London Health Sciences Centre (LHSC), London Health Sciences Foundation (LHSF) and Children’s Health Foundation announced the recipients of LHSC’s Academic Realignment Initiative Awards. The partnership between the two Foundations and LHSC's research institute will support 21 research and quality improvement initiatives. We will also begin recruitment for two additional positions – an Endowed Chair in Translational Cancer Research and a Limited Term Chair in Midwifery. We look forward to sharing more details on these two exciting positions in the future.
Paediatric neurosurgery and neuroscience
Chair: Dr. Sandrine de Ribaupierre
Clinical Program Area: CNS/Neurosurgery/Paediatric
Brain health is critical to a child’s development, but it is too commonly impacted by disease and trauma. While Children’s Hospital at LHSC is a leader in paediatric neurosurgery, there is still much to learn about the human brain and how it is impacted by complex diagnoses. This research program aims to further our understanding through tools like advanced medical imaging with a goal of improving patient outcomes. The team will develop tools to investigate the best timing for the treatment of infantile hydrocephalus (a condition often associated with premature births where too much brain fluid is retained in the skull). They will work to enhance understanding of how brain networks are affected by seizures in paediatric epilepsy, using functional MRI scans and near-infrared spectroscopy (advanced imaging to visualize oxygen in body tissues). And they will further develop functional and structural MRI as a prognostic tool for potential brain rehabilitation and to help plan surgery with minimal impact on brain function. The team will also advance work with augmented and virtual reality tools to visualize the brain as a way to assist patients and families in understanding their condition and treatment. These same tools will be used to design a ‘virtual Children’s Hospital’ that allows children to familiarize themselves with the hospital before their visit, with a goal of decreasing anxiety. The team will continue to build on their research program to provide world-class paediatric health care.
LIMITED TERM CHAIRS:
Clinical genomics and epigenomics (Verspeeten Clinical Genome Centre)
Chair: Dr. Bekim Sadikovic
Clinical Program Area: Department of Pathology and Laboratory Medicine / Molecular Diagnostics Program
Epigenetic mechanisms are chemical signals layered across our DNA. Acting as on/off switches for thousands of genes, they fine-tune our biology and adapt to changes in our environment and behaviours. However, these molecular mechanisms are not perfect. Individuals can experience genetic and epigenetic defects that lead to disease. To better understand, diagnose, and effectively treat disease, we need to develop technologies to identify genetic and epigenetic factors. This chair position will drive advanced clinical genomic and epigenomic research while simultaneously developing translational pathways for its integration into patient care.
From diagnostic test to patient diagnosis: Pursuing excellence when testing for neuro-inflammatory diseases
Chair: Dr. Adrian Budhram
Clinical Program Area: Clinical Neurological Sciences (CNS)
Neural antibody testing has revolutionized neurology by facilitating prompt diagnosis of neuro-inflammatory diseases. This leads to earlier treatment, improved patient outcomes, and reduced health-care costs. LHSC is the leading site for neural antibody testing in Ontario. However, neural antibody testing has only recently become available, creating a significant knowledge gap: how well do novel neural antibody tests perform in real-world clinical practice? This project aims to determine the diagnostic accuracy of novel neural antibody tests implemented at our centre. Results will help to identify deficiencies in test performance, and inform the development of test optimization strategies that maximize test accuracy, minimize patient misdiagnosis, and ultimately improve patient care.
Inpatient medicine continuous quality improvement
Chair: Dr. Mark Goldszmidt
Clinical Program Area: Department of Medicine/Division of Internal Medicine
Patients admitted to an internal medicine inpatient clinical teaching unit at an academic health science centre like LHSC are some of the most ill patients in the health-care system. They experience unique complications and their care requires a high amount of resources. Improving quality and safety for this population is complex and there are no ready-made solutions. This chair aims to create improvement through the development of clearly defined quality measures and the creation of a quality improvement hub for LHSC’s internal medicine inpatient clinical teaching unit. Research and quality improvement will be closely intertwined to improve quality and safety for this patient population.
Development and clinical integration of artificial intelligence tools to improve quality and efficiency in prostate brachytherapy
Clinician Scientist: Dr. Douglas Hoover
Clinical Program Area: Radiation Oncology
Prostate brachytherapy is a form of radiation therapy for prostate cancer that uses hollow needles to place radioactive seeds directly within the prostate. It demands a high level of skill, resources, medical equipment, and time. Needle placement can be a difficult part of the procedure as needles often don't follow the intended trajectory and specific areas of the prostate can be hard to reach. Poor needle placement reduces the quality of the radiation treatment plan and can lead to longer procedure times, potentially impacting patient outcomes. This project will use a local database of 500 brachytherapy procedures to train an artificial intelligence (AI) network to automatically detect the prostate and needles on live ultrasound imaging. The AI network will provide continuous and adaptive feedback on optimal needle placement throughout the procedure. It will leverage existing technology and collaborations with Robarts Research Institute and the Gerald C. Baines Centre for Translational Cancer Research. The new technology will be tested in a clinical trial with patients at the London Regional Cancer Program at LHSC. It aims to reduce hospital costs and training time for new physicians, and ultimately to improve patient outcomes through enhancements in radiation plan quality and procedure efficiency.
Virtual care: Learning from the past, planning for the future
Clinician Scientist: Dr. Natasha McIntyre
The COVID-19 pandemic accelerated the adoption of virtual care, which is likely to have a significant presence in health care even after the pandemic has ended. However, little is known about health care providers’ experiences with using virtual care. This program will focus on understanding the perceptions and experiences of providers across LHSC during and after the COVID-19 pandemic. The goal is to identify areas for development and improvement in the delivery of virtual care in a post-pandemic health care system, and its subsequent implementation and evaluation.
Optimization of advanced imaging technologies
Clinician Scientist: Jonathan Collier
Clinical Program Area: Interventional Radiology
The next generation of advancements in image-guided interventions have been made possible through LHSC's investment in the newest cutting-edge angiography suites. There are several key critical metrics that these innovations improve such as accuracy of service, staff and patient safety, reduction in procedure time, improvement of the patient experience, and cost of the procedure. The knowledge and skills required to operate these new technological innovations require the technologist to build upon and advance their knowledge to meet the ever-changing technology. Additional dedicated time and advanced training are required for the new applications to be optimized and effectively translated into routine care. This project seeks to implement an advanced training and education program for Medical Radiation Technologists to improve all metrics, ultimately leading to improved patient outcomes and safety, as well as reduced procedure and wait times. This proposal will provide opportunities to validate, implement, and then showcase these benefits with the quantitative data collected. These advanced imaging techniques will also support our clinical scientists in finding and advancing research opportunities in medical imaging while showcasing LHSC as a centre of excellence.
Advancing evidence-informed quality physiotherapy practices in acute care
Clinician Scientist: Dr. Tania Larsen
Clinical Program Area: Physiotherapy, Health Disciplines
Physiotherapy is an essential component of a patient’s health care and recovery journey. Physiotherapy helps manage breathing complications, prevents postoperative complications, and helps restore, optimize, and maintain physical function. The main objective of this research program will be to produce safe, effective, and quality physiotherapy management strategies that lead to improved patient outcomes. Projects will include studies examining the combined effects of protein supplementation and exercise training in patients with interstitial lung disease; patient and physiotherapist experiences with virtual outpatient physiotherapy; and the effectiveness of a physiotherapy-led pre-operative education session on post-operative length of stay, pain, and physical function.
Advanced Practice Fellowships
Innovative clinical research and optimizing quality care in dialysis
Fellow: Jarrin D. Penny
Supervisor: Dr. Chris McIntyre
Clinical Program Area: Kidney Clinical Research Unit
Although hemodialysis is a life sustaining treatment for patients with kidney failure, it is associated with other medical complications, poor quality of life, and symptom burden. This research will focus on transforming the lives of patients requiring dialysis by improving quality of life and clinical outcomes through novel interventions and innovation. There are two components to this project. The first is a dialysis optimization program, where we will use advanced monitoring technologies to better understand a patient's individual physiological response to their prescribed treatment, resulting in a patient-specific treatment plan. The second component will focus on research and development - testing and implementing new technologies and interventions in collaboration with academic and commercial partners. This research aims to improve clinical outcomes and quality of life for dialysis patients with immediate translation into LHSC’s Renal Program and beyond.
Introducing coaching for renal staff to optimize resiliency and agility post-pandemic
Fellow: Julie Ann Lawrence
Clinical Program Area: Kidney Care Centre
The COVID-19 pandemic has impacted health-care workers in unique ways. The vision of this initiative is to improve the resiliency, agility, and satisfaction of LHSC staff during and after the pandemic. Through new training initiatives and coaching, staff at LHSC’s Kidney Care Centre will have opportunities to incorporate insights, awareness, and self-management tools based on the science of neuroplasticity. Assessment tools from a recognized coaching program will enable staff to have an individualized report on how their energy has shifted, which may inform impacts on patient care, staff satisfaction, and daily interactions in the clinical area.
Patient safety from the patient’s perspective: A quantitative study to explore inpatients’ ratings of patient safety on selected inpatient units at LHSC
Fellow: Kayley Perfetto
Department: Patient Safety and Accreditation
Patients are keen observers of what is happening around them and can provide insight into potential risks to patient safety. Organizations can use information provided by patients to prioritize and proactively implement strategies to improve quality and safety. This study aims to engage inpatients on select units at LHSC to gain insight into safety from the patient's point of view. Results will be used to guide the prioritization of improvement initiatives to optimize patient safety.
Program evaluation of the paediatric epilepsy program with focus on the Comprehensive Epilepsy Clinic (CEC) model at Children’s Hospital at LHSC
Fellow: Michelle Gratton
Supervisors: Drs. Andrea Andrade and Maryam Nouri
Clinical Program: Paediatric Epilepsy Program/Division of Neurology
Epilepsy affects approximately 15,000 children in Ontario. One third of them develop complex epilepsies that do not respond to medications. Children’s Hospital at LHSC is one of only two designated regional paediatric epilepsy surgical centres of excellence in Ontario, with a paediatric epilepsy program that offers unique models of care through a family-centered lens. One of these is the Comprehensive Epilepsy Clinic (CEC) model in which a team of professionals provide multidisciplinary care ranging from hospital-based services to community support. This study will focus on measuring the CEC’s effectiveness from the provider, stakeholder, and patient perspective. The results will inform cost-effectiveness, resource utilization, and ultimately the creation of guidelines that could be used to expand this unique model to other underserved areas in southwestern Ontario.
Development and implementation of an academic partnership in molecular imaging and theranostics (DIAP-MIT)
Fellow: Stephen Nelli
Supervisor: Dr. Jonathan Romsa
Clinical Program: Nuclear Medicine
Molecular imaging and theranostics is a fast-growing field in medicine. Theranostics combines the terms therapeutics and diagnostics. It describes the process of using a radioactive molecule to identify disease through imaging, like a cancerous tumour, and then using higher energy radioactive molecules to deliver therapies to it. This project aims to develop a nationally recognized molecular imaging and theranostics program at LHSC which will:
- Improve patient care by embedding molecular imaging and theranostics into cancer care through alignment with the London Regional Cancer Program at LHSC;
- Optimize resources through a cohesive systems approach with research on new theranostic agents;
- Promote research, innovation, and knowledge dissemination through the creation of a critical mass of clinicians and researchers; and
- Provide unique educational opportunities.
Improving the care of women who become pregnant after kidney donation
Fellow: Dr. Carol Wang
Supervisor: Dr. Amit Garg
Clinical Program Area: Department of Medicine, Division of Nephrology
The best treatment option for patients with kidney failure is a transplant from a living donor. Women of childbearing age make up the majority of all living kidney donors. These prospective donors may inquire about how donating a kidney can impact any future pregnancies. This research will span four Canadian provinces with an aim to study the health records of more than 5,000 women to assess the risks of maternal and fetal outcomes following a living kidney donation. It will examine the risks of gestational hypertension or pre-eclampsia, maternal comorbidities such as postpartum hemorrhage, need for Caesarean section, and kidney injury. It will also assess fetal outcomes like premature birth and low birthweight. The results of this study will better inform prospective donors on risks of post-donation pregnancies.
Advanced GI minimally invasive surgery fellowship
Supervisor: Dr Christopher Schlachta
Clinical Program Area: Department of Surgery / Division of General Surgery
Minimally invasive surgery (MIS) represents the most patient-centred revolution in surgery in the last thirty years. Smaller ‘keyhole’ incisions have led to a paradigm shift resulting in less pain, less opioid use, reduced complications, shorter hospital stays, and a faster return to normal productive activities. Every major abdominal gastrointestinal (GI) operation can now be performed in a minimally invasive way, reducing 10-14 days of hospitalization to outpatient surgery in some cases. LHSC is a leader in minimally invasive surgery and is home to CSTAR (Canadian Surgical Technologies and Advanced Robotics). This funding will support the Advanced GI MIS Fellowship in partnership with the Schulich School of Medicine & Dentistry at Western University. It will help to advance care, teaching, and research at LHSC in the area of minimally invasive surgery. Each fellow will establish a research focus, ranging from simulation training and technology development to clinical outcomes and quality improvement. Some will advance work in digital surgery and artificial intelligence applied to surgical skills learning and automating repetitive tasks. In addition to receiving leading-edge clinical training in minimally invasive surgery, these fellows may also contribute to the education of residents and medical students.
Fellowship in Urologic Oncology
Fellow: Dr. Jesus Cendejas
Supervisor: Dr. Nicholas Power
Clinical Program Area: Department of Surgery, Division of Urology
LHSC is home to one of only two accredited Society of Urologic Oncology Fellowship Programs in Canada. The Fellowship in Urologic-Oncology supports a fellow conducting research in prostate, bladder, and renal cancers. The fellow will participate in clinical trials involving androgen deprivation therapy, chemotherapy and investigational agents. They will contribute valuable scientific data on urologic cancer while providing comprehensive cancer care to patients at LHSC.
Fellowship in Kidney and Pancreas Transplantation
Fellow: Dr. Jirong Lu
Supervisor: Dr. Alp Sener
Clinical Program Area: Department of Surgery, Division of Urology
LHSC’s Multi-Organ Transplant Program is a leading transplant program in Canada. This funding will help support the two-year kidney transplant fellowship program, which has helped train urologists, general surgeons, and vascular surgeons in kidney and pancreas transplantation. In addition to clinical experience in complex urological procedures, fellows participate in structured educational sessions and are mentored to complete research projects. In their second year, fellows carry out translational transplant-related research in several in-house translational research laboratories. Previous fellows have gone on to spearhead new transplant programs and become global leaders in urology and transplantation.
Establishing role of functional near infrared spectroscopy (fNIRS) in pediatric epilepsy surgery
Fellow: Dr. Juan S. Bottan
Supervisors: Drs. Maryam Nouri and Sandrine de Ribaupierre
Clinical Program Area: Pediatric Epilepsy Surgery
Children’s Hospital at LHSC is a leading centre for paediatric epilepsy surgery. Currently, functional MRI (fMRI) is used as a standard of care to define which part of the brain is responsible for language when planning for surgery. When performing fMRI, children need to sit still and perform language tasks. However, this can be challenging for younger children. This study will investigate whether functional near-infrared spectroscopy (fNIRS) can be used to complement or replace fMRI to localize language or other higher-order brain functions when planning epilepsy surgery. fNIRS is a relatively new neuroimaging technique that has become a valuable tool for brain activity monitoring due to its portability and limited costs. Children are free to move around during fNIRS testing. This study builds on existing expertise using fNIRS in the neonatal population. It will assess the feasibility of implementing this novel technique in the epilepsy surgery population.
Clinical academic fellowship in gynecologic and prostate brachytherapy
Supervisor: Dr. Lucas C. Mendez
Clinical Program Area: Oncology/Radiation Oncology
LHSC offers a leading brachytherapy program, with our clinicians performing more than 700 procedures each year. Brachytherapy delivers radiation therapy through the placement of radioactive source(s) in close contact or directly inside the cancerous lesion. This is a standard of care treatment for gynecologic tumours like cervical cancer and for prostate cancers, as it has been shown to improve patient outcomes. Unfortunately, the number of hospitals and physicians offering brachytherapy is declining around the world. This project aims to offer practical brachytherapy workshops and training programs to increase treatment awareness and strengthen knowledge and skill among trainees. The goal is to impact treatment availability in Ontario to ultimately improve patient care.
A retrospective population-based cohort study to identify the time period when complications occur after a paediatric surgical procedure: Proposing a new definition of ideal follow-up duration
Fellow: Noam Bar-Yaakov
Supervisors: Dr. Sumit Dave and Dr. Peter Wang
Clinical Program Area: Surgery and Pediatrics/Pediatric Surgery and Urology
While outcomes of paediatric surgery can affect children for the rest of their life, follow-up protocols largely depend on the preference of individual surgeons. An ideal follow-up protocol should ensure no adverse outcomes or complications are missed while avoiding additional burden to the family and unnecessary costs to our health-care system. This project will use administrative health data in Ontario to study paediatric patients following five select surgeries. The study will identify the time after surgery during which most complications occur and will assess the current variability in duration, frequency, and investigations ordered for follow-up. It will also aim to identify procedure, patient, and surgeon-related risk factors to predict how long paediatric patients should be followed after surgery. The results of this project will be applicable across Canada and internationally, allowing surgeons to safely and economically tailor how long and frequently they should follow paediatric patients after surgery.
Clinical fellowship in cardiac hybrid imaging
Fellow: Dr. Rami Abazid
Supervisor: Dr. William Vezina
Clinical Program Area: Nuclear Medicine Division, Diagnostic Imaging Department
Myocardial perfusion imaging (MPI) is a powerful tool in evaluating patients with suspected and known coronary artery disease. But MPI is significantly limited in evaluating severe multivessel coronary artery disease and microvascular cardiac disease. Other imaging techniques like coronary calcium scoring and quantitative myocardial blood flow assessment have evolved to address these shortcomings. This clinical fellowship in cardiac hybrid imaging will improve patient care through developing a refined patient cardiac risk stratification algorithm relevant to the population is southwestern Ontario. The fellow will collaborate with stakeholders to establish an advanced cardiac imaging program and design evidence-based, patient-centered cardiac imaging care pathways. Other anticipated outcomes include more efficient resource utilization, enhanced research collaboration, and knowledge dissemination.