The Science of Sinai R E S EA R C H I M P A C T R E P O R T 201 7 –201 8
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AN ARMY OF GAME CHANGERS AND FUTURE MAKERS Behind every breakthrough that changes our understanding of health and disease stands an army of medical researchers, clinician-scientists, lab specialists, and brave patients. In this report, you will meet just a few of Sinai Health System’s curious and courageous frontline soldiers who are battling today’s most challenging diseases and finding health solutions that improve the lives of people all around the world. Located across Sinai Health, and organized under the leadership of the Lunenfeld-Tanenbaum Research Institute (LTRI), our scientists conduct their world-leading research in four broad fields that often overlap: fundamental lab-based discovery research, translational research that begins in the clinic with patients as research subjects, population health research, and health systems research that aims to optimize how care and services are delivered. But despite their diverse approaches, our scientists have one shared goal: to improve the health of patients not just here at Sinai Health, but everywhere. Strengthening and advancing Sinai Health’s army of game changers and future makers is a critical group, without whom our scientists would not be as successful as they are today: philanthropists like you. Thanks to your generous and forward-thinking support, Sinai Health’s scientists conduct their research in world-class facilities and offer patients access to some of the most important clinical trials and studies that have taken place over the past 30 years. Thank you for helping make the future a healthier place for ourselves and for generations to come. We are truly grateful for your support. Sincerely,
Louis de Melo Dr. Jim Woodgett CEO, Sinai Health Foundation Koffler Research Director Executive Vice-President, Lunenfeld-Tanenbaum Academic Advancement, Sinai Health System Research Institute
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DISCOVERY Making connections between lab discoveries and patient care
Scientists across Sinai Health make discoveries that reveal the mysteries of disease and nurture those discoveries to improve human health here and afar. They could not do this without your support.
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A successful pregnancy, guided by a Sinai Health-developed test
BABY N Y L A AN D DR . JO H N K I N G D O M W IT H MO M AN D PAT I E N T, PR IS C I L L A
“I can’t say enough about this experience. It’s been amazing. I would recommend Mount Sinai to anybody, any time.” — P R I S C I LL A PAT I E N T
Having experienced the heartbreak of a stillbirth caused by severe preeclampsia, Priscilla was grateful that a new blood test, developed and launched at Mount Sinai Hospital, was available to help guide her latest pregnancy. Preeclampsia is a rare but potentially deadly pregnancy complication characterized by high blood pressure in the mother. It can be reversed only by delivering the baby, often well before the mother’s due date. Premature birth leads to babies with very low birth weights, stays in the neonatal intensive care unit, and numerous physical and cognitive complications. Therefore, quickly diagnosing preeclampsia — so it can be effectively managed to safely prolong pregnancy — is key to optimizing the health of both mother and baby.
Priscilla was among the first patients to benefit from the Placenta Growth Factor test, which was developed by Lunenfeld-Tanenbaum Research Institute clinician-scientist Dr. John Kingdom in collaboration with Sinai Health colleagues Drs. Rory Windrim, Rita Kandel, Barry Hoffman and Sergio Carmona. The test can rapidly determine a woman’s risk of having preeclampsia, particularly in the absence of maternal symptoms. “This test tells us very specifically about a patient’s placental function and risk for preeclampsia so that we can determine the right level of care,” says Dr. Kingdom. “If we identify a risk, we can act quickly.” Priscilla’s test at 35 weeks revealed she was “in the zone” for preeclampsia. Her scheduled C-section was moved up and she was closely monitored for the critical warning signs of preeclampsia. Soon after, Priscilla noticed some of these signs and Mount Sinai jumped into action. Baby Nyla was born safely and in good health on March 17, 2017.
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DISCOVERY
PAT I E NT E R I N N A N D D R. E DWA R D KEYS TON E
Arthritis research that gives hope and changes lives
“Ongoing research into new treatments has allowed me to enjoy physical activities again, and I’m determined to live each day as best as I can. Research is a big part of why I still have hope.” — E R I N N, PATI E NT
Erinn McQueen is one of many rheumatoid arthritis (RA) patients who thrives for a period of time on a medication, but for unknown reasons reaches a point when that same medication stops working. Erinn’s journey began more than 17 years ago when, at age 21, she suddenly started feeling chronically exhausted and in pain. After several misdiagnoses, she was finally diagnosed with RA by doctors at Mount Sinai Hospital. “Things that were easy before my diagnosis, like climbing stairs or riding my bike, became very difficult,” Erinn says. RA is an illness of the immune system that, due to an imbalance triggered by genetics and the environment, becomes over-reactive and attacks the tissues lining the joints. As one of the best understood autoimmune diseases, research into RA helps to shed light on the mechanics of
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Many autoimmune diseases are highly inheritable and interconnected. By understanding rheumatoid arthritis, we open the door to a better understanding of other genetically-linked autoimmune disorders.
CeD C E L I AC D I S E AS E I L2- I L 2 1 I L12 A SH2 B 3
PT PN2 PTPN22
I L 2-I L 21
CD
CROHN’S DISEASE
T1D
TYPE 1 DIABETES
I L2RA
I L 2-I L 2 1
MS
I FI H 1 PT PN22
P TP N2 2
M U LT I P L E S C L E R O S I S
SLE
PTPN22
I BD5 PT PN22
LUPUS STAT4
RA
R H E U M AT O I D A R T H R I T I S
other autoimmune diseases that share genetic traits. Over the course of her illness, Erinn has become unresponsive to her medication five times. At her worst, she couldn’t tie her shoes and had multiple surgeries to remove damaged and disfigured joints, including a hip replacement in her early 30s. For Erinn, knowing that researchers at Sinai Health and elsewhere continue to unravel the mysteries of RA gives her hope about her future. One of the world’s leading RA research teams is located right here at Mount Sinai. Dr. Edward Keystone, Erinn’s rheumatologist and director of Mount Sinai’s Rebecca MacDonald Centre for Arthritis and Autoimmune Disease, and his frequent collaborator, Lunenfeld-Tanenbaum Research Institute senior investigator Dr. Kathy Siminovitch, together have made numerous discoveries that have changed our
understanding of the disease. In 2013, they uncovered 40 genetic links to RA that offer many new potential targets for treatment. More recently, RA patients at Mount Sinai participated in an international clinical trial that investigated a new biologic drug called baricitinib. The trial tested the effectiveness of adding baricitinib to therapy for RA patients who, like Erinn, have stopped responding to the standard treatment of methotrexate. Adding baricitinib to patients’ treatment led to fewer symptoms, better physical function, and slower progression of structural joint damage. For Erinn, rheumatoid arthritis has changed her life. Though she has had to abandon some of her earlier dreams, like playing sports competitively and pursuing a career in massage therapy, she remains optimistic about what she still can do.
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CLINICAL/ TRANSLATIONAL RESEARCH
Research rooted in clinical investigations
Patients, clinicians and philanthropic investment — all are essential to clinical research at Sinai Health. With your support, our researchers carry out studies that improve treatments — and seek cures — for some of today’s most intractable diseases.
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Leading the search for a cure to Crohn’s disease
Crohn’s disease has spared few in Amie Creighton’s family. Her mom has coped with the disease since her 20s, and both she and her sister were recently diagnosed. Crohn’s and ulcerative colitis — conditions collectively known as inflammatory bowel disease (IBD) — inflame the lining of the gastrointestinal tract, disrupting the body’s ability to digest food, absorb nutrients and eliminate waste. The symptoms of Crohn’s can be excruciating, severely limiting sufferers’ ability to live life to its fullest and often requiring multiple surgeries. The exact cause of the disease is unknown, but a variety of factors are suspected, such as abnormal immune system responses and genetic susceptibility. While treatment options continue to expand, there is still no cure. One in 150 Canadians suffers from IBD — the highest rate of any country. “Crohn’s is a life-altering disease. Watching my mom go through everything she has, that’s one reason I enrolled in the GEM Study in 2015 before I was diagnosed with the disease,” says Amie, referring to a one-of-a-kind study led by Mount Sinai gastroenterologist and Lunenfeld-Tanenbaum Research Institute clinician-scientist Dr. Kenneth Croitoru. The GEM (Genetics, Environment, Microbiome) Study is following 5,000 people at 89 sites around the world who don’t yet have Crohn’s but whose family medical history puts them at an elevated risk of developing the disease. Participants contribute blood, stool and urine samples when they enter the study, in addition to completing questionnaires about past environmental exposures, eating habits and medical history. They repeat the process if they develop the disease.
PAT I E NT AM I E AN D D R. K E N N E T H CRO I TO RU
By looking at participants before and after they get Crohn’s, researchers aim to determine the ways in which a person’s genetics, environment and microbial composition change and interact to trigger the onset of the disease. “We need to better understand the root causes of Crohn’s. It is through these efforts that we hope to develop strategies for prevention and improved treatments, while working toward a cure,” says Dr. Croitoru. The study is funded by the Helmsley Charitable Trust and Crohn’s and Colitis Canada, as well as supporters of Mount Sinai’s IBD Program, a global leader in IBD care and research. Together these funds represent the largest single investment in IBD research in Canada. Amie is one of 63 participants around the world who has developed Crohn’s during the study’s course, helping to reveal the multiple factors that cause the disease. Amie says her participation has taken on new meaning since she and her sister have been diagnosed with Crohn’s.
“I want to help advance the science, so that treatments can continue to improve and, ultimately, a cure may be discovered.” — A M I E , PATI E N T
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CLINICAL/TRANSLATIONAL RESEARCH
PAT I E NT AN D RE A AN D H E R S O N ANT H O NY, W IT H D R. CAN D ICE S I LVE RS I D E S 11
“To have the hope that it’s possible to have a healthy pregnancy, with all that research and support behind you, that’s priceless.” — A N D REA, PATI E NT
A high-risk pregnancy made possible by determination and research Andrea Querido has never been a quitter. Born in 1976 with an abnormal heart valve, she underwent multiple surgeries, including the insertion of a mechanical heart valve at the age of nine. Andrea lived to her 30s believing her heart condition meant she might never have children. Yet she always held out hope. When Andrea and her husband Armindo learned about Mount Sinai’s internationally renowned Pregnancy and Heart Disease Program, their hope grew into optimism. It wasn't easy, but Andrea gave birth to a healthy baby boy in April 2014. Today, their son Anthony is a chatty, superhero-loving preschooler. “He’s thriving,” says Andrea. Pregnancy places enormous demands on the body and the heart especially. Women like Andrea with a mechanical heart valve are at greater risk of developing potentially life-threatening blood clots. But two decades of research, including important studies by Andrea’s own cardiologist, Dr. Candice Silversides, have contributed to making pregnancy safer for women with high-risk heart conditions. This paradigm-shifting research includes an influential 2001 national study led by Mount Sinai researchers that enrolled 600 women from across Canada, and led to the development of the first “risk score” that predicts the likelihood of heart complications during pregnancy. “The risk
score helps us figure out who is at serious risk for complications during pregnancy and how we should best tailor their care to prevent them,” says Dr. Silversides, who is also a clinician-scientist at the Lunenfeld-Tanenbaum Research Institute. Three years before Andrea and Armindo tried to conceive, she met with Dr. Silversides to discuss how she might have a healthy pregnancy. Dr. Silversides described several steps Andrea would need to take before and during pregnancy. One of these included switching Andrea from her regular blood-thinning medication during pregnancy, which would have been unsafe for the baby, to an injectable blood thinner called Fragmin. A 2009 study by Dr. Silversides and Mount Sinai colleagues was among the first in the world to show that Fragmin could be used safely in women with mechanical heart valves during pregnancy. “Our study proved that Fragmin was safe for both mom and baby, and it outlined a treatment and monitoring protocol,” says Dr. Silversides. Andrea visited Mount Sinai weekly during her pregnancy to meet with members of her multidisciplinary care team, which included Dr. Silversides and her high-risk obstetrician Dr. Mathew Sermer, Dr. Nadine Shehata, a hematologist, and others. “I can’t rave enough about Mount Sinai,” Andrea says. “Dr. Silversides is always striving to provide the best care for pregnant women with heart disease.”
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The Breakthrough Fund: generosity that drives medical breakthroughs Without our medical researchers and the well-equipped facilities they work in, Sinai Health cannot make the breakthroughs that improve and save lives both here and around the world. Donor support for the Breakthrough Fund ensures our scientists have access to state-of-the-art infrastructure.
A history of INNOVATION For more than 30 years, the Lunenfeld-Tanenbaum Research Institute has been an incubator for scientific discovery. Below are just a few examples of breakthroughs made at the LTRI.
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Dr. Steven Gallinger helps identify the first gene variation associated with colorectal cancer. It is so determinative that it becomes a tool for colorectal cancer prediction and screening world-wide.
Dr. John Roder reveals a genetic connection between schizophrenia and depression, prompting a reevaluation in how clinicians test for schizophrenia.
Dr. Jim Dennis discovers a biomarker for progressive multiple sclerosis (MS). In 2016, he begins clinical trials with U.S. collaborators on a treatment to stop and reverse symptoms of the disease.
2004
2007
2011
1986
2005
2010
Dr. Tony Pawson discovers a key mechanism that drives protein regulation in cells that is critical for growth, leading to the development of new selective cancer therapies. In 2008, he becomes the first Canadian to win the prestigious Kyoto Prize.
Dr. Andras Nagy develops Canada’s first human embryonic stem cell lines. Later, he identifies a new way to create safer stem cells and maps the process of making stem cells for the first time, opening the door for countless new stem cell therapies.
Dr. Anne-Claude Gingras unveils a complete map of signaling protein interactions, allowing scientists to predict which drugs may be most effective for particular diseases and patients.
Help us make the next breakthrough by supporting the Breakthrough Fund at Sinai Health.
The Lunenfeld-Tanenbaum Research Institute (LTRI) is among the world’s top health research entities. Government funders have long recognized our excellence: per scientist, we’re consistently awarded more peer-reviewed grant funding than any other medical research facility in Canada — a testament to the widely recognized merit of the LTRI’s work. But government funding does not support the advanced technologies and infrastructure our scientists need to make their breakthroughs. Your donations to the Breakthrough Fund bridge this gap. The Breakthrough Fund supports one of the world’s largest bone and tissue banks used in cancer research; Canada’s most sophisticated facility to create models of human disease; one of North America’s best outfitted mass spectrometry and high-throughput and robotics facilities; a microscopy engineering unit that assembles customized photon laser microscopes that can differentiate between synapses and see into a cell’s super-microscopic centrosome; and so much more that keeps our researchers at the forefront of finding solutions to today’s biggest health challenges.
Dr. Graham Collingridge is awarded The Brain Prize for his breakthrough work in identifying the mechanism that triggers neurodegeneration and memory loss. This research lays the foundation for the blockbuster drug Memantine, which is the world’s leading drug for patients with advanced Alzheimer’s disease.
Dr. Daniel Drucker wins the International Harrington Prize for Innovation in Medicine. Two years earlier, he is elected to The Royal Society and named an Officer of the Order of Canada for his research leading to two new drug classes to combat diabetes. In that same year, Teduglutide is approved in Canada for use in patients with short bowel syndrome. Developed by Dr. Drucker, Teduglutide is the first long-term advance for this condition in more than 40 years.
2015
2017
2015
2016
Dr. Daniel Durocher describes a new way to perform gene editing that will create new and more reliable gene therapies. He is also awarded the Paul Marks Prize for Cancer Research by Memorial Sloan Kettering Cancer Center.
Dr. Sabine Cordes and her colleague discover a genetic biomarker for autism spectrum disorder (ASD). The hope is to include a test for ASD in newborn screening, allowing for earlier identification of children with this disorder.
supportsinai.ca/breakthroughfund
POPULATION HEALTH RESEARCH People power: Sinai Health’s Prosserman Centre for Health Research in the LTRI has real world impact
Much can be learned about the nature of disease by studying lifestyle, environmental and genetic characteristics among large groups of people. Your support empowers Sinai Health’s population health researchers as they contribute to the development of better disease prevention and treatment strategies.
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K AT H LE E N A N D M E GAN M C DOWE L L WI TH D R . I R E N E A N D R U L IS
Studying the young to learn more about breast cancer The McDowell family knows breast cancer all too well, with three consecutive generations of women being struck by the disease. Now, one of the youngest McDowells is participating in a Lunenfeld-Tanenbaum Research Institute-led study that seeks to establish preventive measures that girls can follow, beginning as early as age six, to reduce their future risk of breast cancer. Megan McDowell, a 15-year-old with a passion for musical theatre, joined the LEGACY Girls Study when she was just nine years old. She heard about it from her mom, Kathleen, who was treated for breast cancer in 2014. Megan’s grandmother has twice battled breast cancer, and her great-grandmother died of the disease in the 1970s. The LEGACY study, which also includes four sites in the U.S., is led in Ontario by Dr. Irene Andrulis, a senior investigator at the LTRI. The study has enrolled over 1,000 girls between the ages of six and 13. Like Megan, half come from families with a history of breast cancer, while the other half come from families with no history of the disease. Legacy researchers aim to better understand the influence of lifestyle, environment and diet on pubertal development in these two cohorts of girls and how these factors might affect their risk of breast cancer later in life. Participants give blood, urine and saliva samples. Every six months, all participants provide body measurements, while girls 10 and older also fill out questionnaires on their pubertal development, exercise history, health knowledge and more.
“We designed LEGACY to find out what factors are involved in breast development and health in addition to genetics — factors such as diet, lifestyle and physical activity,” says Dr. Andrulis, a molecular geneticist. While the study continues, some intriguing results have already been published. In a June 2017 article in the journal Breast Cancer Research, Dr. Andrulis and her colleagues noted that earlier breast development, as well as a slower tempo between the onset of breast development and menstruation, may be related to a family history of breast cancer. Naturally, Megan’s mother Kathleen was concerned about raising her daughter’s anxiety surrounding breast cancer by participating in the study. “But we have very open conversations and I don’t think it’s had a negative impact in any way. If anything, it’s been positive,” Kathleen says, noting that Megan is now more aware of healthy lifestyle choices that may lessen her risk of breast cancer. Ultimately, Megan and her fellow study participants hope to play a role in stopping the painful intergenerational legacy of breast cancer.
“ Giving back to the breast cancer community has been great, I hope the study can help improve prevention and treatment.” — M E G A N, PATI E N T
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POPULATION HEALTH RESEARCH
Decades later, diabetes study continues to transform care
It was the early 1980s and debate raged in the Type 1 diabetes community as to the cause of long-term complications associated with the disease, including eye, kidney and cardiovascular conditions. One theory held that complications were the result of poorly controlled blood sugar levels among people with Type 1 diabetes. The grounds for this being that, by and large, patients with good control developed fewer complications. Another theory held that a patient’s blood sugar level didn’t matter — that, in fact, one’s genetic susceptibility to developing complications was of paramount importance. The evidence for this was that some people with very poor control didn’t develop complications at all. Dr. Bernard Zinman, director of the Leadership Sinai Centre for Diabetes, and
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PAT I E NT LOR N E AN D DR. B E RNA RD ZI N MA N
collaborators from 27 other North American centres settled the debate through their Diabetes Control and Complications Trial (DCCT). Led by Dr. Zinman, the international study proved in 1993 that tightly controlling blood sugar through intensive insulin therapy is the best way to prevent complications. Intensive therapy quickly became the standard of care around the world. The DCCT and its ongoing followup study — known as Epidemiology of Diabetes Interventions and Complications (EDIC) — have continued to produce new insights that shape care and treatment. Lorne Shiff, a Type 1 diabetes patient of Dr. Zinman’s since 1981, is one of the original 1,441 DCCT participants. Managing his disease requires constant vigilance. “Type 1 diabetes is a 24/7, 365 day-a-year disease. You never have one minute off,” he says. It is Lorne’s vigilance in the face of his disease that has made him such a strong supporter of Sinai Health’s diabetes research, noting that “it’s great to know this study has advanced treatment of Type 1 diabetes globally.” When the DCCT study ended and all participants switched to intensive therapy, Dr. Zinman and colleagues established the EDIC study to observe participants’ health over a longer timeframe. In EDIC results published in 2013, researchers found that the former intensive therapy group had a much lower risk of cardiovascular complications — which are the deadliest
of diabetes’ complications. Intensive therapy also reduced the group’s risk of major cardiovascular events by 42 per cent compared to the former conventional therapy group, and reduced the risk of heart attack and stroke by 58 per cent. The cardiovascular benefits of intensive therapy could potentially be enhanced through the supplemental use of a newer Type 2 diabetes drug called Empagliflozin. In a separate study led by Dr. Zinman, researchers found in 2015 that Empagliflozin reduced the risk of death from cardiovascular causes by 38 per cent among Type 2 diabetes patients, compared to patients who didn’t receive Empagliflozin. Dr. Zinman’s colleague, Dr. Bruce Perkins, is now studying the drug as a supplement to insulin treatment among Type 1 patients. Empagliflozin is the first and only diabetes drug on the market today that reduces the risk of death from diabetes-associated heart failure. Meanwhile, as EDIC’s dedicated participants begin to approach their golden years, researchers will investigate whether Type 1 diabetes affects their memory, attention, language and other cognitive abilities. The changing nature and ongoing impact of EDIC are some of the reasons participants have remained involved for so long, says Lorne. “The hope is that this study will never end, until we’re all gone,” he says with a chuckle.”
“The DCCT has had a huge impact on the lives of people with Type 1 diabetes. The life expectancy of someone with Type 1 diabetes who maintains excellent blood sugar control is now the same as someone without diabetes. That’s incredible.” — DR . B E RNARD ZI N MAN D I R E C TOR OF TH E L E A DE R SH I P SI N AI CE NTRE FO R DIABET ES; AS S O C I ATE DI R EC TO R , C L I N I C AL R ES EAR C H, LTR I ; THE STEPHEN AND SUZIE PUSTIL DIABETES RESEARCH SCIENTIST; THE SAM AND JUDY PENCER FAMILY CHAIR IN DIABETES RESEARCH
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HEALTH SYSTEMS RESEARCH
Innovation that influences care beyond our walls
In response to our country’s changing demographics, Sinai Health is creating an integrated system that serves as a model for the future of health-care delivery across the country. As part of this, our health systems researchers are developing and sharing new evidencebased methods to provide better care and improved patient outcomes at every stage of life. Your generosity is indispensable to this work.
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Placing families at the heart of NICU care “I think the single most important thing parents need to know about Family Integrated Care is that they can do something nobody else can for their baby.” — D R . K ARE L O 'BRI E N STAF F N E ONATOLOGI ST, LT RI CLI N ICIAN-SCI E NTIST
Back in 2011, Jacqueline (Jack) and her partner Andy were the first participants in a new model of Neonatal Intensive Care Unit (NICU) care — called Family Integrated Care (FICare) — being tested at Mount Sinai's Newton Glassman Charitable Foundation NICU. Under FICare, parents learn to be involved in all aspects of their child’s care, including feeding, tracking growth and progress, taking part in medical rounds, and much more. The principle of FICare is that families should be supported, educated and empowered to provide as much of their infants’ care as they are able. “We were so happy when Tess was born but nothing could have prepared us for the shock of being thrust into such a clinical world,” says Jack. “FICare enabled us to become an integral part of our daughter’s medical team.” FICare has its roots in Estonia, where a shortage of NICU nurses in 1979 prompted the implementation of a model whereby parents provide everything but the most advanced medical care for their preterm infants, with support from the medical team. This model produced healthier babies and shorter NICU stays. Impressed by the results from a country with a significantly smaller health budget and far fewer resources than those available in Ontario, Dr. Shoo Lee, Mount Sinai’s paediatrician-in-chief, Dr. Karel O’Brien, a Mount Sinai staff neonatologist, and others travelled to Estonia in 2010 to observe the model in action. They returned and worked with a multidisciplinary team at Mount Sinai — including veteran NICU parents — to develop FICare, which was then tested in the small pilot study that included Jack and Andy.
T H E H O U RIGAN FAM I LY AN D D R. K ARE L O’B RI E N
Led by Drs. Lee and O’Brien, both of whom are also clinician-scientists at the Lunenfeld-Tanenbaum Research Institute, the pilot study found that FICare had several benefits for infants and parents over standard NICU care. To more definitively compare the two models, they then launched an international study involving 1,700 infants at 25 NICUs across Canada and Australia. Completed in 2016, this major study reaffirmed that FICare infants gain weight faster and that their parents experience less stress and anxiety. “Parents perform a role that nobody else can — no nurse, no doctor can do what a parent does at the bedside for their child,” says Dr. O’Brien. FICare’s success has attracted visitors from NICUs in China, the United Kingdom and the U.S., who seek to train with Mount Sinai’s specialists in order to implement FICare at their own sites. Meanwhile, now at six-and-a-half years old, Tess is hilarious, creative and kind. “If someone had told me in the NICU that one day my kid would be riding horses, practising yoga and crossing a stage to pick up her Montessori graduation certificate, I would have never believed them. It’s amazing to see. Our FICare education helped Tess reach goals we could have never imagined,” says Jack.
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HEALTH SYSTEMS RESEARCH
DR . M IC H E L L E N E LSO N A N D JAC KI E E L I
Personalized stroke rehabilitation backed by research
It was two weeks before Christmas in 2015 when Duncan Skinner suffered a progressive stroke over several days. When he was admitted to Sinai Health’s Bridgepoint Active Healthcare, his wife was fearful. “Carole was expecting the worst — that I’d be in a wheelchair for the rest of my life,” says Duncan, a retired accountant and an avid Scottish country dancer, a dance that involves intricate footwork, making it as engaging for the mind as it is for the body. Duncan entered Bridgepoint on a gurney, unable to move his right hand, arm, leg or foot. “By New Year’s Eve I was walking without a cane,” he says. And by the spring he had regained strength and full range of motion in his right hand and arm. He was even able to kick and dribble a soccer ball in bare feet. Duncan’s recovery was no doubt aided by his steely determination and the personalized care he received through Bridgepoint’s stroke rehabilitation program, which holds Stroke Distinction status from Accreditation Canada.
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“The rehab care was wonderful.” — DU N C A N SK I N N E R PATI E N T
Patients like Duncan benefit from the expertise of a whole team of specialists who collaborate closely to deliver coordinated care designed around patients’ own goals. The team can include doctors, nurses, physical and occupational therapists, physiatrists, psychiatrists, social workers, and others. This integrated team approach, in partnership with patients and families, ensures Bridgepoint addresses patients’ complex needs. Standing behind Bridgepoint’s extraordinary stroke rehab clinicians and shedding light on patient complexity are researchers like Dr. Michelle Nelson, a principal investigator at Bridgepoint’s Collaboratory for Research and Innovation, part of the Lunenfeld-Tanenbaum Research Institute. Dr. Nelson has worked closely with Bridgepoint clinicians to understand and address the challenges they — and their peers across the country — face in delivering care to stroke patients. One challenge is that stroke rehab guidelines appear to be most applicable to patients with less complex health histories, not to people with multiple chronic diseases (known as comorbidities), such as diabetes, dementia or any number of other health conditions. In reality, many stroke patients have multiple conditions. To investigate care providers’ suspicions about the gap between stroke rehab guidelines and their limitations when applied to stroke patients in real-life hospital
settings, Dr. Nelson led a review of stroke rehab randomized controlled trials — the kind of studies that are prioritized in the formation of best practice recommendations. Published in February 2017 in the journal Topics in Stroke Rehabilitation, Dr. Nelson’s review found that 83 per cent of the 428 trials reviewed excluded patients with comorbidities. “This is problematic as the evidence used to generate guidelines may not match the patient typically seen in practice,” says Dr. Nelson. Jackie Eli, senior director of rehabilitation and ambulatory care at Bridgepoint, says Dr. Nelson’s research helps validate the clinical team’s experiences and challenges as they continue to use the guidelines when planning stroke care. “By revealing the limitations of existing guidelines, her research empowers clinicians to use their clinical expertise, teamwork and creativity to develop personalized care plans for patients,” Eli notes. Dr. Nelson’s research stands to benefit stroke rehab clinicians — and the patients they care for — not just at Bridgepoint, but globally. Since leaving Bridgepoint, Duncan has returned to his regular daily activities, travelling with his wife Carole, and enjoying his family. He still hopes to return to Scottish country dancing.
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LUNENFELD -TANENBAUM RESEARCH INSTITUTE: BY THE NUMBERS
$19 million
360
scientists, clinician scientists and research trainees
770 primary
233,000
353
papers
new clinical research projects
square feet of research space
Canadian Institutes of Health Research direct funding
11 12 fellows,
Canada Research Chairs
Royal Society of Canada
TOP 4
500
technical and administrative research staff
HIGHEST impact worldwide in endocrinology & metabolism research of health care, research & academic institutions
in impact in fundamental cell biology research among North American academic or health care institutions
2016 / 17 BUDGET: $99.8 MILLION $15.3 INTERNAL FUNDING HIGHEST FUNDING PER SCIENTIST IN CANADA • 13 CIHR Foundation grants • 11 Canada Research Chairs 1ST in share of publications in leading journals TOP 1% by citations
$84.5 EXTERNAL FUNDING (GRANTS)
WORLD-CLASS TECHNICAL FACILITIES • The Centre for Phenogenomics • Drug and Gene Screening Core • Biobanks (tissues and tumours) • Molecular Imaging • Genome Sequencing
LTRI LEADERSHIP
DR. JIM WOODGETT Koffler Research Director
DR. DANIEL DUROCHER
DR. RAYJEAN HUNG
DR. ROSS UPSHUR
DR. BERNARD ZINMAN
Associate Director, Discovery Research
Associate Director, Population Health/ Epidemiology
Associate Director, Health Systems
Associate Director, Translational/Clinical
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