Five Canadian universities have been chosen in a prominent international competition to represent North America as one of 4 global innovation collaboratives to work with the prestigious U.S. Institute of Medicine (IOM) on a project to lead innovation in health education across the globe.

Related Document(s)

Read Full Press Release (PDF)

The craving for nicotine experienced by smokers trying to kick their habit—and which pushes many to relapse—is in part the result of specific patterns of dopamine neuronal activity, according to new research from the University of Toronto, done in collaboration with The Scripps Research Institute and the University of Western Ontario.

Related Document(s)

Read Full Article (PDF)
 

Prof. Jane Philpott is an Assistant Professor in the University of Toronto's Department of Family and Community Medcine and Chief of Family Medicine at Markham Stouffville Hospital. She is also the founder of Give a Day, a movement that encourages Canadians to give one day’s pay to an organization that will use the money well in the fight against HIV.

Related Links

External Iink: Read the Globe and Mail's interview with Prof. Philpott
 

Many patients get a urine culture at some point during their hospital stay.  Only a few will have an infection that needs treatment, but many more will test positive, triggering further tests and treatment with antibiotics that may be unnecessary or harmful.

What if there was a way to limit urine cultures and still catch dangerous infections?

Dr. Jerome Leis, a recent graduate of a new master’s program in Quality Improvement and Patient Safety at the Institute for Health Policy, Management and Evaluation (IHPME), set out to answer this question in 2012.

With principles he learned in the program — including ways to identify systemic gaps in health care and how to lead change in large organizations — Leis and his colleagues at Mount Sinai Hospital designed a new protocol for ordering urine cultures among hospitalized medical and surgical patients: doctors had to call to request urine cultures, rather than receive test results automatically.

The impact of the change was stunning.

The protocol generated fewer than four calls to the lab per month, reduced unnecessary antibiotic use significantly, and was not associated with any untreated urinary tract infections.  When urinary tract infections were present, the team found, clinicians had no problem calling the lab. Staff treated all patients appropriately.

“Most efforts to reduce the use of antibiotics focus on educating clinicians in how to respond to positive urine cultures,” says Leis, now an Infectious Diseases specialist at Sunnybrook Health Sciences Centre who for his efforts recently received the 2013 Physicians’ Services Incorporated Resident Research Prize and the Harry and Rose Perlstein Graduate Award. “But by looking upstream to the test level, we found we could improve the use of health care resources, limit unnecessary courses of antibiotics and keep patients safe.”

This quality improvement project is one of many underway across Ontario’s health care system, a growing number of which are led by graduates of IHPME’s program — the first quality-improvement master’s in Canada. The institute launched the program last year with U of T’s Centre for Quality Improvement and Patient Safety, amid strong demand from health care professionals and a push from the Ontario Government to improve health care and lower its cost.

“Since 2010, Ontario’s Excellent Care for All act has really heightened awareness of quality improvement in health care,” says Ross Baker, a Professor at IHPME and Director of the new program. “We realized we needed a flexible program that teaches quality improvement skills for mid-career professionals, and for younger trainees looking to specialize in quality improvement as a career.”

Andrea McInerney is a Quality Improvement Coach with Partnering for Quality, which supports over 230 doctors and primary care teams in their efforts to improve chronic disease care in the South West LHIN. She has worked in quality improvement for five years. She was drawn to the program for its modular course offerings, which allowed her to continue work, and for its major-project component.

For her major project, McInerney set up a system to group primary-care patients with seasonal flu symptoms in standing blocks of time, in which staff counselled them together and followed up with short one-one-one sessions. The system, the first of its kind in Canada, allowed patients with more serious conditions continuous access to their primary care provider during peak flu season.  

“I was delighted to see a master’s program in what I do,” says McInerney. “And I appreciate its academic focus on quality improvement methodology, which will allow us to measure our intervention and hopefully avoid unintended consequences as we roll it out in other clinics.”

Emily Musing is a Patient Safety Officer and Executive Director of Pharmacy, Clinical Risk and Quality at University Health Network. She has worked with another recent graduate of the IHPME program, Sandra Nelson, and expects to see more. “Graduates typically have a background in health care, so they bring a practical perspective on how to apply the quality improvement principles they’ve learned in the program,” says Musing. “This provides an advantage for their future employers, who will need to spend less time educating and integrating them into the health care system.”

Nelson, a clinical practice leader based at Mount Sinai Hospital, used a questionnaire at University Health Network to elicit patient perceptions of how care providers ensured their safety. She collected information on hospital-acquired infections, and on potentially harmful miscommunications among staff and between staff and families. Musing says the approach provided valuable information that staff may not otherwise have captured in patient charts.

A further advantage, says Musing, was that patients indicated the face-to-face interviews increased their satisfaction by ensuring staff understood and valued their insights.

“Twenty years ago, patients just followed doctors’ orders,” Musing says. “Now, we have a very engaged population. They demand accountability, and they’re pushing health care professionals to raise their competency. Educational institutes like IHPME are integral in enabling health care professionals to meet the needs of today’s patients.”

Like any 28 year old, Arif Jetha, a fourth-year PhD candidate at the University of Toronto's Dalla Lana School of Public Health, is worrying about his future. Once he completes his PhD, should he remain at home with his parents and pursue post-doctoral work or move on to full-time employment and begin establishing his career?

Related Links

External Link: Research focuses on youth, chronic illness and employment
 

Research from the University of Toronto, led by Prof. Corey Nislow (Dept. of Molecular Genetics) in collaboration with Synta Pharmaceuticals and published in the scientific journal PLoS ONE, details how the cancer drug Elesclomol targets cancer cell metabolism. The research could lead to safer and more effective cancer therapies with the drug, the molecular workings of which were previously unknown.

Related Document(s)

Read Full Article (PDF)
 

Two University of Toronto medical students will use a $50,000 prize to explore the potential to bring a new type of eye examination tool to patients in Ontario.

Mohan Pandit and Jeff Martin are the winners of this year’s Richard Ivey Reverse Innovation Challenge, which took place in late November. With the new funding, they will begin a local pilot test for the device, called a 3nethra, and train a small number of doctors to use it.

The 3nethra, developed by Indian health technology firm Forus, lets clinicians easily examine the back of the eye. Pandit and Martin expect it will enable doctors to find earlier signs of two of the leading, treatable causes of blindness in Canada — diabetic retinopathy and glaucoma — as well as cataracts, corneal disease and refractive error.

The device is portable, easy to use and costs just $15, 000.

“This technology could be used on anybody who comes into a family doctor’s office, or another facility housing the device,” says Martin. “It’s meant as a pre-screening tool, to pick up an eye disease before we have objective blood tests or symptoms of the disease.”

The current testing method requires an ophthalmoscope, and although many family doctor’s offices have one, the device can be difficult to use and lacks sensitivity.

A 1996 study in the British Medical Journal found the sensitivity of detecting background diabetic retinopathy in general medical practice to be as low as 22 per cent. And a 1998 study published in Milbank Quarterly revealed that just 49 per cent of diabetic patients are screened by their primary care doctor for retinopathy.

Pandit and Martin believe that if the 3nethra can help Ontario’s family health care practitioners find earlier signs of eye disease, it will mean better outcomes for patients, fewer referrals to specialists and significant cost savings for the Canadian health care system.

The 3nethra could also make the screening process more comfortable for patients, because it does not require pupil dilation.

“If you’ve ever had your eyes dilated for an eye exam, after you leave, everything is bright for up to two hours. Sometimes people get headaches, they avoid the tests because they don’t want to be temporarily unable to read or drive,” says Pandit.

A patient sits in front of the 3nethra’s camera, with the operator on the other side of the device. The operator takes a photo of the back of the eye, and the machine analyzes the data in the picture and generates a report. A doctor can go over the report with the patient, and plan a course of action if necessary.

Forus has even developed infrastructure to store the photo and data online.

“If you picture one of the early Mac computers with the screen in front, it’s a stand-alone, all in one device. That’s essentially what the 3nethra is,” explains Martin. “It’s an ophthalmoscope with a camera and a computer assisted diagnosis device.”

Pandit and Martin are now recruiting family doctors, ophthalmologists and optometrists to take part in the pilot test.

Brain bucket, skid lid, crash cup, whatever you call your bicycle helmet, the 276 student volunteers of the University of Toronto’s Brain Day Association want all cyclists to wear one. In fact, they are so concerned about brain injury prevention, they will be spending the better part of March and the first week of April giving Brain Day presentations to junior elementary students in the Toronto District School Board and the Toronto Catholic District School Board.

Related Links

External Link: U of T Brain Day volunteers spread the word about preventing brain injury

Prof. Andreas Laupacis (Dept. of Medicine) was awarded the Canada Research Chair in Health Policy and Citizen Engagement, and Prof. Milica Radisic (Institute of Biomaterials and Biomedical Engineering) received the CRC in Functional Cardiovascular Tissue Engineering. Twelve other U of T Faculty of Medicine researchers received CRC renewals.

Related Links

External Link: U of T wins four new Canada Research Chairs

For the estimated 3.5 million Canadians with hearing loss, difficulty finding employment, social isolation and mental distress are just a few of the daily realities they face, yet treatment options are largely inadequate.

“There are no biological solutions for hearing loss. Current therapies are limited to hearing aids or cochlear implants, neither of which address the basic biological defects underlying hearing loss,” said Alain Dabdoub, Assistant Professor in U of T’s Departments of Otolaryngology - Head and Neck Surgery and Laboratory Medicine and Pathobiology.  Dabdoub is discovering biological solutions for hearing impairment to alleviate patient dependence on these devices.

Deafness is one of the most common birth defects in humans. Many forms of deafness are the result of abnormalities in the developmental processes necessary for the formation of the cochlea — the spiral-shaped hearing organ inside the ear.

Dabdoub is studying cochlear development and the genetic pathways responsible for how we hear.  By looking at the formation of the cochlea, he hopes to inform future therapies. For example, Dabdoub’s lab is studying ways to regenerate auditory neurons — cells that are responsible for transmitting sound information from the inner ear to the brain.

“By pinpointing important milestones in the ear’s development, we’re creating a map that will be used to create novel therapies, including regeneration, that address specific hearing dysfunction,” said Dabdoub, who received a grant from the Canada Foundation for Innovation on January 8, 2014.

Born in Bethlehem, Palestine, Dabdoub left the University of California-San Diego in fall 2012 to become Research Director of the Hearing Regeneration Initiative at Sunnybrook Research Institute. After visiting Toronto in November 2011, he was inspired by Toronto’s Academic Health Science Network’s multidisciplinary care and research approach.

“The idea of putting scientists and clinicians together seemed very appealing, and there’s also a clear understanding that the fuel for all of this is discovery-driven, basic science research.”

In addition to Dabdoub's work, 43 other U of T projects were awarded a total of $12.1 million from the Canada Foundation for Innovation (CFI). To read more, click here.

Photo credit: Alisa Kim/Sunnybrook Research Institute