CREMS SUMMER RESEARCH PROGRAM
2015 PROJECTS
PLEASE READ CAREFULLY
The following catalogue represents the projects that are available for the 2015 CREMS Summer Research Program.
You must use the contact information provided in order to set up an appointment to discuss the project in more detail
with the supervisor.
While you may contact multiple supervisors, you can only submit ONE application. Some supervisors have multiple
projects in their lab but you must choose ONE and submit an application for that.
Contact the supervisor on the project you are interested in. Once the supervisor confirms that you are the
successful applicant you must complete the 2015 Summer Research Student Application. Please request this
form from once you are the confirmed choice. We will not be giving out applications until you have been chosen by
the supervisor.
The completed application form is due by 5 pm on Friday March 27, 2015.
The application form must be sent via email ONLY to crems.programs@utoronto.ca
Good Luck!!
Page 1 of 47
Identifying genetic causes of congenital and developmental disorders in adults
Supervisor Name: Anne Bassett
Hospital/Research Institution: Centre for Addiction and Mental Health
Email: anne.bassett@utoronto.ca
Department: Psychiatry
Brief Project Description
We are studying major developmental diseases, including congenital cardiac disease and
schizophrenia. Together with colleagues at the University Health Network, Hospital for Sick
Children and other international institutions, we are clinically screening patients with these
conditions to determine those most likely to have genetic syndromes and/or other de novo or
inherited forms of these diseases. Using state-of-the-art molecular genetic methods we are
identifying patients with structural (deletions or duplications) and other mutations and studying
inheritance patterns and clinical expression. We directly translate clinically significant results to
help patients and their families with anticipatory care and genetic counselling. This is clinical and
statistical research (not bench lab research - this is with our colleagues) at the forefront of
molecular medicine
Page 2 of 47
Which protocol identifies retinal toxicity associated with an antiepileptic drug used in
early childhood
Supervisor Name: Carol Westall
Hospital/Research Institution: The Hospital for Sick Children
Email: Carol.westall@sickkids.ca
Department: Ophthalmology and Vision Science
Brief Project Description:
Infants with seizure disorders are treated with the anti-epileptic drug vigabatrin. About 20% of
treated children develop retinal toxicity. This project will compare the predictive ability of the
standard clinical electroretinogram (ERG) and a structural assessment tool called ocular
cohehence tomography (OCT). Over the summer it is expected that 20 infants will be assessed
clinically including electroretinogram testing and retinal examination.
The summer student will work with a coordinator, physicians, electrophysiologists and technical
staff.
Appointments will be coordinated and the student will collect clinical and study data; will
evaluate data and conduct statistical assessment using a Cox regression model with time
dependent covariates. The hazard ratio associated with the measurements on the risk of retinal
damage in infants and young children will be estimated for both test paradigms. The results of
this assessment are expected to help determine the optimal tool to assess retinal toxicity
associated with the antiepileptic drug vigabatrin.
Page 3 of 47
Genome-based personalized therapy for prostate cancer
Supervisor Name: Dr. Paul C. Boutros
Hospital/Research Institution: Ontario Institute for Cancer Research & University of Toronto
Email: Paul.Boutros@oicr.on.ca
Brief Project Description:
The Canadian Prostate Cancer Genome Network (CPC-GENE) is a coordinated multi-centre effort
to identify prognostic and predictive biomarkers for intermediate-risk prostate cancer patients.
Approximately 1 in 7 Canadian men will be diagnosed with prostate cancer over the course of
their lifetime. About a third of these are diagnosed with intermediate-risk disease – as
determined by the clinical variables of T-category and pre-treatment PSA and the pathological
grade (Gleason score). Despite best-treatment with precision radiotherapy or surgery, about 40%
of patients will suffer relapse. CPC-GENE aims to use whole-genome sequencing, RNA-sequencing
and epigenetic profiling to identify those patients who suffer relapse at the time of initial
therapy. This project, as part of CPC-GENE, involves working with the resulting data to develop
these clinical-tools. This includes primarily clinical, biostatistical and bioinformatic data-analysis,
and working to link the clinical data to the genomic information on a per-patient basis to create
a portrait of disease risk and progression. The applicant will be directly supervised by a
computational biologist, but will work very closely with the study pathologist and overall-lead (a
radiation oncologist), and thus is designed to give a strong sense of the interactions of a large
translational research program.
Page 4 of 47
Magnetic Occult Lesion Localization and Imaging (MOLLI) for Non-Palpable Breast
Cancers
Supervisor Name: Nicole Look Hong / Anath Ravi
Hospital/Research Institution: Sunnybrook Research Institute
Email: nicole.lookhong@sunnybrook.ca
Brief Project Description
Purpose:
The goal of this project is to evaluate an alternative to wire localization for surgical resection of nonpalpable breast lesions: Magnetic Occult Lesion Localization and Imaging (MOLLI).
This novel approach to
tumour localization, developed at Sunnybrook Odette Cancer Centre, involves implanting non-radioactive
magnetic seed(s) under radiographic guidance to clearly define the center and extent of tumour.
Seeds
are completely contained within the breast, do not pose a risk of dislodgement or movement-related
discomfort, and can be implanted several days in advance.
any need for radiation safety precautions.
Seeds are also non-radioactive, eliminating
Using a novel and user-friendly detection system, the surgeon
can precisely identify the location of seeds, and perform skin incisions and resection achieving both
optimal cosmetic result and oncologic outcomes.
Methodology:
Pre-clinical validation studies will be performed on anthropomorphic phantoms to determine whether
MOLLI can replace wire localization.
Tests will include quantifying the sensitivity and resolution of the
MOLLI system to ensure accurate detection of the magnetic seeds under clinically representative
scenarios.
These phantom studies will form the basis of a pre-clinical validation study a pilot series of
localizations in breast cancer patients with small non-palpable tumors will be completed to ascertain
feasibility, safety, patient acceptability, and satisfaction of all involved clinicians.
Objectives:
At the end of this study it is expected that the student contribute to a manuscript that characterizes the
performance of the MOLLI system in phantom geometries.
These results will also be presented at an
international conference for rapid knowledge translation into the surgical oncology community.
Additionally, based on the outcomes from the preliminary pre-clinical studies it is expected that the
student may also participate in filing for research ethics board approval for subsequent pilot series
clinical trials.
Page 5 of 47
Endo-bronchial ultrasound guided trans-bronchial biopsy; the impact of limited
resources on diagnostic accuracy
Supervisor Name: Abdollah Behzadi
Hospital/Research Institution: Credit Valley Hospital
Email: abdollah.behzadi@trilliumhealthpartners.ca
Brief Project Description
Endo-bronchial ultrasound is a relatively new technology that is increasingly used to make pathological
diagnosis of mediastinal abnormalities. Given the high cost of the equipment and resources that this
technology requires, the wide adaptation of this procedure, which results in lesser surgical procedures on
affected patients, has been hampered.
This is a retrospective chart review study of approximately 180 patients who underwent this procedure
over a 2 year period in a university-affiliated community hospital. The goal of this project is to identify a
patient cohort whose biopsy results provide accurate and actionable clinical information hence avoiding
the procedure in low yield situations.
the With the help of supervisor, the student is responsible to develop an understanding of indications for
this procedure, write a proposal, collect clinical data, perform statistical analysis, write the initial
manuscript, and present the findings in a scientific conference.
The student-candidate should have
interest in outcome research, background knowledge in statistics, and drive to work independently.
Page 6 of 47
The ABCS Trial (Anesthesia for Breast Cancer Surgery): A Two-center Randomized
Controlled Comparison of the Impact of General Anesthesia with and without Thoracic
Paravertebral Blocks on the Three-month Incidence of Chronic Neuropathic Pain in
Women Undergoing Ambulatory Breast Tumor Resection
Supervisor Name: Faraj Abdallah
Hospital/Research Institution: St. Michael’s Hospital
Email: abdallahf@smh.ca
Brief Project Description
People with breast cancer now live much longer because of better treatments. However, almost 60% of
women who have successful breast cancer operations then develop long-term pain. This pain is makes it
very hard for these women to sleep, work, interact with family, and carry out their normal daily life. If we
can find better ways to stop this pain from happening, women will be able to live a better and pain-free
life after their breast cancer surgery.
Thoracic paravertebral block (PVB) is a method for using local anesthetics (drugs that ‘numb’ the nerves)
to freeze or ‘block’ the nerves around the breast. Some small older studies suggest that using these
nerve blocks before surgery can help prevent long-term pain. However, we cannot be certain that these
small studies are correct because they have many problems. We therefore want to do a large study to
find out if nerve blocks before breast cancer surgery can prevent long-term pain and improve women’s
quality of life.
In our study, women undergoing breast cancer surgery will be randomly chosen to have either the nerve
block or no block before surgery. We will then follow them for 3 months to see whether women who
receive the nerve block are less likely to develop long-term pain, and more likely to go back to a good
quality of life.
We hope that our study will help women survive longer, and also better, after a diagnosis of breast
cancer.
Page 7 of 47
The INFerence from Observational Reseach Methods (INFORM) Study
Supervisor Name: David R. Urbach
Hospital/Research Institution: Toronto General Research Institute Division of Support, Systems
and Outcomes
Email: david.urbach@uhn.ca
Brief Project Description
As part of a larger project with the overarching aim of developing methods to properly interpret nonrandomized studies of clinical interventions, we are seeking students to undertake components of the
research, including: conducting systematic reviews, developing analytic procedures to measure bias in
non-randomized studies, co-develop an interactive tool to “adjust” study findings to account for bias, and
write a monograph/short book on the problem of bias in health research, how it impacts our
understanding of research findings, and how it can be addressed. Students will take “ownership” over
their parts of the research program, and will work collaboratively with the larger research team. Research
activities will be carried out in the Division of Support, Systems and Outcomes at the Toronto General
Hospital Research Institute. Students are provided excellent resources, including modern workstations in a
collaborative and interactive research environment, weekly lab meetings, weekly health services research
rounds at the Research Institute, and close supervision by their supervisor and the research team.
Page 8 of 47
Clinical predictors of outcomes in patients with granulomatosis with polyangiitis with
nodular lung involvemnet
Supervisor Name: Christian Pagnoux
Hospital/Research Institution: Mount Sinai Hospital
Email: cpagnoux@mtsinai.on.ca
Brief Project Description
GPA (Wegener’s) is a rare systemic necrotizing granulomatous vasculitis, associated with anti-neutrophil
cytoplasm antibodies (ANCA). Disease onset can occur at any age, most commonly about 40 to 50 years.
The main target organs or systems are the upper respiratory tract (erosive rhinitis and sinusitis, saddlenose deformity), lungs (nodules, alveolar hemorrhage) and/or kidney. Biopsy of an affected organ can
support the diagnosis, as can detection in serum of cANCA by immunofluorescence and proteinase 3
(PR3) specificity. Current therapy, based on a staged induction–maintenance strategy, can achieve
remission in most patients, but relapses are very common, occurring in up to 50% of the patients at 5
years post-diagnosis. Already identified predictors of relapse include PR3-ANCA, lung disease and ENT
manifestations.
Lungs are involved in 70–100% of patients, with clinical manifestations ranging from mild cough, dyspnea
to acute and massive alveolar hemorrhage. Lung nodules are among the most characteristic signs,
detected in 40% to 66% of patients; nodules are unilateral or bilateral, single or multiple, measuring 0.5
to 10 cm in diameter, and excavated in half of cases. Whether the presence of excavated nodules, which
can be frightening to inexperienced physicians, have poorer prognostic values or not, compared to only
plain nodules, in term of treatment response or relapse risk is unknown. The aim of this study is to
analyze and compare the characteristics, treatment and outcomes of a cohort of patients with GPA and
lung nodules, excavated or not, at the time of disease flares. Study patients will be those followed in the
Toronto and Hamilton vasculitis clinics (around 250). Their data will be entered into a recently and
already developed and functional database, in order to facilitate this analysis for this study and, perhaps,
lead to other similar studies.
Page 9 of 47
CLEAN Meds: Carefully seLected and Easily Accessible at No charge Medications
Supervisor Name: Nav Persaud
Hospital/Research Institution: St. Michael’s Hospital / Keenan Research Centre of the Li Ka Shing
Knowledge Institute
Email: nav.persaud@utoronto.ca
Brief Project Description
Background
Access to appropriate medications is an important determinant of health. Barriers to Canadians accessing
appropriate life-saving or enhancing medications include costs, inappropriate prescribing, lack of
healthcare integration and inability to physically obtain medications.
Lists of carefully selected
medications in the United Kingdom, managed care settings in the United States, and in Sweden have
reduced healthcare expenditures and harmonized prescribing behaviors. Providing free medications by mail
is expected to increase medication adherence based on clinical trials and observational studies in other
countries.
Study Objectives
We are determining the effects of providing carefully selected essential medications at no charge via a
centralized dispensing program on health outcomes and costs. This will be accomplished by fulfilling three
objectives:
1. Develop a Canadian list of essential primary care medications
2. Use current Canadian prescribing data to estimate effects on patient care and societal health care
expenditure of substituting currently prescribed medications with essential medications.
3. Determine the acceptability and effects of an integrated pharmacist-prescriber model of no charge
essential medication dispensing.
Student Role
Students may have the opportunity to design and perform literature reviews, perform prescribing data
analyses, develop and present poster/seminar presentations, interview study participants and/or contribute
to protocol, report and manuscript writing.
Page 10 of 47
Predictors of success and outcomes for men in chronic, non-obstructive urinary
retention treated with sacral neuromodulation
Supervisor Name: Girish Kulkarni / Dean Elterman
Hospital/Research Institution: PMCC / UHN
Email: dean.elterman@uhn.ca
Brief Project Description
As men age, their prostate glands grow which may lead to blockage of urinary flow. Over time, the
muscle of the bladder may become stretched out from squeezing against the blockage and eventually
lose its ability to squeeze out urine. A surgery may be performed to open up the channel of the prostate
through which urine flows, however, many men will remain unable to void (retention) despite this
procedure, as the bladder muscle is too weak. These men will have to insert a tube (catheter) several
times a day to empty their bladder. There is a technology, called sacral neuromodulation, which acts like
a bladder pacemaker. Just like a heart pacemaker, but implanted under the skin of the lower back, it has
a battery and wire that send a gentle electrical signal to the nerves controlling the bladder, which
corrects certain abnormal conditions. It is approved to treat overactive bladder, urinary leakage, and
retention. However, no previous research has looked exclusively at men with retention using a catheter,
as most studies had >90% female participants. As only one of two physicians in Ontario performing this
procedure, my research will study predictors of success and outcomes for men in chronic urinary
retention treated with sacral neuromodulation. The goal of my study will be to show that the bladder
pacemaker can lead this group of men to urinate spontaneously and not require the use of a catheter
any longer.
Page 11 of 47
Taxonomy of adverse events in critical care transport: Definitions derivation and
taxonomy
Supervisor Name: Russell MacDonald
Hospital/Research Institution: Sunnybrook Health Sciences Centre / Ornge Transport Medicine
Email: rmacdonald@ornge.ca
Brief Project Description
The Institute of Medicine recommends development of taxonomy to standardize error reporting and
analysis. Despite the recommendation, many health care settings have not adopted a taxonomy or
common terminology. This prevents meaningful generation of new knowledge and improvement in patient
safety.
Ornge is Ontario’s air and land critical care transport program. It has developed a taxonomy to collect,
categorize and analyze adverse events and near-misses in the air and land critical care transport setting.
Two items remain: a) derive and standardize terms and definitions for terms used in the taxonomy and
b) utilize the taxonomy and its definitions to categorize events reported to coordinator and investigations
officer, all under the direct supervision of the program’s Medical Director.
This project is well suited to students interested in a future career path in medicine that includes quality
care processes, safety, and/or aviation. While experience is not mandatory, the ideal candidate will have
some experience in literature searches and chart review, have solid communication and computer skills,
and can function well in an interdisciplinary work setting. This summer project can be funded from an
existing external grant, and would not be dependent on the student obtaining funding from the CREMS
program or other sources.
Page 12 of 47
Anesthesia Practices for Laser Therapy in a Pediatric Population
Supervisor Name: Joel Fish
Hospital/Research Institution: Hospital for Sick Children
Email: joel.fish@sickkids.ca
Brief Project Description
Laser therapy is the newest form of scar modulation available for burn injured patients. At present, the
Hospital for Sick Children (SickKids) is fortunate to be the only pediatric center offering this method of
scar treatment in Canada. Since its introduction in January 2014, we have treated over 100 patients with
pulsed dye and/or CO2 laser therapy. In order to provide laser therapy, children require sedation so that
the procedure can be carried out safely. Thus, we would like to conduct a retrospective review of our
current anesthesia approach for this procedure. We are particularly interested in examining specific
factors such as the type of anesthetic used, dosage, complications, etc. The results of this study are
necessary in order to help us optimize treatments and learn more about our ongoing anesthesia
practices. At present, there is no published data regarding anesthesia and laser therapy in the literature.
Thus, the student who undertakes this study will contribute to a novel area. A student who is detailoriented and highly independent would be an ideal candidate to complete this project.
-
NOTE: Please list the Research Coordinator for the Burn Program at SickKids as the contact
person for this project. Her information is as follows: Jennifer Zuccaro, Email:
jennifer.zuccaro@sickkids.ca, Phone: 416-813-7654 x203018
Page 13 of 47
microRNA as novel biomarkers to guide adjuvant prostate radiotherapy decisionmaking
Supervisor Name: Stanley Liu
Hospital/Research Institution: Sunnybrook Research Institute
Email: stanley.liu@sunnybrook.ca
Brief Project Description
Despite many studies, a clinically important need remains in the post-radical prostatectomy setting:
development of biomarkers reflective of a patient’s unique genomic status, that will allow for improved
triaging based upon their risk of developing local versus distant recurrence. Despite possessing similar
clinicopathological features, some patients are at high risk of developing local and/or distant recurrence
and dying of their cancer, whereas many others will have clinically insignificant disease and will not
benefit from adjuvant radiotherapy.
Determining which patients are unlikely to derive a therapeutic
benefit from RT will prevent overtreatment, removing the burden of unnecessary therapy and side-effects
from patients and healthcare systems. Conversely, the ability to accurately identify which patients harbor
residual aggressive disease requiring more intensive therapy (i.e., dose intensification or early integration
of systemic therapies) could improve patient outcomes.
Recent studies indicate that circulating microRNAs are useful as non-invasive biomarkers for different
cancers, including PCa. miRNAs are secreted from cancer cells into body fluids such as blood and urine
within exosomes. Exosomes are small cell-derived extracellular vesicles actively shed by tumor cells, and
contain tumor miRNAs which can exert biological effects in a paracrine manner on normal and cancer
cells.
Recently, exosomal miRNAs have been attracting major interest as potential diagnostic, prognostic,
or even therapeutic biomarkers in urologic malignancies.
We believe that exosomal-derived miRNA expression profiling will help to: 1) prognosticate long-term
prostate cancer behavior, and 2) predict which therapy could provide the best chance of disease control
with acceptable toxicity. This project will involve isolation of exosome-derived microRNA from radical
prostatectomy patients, and real-time PCR quantification of a panel of microRNA known to have
prognostic significance.
Page 14 of 47
Improving survivorship for testicular cancer patients at Princess Margaret Cancer
Centre
Supervisor Name: Robert Hamilton
Hospital/Research Institution: Princess Margaret Cancer Centre
Email: rob.hamilton@uhn.ca
Brief Project Description
Testicular cancer predominantly affects young men age 15-35.
Fortunately, the cure rate is very high.
Many present with Stage I disease and the only treatment they require is removal of the affected testicle
(orchiectomy) followed by close monitoring. However, a significant proportion present with more
advanced disease and require further surgery or chemotherapy in addition to an orchiectomy.
The
treatments, even if only orchiectomy, can affect sexual, reproductive, physical and emotional health.
At
Princess Margaret Cancer Centre, we have a multidisciplinary testicular cancer clinic and we see the
largest volume of testis cancer in Canada. Our current research interests include improving quality of life
for survivors of testicular cancer.
There are a number of research opportunities a prospective student could choose in our active research
group and the summer experience could be molded to suit their wishes.
Three projects to consider
include:
1) Quantifying prevalence and severity of hypogonadism among men after orchiectomy.

Androgen and gonadotropin levels have been collected prospectively in our clinic since 2005
but have yet been analyzed.
2) Creating an application (e.g. iPAD) that serves as a decision aid for men recommended to undergo
retroperitoneal lymphadenectomy (RPLND) for metastatic testis cancer.

There is a need to better explain the nature of the surgery and potential complications in a
dynamic way that can minimize decisional regret as a survivor.
3) Surveying men about uptake of testicular prosthesis insertion at the time of orchiectomy to explore
barriers and needs.

The aim would be to learn more about the patient and physician factors determining choice of
prosthesis to address barriers.
Students will be fully integrated within the urologic oncology group at Princess Margaret and will be
invited to attend our research rounds, our multidisciplinary tumour rounds, urology rounds, renal tumour
board rounds and our testicular cancer research group rounds.
Page 15 of 47
Knee Osteoarthritis Quality Improvement Project
Supervisor Name: Noah Ivers
Hospital/Research Institution: Women’s College Hospital
Email: noah.ivers@wchospital.ca
Brief Project Description
Osteoarthritis (OA) is one of the most common chronic diseases in Canada; affecting 10% of the total
population (3% more women than men). With such a large disease burden, it is important that physicians
caring for these individuals are aware of, and utilizing all available management strategies. This pilot
study will audit a group of patients with a confirmed diagnosis of knee OA and determine their individual
quality of care. The gaps in care will be identified and presented to their physicians along with evidencebased recommendations to improve management. We will assess the impact of this audit and intervention
using validated OA outcomes.
Although the avenues of OA management are well known, evidence-based solutions are not always put
into practice. By providing information to physicians about sub-optimal patient care linked to evidencebased solutions, this project hopes to close some of the OA care gaps. In using validated questionnaires
as outcome measures, as well as patient and physician feedback, we can assess the necessity and
effectiveness of this audit and feedback intervention. By connecting patients with services of which they
are in need, we will see improvement, not only in the satisfaction with their OA care, but also in disease
measures. We will pilot collecting patient-reported outcome measures using Tablets in the waiting room.
Information patients provide will be directly linked to fields in their electronic medical record.
The medical student will participate in analyzing and summarizing the project data, develop the feedback
reports to family physicians, and assist with manuscript development and PowerPoint slide decks. They
will also have the opportunity to work with clinical team members, (e.g., rheumatologist,
family physician,
and allied care providers) involved in providing care to patients with OA to better understand the patient
perspective on how health services for patients with this condition can be improved.
Page 16 of 47
Relationship between neurochemical and functional MRI measures in Substance Use
Disorder
Supervisor Name: Doris Payer
Hospital/Research Institution: Centre for Addiction and Mental Health
Email: doris.payer@camh.ca
Brief Project Description
The summer project will be part of a rich MRI research program investigating brain function, structure,
and neurochemistry in clinical samples with substance use disorders (SUD), with a focus on opioid,
cocaine, alcohol, or nicotine dependence. MRI measures include: functional activation during craving,
emotion, and cognitive tasks (fMRI); resting-state activity to be analyzed for network-wide functional
connectivity; regional cerebral blood flow; biochemistry (GABA/glutamate concentrations and
neurometabolites); and tissue microstructure. The aim of the study is to characterize the relationship of
biochemical alterations to functional abnormalities commonly observed in SUD. Analyses will test for these
relationships, compare measures to healthy control samples, and investigate longitudinal changes with
abstinence or treatment.
The project may also relate MRI measures to outcomes from the lab’s PET imaging program, such as
dopamine receptor availability in Rx opiate dependence.
Page 17 of 47
Feasibility of remote administration of the Fundamentals of Laparoscopic Surgery
(FLS) skills test using Google Glass
Supervisor Name: Allan Okrainec
Hospital/Research Institution: Temetry/Change Telesimulation Centre / Toronto Western Hospital
Email: allan.okrainec@uhn.ca
Brief Project Description
The most well-known curriculum for laparoscopic surgery training is the Fundamentals of Laparoscopic
Surgery (FLS), an educational program developed by the Society of American Gastrointestinal and
Endoscopic Surgeons and endorsed by the American College of Surgeons. The FLS program is an
education and assessment package consisting of an online cognitive module and a manual skills
assessment. The skills component consists of the following 5 tasks: peg transfer; precision cutting;
placement of a ligating loop; and suturing using extracorporeal and intracorporeal knot tying. The tasks
are scored for efficiency and precision, and each task has a predetermined cutoff time.
Google Inc. has introduced Glass, a wearable computer containing a heads-up display, a speaker, a
camera, a battery and a flash drive mounted on a titanium eyeglass frame. The display allows users to
pull up information as they would on any other computer with a simple voice command. It has a camera
that offers a point-of-view image and the ability to take both photos and videos while the device is worn.
Although there are reports of the potential utility of Glass for medical doctors in the printed and online
press, very little has been published in the peer-reviewed medical literature. To our knowledge, Google
Glass has not been used in the training or evaluation of FLS yet. Thus, the purpose of this study is to
assess the feasibility of evaluating the FLS skills component using Google Glass.
This study will use FLS scoring data and participant feedback to assess the administration of the FLS
examination with remote proctoring. The student will be involved with data collection, management and
analysis. The student will also have an opportunity to learn FLS skills and to test Google glass.
Page 18 of 47
The risk factors associated with foot deformity in diabetic foot ulcer patients referred to
wound care clinic at Women’s College Hospital
Supervisor Name: Afsaneh Alavi
Hospital/Research Institution: Women’s College Hospital
Email: afsaneh.alavi@utoronto.ca
Brief Project Description
The relationship between foot deformity, and ulceration has been explored previously. For example,
studies have shown that foot morphology affects peak plantar pressure1 and subsequent plantar pressure
is related to ulceration.2–4 Another study found, retrospectively, that everted calcanei were associated
with medial metatarsal head ulcers, while inverted calcanei were associated with lateral metatarsal head
ulcers.5 Foot deformities such as hammer/claw toe deformity or hallux limitus have been significantly
associated with ulcer incidence in a univariate analysis.6
Thus, previous research indicates that foot morphology (foot type) and foot deformity can affect foot
ulcer occurrence and foot ulcer location directly by ulcer development5,6 or indirectly by increased
plantar pressure.2–4 This study further explores the relationship between foot type or foot deformity and
ulcer as prospective study. This study will further help us understand how foot shape is associated with
the development of foot ulcers.
No formal studies have been conducted to determine the prevalence of foot deformity as a risk factor
in diabetic foot ulcer patients in the Canadian population.
The aim of this study is to determine such
prevalence in this population. We also aim to determine the risk factors and the comorbidity associated
with diabetic foot ulcers including neuropathic versus neuroischemic foot ulcers.
Objectives:
The primary objective of this study is:
•
To determine the prevalence of foot deformity as risk factor in diabetic foot ulcer patients.
Secondary objectives in this study include:
•
To determine the risk factors associated with diabetic foot ulcers.
•
To determine the characteristics of diabetic neuropathic versus diabetic neuroischemic foot ulcers.
Page 19 of 47
A Study to Identify the Prevalence of, Risk Factors for, and Effect of Alternative Antimicrobial Administration in Patients who Carry Ciprofloxacin Resistant Enteric
Organisms in a Population of Patients Undergoing Transrectal (TRUS) Biopsy of
Prostate
Supervisor Name: Frank Papanikolaou
Hospital/Research Institution: Trillium Health Partners / The Credit Valley Hospital
Email: frank.papanikolaou@trilliumhealthpartners.ca
Brief Project Description
Background
Ciprofloxacin is an antibiotic drug of the fluoroquinolone (FQ) class. It has been shown to be effective against organisms causing
urinary tract infections (UTIs) and as a result is often used in prophylactic treatment in procedures such as TRUS guided
prostate biopsies.
Recent studies have shown an increase in the number of infective complications after TRUS despite
ciprofloxacin prophylaxis. Researchers have traced this rise in infections to an increase in the bacterial resistance of FQs
including ciprofloxacin. This study will determine the prevalence of ciprofloxacin resistant enteric organisms in patients undergoing
TRUS and to determine risk factors for carriage of the resistant bacteria. Matching the presence of the resistant bacteria with
certain risk factors will help to predict which patients are likely to have the resistant bacteria. This will allow tailored antibiotic
prophylaxis, thus reducing the patient’s chance of becoming infected. Based on our knowledge, there have not been any previous
studies which have prospectively tried to view a wide array of potential risk factors for carriage of the resistant bacteria, in
addition to finding the prevalence of the resistant bacteria in this population.
Study Design and Methodology
The urologist will perform a Digital Rectal Examination (DRE) and PSA blood test, and will determine if the patient needs a TRUS
biopsy. The patients will be informed about the study and be given the consent form along with a brochure regarding the study.
At the Urology Research Clinic appointment, the study nurse will obtain the consent form from the patient, and collect a rectal
swab sample if the patient agrees to participate in the study.
The patient will also fill out a questionnaire regarding risk factors
which may be associated with Cipro resistant bacteria. All information contained in the questionnaire will be kept confidential, via
a generated participant ID, and will only be viewed by the study team for research purposes only. The nurse will submit the
swab sample to the CVH Microbiology laboratory, where it will be incubated using a selective medium in order to identify the
presence of ciprofloxacin resistant enteric organisms. The results of the swab will be disclosed to the study team for research
purposes and be recorded in the patient’s chart, so that the urologist may determine the appropriate treatment for the patient. If
the patient is found to be carrying a ciprofloxacin resistant organism, their attending urologist will determine appropriate
treatment prior to the biopsy. Patients without the ciprofloxacin resistant organisms will be given the standard prophylaxis of oral
ciprofloxacin, whereas the patients with the ciprofloxacin resistant organisms will be given a more tailored prophylactic regimen.
Both groups (patients with the resistant bacteria and patients without the resistant bacteria) will then undergo the TRUS guided
biopsy under the standard protocol. Six weeks after the biopsy all patients will be contacted to determine if they suffered any
complications post biopsy.
Summary
The study is underway at CVH and we are confident that it has the potential to change the standard of care and provide a
process by which physicians can decrease the frequency of infective complications after prostate biopsies, preventing sepsis,
urinary tract infections, and potential death.
Page 20 of 47
The risk factors associated with chronic venous ulcers in Canadian Population
Supervisor Name: Afsaneh Alavi
Hospital/Research Institution: Women’s College Hospital
Email: afsaneh.alavi@utoronto.ca
Brief Project Description
Venous ulcers are a common medical condition that affect up to 2% of the population in developed
countries and may
lead to devastating consequences. These ulcers typically take a long time to heal and can cause a
deterioration in a
patient's quality of life. It has been estimated that the complications of venous ulcers may cost taxpayers
about 1% of a
developed nation's annual healthcare budget. Previous studies have characterized the risk factors for the
development of venous ulcers in different parts of the world. Different treatments have also been
proposed for the management of this difficult condition, with varying degrees of success. The aim of this
retrospective cohort is to examine the characteristics of a population of Canadian patients with venous
ulcers and determine the risk factors associated with chronic venous leg ulcers. We also compare the
population who received surgery in compare to patients who were managed non operatively in terms of
duration of
ulcers .
The objective of this project is to determine the risk factors associated with the development of venous
ulcers in our
Canadian patient population and compare the outcomes between patients who have received a surgical
intervention
with those who were managed non-operatively. We hypothesize those patients who receive surgery for the
management
of venous ulcers have a better outcome than those who are managed non-operatively. A retrospective
chart review will be carried out of the included patient population. The patient charts will be mined for
the data points .After the completion of data collection, descriptive statistics will be generated using the
statistical software package, SAS 9.3. The baseline patient characteristics will be calculated and a logistic
regression model will be developed to identify the factors associated with adequate ulcer healing and
assess whether surgery is a significant predictor of wound healing.
Page 21 of 47
Are lower doses of cyproterone acetate effective in the hormonal treatment of
transgender females
Supervisor Name: Raymond Fung
Hospital/Research Institution: Toronto East General Hospital
Email: rfung@tegh.on.ca
Brief Project Description
Introduction
Though up to 0.5% of the population identifies as transgendered,1
there are very limited data examining the dosing of hormone
therapy regimens for transition from male to female. In the hormonal treatment of transgender females, an anti-androgen agent
is used in combination with estrogen to block the effects of testosterone, enabling feminization to occur. Cyproterone acetate is
one of two anti-androgen agents commonly used, the other being spironolactone. The recommended dose range of cyproterone
acetate is 50-100mg daily, according to the Endocrine Society Practice guidelines published in 2009. 2 The European Network for
the Investigation of Gender Incongruence have published short term data using a standardized protocol of estradiol 4mg in
combination with cyproterone at a dose of 50mg per day.3 However, doses of cyproterone lower than 50 mg per day have not
been studied in this population.
Rationale
It is well known that estrogen increases thrombotic risk.4–6 Whether cyproterone acetate confers additional thrombotic risk when
used in combination with estrogen is unknown. However, looking at the oral hormonal contraceptive literature, the oral combined
contraceptive containing ethinyl estradiol and cyproterone acetate has been associated with an increased risk of thrombosis
compared with other second generation oral contraceptives with similar doses of ethinyl estradiol, suggesting that cyproterone
may confer additional risk.4
Therefore, it is important to examine whether a lower dose of cyproterone acetate is effective in the
treatment of transgender females, to minimize any possible increased thrombotic risk. Furthermore, other known risks of
cyproterone, such as depression, hepatotoxicity, and fatigue may also be minimized by using a lower dose. Dose-dependent
hepatotoxicity has been reported; fatal case reports of hepatic failure with doses >100mg per day. 7
Objectives:
To determine whether a dose of less than 50 mg of cyproterone acetate daily is enough to suppress levels of testosterone into
the physiologic female range in combination with standard recommended doses of estrogen in patients who are transitioning
from male to female.
Page 22 of 47
An institutional ethnography of chronic pain management in family medicine (COPE)
Supervisor Name: Fiona Webster
Hospital/Research Institution: Department of Family and Community Medicine
Email: fiona.webster@utoronto.ca
Brief Project Description
Providing cost effective care for the increasing numbers of complex patients is a global problem facing
industrialized and non-industrialized nations. With an aging population and individuals living longer lives,
healthcare costs continue to rise at rates faster than other parts of the economy. Exacerbating these
challenges is the growing numbers of individuals with chronic disease and multi-morbidities, a proportion
of who became complex patients. Arthritis, specifically osteoarthritis (OA), is one of the most common,
disabling, and costly chronic diseases. Arthritis is the most frequent cause of chronic pain, which is
debilitating to the individual and extremely costly to society. Primary care is most often the first contact
for people seeking symptom relief. This CIHR-funded study will employ the approach of institutional
ethnography (IE) to investigate how primary care physicians define, encounter and manage these complex
patients. Our overarching research question will be “How do primary care physicians describe the work
they do in caring for patients with complex chronic conditions?” This question will become the starting
point, rather than the end point, to allow our team to explicate how care is put together at the level of
the institution with attention to those at the local practice. Using an expanded definition of work will
allow us to understand the many types of work that physicians do (e.g., making phone calls, filling out
forms, email) and also alerts us to how the discourses and concerns of institutions enters into the
everyday language of care providers. The CREMS summer student will have an opportunity to be involved
in qualitative data collection and analysis for this project, working with a multi-disciplinary team.
Page 23 of 47
Breastfeeding and Maternal Substance Use: Women’s experience of Infant Feeding
Choices
Supervisor Name: Lisa Graves / Maya Nader / Suzanne Turner
Hospital/Research Institution: St. Michael’s Hospital
Email: gravesl@smh.ca / naderm@smh.ca / turners@smh.ca
Brief Project Description
This qualitative research project will explore women’s experience with breastfeeding and other infant
feeding choices.
feed.
There exists a significant body of literature on how women make the decision to breast
What is more poorly understood is the decision making process among socially vulnerable women.
Recent data from Ontario suggests this population is less likely to initiate and continue breastfeeding.
Through brief semi-structured interviews, we will gather data on how women with substance use feed their
babies and why they choose one method over the other. We hope to find out what information was
given to these women about breastfeeding or other feeding choices and which of that information was
helpful for decision-making. We will explore both personal and system factors that impact these choices
using a woman centered lens.
The collected data will later be used to design appropriate patient and
provider education about breastfeeding, infant feeding and substance use.
Page 24 of 47
How does ethnicity affect the effectiveness of Ulipristal Acetate for the treatment of
uterine fibroids?
Supervisor Name: Ally Murji
Hospital/Research Institution: Mount Sinai Hospital
Email: amurji@mtsinai.on.ca
Brief Project Description
Fibroids are a common benign condition that can be found in over 70% of women. About half of
these women will be symptomatic from their fibroids. In June 2013, Health Canada approved a new
selective progesterone receptor modulator, ulipristal acetate (UA), for the treatment of symptoms
from uterine fibroids. Health Canada’s decision was made based on two phase III randomized
controlled trials published in the New England Journal of Medicine. The patient population in these
trials consisted mainly of European descent. Due to this significant limitation, other regulatory
authorities such as the US FDA has not been so quick to approve this drug until more ethnicspecific data is available. This data will not be available for yet another few years.
Objective:
To determine how ethnicity affects the efficacy of UA in the treatment of uterine
fibroids, with respect to improvement in quality of life and change in fibroid size.
Methods: At Mount Sinai Hospital, we have started a prospective database of women who have
been started on UA. We have followed these women to assess treatment response. This is the
largest Canadian database of this kind.
REB approval for this study has been obtained.
Page 25 of 47
Using the F-scan to assess plantar pressure using the recumbent bike
Supervisor Name: Robyn Evans
Hospital/Research Institution: Women’s College Hospital
Email: rmejones@rogers.com
Brief Project Description
Neuropathy is the most important risk factor for the development of a diabetic foot ulcer. Ulcers occur in
about 25% of people with diabetes with most being on the plantar aspect of the foot on either the first
or fifth metatarsal head.
Once these ulcers heal there is always a risk to re-ulcerate due to the ongoing
challenges related to neuropathy and pressure off-loading with foot-ware.
Patients with diabetes are encouraged to exercise in an effort to manage healthy weight and improve
cardiovascular function. There is no recommendation for what is a reasonable exercise that would allow
for reduced plantar pressure to the foot in these high-risk patients.
The study is being undertaken to
determine what the plantar pressure is while using the recumbent bike.
The F-scan is able to measure
and record the pressure areas on the foot. This study would evaluate the pressure areas on the plantar
aspect of the foot in healthy subjects with no neuropathy, then to extend this to patients with neuropathy
if the results are encouraging.
These results will be compared to the pressure obtained on the plantar
foot while walking which is the usual prescribed exercise.
Page 26 of 47
Barriers to the Optimum Management of Diabetic Foot Ulcers
Supervisor Name:
Carol Ott / Robyn Evans
Hospital/Research Institution: Women’s College Hospital
Email: rmejones@rogers.com
Brief Project Description
Optimum management of diabetic foot ulcers requires timely treatment at a multidisciplinary clinic.
As a
referral center it is apparent that there are barriers to the delivery of optimum care to this high-risk
population.
Some of the factors that will be assessed are; time to referral to a specialty clinic,
availability of appropriate off-loading devices and work accommodation to allow for modified activities.
The purpose of this study is to retrospectively review charts of patients with diabetes to assess what the
barriers to treatment are and how this can impact overall healing rates and complications. A survey will
also be developed to understand the patient perspective with regarding barriers to care.
This study will highlight the factors that are missing in the care of the diabetic patient with a foot ulcer
and what can be done to improve on the care of this high risk population.
Page 27 of 47
Improving patient reported nausea and vomiting in cancer patients undergoing
moderately and highly emetogenic chemotherapy at Trillium Health Partners – A
quality improvement initiative
Supervisor Name:
Katherine Enright
Hospital/Research Institution: Trillium Health Partners / Credit Valley Hospital
Email: katherine.enright@trilliumhealthpartners.ca
Brief Project Description
Background
Chemotherapy induced nausea and vomiting (CINV) remains one of the most feared treatment related toxicities for patients
undergoing systemic therapy for cancer.
CINV has been shown to both have a negative impact on patient experience and
quality of life, as well as increase the likelihood of dose delays, dose reductions and unplanned hospital visits.
Advances in
anti-emetic prophylaxis over the past decade have resulted in significant improvements in CINV control, but despite this up to
70% of patients receiving moderately or highly emetogenic chemotherapy still report some nausea and vomiting.
In 2013 Cancer Care Ontario released updated anti-emetic guidelines which included (among other recommendations), the
incorporation of a new class of anti-emetics (NK-1 antagonists) in most patients receiving moderate-highly emetogenic therapy.
Due to funding restrictions, these guidelines could not be implemented universally at time of initial publication.
As of September
2014 funding of these new anti-emetic agents is now available for most cancer patients, and can be universally be implemented.
As we work towards implementing the new anti-emetic guidelines at Trillium Health Partners we are undertaking a quality
improvement initiative to ensure that our treatment is meeting guideline recommendations and that this change is resulting in
improved patient outcomes.
Through this work we aim decrease the percentage of patients who report grade 2 or higher
nausea or vomiting with cycle number 1 of their moderately-highly emetogenic chemotherapy to <10%.
Methods
Our primary outcome measure of interest will be percentage of patients undergoing moderate-highly emetogenic chemotherapy
that report grade 2 or higher nausea or vomiting with their first cycle of chemotherapy.
We will also look at numerous process
measures such as the percentage of patients who are prescribed NK1 antagonists, the percentage of patients who received
guideline recommended care, patient reported compliance with prescribed anti-emetics.
We will also examine the impact on
unplanned hospital visits.
The updated anti-emetic guidelines will be implemented in a stepwise fashion (provider education, integration into the
computerized order entry system, surveillance and reporting).
Using rapid cycle improvement methodology we will evaluate the
impact of each stage and use this to inform the next step of implementation.
Students will be exposed to data collection and analysis using standard statistics and statistical process control charts.
They
will collect quantitative date (percentage of patients who develop CINV) and qualitative data (patient experience). They will also
be involved in the quality improvement process and gain exposure to Plan-Do-Study-Act cycles and other quality improvement
tools such as Ishikawa diagrams, pareto charts and process maps.
Page 28 of 47
Improving hepatitis B screening rates in patients undergoing adjuvant or curative intent
cytotoxic chemotherapy at Trillium Health Partners – A quality improvement initiative
Supervisor Name:
Katherine Enright
Hospital/Research Institution: Trillium Health Partners / Credit Valley Hospital
Email: katherine.enright@trilliumhealthpartners.ca
Brief Project Description
Background
Chemotherapy induced hepatitis B viral reactivation is a serious and potentially preventable complication of cytotoxic
chemotherapy treatments.
The clinical outcomes of hepatitis B reactivation can range from asymptomatic elevations in liver
enzymes to hepatic failure and even death.
chemotherapy regimen in question.
The risk of reactivation is dependent on both patient characteristics and the
Reactivation has been reported in up to 67% of patients with non-Hodgin’s lymphoma
treated with rituximab containing regimens, and 21% of breast cancer patients undergoing standard adjuvant treatment.
In patients with evidence of latent hepatitis B infection, prophylactic treatment with the antiviral lamivudine has been shown to
decrease the likelihood of biochemical reactivation. Cancer Care Ontario has recently released updated screening
recommendations that recommends at least hepatitis surface antigen testing prior to initiating cytotoxic chemotherapy in patients
being treated with adjuvant or curative intent.
As we work towards implementing the new screening recommendations at Trillium Health Partners we are undertaking a quality
improvement initiative to ensure that our treatment is meeting guideline recommendations and that this change is resulting in
improved patient outcomes.
Through this work we aim increase the number of patients who have been screened for a latent
hepatitis B infection prior to starting on adjuvant or curative intent cytotoxic chemotherapy for either solid tumours or lymphoma
to 90%.
Methods
Our primary outcome measure of interest will be percentage of patients undergoing adjuvant or curative intent cytotoxic
chemotherapy that have a screening test in the medical record prior to the start date of chemotherapy. We will also look at
additional measures including percentage of patients with elevated liver enzymes and percentage of hepatitis reactivations.
Balance measures such as increase use of lamivudine, increase cost of screening and delays in treatment will also be tracked.
Clinical, patient and provider factors associated with screening will be evaluated to help target quality improvement interventions.
The first process improvement step (incorporation in pre-printed chemotherapy orders), will be initiated in March 2015. The
student will evaluate the impact of this plan-do-study-act cycle on screening rates.
Based on the results of the first process
improvement phase, the student will be involved in developing and implementing further rapid cycle improvement cycles.
Students will be exposed to data collection and analysis using standard statistics and statistical process control charts.
They
will collect quantitative date (percentage of patients who are screened) and qualitative data (patient experience). They will also
involved in the quality improvement process and gain exposure to Plan-Do-Study-Act cycles and other quality improvement tools
such as Ishikawa diagrams, pareto charts and process maps.
Page 29 of 47
Pills or post-coital IUD? Factors associated with women’s choice of emergency
contraception
Supervisor Name:
Sheila Dunn
Hospital/Research Institution: Women’s College Hospital
Email: sheila.dunn@wchospital.ca
Brief Project Description
Emergency contraception reduces the risk of pregnancy after unprotected intercourse and is used by
almost 4% of women aged 20-24 each year.
commonly used method.
Emergency contraceptive pills (ECP) are by far the most
However, insertion of a copper intrauterine device (IUD) is much more effective
and provides reliable long term contraception.
We are conducting a study in a sexual health clinic to
examine women’s knowledge and choice of emergency contraception (either ECP or IUD), satisfaction with
that choice and use of effective contraception 3 months after presentation.
The CREMS student project will help complete our study that is recruiting and following women who
present for emergency contraception at the Bay Center for Birth Control.
The study determines women’s
knowledge of the methods, their choice of emergency contraception and their satisfaction and use of
effective contraception 3 months after their presentation. The student will assist in the final completion
of that project and will undertake a sub-study, done through chart review, of all women presenting for
emergency contraception from July 2014-July 2015 to examine EC choice and associated demographic
and reproductive health variables.
The CREMS student will assist the research team with the following:
1.
3 month follow-up telephone surveys with women recruited into the follow-up study
2.
chart reviews, data abstraction and input
3.
assist with analysis and interpretation
4.
assist with administrative requirements of the study
The student will provided office space and a computer at the Bay Centre for Birth Control and will be
directly supervised by Dr. Sheila Dunn, a family physician researcher and Scientist at the Women’s College
Research Institute (WCRI).
There are opportunities to gain experience a clinical environment that delivers
reproductive health care and to participate in the WCRI Summer Research Student rounds and seminars.
Page 30 of 47
Implementation and Evaluation of a Program for “Rapid Assessment of Febrile
Travelers” (RAFT) in Primary Care and Emergency Room Settings in Ontario
Supervisor Name:
Andrea Boggild
Hospital/Research Institution: UHN / Toronto General Hospital
Email: andrea.boggild@utoronto.ca
Brief Project Description
Fever in the returned traveler is a common presentation to the emergency room (ER) and primary care,
and may herald serious and life-threatening illness, the most important of which is malaria. Thus, fever
after travel warrants prompt attention and is considered a medical emergency. Yet each year, several
Canadians die of malaria due to delay in diagnosis and/or treatment, and many more become critically
unwell. In most ERs, if a returned traveler with fever does not need hospital admission, there is no
mechanism in place for rapid follow-up assessment, and the patient will simply wait for the next available
outpatient infectious diseases appointment. Meanwhile, primary care offices routinely send travelers with
fever to the ER due to a lack of rapid, safe alternatives. We plan to scale-up a simple health-system
innovation that reduces barriers to safe and rapid care of ill returned travelers. Our "Rapid Assessment of
Febrile Travelers" (RAFT) clinic at UHN/Mount Sinai has improved delivery and efficiency of care, and
reduced emergency room bed usage at UHN/Mount Sinai. We plan to expand the RAFT program to
community ERs and primary care clinics in order to optimize the delivery of care to ill returned travelers
in Ontario. The CREMS student will work closely with our local RAFT team in the Tropical Disease Unit of
TGH as well as our RAFT collaborators at other downtown centres.
Keywords:
Fever; malaria; patient-centered care; travel medicine; tropical medicine.
Page 31 of 47
High Volume Foleys increasing Vaginal Birth Feasibility Trial
Supervisor Name:
Anne Berndl
Hospital/Research Institution: Sunnybrook Health Sciences Centre, SRI
Email: anne.brerndl@sunnybrook.ca
Brief Project Description
The rising rate of caesarean sections is concerning to both women and physicians. One quarter of
Ontario women in their first pregnancy undergo an induction of labour, and one third of these women
deliver by caesarean section.
Before inducing labour, a woman’s cervix often requires “ripening”, a
process that makes it open and soft.
Most Canadian obstetricians use prostaglandins for cervical ripening, and a minority use Foley catheters
filled to 30-60cc. Currently no method of cervical ripening has been found superior regarding risk of
caesarean section. However, a recent meta-analysis suggests Foley catheters filled to 80cc may be
associated with a greater chance of vaginal birth.
This proposed study aims to determine if it is feasible to successful insert a Foley catheter for cervical
ripening and inflate it to 80cc, and to assess the acceptability of this procedure to Ontario women and
maternity care providers.
This information will inform the design of a larger clinical trial comparing
cervical ripening with 80cc Foley catheters to prostaglandins with rate of caesarean birth as the outcome.
This is a first step towards clinical practice changes that could have a significant impact on the
caesarean section rate and the wellbeing of women and babies.
Page 32 of 47
Clinical Research in Adolescent Bipolar Disorder
Supervisor Name:
Benjamin Goldstein
Hospital/Research Institution: Sunnybrook Health Sciences Centre, SRI
Email: benjamin.goldstein@sunnybrook.ca
Brief Project Description
The focus of this CREMS project is on adolescent bipolar disorder. The selected student will be integrated
into the overall activities of the laboratory, which includes pharmacology graduate students,
undergraduate research students, and research staff. The student will gain exposure to current methods
being applied in the laboratory, including neuroimaging (MRI), vascular imaging (ultrasound, peripheral
arterial tonometry), computerized cognitive testing, serum biomarkers, genetics, and novel complementary
therapeutics. Descriptions of current ongoing studies can be found at the following website:
http://sunnybrook.ca/content/?page=bsp-youth-bipolar-disorder-research
The selected student will have access to two archival datasets, one based on approximately 116
adolescents enrolled in a research registry at Sunnybrook, the other based on approximately 400
adolescents and young adults participating in a multi-site cohort study in the United States. Working
together with the supervisor, the selected student will identify a specific project based on one of the
above datasets. The student will be expected to undertake the necessary literature review and to
generate one manuscript for submission to a peer-reviewed journal. Guidance will be provided by the
supervisor and other laboratory members regarding literature search and statistical methods.
Page 33 of 47
Do pediatric clavicle fractures need to be managed by orthopaedic surgeons?
Supervisor Name:
Mark Camp
Hospital/Research Institution: SickKids
Email: mark.camp@sickkids.ca
Brief Project Description
Clavicle fractures are one of the most common fractures sustained during childhood. In Ontario, children
with clavicle fractures are managed by orthopaedic surgeons who follow them until the fracture has
healed. However, the rate of requiring surgical intervention either at the time of injury or after healing
occurs is anecdotally extremely low which begs the question: do pediatric clavicle fractures need to be
managed by orthopaedic surgeons or can they be managed more cost-effectively by pediatricians and
family doctors?
This project will include a retrospective chart review to determine the rate of surgical intervention in
pediatric clavicle fractures at the Hospital for Sick Children from 2005 to 2014. The results of this audit
will provide the evidence for a clinical practice pathway for pediatric clavicle fractures in Ontario. This
clinical practice pathway will be publically available on the SickKids website (created as part of a
separate research project). This project can be realistically completed within the CREMS Summer Research
Program. Funding is available to present this work at either the COA meeting in Halifax in 2016 or the
CAEP meeting in Quebec City in 2016. Presentation at other meetings will also be considered.
Page 34 of 47
Eliminating Digestive Irregularities caused By Late Effects (EDIBLE) of
abdominopelvic radiation: A Pilot Study of a culinary and nutrition intervention
Supervisor Name:
Jennifer Jones / Sarah Ferguson
Hospital/Research Institution: Princess Margaret Cancer Centre
Email: jennifer.jones@uhn.ca / sarah.ferguson@uhn.ca
Brief Project Description
Background: Patients diagnosed with gynecological (GYN) cancers are commonly treated with radiation
therapy to the pelvic area. Exposing the pelvic area to radiation therapy can result in long-term
gastrointestinal (GI) side effects. Providing self-management support to GYN patients who suffer from GI
symptoms after radiation therapy may be an effective strategy to help them improve their QoL. The
dietary management of GI symptoms resulting from radiation therapy includes increasing soluble fibre and
limiting insoluble fibre, fat and lactose. We are proposing to conduct a pilot study to evaluate a newly
developed nutrition and culinary education intervention for GYN cancer patients (EDIBLE). The research
objectives are to: 1) assess the feasibility and acceptability of the methods and the intervention; and 2) a
preliminary estimate on the efficacy of the intervention on bowel symptoms (primary clinical outcome);
QoL, knowledge and food intake (secondary outcomes).
The summer CREMS student will assist with the pilot of EDIBLE and work closely with Drs. Jones and
Ferguson and the research and clinical team at ELLICSR (http://ellicsr.ca/) and will also take part in the
ELLICSR Summer Student Program which includes a series of seminars and presentations to introduce
students to cancer survivorship and research.
Page 35 of 47
Incidence of Intracranial Hemorrhage in Pediatric Oncology Patients
Supervisor Name:
Lani Lieberman
Hospital/Research Institution: Toronto General
Email: lani.lieberman@uhn.ca
Brief Project Description
Introduction
Intracranial hemorrhage (ICH) is a rare, serious bleeding complication seen in thrombocytopenic oncology patients.
It is unclear
why some patients with severe thrombocytopenia develop ICH and others do not.
Objectives
1.
To identify the characteristics, incidence, and risk factors for ICH development in pediatric oncology patients.
2.
To assess major morbidity and mortality 30 days following the event.
Methods
This retrospective case control study (nested within a cohort) will be performed at the Hospital for Sick Children.
been identified through the Pediatric Oncology Group of Ontario Networked Information System (POGONIS).
Cases have
Oncology patients ≤
19 years old, treated between 1995-2013 and diagnosed with an ICH will be eligible. Controls will be similar to cases, except for
ICH, and a maximum of 5 will be selected randomly from the same institution and the same diagnosis year. The original charts
will be reviewed to augment information contained within POGONIS. Variables of interest include patient demographics, laboratory
results, radiological reports and patient outcome data. ICH will be based on radiographic diagnosis.
Analysis
The incidence of ICH and the types of patients affected will be determined utilizing the entire population of pediatric oncology
patients. Characteristics of the different bleeds will be presented (clinically or radiologically overt). To assess risk factors, a
multivariable logistic regression model will be constructed where the outcome is case or control status and the variables of
interest will be examined. Odds ratios and confidence intervals will be determined.
Conclusion
Results of this study will provide an estimate of the incidence of ICH in pediatric oncology patients and attempt to link this
event to risk factors including hematologic lab values. This foundational information is required to generate hypotheses to be
tested in larger, international collaborative studies.
Currently, transfusion thresholds drive ordering practice to prevent ICH.
Future studies will investigate the value of using other risk factors or a bleeding scale prior to ordering a platelet transfusion.
Page 36 of 47
Thoracic CT using Low Dose Dual Energy Temporal Subtraction : A Feasibility Study
in Patients with Chronic Thromboembolic Pulmonary Hypertension
Supervisor Name:
Narinder Paul
Hospital/Research Institution: University Health Network
Email: narinder.paul@uhn.ca
Brief Project Description
Acute pulmonary embolism (PE) is a life threatening condition in which a blood clot lodges in the
pulmonary arteries (PA). 1% of acute PE becomes chronic PE resulting in pulmonary artery hypertension
(PAH) and eventually Chronic Thromboembolic Pulmonary Hypertension (CTEPH). CTEPH is a significant
cause of death for Canadian patients due to right heart failure. Surgical clot removal, pulmonary
thromboendarterectomy (PTA) is the only cure but has a perioperative mortality of ~5%. The key to
reduce perioperative mortality and to improve functional status is to stratify patients at higher risk by
accurately measuring the severity of PAH and pulmonary vascular resistance (PVR) pre and post PTA.
Therefore, CTEPH patients undergo multiple investigations including: 2d echocardiography, to assess right
heart pressure and function; CT pulmonary angiography (CTPA) to document severity and distribution of
PA clot; VQ scans, to confirm severity and pattern of lung perfusion deficits; invasive cardiac/pulmonary
catheterization, to establish right heart and pulmonary pressures; and exercise tests to establish
functional status.
Our team has developed a technique called low dose temporal subtraction (LD-TS) by performing low
dose computed tomography (LDCT) at the time of CTPA. The LDCT demonstrates areas of lung
heterogeneity; these correspond to the severity of PVR. The LD-TS demonstrates pulmonary blood
distribution; this information can be compared to the data from the V/Q scan and from pulmonary artery
catheterization.
The purpose of this study is to test the utility of LD-TS in an established cohort of CTEPH patients in
order to evaluate whether LD-TS provides information that is useful in patient management. In particular,
we will determine whether LD-TS could replace other tests that are currently performed in CTEPH patients.
If successful, LD-TS would provide a cost effective, non-invasive, comprehensive and time efficient
evaluation of CTEPH patients pre and post PTA.
Page 37 of 47
Correlation of cortical perfusion and cognitive dysfunction between Multiple Sclerosis
subtypes using a novel quantitative perfusion sequence
Supervisor Name: Richard Aviv
Hospital/Research Institution: Sunnybrook
Email: richardaviv@sunnybrook.ca
Brief Project Description
Exciting research opportunity with opportunity to lead author a manuscript if appropriately skilled. The project utilizes novel
imaging and plasma biomarkers to explore the link between cortical quantitative blood volume (CqCBV) reduction, cortical
lesion load, perivascular inflammation and cognitive impairment. Prior CqCBV localization to anatomically appropriate regions,
high correlation with individual cognitive domains and improved prediction of cognitive impairment over established indicators
support the validity of the technique as a biomarker of cortical pathology and disease progression. Our prospective data should
add to this body of data. The anticipated basic role is to facilitate data processing and analysis in a prospective study of
cognitive impairment and Multiple Sclerosis using novel MRI perfusion imaging. Ideally candidate will have a computational
sciences or engineering background. Work will be supported by an experienced research team with multidisciplinary expertise
in Radiology, engineering and computational sciences. MATLAB ability is expected.
Page 38 of 47
Is neurovascular coupling impaired in patients with concussion?
Supervisor Name: David Mikulis
Hospital/Research Institution: Toronto Western Hospital
Email: mikulis@mac.com
Brief Project Description
Recent work in patients with concussion has indicated that significant blood flow abnormalities can occur
during the recovery phase of this condition. Previous studies examining resting blood flow usually indicate
that it is decreased. However it is unclear if the decrease is appropriate for the level of brain activity
that may similarly be decreased. It would be important to know if the usual coupling of blood flow to
neural activity is impaired in these patients since it is theorized that neurovascular uncoupling may be
related to symptoms.
We have developed a method for assessing the mechanism that controls brain blood flow using a device
that provides precision control over arterial levels of CO2, a potent vasodilator. A unique advantage of
this device is that it can raise arterial levels of CO2 by 10 mmHg within 2 breaths. This then provides
the ability to measure the dynamic response of the blood flow control mechanism to a vasodilatory
stimulus.
Transfer function analysis can then be applied to determine the transient response and
magnitude of this response. These can then be compared to our database of age matched controls for
testing of the relationship between NVU if present and symptoms.
Page 39 of 47
The Relationship between health literacy and knowledge of prenatal screening options
for trisomy 21: a needs assessment
Supervisor Name: Amanda Selk
Hospital/Research Institution: Mount Sinai Hospital
Email: aselk@mtsinai.on.ca
Brief Project Description
This study aims to assess knowledge among pregnant women undergoing prenatal screening for Trisomy
21(prenatal screening) at Mount Sinai Hospital. The study will also examine the relationship between
knowledge of screening options and health literacy among participants. There are multiple testing options
for prenatal screening and explaining them to patients can be time consuming and difficult.
Prenatal
screening is considered an optional test. After a positive test patients can undergo confirmatory testing
(chorionic villous sampling, amniocentesis) and choose to either continue or terminate the pregnancy if
the positive screening result is confirmed. Mount Sinai Hospital has recently developed a structured
counseling session open to all their pregnant patients to aid in the complexities of counselling.
It is
unknown whether the patients are benefiting from this counseling session or are even aware of its
existence. Of the patients who are not utilizing this counseling option, the quantity and quality of any
counseling they are receiving is unknown. Previously published literature suggests that there is a large
knowledge gap among pregnant women on crucial information pertaining to prenatal screening.
Knowledge regarding screening in Canada has not been assessed in studies for >20 years and the
screening options have changed dramatically in that period of time. This study is a cross-sectional study
that utilizes a demographics questionnaire as well as previously validated measures of knowledge
regarding prenatal screening and health literacy.
REB has already been attained for this study. This
study started as a DOCH-2 project in 2014 and some patients have already been recruited. The job of
the CREMS student would be to finish recruiting, data analysis and writing up the results for publication
in an obstetrical journal.
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Examining Concomitant Extensor Mechanism Injuries in the setting of Knee
Dislocations and Multi-Ligament Injuries
Supervisor Name: Dawn Pearce
Hospital/Research Institution: St. Michael’s Hospital
Email: pearced@smh.ca
Brief Project Description
ABSTRACT
Multi-ligament knee injuries and knee dislocations are devastating injuries.
this time regarding concomitant extensor mechanism injuries.
Little information is present at
These injuries may involve the quadriceps,
patella, patellar tendon, medial patellar retinaculum or medial patellofemoral ligament.
STUDY HYPOTHESIS
The purpose of this study is to determine the prevalence of extensor mechanism injuries in the setting of
multi-ligament knee injuries.
STUDY DESIGN
This is a retrospective study.
Dr. Daniel Whelan’s patients who have a multi-ligamentous knee injury or
knee dislocation and whom have had a Knee MRI will be recruited for this retrospective study.
For
patients who have multiple MRI’s, the MRI that is performed soonest after the injury will be used.
sheet will be used to collect data on all of those patients.
A data
The MRI images will be evaluated by Dr.
Pearce and Dr.Whelan. The images will be evaluated independently, and disagreements resolved by
consensus.
The summer student will transcribe and organize our data sheets and sit with us during read
outs.
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Novel Noninvasive Assessment of Kidney Transplant Fibrosis with Magnetic Resonance
Elastography
Supervisor Name: Anish Kirpalani
Hospital/Research Institution: St. Michael’s Hospital
Email: kirpalania@smh.ca
Brief Project Description
OBJECTIVE:
The primary objective of this study is to measure organ stiffness through a non-invasive test called Magnetic resonance
elastography (MRE).
INTRODUCTION:
Kidney transplantation has greatly improved the quality of life and survival of people living with kidney failure. Unfortunately, up
to 60% of these people go on to have failure of their transplant within 10 years, in many cases requiring drugs and/or return
to dialysis. The cause for transplant failure is almost always, at least in part, due to scarring of the transplanted kidney. There is
currently no good test to detect this scarring. The best test we have is a needle biopsy, which is associated not only with
significant bleeding risks, but also an inability to take sample and analyze the entire kidney.
A new type of MRI called “MR elastography” has been proven to accurately measure scarring in the liver, but not yet in the
kidney. It does not need any injections, can be done in 30 minutes, and may be able to measure scar throughout the entire
kidney without needles. Our project aims to compare this new MRI test with needle biopsy. We will determine if it can measure
scar in the transplanted kidneys of people with both normal and abnormal transplant function. This could drastically change how
a doctor treats transplant failure.
STUDY DESIGN:
The study design is entirely prospective where patients with a history of renal transplantation (more than 1 year) will be eligible
for this study. 25 patients with chronic renal allograft dysfunction and 25 control patients with normal renal allograft function will
be selected.
PREDICTED OUTCOMES:
1) MRE-derived stiffness measurements will be higher in scarred, dysfunctional kidneys and lower in healthy, normal functioning
kidneys.
2) MRE-derived stiffness values will correlate positively with biopsy-measured fibrosis scores, and inversely with renal function.
3) Since fibrosis often pre-dates renal dysfunction, MRE-derived stiffness values will increase prior to increases in conventional
biomarkers of renal function.
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Menstrual irregularities in the obese adolescent female that has undergone bariatric
surgery
Supervisor Name: Sari Kives
Hospital/Research Institution: The Hospital for Sick Kids
Email: zarine.tilak@sickkids.ca
Brief Project Description
Student will develop a proposal for the Research Ethics Board (REB) and a data collection sheet looking
at menstrual irregularities in the obese adolescent female that has undergone bariatric surgery
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Review the results of a large cohort of ovarian torsion in the adolescent population and
its implications for intervention towards ovarian conservation
Supervisor Name: Sari Kives
Hospital/Research Institution: The Hospital for Sick Kids
Email: zarine.tilak@sickkids.ca
Brief Project Description
Student will review the results of a large cohort of ovarian torsion patients in the adolescent population
and prepare a manuscript based on findings including management and care and its implications towards
ovarian conservation
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Platelet transfusion threshold prior to lumbar puncture
Supervisor Name: Yulia Lin
Hospital/Research Institution: Sunnybrook Health Sciences Centre
Email: yulia.lin@sunnybrook.ca
Brief Project Description
The most recent 2014 AABB guidelines suggest that a prophylactic platelet transfusion should be
administered for patients having elective diagnostic lumbar puncture with a platelet count less than 50 x
109/L. This is a weak recommendation based on very low-quality evidence. However, in practice, we have
noted that lumbar punctures are often performed at lower platelet counts without platelet transfusion. The
objective of this project is to determine 1) the frequency with which lumbar punctures are performed with
a platelet count less than 50 x 109/L without platelet transfusion; 2) whether any bleeding complications
occur as a result; and 3) whether bleeding complications are increased compared to lumbar punctures
performed either with a platelet count of 50 x 109/L and above or after a prophylactic platelet
transfusion. The study design will be a retrospective audit of all lumbar punctures occurring on the
inpatient hemato-oncology ward and in the outpatient Odette Cancer Centre. The results of this audit
may help to inform whether changes to the AABB guidelines are warranted. The medical student will be
working with a hematology resident and transfusion medicine specialists on this project. By participating
in this project, the medical student will have the opportunity to present the results at hematology rounds,
submit an abstract to a national or international conference and have authorship in a publication.
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Platelet transfusion threshold prior to lumbar puncture
Name: Yulia Lin
Hospital/Research Institution: Sunnybrook Health Sciences Centre
Email: yulia.lin@sunnybrook.ca
Brief Project Description
The most recent 2014 AABB guidelines suggest that a prophylactic platelet transfusion should be
administered for patients having elective diagnostic lumbar puncture with a platelet count less than 50 x
109/L. This is a weak recommendation based on very low-quality evidence. However, in practice, we have
noted that lumbar punctures are often performed at lower platelet counts without platelet transfusion. The
objective of this project is to determine 1) the frequency with which lumbar punctures are performed with
a platelet count less than 50 x 109/L without platelet transfusion; 2) whether any bleeding complications
occur as a result; and 3) whether bleeding complications are increased compared to lumbar punctures
performed either with a platelet count of 50 x 109/L and above or after a prophylactic platelet
transfusion. The study design will be a retrospective audit of all lumbar punctures occurring on the
inpatient hemato-oncology ward and in the outpatient Odette Cancer Centre. The results of this audit
may help to inform whether changes to the AABB guidelines are warranted. The medical student will be
working with a hematology resident and transfusion medicine specialists on this project. By participating
in this project, the medical student will have the opportunity to present the results at hematology rounds,
submit an abstract to a national or international conference and have authorship in a publication.
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