Hospitals frequently seek the help of patients in the planning and improvement of health care services. Dr. Anna Gagliardi at the Toronto General Hospital Research Institute led a study to identify the impact of patient engagement at hospitals.
“Even though it’s common for hospitals to have a patient and family advisory committee, we wanted to know what the effect of these activities are,” says Dr. Gagliardi.
The research team set up interviews at nine hospitals that seek patient participation for planning and improving their clinical programs. They interviewed a wide range of stakeholders, including the managers of patient engagement programs, physicians, patients and family partners. The research team also included patient partners who contributed to the design of the study.
The team found that the engagement of patient partners in the design and improvement of hospital services had a positive impact on patients and their families, physicians and hospital staff.
“We found that when hospitals engage patient partners in designing care, there were multiple benefits. Patients felt that their needs were seriously considered. Physicians and hospital staff felt that they communicated better with their patients, were more efficient in providing health care, felt more confident and at ease with their work, and enjoyed their work more,” says Dr. Gagliardi.
The study also found that the inclusion of patient engagement programs led to better patient outcomes—hospitals with these programs reported reduced wait times, incidents of falls and readmissions. Through consulting patients, hospitals improved their policies and strategic plans, programs and services, and provided better educational material for patients.
Several unintended consequences of engaging patients to improve hospital programs were also identified. For example, some patients and families may have felt overburdened with frequent consultations. “These potential drawbacks can be addressed by establishing a larger pool of patient and family advisors,” says Dr. Gagliardi.
The study provides key insights that could be used by hospitals and policy makers to decide how best to invest their resources to improve services—paving the way for a healthier health care system.
This work was supported by the Canadian Institutes of Health Research and the UHN Foundation. Dr. Anna Gagliardi is a Professor of Surgery at the University of Toronto.
Anderson NN, Dong K, Baker GR, Moody L, Scane K, Urquhart R, Wodchis WP, Gagliardi AR. Impacts of patient and family engagement in hospital planning and improvement: qualitative interviews with patient/family advisors and hospital staff. BMC Health Serv Res. 2022 Mar 18. doi: 10.1186/s12913-022-07747-3.
For other publications related to the study, see here.
As the popularity of virtual reality (VR) increases across all sectors, including health care, some people might be left behind. This is because certain individuals are prone to experiencing visually induced motion sickness (VIMS), a special form of motion sickness.
New research is revealing that VR can help patients manage chronic pain, anxiety, phobia and depression. It can also help them to recover after physical injury through VR-based rehabilitation. “Motion sickness in VR is a concern because it can limit individuals from receiving these benefits,” says Dr. Behrang Keshavarz, KITE Scientist.
Dr. Keshavarz led a research team, along with another KITE Scientist, Dr. Babak Taati, to find ways to detect and predict the early onset of VIMS.
Many of the symptoms of VIMS, such as nausea, disorientation, and fatigue are hard to objectively quantify and assess. The body does provide some clues: motion sickness changes heart rate and breathing. It can also cause stomach churning. However, researchers have not yet identified a pattern to these changes that can predict VIMS.
To address this problem, the team used their expertise in machine learning. They set out to identify measurable physiological patterns that could potentially detect the early stages of VIMS or even predict which people are vulnerable to it.
A group of 56 volunteers were equipped with a variety of sensors that monitored their breathing, heart activity, sweating response, body and facial skin temperature, body movement, and the electrical activity from their digestive system. They were then exposed to a first-person video of a bicycle ride, which causes VIMS in the majority of people.
Changes in the skin temperature of the face and the amount of the participants’ body movement were the best indicators for VIMS—physiological changes that are fortunately easy to measure non-invasively. Unfortunately, the degree of accuracy that the machine learning models achieved were not high enough to be used as a sole measure of VIMS: it would correctly identify approximately 70% of those who had motion sickness, while mistakenly flagging 30% of those who did not experience motion sickness as being at risk.
“These results are a first step. While our results identified physiological measures that are closely linked to the onset of VIMS, we also discovered that the physiological measures that we tested are not sufficient to make definite predictions. To increase our predictive power, our future work will explore the use of facial skin temperature and other measures that have been under-studied in evaluating motion sickness,” concludes Dr. Keshavarz.
To learn more about how UHN researchers are using virtual reality to address health issues visit the Prescribing VR website.
This work was supported by Faurecia and the UHN Foundation. Dr. Behrang Keshavarz is an Adjunct Professor with the Department of Psychology at Toronto Metropolitan University. Dr. Babak Taati is an Assistant Professor in the Institute of Biomedical Engineering at the University of Toronto.
Keshavarz B, Peck K, Rezaei S, Taati B. Detecting and predicting visually induced motion sickness with physiological measures in combination with machine learning techniques. Int J Psychophysiol. 2022 Jun;176:14-26. doi: 10.1016/j.ijpsycho.2022.03.006.
Welcome to the latest issue of Research Spotlight.
As Canada’s largest research hospital, UHN is a national and international source for discovery, education and patient care. This newsletter highlights top research advancements from over 5000 members of TeamUHN—a diverse group of trainees, staff, and principal investigators that conduct research at UHN.
Stories in this month’s issue:
● Improving Concussion Policies: Researchers develop the first expert consensus on concussion policies for the school setting.
● Brain Aging in Fast Forward: Study reveals how trigeminal neuralgia and other chronic pain conditions speed up brain aging.
● Cell Therapy for Hemophilia A: Proof-of-concept cell therapy for hemophilia A has been demonstrated in an experimental model.
● Ranking Cancer Cells for Treatment: Cell hierarchies established by leukemia stem cells can predict response to therapy.
Researchers at the Krembil Brain Institute, the Hospital for Sick Children and the University of Toronto have developed a comprehensive list of recommendations for concussion policies for the school setting.
Concussions are a significant public health issue and several government-initiated policies address concussion diagnosis, management and prevention, particularly in student athletes in elementary and secondary schools.
According to Dr. Charles Tator, an Emeritus Scientist at the Krembil Brain Institute and Director of the Canadian Concussion Centre, “school-based concussion policies vary widely in content and in the way that they are implemented.”
Dr. Tator explains that increasing consistency between policies is an important first step towards ensuring that they are applied effectively and have a positive impact. “If we can streamline policies, we can reduce confusion and facilitate communication among various stakeholders, including educators, students, parents and guardians, and clinicians. We can also better allocate funding to support policy development and implementation.”
Dr. Tator’s team comprised Swapna Mylabathula, an MD/PhD student in Dr. Tator’s lab and first author of the study, Dr. Colin Macarthur, a Senior Scientist at the Hospital for Sick Children, and Drs. Astrid Guttmann and Angela Colantonio, Professors at the University of Toronto. The team brought together 20 experts who have roles in concussion prevention and management to form the Concussion Policy Consensus Group—tasked with reviewing school-based policies and developing recommendations to improve their consistency. This group included public health representatives, policymakers, clinicians, school board representatives, and parents and guardians of students who have experienced a concussion. The group also included members of Parachute Canada—a national injury prevention organization—and the Ontario Physical and Health Education Association.
After providing feedback about an initial set of recommendations prepared by the research team, the experts met by teleconference to discuss recommendations and suggest revisions. This process was repeated, resulting in a comprehensive list of 30 recommendations that spanned concussion education, prevention and communication, as well as best practices for return-to-learn or play following a concussion.
Final recommendations for concussion policies included:
1. Outlining that concussion education should be required for coaches, referees, trainers, teachers, school staff, students, and parents and guardians;
2. Specifying which individuals are responsible for planning return-to-learn or play following a concussion;
3. Outlining that schools should communicate information about previous concussions for students moving between grades or schools; and
4. Requiring that concussion surveillance data be collected at the school level and collated by school boards and the province or territory to help assess the policy’s impact.
This list of recommendations represents the first expert consensus for school-based concussion policies and reflects the diverse perspectives of a multidisciplinary group of stakeholders in and outside the school system.
“The aim of these recommendations is to safeguard the well-being of children and youth by improving concussion management and prevention in the school setting,” says Mylabathula. “An important next step is to assess the feasibility of implementing these recommendations and the impact of the new policies on concussion in schools.”
This work was supported by the UHN Foundation. Dr. Astrid Guttmann holds a Tier I Canada Research Chair in Applied Child Health Services and Policy at the University of Toronto. Dr. Angela Colantonio holds a Tier I Canada Research Chair in Traumatic Brain Injury in Underserved Populations at the University of Toronto. Dr. Charles Tator is a Professor in the Department of Surgery at the University of Toronto.
Mylabathula S, Macarthur C, Guttmann A, Colantonio A, Tator C. Development of a concussion public policy on prevention, management and education for schools using expert consensus. Inj Prev. 2022 May 4. doi: 10.1136/injuryprev-2021-044395.
I'm a Mitacs Postdoctoral Fellow at the Clinical and Computational Neuroscience Division at the Krembil Research Institute, the brain research arm of the Toronto Western Hospital. I'm currently investigating the knowledge translation of novel representation and machine learning algorithms to process electrophysiological recordings (i.e., EEG, iEEG) to represent cross-regional brain activity as graphs. The ultimate goal is to identify circuit-based biomarkers involved in Major Depression Disorder and/or Epilepsy.
I'm a Computer Science Engineer by training. I obtained my bachelor's degree from CETYS University (Mexicali, Mexico). During my bachelor studies I was fortunate to study for a year at San Diego State University (SDSU, CA, USA), where I became involved in research projects focused on breast cancer imaging classification and the internet of things (IoT) for health care applications. I published a book chapter on the latter topic.
I then pursued a doctoral degree in Computer Science, at Trinity College Dublin (Ireland), where I investigated the future of optical networking and communication. During this time, I co-lead the development of Mininet-Optical, the first packet-optical network emulation and simulation software system for benchmarking software-defined optical network technologies. This tool is intended to be released as an open-source resource, with the aim of providing students, researchers, professors and engineers a platform to test control systems operating on optical networks. Also during this time, I gained machine-learning experience through projects that aimed to predict the quality of optical signals as they traverse a network—a process that is crucial for moving data from one point to another. My research and findings were disseminated through multiple presentations at prestigious international conferences in the field (ONDM-Ireland,Greece, ICC-China, OFC-USA), public demonstrations, workshops and scientific publications.
The pursuit of a doctorate degree was crucial to my development as a researcher. I gained experience in working in multi-form, multi-cultural, international teams, where I played a variety of roles. I also gained experience in critical thinking, scientific reading and writing, and strengthened my skills in public speaking. I am a firm believer that science benefits when collaboration cuts across multiple disciplines and fields. With this in mind, after training in the area of telecommunications, I decided to embark on translating my skills to the health care sector, and to investigate the most mysterious system to date: the human brain. And UHN gave me the opportunity to do this.
Joining UHN allowed me to train at a different level (now as a postdoctorate fellow), in a different country and environment (from Ireland to Canada), and in a different field. Through this experience, I have gained new insight into the scientific process and culture in Canada. What I love about my job at UHN is that the work that we do advances our knowledge about the brain—on a very foundational level—a level that will ultimately open the door to new strategies, treatments and technologies to improve the health and wellbeing of those living with neurological diseases.
Medical research is key to unlocking a healthier world. There are three ways in which I believe I have contributed to this.
First, I have had the opportunity to mentor others through co-supervising bachelor students completing a co-op placement. Mentorship is one of the most rewarding things that we do at UHN.
Second, have helped to promote multi-disciplinary collaborations by developing knowledge translation tools that enable crosstalk between computer scientists into neuroscientists. I believe that multi-disciplinary collaboration is vital to translating research into tangible health solutions.
Lastly, as an early-career researcher, I have had the chance to help guide our research projects, which has helped me to reflect on how we conduct science. Science is driven by people. Because of this, I am a strong proponent of acknowledging and celebrating the ‘human’ side of science. For us to achieve our goals, I believe that human values must always be at the core of our research activities.
UHN is full of intelligent and motivated individuals who share the same goals: to improve our knowledge of the health sciences, to improve the health care system, and to maintain high professional practice standards. Also, given the nature of UHN—Canada’s largest research hospital—it promotes and enables important multidisciplinary research. As such, at UHN, teams could consist of medical doctors, engineers, mathematicians, psychologists, therapists, artists, and many other professionals, who work together to tackle important scientific questions and to explore strategies to improve health.
Outside of work I enjoy spending time with my family and friends. I do creative writing (short stories, essays, poetry) and I'm hoping to get some of it published in the coming years. I'm also interested in music and exploring creating some of my own.
When I was in elementary school, my generation was told that the future was going to be about data. What they couldn't tell us then was that data analysis (ie, making sense of the data) would be so expansive and such a key area of focus. Today, technological progress is being made at great speeds. I think that the same is starting to happen in the health sciences, but at a slower pace—and this slower pace is necessary because there's very little room for error (as there should be). However, I think in the years to come, advances made through artificial intelligence, robotics, telecommunications and big data will impact health research in way that we cannot currently imagine. While the dynamic changes happening in the field make it impossible to predict how the future of health care will look, I’m excited that I can be part of it.
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 (UHN Office365 account is required; open to UHN staff, trainees and volunteers).
A team of researchers led by Dr. Phedias Diamandis at the Princess Margaret Cancer Centre has linked a protein called RuvB-like 2 (RUVBL2) to certain rare neurodevelopmental disorders. The research team did this by generating profiles of the proteins found at various stages of development in human brain tissue and in mini brains-in-a-dish.
The brain is the body’s most complex organ. It is also one of the most difficult to study because access to human brain tissue is limited. To overcome this limitation, the researchers used small three-dimensional brain-like organs in the lab called cerebral organoids.
“These experimental models have enabled researchers to mimic the development of the brain and to study the biology underlying diseases, such as Alzheimer disease, Zika virus infection and cancer,” says Dr. Diamandis.
In the current study, the researchers profiled the proteins expressed in two cell populations within cerebral organoids that represent different stages of brain development. They also profiled proteins in nine regions of the developing human brain. They found that the profiles of proteins in cerebral organoids were very similar to those found in fetal brain tissue.
“Cell-type specific markers have been key for defining the proteins and pathways involved in the early steps of brain development. But questions remain,” says Sofia Melliou, a PhD student in Dr. Diamandis’ lab. “By using organoids to characterize changes in proteins in different cell populations—those at early and late stages of development—we were able to open a window into how the brain changes as it grows.”
Using this approach, the team identified an intriguing difference between the two populations of cells in cerebral organoids: the cells representing an earlier stage of development exhibited a higher expression of the RUVBL2 protein.
Chemically inactivating RUVBL2 resulted in cell displacement and cell death within the organoids. To see whether what they observed in the lab had any clinical implications, the researchers examined clinical datasets and found that some individuals with neurodevelopmental impairments displayed mutations in the RUVBL2 gene. Examples of these impairments include mild microcephaly, severe developmental disorder and an abnormal nervous system.
“Our findings illustrate how cell-type specific profiling of these model systems can be a powerful discovery tool for uncovering the underlying mechanisms of brain development and neurological diseases,” says Dr. Diamandis.
This work was supported by the Natural Sciences and Engineering Research Council of Canada, the Terry Fox Research Institute, the Canadian Institutes of Health Research and The Princess Margaret Cancer Foundation. Dr. Phedias Diamandis is an Assistant Professor of Laboratory Medicine and Pathobiology at the University of Toronto.
Melliou S, Sangster KT, Kao J, Zarrei M, Lam KHB, Howe J, Papaioannou MD, Tsang QPL, Borhani OA, Sajid RS, Bonnet C, Leheup B, Shannon P, Scherer SW, Stavropoulos DJ, Djuric U, Diamandis P. Regionally defined proteomic profiles of human cerebral tissue and organoids reveal conserved molecular modules of neurodevelopment. Cell Rep. 2022 May 24. doi: 10.1016/j.celrep.2022.110846.
The COVID-19 pandemic has had a profound effect on research institutions. While some changes have limited research activity, others have created opportunities for collaboration.
Thanks to an innovative UHN-led approach, research involving biospecimens—i.e., materials such as blood, tissue, or cell lines and associated data—have been streamlined among health care organizations Canada-wide.
The initiative began within just weeks of the start of the pandemic and is called the COVID-19 Master Data & Biological Sample Transfer Agreement or COVID-19 D/MTA. Led by Commercialization at UHN and the Toronto Academic Health Science Network (TAHSN), the program has grown quickly and now counts with nearly 40 signatory institutions across Canada.
A simple, flexible approach
Typically the transfer of biomaterials between organizations involves extensive documentation, legal reviews and negotiations. The COVID D/MTA process is streamlined and depends on a flexible template letter that has been adopted by all signatories. This significantly reduces the administrative burden, while enabling inter-institutional research collaboration and team science on COVID-19.
“This collaboration—whose inception was at UHN—is strengthening Canadian research and partnerships across the country,” says Brad Wouters, Executive Vice President, Science and Research, University Health Network.
“The initiative can be likened to a universal COVID-19 research pass. By helping us to rapidly enable research partnerships, it has become a vital tool for supporting life science research. During the pandemic, we were reminded that we are in this together, and the COVID-19 D/MTA, through fostering inter-institutional collaboration, has strengthened our ability to work together and bring benefits to patients.”
Participating organizations include most major Canadian universities and hospitals and research centres, public health agencies from across the country, including several members of the British Columbia Provincial Health Services Authority, the New Brunswick Regional Health Authority and the Ontario Agency for Health and Promotion.
The network is still growing and the initiative is open for others to join. To see a list of current signatories, click here.
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.
Learn more about our institutes by clicking below: