Chronic pain affects one in five Canadians and is a heavy burden for individuals and the health care system. Researchers at UHN’s KITE Research Institute (KITE) reviewed the impact of ECHO Pain, a chronic pain and opioid management education program for health care professionals, and identified how it has strengthened chronic pain care across Canada.
People living with chronic pain face higher health care costs, limited access to specialized care, and reduced quality of life. At the same time, the rate of opioid addiction and overdose in Canada continues to rise. Together, these challenges highlight the need for better education and support for health care providers to ensure safe and effective chronic pain management and reduce the risks associated with prescribing opioids.
To address this need, a team at UHN and Queen’s University co-developed ECHO Ontario Chronic Pain and Opioid Stewardship (ECHO Pain). This virtual, case-based health professions education program brings together a team of specialists and primary care providers to discuss real patient scenarios, share best practices, and strengthen chronic pain and opioid management skills. Between June 2014 and June 2024, the program delivered 529 sessions and engaged over 1,500 health care professionals from across Ontario, including many practising in remote communities.
Participants of ECHO Pain reported high program satisfaction and increased confidence and knowledge in both chronic pain and opioid management. When the research team evaluated prescribing patterns, ECHO-trained care providers significantly reduced opioid prescriptions compared to those who did not participate. The program also fostered a strong, interdisciplinary community where health care providers could share knowledge, skills, and resources. Its virtual format provided timely access to education for physicians working in rural, remote, and underserved communities.
The research team identified several components of the program that contributed to its success, including strong administrative support, a dedicated research and education team, and consistent engagement from the multidisciplinary program team. They also emphasized the importance of regular recruitment of participants and patient cases, and ongoing evaluation to ensure the program continues to meet the needs of health care providers.
As the program model continues to be adopted nationwide, ECHO Pain offers a promising approach to strengthening chronic pain management and equipping health care professionals with the necessary skills, resources, and community to improve care for people living with chronic pain.
Dr. Andrea Furlan, first author of the study, is a Senior Scientist at UHN’s KITE Research Institute. Dr. Furlan is also a Professor in the Department of Medicine and the Institute of Medical Science at the University of Toronto.
This work was supported by UHN Foundation, the Canadian Institutes of Health Research, the Ontario Ministry of Health and Long-Term Care, the Ontario Medical Association, and the Northern Ontario Academic Medicine Association.
Dr. Furlan has a monetized YouTube channel and receives royalties from two published books for people with chronic pain.
Furlan AD, Zhao QJ, Taenzer P, Smith AJ, Fabico R, Morgan K, Mostyn R, Flannery JF. Ten Years of ECHO Chronic Pain and Opioid Stewardship in Ontario: Impact and Future Directions. Healthcare (Basel). 2025 Dec 8. doi: 10.3390/healthcare13243203.
A recent international, multi-centre study published in JAMA Neurology, coordinated by researchers from UHN’s Krembil Brain Institute (KBI), revealed that repeated head impacts (RHI) have more far-reaching effects that previously thought.
The last few years have seen a resurgence of discourse on the long-term effects of RHI, particularly for professional athletes such as football players and boxers. RHI is associated with an increased risk of chronic traumatic encephalopathy (CTE), a progressive neurodegenerative disease that can cause behavioural issues and cognitive decline.
CTE can only be diagnosed by examining the brain for CTE neuropathological change (CTE-NC) after an individual dies. CTE-NC is characterized by abnormal accumulations, called aggregates, of a misshapen form of the tau protein in neurons and astrocytes—cells that support neurons—in their brain’s cortex. However, until now, research has focused almost exclusively on the brain, overlooking another vulnerable part of the nervous system: the spinal cord.
Dr. Gabor Kovacs, a Senior Scientist at KBI, and his research team set out to address this gap by examining the effects of RHI on the spinal cord. In this postmortem study, the team analyzed brain and spinal cord tissue from 70 individuals for the presence and severity of CTE-related tau aggregates beyond the brain.
They found that individuals with CTE-NC in the brain showed significantly more frequent and severe tau aggregates in the spinal cord than those without CTE, regardless of RHI history. Notably, CTE cases also exhibited tau aggregates in spinal astrocytes, which is a feature not seen in other conditions with tau aggregates such as Alzheimer disease.
Among those with CTE, both neuronal and astrocytic tau pathology were more pronounced in individuals with a history of RHI, highlighting a cumulative effect of repeated trauma.
Age further amplified these changes with individuals over the age of 65 who had a both CTE and a history of RHI exhibiting the most severe tau aggregates. Other protein aggregates in the brain were also seen in the spinal cord, including α-synuclein, amyloid-beta, and TDP-43, which contribute to Parkinson disease, Alzheimer disease, and amyotrophic lateral sclerosis, respectively. These other protein aggregates were also more common in this group—suggesting that RHI may accelerate age-related neurodegeneration and contribute to the development of other conditions beyond CTE.
“For too long, the effects of repeated impacts on the central nervous system beyond the brain have been understudied,” says first author Dr. Hidetomo Tanaka. Dr. Kovacs adds, “It is time we shift the definition of CTE to encompass not only the brain but the spinal cord as well.”
By broadening the scope of CTE research, this work deepens our understanding of trauma-related neurodegeneration and underscores the need for protective strategies to safeguard the spine as well as the brain for those at risk of RHI. Ultimately, these insights may help reduce long-term neurological burden later in life and improve quality of life for those impacted by RHI—including former professional athletes long after their sport careers have ended.
The first author of this study is Dr. Hidetomo Tanaka, a neuropathologist and a Research Fellow at the Tanz Centre for Research in Neurodegenerative Disease (CNRD) at the University of Toronto.
The senior author of this study is Dr. Gabor G. Kovacs, a Senior Scientist at UHN’s Krembil Brain Institute (KBI), a Professor in the Department of Laboratory Medicine and Pathobiology at the University of Toronto, and a Principal Investigator at the Tanz CRND at the University of Toronto.
Drs. Carmela Tartaglia, a Clinician Investigator at KBI, and Charles Tator, a Senior Scientist at KBI, are co-authors of this study.
This work was supported by the National Institutes of Health (NIH), the United States Department of Defense, the Medical Research Council, and UHN Foundation.
Dr. Kovacs has a shared patent for 5G4 synuclein and a patent pending for diagnostic assays for movement disorders. He also reported royalties from Wiley, Cambridge, Taylor and Francis, as well as research support from the Rossy Family Foundation, Edmond Safra Foundation, Krembil Foundation, MSA Coalition, Michael J. Fox Foundation, Parkinson Canada, and the NIH outside of this work.
For a complete list of other authors’ conflicts, see the publication.
Tanaka H, Black LE, Forrest SL, Danics K, Sadia N, Khodadadi M, Tator C, Smith DH, Tartaglia MC, Stewart W, Kovacs GG. Spinal Cord Tau and Protein Copathologies Associated with Chronic Traumatic Encephalopathy. JAMA Neurol. 2026 Jan 26. DOI: 10.1001/jamaneurol.2025.5421.
I am a Scientific Associate III at the University Health Network (UHN), where I conduct translational cancer research focused on understanding how colorectal cancers adapt to therapy and recur.
I have been at UHN for 10 years, progressing through research roles that have expanded in scope and responsibility. I started as a postdoctoral researcher in Catherine O’Brien’s lab and, with her support, transitioned to the Scientific Associate position after returning from my second maternity leave in 2022. Since then, I have grown from a bench-focused scientist into a mentor, and emerging leader, while remaining deeply engaged in hands-on research.
My day-to-day work spans experimental design, data analysis, and mentoring trainees, with a strong emphasis on collaborative, patient-informed research that bridges discovery and clinical relevance. My primary focus is translational oncology and cancer biology.
Although I spend much of my time engrossed in laboratory research, I also contribute to institutional initiatives that support inclusive research excellence and trainee development, such as Project Chrysalis and the Biosciences Oncology Leadership Development (BOLD) program.
In the lab, my current research focuses on understanding how cancer cells contribute to colorectal cancer progression, relapse, and metastasis. By combining experimental models with advanced analytical approaches, my work aims to uncover mechanisms of treatment resistance that can help improve future treatment strategies. Specifically, my current research is dedicated to addressing the ongoing challenge of metastasis by defining the non-genetic mechanisms that enable tumour spread.
Previously, as a post-doctoral researcher, I helped identify a population of cells, called Drug Tolerant Persisters (DTPs), responsible for cancer relapse. These findings contributed to the development of a prognostic relapse signature—a set of markers that clinicians can use to identify the likelihood that a patient will relapse in colorectal cancer patients. As an extension of these findings, I built a biotherapeutic venture focused on treatments targeting DTPs through the Health Innovation Hub (H2i), the University of Toronto Accelerator. The venture earned significant seed funding from investors, including the prestigious FACIT Falcons’ Fortunes Ernsting Entrepreneurship Award.
Integrating inclusion, diversity, equity and accessibility (IDEA) principles into both my scientific work and mentorship is a core value for me. I have worked to establish research practices that consider gender and ethnic diversity where appropriate; CIHR’s Research Excellence, Diversity, and Independence (REDI) Early Career Transition Award has allowed me to formalize and strengthen this approach.
Mentorship and training are also central to how I approach my work. Catherine’s mentorship over the years has significantly shaped my approach and perspectives—particularly the practice of approaching everything with grace and curiosity—which I strive to implement daily and encourage through my mentorship efforts.
I have mentored students, postdoctoral researchers, and emerging innovators through H2i. Additionally, under UHN’s Education programs, I am a founding member of UHN’s Biosciences and Oncology Leadership Development (BOLD) Program, a leadership course supporting early-career scientists, where I serve on the advisory committee and mentor trainees. I am also a core member of the Project Chrysalis team, whose mission closely aligns with my commitment to embedding IDEA principles across research practices at UHN. Through these efforts, I aim to advance impactful science while helping to foster research environments that are supportive, transparent, and people-centred.
I am deeply motivated by research that leads to tangible improvements in patient outcomes. Health research, to me, means seeing discoveries move beyond the lab to directly influence how patients are treated. It has been incredibly meaningful to see my team's work progress from foundational research to informing a clinical trial and ultimately serving as a cornerstone for a therapeutic development aimed at preventing cancer relapse.
As my role has evolved, so has my sense of responsibility—not only to advance the science, but to help guide projects, mentor trainees, and build pathways that accelerate translation. I am passionate about leading research that keeps patients at the centre while supporting the next generation of scientists to think boldly about impact.
My work contributes to UHN’s vision by addressing one of the most critical challenges in cancer care: disease relapse. By developing molecular signatures that predict tumour relapse and identifying key vulnerabilities—the “Achilles’ heel”—of recurring tumours, my team’s research aims to inform earlier interventions and better treatment strategies that will, hopefully, help reduce the global burden of cancer.
Beyond the science I do, my leadership and educational program involvements, including Project Chrysalis and the BOLD program, help strengthen the research ecosystem by embedding IDEA principles into training and mentorship. Together, these efforts support UHN’s vision of A Healthier World by advancing both patient outcomes and the inclusive research environments needed to sustain innovation.
UHN has provided an exceptional environment to grow as both a scientist and a leader. The institution’s collaborative culture has enabled meaningful partnerships across disciplines, giving me access to world-class expertise, patient-derived resources, and cutting-edge research infrastructure.
Equally important, UHN has created opportunities to translate discovery into impact—from advancing clinically relevant research to engaging in entrepreneurial initiatives and leadership programs. These experiences have allowed me to pursue innovative science while developing the skills needed to lead, collaborate, and advance research toward real-world solutions.
Outside of work, I enjoy spending time with my children and working on community-focused projects through Essentials First Canada, a non-profit I co-founded with my family. At home, I enjoy gardening and doing creative projects with my kids. These activities help keep me grounded and constantly remind me of the value of creativity, curiosity, and balance.
I see the future of health research moving toward more predictive, personalized, and prevention-focused care. Advances that enable us to anticipate disease relapse, understand tumour adaptation, and intervene earlier in the disease process are especially exciting to me. I am also energized by a future where research pathways are more fluid—where discoveries can move seamlessly from the lab to the clinic and, when appropriate, into entrepreneurial ventures.
Equally important is the growing recognition that inclusive leadership and mentorship are essential to scientific progress. Programs like REDI, Chrysalis, and BOLD signal a future where excellence in research is paired with excellence in training, leadership, and culture—and that is what excites me most.
You @TeamUHN is a campaign to highlight the important scientific contributions that research lab staff, trainees and learners, administrative staff, core facilities staff, Research Solutions & Services staff, and volunteers make towards A Healthier World through discovery and innovation. If you’re interested in sharing your story, we invite you to complete this form here (Open to UHN staff, trainees and volunteers).
About 300 million people globally live with some form of depression, including major depressive disorder and bipolar disorder. Although antidepressant medications can be effective for many individuals, a subset does not respond despite repeated treatment attempts. This condition—known as treatment-resistant depression (TRD)—is often accompanied by cognitive impairments, such as memory and attention difficulties, that standard therapies fail to address.
Psilocybin—a psychedelic and psychoactive compound colloquially known as “magic mushrooms”— has shown promise in improving mood symptoms in TRD in previous studies. Unlike conventional antidepressants, psilocybin can re-wire and form new connections in the brain—a process called neuroplasticity. These neuroplastic effects suggest psilocybin could also improve cognitive impairments in TRD. However, to date, research in patient populations has been very limited and results have been mixed.
In a recent clinical trial, researchers from UHN’s Krembil Brain Institute (KBI), led by Dr. Joshua Rosenblat, explored whether psilocybin could improve both mood and cognition in 26 patients with TRD. The team administered a single dose of psilocybin and assessed cognition one day and two weeks later using two standard tests: the Trail Making Test (TMT), and the Digit Symbol Substitution Test (DSST). These tests are used to measure the brain’s processing speed and executive function—skills that you use to manage everyday tasks.
Results indicated that psilocybin improved cognition modestly over time, as early as one day post-treatment. Importantly, these improvements occurred even when changes in depressive symptoms were considered, suggesting that the cognitive improvements were not just a byproduct of people feeling less depressed.
Although this was an encouraging group-level effect, only a minority of individual patients exhibited a change large enough to be considered clinically meaningful and the number of individuals who improved did not exceed what would be expected by chance alone. More studies are necessary to determine whether these changes were due to psilocybin specifically or more general factors.
Reflecting on this early-stage work, Dr. Rosenblat notes, “even though the results of our study should be interpreted cautiously, this is an invaluable first step in identifying and introducing a new treatment that could revolutionize care for TRD.” These results highlight the need for larger, controlled studies to determine whether initial findings are reproducible and whether psilocybin has a meaningful and reliable impact on cognition.
You can read the results of the original clinical trial that this study was based on here.
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Danica Johnson is the first author of this study. She is a Graduate Research Appointee at UHN’s Poul Hansen Family Centre for Depression (formerly the Mood Disorders Psychopharmacology Unit) and a PhD Candidate at the University of Toronto’s Institute of Medical Science.
Dr. Joshua Rosenblat is the senior author of this study. He is a Clinician Investigator at UHN’s Krembil Brain Institute, and an Associate Professor and a Clinician Scientist at the University of Toronto’s Temerty Faculty of Medicine.
This work was supported by the Brain and Cognition Discovery Foundation and UHN Foundation. The Usona Institute and Braxia Health (formerly the Canadian Rapid Treatment Centre of Excellence, CRTCE) provided in-kind support.
Dr. Rosenblat receives funds from iGan, Boehringer Ingelheim, Janssen, Allergan, Lundbeck, Sunovion, and COMPASS for speaking, consultation, and research beyond this work. During the completion of this study, Dr. Rosenblat was also the Chief Medical Officer for Braxia Health (formerly CRTCE). He is no longer associated with Braxia Health. For a complete list of the other authors’ competing interests, see the publication.
Johnson DE, Meshkat S, Kaczmarek ES, Rabin JS, Brudner RM, Chisamore N, Doyle Z, Bawks J, Riva-Cambrin J, Mansur RB, Lipsitz O, McIntyre RS, Lanctôt KL, Rosenblat JD. Cognitive outcomes following psilocybin-assisted therapy in treatment-resistant depression: A post-hoc analysis of a randomized, waitlist-controlled trial. Prog Neuropsychopharmacol Biol Psychiatry. 2025 Dec 20;143:111565. doi: 10.1016/j.pnpbp.2025.111565.
The COVID-19 pandemic disrupted health care systems worldwide, increasing stress and burnout for health care providers. Surgical residents—doctors training to become surgeons—were especially vulnerable because of long work hours, years of training, and limited time for rest. Researchers at The Institute for Education Research at UHN identified how the pandemic exposed the challenges within the current surgical training structure that hinder residents' well-being.
The research team surveyed 82 general surgery residents at the University of Toronto about their experience with burnout, perceptions of wellness support, and overall mental health during the pandemic. The results of the survey highlighted three key findings:
● Training culture lacks wellness support—the rigid, demanding structure of surgical programs left little room for self-care.
● Limited time off—staffing shortages during the pandemic often led to cancelled vacations and time-off.
● Ineffective wellness education—mandatory wellness modules and activities felt burdensome, and residents preferred protected free time.
The study found that some barriers to wellness are embedded in the culture and structure of surgical training and were further intensified by the pandemic. Addressing these issues requires systemic changes and is essential for preventing burnout and creating more sustainable training environments for future surgeons.
Idil Bilgen and Dr. Matthew Castelo are co-first authors of the study. At the time of the study, Idil Bilgen was a medical student at the School of Medicine at Koç University in Turkey. Dr. Matthew Castelo was a general surgery resident and is currently a Breast Surgical Oncology fellow at the University of Toronto.
Dr. Tulin Cil, corresponding author of the study, is a Clinician Investigator at UHN’s The Institute for Education Research and an Associate Professor in the Department of Surgery at the University of Toronto.
This work was supported by UHN Foundation.
#Bilgen I, #Castelo M, Reel E, Nguyen MA, Greene B, Lu J, Brar S, #Cil T. Barriers to Wellness Among General Surgery Residents During the COVID-19 Pandemic: Qualitative Analysis of Survey Responses. JMIR Perioper Med. 2025 Nov 24. doi: 10.2196/72819.
# These authors contributed equally to the study.
On December 31, 2025, the Governor General of Canada announced 80 new appointments to the Order of Canada—one of Canada’s highest civilian honours. These appointments recognize outstanding achievement, dedication to the community, and service to the nation.
Among those recognized were UHN researchers Dr. Shaf Keshavjee, Chief of Innovation and Senior Scientist at UHN, and Dr. Allison McGeer, Clinician Investigator at UHN and Senior Clinician Scientist at the Lunenfeld-Tanenbaum Research Institute at Sinai Health.
Dr. Keshavjee was promoted from Officer to Companion of the Order of Canada—the highest honour within the Order—for his transformative contributions to transplant surgery. He was appointed an Officer of the Order of Canada in 2014. Dr. Keshavjee co-developed the Ex Vivo Lung Perfusion (EVLP) system, which maintains donor lungs outside the body by mimicking body temperature and providing nutrients prior to transplantation—doubling the number of lungs available for transplant. He continues to lead research in lung preservation during transplant procedures. Dr. Keshavjee is also a Professor of Thoracic Surgery and Biomedical Engineering at the University of Toronto.
Dr. McGeer has been named a Member of the Order of Canada for her contributions to epidemiology, which have shaped national and global strategies for infection prevention. She is one of Canada’s most trusted epidemiological policy advisors and was a key figure in the COVID-19 pandemic. Her research has advanced knowledge in the fields of influenza epidemiology, prevention of health care-associated infection, and immunization. Dr. McGeer is also a Professor in the Department of Laboratory Medicine & Pathobiology at the University of Toronto.
See the full list of appointees and read the official press release.
The Order of Canada, created in 1967, recognizes individuals who have made extraordinary contributions to Canadian society. More than 8,250 people from all sectors have received this prestigious honour.
Remote patient management (RPM) programs enable patient care to be accessible from anywhere. For heart failure—a serious condition in which the heart does not pump blood as well as it should—remote management can help track health data, detect early warning signs, and alert care teams when interventions are needed. In a new study, researchers at UHN found that well-designed remote management programs can make heart failure care more equitable and accessible.
Medly is a digital therapeutic platform for heart failure management and care developed at UHN by Clinician Investigator Dr. Heather Ross and Senior Scientist Dr. Joseph Cafazzo. The platform was developed in concert with UHN's Peter Munk Cardiac Centre and Centre for Digital Therapeutics, as well as the Ted Rogers Centre for Heart Research. Medly is an RPM program that enables patients to record symptoms, heart rate, blood pressure, and daily weight on a mobile device—most often a smartphone—and receive personalized self-care messages generated by a clinically validated algorithm.
The program was designed to be used with any smartphone, regardless of the model or operating system. All patients are eligible as long as they are able to use Medly as intended (e.g., stepping on a weight scale). The program also provides equipment and connectivity to those who need it, without charge or additional requirements to qualify.
Although programs such as Medly are becoming more common in heart failure care, questions remain about who can actually access them. To assess this, a new study examined validated markers of marginalization—the process by which individuals and groups are prevented from fully participating in society—among patients with heart failure enrolled in Medly. The study also measured how many patients needed partial or full equipment support from the program and where patients lived in relation to the hospital.
Using a measurement called the Ontario Marginalization Index (ON-Marg), the researchers identified the levels of marginalization across neighbourhoods where Medly patients lived over five years. They found that Medly was used by patients across all levels of marginalization. They also found that out of 1115 patients, 38% required at least some equipment from the program to participate and that the program served patients both near and far from their treating hospital.
The findings highlight that providing equipment, minimizing exclusions, and ensuring compatibility with any device can make RPM programs like Medly broadly accessible and help overcome barriers such as cost or lack of technology.
Overall, the study found that thoughtfully designed remote monitoring programs can make heart failure care more equitable and accessible.
Dr. Mali Worme, Clinician Investigator and staff cardiologist at UHN, Clinician in Quality Improvement and Innovation, and Assistant Professor at the University of Toronto, is the first and corresponding author of the study.
Dr. Heather Ross, Clinician Investigator at UHN, Division of Cardiology at UHN’s Peter Munk Cardiac Centre, and Professor in the Institute of Medical Science at the University of Toronto, is the senior author of the study.
This work was supported by UHN Foundation.
Please see the manuscript for any competing interests.
Worme M, Kim B, Ware P, Seto E, Simard A, Ross H. Equity in Heart Failure Care: Examining the Area-based Marginalization Status of Patients in an RPM Program. Can J Cardiol. 2025 Nov 20:S0828-282X(25)01430-8. doi: 10.1016/j.cjca.2025.11.021. Epub ahead of print.
Research at UHN takes place across its research institutes, clinical programs, and collaborative centres. Each of these has specific areas of focus in human health and disease, and work together to advance shared areas of research interest. UHN's research spans the full breadth of the research pipeline, including basic, translational, clinical, policy, and education.
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