improve overall dietary quality,” says Andrew.

Of all 18 countries involved in the study, China was the only country where the majority of people consume more than five grams of sodium a day.

The study findings have been published in The Lancet in August 2018. Click here to read the full article.

Acting VP Research, Ted Scott

BLOG: Redefining research

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By: Ted Scott, Acting Vice President Research & Chief Innovation Officer

The dictionary definition of “researcher” is painfully self-explanatory: “someone who conducts research.” Based on my experience at Hamilton Health Sciences (HHS) over the last few years, this description does no justice.

The word “research” itself has attracted a certain connotation that invokes images of anonymous individuals in lab coats analyzing samples in whitewashed, sterile rooms in the pursuit of some far-off, seemingly impossible discovery. Sure, some discovery happens that way. But, so often, it’s so much more than that.

At HHS, our researchers are so much more than people in lab coats. They are innovative, strategic, highly creative minds who translate complex data into new knowledge. Many of our researchers are also healthcare providers. Every day, they work alongside the patients who are the inspiration for their research pursuits. Their “labs” are patients’ rooms, clinics, and operating theatres. Every day, they’re on the front lines of our healthcare system, asking questions and solving problems. Their roles span the entire spectrum of healthcare professions: they’re surgeons, pediatricians, physiotherapists, nurses, students. They’re also our neighbours, friends, family members and, sometimes, they’re patients, too.

In my short time at HHS, I’ve learned that our researchers are also some of our community’s top innovators and collaborators. They’re forming networks across our city and region that are aimed at improving the way we provide healthcare, applying technology and expertise to make our healthcare system better. And, most importantly, their work has immense, tangible impact. Beyond the lab and the computer database, our nearly 2,000 researchers and research staff are discovering and implementing new knowledge that’s changing the way we care for people, in real-time.

For example, they’re testing in-home technology that our nurses and doctors can use to monitor patients once they go home after heart surgery. They’re working with tech innovators to find better ways of predicting outcomes for cancer therapies, so patients can make better decisions around their treatment options. They’re trialling the latest therapies to help make life easier for kids with chronic diseases, like inflammatory bowel disease (IBD).

This is just a sampling of the research happening at our hospitals, right now. It wouldn’t be possible without our researchers and research staff who are unwavering in their pursuit of making life better for people in our community, across our country, and around the world.

It’s this insatiable drive to know the unknown that I believe better defines a researcher.

I admire their persistence, their patience, and their will to keep exploring, even when the answers aren’t clear. And especially when competing commitments – of being doctors, nurses, allied health professionals, students – are as demanding as they are in our very busy health system.

It’s this insatiable drive to know the unknown that I believe better defines a researcher, no matter how big or small the issue at hand.
At HHS, we’re redefining what “research” means to our community, and to the world.

We’re not just researchers. We are explorers. It’s in our DNA.

Read our stories here.

researcher analyzing a brain scan after a stroke

Creating a world without stroke

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For decades, our teams have been tackling stroke head-on. Their discoveries have set the compass for how we treat and prevent stroke worldwide.

Cutting stroke in half

Can you imagine a world without stroke? Dr. Jackie Bosch can, and she’s leading a mission to make that vision a reality.

While research has made great strides in finding new and better ways to treat stroke, prevention is even more important. Dr. Bosch has led worldwide studies showing that certain safe, inexpensive, easily accessible medications (e.g. blood pressure-lowering and cholesterol-lowering drugs) are better at reducing the risk of stroke than previously believed. Together, these medications have the potential to prevent 50 per cent of all strokes, which equates to tens of thousands of lives saved each year.

Stopping stroke in its tracks, sooner

When a stroke happens, millions of brain cells die with each minute that passes. In other words, the quicker a person receives emergency treatment, the less likely they are to suffer severe, potentially disabling brain damage. In recent years, the discovery of clot-busting drugs and special clot removal procedures have benefited countless patients by limiting the effects of stroke once it happens, but their effectiveness depends on how quickly the person receives treatment. Dr. Michael Sharma and his team are testing new drugs that act even faster and more effectively against a stroke to limit progression, giving more stroke victims a chance at life and, for many, a full recovery.

Treating the worst strokes, better

Strokes are devastating, but some are worse than others. Hemorrhagic strokes, which happen when blood vessels rupture and cause bleeding in the brain, are more likely to lead to death and severe disability, yet fewer researchers have ventured into understanding them. Dr. Ashkan Shoamanesh is one of those few, and he leads a Canada-wide research group aimed at exploring how to prevent hemorrhagic strokes and to better treat people who suffer from them.

HHS & McMaster researchers find “simple” methods to prevent heart attack & stroke

Three simple methods to prevent heart attack and stroke have been proven by an international team led by Hamilton Health Sciences (HHS) and McMaster University researchers.

The research team, based at the Population Health Research Institute of HHS and McMaster, studied more than 12,000 patients from 21 countries to evaluate drugs that can prevent cardiovascular disease (CVD), which cause 18 million deaths and about 50 million heart attacks and strokes around the world each year.

“These are incredibly important findings with potential for significant global impact,” says Dr. Salim Yusuf, principal investigator and executive director of PHRI. “If just 10 per cent of the world’s population at intermediate risk of CVD is impacted, we’re talking about 20 to 30 million people who could be helped by these drugs.”

The study, “HOPE-3”, examined three methods using two forms of therapy: Statins, a group of cholesterol-lowering drugs, and antihypertensives, a class of drugs used to treat high blood pressure. In addition, a combination of statins and antihypertensives was reviewed.

Statins proved to significantly and safely reduce CVD events by 25 per cent in patients at intermediate risk without CVD. Antihypertensives did not reduce major CVD events overall in the population studied, but did reduce such events in the group of people with hypertension, but not in those without hypertension. When combined, statins and antihypertensives reduced CVD events by 30 per cent—with a 40 per cent benefit in those with hypertension, suggesting that patients with hypertension should not only lower their BP but also consider taking a statin.

“These simple methods can be used practically everywhere in the world, and the drugs will become even cheaper as more and more systems and people adopt these therapies,” he said.


This article is featured in the latest Explorers publication.

Dr. Alexandra Papaioannou by the YMCA swimming pool

Pre-surgery program for better post-surgery results

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Age hasn’t slowed Annette Atwood down. She’s never been one to sit around in front of the TV, even now in her 70’s, unless perhaps if Wimbledon is on.

When she started to notice a dull constant pain in her hip, she chalked it up to getting older. But when her hip started to frequently give out causing her to fall, she realized it was more than just old age. Annette was in need of a hip replacement.

Being the outgoing person that she is, Annette wasn’t going to let the wait for surgery slow her down. She still went out and about, making sure to always bring a walker or cane with her.

“It’s not just about ensuring our patients get the surgery they need, but ensuring it improves their quality of life.”

When she went for an appointment with her surgeon, he told her about a research study called Fit Joints that’s exploring whether participation in a pre-surgery program, which includes exercise, nutrition, medication review and goal setting, can help patients undergoing hip and knee replacements recover better. It’s well-known that the healthier a person is before surgery, the more likely they are to have a positive outcome. Researchers at the Geriatric Education and Research in Aging Sciences (GERAS) Centre of Hamilton Health Sciences (HHS) and McMaster University are applying that same concept through the Fit Joints study.

“Since many patients in need of hip or knee replacements are frail, surgery may not be as effective,” says Dr. Alexandra Papaioannou, geriatrician at HHS, executive director at the GERAS Centre and Fit Joints study lead. “But, there’s growing evidence showing that frailty can be treated through proper diet and exercise. This means our study could not only better prepare our patients for surgery, but also improve their frailty and reduce their chance of falling. The goal is to help patients get back to the life that they enjoy.”

Swimming instructor teaching Annette Attwood's aquatics class

Study participants are given an exercise plan, a food intake log and vitamin D and protein supplementation. With help from the Les Chater YMCA, participants can attend aquatic classes and receive coaching in the gym. They’re also given gentle exercises to complete at home. Since it’s a fairly big change for people who don’t exercise regularly, study coordinators provide ongoing guidance with monthly home visits. The program continues as long as patients have to wait for their surgery.

“As healthcare providers, it’s not just about ensuring our patients get the surgery they need, but ensuring it improves their quality of life,” says Dr. Papaioannou. “Regardless of the complexity, surgery can be hard on the body. So, we’re hoping this program can help patients’ recover well and enjoy the benefits of their new hip or knee.”

If the study is successful, the team at the GERAS Centre hopes the program can become a routine part of care for all joint replacement patients across Ontario.

Annette Attwood in the swimming pool at the YMCA

As for Annette, one year post hip replacement, she’s still swimming at the YMCA twice each week.

“I loved the program as soon as I started it before my surgery,” she says. “But now, it’s not just exercise, it’s a social outing.”

Annette Attwood speaking to study coordinator Ahmed Negm

Explorer Dr. Alexandra Papaioannou

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

This story was featured in our community report. Click to read the full report.

An HHS geriatrician meeting with a patient

Helping people age better

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We’re living longer than ever before, and that’s a good thing. But, are we aging well? Our researchers are exploring ways to help people live better, longer by tackling aging early on.

Getting a grip on frailty and aging

Can the strength of your grip reveal how well you’ll age? According to Dr. Darryl Leong and his colleagues at the Hamilton Health Sciences and McMaster University Population Health Research Institute, it can. They’re using data from 200,000 people in 25 countries around the world to better understand what factors affect longevity, but also how frailty can be avoided through early intervention. Hamilton is also home to the Canadian Longitudinal Study on Aging (CLSA) at McMaster University, where Parminder Raina and his team have established a robust data platform to better understand the biological, clinical, social, psychological, economic and environmental aspects of aging. The CLSA will follow over 50,000 Canadians between the ages of 45 and 85 for the next 20 years to gain insight in to why some people age well, and some others don’t.

By identifying how a young person’s eating and exercise habits, as well as their genes, affects their muscle strength and physical functioning down the line, we can learn how to delay, and even prevent, disease and frailty before they take hold.

Patient-driven aging research: A living lab

Despite their best efforts, frailty will remain a reality for some people as they grow older. In their “living laboratory”, Dr. Alexandra Papaioannou and her colleagues at the Geriatric Education and Research in Aging Sciences (GERAS) Centre at Hamilton Health Sciences’ St. Peter’s Hospital combine patient care with research to create innovative healthcare solutions based on the needs and lived experiences of their patients. Current projects include a new mobile app that will allow clinicians to quickly identify patients at risk for frailty; a wireless bed that uses artificial intelligence will anticipate patients’ needs; and a dance program for seniors to promote mobility and mental ability.


This article is featured in the latest Explorers publication.