The Princess Margaret Cancer Centre is joining forces with RaySearch AB to further develop RayCare, a next-generation oncology informatics platform.
RayCare will build on the capabilities of the existing RayStation radiation therapy treatment planning system used at Princess Margaret to help improve clinical workflows, resource usage and to enable adaptive radiation therapy.
This project represents an example of UHN’s emerging ‘3-mode innovation framework’ for technology development. This framework was developed to ensure that different rules, processes and teams are used for different technologies, depending on their level of development and the needs of UHN’s clinicians and researchers.
UHN’s Techna Institute is leading the project management for UHN activities in the collaboration with RaySearch. The project will involve a diverse cross-functional team made up of technical staff, clinicians and researchers who will test and develop new features and improvements to RayCare so that it can further support Princess Margaret’s clinical activities.
The collaboration will build on the advances UHN has made in cancer informatics and treatment planning, such as the Cancer Informatics Platform and the recent licensing of AutoPlanning technology to RaySearch.
Dr. Mary Gospodarowicz, Medical Director at Princess Margaret says “This is a collaboration that will shape the future of oncology systems.”
In the press release announcing the partnership, Dr. Johan Löf, CEO of RaySearch, concludes: “Princess Margaret is one of the most important cancer centers worldwide, and their experience and insight will be invaluable in the continuing development of RayCare. Our partnership, which spans more than a decade, is one of the pillars supporting RaySearch’s work to advance cancer treatment. Together we are taking cancer treatment to new levels and enabling truly patient-centered care.”
It can happen to anyone, anywhere and at anytime. Eventually, we all loose our footing and fall. Most of the time, a fall results in no more than a bruise and a few scratches. However, for some people, falls occur more frequently and the consequences can be much more severe.
Older adults are one of the demographics at a high risk for falls. It is estimated one third of Canadians over the age of 65 take a tumble every year. Moreover, almost half of those who fall experience serious injuries, like fractures and sprains.
“There is evidence that likelihood of recovery from a fall is dramatically reduced the longer the person remains without help,” says Dr. Alex Mihailidis, a Senior Scientist at Toronto Rehabilitation Institute and a Scientific Director of the AGE-WELL Network of Centres of Excellence.
In order to decrease the response time to assistance after a fall, Dr. Mihailidis’ team is developing an automatic fall detection system, known as the HELPER system. The ceiling-mounted system is equipped with a camera, a computer processor and an infrared light array enabling it to detect falls during the day and night. When a fall occurs in the room, the system immediately sends an alert to the caregiver’s smartphone.
Recently, Dr. Mihailidis evaluated the performance of the HELPER system in a pilot test in a real hospital. Several older patients with dementia and nurses took part in the study. The HELPER system monitored a hospital room for 267 nights, during which the nurses carried HELPER system smartphones.
The researchers found that the system detected four of five falls. However, it also generated over 800 false alarms, which were attributed to the unexpectedly high level of activity and movements in the room—especially when nurses were caring for patients.
Although the nurses wanted to be notified of a fall as soon as it happened, they found the current version of the system burdensome because of frequent false alarms.
"Our findings add to our understanding of the value of technology in the care of older adults. Further development of the HELPER system will focus on reducing false alarms and ensuring that it meets the needs of the nursing staff. Combining video imaging with other types of sensors could improve performance and provide additional information to nurses—such as an image of a room—to determine whether or not a fall has actually occurred,” says Dr. Mihailidis.
This work was supported by St. Joseph Health Care London, the Academic Medical Organization of Southwestern Ontario, the Ontario Centres of Excellence and the Toronto Rehab Foundation.
Coahran M, Hillier LM, Van Bussel L, Black E, Churchyard R, Gutmanis I, Ioannou Y, Michael K, Ross T, Mihailidis A. Automated Fall Detection Technology in Inpatient Geriatric Psychiatry: Nurses' Perceptions and Lessons Learned. Can J Aging. 2018 Sep. doi: 10.1017/S0714980818000181.
“Doc, how long do I have left?”
In movies and television shows, as in life, this is often the first question asked upon the diagnosis of a fatal illness. And for good reason: the answer helps individuals plan their remaining time. While only an estimation, the knowledge of how much time you have can also be the source of immense anxiety and depression.
“While our health care system focuses on the diagnoses, treatments and minimizing physical suffering, easing the emotional challenges and anxiety faced by these individuals also needs to be a priority,” says Dr. Gary Rodin, a Senior Scientist at Princess Margaret Cancer Centre and the Toronto General Hospital Research Institute.
To address this issue, Dr. Rodin and his team created a support program to reduce psychological burden. Specifically, the program was designed to help individuals with advanced and progressive disease gain 'double awareness'—a quality that enables them to live their lives as well as possible while also planning for end of life.
Known as Managing Cancer And Living Meaningfully (CALM), the support program involves a series of customized psychological therapy sessions, which enable patients to discuss symptom management, spiritual well-being, their relationships with others and concerns for the future.
In a randomized controlled trial, patients who had three to six months of support from CALM experienced significant relief from depression and anxiety compared to those who received standard care, which typically does not include psychological therapy. The findings also revealed that those who completed the CALM program were more likely to be better prepared for end of life than those who were not enrolled.
“Individuals with advanced cancer face the challenge of physical suffering and dependency while making difficult treatment decisions in a complex health care system. CALM can help us provide more comprehensive care to our patients,” explains Dr. Rodin. “With further improvements in its design and delivery, the program will help us establish a new standard of care for those with advanced and progressive disease.”
This work was supported by the Canadian Institutes of Health Research, The Princess Margaret Cancer Foundation and the Toronto General & Western Hospital Foundation.
Rodin G, Lo C, Rydall A, Shnall J, Malfitano C, Chiu A, Panday T, Watt S, An E, Nissim R, Li M, Zimmermann C, Hales S. Managing Cancer and Living Meaningfully (CALM): A Randomized Controlled Trial of a Psychological Intervention for Patients With Advanced Cancer. J Clin Oncol. 2018 Jun 29. doi: 10.1200/JCO.2017.77.1097.
An age group analysis of data from the ADvance trial has shown that participants with Alzheimer disease over the age of 65 continue to derive the most benefit from deep brain stimulation of the fornix (DBS-f).
These findings are the potential beginnings of a patient profile for DBS-f treatment for Alzheimer disease. They were published on June 19 in the Journal of Alzheimer's Disease by a team of researchers co-led by Dr. Andres Lozano, a neurosurgeon at Toronto Western Hospital and a Senior Scientist at the Krembil Research Institute.
To further explore the benefits for this demographic, the research team is soon launching a phase 3, multicentre international trial that will study the effects of DBS-f in 140 patients over the age 65.
"We are encouraged by these findings as they continue to help us identify who will benefit most from DBS to treat Alzheimer disease and learn more about this illness," says Dr. Lozano. "With so few treatments available and the incidence of Alzheimer's only expected to increase, we really need to fully explore all treatments that seem to be of benefit to patients."
These latest results were captured from the second year of data of the ADvance trial whose first-year data was published in 2016. In that trial, 42 patients with mild Alzheimer disease were enrolled in a randomized, double-blind multicentre phase 2 clinical trial and implanted with DBS electrodes directed at the fornix—a bundle of nerve fibres in the brain that carry signals from the hippocampus—and followed for a total of two years.
In the first 12 months of the trial, to better measure the impact of electrical stimulation in the brain, patients were randomly assigned to either the "on" or "off" stimulation group after their procedure and monitored. Once this phase of follow up was complete, all patients then had their electrodes turned on and were followed for another 12 months.
In the second 12-month phase, researchers noted similar observations they had seen in the first phase: that, although there were no differences overall in cognitive outcomes between study participants who had their device turned on right after surgery and those who had it turned on after 12 months, those 65 years of age and older appeared to experience a slower progression of Alzheimer disease than those under that age, regardless of when their device was turned on.
"The next phase of our research will help determine whether this observed benefit is something we continue to see in this age group," says Lozano. "If it does, this could potentially give us a treatment for mild, late-onset Alzheimer disease."
This is an adaptation of a story originally published by UHN News on www.uhn.ca.
It’s easy to describe how much pain you’re in when you stub your toe. However, describing chronic pain—persistent pain that lasts longer than three months—is much more complex. Not only does the intensity of chronic pain fluctuate from day to day, but the features of pain may also change over time.
To better understand what happens in the brain during chronic pain, clinicians and researchers are using functional magnetic resonance imaging (fMRI), a sophisticated technology that enables them to visualize the communication within or among brain networks. fMRI can be used to measure communication as a single snapshot or as a flexible dynamic interaction over a longer period of time.
However, it is not well understood how these measurements relate to chronic pain or whether they better reflect a person’s current state of pain or the overall intensity of their chronic pain over time.
To address this gap in knowledge, Krembil Senior Scientist Dr. Karen Davis and her PhD student Joshua Cheng initiated a study in research participants with or without ankylosing spondylitis, a form of arthritis that causes chronic back pain.
Dr. Davis’s research team collected fMRI measurements of brain network communication that reflect a static snapshot and a dynamic interaction over time, and also asked participants to rate their current pain and their average monthly pain using a questionnaire. Computer-based machine learning was then used to create two chronic pain brain models based on the fMRI measurements and pain scores—one to represent current ‘state’ pain and another to represent average ‘trait’ pain over a period of time.
The team found that three specific brain networks displayed abnormal communication in people with ankylosing spondylitis, all of whom experience chronic pain. They also found that different patterns of communication between these networks were related to current or monthly trait pain ratings. In general, the dynamic fMRI measurements taken over time were more informative than the static snapshots in relating communication to chronic pain.
“Our study is the first to reveal how changes in the communication patterns of brain networks relate to fundamental features and timing of chronic pain,” explains Dr. Davis. “These findings shed new light on the complexities of chronic pain and will contribute to the development of new solutions for those with this long-term and disabling condition.”
This work was supported by the Canadian Institutes of Health Research, the Canadian Chronic Pain Network, The Mayday Fund and the Toronto General & Western Hospital Foundation.
Cheng JC, Rogachov A, Hemington KS, Kucyi A, Bosma RL, Lindquist MA, Inman RD, Davis KD. Multivariate machine learning distinguishes cross-network dynamic functional connectivity patterns in state and trait neuropathic pain. Pain. 2018 Apr 26. doi: 10.1097/j.pain.0000000000001264.
On July 18, 2018, Canadian company Thornhill Medical announced that it had completed its Series A financing round. Completion of this round of funding requires companies to demonstrate solid market success—an important milestone that requires an enormous amount of work and perseverance.
Thornhill Medical makes innovative healthcare devices and has been awarded over 40 patents. The company was founded by Dr. Joseph Fisher and Dr. Ludwik Fedorko, both from the Department of Anesthesiology at University Health Network. Dr. Fisher is a Senior Scientist at the Toronto General Hospital Research Institute, and a world-renowned researcher in the field of cardio-respiratory physiology and neurovascular research.
Since spinning off from the University Health Network in 2003, Thornhill Medical has built upon their expertise to develop and manufacture a compact mobile life support system used by the US military to treat field casualties and other emergency respiration and anesthesia devices. In addition, Thornhill Medical Inc. has developed a device that is a portable treatment for carbon monoxide poisoning, and a device used with MRI scanning to examine brain and heart blood vessel function with a view to predicting the risk for stroke and heart attack.
The funding was provided by Yonghua Investment Management Co., Ltd. (“Yonghua Capital”) of Shanghai, PRC—an experienced private equity investor, which has invested in over 100 outstanding companies, among which nearly 60 have been listed with stock exchanges.
Kipton Lade, President & CEO of Thornhill Medical, comments, "The financial investment focus of the Yonghua Capital compliments Thornhill's approach to clinical research, product development and global commercialization. We are excited to partner with such a dynamic and well-managed professional team as we continue our mission to deliver unique medical devices, using the lung as a portal, to transform current diagnostic and therapeutic patient care."
Thornhill Medical will use the funding to support its market released line of emergency mobile products, expand its global sales and marketing presence and continue clinical research in the fields of non-invasive cardiac and brain stress testing.
For more information, see the press release.