A recent UHN study shows mental health and wellness programs offered to health care workers during the COVID-19 pandemic are not enough.
“Health care workers feel the burden of the COVID-19 pandemic in extraordinary ways and rates of burnout and distress are high,” explains study lead Dr. Susan Abbey, who is a Clinician Investigator at the Toronto General Hospital Research Institute. “We want to understand the range of concerns impacting the mental health and wellbeing of health care workers, how these concerns are changing over the course of the pandemic and why resources might not be maximized despite being made readily available.”
To shed light on this issue, the research team gathered and analyzed questions posted by staff as part of a series of open forums or virtual town halls hosted by hospital senior leaders. These forums were conducted between March 16 and December 1, 2020 at UHN, which is one of Canada’s largest health care institutions. All of UHN’s 21,555 staff were able to submit questions and upvote or ‘like’ questions posed by others.
To study this data, an approach known as critical discourse analysis was used. This approach studies the elements of language—such as vocabulary, grammar and persuasive style—to provide deep insights into the meaning of text. The approach can also reveal how attitudes and feelings are affected by external factors (i.e., in this case, factors such as media, social media, peers and institutional leaders).
Not surprisingly, the findings revealed that during the first wave of COVID-19, staff expressed nervousness and anxiety related to safety and the risk of COVID-19 infection. At this earliest stages in the pandemic, staff concerns were closely aligned with leadership concerns, which were centered on personal protective equipment supplies, infection control and prevention policies, as well as increased stress on frontline staff.
“Concerns around worker safety have remained high throughout the pandemic,” explains first author Dr. Berkhout. “As the pandemic continued, concerns around trust and transparency in leadership have begun to emerge—these feelings can affect how one manages fear and uncertainty. They can also contribute to burnout and loss of meaning in one’s work.”
Later in the pandemic, health care workers’ concerns grew to include feelings of being undervalued and underappreciated. Some staff voiced concerns relating to communication and information management. Staff also felt that existing employee assistance and wellness programs did not fully address staff concerns. These programs were seen as short-term fixes rather than addressing larger and underlying problems.
“Our study highlights how organizational culture, leadership practices, relationships and communication are critical to support wellness and mental health in staff. The world around us plays a big role in how we are able to cope,” comments Dr. Abbey.
“We need to work together so that staff feel heard, valued and supported in order to truly reduce stress and improve well-being.”
This work was supported by the Mount Sinai Hospital-University Health Network Academic Medical Organization. Berkhout SG, Sheehan KA, Abbey SE. Individual- and Institutional-level Concerns of Health Care Workers in Canada During the COVID-19 Pandemic: A Qualitative Analysis. JAMA Netw Open. 2021 Jul 1;4(7):e2118425. doi: 10.1001/jamanetworkopen.2021.18425.
There are many sub-types of breast cancer and the triple-negative variety is particularly difficult to treat. A recent study from researchers led by Princess Margaret Cancer Centre Senior Scientist Dr. Michael Reedijk reports a promising new treatment strategy.
The new treatment strategy is centred on targeting a protein called Notch, which is present on the surface of cells in the body and is used by them to signal to one another. It also plays a role in making breast cancer aggressive and difficult to treat. One way that Notch influences cancer is through controlling the way that the cells of the immune system interact with cancer cells. Blocking Notch activity in tumours could help slow cancer growth and improve treatment outcomes.
The problem is that Notch is used by many cells all the time, so drugs that target Notch can have major side effects because they disrupt many essential bodily processes.
“Targeting Notch activity specifically within cancer cells would be a major step forward with widespread clinical potential,” explains Dr. Reedijk.
The team’s approach to this problem came from the insight that cancer cells do not exist in a normal environment: tumours are often places with low levels of oxygen and other irregularities. These factors cause cellular stress, and a cell’s response to stress can activate Notch.
By targeting another signalling pathway—called USP9x—which activates Notch in conditions of stress, the team identified a way to precisely target the Notch activity that is relevant to triple-negative breast cancer.
The team tested this approach in experimental models with promising results. “By targeting and reducing USP9x, we were able to reduce Notch levels and tumour growth without causing the side effects that are typically seen with treatments that broadly target Notch activity,” says Dr. Arushi Jaiswal, the first author of the study and a former graduate student in Dr. Reedijk’s laboratory.
The experimental treatment also changed the way that tumours interact with the immune system, an indication that they will be more susceptible to other therapies. This finding suggests that targeting USP9x could help advance the development of immunotherapies—approaches that help activate the immune system so it can better detect and kill cancer cells.
“This study provides pre-clinical evidence that it is possible to target USP9x and it is a promising approach to treat triple-negative breast cancer,” concludes. Dr. Reedijk. “Our findings lay a solid foundation for future studies and clinical trials.”
This work was supported by the Canadian Cancer Society, the Ontario Ministry of Health and Long-Term Care and The Princess Margaret Cancer Foundation. P Ohashi holds a Tier 1 Canada Research Chair in Autoimmunity and Tumour Immunity.
Jaiswal A, Murakami K, Elia A, Shibahara Y, Done SJ, Wood SA, Donato NJ, Ohashi PS, Reedijk M. Therapeutic inhibition of USP9x-mediated Notch signaling in triple-negative breast cancer. Proc Natl Acad Sci U S A. 2021 Sep 21. doi: 10.1073/pnas.2101592118
The Krembil Research Institute is pleased to welcome Dr. Martin Ingelsson as its newest Senior Scientist. Dr. Ingelsson is a geriatrician and neuroscientist with expertise in neurodegenerative diseases.
Dr. Ingelsson’s research is focused on characterizing the molecular mechanisms that underlie neurodegenerative diseases, such as Alzheimer disease, and developing strategies to diagnose and treat these conditions.
Prior to moving to Krembil, Dr. Ingelsson published a detailed characterization of the Uppsala mutation—a mutation in the amyloid precursor protein gene that leads to an early-onset form of Alzheimer disease. His study of this mutation has generated important insights into the formation of amyloid-beta, a peptide that accumulates in the brain of patients with Alzheimer disease.
“I am fascinated by the function of the brain and how dysregulation of molecular pathways can cause disease,” explains Dr. Ingelsson. “There is currently no effective treatment for Alzheimer disease, likely because of our limited understanding of its underlying mechanisms. It is thrilling to characterize disease-causing processes and develop strategies to counteract them.”
At Krembil, Dr. Ingelsson will continue to explore the causes of Alzheimer disease and other dementias. He will also explore biomarkers of neurodegeneration and work to develop treatments for dementia, with a focus on gene therapies.
Regarding his move to Krembil, Dr. Ingelsson comments that he looks forward to “...collaborating with the exceptional researchers at the institute to advance our understanding of devastating brain diseases and how to diagnose and treat them.”
Dr. Ingelsson earned his MD and PhD at the Karolinska Institute, where he was trained in the laboratory of Dr. Lars Lannfelt, and completed postdoctoral training with Dr. Bradley Hyman at Harvard Medical School. He has been a Professor at Uppsala University since 2016.
Welcome to Krembil, Dr. Ingelsson!
Dr. Ingelsson’s recruitment was made possible by a generous donation from the Krembil Foundation as part of the Krembil Strategic Research Plan Fund.
UHN is home to countless research programs that are helmed by world-leading scientists. The Behind the Breakthrough podcast, launched in 2019, offers a behind-the-scenes take on these scientists’ groundbreaking medical discoveries.
Returning for its third season, the podcast features a new lineup of interviews between host Christian Cote and scientists from across UHN. In addition to discussing solutions to some of the most pressing health issues, the one-on-one conversations delve into these scientists’ personal journeys in life and research.
Listen and subscribe to season three here: https://www.uhn.ca/corporate/News/UHN_Podcasts/Behind_the_Breakthrough
The new season kicks off today, October 12, with a special episode with Dr. Brad Wouters, UHN Executive Vice President of Science and Research, on the pandemic and the cutting-edge COVID-19 studies led at UHN.
Among the COVID-19 topics that Dr. Wouters and Christian discuss are a number of UHN-led clinical trials: one that identified the commonly available heparin blood thinner as an effective treatment for individuals with moderate COVID-19 symptoms; and another that revealed that COVID-19 vaccine boosters can significantly improve immune protection in transplant patients. They also discuss UHN’s vital work in guiding Ontario public health policy and the decades of basic science research that have enabled the rapid development of vaccines.
“It was very exciting. I do remember that day very clearly,” says Dr. Wouters in recalling when the first dose of a COVID-19 vaccine was administered in Canada. “We’ve all been really stunned by how great these vaccines are, and how effective they are, and it is a triumph of science, and I think perhaps one of the greatest examples of the importance of investing in science.”
Future episodes will involve discussions on a broad mix of research topics. Among the guests are:
New episodes will be released every Tuesday until early December—remember to subscribe here: Behind the Breakthrough.
Despite new, more equitable approaches for allocating donor livers to patients, women are at a disadvantage and are more likely to die waiting for a transplant than men. A recent study in JAMA Surgery identified a strategy to address this disparity.
The study was led by Dr. Mamatha Bhat at the Ajmera Transplant Centre and the Toronto General Research Hospital Institute (TGHRI) Transplant Hepatology and first author and fellow Dr. Ravikiran Karnam. “We explored whether access to living donation could improve women’s chances of receiving a donor organ,” says TGHRI Scientist Dr. Bhat.
Liver transplantation is the only treatment available for patients with end-stage liver disease. Because the demand for donor livers is greater than the supply, medical professionals select the patients who are most in need. To do this, a test, known as the Model for End-stage Liver Diseases (MELD), is used.
Although MELD has helped to improve how donor organs are allocated to those in need, inequalities remain. Because of a number of factors like a person’s height, the amount of muscle mass or the size of the liver, women’s MELD values are lower than men’s for the same severity of liver disease. A previous study suggests that this reduces women’s chances of receiving a liver by half.
To address this issue, Dr. Bhat led a clinical study to see whether access to living donation could improve women’s chances of receiving a transplant. The study included 1,289 adult patients on the waiting list for a liver transplant at UHN in Toronto and living donations were received from the Living Donor Liver Program led by Drs. Mark Cattral and Dr. Nazia Selzner.
When patients had access to deceased donors, the chances of receiving a transplant were higher in men than in woman. However, when patients had access to a living donor, the chances of receiving an organ were equal between men and women. “Our findings suggest that expanding access to living donor liver transplantation across transplant programs could help overcome the multifaceted problems of access to organs from deceased donors,” clarifies Dr. Bhat.
“While access to living donation benefits both men and women, this approach has the potential to particularly help women, who are at a disadvantage for deceased donor organs on the waiting list,” comments Dr. Bhat. “What we show here is that, by performing living donor liver transplants, our program is able to alleviate sex disparity on the waiting list. Our work also highlights the need to refine current clinical tests such as MELD to ensure that the process of organ allocation is truly unbiased.”
Dr. Bhat’s research has been supported by the Canadian Liver Foundation, American Society of Transplantation, Canadian Donation and Transplant Research Program, and UHN Foundation.
Karnam RS, Chen S, Xu W, Chen C, Elangainesan P, Ghanekar A, McGilvray I, Reichman T, Sayed B, Selzner M, Sapisochin G, Galvin Z, Hirschfield G, Asrani SK, Selzner N, Cattral M, Lilly L, Bhat M. Sex Disparity in Liver Transplant and Access to Living Donation. JAMA Surg. 2021 Aug 18. DOI: 10.1001/jamasurg.2021.3586
Recent results published in The New England Journal of Medicine revealed that heparin increased the chance of survival in patients who are moderately ill with COVID-19.
Heparins are a group of molecules that prevent blood from coagulating. Blood clots are a common symptom of COVID-19; they can be deadly for seriously ill patients by inducing lung failure and heart attacks.
Drs. Ewan Goligher and Patrick Lawler, Scientists at Toronto General Hospital Research Institute, are among the leads for a randomized clinical trial that evaluated the efficacy of heparin against moderate and severe forms of COVID-19. The international trial was conducted from April 2020 to January 2021 and involved over three thousand patients in 10 countries.
“While patients are commonly given blood thinners to prevent blood clots in the hospital, we wanted to know if higher doses of heparins could help patients hospitalized for COVID-19 to recover,” says Dr. Goligher.
Once admitted to a hospital, a patient with COVID-19 is considered severely ill if they require life support in an ICU. If they do not immediately require life support, they are considered moderately ill.
The researchers found that therapeutic doses of heparins improved survival in patients who were moderately ill with COVID-19, but not in patients who were critically ill.
For the 2,219 moderately ill patients enrolled, therapeutic doses of heparin were superior to standard care practices in reducing the chance of death with less need for life support. Major bleeding events were rare, with 1.9% in those receiving heparin and 0.9% in those receiving standard care.
For the 1,098 critically ill patients enrolled, therapeutic doses of heparin led to a higher probability of death or prolonged life support in the ICU.
“For moderately ill patients, limited therapies are currently available to prevent the progression of the disease to organ failure and death,” says Dr. Lawler, who is also affiliated with the Peter Munk Cardiac Centre at UHN. “These trial results suggest that if we use escalated doses of heparin as a first-line treatment for select moderately ill patients admitted to the hospital for COVID-19, more patients would survive this disease without needing intensive care.”
“Vaccination remains the best defence against COVID-19, because it reduces the likelihood of hospitalization even if a breakthrough infection occurs,” says Dr. Goligher.
Funding support received for these clinical trials are listed in the research articles linked below.
ATTACC Investigators; ACTIV-4a Investigators; REMAP-CAP Investigators. Therapeutic Anticoagulation with Heparin in Noncritically Ill Patients with Covid-19. N Engl J Med. 2021 Aug 4. doi: 10.1056/NEJMoa2105911.
REMAP-CAP Investigators; ACTIV-4a Investigators; ATTACC Investigators. Therapeutic Anticoagulation with Heparin in Critically Ill Patients with Covid-19. N Engl J Med. 2021 Aug 4. doi: 10.1056/NEJMoa2103417.
In celebration of his belated 86th birthday, legendary Bay Street investment banker and philanthropist Donald K. Johnson announced an incredibly generous $50 million donation to support and expand his namesake, the Donald K. Johnson Eye Institute.
As the largest donation to a vision program in Canada, this investment will advance vision research and patient care for the more than five million Canadians living with eye disease. With this donation, Mr. Johnson will have committed over $65 million to support the exceptional vision scientists and clinicians at UHN.
"Don's support has totally changed the vision research landscape in Canada. With his significant gift six years ago, we built our discovery research capacity and enhanced clinical research,” says Dr. Valerie Wallace, Research Director of the Donald K. Johnson Eye Institute and the Donald K. Johnson Chair in Vision Research. “Now, with his new, transformative gift, the impact will be global and the legacy long-lasting."
The Donald K. Johnson Eye Institute at the Toronto Western Hospital is home to Canada’s largest concentration of vision researchers and the most comprehensive clinical program dedicated to vision. Comprised of more than 54 clinicians, residents, researchers and fellows, the Institute completes more than 6,000 surgeries and 120,800 patient visits each year, spanning nine specialty clinics and services.
Through leading-edge research and clinical trials, the Institute’s scientists and clinicians are developing real-world treatments to change the lives of individuals living with vision impairment and blindness.
Mr. Johnson’s gift will provide long-term financial resources to expand clinical research, retain and recruit top talent in vision science and clinical care, and accelerate technological innovation. In addition, this gift will create three endowed clinical fellowships—in tribute to Drs. Robert Devenyi, Allan Slomovic and Graham Trope—clinicians who have helped restore Mr. Johnson’s sight.
“We are humbled by and so grateful for Don’s continued generosity and commitment to investing in the best talent, tools and training, to ensure that our hospital leads the world in vision care,” comments Tennys Hanson, Chief Executive Officer of the UHN Foundation.
Congratulations and thank you to Drs. Valerie Wallace and Robert Devenyi (Clinical Director, Donald K. Johnson Eye Institute, and Ophthalmologist-in-Chief, UHN) and to the Institute’s scientists, clinicians and staff for their work to change the way people see the world.
Donald K. Johnson and his late wife, Anna McCowan-Johnson, have been long-time supporters of vision research and patient care at UHN. Mr. Johnson has served on the UHN Foundation Board of Directors for 22 years.
Research conducted at UHN's research institutes spans the full spectrum of diseases and disciplines, including cancer, cardiovascular sciences, transplantation, neural and sensory sciences, musculoskeletal health, rehabilitation sciences, and community and population health.
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