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Volume 93, Supplemental Issue · www.utmj.org
University of Toronto’s Faculty of Medicine presents:
The 30th Annual Medical Student Research Day
Tuesday, February 2nd, 2016
Chestnut Residence
University of Toronto Faculty of Medicine
30th Annual Medical Student Research Day
Tuesday, February 2rd, 2016 – 11:30am-6:00pm
89 Chestnut Residence and Conference Centre,
Colony Grande Ballroom, 2nd Floor, Toronto, Ontario
11:30am – 1pm
Registration & Refreshments
12:50-1pm
Opening Remarks
Dr. Trevor Young
Dean, Faculty of Medicine
1pm – 1:45pm
Keynote Speaker Presentation
Dr. David Malkin
(includes 15min discussion)
1:45pm – 2pm
2pm – 2:45pm
2:45pm – 3pm
Hallway by Colony Grande Ballroom
Colony Grande Ballroom
Poster Preparation / Break
Oral Presentations
Poster Preparation / Break
3pm – 4pm
Poster Judging – Session 1
4pm – 5pm
Poster Judging – Session 2
5pm – 5:15pm
5:15pm – 5:30pm
Poster Take-Down / Break
Award Ceremony &
Closing Remarks by
Dr. Jay Rosenfield
Vice Dean, MD program
MSRD • February 2nd, 2016
1
Organizing Committee
Executive
Michael Atkins, MD/PhD
Sally Hu, 1T8
Yiwen Liu, 1T8
Talhal Maqbool, 1T8
Weining Yang, 1T8
Staff Advisors
Dr. Neil Sweezey, CREMS Director
Lisa Charrette, CREMS Coordinator
Annamarie Butler, Sponsorship Manager
Contributors
Effie Slapnicar (Director of Operations, UME)
Team Lab Coat (Host website, uoftmeds.com)
Amy Wang (Photography)
Stephanie Zhou (Photography)
Jung-Hee Lee (Logo Design)
([email protected])
2
Table of Contents
Messages
Abstracts
4
Message from Organizing Committee
11
Basic Sciences (BS)
Message from Dean, Faculty of Medicine
Dr. Trevor Young
22
Clinical (CL)
5
38
Public/Population Health (PPH)
41
Quality Improvement (QI)
6
Message from Vice-Dean, Undergraduate
Medical Professions Education
Dr. Jay Rosenfield
46
Health Services (HS)
51
Medical Education (ME)
7
Message from CREMS Director
Dr. Neil Sweezey
8
MSRD Keynote Biography
Dr. David Malkin
Past Winners
9
29th MRSD Poster Winners
2016 MSRD Oral Presenters
10
2016 Selected Oral Presenters
3
MESSAGES
Message from the Executive Organizing Committee
WelcometoMedicalStudentResearchDay!The30thanniversaryofMSRD
representsanopportunityformedicalstudentstodisseminatetheirresearchwith
theacademiccommunityandhighlightsthestrongtraditionofresearchatthe
UniversityofToronto.
WeareexcitedtobeginMSRDwiththekeynotepresentationbyclinician‐scientist
andpediatriconcologistDr.DavidMalkin.Thereafter,welookforwardtomedical
studentoralandposterpresentations.Thereisstrongrepresentationacrossall
levelsofmedicalstudentswithover170abstracts.TheMSRDOrganizing
Committee,alongwithMs.LisaCharrette,CREMSCoordinatorarehappytoanswer
anyquestionsthatmayarise.
Wewouldliketothankouradvisorsandcollaborators:Dr.NeilSweezey,Dr.Trevor
Young,Dr.JayRosenfield,Dr.NormanRosenblumandMs.LisaCharrette,
AnnamarieButler,EffieSlapnicar,Jung‐HeeLee,TeamLabCoatandundergraduate
volunteers.Wewouldalsoliketothankthenumerousjudgesthatplayavital
supportiveroletoMSRDinevaluatingabstractsandposterpresentations.These
contributionshelpguaranteethesuccessofMSRD2016.Thesuccessofthe30th
MSRDwasbolsteredbythestronginvolvementofoursponsors.Theirlogosare
listedatthebackofthisbooklet.Weinviteyoutovisitsomeofoursponsorsduring
breaks.Wehopetheafternoonisoneofdiscovery,wherenewideasareformulated
andacademicresearchismovedforward.
Your MSRD 2016 Executive Organizing Committee
4
MESSAGES
Message from the Dean, Faculty of Medicine
Welcometothe2016
MedicalStudent
ResearchDayatthe
UniversityofToronto.
Thisisashowcasefor
researchprojectsbeing
donebyourMD
students.Butmorethan
that,it’satestamentto
theircommitmentto
advancingdiscoveryand
knowledgeinthe
medicalsciences.
Doingresearchisnotalwaysaneasyexperience.Itisvigorous,timeconsumingand
occasionallyfrustrating.Butitisnecessaryandwhenweuncoveranewunderstandingof
acondition,oranewwaytotreatpatients,itcanbeveryrewarding.Andthatmakesthe
hardworkworthwhile.Iencourageyoutolearnabouteachoftheprojectsheretoday.It
willexpandyourknowledgeandmayleadtogreatcollaborationsandfutureresearch
projects.
Iwanttothankthestudents,staffandfacultywhoorganizedthisday.Ialsowanttothank
theresearchfacultywhoguidedandmentoredourmedicalstudents.Finally,Iwantto
thankthestudentswhohavetakentimetopresenttoday.Ilookforwardtomeetingmany
ofyouandseeingyourresults.
Trevor Young, MD, PhD, FRCPC, FCAHS
Dean, Faculty of Medicine
Vice-Provost, Relations with Health Care Institutions
5
MESSAGES
Message from the Vice-Dean, Undergraduate Medical Professions
Education
It is with great pride that I welcome you to the 30th annual
Medical Student Research Day (MSRD).
Congratulations to all students participating in the year’s MSRD.
I commend your thirst for knowledge and discovery. Thank you
for your tremendous enthusiasm, support for one another and
commitment to improving the health of others.
The caliber and diversity of this year’s poster presentations are
nothing short of remarkable. We have students proudly
showcasing more than 170 posters across a variety research
fields – ranging from basic and clinical science disciplines to
topics related to health care, medical education and
international health.
Many of the students who partake in this annual event are part of the Comprehensive Research
Experience for Medical Students (CREMS) Programs, while others are enrolled in our MD/PhD
program, or find ways to participate in research projects on their own terms, sometimes through
electives, and often by giving up their limited leisure time. Some MSRD participants entered
Medicine with advanced degrees and have carried a thesis-based project to fruition since
enrolment.
This exceptional event wouldn’t be possible without the efforts of the MSRD organizing
committee, supported by Dr. Neil Sweezey, CREMS Program Director and Lisa Charrette,
CREMS Program Coordinator. Thank you to the MSRD organizing committee:





Michael Atkins, MD/PhD program student
Sally Hu, IT8 MD program student
Yiwen Liu, IT8 MD program student
Talha Maqbool, IT8 MD program student
Weining Yang, IT8 MD program student
The continued success of MSRD each year reflects positively on our esteemed faculty
members who mentor and supervise medical students throughout the course of their research
projects. Your commitment and dedication to our students is deeply appreciated.
Enjoy the day!
Jay Rosenfield MD, MEd, FRCPC
Vice Dean, MD Program
Professor of Paediatrics
6
MESSAGES
Message from the CREMS Director
It is a distinct pleasure to welcome all to the 30th Annual
Medical Student Research Day of the Faculty of Medicine of the
University of Toronto.
This event showcases the breadth, depth and sophistication of
the wide variety of research projects recently carried out by a
significant number of U of T medical and MD/PhD students, over
and above all of their required learning and training activities.
Under the guidance of expert faculty supervisors, these students
are acquiring a series of cutting edge methodological and critical
thinking skills that will help equip them for their future careers.
This knowledge will ultimately be useful to those who will serve
as future clinicians who can understand, interpret and apply the
fruits of research to the benefit of their patients, as contributing
members of investigative teams or as Clinician-Scientists who
will lead their own health research enterprises.
In the research projects described, a wide variety of disciplines and academic approaches have
been used to answer questions that are intrinsically interesting from strictly scientific points of
view. But more than this, a common theme (that will not be lost upon those attending this day) is
that these projects were deliberately designed to produce results with current and/or potential
future applicability to the improvement of human health.
It has been delightful working with the Executive of this year's student Organizing Committee,
Yiwen Liu, Sally Hu, Weining Yang, Talha Maqbool and Michael Atkins. Special thanks for
support are owed to Lisa Charrette, Coordinator of CREMS Programs and Kendra Hawke,
Administrative Manager MD/PhD programs. I am grateful for the commitment of the day's
keynote speaker, Dr. David Malkin, the numerous research project supervisors and the poster
judges, who have given so freely of their valuable time. Especially, the ongoing support of the
Faculty of Medicine for research experiences for medical students is very much appreciated.
I look forward to meeting many of you and to hearing of the results of your specific projects
Neil Sweezey, MD, FRCPC
Director, Comprehensive Research Experience for Medical Students (CREMS) Programs
Associate Professor of Paediatrics and Physiology
7
MESSAGES
Keynote Speaker Biography
Dr. Malkin is Professor of Pediatrics and Medical Biophysics, POGO Chair in Cancer Control,
Faculty of Medicine, University of Toronto, and Medical Director of the Pediatric Oncology Group
of Ontario. He is a pediatric oncologist, Director of the Cancer Genetics program and a Senior
Scientist in the Genetics and Genome Biology Program at SickKids. Dr. Malkin’s research
program focuses on: 1) genetic and genomic mechanisms of childhood cancer susceptibility;
and 2) signaling pathways and novel therapeutic targets in rhabdomyosarcoma. Recently, his
work has addressed the application of genomics to develop rational clinical surveillance and
treatment guidelines for children and adults at genetic ‘high risk’ for cancer. His work is funded
by the Canadian Cancer Society, CIHR, CFI, Terry Fox Research Institute, Genome Canada,
the NIH, Ewing Foundation Canada, and the Department of Defense (US). In addition to his
more than 200 invited lectures and 170 publications, he is recognized for his dedication to clinical
care, advocacy, medical education and mentorship. Dr. Malkin has served on many national and
international grant panels, is past Chair of the Advisory Council on Research for the Canadian
Cancer Society Research Institute (CCSRI), a member of the National Board of Directors of
CCS, and is Medical Director and long-standing Board Member of Camp Oochigeas – a yearround camp for children with cancer in Ontario.
Dr. Malkin’s presentation is titled: Through the Looking Glass: Reflections on a Career in
Science and Medicine
8
PAST WINNERS
2015 Medical Student Research Day Winners
Congratulations to the winners of the best poster presentation in their category of the 29th annual
Medical Student Research Day.
Basic Sciences: Ahmed Cherry
Supervisor: Dr. C. Licht
Poster: NEUTROPHIL EXTRACELLULAR TRAPS SHIELD PSEUDOMONAS AERUGINOSA FROM
COMPLEMENT MEDIATED KILLING
Clinical 1: Anne Mullen
Supervisor: Dr. J. Nyhof-Young
Poster: CREATING CLINICAL COMFORT IN PRECLERKSHIP CLINICAL SKILLS TRAINING: INVESTIGATING
THE STUDENT PERSPECTIVE
Clinical 2: Akanksha Kulshreshtha
Supervisor: Dr. S. Sierra
Poster: POLYCYSTIC OVARY SYNDROME AND RECURRENT EARLY PREGNANCY LOSS – A CANADIAN
PERSPECTIVE
Clinical 3: Carolyn Sawicki
Supervisor: Dr. E.A. Yeh
Poster: SELF-EFFICACY AND FUNCTIONAL DISABILITY AS BARRIERS TO PHYSICAL ACTIVITY
PARTICIPATION IN PEDIATRIC MULTIPLE SCLEROSIS
CREMS Scholar: Kevin Kirouac
Supervisor: Dr. G. Prive
Poster: HUMAN CEACAM6 AND CEACAM8 FORM A CO-RECEPTOR COMPLEX
Determinants of Community Health: Alex Cressman
Supervisor: Dr. D. N. Juurlink
Poster: SOCIOECONOMIC STATUS AND RISK OF HEMORRHAGE DURING WARFARIN THERAPY FOR
ATRIAL FIBRILLATION: A POPULATION-BASED STUDY
Health Care: Ali Damji
Supervisor: Dr. CM Hepburn
Poster: AN ALTERNATE CARE ENVIRONMENT TO REDUCE PAEDIATRIC INPATIENT LENGTH OF STAY
International Health: Daniel Abrams
Supervisor: Dr. D. Wiljer
Poster: PERCEPTIONS AND EXPERIENCES OF PERINATAL MENTAL DISORDERS IN RURAL NORTH
VIETNAMESE COMMUNITIES
MD/PhD: Robyn Elphinstone
Supervisor: Dr. KC. Kain
Poster: INCREASED LEVELS OF S-NITROSYLATION IMPROVES OUTCOMES IN A MODEL OF
EXPERIMENTAL CEREBRAL MALARIA
First Year: Mark Barszczyk
Supervisor: Dr. C. Hawkins
Poster: TELOMERASE REPRESENTS A PROGNOSTIC MARKER AND THERAPEUTIC TARGET IN
PAEDIATRIC EPENDYMOMA
9
ORAL PRESENTERS
MSRD 2016 Selected Oral Presenters
A panel of judges selected the following students’ abstracts. They have been invited to share
their work in the form of an oral presentation. Congratulations!
Clinical: Mr. Omri Arbiv, 1T8
Supervisor: Dr. Yigal Dror
Title: RISK FACTORS FOR HEMATOPOIETIC STEM CELL TRANSPLANTATION IN INHERITED BONE MARROW
FAILURE SYNDROMES
Basic Science: Josh Abraham, MD/PhD
Supervisor: Dr. Karim Mekhail
Poster: SUPPRESSION OF RNA-DNA HYBRIDS - TOWARDS A NOVEL AND COHERENT MECHANISM GOVERNING
REPETITIVE DNA STABILITY, AGING, AND NEURODEGENERATION
Public/Population Health: Mr. Johnny-Wei Bai
Supervisor: Dr. Bruce Perkins
Poster: CARDIOVASCULAR DISEASE GUIDELINE ADHERENCE AND STATIN USE IN LONGSTANDING TYPE 1
DIABETES: RESULTS FROM THE CANADIAN STUDY OF LONGEVITY IN DIABETES COHORT
10
ABSTRACTS
BS-01
SUPPRESSION OF RNA-DNA HYBRIDS – TOWARDS A NOVEL AND
COHERENT MECHANISM GOVERNING REPETITIVE DNA STABILITY,
AGING, AND NEURODEGENERATION
K.J. Abraham1, J. Salvi1, J.N. Chan1, K. Szafranski1, A. Hall1, E. Vidya1,
R.Guo1, L. Ostrowski1 & K. Mekhail.1
1.
Department of Laboratory Medicine and Pathobiology, University of Toronto,
Toronto, ON.
Some of the most critical processes impacting human aging were discovered
initially in yeast cells. This includes the discovery that increasing instability in
repetitive DNA regions like ribosomal DNA (rDNA) and telomeres is a major
driver of natural aging and age-associated disease. Here, we combine yeast
genetics with innovative approaches (CRISPR-Cas, chromatin-RNA IP,
confocal microscopy) in human cells to uncover a completely new mechanism
governing repetitive DNA stability. We show that non-coding RNAs emerging
from rDNA/telomeres can get ‘stuck’ on to DNA itself, forming DNA-damaging
structures called RNA-DNA hybrids (i.e. R-loops). Importantly, an evolutionarily
conserved RNA binding protein called ATXN2 localizes to rDNA, suppresses
RNA-DNA hybrids, and preserves DNA stability and lifespan in both yeast and
human cells. Intriguingly, polyglutamine expansion mutations in ATXN2 are
found in patients with amyotrophic lateral sclerosis and a related disease called
spinocerebellar ataxia type 2. Indeed, cells engineered with
neurodegeneration-linked ATXN2-mutations age prematurely, are burdened
excessively with RNA-DNA hybrids, and accrue widespread genomic defects.
We report additionally that a specific environmental intervention called caloric
restriction can hyperactivate endogenous hybrid-suppressing proteins
(RNaseH1 and Pif1) and thereby rescue genomic and aging defects
associated with ATXN2 loss/mutations. We propose that RNA-DNA hybrid
accumulation associated with ATXN2 defects drives repeat and genomic
instability and represents a putative pathogenic mechanism in ATXN2-linked
neurodegenerative diseases. Our discoveries yield important insights into the
biology and potential treatment of a wide spectrum diseases linked to DNA
instability and aberrant genome dynamics downstream of RNA-DNA hybrid
accumulation.
BS-03
ATHLETIC RELATED VISUOMOTOR STRATEGIES FOR NAVIGATING
OPEN SPACE
C. Baker MSc1, 2, J. Campos PhD2, M. Cinelli PhD1
1. Kinesiology, Wilfrid Laurier University
2. CEAL iDAPT, Toronto Rehabilitation Institute
BS-02
CLATHRIN-DEPENDENT ENTRY AND VESICLE-MEDIATED
EXOCYTOSIS DEFINE INSULIN TRANSCYTOSIS ACROSS
MICROVASCULAR ENDOTHEILAL CELLS
P. M. Azizi1,2, R. Zyla1, S. Guan1,2, C. Wang1, S. Bolz1, B. Heit3, A. Klip2, W.
L. Lee1
5
1
Keenan Research Centre, St. Michael’s Hospital, Toronto;2Programme in
Cell Biology, Hospital for Sick Children, Toronto; 3Department of Microbiology
& Immunology, The University of Western Ontario, London, Ontario – all in
Canada.
Before insulin can reach its target tissues it must cross the micovasculature, a
process which has been shown to be rate-limiting in insulin action. Most
evidence to date suggests that the major route by which insulin is transported
across the endothelium is through individual cells (transcytosis); however, little
is known about how this is regulated due to technical limitations. We devised
a novel method of studying insulin transcytosis across live human adipose
microvascular endothelial cells (HAMECs) using total internal reflection
fluorescence microscopy. We show that insulin transcytosis is dynamindependent as treatment with Dyngo 4a ablated insulin uptake and transcytosis.
Intriguingly, insulin transcytosis was unaffected by cholesterol depletion by
methyl-β-cyclodextrin or nystatin. Moreover, caveolin-1 depletion by siRNA
had no effect and there was little colocalization of insulin with caveolin-1 by
immunofluorescence. Instead, interfering with clathrin-mediated endocytosis
with Pitstop 2 or siRNA to clathrin heavy chain significantly impaired
transcytosis. Insulin also colocalized with clathrin-heavy chain by
immunofluorescence. Together, these data indicate that insulin transcytosis in
HAMECs is clathrin-dependent, in contrast to what has been reported
previously for insulin uptake in macrovascular endothelial cells. Elucidating the
mechanisms of insulin transcytosis may identify novel targets for insulin
resistance.
BS-04
ROBUST EFFECTS OF GENETIC BACKGROUND ON RESPONSES TO
SUBARACHNOID HEMORRHAGE IN MICE
J. A. D'Abbondanza, M.Sc.1,2,3,4, J. Ai, M.D., Ph.D.1,2,3, E. Lass1,2,3, B.Sc. 1,2,3,
H. Wan, B.Sc. 1,2,3, S. Brathwaite, B.Sc. 1,2,3,6, M. K. Tso, M.D.1,2,3,4, C. K.
Lee1,2,3, P. A. Marsden, M.D. 3,4,5, R. L. Macdonald, M.D., Ph.D.1,2,3,4,6,7
Division of Neurosurgery, St. Michael’s Hospital, 2Labatt Family Centre of
Excellence in Brain Injury and Trauma Research, 3Keenan Research Centre
for Biomedical Science and the Li Ka Shing Knowledge Institute of St.
Michael's Hospital, 4Institute of Medical Science, 5Department of Laboratory
Medicine and Pathobiology, 6Department of Physiology and 7Department of
Surgery, University of Toronto, Toronto, ON, Canada
1
INTRODUCTION Specifically trained athletes have been identified as
demonstrating more efficient perception-action integration in discrete motor
tasks related to their sport. Yet, whether these abilities translate to the
continuous motor task of obstacle avoidance in open space is unknown.
Purpose: To identify nuances of athletes specifically trained in navigating in
open space compared to age-matched, non-athletes. It was hypothesized that
athletes would demonstrate more efficient gaze fixations through fewer, longer
fixations and would employ more efficient navigation strategies than nonathletes by maintaining their straight trajectory toward the goal. METHODS
Female non-athletes (N=12, age=21.4±1.13) and female athletes (N=12,
age=21.4±.97; >250 hours of training) participated. Individuals walked toward
a goal and were asked to avoid colliding with two vertical obstacles that created
a body-scaled gap (0.9-1.7x individual shoulder width), at one of three obstacle
distances (3m, 5m, 7m from start). Gaze behaviours (ASL Mobile Eye) and
navigation strategies (anterior-posterior and medial-lateral trunk center of
mass kinematics, NDI Optotrak) were obtained. RESULTS Athletes were
found to make fewer, longer fixations (i.e., more efficient strategy) than nonathletes (p<.05). However, no differences were observed between pathways
selected of the two groups, nor were any kinematic measures different
between the groups. It can be concluded that athletes and non-athletes
differentially obtain visual information to perform the same actions, which may
be attributable to an increase in cognitive load required by the non-athletes.
CONCLUSION The findings of this study suggest that although navigation
strategies did not differ between specifically trained athletes and non-athletes,
attentional demands of this task likely did. Such findings add to the
understanding that sport-specific training influences perception-action
integration, through our understanding of how athletes obtain visual
information to perform actions.
BACKGROUND: Outcome varies among patients with subarachnoid
hemorrhage (SAH) but known prognostic factors explain only a small portion
of the variation in outcome. OBJECTIVE: We hypothesized that individual
genetic variations influence brain and vascular responses to SAH and
investigated this using inbred strains of mice. METHODS: SAH was induced
in 7 inbred and a chromosome 7 substitution strain of mouse. Cerebral blood
flow (CBF), vasospasm of the middle cerebral artery (MCA) and brain injury
were assessed. Changes in gene expression after SAH across 5 selected
strains were assessed using microarray. RESULTS: 48 hours after SAH, mice
showed significant MCA vasospasm that correlated positively with reduction in
CBF at 45 minutes. Mice also had increased neuronal injury compared to sham
controls; A/J and C57BL/6J strains represented the most and least severe,
respectively. However, brain injury did not correlate with CBF reduction at 45
minutes or with vasospasm at 48 hours. Chromosome 7 substitution did not
influence the degree of vasospasm or brain injury. Lyz2, Hmox1, and Lgals3
genes showed a greater than 1.5-fold increase across strains after SAH.
DISCUSSION: Our data suggested that mouse genetic background influences
outcome of SAH. Investigations into the genetic factors causing these interstrain differences may provide insight into the etiology of the brain damage
following SAH. These findings also have implications for animal modeling of
disease, and suggest that genetic differences may also modulate outcome in
other cardiovascular diseases.
11
ABSTRACTS
BS-05
DISCOVERY OF HIDDEN CLINICAL AND METABOLIC GENETIC
SYNDROMES IN NEUROPSYCHIATRIC PATIENTS
A. Cozma,1,2, S. Wasim 2, J. Silver 2, J. Murphy 2, H. Faghfoury 2, and J. So 2
1
MD Program, University of Toronto, Toronto, Ontario, Canada 2 Fred A. Litwin
Family Centre in Genetic Medicine, University Health Network, Toronto,
Ontario, Canada
BACKGROUND: More than 6.7 million Canadians are living with a mental health
problem or mental illness – three times as many living with type 2 diabetes and five
times as many as living with heart disease. An emerging body of evidence has shown
that many rare genetic disorders may present with psychiatric features that are
indistinguishable from primary psychiatric disorders. As a result of this similarity,
underlying genetic disorders may be masked, and evade appropriate treatment. If
even a fraction of the psychiatric population is found to be affected by co-occurring
genetic conditions, and if these conditions are treatable, there exists the potential for
immense benefit to the health of these individuals, with significant cost savings to the
healthcare system. OBJECTIVES: We aim to identify and determine the prevalence
of underlying genetic conditions within the psychiatric population in order to (1)
establish a clinical database of phenotypic correlates to delineate the highest-yield
data that lead to the most effective and efficient diagnosis of genetic syndromes in
patients with psychiatric disorders, and in particular the dual diagnosis (psychiatric +
intellectual disability) population, which suffers from significant stigma and barriers
to access to care and to (2) delineate novel adult phenotypes associated with known
genetic syndromes. METHODS: We analyzed the medical and family history data
collected from individuals with psychiatric conditions and other medical findings
suggesting co-occurring genetic disorder. Statistical analysis using SPSS software
will be used to: conduct correlation analyses between genetic test results and
phenotypic data in order to identify phenotypic “red flags” or markers that will
increase efficiency of genetic diagnosis for psychiatric patients. RESULTS: Our
preliminary results show that certain neurodevelopmental phenotypic markers
increase the likelihood of a psychiatric patient having an underlying genetic
disorders. FUTURE DIRECTIONS: We are in the process of compiling a screening
algorithm based on the results of the present study in order to help guide physicians
in determining when to suspect an underlying genetic condition in a patient
presenting with mental illness.
BS-06
UV RADIATION RESISTANCE PROTEIN (UVRAG) DELETION IN
PANCREATIC ISLET CELLS PROTECTS AGINST HIGH FAT DIET
INDUCED DIABETES
D.W. Dodington1, S.A. Schroer-McFarland2, T. Sivasubramaniyam2,3, Y.
Park2, and M. Woo2,3,4
1
MD Program, University of Toronto, Toronto, Canada 2Toronto General
Research Institute; Toronto, Canada 3Institute of Medical Science; University
of Toronto; Toronto, Canada 4Division of Endocrinology; Department of
Medicine; Toronto General Hospital; University Health Network; Toronto,
Canada
INTRODUCTION: Diabetes mellitus is a chronic condition that affects over 2.4
million Canadians and is a significant risk factor for cardiovascular disease,
renal disease and cancer. Autophagy is an intracellular self-degradation
system that maintains homeostasis in response to nutrient availability and is
hypothesized to play a role in the pathogenesis of diabetes. UV radiation
resistance protein (UVRAG) is a novel protein involved in autophagy and has
distinct roles in various tissues, however the specific role of UVRAG in
pancreatic islet cells and its relationship to the pathogenesis of diabetes has
yet to be investigated. OBJECTIVE: To elucidate the role of UVRAG in
pancreatic islet cells in the maintenance of glucose homeostasis under
conditions of metabolic stress. METHODS: Mice with pancreatic islet cellspecific knockout (KO) of UVRAG were generated by breeding mice with the
UVRAG gene flanked by loxP sites to mice expressing Cre under the control
of the pancreatic and duodenal homeobox 1 (Pdx1) promoter. Mice were
placed a high fat diet (HFD) beginning at 6 weeks of age. RESULTS: KO mice
gained significantly less weight compared to littermate controls, which was
associated with an increase in energy expenditure, measured by oxygen
consumption over 24 hours, with no difference in food intake or physical
activity. After 4 months of HFD, KO displayed decreased glucose excursion in
response to an intraperitoneal glucose tolerance test indicating that the KO
mice were more glucose tolerant compared to littermate controls.
CONCLUSION: Deletion of UVRAG in pancreatic islet cells protects against
HFD-induced obesity and diabetes. UVRAG may be a novel therapeutic target
for treatment of these conditions.
BS-07
COMPARISON OF QUANTITATIVE CEREBRAL BLOOD FLOW
BETWEEN BOOKEND AND PSEUDO-CONTINUOUS ARTERIAL SPIN
LABELLING IN RELAPSING REMITTING MULTIPLE SCLEROSIS
R. M. D’Ortenzio2, P. Hojjat1, R. Vitorino1, C.G. Cantrell3, L. Lee2, A.
Feinstein1,2, P. O’Connor2, T. Carroll3, R. I. Aviv1,2
BS-08
MAGNETIC-RESONANCE GUIDED HIGH-INTENSITY FOCUSED
ULTRASOUND TREATMENT IN A MURINE MODEL OF
NEUROBLASTOMA
C. Dziegielewski1,2, K. Piorkowska3, A. C. Waspe3, S. Pichardo3, L. Zhang4,
J. Drake3, S. Baruchel4, and J. T. Gerstle2
1. Sunnybrook Health Sciences Centre
2. University of Toronto 27 King's College Circle, Toronto, Ontario, M5S 1A1.
3. Department of Biomedical Engineering and Radiology, Northwestern
University, Chicago, Illinois 60611, USA
1
MD Program, University of Toronto, Toronto, ON, Canada 2Department of
General Surgery, The Hospital for Sick Children, Toronto, ON, Canada
3
Centre for Image Guided Innovation and Therapeutic Intervention, The
Hospital for Sick Children, Toronto, ON, Canada and 4Department of
Haematology and Oncology, The Hospital for Sick Children, Toronto, ON,
Canada
Background and Purpose: Quantitative CBF usage as a biomarker for
cognitive impairment and disease progression in MS is potentially a powerful
tool for longitudinal patient monitoring. Dynamic Susceptibility contrast
perfusion with Bookend T1-calibration (Bookend Technique) and pseudocontinuous Arterial Spin Labeling have recently been used for CBF
quantification in relapsing-remitting MS. The non-invasive nature of pseudocontinuous Arterial Spin Labeling is potentially advantageous over gadoliniumbased techniques in relapsing-remitting MS but correlation between the
techniques is not well established. Materials and Methods: We compared
pseudo-continuous Arterial Spin Labeling CBF to the Bookend technique in a
prospective cohort of 20 healthy controls, 19 relapsing-remitting MS subjects
without cognitive impairment and 19 relapsing-remitting MS subjects with
cognitive impairment on a voxel-wise and Brodmann regional basis. Linear
Pearson correlation, SNR and coefficient of variation were tested. Results:
Voxel-wise paired T-tests revealed no significant CBF differences between
techniques. Highest Pearson correlations were observed in deep GM
structures (average r = 0.69 basal ganglia, and r = 0.63 thalamus) but remained
robust for cortical GM and WM (average r = 0.53 each). Brodmann regional
correlations were significant for all groups. All correlations were maintained in
healthy controls and in RRMS disease. Highest SNR was present in Bookend
perfusion while the highest coefficient of variation was present in WM.
Conclusion: Agreement between pseudo-continuous Arterial Spin Labeling
and Bookend technique CBF measurements is demonstrated in healthy
controls and relapsing-remitting MS patients, supporting the potential use of
pseudo-continuous Arterial Spin Labeling CBF as a potential non-invasive
biomarker of relapsing-remitting MS patients
12
INTRODUCTION: Neuroblastoma is the most common solid extracranial
tumour in children, accounting for 6% of childhood cancers. It primarily occurs
in the adrenal glands. High-risk neuroblastoma is associated with survival rates
below 40% with standard treatments of surgery, chemotherapy, and radiation.
Magnetic resonance-guided high intensity focused ultrasound (MRgHIFU)
non-invasively focuses ultrasound energy to a specific target in the body, which
raises tissue temperature to >57°C, resulting in necrosis. MRgHIFU may
represent a more effective therapeutic approach for high-risk neuroblastoma.
OBJECTIVE: This study investigated whether HIFU can ablate tumour tissue
in a murine model of neuroblastoma. METHODS: Six SCID mice (n=4
treatment, n=2 control) were subcutaneously injected with CHLA-15
neuroblastoma cells to form a tumour. Once tumours reached 1.5 cm in
diameter, T1-weighted imaging was used to visualize tumours for treatment
planning. MRgHIFU energy was applied to targets continuously for 10-15 s and
monitored with thermometry in real-time. Animals were euthanized, and tissue
viability was assessed using H&E histological analysis. RESULTS: Tumours
can be visualized and targeted using MRgHIFU imaging. Treatment
parameters of 1.15 MHz, 15-50 W, for 10-15 s raised tumour tissue
temperatures to >58°C in treatment mice, correlating to tissue necrosis.
Histological analysis did not confirm significantly necrotic tumour tissue.
CONCLUSION: HIFU may be used to treat high-risk neuroblastoma, although
whether tumour tissue ablation can be achieved remains inconclusive. Further
research is required before clinical translation is possible.
ABSTRACTS
BS-09
INVESTIGATING THE MECHANISMS MEDIATING IMPROVED
OUTCOMES OF S-NITROSOGLUTATHIONE REDUCTASE (GSNOR)
NULL MICE IN EXPERIMENTAL CEREBRAL MALARIA
R. E. Elphinstone1, E. Shikatani1, M. Husain1, J. S. Stamler2, and K. C. Kain1
BS-10
INTERMITTENT ACCESS TO PALATABLE FOODS IN AN ANIMAL
MODEL: A COMPARISON OF SUGAR, FAT AND SUGAR-FAT DIETS IN
ADOLESCENT MALE AND FEMALE RATS
T. Felfeli1 and C. M. Tenk2
1
University Health Network, Department of Laboratory Medicine and
Pathobiology, University of Toronto, 2Institute of Transformative Molecular
Medicine, Harrington Discovery Institute, Case Western Reserve University
and University Hospitals
Schulich School of Medicine and Dentistry, Department of Physiology and
Pharmacology, Western University. London, ON1
Department of Psychology, Western University, London, ON1,2
Department of Psychology, Brescia University College, London, ON2
INTRODUCTION: Severe malaria is associated with decreased nitric oxide
(NO) bioavailability. S-nitrosoglutatione reductase (GSNOR) knockout (KO)
mice have increased bioavailable nitric oxide (NO) due to increased levels of
S-nitrosothiols (SNOs). We have previously shown that they have improved
survival from experimental cerebral malaria (ECM). OBJECTIVE: To
investigate potential mediators of the improved outcomes to ECM in the
GSNOR KO animals. METHODS/RESULTS: GSNOR KO animals had higher
pro-inflammatory markers, including IFN-ɣ and TNF, throughout the course of
infection suggesting that the GSNOR KO mice have altered immune
responses. In order to evaluate the role the hematopoietic compartment,
specifically T cells, in mediating improved outcomes for the GSNOR KO mice,
bone marrow transplants were performed. KO animals were irradiated and
given bone marrow from either a GSNOR KO or WT donor. After 8 weeks of
recovery, the animals were infected and followed for survival.
GSNOR KO animals receiving WT bone marrow succumbed to infection
significantly earlier than animals receiving KO bone marrow (p=0.005),
suggesting an important role for the hematopoietic compartment. In order to
confirm these findings a reciprocal transplant was performed. WT animals
receiving either KO or WT bone marrow had similar survival (p=0.978).
However, further analysis showed that the animals receiving KO bone marrow
had poor T cell reconstitution, with the majority of the T cells still being recipient
derived (WT). CONCLUSION: GSNOR KO T cells appear to be the primary
mediators of improved outcomes to ECM. This suggests that interventions that
target GSNOR function, such as GSNOR inhibitors currently in Phase 1 clinical
trials, may improve outcomes from severe malaria.
INTRODUCTION: Intermittent overconsumption of food has been linked with
obesity and its presence in several eating disorders makes it the most common
eating disturbance. These eating behaviours arise from complex interactions
between societal, psychological as well as homeostatic and hedonic
physiological brain mechanisms.
In humans, most intermittent
overconsumption consists of highly palatable foods that are rich in sugar, fat
or both. In animal models, intermittent access to the same palatable foods has
been used to effectively elicit intermittent overconsumption of food. However,
a clear distinction in food overconsumption in response to foods high in sugar,
fat and sweet-fat as well as associated sex differences has yet to be
established. OBJECTIVE: Compare intermittent overconsumption behaviour
elicited by palatable foods in non-food-deprived adolescent male and female
Long-Evans rats. METHODS: Rats were given 2hr access to one of four diets
(sugar, fat, sugar-fat, or standard lab chow) three times per week for five
weeks. Consumption of intermittently available food, as well as freely available
lab chow was examined. RESULTS: Access to a sweet-fat diet led to
discernable calorie overload in a restricted two-hour period, which highlights
the pronounced palatability of a sugar and fat combination in this animal model.
Taken together, these results lend support to the unique macronutrient
combination, texture and reward pathways associated with sweet-fat foods.
Sex dimorphisms in eating behaviour were also observed in the current study
where females displayed greater susceptibility to palatable food consumption
and caloric overload. CONCLUSIONS: These data will be critical for future
investigations examining the underlying neural circuitry of intermittent
overconsumption behaviours, and the ultimate understanding of disordered
eating in humans.
BS-11
GOLD NANOPARTICLES WITH SURFACE ENHANCED RAMAN
SCATTERING CAPABILITY FOR THE DETECTION AND TREATMENT OF
GLIOBLASTOMA TUMOURS
C. A. Figueiredo1,2, D. Coluccia2, A. Luck2 , C. A. Smith2, J. T. Rutka1,2
BS-12
GLUTAMATE INCREASES SURVIVAL AND PROLIFERATION AND
ATTENUATES OXIDATIVE STRESS-INDUCED CELL DEATH IN ADULT
SPINAL CORD-DERIVED NEURAL STEM/PROGENITOR CELLS
L. D. Hachem1, A. J. Mothe1, C. H. Tator 1,2
1
Laboratory Medicine and Pathobiology, University of Toronto, Toronto,
Canada
2
Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto,
Canada
1
Krembil Neuroscience Centre, Toronto Western Hospital, University Health
Network
2
Department of Surgery, Division of Neurosurgery, University of Toronto
INTRODUCTION: Glioblastoma multiforme (GBM) is the most common and
lethal form of primary brain tumour, categorized by the WHO as a grade IV
glioma. Median survival time following diagnosis is approximately 12-15
months, even after aggressive treatment. Given the infiltrative properties of
GBM, neuro-oncologists have been faced with a number of challenges with
regards to access and visualization of tumour tissue for adequate resection.
Novel strategies to visualize and target the cells responsible for metastatic
recurrence of GBM is urgently needed. HYPOTHESIS: Surface enhanced
Raman scattering (SERS) gold nanoparticles (GNPs) can be specifically
targeted towards GBM tumours in vivo. Furthermore, the addition of
therapeutic moieties on the surface of these nanoparticles will provide methods
to control tumour growth and proliferation. METHODS/RESULTS: SERS
GNPs allow for easy in vitro detection within U87 and U251 glioma tumour cell
populations. In tumour bearing mice, i.v. injection of GNPs enabled Raman
mapping of tumour areas. We also examined erlotinib-GNP conjugates
considering that erlotinib contains a C≡C peak. Erlotinib-GNP shows an
enhanced effect in inhibiting U251 proliferation as opposed to the drug alone.
Additionally, we were able to identify the C≡C peak and imaged GNPs within
the cell. CONCLUSION: We demonstrate unique techniques to study GBM
tumours in the realm of nanoneurosurgery. Functionalized GNPs in conjunction
with Raman spectroscopy will help identify, image and target tumours cells in
microscopic regions, enhancing our capabilities to combat brain tumours
without causing excessive damage to normal functioning tissue. This system
shows promise for clinical implementation as a strategy to ensure maximum
resection of the tumour margin, while also targeting cancer cells to prevent
further GBM recurrence and improving patient outcome.
INTRODUCTION: Traumatic spinal cord injury (SCI) leads to a cascade of
secondary chemical insults including oxidative stress and glutamate
excitotoxicity which damage host neurons and glia. Transplantation of
exogenous neural stem/progenitor cells (NSPCs) has shown promise in
enhancing regeneration after SCI however graft survival remains poor.
Understanding the response of NSPCs to the chemical mediators of secondary
injury is essential for finding therapies to enhance survival of transplanted cells.
We examined the effects of glutamate on adult spinal cord-derived NSPCs
both alone and in the setting of oxidative stress. METHODS: NSPCs isolated
from the central canal region of the adult rat spinal cord were exposed to
glutamate (0-1000uM) in vitro. Oxidative stress was induced using 500uM
H2O2. Glutamate receptor-specific antagonists and agonists were used to
elucidate the mechanisms by which glutamate acts on NSPCs. RESULTS:
Treatment with glutamate (500uM) for 96h significantly increased live cell
numbers, reduced cell death and increased proliferation. Concurrent glutamate
treatment in the setting of H2O2 exposure enhanced cell viability compared to
H2O2 exposure alone. These effects were blocked by AMPA/kainate receptor
antagonism but not by NMDA receptor or metabotropic mGluR3 antagonists.
Furthermore, treatment with AMPA, kainic acid or the kainate specific agonist
ATPA mimicked the responses seen with glutamate both alone and in the
setting of oxidative stress. CONCLUSION: Glutamate increases survival,
proliferation and attenuates oxidative stress-induced cell death in adult NSPCs
via AMPA/kainate receptors. These findings offer new insights into
mechanisms to enhance NSPC survival and implicate a potential role for
glutamate in enhancing NSPC survival and proliferation after traumatic SCI.
13
ABSTRACTS
BS-13
VISUALIZING THE OUTCOME OF VIRAL ENCEPHALITIS IN LRRK2
MUTANT MICE: A ROLE FOR LRRK2 IN MICROBIAL SUSCEPTIBILITY
OR HOST RESPONSE
I.E. Harmsen1,3, M. Hakimi2,3, J. Majithia2, J.J. Tomlinson3, E. Brown2,3, M.G.
Schlossmacher2,3
1
Faculty of Science, University of Ottawa, Ottawa, Canada. 2Faculty of
Medicine, University of Ottawa, Ottawa, Canada. 3Program in Neuroscience,
Ottawa Hospital Research Institute, Ottawa, Canada.
BS-14
MONITORING MYELOID-DERIVED SUPPRESSOR CELLS IN THE
PERIPHERAL BLOOD OF CANCER PATIENTS
E. Helson1, V. Sotov2,3, V. Motta2,3, D. Gray2,3, S. Hansra2,3, S. Sharafi2,3, N.
Hirano2,3, and M. Butler2,3
1
Faculty of Medicine, and 2Department of Immunology, University of Toronto,
ON
3
Department of Ontario Cancer Institute, Princess Margaret Cancer Centre,
Toronto, ON
OBJECTIVE: Leucine-rich repeat kinase-2 (LRRK2) has been implicated in
modulating the risk of Parkinson’s, Crohn’s disease and leprosy. A proposed
LRRK2 function lies within the innate immune system. To better study its role
in complex diseases, we employed a recently described infection model using
a neurotropic, respiratory-enteric-orphan (REO) virus, serotype-3-Dearing
(Gauvin et al., 2013). We hypothesized that LRRK2 modulates disease
severity. METHODS: After nasal administration of REO-virus to suckling lrrk2
knock-out mice and wild-type littermates (Tong et al., 2009), we used
holocranomicroscopy (ie, whole skull mounts) to monitor infection from rhinitis
to terminal encephalitis. To probe for genotypic differences, we quantified antiREO antibody positivity by Aperio-ImageScope software examining serial, 4
micrometer-thin sections. We juxtaposed these data with available viral titres
of select organs. RESULTS: The rate of neuronal infection at the time of
euthanasia (day 10 post inoculation) was higher in knock- out mice for four
regions examined. Mean percentage counts for anti-REO antibody-positive
neurons in knock-out (versus wild-type) mice of cortex, thalamus, midbrain,
and pons/medulla measured 0.234(0.029), 7.467(0.229), 4.118(0.172), and
1.391(0.112), respectively; corresponding p-values for the differences were
calculated at 0.005, 0.001, 0.003, and 0.031, respectively. These
neuropathological results were associated with preliminary findings of higher
viral titres systemically in the liver, lungs and brain of knock-out (versus wildtype) mice three days post inoculation. CONCLUSIONS: Infection of lrrk2
knock-out mice with a virulent REO virus, as monitored by whole skull mounts
and automated analysis, showed significantly greater rates of neuronal
infection in the cortex, thalamus, midbrain and pons/medulla when compared
to wild-type animals. We conclude that LRRK2 likely modulates host
susceptibility and/or response after nasal exposure to a neurotropic pathogen.
INTRODUCTION: Myeloid derived suppressor cells (MDSCs) are an immature
heterogeneous cell population that have a variety of suppressive functions and
are reported to correlate with tumor burden and poor prognosis in cancer
patients. Unlike in mice, MDSC research methodology and MDSC phenotype
in humans is unclear and inconsistent. Many combinations of cellular markers
have been proposed to identify monocytic-MDSC (M-MDSC) and granulocyticMDSC (G-MDSC) subpopulations including lineage markers (CD3, CD19,
CD56), HLA-DR, CD33, CD11b, CD14, CD15, and CD16 amongst others.
OBJECTIVE: Design and establish experimental protocols to analyze MDSCs
in the peripheral blood of patients receiving cancer treatments. METHODS:
Reviewed recent literature for different methods of analyzing and
phenotypically defining MDSCs. Healthy donors’ and cancer patients’ blood
was then drawn and analyzed for MDSC markers using either whole blood or
isolated PBMCs. Peripheral blood from healthy donors was compared to one
patient, CCP142 (pre-treatment), suspected of having high MDSCs based on
clinical presentation (elevated white blood cell count and high tumor burden)
and was stained and analyzed by flow cytometry for MDSC markers.
RESULTS: Based on recent literature and control experiments, fresh whole
blood was the preferred methodology for analyzing MDSCs in patients. MMDSCs
were
defined
as
Lin(CD3/CD19/CD56)-,HLA-DR,CD33+,CD11b+,CD14+ and G-MDSCs were defined as Lin-,HLA-DR,CD33+,CD11b+,CD14-,CD15+,CD16-. Healthy donors had on average 0.75%
(+/- 1.06% SD) M-MDSCs and 0.10% (+/- 0.12% SD) G-MDSCs while patient
CCP142 had a higher proportion of M-MDSCs (4.16%) and G-MDSCs (4.89%).
CONCLUSIONS: We are now ready to monitor MDSCs in patient blood
samples throughout their respective treatment regimens.
BS-15
INVESTIGATION OF FAM83A AS A NOVEL MODIFIER OF THE TP53
PHENOTYPE IN LI-FRAUMENI SYNDROME
J. Himelfarb1, N. Samuel1, D. Malkin1,2,3
BS-16
HUMAN GLOBUS PALLIDUS PARS INTERNA NEURONS SIGNAL
REWARD AND SENSORY STIMULI
N. A. Howella,b,c, I. A. Prescottb,d, A.M. Lozanob,e, M. Hodaiea,b,e, V. Voonc*,
W. D. Hutchisona,b,d,e*
1
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
Program in Genetics and Genome Biology, The Hospital for Sick Children,
Toronto, Ontario, Canada
3
Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
2
BACKGROUND: Li-Fraumeni Syndrome (LFS) is a highly penetrant cancer
predisposition syndrome associated with the development of a wide range of
cancers. Over 80% of cases of LFS can be linked to the inheritance of a
mutated copy of the TP53 tumour suppressor gene. To uncover the epigenetic
modifications that play a role in transformation of normal cells of LFS patients,
investigations have been done to compare methylation of CpG sites between
TP53 mutant carriers and individuals with wild-type TP53. These findings
reveal several genes that are significantly differentially methylated within LFS
patients. One of the most significant genes uncovered was FAM83A, which
was found to be hypomethylated in patients harboring germline TP53
mutations. OBJECTIVE: Examine the role of FAM83A on cell proliferation and
metabolism of LFS-derived fibroblasts. METHODS: Primary LFS patientderived fibroblast cell lines were cultured (n=4), each containing unique
germline TP53 mutations. For each line, knockdowns were prepared by
introducing a lentivirus containing shRNA for FAM83A. These knockdowns
were then compared to non-silencing controls through colony forming assays
(CFAs) and cell proliferation assays (MTS). RESULTS: MTS Assays revealed
that fibroblasts with a FAM83A knockdown resulted in a significant increase in
the metabolic activity across all cell lines examined. Further, results from
colony forming assays show significant increases in proliferative potential of
FAM83A knockdown cells. CONCLUSION: These results may suggest a role
for FAM83A as a tumor suppressor in the context of non-transformed cells
derived from TP53 deficient patients. Further investigation is needed regarding
the behavior of FAM83A in TP53 insufficient patients. Specifically it’s role in
major molecular pathways including pathways of apoptosis and cell cycle
control.
14
a
Institute of Medical Science, Faculty of Medicine, University of Toronto, 1
King’s College Circle, Toronto, Ontario, M5S1A8, Canada
Division of Brain Imaging & Behaviour - Systems Neuroscience, Toronto
Western Research Institute, University Health Network, 399 Bathurst Street,
Toronto, Ontario, M5T 2S8, Canada
c
Department of Psychiatry, University of Cambridge, Herchel Smith Building
for Brain & Mind Sciences, Cambridge, CB2 0SZ, UK
d
Department of Physiology, Faculty of Medicine, University of Toronto, 1
King’s College Circle, Toronto, Ontario, M5S 1A8, Canada
e
Division of Neurosurgery, Department of Surgery, Krembil Neuroscience
Center, University of Toronto, 399 Bathurst Street, Toronto, Ontario, M5T
2S8, Canada
*These authors contributed equally to the work.
b
The globus pallidus pars interna (GPi) is a component of the basal ganglia, a
network of subcortical nuclei that process motor, associative, and limbic
information. While primate studies have suggested a role for the GPi in nonmotor functions, there have been no studies of the single-cell non-motor
electrophysiological behavior of human GPi neurons. We therefore sought to
extend these findings by collecting single-unit recordings from awake surgical
patients during functional neurosurgery targeting the GPi. To assess cellular
responses to non-motor information, patients performed a reward task where
virtual money could be won, lost, or neither depending on their performance
while cellular activity was monitored. Changes in the firing rates of isolated GPi
neurons after the presentation of reward-related stimuli were compared
between different reward contingencies (win, loss, null). We observed neurons
that modulated their firing rate significantly to the presentation of rewardrelated stimuli. We furthermore found neurons that responded to visual-stimuli
more broadly. This is the first single-unit evidence of human GPi neurons
carrying non-motor information. These results are broadly consistent with
previous findings in the animal literature and suggest non-motor information
may be represented in the single-unit activity of human GPi neurons.
ABSTRACTS
BS-17
DEFINING THE SAFE LIMITS OF FORCE IN LAPAROSCOPIC SURGERY
BY USING A NOVEL SENSORIZED BABCOCK GRASPER
A. Khan1,2, C. Streutker3, J. Drake4, T. Grantcharov5
BS-18
CHARACTERIZING THE ROLE OF PROTEIN TYROSINE KINASE 7
(PTK7) IN CANCER DEVELOPMENT AND CELLULAR FITNESS
S. Kumar1,2, A. Uetrecht1, J. Moffat1
1. Faculty of Medicine - MD/PhD Program, University of Toronto, Toronto, ON
2. Institute of Biomaterials and Biomedical Engineering, University of Toronto,
Toronto, ON
3. Division of Surgical Pathology, St. Michael’s Hospital, Toronto, ON
4. Division of Neurosurgery, Hospital for Sick Children, Toronto, ON
5. Division of General Surgery, St. Michael’s Hospital, Toronto, ON
1
BACKGROUND: In open surgery, surgeons can manipulate organ tissues
directly with their hands. They gain an implicit understanding of how much force
they should exert with surgical tools to avoid tissue damage. However, this is
not the case in laparoscopic surgery, where surgeons must use awkward, long
instruments instead, that diminishes and skews force feedback to the surgeon.
Understanding the amount of crush force a tissue can take before cellular injury
occurs then is critical in defining the safe limits of tissue compression with
laparoscopic tools. However, this information has not been experimentally
characterized yet, due to the expense and complexity of such an endeavor.
OBJECTIVE: To deduce how much force standard laparoscopic tools can
exert on tissue before cellular damage occurs. This will be experimentally
determined using a novel sensorized Babcock grasper and samples obtained
from the operating room. METHODS: Our study will include 150 tissue
samples from gastrointestinal organs. We will determine how much crushing
force it takes to induce tissue injury. This will be determined by crushing the
excised tissue sample and analyzing it under a microscope. The morphological
changes in the cells of the tissue will be quantified. We have invented a novel
sensorized Babcock grasper and submitted an ethics REB proposal for this
study, which will commence in January 2016. DISCUSSION: At the conclusion
of this study, we will be able to determine how much force can be safely exerted
on each gastrointestinal tissue. This, along with the Babcock grasper we have
invented, can revolutionize how laparoscopic surgery is performed.
BS-19
WHOLE
EXOME
SEQUENCING
IDENTIFIES
NEURODEVELOPMENTAL DISORDER MUTATIONS
a
b
b
A.C. Lionel , C.R. Marshall , S. Walker , S.W. Schererb
a
Faculty of Medicine, University of Toronto,
Genomics, Hospital for Sick Children
b
NOVEL
MD/PhD Program, University of Toronto, Toronto, Canada
Department of Molecular Genetics, University of Toronto, Toronto, Canada
Protein Tyrosine Kinase 7 (PTK7), a catalytically inactive member of the
receptor tyrosine kinase family, has been recently affiliated with the
development and progression of various cancers. Contradictory results about
its expression, localization and processing across various cancer types has left
a major gap in understanding its molecular mechanism and function. The
purpose of this study is to understand the role and mechanism of PTK7
signaling on cancer progression and tumorigenesis. Utilizing large data sets
from essentiality screens and RNAseq, as well as human synthetic antibody
tools, we investigated the role of PTK7 in cellular fitness. A novel cytometric
bead array was engineered to detect soluble PTK7 from cell culture
supernatants. We observed a negative correlation between PTK7 processing
and its degree of essentiality. Furthermore, we demonstrated that the PTK7
intracellular domain (ICD) is integral to its function. Treatment of mouse
xenografts with PTK7 antibodies, capable of blocking PTK7 processing,
inhibited tumour growth in an ICD-expression dependent manner. Lastly,
mRNA profiling of PTK7-knockdown cells and ICD over-expression cells
provided a list of putative downstream gene targets under PTK7 regulation.
Collectively, these findings implicate PTK7 in cellular transformation and
provide insight into its signaling mechanism. Our research establishes PTK7,
and its relative processing, as an important prognostic biomarker for cancer.
Further investigation into the efficacy of PTK7 as a putative therapeutic target
is warranted.
BS-20
LOCALIZATION OF LIGHT IN PLASMONIC AXISYMMETRIC GRADED
GRATINGS
A. X. Lozano1,2, M. Shayegannia1, A. O. Montazeri1, Y. Fang4, K.
Moussakhani1, N. P. Kherani1,3
The Centre for Applied
INTRODUCTION: There is substantial evidence from family and twin studies
for a strong underlying genetic basis to neurodevelopmental disorders such as
autism. Pinpointing the precise genes responsible has proven to be extremely
challenging. In recent years, the study of rare sequence level mutations in the
genomes of patients has proven to be a powerful tool for the identification of
novel genes for further investigation by functional studies. OBJECTIVE: The
objective of this study was to identify new genetic risk loci for
neurodevelopmental disorders through the detection of rare sequence level
mutations. METHODS: The study included 100 patients referred for genetic
testing to the Genome Medicine clinic at the Hospital for Sick Children. DNA
from blood samples was utilized for next generation whole exome sequencing
using the Ion Proton system after exonic amplification with the Ion AmpliSeq
Exome Kit (Life Technologies). Rare variants with a frequency of less than 1%
in population databases were prioritized to search for potential disease
mutations. Further prioritization was done based on disease genes from the
Online Mendelial Inheritance in Man (OMIM) database and manual curation.
RESULTS: We identified rare sequence mutations in the patients that
overlapped previously known disease genes or identified new candidate
genes. Examples of such findings include mutations affecting MED23 in
epileptic encephalopathy, TUBB2A in cortical dysplasia and KCNA1 in episodic
ataxia. We are currently collecting samples from the parents and extended
family of the patients in order to study the inheritance patterns of the mutations
of interest and their potential segregation with elements of phenotype.
CONCLUSION: The findings of this study illustrate the utility of next generation
whole exome sequencing in the discovery of novel genetic mutations in
neurodevelopmental disorders. These results have immediate utility for guiding
diagnosis of the patients and genetic counseling of their families and also shed
new light on the molecular etiologies of neurodevelopmental disorders.
2
1
Department of Electrical & Computer Engineering, University of Toronto,
Toronto, Ontario, Canada, 2Department of Physics, University of Toronto,
Toronto, ON, Canada, 3Department of Materials Science & Engineering,
University of Toronto, Toronto, Ontario, Canada 4Department of Physics, UC
Berkeley, Berkeley, CA, USA
INTRODUCTION: The interaction of polarized light with sub-wavelength
metallic graded-grating structures has the ability to disperse light into its
component frequencies. This results from the coupling of light to the surface
plasmon modes within the gratings. A nano-scale plasmonic grating has
applications as a biosensor and diagnostic tool, as it could act as an in-situ
spectrometer in biological systems. OBJECTIVE: Herein, we propose an
axisymmetric graded plasmonic grading comprising concentric grooves inset
in a metal. The grooves decrease in width as one goes from the edge to the
center of the structure and range from 35nm to 5nm in width. This proposed
variation within an axisymmetric structure greatly improves light trapping
abilities. METHODS: The structures were constructed and simulated in
COMSOL Multiphysics software. They were excited by infrared light, and
trapped light intensity inside of each groove was measured by integrating the
electromagnetic power outflow over the groove area. RESULTS: Upon
excitation with multiple frequencies, the grating spatially resolves the
frequencies by trapping a specific frequency in a corresponding groove.
Furthermore, the results suggest an order of magnitude increase in trapping
intensity between the axisymmetric structure over the analogous rectangular
graded-grating structure. CONCLUSION: A novel axisymmetric plasmonic
structure has been proposed, studied and shown to yield promising properties
in light trapping and spectral decomposition of incident light at sub-wavelength
dimensions. The light trapping properties will enable bio-sensing on a nanoscale, since separation of incident frequencies will allow for the determination
of the spectrum and hence the identity of biomolecules in close proximity.
15
ABSTRACTS
BS-21
INVESTIGATION OF GDNF-EXPRESSING NEURAL PROGENITOR
CELLS FOR REPAIR AND REGENERATION FOLLOWING CERVICAL
SPINAL CORD INJURY.
Mann1,2, M. Khazaei1, N. Nagoshi1, H. Nakashima1, A. Badner1, M.
Fehlings1,3,4
1) Department of Genetics and Development, Toronto Western Research Institute,
University Health Network, Toronto, ON, Canada
2) Faculty of Medicine, University of Toronto, Toronto, ON, Canada
3) Department of Surgery, University of Toronto, Toronto, ON, Canada
4) Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
The discovery of stem cells has revolutionized the development of treatments for
spinal cord injury (SCI). In recent work, our team has demonstrated the potential for
neural precursor cells (NPCs) to promote recovery following thoracic SCI via
remyelination of spared axons. Delivery of Glial Cell Derived Neurotrophic Factor
(GDNF) to the injured spinal cord has been demonstrated to enhance axonal
regeneration and myelination. GDNF is a potent neurotrophic factor that promotes
survival of graft cells by activating several survival signaling pathways and inhibiting
death signals. However, delivery of GDNF in vivo has been hindered by its limited
inability to cross the blood-brain barrier or penetrate gray matter, and by a relatively
short half-life.
To address this limitation we engineered human induced pluripotent stem cell derived
neural precursor cells (iPSC-NPCs) to express GDNF. GDNF-expressing hiPSCNPCs were transplanted into a rodent model of cervical contusion SCI two weeks
post injury. One week following transplantation, the rats underwent neurobehavioural
testing assessment of gait, forelimb and hindlimb function, trunk stability, and
neuropathic pain. Rodent spinal cords also underwent neuroanatomical assessment
for analysis and quantification of lesion volume.
Our data suggests that injured rodents transplanted with GDNF-expressing hiPSCNPCs had enhanced functional recovery compared to controls. This was reflected by
improved gait and forelimb function. Spinal cords of transplanted animals also
revealed decreased lesion cavity size compared to controls.
All together, this data supports GDNF-expressing hiPSC-NPCs as a promising novel
therapy following SCI. By further understanding the ability of GDNF-hiPSC-NPCs to
repair the injured cord, we hope to reveal the potential of stem cell therapies for SCI,
which in turn may guide future therapeutic approaches for SCI and by extension other
BS-23
CONDITIONED PAIN HYPERSENSITIVITY UNIQUE TO MALE MICE: A
NOVEL MODEL FOR PAIN MEMORY
S. Mirali1, L.J. Martin2, E.A. Acland2, J.S. Mogil2
1
2
MD/PhD Program, University of Toronto, Toronto, Ontario, Canada
Department of Psychology, McGill University, Montréal, Québec, Canada Persistent pain conditions are among the most common cause of long-term
disability. Despite its widespread occurrence, treatment options are limited
and an established mechanism remains elusive. The concept of an implicit
pain memory is of increasing interest to researchers because it offers an
alternative approach to understanding the neurobiological pathways
underlying chronic pain. Using the radiant heat withdrawal test in a paradigm
of conditioned hyperalgesia, we found that male, but not female mice
subjected to a noxious pain stimulus developed hypersensitivity when retested in the same context as the noxious pain stimulation. Re-testing thermal
thresholds in a novel environmental context abolished the conditioned
hypersensitivity effect. Further, this type of long-lasting conditioned
hypersensitivity is dependent on testosterone, as castrated mice no longer
demonstrate the effect. Female sex hormones do not play a prominent role
because testing ovariectomized mice did not alter the female response. Here,
we show that pain memory is context-dependent, sex-specific and likely
mediated by testosterone. This finding provides the foundation for further
characterizing the molecular components underlying these sex differences,
and implicating novel drug targets that act in a sex-specific manner on the
source of pain, rather than attenuating sensation.
16
BS-22
INVESTIGATING NEUROCHEMICAL MARKERS OF OXIDATIVE STRESS
IN CIGARETTE SMOKERS
K. Mattina1, N. Sailasuta1, F. Gallant1, D. J. Westwood1, P. Truong1, J.
Tong1, R. Mizrahi1, D. Payer PhD*1, I. Boileau PhD*1
*Co-supervisors
1
Centre for Addiction and Mental Health (CAMH), Toronto, ON
INTRODUCTION: Cigarette smoking might be associated with oxidative stress
and free radical injury in the brain. Rodent models have shown that nicotine
exposure decreases levels of brain glutathione (GSH), the major antioxidant
for detoxification of reactive oxygen species. However, disturbance in brain
GSH has not been extensively assessed in human smokers except for a
preliminary report of decreased GSH in smokers with bipolar disorder.
OBJECTIVE: To measure in-vivo GSH levels in the dorsolateral prefrontal
cortex (DLPFC) of cigarette smokers vs. non-smokers. We hypothesize that
cigarette smokers would have lower GSH levels (added oxidative stress)
relative to non-smokers. METHODS: GSH levels were measured by a recently
developed (at CAMH) 1H magnetic resonance spectroscopy protocol
(optimized modified J-editing MEGA-PRESS) on 3T GE Discovery MR750. 16
healthy non-smoking controls (7M/9F; 34±11 years) and 7 matched cigarette
smokers (4M/3F; 40±13 years) were recruited. RESULTS: There was no
correlation between brain GSH levels and age (r=0.22, p=0.42) or gender
(p=0.31) of the healthy subjects. Relative to non-smokers, levels of GSH
(normalized per creatine) in DLPFC were 2334% greater in smokers although
this difference was not statistically significant (p=0.11, two-tailed t-test).
Interestingly, negative correlations were observed between GSH levels and
self-reported number of cigarettes smoked per day (r=-0.71, p=0.07) and
scores on the Obsessive Compulsive Smoking Scale (r=-0.88, p=0.02).
DISCUSSION: Despite the limited sample size, we suggest that a
compensatory homeostatic GSH response to chronic smoking might explain
the trend for increased GSH values in smokers and that heavy smoking might
compromise this protective mechanism. Further studies with a larger sample
size are warranted to confirm the preliminary findings and to assess whether
GSH can be a relevant biomarker in smoking cessation and a target for
therapeutic development.
BS-24
THE NEURONAL REPELLENT SLIT2 INHIBITS OXLDL UPTAKE AND
FOAM CELL FORMATION IN HUMAN AND MURINE MACROPHAGES.
I. Mukovozov1,2, Y.W. Huang1, G.Y. Liu1, S. Patel1, H.S. Wong1,2, and L.A.
Robinson1,2
a
Cell Biology Program, The Hospital for Sick Children Research Institute,
Toronto, ON
b
Institute of Medical Science, Faculty of Medicine, University of Toronto,
Toronto, ON
BACKGROUND: While the clearance of oxidized low-density lipoproteins (oxLDL)
by macrophages is initially beneficial, excessive accumulation results in cholesterolladen foam cells that drive disease pathogenesis. The uptake of oxLDL is mediated
predominantly by the scavenger receptor CD36 and requires dynamic actin
reorganization driven by Rac GTPases. However, external signals that regulate this
process remain elusive. The Slit family of secreted proteins inhibit cell migration, in
part by inactivating Rac and blocking dynamic actin rearrangement. PURPOSE: To
investigate the role of Slit2 in oxLDL-mediated foam cell formation in human and
murine macrophages. HYPOTHESIS: We hypothesize that Slit2 will decrease
oxLDL-mediated foam cell formation by blocking Rac dependent uptake of oxLDL by
CD36 in macrophages. METHODS: Peripheral blood mononuclear cells (PBMC)
were isolated and monocytes polarized to M1- or M2-like macrophages using
granulocyte-macrophage colony-stimulating factor or macrophage colonystimulating factor (M-CSF), respectively. Murine bone marrow-derived macrophages
polarized with M-CSF were also used. Immunofluorescence microscopy and flow
cytometry was used to investigate the expression of Robo-1 in human and murine
macrophages. Foam cell formation was investigated using a neutral lipid probe,
BODIPY 497/503, and quantified by immunofluorescence microscopy and flow
cytometry. Quantification of cholesterol ester content in lipid droplets was performed
in parallel assays. The binding and uptake of oxLDL was investigated using
fluorescently (DiI)-labeled oxLDL, and quantified by microscopy and flow cytometry.
RESULTS: Human and murine macrophages express the Slit2 receptor, Robo-1.
Treatment with Slit2 inhibited foam cell formation in human and murine macrophages
(P<0.01). Slit2 blocked macrophage binding and uptake of oxLDL (P<0.01).
CONCLUSIONS: These experiments demonstrate that Slit2 inhibits oxLDL-mediated
foam cell formation in human and murine macrophages.
ABSTRACTS
BS-25
MIR-200 FAMILY EXPRESSION DURING NORMAL AND ABNORMAL
LUNG DEVELOPMENT DUE TO CONGENITAL DIAPHRAGMATIC
HERNIA
Drew Mulhall, Robin Visser, Barb Iwasiow, Fuqin Zhu, Richard Keijzer
Surgery, Pediatrics & Child Health, Physiology (adjunct), University of
Manitoba Children’s Hospital Research Institute of Manitoba, Biology of
Breathing, Winnipeg, MB
INTRODUCTION: Congenital Diaphragmatic Hernia (CDH) is a life-threatening
disease associated with abnormal lung development. CDH occurs
approximately 1 in every 2000- 3000 live-births and the pathophysiology is
unknown. MicroRNAs (miRNAs) are short, non-coding RNAs that control
protein expression through post-transcriptional regulation. Based on our
previous work, we hypothesized that the miR-200 family is differentially
expressed in normal and abnormal lung development. OBJECTIVE: To
determine and compare the expression of all miR-200 family members during
normal and abnormal lung development due to CDH. METHODS: Abnormal
lung development was induced using the nitrofen rat model for CDH.
Digoxigenin-labelled probes were used to detect the miR- 200 family through
fluorescent in situ hybridization (FISH). Fluorescein-tyramide conjugation was
used for tyramide signal amplification (TSA) with HRP-conjugated antibodies.
FISH was performed on embryonic day 21 (E21) rat control and nitrofeninduced CDH lung tissues. MiRNA expression levels were analyzed using a
Zeiss LSM 710 confocal microscope and Zeiss Efficient Navigation imaging
software. RESULTS Control vs nitrofen-induced CDH rat lungs showed
contrasting expression of each member of the miR-200 family. MiR-200a, miR200b and miR-429 showed higher expression in control rat lung tissues,
especially in the epithelial cells lining the bronchioles. MiR-141 and miR-200c
showed markedly higher expression in nitrofen lung tissues, also mainly in the
epithelial cells of the bronchioles. CONCLUSIONS: Our findings using FISH
demonstrate that CDH lungs display dramatic changes in expression of miR200 family members. This suggests that disruption of miR-200 family
expression plays a role in pulmonary hypoplasia associated with CDH.
BS-26
A MODEL OF TOXIC Α-SYNUCLEIN OLIGOMERS FOR DRUG
SCREENING IN PARKINSON’S DISEASE
J. K. Perera1, S. Ihn1, H. Chau1, S. Kalia1, L. Kalia1,2,3,4
1
Toronto Western Research Institute, Krembil Discovery Tower, University
Health Network, Toronto, Ontario, Canada; 2Division of Neurology,
Department of Medicine, Toronto Western Hospital, University of Toronto,
Canada; 3Morton and Gloria Shulman Movement Disorders Centre and
Edmond J. Safra Program in Parkinson’s Disease, Toronto Western Hospital,
Toronto, Ontario, Canada; 4Tanz Centre for Research in Neurodegenerative
Diseases, University of Toronto, Canada.
INTRODUCTION: Synucleinopathies are a group of neurodegenerative conditions
resulting from aggregation of the protein α-synuclein. In Parkinson’s Disease (PD),
these α-synuclein aggregates are associated with dopaminergic neuronal death
leading to the motor symptoms that characterize the illness. There is growing
evidence that α-synuclein aggregations spread in a prion-like manner and are
seeded by toxic α-synuclein oligomers. Elucidating and inhibiting the mechanism that
leads to harmful α-synuclein particles will have important implications for
understanding the pathogenesis of PD and developing novel therapies.
OBJECTIVES: [1] To compare our current structural knowledge of α-synuclein with
that of other aggregating proteins to determine where α-synuclein fits in the family of
prion-like proteins. [2] To establish a highly sensitive luciferase-based assay for in
vitro drug screening to identify inhibitors of α-synuclein oligomerization. METHODS:
Several proteins known to aggregate in a prion-like fashion, including α-synuclein,
were screened and compared using novel algorithms. We used in vitro genetic
manipulations to establish two drug-controlled models of α-synuclein oligomers.
Once established, these two cell lines will undergo high-throughput screening of
multiple drug libraries at NIH to identify inhibitors of oligomer formation. RESULTS:
Our initial analysis of several aggregating proteins suggests that α-synuclein is
unique in its structural characteristics. We have established two cell lines with a
tetracycline-controlled transactivator or repressor and are currently selecting clones
that stably express two α-synuclein-luciferase fragment proteins. CONCLUSIONS:
The protein α-synuclein may have structural characteristics distinct from other prionlike prions and thus α-synuclein aggregates are expected to be inhibited by a unique
set of small molecules. Protein aggregation is a feature of PD but is also known to
occur in other diseases, such as diabetes and cancer. Therefore, further
understanding of α-synuclein aggregation could have implications in various areas
of medicine.
BS-27
THE ROLE OF RARE GENETIC VARIANTS IN PEDIATRIC OBSESSIVECOMPULSIVE DISORDER
R. Rajendram1,4, S. Kronenberg1,4, S. Shaheen2, C. Marshall1, S. Scherer1,
G. Hanna3,
P. Arnold2
BS-28
MAGNETIC OCCULT LESION LOCALIZATION AND IMAGING (MOLLI)
FOR NON-PALPABLE BREAST CANCERS
K. Saikaley1,2, M. Germansky1,2, J. Dillon1, N.Look Hong2,4, A. Ravi1,3
1) The Hospital of Sick Children, 2) University of Calgary, 3) University of
Michigan, 4) University of Toronto
3
INTRODUCTION: Despite many lines of evidence supporting a genetic
etiology to Obsessive-Compulsive Disorder (OCD), the discovery of causal
variants remains elusive. Earlier studies were beset by focusing on common
variants, although there is growing evidence that rare variants play a major role
in OCD. These rare variants are often found in the exome, the coding region
of genes, in which variants are most likely to have a functional effect.
OBJECTIVE: To discover rare genetic variants associated with pediatric OCD.
METHODS: First, utilizing a trio-based approach, 75 OCD probands along with
their parents and siblings were recruited at SickKids (248 samples). Second,
utilizing an extended pedigree-based approach, 5 families with multiple
affected individuals were identified. Probands in the first approach, and the two
most distantly related affected individuals with shared alleles in the second
approach, were Whole Genome or Whole Exome Sequenced. Probands and
siblings in both approaches were assessed by a clinician and various
psychometrics (CY-BOCS; TOCS) in order to determine phenotype. Parent
phenotype was assessed through parent questionnaires and interviewing.
RESULTS: Preliminary clinical data identified that all probands had moderate
OCD or worse (CY-BOCS  15). In the trio sample, 30 families were identified
where both parents did not qualify for any psychiatric disorder. Twenty-five
families had one parent affected with depression, anxiety or OCD. Preliminary
genetic data in the extended pedigree dataset has identified several rare
variants in pathways known to be associated with OCD. CONCLUSION: We
have demonstrated the viability of our methodology in identifying families
enriched for rare variants in OCD, and identified some rare variants in genes
previously associated with OCD. Our results are significant first steps towards
understanding the role of rare variants in pediatric OCD and novel targets for
therapeutics.
1
Department of Medical Physics, Sunnybrook HSC, Toronto, Ontario, Canada
Division of Surgical Oncology, Sunnybrook HSC, Toronto, Ontario, Canada
Department of Radiation Oncology, University of Toronto, Toronto, Ontario,
Canada
4
Department of Surgery, University of Toronto, Toronto, Ontario, Canada
2
BACKGROUND: Radioactive seed localization (RSL) and wire guided
localization (WGL) guide the excision of non-palpable breast tumours in breast
conserving surgery. To address the shortcomings of RSL and WGL, magnetic
occult lesion localization and imaging (MOLLI) involves the implantation of a
non-radioactive magnetic seed into the breast to localize non-palpable
tumours. Seeds are detected intraoperatively using a novel handheld magnetic
detector. OBJECTIVE: To determine MOLLI’s technical equivalency to RSL by
evaluating the depth of magnetic seed detection, spatial resolution, and
bracketing ability. METHODS: The MOLLI probe was affixed to a mobile stage,
permitting horizontal and vertical manipulation of the probe over the seed. The
full width half maximum (FWHM) was measured at incremental seed-probe
distances to determine the relative accuracy of localization. Bracketing ability
was investigated by using two seeds arranged side-by-side while varying seedseed and probe-seed distances. Results were compared to reported values for
RSL in the literature. RESULTS: Maximum depth of detection of the MOLLI
system was 5 cm, which is equivalent to the reported maximum depth detection
capability of RSL. In bracketing simulation, MOLLI detected two independent
signals up to an inter-seed distance of 0.4 cm. Bracketing resolution with RSL
has not been reported. MOLLI spatial resolution was superior to reported RSL
detection at depths of 1 cm, 2 cm, and 5 cm, as demonstrated by comparative
values of FWHM (11 mm (MOLLI) vs 20 mm (RSL), 23 mm vs 25 mm, 44 mm
vs 55 mm, respectively). CONCLUSION: MOLLI's spatial resolution, detection
at depth, and bracketing ability, along with its regulatory advantages over RSL
and WGL, renders it a preferable alternative for breast tumour localization.
17
ABSTRACTS
BS-29
ELECTRICAL MUSCLE STIMULATION (EMS) DOES NOT INFLUENCE
SYNKINETIC REINNERVATION IN A NOVEL RAT MODEL OF
PERIPHERAL NERVE INJURY AND REPAIR
J. Catapano and M. P. Willand, D. Scholl, T. Gordon, and G. Borschel
BS-30
COMPENSATORY MUSCLE HYPERTROPHY IN UNRESTRAINED AND
MOBILE MICE FOLLOWING FOLLOWING SEVERE CUTANEOUS
THERMAL INJURY
A. Shah1, S. Amini-Nik2,3, A. Sadri3, A. Datu3, M. Jeshcke2,3
Division of Plastic and Reconstructive Surgery, Department of Surgery, The
Hospital for Sick Children, Toronto, ON, Canada.
1 Faculty of Medicine, University of Toronto
2 Department of Surgery, Division of Plastic Surgery and Department of
Immunology
3 Sunnybrook Health Sciences Centre
OBJECTIVE: Recovery following nerve repair is limited by axon misdirection.
Studies have shown that EMS following nerve repair reduces synkinetic
reinnervation. Conclusions were based on functional measurements with no
direct evidence. Here, we used a novel rat model to directly investigate whether
EMS increases the proportion of motoneurons reinnervating original targets
after injury. METHODS: The original soleus motoneuron pool was labeled with
True-Blue. Following one-week, the right lateral gastrocnemius soleus nerve
was transected and repaired, and the soleus muscle implanted with electrodes.
One group received EMS with a natural activation paradigm. Two months later,
the right soleus nerve was retrograde labelled with Fluoro-Ruby to label
regenerated motoneurons. The contralateral uninjured lateral gastrocnemius
and soleus nerves were labelled with True-Blue and Fluoro-Ruby respectively
to compare the spatial distribution of the contralateral motoneuron pool with
the injured side. The number of regenerated axons was counted with
histomorphometry. RESULTS: 3D reconstructions of labelled motoneuron
pools demonstrated the majority of motoneurons regenerating to the soleus
muscle derived from the lateral gastrocnemius motoneuron pool. EMS did not
increase the proportion of original soleus motoneurons regenerating towards
the soleus muscle (EMS: 10.9±2.3% vs Sham: 15.5±9.9%). There were no
differences in axons counts (EMS: 200±68 vs Sham: 163±47).
CONCLUSIONS: While studies suggest EMS reduces muscle atrophy, our
model does not support the use of EMS to reduce axonal misdirection following
nerve repair.
BS-31
MYOCARDIAL ENERGY METABOLISM DURING EX-VIVO HEART
PERFUSION (EVHP):IMPROVING DONOR HEART PRESERVATION AND
AVAILABILITY FOR TRANSPLANTATION
S.Shan1, C.White2, S.Hatami2, D.Freed1,2,3
Department of Physiology1,Surgery2, and Biomedical Engineering3,University
of Alberta
INTRODUCTION: EVHP has emerged as an alternative storage and transport
method that minimizes cold-ischemic injury and facilities assessments of
functional and metabolic parameters. Myocardial function demonstrates timedependent decline limiting potential donor pool expansion. OBJECTIVE:
Determine if the metabolic demand placed on the heart during EVHP would
impact the preservation of function. METHODS: 8 pigs were randomly
allocated to a high (HMD; n=4) or low metabolic demand group (LMD;
n=4).Functional (cardiac output, index and efficiency, minimum and maximum
rate of pressure change (dP/dT max/min), pre-load recruitable stroke work
(PRSW), myocardial injury) and metabolism parameters (oxygen consumption
and
extraction,
coronary
vascular
resistance,
free
fatty-acid,
triglyceride,lactate, epinephrine, insulin, tri-iodothyronine were measured.
RESULTS: Hearts in both experimental groups exhibited a decline in function
that paralleled decline in free-fatty acids, thyroid, insulin, and epinephrine
levels. HMD hearts exhibited significantly better preservation of function (CO:
HMD: 1.41±0.27L/min vs. LMD: 0.37±0.22L/min; p-value:0.02; PRSW:
HMD:279.03±64.67 L.mmHg vs. LMD: 66.29±38.30L.mmHg;p-value:0.03),
and cardiac efficiency: HMD:10.96%±1.23% vs. LMD:2.26% ± 1.43%; pvalue:0.007) over the 12-hour interval. Triglyceride levels declined over time in
HMD hearts but increased in LMD hearts (hour 11:HMD:0.09±0.03mM vs.
LMD:0.39±0.02mM;p-value:0.001).The differential preservation of function
between HMD and LMD hearts were not attributed to differences in myocardial
injury. CONCLUSION: Functional decline during EVHP can be explained by
decreasing free- fatty acids and inadequate supplementation of insulin, T3 and
epinephrine. Metabolic down regulation of LMD hearts by triglycerides may
contribute to greater functional decline. Further studies are needed to delineate
metabolic complexities during EVHP and to offer experimental protocolization
so EVHP can increase the donor pool.
18
BACKGROUND: Systemic muscle atrophy is a common complication from
severe cutaneous burn injury to greater than 30% of total body surface area
(TBSA). Patients suffering from burn undergo a period of systemic
hypermetabolic state during which there is increased protein, fat and glycogen
catabolism. Consequentially, burn patients suffer from substantial loss in lean
muscle mass. Furthermore, applying traditional bed rest to burn patients may
further exacerbate the systemic muscle atrophy due to disuse. It is believed
that helping patients to move and exercise will improve muscle atrophy and
improve patient outcome. Studies examining rodents have characterized the
hypermetabolic state and muscle atrophy that lasts for several weeks postburn. In this study we performed 30% TBSA burn in the dorsum of mice. We
have previously recorded that these mice are highly active post-burn if left
unrestrained, making them a good model to assess the effects of mobility after
cutaneous burn injury. OBJECTIVE: The objective of this study was to assess
the systemic effects of severe cutaneous burn injury on muscles and Pax7
expressing muscle stem cell in mobile and unrestrained mice. METHODS:
Mice were sacrificed 48h, 1 week and 2 weeks post-burn and the
gastrocnemius muscle were dissected and histology slides were prepared to
perform Masson’s trichrome staining and immunohistochemistry. RESULTS:
We observed reduced myofiber cross-sectional area, and decreased
prevalence of Pax7-positive muscle stem cells 48h post-burn compared to
sham typical for an atrophic phenotype. However, after 1 and 2 weeks postburn, we observed an increase in cross-sectional area and increase in Pax7positive stem cells post-burn suggesting muscle hypertrophy. CONCLUSION:
Rapid reversal in burn atrophy has not been reported before, and may have to
do with the hypermobility in response to catecholamine surge in unrestrained
mice after burn injury.
BS-32
ARCHITECTURAL MANIPULATION OF LUNG PROGENITOR CELLS TO
CONTROL CELL FATE CHOICE
J. P. Soleas1, A. P. McGuigan1, T. K. Waddell1
1
Institute of Biomaterials and Biomedical Engineering, University of Toronto,
Toronto
Mechanical forces are essential for normal lung development, however, little
has been done to investigate the influence of the mechanical
microenvironment on epithelial organization. It is known that during epithelial
differentiation in vivo the proximal (SOX2+), pseudostratified airway epithelium
develops in tube diameters larger than those found in the distal (SOX9+),
squamous epithelium. We hypothesize that lung progenitor cell grown in tubes
of larger diameters (>60μm) will guide fate choice towards a proximal fate. Our
aim is to expose lung progenitors, derived from embryonic stem cells, to
geometric constraints, in the form of hollow, three-dimensional cylinders of
differing diameters to create cell lined cavities reminiscent of the developing
lung tubule and to study how this geometric configuration affects cell fate
choice. Using photolithographic and molding technologies we have created
hollow cylinders of 40-100µm in diameter with a height of 180µm in 15%
gelatin. Our data suggests that fate choice between proximal SOX2+, distal
SOX9+, and dual positive SOX2+/SOX9+ is indeed different between curved
and flat architecture. We are currently studying what is causing this affect, and
whether other mechanical forces can affect the fate choice of these progenitor
cells.
While progress has been made in understanding the chemical cues required
to guide a pluripotent cell to an immature lung population, additional cues are
required to specify and organize these populations. Utilizing a tissue
engineering approach to apply architectural cues to heterogeneous lung
progenitors, we have guided these progenitors towards a distal fate. This
specificity in cell fate increases the cell purity of our end products and could
serve as platform to create purer cell populations for cell therapy.
The authors thank the following funding sources: CIHR Training Programme
in Regenerative Medicine. McLaughlin Centre. The Henry White Kinnear
Foundation.
ABSTRACTS
BS-33
SURFACE-BASED ANALYSIS OF THE WHITE-GREY MATTER TISSUE
BOUNDARY OF THE CEREBELLUM BETWEEN THE FVB AND C57BL6
INBRED MOUSE STRAINS
Patrick E. Steadman1,2,3, Jacob Ellegood1,3 and Jason P. Lerch1,3,4
BS-34
INVESTIGATION OF THE MODULATORY EFFECTS OF MIR330-3P ON
THE PHENOTYPE OF MDA-MB-231 BREAST CANCER CELLS IN THE
CONTEXT OF RADIOTHERAPY
S. Strum1, X. Huang1, S. Taeb1, S. Liu1.
1-Mouse Imaging Centre, The Hospital for Sick Children
2-Institute of Medical Science, University of Toronto
3-Program in Neuroscience and Mental Health, The Hospital for Sick Children
4-Department of Medical Biophysics, University of Toronto
1
BACKGROUND: Analysis of Magnetic Resonance (MR) images in
neuroimaging provides insight into how health and disease states alter
neuroanatomy. In the mouse, a common analysis method, deformation-based
morphology, has allowed for numerous studies of mouse neuroanatomy.
However it relies on the assumption that brain structures are homologous
between experimental groups. This is not always the case for the mouse
cerebellum, where the foliation pattern or folding of the structure, can vary such
that homology is lost. To deal with this case an analysis pipeline using MR
images of the mouse brain was developed to characterize the structure of the
mouse cerebellum white-grey matter boundary that does not rely on structure
homology. METHODS: Initially MR images are linearly registered to mask out
the brain except the cerebellum. Then the pipeline uses tissue classification
methods to isolate the white-grey matter boundary and a deformable model to
extract the boundary surface. Analysis metrics such as surface area, lobule
index (cerebellar version of gyrification index), curvature, and depth potential
can be computed. RESULTS: A comparison of the FVB/AntJ and C57Bl/6J
inbred strains had only been performed once before using poor MR image
resolution. Increase resolution and the developed methods showed the FVB to
have a larger surface area (p=3.24x10-10), lobule index (p=4.01x10-5) and
greater number of lobules in the cerebellar vermis (p=2.21x10-4). Foliation
differences in depth were found extensively across the white-grey matter
boundary, showing that the two strains differ greatly in cerebellum morphology.
CONCLUSION: This pipeline can be used to characterize cerebellar structural
differences between experimental groups where homology between structures
does not exist.
Faculty of Medicine, University of Toronto, Toronto M5S 1A8, Canada
INTRODUCTION: MicroRNAs (miRs) are small non-coding RNAs that have
been implicated in the regulation of a broad range of cellular processes,
including the development of cancer cell radioresistance. To date, however,
our understanding of the roles that miRs play in modifying cancer cell behavior
remains poorly understood. In this study we investigate the modulatory effects
of miR330-3p, a microRNA associated with more aggressive phenotypes in
several types of cancer, on the behavior of MDA-MB-231 breast cancer cells
in the context of radiotherapy. METHODS: First, the levels of radioresistance
in MDA-MB-231 cells transiently transfected with miR330-3p and
corresponding controls were analyzed using clonogenic assay. Second,
miR330-3p transient transfectants and controls were used in an in vitro
invasion assay and a validated chicken allantoic membrane assay to study
invasion and metastatic potential, respectively. Third, gene array analysis was
used to identify targets of miR330-3p. Finally, lead targets that were identified
from the gene array analysis were confirmed by luciferase reporter assays and
qPCR experiments. RESULTS: Overexpression of miR330-3p in MDA-MD231 cells was not found to increase radioresistance. However, overexpression
was found to significantly increase cell invasiveness and metastasis.
Correspondingly, reduction of miR330-3p levels with a miR-inhibitor decreased
cell invasion. Using gene array analysis we identified PTEN as a potential
target of miR-330-3p. Overexpression of miR330-3p decreased PTEN mRNA
levels by targeting the transcript directly, confirmed by luciferase reporter
assay. PTEN loss also resulted in an increase in MMP2 mRNA levels, whose
protein product has been associated with more aggressive breast cancer
behavior. CONCLUSION: Our results indicate that miR330-3p is an important
regulator of MDA-MB-231 cell transformation by increasing invasive capacity
and metastatic potential through the down-regulation of PTEN.
BS-35
YAP AND TAZ ARE MECHANOREGULATORS OF TGF--SMAD
SIGNALING AND RENAL FIBROGENESIS
S. Szeto1, M. Narimatsu1, A. Sidiqi1, M. Lu1, J. Wrana1, A. Kapus1, and D.
Yuen1
BS-36
STRUCTURAL AND FUNCTIONAL CHANGES IN THE ADOLESCENT
RODENT BRAIN IN STREPTOZOTOCIN INDUCED TYPE 2 DIABETES
MELLITUS
M.W. Taylor1,2, P. Croal1, J. Leung1, A. Kassner1,3
1
1.
Department of Physiology and Experimental Medicine, The Hospital for Sick
Children,
Toronto,
Canada
2.
Faculty of Medicine, University of Toronto, Toronto, Canada
3.
Department of Medical Imaging, University of Toronto, Toronto, Canada
University of Toronto, Toronto, Ontario Canada
BACKGROUND: Kidney fibrosis is a final common pathway of injury
responsible for progressing most chronic kidney diseases, for which no specific
treatments exist. Fibrogenesis is largely driven by transforming growth factor (TGF-)-induced fibroblast activation into a scar-producing myofibroblast.
While fibroblast activation is known to be mechanosensitive, with soft matrix
mimicking a healthy kidney impeding TGF- responsiveness, the underlying
mechanisms are unknown. TAZ and YAP are homologous mechanosensitive
transcription co-factors with TGF- regulatory effects whose nuclear
localization and activity are regulated by matrix stiffness. OBJECTIVE: To
examine if matrix stiffness regulates TGF- signalling via TAZ/YAP, and to test
if TAZ/YAP inhibition can attenuate renal fibrosis. METHODS: The effects of
matrix stiffness on TAZ/YAP localization and TGF-/Smad signalling were
examined in rat renal fibroblasts cultured on soft, healthy-like (2 kPa) and stiff,
disease-like (100 kPa) gels. To test the effect of TAZ/YAP inhibition,
verteporfin, a clinically approved drug for optical diseases with novel TAZ/YAP
inhibitory properties, was used in vitro and in vivo followed by assessing fibrotic
markers. RESULTS: In renal fibroblasts, TAZ/YAP are nuclear localized on stiff
gels while diffusely localization on soft gels. Although stiffness does not alter
TGF--induced Smad2 phosphorylation, soft matrix impairs TGF--induced
Smad2/3 nuclear accumulation and downstream Smad transcriptional activity.
Also, TAZ/YAP inhibition via verteporfin exhibited similar effects to soft matrix,
as well as a loss of TAZ/YAP that was associated with a loss of Smad2/3. In
vivo, verteporfin reduced renal myofibroblast accumulation and interstitial
collagen deposition in UUO mice. CONCLUSION: Our data suggest that renal
fibrogenesis is driven by mechanical and chemical stimuli mediated by
TAZ/YAP and Smad2/3. Furthermore, we identify verteporfin as a potential
anti-fibrotic treatment that interferes with this mechano-chemical synergy.
BACKGROUND: Type 2 diabetes mellitus (T2DM) was formerly a disease
associated with adulthood and old age. Now, it has been recognized to also affect
younger populations, with increases in obesity thought to be partially responsible. In
adults, T2DM has been shown to impair cognitive function, increase the risk of
dementia, and MRI studies indicate both vascular and non-vascular cerebral
pathologies. Few studies have examined young T2DM patients, but preliminary
reports indicate significant cognitive impairment in adolescents alongside structural
brain changes, but the underlying mechanisms remain unclear. OBJECTIVE: The
objective of the present study is to investigate the cerebral pathophysiology that
occurs in adolescent T2DM and determine its involvement in cognitive impairment.
We hypothesize that subtle vascular changes that are detectable by MRI occur early
in disease progression and lead to anatomical changes and cognitive impairment in
adolescent T2DM. METHODS: During the pilot phase of the study, we optimized the
inducible high-fat diet/streptozotocin (HFD/STZ) rat model of T2DM to the adolescent
stage and the novel object recognition (NOR) test of memory. The HFD was started
at 3 weeks of age, followed by 40 mg/kg (i.p) STZ injection under anesthetic at 5
weeks of age, to generate an induction rate of 75%, based on non-fasting blood
glucose measurements. Lower dose injections of 35 mg/kg (i.p) without anesthetic
did not induce disease consistently. RESULTS: Diabetic rats had an average blood
glucose of 18 mmol/L and weight of 222 g, compared to 9.45 mmol/L and 213 g in
healthy controls, 1 week post-injection. The NOR test was optimized to a 3 day
protocol, testing 30 and 24 hour memory after a habituation and familiarization
phase. DISCUSSION: Anatomical and vascular MRI parameters are currently being
optimized. In the future, cohorts of 10 diabetic and healthy rats will undergo the
behaviour test and imaging. A separate cohort of 10 rats per group will undergo
glucose tolerance and insulin tolerance testing to establish metabolic profiles for
each group.
19
ABSTRACTS
BS-37
INTEGRATED GENOMIC ANALYSIS OF B-CELL ALL METASTASIS
R. Vanner1,2, S. Dobson1,2, I. Grandal3, O. Gan1, J. McLeod1, J. Dick1,2
1
2
3
Princess Margaret Cancer Centre
University of Toronto
Sickkids Research Institute
1
BS-39
ANGIOPOIETIN-2 INHIBITION VERSUS ANTIANGIOGENIC VEGFR2
TYROSINE KINASE INHIBITORS IN THE ADJUVANT (POSTSURGICAL)
OR EARLY-STAGE METASTATIC DISEASE SETTING
F.T.H. Wu1,2, S. Man2, P. Xu2, M. Pàez-Ribes2, C.R. Lee2, S.R. PirieShepherd3, U. Emmenegger2 and R.S. Kerbel1,2
2
Dept of Medical Biophysics, University of Toronto; Biological Sciences
Platform, Sunnybrook Research Institute;
Oncology Research Unit, Pfizer Worldwide R&D, USA
3
BACKGROUND: Despite being clinically approved therapies for several
cancer types in the advanced metastatic disease setting, antiangiogenic
tyrosine kinase inhibitors (TKIs) that target the VEGF receptor 2 (VEGFR2)
pathway have not been effective in the adjuvant treatment setting involving
early-stage micrometastatic disease. Besides VEGF, there is another proangiogenic and pro-inflammatory vascular destabilizer called Angiopoietin-2
(Ang2), a ligand of the Tie2 receptor. OBJECTIVE: To test whether the
systemic vascular-stabilizing effects of Ang2 blockade can be exploited to limit
tumor cell extravasation and metastatic seeding at distant organs. METHODS:
CVX-060 (an Ang2-specific CovX-body) was tested against and in combination
with TKIs (sunitinib, which targets VEGFR2; or regorafenib, which targets both
VEGFR2 and Tie2) in 3 mouse models of postsurgical or early-stage
metastatic disease. RESULTS: In a model of orthotopically implanted and
resected human breast cancer (MDA-MB-231.LM2-4), adjuvant sunitinib
therapy was ineffective, while adjuvant CVX-060 monotherapy delayed the
progression of distant pulmonary or lymphatic metastases, and furthermore
improved overall survival when combined with VEGF neutralization in the form
of a VEGF/Ang2-bispecific CovX-body (CVX-241). In a model of experimental
liver metastasis from human colorectal cancer (HCT116), both CVX-060 and
regorafenib as monotherapies were effective in suppressing liver metastases
growing in the absence of a primary tumor. In a model of lung-metastasizing
mouse renal carcinoma (RENCA), concomitant CVX-060 enhanced the overall
survival benefit of sunitinib therapy. CONCLUSION: Targeting Ang2 is
effective, and in some cases can improve VEGFR2-targeting TKI therapies, in
the adjuvant or adjuvant-like treatment setting.
20
MD/PhD Program, University of Toronto, Toronto, Ontario, Canada and
Department of Biochemistry and Biomedical Sciences, McMaster University,
Hamilton, Ontario, Canada
2
B-cell acute lymphoblastic leukemia (B-ALL) commonly metastasizes to the
leptomeninges of the central nervous system (CNS), which confers a worse
prognosis. Despite the frequency and severity of this clinical problem, the
genetic drivers of B-ALL metastasis to the CNS are poorly understood.
Intratumoural genetic heterogeneity – the coexistence of clones with distinct
DNA mutations within a single tumour – underlies differences in leukemia cells’
functional properties but has an unknown contribution to metastasis. To
understand the biology and evolutionary histories of B-ALL CNS metastases,
primary cells from 9 B-ALL patients were xenografted by injection in to NSG
mice. Matched bone marrow and CNS metastatic cells were purified when
mice became moribund. Bone marrow and CNS xenografts paired from
individual mice were subjected to CNV analysis (33 mice) using Illumina SNP
arrays and stranded total RNA sequencing. We hypothesized that if the
metastatic environment selects for a distinct biology from the primary leukemia
site, unique genetic lesions would be detected in CNS metastases and
metastatic cells would express a distinct gene expression signature. CNS
metastases from 13/33 mice showed genomic discordance suggesting clonal
selection for the metastatic phenotype. In 3 mice, CNS cells were derived from
an early branch of the leukemia evolutionary tree, while 10 CNS metastases
were late events. RNA-seq revealed distinct gene expression profiles between
bone marrow and metastatic cells with over 1000 significantly differentially
expressed genes. Pathway analysis to define the metastasis biology is
ongoing. A metastasis gene signature is being developed to identify patients
at high risk of experiencing CNS relapse. Our study suggests that CNS
metastases are the product of late clonal divergence due to selection for cells
with a unique metastatic genotype. Future studies will aim to completely define
the evolutionary history of CNS metastases and test therapeutic vulnerabilities
of metastases.
1
BS-38
NOVEL ROLE OF THE HUNTINGTON’S DISEASE PROTEIN IN
MEMBRANE DELIVERY AND CHROMATIN DYNAMICS DURING
CYTOKINESIS
G. Walpole*1,2, A. Mocle2, and R. Truant2
Huntington’s disease (HD) is an autosomal dominant, late-onset
neurodegenerative disease characterized by a polyglutamine expansion at the
amino-terminus of the huntingtin protein (Htt). To date, the exact pathological
mechanism of the disease is unknown but abnormal neurogenesis has been
described. Here we report Htt as a mitotic protein that associates with distinct
sub-cellular regions of the mitotic spindle including the midbody - a transient
microtubule-rich structure that connects daughter cells during cytokinesis. Htt
localization is regulated through phosphorylation of Ser13, Ser16, and Ser421
at the amino-terminus, all of which have been implicated in disease
progression. Knockdown of huntingtin led to a decrease in the percentage of
both mitotic cells and cells completing cytokinesis. We demonstrate that a
central fragment of huntingtin is sufficient for delivery to the stem body, the
central region of the midbody, while the amino-terminus is sufficient for
localization to the lateral edges of the midbody. Interestingly, over-expression
of several carboxyl-terminus fragments of Htt induced midbody chromatin
bridges that require clearance prior to abscission (final division) to avoid DNA
damage. Lastly, we demonstrate that endogenous Htt localizes to sites of
membrane deposition on the plasma membrane surrounding the midbody
suggesting a multi-functional role for Htt during cytokinesis. Future work
should focus on elucidating the importance of Htt in the molecular events of
abscission and the importance of abscission control and asymmetric midbody
inheritance to the progression of Huntington’s disease.
BS-40
THE ROLE SURGICAL GLOVES AND INSTRUMENTS IN CANCER
WOUND RECURRENCE
R.Xu1, D. Berger-Richardson1,2, C.J. Swallow1,2
1
2
Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital,
Department of Surgery, University of Toronto Faculty of Medicine
BACKGROUND: Recurrence of cancer in the surgical wound is associated with
significant morbidity and predicts death from cancer. The mechanism(s) of wound
recurrence is currently unknown. Our hypothesis is that malignant cells are harbored
on gloves and instruments following the extirpative phase of oncologic resection.
These cells may be exfoliated into the wound during closure and lead to recurrence.
The OBJECTIVE of this study was to determine whether cancer cells can survive on
the surface of surgical gloves and instruments and then proliferate afterwards.
METHODS: 105 cells in minimal suspension were seeded onto either a stainless steel
washer or a surgical glove and left to dry at room temperature (RT). At defined time
intervals, the cells were washed off into a 24-well plate using 2ml of culture medium,
and then tested for viability as well as replication capacity. For viability assays, cells
were incubated at RT with Hoechst (1:800) and Propidium Iodide (1:400) for 15
minutes, then imaged using the Celigo Cytometer. For proliferation, the 2ml sample
was divided into twenty 100µl samples and 5 replicates stained and imaged each
day for the subsequent four days. RESULTS: Using both benign (HEK293) and
malignant cell lines (HeLa, MDA-MB 231 and DLD-1), we demonstrated that >80%
of the cells seeded onto a dry steel surface were viable for 10 minutes, with some
minimal variation between cell lines. Importantly, >80% of the cells survived on a dry
surgical glove for 30 minutes after seeding. Of note, we retrieved ≈100% of the cells
following irrigation with culture medium at these time points. Intriguingly, HeLa and
MDA-MB231 cells retrieved from the stainless steel surface at both 5 minutes
(viability >80%) and 25 minutes (viability <20%) after seeding demonstrated similar
rates of proliferation over the course of the ensuing 4 days. CONCLUSION: We show
here that surface of surgical gloves and instruments are environments on which cells
can survive. Furthermore, these cells are easily transferred from the gloves and
instruments via irrigation and have the potential to proliferate. It may therefore be
prudent for surgeons to take specific precautions to minimize contact of gloves and
instruments with the malignant tissue, and in particular to minimize contact with the
surgical wound.
ABSTRACTS
BS-41
RILUZOLE ATTENUATES NEUROPATHIC PAIN FOLLOWING HIGH
CERVICAL SPINE HEMISECTION
W. Yang1, K. Satkunendarajah1, F. Nassiri2, S.K. Karadimas1, M.G. Fehlings1
1.
Department of Genetics and Development, Toronto Western Research
Institute, and Spinal Program, Krembil Neuroscience Center, University Health
Network, Toronto, Ontario, Canada.
2
Department of Surgery, University of Toronto, Ontario, Canada.
Traumatic injury to the cervical spinal cord can result in full or partial
quadriplegia and can also lead to a loss of respiratory or diaphragmatic
function. In addition, cervical spinal cord injury (SCI) may induce chronic
neuropathic pain, a clinical feature which remains refractory to currently
available treatments. Our study examined the role of riluzole, an antiglutamatergic drug currently under Phase III clinical trials for the treatment of
SCI, and its effects on neuropathic pain induced in a rodent C2 hemisection
model. Following high cervical spinal hemisection at the C2 level, animals
were placed into one of three groups. The first group was administered riluzole
1h post-injury and every 12h thereafter for 7 days while the second group
received a vehicle solution for the same duration. A third sham group
underwent C2 laminectomy without hemisection. Functionally, von Frey
filament testing revealed that riluzole attenuated mechanical allodynia in the
forelimbs and hindlimbs. We further demonstrated that riluzole reduced the
sensation of thermal hyperalgesia as measured by tail flick test. Given the role
of Iba-1 as a marker of microglial activation, we performed stereological
quantification of Iba-1 positive perilesional macrophages and microglia. We
found a significant decrease in Iba1-positive microglia and macrophages in
spinal cord samples taken 7 days post injury. Thus using a C2 hemisection
injury model, this study provides further evidence for the role of riluzole in
attenuating neuropathic pain via microglial activation.
BS-43
OVERCONNECTIVITY IN STEM CELL-DERIVED NEURONS OF AN
AUTISTIC CHILD
K. Zaslavsky1,2, E. Deneault1, W. Zhang1, M. Zhao1,2, P.J. Ross1, A.
Dedeagac1, A. Piekna1, W. Wei1, T. Thompson1, P. Pasceri1, M.W. Salter1,3,
S.W. Scherer1,2, J. Ellis1,2
1
Peter Gilgan Center for Research and Learning, Hospital for Sick Children
Department of Molecular Genetics, University of Toronto
3
Department of Physiology, University of Toronto
2
De novo deletions and nonsense mutations of SHANK2 (SH3-domain and
ankyrin repeats) have been implicated in several autism spectrum disorder
(ASD) cases. To determine how ASD-associated SHANK2 mutations affect
human neuronal function, we have generated induced pluripotent stem cells
(iPSC) from two children with ASD, one harboring a nonsense mutation and
the other a deletion, as well as their parental controls. To isolate the effect of
SHANK2, we have corrected the nonsense mutation in ASD iPSCs and
knocked out SHANK2 in iPSCs from an unrelated neurotypic individual using
CRISPR/Cas9 technology. Using directed differentiation by inhibition of BMP,
Activin/Nodal, and Wnt signaling, we have generated neural precursor cells
(NPCs), which we use to generate cortical neurons. To assess
synaptogenesis, four week-old neurons are re-seeded on mouse astrocytes to
promote synapse formation. Five weeks after re-seeding, electrophysiological
and imaging approaches are used in parallel to assess synaptic connectivity
and cell morphology. Both synapse number and the frequency of AMPAR
excitatory postsynaptic currents are increased in neurons of the autistic
individual with the nonsense mutation, suggesting the cells make an
overabundance of functional synaptic connections. This increase is driven
primarily by increases in dendrite length and complexity, as well as synapse
density. We are currently investigating whether SHANK2 knockout and
deletion cells share the same phenotype, and whether SHANK2 correction in
ASD iPSCs rescues it. Using these approaches, we aim to determine how
development and function are perturbed in neurons specific to children with
ASD and SHANK2 mutations.
BS-42
EVIDENCE THAT LAMINAR IDENTITY SPECIFICATION IN THE
DEVELOPING NEOCORTEX INVOLVES TRANSLATIONAL REPRESSION
OF BRN1
S. Zahr1, G. Yang2, G. Amadei3, D.R. Kaplan1-3, F.D. Miller1-4
Institute of Medical Science1, University of Toronto, Toronto, Canada; Program
in Neuroscience and Mental Health2, Hospital for Sick Children; Department of
Physiology3 and Molecular Genetics4, University of Toronto, Toronto, Canada
During cortical development, neurons are sequentially generated to populate
six layers in an inside-out fashion, with deep-layer (V-VI) neuron generation
preceding that of superficial-layer neurons (II-IV). It has previously been shown
that a 4ET-containing complex regulates the onset of neurogenesis during
cortical development (Yang et al., Neuron, 2014). This complex binds mRNAs
encoding regulators of transcription and cell differentiation, including Brn1
mRNA. Brn1 is a transcription factor that is required for the production of upperlayer projection neurons in the cerebral cortex. Interestingly, we observed that
mRNAs encoding laminar-identity specific genes of all layers (Brn1, Tle4,
Diap3) were present in the majority of early neural precursors (NPCs),
suggesting that a significant proportion of early NPCs are competent to
generate neurons of every layer as opposed to being lineage-restricted. We
show that brn1 mRNA is robustly transcribed in the early stage dorsal cortex
(E12), while no Brn1 protein is detected until later stages (E14) when
superficial-layer neuron production predominates. Genetic knockdown of the
translational repressor 4ET in E11.5 culture resulted in an increase in Brn1
expression. Moreover, the 3’UTR of brn1 contributed to its translational
repression in a temporally-sensitive manner. Knockdown of 4ET partially
released the repression on brn1 3’UTR in early NPCs (E11) but not in later
NPCs (E15). These findings support a model in which a 4ET-containing
complex is involved in the translational repression of brn1 mRNA via the brn1
3’UTR during early neurogenesis, preventing the expression of Brn1 until later
stages of neurogenesis when superficial-layer neurons are generated.
BS-44
INFLUENZA INFECTION OF THE ENDOTHELIUM RESULTS IN
PLATELET-ENDOTHELIUM ADHESION AND LUNG INJURY
M. G. Sugiyama*1, 3, A. Gamage*1, 2, R.E. Zyla1, S. M. Armstrong1, 2, S. Advani1,
A. Advani1, C. Wang1, W. L. Lee1, 2, 3, 4
1 Keenan Centre for Biomedical Sciences, Li Ka Shing Knowledge Institute,
St. Michael's Hospital
2 Institute of Medical Science, University of Toronto
3 Department of Laboratory Medicine and Pathobiology, University of Toronto
4 Division of Respirology and Interdepartmental Division of Critical Care
Medicine, University of Toronto
Acute lung injury is an important complication of influenza infection, and may
be partly caused by platelet adhesion to activated lung endothelial cells.
However, little is known about how influenza infection contributes to plateletendothelial adhesion. The purpose of this study was to investigate whether
influenza infection of lung endothelial cells causes increased plateletendothelial adhesion in vitro, and whether this adhesion plays a role in mortality
in a mouse model of severe influenza. Human pulmonary microvascular
endothelial cells (HPMECs) were infected with influenza virus and then
assayed for platelet-HPMEC adhesion. There was significantly higher plateletHPMEC adhesion in infected monolayers. This increase in adhesion was
inhibited by a blocking antibody to platelet integrin α5β1, suggesting a role for
fibronectin in mediating the interaction. Mice were then infected with influenza
and lung histology performed. In vivo, influenza was shown to infect the
pulmonary endothelium in a dose-dependent manner in infected mice, and
infection was associated with platelet adhesion and fibronectin deposition in
the lungs. Treatment with anti-platelet agents improved survival in influenza
infected mice. The results of this study show that influenza infection of the
endothelium induces platelet-endothelial adhesion via increased fibronectin
deposition. This interaction was shown to have an effect on mortality in vivo.
Inhibition of platelet adhesion may be a possible therapeutic intervention for
the treatment of severe influenza.
21
ABSTRACTS
C-01
DO ALL CLAVICLE FRACTURES IN CHILDREN NEED TO BE MANAGED
BY ORTHOPAEDIC SURGEONS?
J. Adamich1, A. Howard1,2, M. Camp1,2
C-02
AN FMRI STUDY OF THE NEURAL AND CLINICAL IMPLICATIONS OF
PEDIATRIC SPORTS RELATED CONCUSSION
S. Green1,2, S. Agnihotri1,2, J.K. Chen3, N. Lobaugh4, M.L. Keightley1
1
1
2
The Hospital for Sick Children, Toronto
Department of Surgery, University of Toronto
INTRODUCTION: Although many uncomplicated pediatric fractures do not
require routine long-term follow-up with an orthopedic surgeon, practitioners
with limited experience dealing with pediatrics fractures will often defer to a
strategy of frequent clinical and radiographic follow-up. Development of an
evidence-based clinical care pathway can help unnecessary radiation
exposure to this patient population and reduce costs to patient families and the
healthcare system. METHODS: A retrospective analysis including patients
who presented to the Hospital for Sick Children (SickKids) for management of
clavicle fractures was performed. RESULTS: Three hundred and forty patients
(227 males, 113 females) with an average age of 8.1 (range 0.1-17.8) were
included in the study. The mean number of clinic visits including initial
consultation in the emergency department was 2.1 (±1.3). The mean number
of radiology department appointments was 1.8 (± 1.3) where patients received
a mean number of 4.2 (±3.0) radiographs. Complications were minimal; 2
refractures in our series and no known cases of non-union. All patients
achieved clinical and radiographic union and returned to sport after fracture
healing. CONCLUSIONS: Our series suggests that the decision to treat
operatively is made at the initial assessment. If no surgical indications were
present at the initial assessment by the primary-care physician, then routine
clinical or radiographic follow up is unnecessary. Our paediatric clavicle
fracture pathway will reduce patient radiation exposure and reduce costs
incurred by the healthcare system and patients’ families without jeopardizing
patient outcomes.
C-03
SHORT-TERM REDUCED PHYSICAL ACTIVITY IMPAIRS GLYCEMIC
CONTROL AND INSULIN SENSITIVITY IN OLDER ADULTS
M.T. von Allmen, T. Stokes, C. McGlory and S.M. Phillips
Department of Kinesiology, McMaster University, Hamilton, Canada
BACKGROUND: Aging results in a progressive loss of muscle mass that is
accelerated by periods of muscular disuse, common for older adults during
hospitalization or convalescence from illness. Transient physical inactivity (PI)
has been shown to cause muscular atrophy and impairments in insulin
sensitivity in both younger and older adults. However, the recovery capacity of
older adults after such PI remains unknown. OBJECTIVES: We aimed to
determine the impact of daily step reduction (SR; ≤1000 steps/d), an
experimental model mimicking short-term PI, on glycemic control in older
adults and further investigate whether they were able to recover from SR
simply by returning to their habitual activity for 14d. METHODS: Ten older
adults (6 men, 4 women, 69 ± 3 yr) completed 7d of monitored normal baseline
activity (BL), followed by 14d of SR (8568 ± 3741 to 973 ± 76 steps/d; p<0.001).
After SR, participants returned to habitual activity for a 14d recovery period
(RC). RESULTS: Analysis of oral glucose tolerance tests (OGTT) showed that
SR resulted in elevated plasma blood glucose concentration ([G]) area under
the curve (325 ± 126 to 375 ± 137, ns: p = 0.13), maximum [G] (10.2 ± 2.4 to
11.9 ± 1.7 mM, p = 0.027) and [G] at 120 min (7.9 ± 1.3 to 9.1 ± 1.1 mM, ns: p
= 0.085) compared to BL. All measures of glycemic control during OGTT
returned to BL values after 14d of habitual activity. However, Matsuda insulin
sensitivity index, which was reduced (3.5 ± 0.3 to 2.7 ± 0.7, p < 0.001) and
insulin resistance (HOMA-IR), which was elevated (2.8 ± 0.3 to 3.6 ± 0.7, p =
0.02) with SR, remained significantly different than BL even after RC (p <
0.005). CONCLUSION: These results show that periods of PI, characterized
by reduced daily stepping, result in impaired glycemic control in older adults.
While the reduction in glycemic control seems transient and undetectable with
14d of normal daily physical activity, these findings suggest that insulin
sensitivity, which was reduced with SR, remains compromised.
22
Rehabilitation Sciences, University of Toronto; 2Bloorview Research
Institute, Bloorview Kids Rehabilitation Hospital, Toronto; 3Montreal
Neurological Institute; 4Centre for Addiction and Mental Health (CAMH),
Toronto
BACKGROUD: There is a current lack of research in neuroimaging studies
demonstrating evidence of injury and level of recovery for youth who have
incurred a concussion, or mild traumatic brain injury (mTBI). Little evidence
exists showing the impact of mTBI on pediatric brain activity and how brain
activity changes after mTBI symptoms resolve. The current series of case
studies aimed to investigate the influence of injury in 2 concussed minor
hockey players pre- and post-mTBI. OBJECTIVE: To examine differences in
brain activity associated with both symptomatic and asymptomatic post-injury
status of youth with mTBI using tasks known to be sensitive to frontal lobe
damage [working memory (WM)]. METHODS: We compared WM performance
and related brain activity using functional magnetic resonance imaging (fMRI)
in 2 youth pre and post-concussion (11 year old male and 13 year old female).
Three testing intervals were used: pre-injury, symptomatic post-injury and
asymptomatic post-injury. Blood oxygen level dependent (BOLD) signal
change between testing intervals was compared within subjects. Analyses
were completed using AFNI and fMRIstat. RESULTS: Overall for both
participants, t-maps between testing times showed significantly reduced
activation in baseline and symptomatic follow-up during the WM tasks.
Compared with symptomatic brain activity, asymptomatic follow-up showed
greater activation, although this was still reduced from baseline. BOLD signal
change during asymptomatic testing varied, with signal change being lower or
higher than symptomatic testing. CONCLUSIONS: Changes in brain activity
patterns were observed even when youth no longer reported physical or
cognitive symptoms post-mTBI. Future research using a larger sample size will
help determine whether this finding is associated with any behavioural or
cognitive changes post-injury.
C-04
RISK FACTORS FOR HEMATOPOIETIC STEM CELL
TRANSPLANTATION IN INHERITED BONE MARROW FAILURE
SYNDROMES
*O. A. Arbiv, *1M. Kalbfleisch, 2R. Klaassen, 3C. V. Fernandez, 4R. A.
Yanofsky, 5J. Wu, 6Y. Pastore, 7M. Silva, 8J. H. Lipton, 9J. Brossard, 10B.
Michon, 11S. Abish, 12M. Steele, 13R. Sinha, 14M. Belletrutti, 15V. Breakey, 16L.
Jardine, 17L. Goodyear, 1L. Sung, 1T. Schechter-Finkelstein, 1B. Zlateska,
**1M. Cada, **1Y. Dror
1
The Hospital for Sick Children; 2Children's Hospital of Eastern Ontario; 3IWK
Health Centre; 4CancerCare Manitoba; 5British Columbia Children’s Hospital;
6
Hôpital Ste. Justine; 7Queen’s University; 8Princess Margaret Hospital;
9
Centre U Sante de l’Estrie-Fleur; 10Centre Hospital University Quebec-Pav
CHUL; 11Montreal Children's Hospital; 12Alberta Children's Hospital;
13
University of Saskatchewan; 14University of Alberta/Health Sciences Centre;
15
McMaster Children’s Hospital.
BACKGROUND: Inherited bone marrow failure syndromes (IBMFS) are
genetic syndromes characterized by hypoproductive bone marrow, which can
only be cured by hematopoietic stem cell transplantation (HSCT). Our aim was
to identify risk factors for mortality in patients with IBMFS following HSCT.
METHODS: Patients were prospectively enrolled in the Canadian Inherited
Marrow Failure Registry (CIMFR). Survival analyses were performed to identify
factors associated with all-cause mortalitiy for patients who underwent HSCT.
RESULTS: Among 487 patients enrolled in CIMFR, 81 received HSCT. 23
patients died during post-transplant, and overall survival at five years was 71%.
Clinically relevant risk factors were assessed using a Kaplan-Meier analysis
and Cox proportional hazards model. Two risk factors were predictive of
survival: (1) receiving ≥20 platelet transfusions pre-transplant (P = 0.008), and
(2) having a non-HLA matched donor (P = 0.006). Several risk factors were
analyzed to ensure these results are not related to disease severity, and none
were significantly different. CONCLUSIONS: Our analysis shows that
receiving more platelet transfusions or having a non-matched donor are risk
factors for HSCT in patients with IBMFS. This suggests that platelet
transfusions, even if leuko-reduced, are a major risk factor to patients.
ABSTRACTS
C-05
CAROTID INTRAPLAQUE HEMORRHAGE IS ASSOCIATED WITH
INCREASED CEREBRAL WHITE MATTER HYPERINTENSITIES
M. Barszczyk1, O. Mitchell1, N. Singh1, A. Moody1
1. Department of Medical Imaging, Sunnybrook Health Sciences Centre,
Toronto, Canada
C-06
INTRACRANIAL HAEMORRHAGE IN PAEDIATRIC ONCOLOGY PATIENTS
L. Betcherman1, J. Pole2, L. Estcourt3, S. Stanworth3, L. Sung5, L. Lieberman5
University of Toronto, Toronto, ON, 2Paediatric Oncology Group of Ontario,
Toronto, ON, 3University of Oxford, Oxford, UK, 4Hospital for Sick Children,
Toronto, ON,5 University Health Network, Toronto, ON
1
INTRODUCTION: White matter hyperintensities (WMHs) are hyperintense
signals found upon T2-weighted magnetic resonance imaging (MRI) within
cerebral white matter. These lesions are associated with an increased risk of
dementia and stroke, and have been attributed to atherosclerosis of small
penetrating vessels. However, emerging evidence suggests that
atherosclerosis of the carotid arteries, particularly carotid intraplaque
hemorrhage (IPH), may also contribute to WMHs, but a lack of robust WMH
quantification protocols has hampered investigation into this association.
OBJECTIVE: Our work aims to develop a reliable protocol to quantify WMHs
and investigate the association between cerebral WMHs and carotid IPH.
METHODS: Using Xinapse, a well validated software used in multiple sclerosis
clinical trials, a protocol was developed to quantify WMH volume. Intraobserver
and interobserver reliability of the established protocol was then assessed
using intraclass correlation coefficients (ICCs) and Bland-Altman plots (n=15).
Once validated, a retrospective cohort of asymptomatic patients with moderate
carotid artery stenosis (n=84) was used to investigate the association between
carotid IPH and cerebral WMHs. RESULTS: Using Xinapse, a semi-automatic
protocol was developed to quantify WMHs using only T2 FLAIR MRI
sequences that could classify WMHs into right or left periventricular or deep
subcortical localizations. The protocol showed excellent intraobserver and
interobserver reproducibility with ICC values over 0.960 for all lesion
classifications. Preliminary evidence comparing patients with IPH-negative
carotid arteries (n=13) to those with unilateral (n=10) or bilateral (n=6) carotid
IPH found significant increases in WMH volume from 5.55±3.06 mL to
14.82±14.27 mL (p=0.03) and 20.58±10.90 mL (p<0.01), respectively.
CONCLUSION: Future work involves investigating WMHs ipsilateral and
contralateral to carotid IPH to determine whether this association is due to
thrombo-embolization or shared vascular risk factors with small vessel
disease.
BACKGROUND: Intracranial haemorrhage (ICH) is a rare but serious complication
seen in paediatric oncology patients and is associated with significant long-term
morbidity and mortality. ICH risk factors differ between the general population and
those with cancer. Few studies have directly examined the incidence, risk factors and
clinical outcomes for ICH in the paediatric oncology population. OBJECTIVES: (1)
To describe patient and treatment-based factors for the development of ICH in
paediatric oncology patients and (2) To assess morbidity and mortality 24 hours and
30 days following the event. METHODS: A retrospective chart review of oncology
patients <18 years of age treated between 1995-2014 at the Hospital for Sick
Children (HSC) was conducted. Patients were identified via: 1) The Paediatric
Oncology Group of Ontario (POGO) identified ICH cases from their database and (2)
the entire POGO database was cross-linked with ICD-9 and ICD-10 coded ICH from
Health Records at HSC. Controls were selected via a case-crossover design.
INTERIM RESULTS: Methods 1 and 2 identified 63 and 136 cases, respectively. 61
were excluded based on no radiological documented ICH or cancer diagnosis,
traumatic ICH, or lack of available data. The remaining 138 cases corresponded to
200 bleeding episodes. 95 episodes were excluded (occurred within two weeks of
neurosurgery). Group 1 included non-primary brain tumor patients (39 cases, 42
bleeding episodes) and group 2 included brain tumor patients (51 cases, 62 bleeding
episodes). Primary descriptive statistics were applied to group 1, without analysis
performed on the controls: prevalence of IV beta-lactams (77%), IV antifungals
(33%), L-asparaginase (19%), bone marrow transplants (5%). 68% of bleeds were
preceded by a suspected or proven infection. At 48 hours post-ICH 70% were
transfused and 68% were transferred to the ICU. 23% received ICH medications,14%
required surgical intervention,14% had treatment suspended and16% died. 30 days
post-ICH, 26% remained in hospital (7% in ICU). 14% experienced neurological
sequelae and an additional 30% died. DISCUSSION & FUTURE DIRECTIONS: This
pilot study assessed risk factors for paediatric oncology patients who develop ICH.
The gender discrepancy was unexpected. Most bleeding episodes were preceded
by a suspected infection and IV antimicrobials. Mortality rates were lower than
expected. Logistic regression models will be used to assess the risk factors and their
association with the development of ICH, when comparing cases with their control
admissions.
C-07
DELINEATING EPILEPTOGENIC CORTEX USING NETWORK
CONNECTIVITY MEASURES.
Monica Blichowski1,2, Simeon Wong1,2, Sam Doesburg1,2
C-08
ROLE OF DUAL ENERGY CT IN EVALUATION OF CHRONIC
THROMBOEMBOLIC PULMONARY HYPERTENSION (CTEPH)
A.K. Brar, N. Paul, S. Homampour
Neuroscience and Mental Health Program, Peter Gilgan Research Centre of
Research and Learning, Hospital for Sick Children1, University of Toronto2
BACKGROUND: Areas of variable lung attenuation forming a mosaic pattern
are seen on computed tomography (CT). Mosaic attenuation is a useful CT
feature in the management of vascular disease named chronic
thromboembolic pulmonary hypertension (CTEPH) (Stern et al 1995). King et
al. (1998) found mosaic attenuation in 77% of CTEPH patients. The
attenuation differences mainly result from changes in pulmonary perfusion.
The sensitivity of CT for detecting this pattern due to CTEPH based on CT is
76%. Many of initial studies are based on single or 4 row detector CT.
Significant advancements have taken place in CT that provide improved
spatial and temporal resolution, and require less time. Dual energy CT can be
used to assess pulmonary perfusion through distribution of iodinated contrast
medium. In a recent study conducted with 20 CTEPH patients, Hoey et al
2010, found a strong correlation between dual energy CT derived perfusion
and mosaic attenuation when both lobar and whole lung scores were
assessed and it was concluded that the additional information by dual CT
could have a role in guiding surgery for CTEPH patients. PURPOSE: The
objective of our study is to further validate the use of dual energy maps in
management of CTEPH. A prospective study with 30 CTEPH patients will be
conducted. Low dose temporal subtraction (LD-TS) CT will be performed to
generate maps. The maps will compared to clinically obtained ventilationperfusion (V/Q) scan, and 64 row detector CT pulmonary angiography
images. Mosaic attenuation will be evaluated at lobar and segmental levels in
both the iodine maps and on CT images of the lung. The sensitivity and
specificity of mosaic attenuation for CTEPH will be examined. METHODS:
Following consent, CTEPH patients that come to hospital for their CT are
asked to undergo a LDTS CT pre-operatively and 3 months following surgery.
RESULTS: 9 CTEPH patients have been consented and have participated in
the study. Their perfusion maps have been obtained. The maps are still being
analyzed and the correct window settings for evaluation of perfusion maps is
being explored.
INTRODUCTION: Surgical resection of the seizure onset zone is often the
most effective treatment for focal drug-resistant epilepsy. Due to the
heterogeneity of epileptogenic cortex among children with neocortical epilepsy,
accurate delineation of the area comprising the seizure onset zone continues
to be challenging. The gold standard for determining the epileptogenic zone
remains ictal electroencephalography (ECoG), in which recordings are made
using electrodes surgically implanted onto the surface of the brain. The
epileptogenic cortex is associated with altered functional network connectivity,
including frequency-specific alterations in the inter-electrode synchronization
of brain rhythms. OBJECTIVE: The aim of the present study is to identify
characteristics of functional connectivity dynamics, which may be biomarkers
of epileptogenic cortex. ECoG data recorded from children with drug-resistant
epilepsy undergoing neurosurgery at the Hospital for Sick Children was
collected. Animated videos were then created showing the dynamic changes
of inter-electrode synchrony during pre-ictal, ictal, and post-ictal periods. These
videos were analyzed visually to determine common patterns of network
synchronization dynamics that might suggest a reliable biomarker of
epileptogenic cortex. Quantitative analysis will ascertain significant changes,
and allow for the determination of sensitivity and specificity of identified
biomarkers. RESULTS: Preliminary results based on visual observation
suggest that synchrony in the seizure onset zone for low-frequency brain
rhythms, coupled with high-frequency desynchrony may be biomarkers for
epileptogenic cortex. The connectivity between the seizure onset zone and
other regions appears to be highest pre-ictally, less ictally, and least postictally. DISCUSSION: These results raise the possibility that biomarkers can
be identified from ECoG data that can better delineate cortical seizure onset
zone.
23
ABSTRACTS
C-09
THE EFFECT OF MUSIC EXPOSURE ON PSYCHOLOGICAL
FUNCTIONING IN CHILDREN UNDERGOING ELECTIVE SURGERY
F. Chan1, T. Gimon1, A. Pierro2, C. Oliveira2, F. Campbell2, D. Joo3, N.
Grace3, J. Wolinska2, S. Eaton4, R. Geist5, S. Himidan2,3
University of Toronto, ON, Canada 2The Hospital for Sick Children, Toronto,
ON, Canada 3North York General Hospital, Toronto, ON, Canada 4University
College London Institute of Child Health, London, United Kingdom 5Trillium
Health Centre, Mississauga, ON, Canada
1
BACKGROUND: Medical interventions may be upsetting to children and cause a
physiological stress reaction. Music therapy has been shown to be beneficial,
by addressing mood issues, anxiety, pain, and behavioural distress.
OBJECTIVE: We aim to determine the effect of repeated pre- and intra-operative
music exposure on psychological outcomes in 6- to 14-year old children
undergoing elective open inguinal hernia repair in a randomized clinical trial.
METHODS: 3 groups were compared: repeated listening to own playlist vs. own
composition vs. no music. Playlist and composition creation were facilitated
during 60-minute sessions with a music teacher. Patients listened to their
treatment prior to and on the day of surgery using headphones. The primary
outcome was anxiety level, quantified using the age-specific and widely
validated State-Trait Anxiety Inventory for Children. RESULTS: 64 participants
were recruited; however, compliance was 55% and data collection/analysis is
still in progress. In a preliminary sample of 24 participants (6 playlist, 8
composition, 10 control), all children who attended a music session found it
“fun, comfortable, not difficult, and not stressful”. Pre-operative anxiety level
was compared to baseline anxiety measured at the primary clinic visit. In the
control group, median pre-operative anxiety score was 68 out of 120 (IQR=6.8)
with baseline 65.2 (16.3). In the playlist group, pre-operative was 63.8 (2.4)
with baseline 65.3 (6.9). In the composition group, pre-operative was 76.5 (10)
with baseline 67.5 (11.9). CONCLUSION: Our preliminary data suggests that
children are receptive to this music therapy. Those who had repeated exposure
to a playlist may have experienced the lowest pre-operative anxiety levels.
C-11
REFERRAL AND TREATMENT PATTERNS IN NON-SMALL CELL LUNG
CANCER (NSCLC)
M. Chen1, S. Verma2
1
Faculty of Medicine, University of Toronto, 2Odette Cancer Centre,
Sunnybrook Health Sciences Centre, Toronto, ON
INTRODUCTION: In Canada, lung cancer is the leading cause of cancerassociated mortality. Despite recent advances in treatment options, Canadian
studies conducted in Ontario and British Columbia have shown that only about
50-70% of patients with advanced NSCLC are referred to medical oncology
and only 25-30% receive systemic treatment. OBJECTIVE: The study aims to
evaluate the current gaps in referral patterns and investigate reasons for not
initiating systemic treatment. Overall, the aim is to develop strategies to
address these gaps in order to optimize patient care and improve access to
treatment. METHODS: To identify potential barriers in treatment and referral
of patients with advanced NSCLC, two online surveys examining stage IV
NSCLC referral and treatment patterns were administered, targeting medical
oncologists and physicians that commonly refer lung cancer patients to
medical oncology throughout Canada. RESULTS: Referring physicians
reported that patients declining referral, patient performance status and comorbidities were the most important reasons influencing their decision to not
refer patients to medical oncology. Medical oncologists reported that patients
declining treatment was the most important reason influencing their decision to
not initiate systemic therapy. More medical oncologists believed that
chemotherapy conferred a survival and palliative benefit compared to referring
physicians. 31.6% of referring physicians reported obstacles when trying to
refer patients to cancer centers – these obstacles include the requirement of
tissue diagnosis for referral, long wait time, and communication barriers.
DISCUSSION: There is discordance between the advancement in treatment
options and the small percentage of individuals being referred for care and
receiving systemic treatment. This is due to a combination of physician, patient,
and systems factors. Continued efforts to mitigate these factors are needed to
improve access to systemic therapy for patients with advanced NSCLC.
24
C-10
CLINICAL APPLICATION OF PHARMACOKINETIC ANALYSIS OF
ANESTHESIA
MEDICATIONS
TO
ASSESS
FUNCTION
OF
TRANSPLANTED LIVER. ANESTHESIA MEDICATIONS AS MARKERS OF
POST REPERFUSION RECOVERY/INJURY.
J. Chan1, A. Jerath2, S. McCluskey2, S. Pang3, B. Bojko4, J. Pawliszyn4, M.
Selzner5, and M. Wasowicz2
1
Faculty of Medicine, U of T, 2Department of Anesthesia, TGH, 3Faculty of
Pharmacy, U of T, 4Department of Chemistry, University of Waterloo,
5
Department of Surgery, TGH
BACKGROUND: Liver transplantation (LT) is a life-saving treatment for
patients with end-stage liver failure or advanced hepatocellular carcinoma.
Currently, the function of newly transplanted liver is based on routine laboratory
tests (INR, Bilirubin, AST, ALT), however, their rise is a late indicator of graft
function. A precise biochemical evaluation of early liver function would allow
us to better understand the functional potential of the new graft. Our pilot data
indicated that routinely used anesthesia medications may serve as marker of
early graft dysfunction. OBJECTIVE: We aimed to correlate PK profile of
rocuronium (ROC) and midazolam (MID) with standard laboratory measures
describing liver function in three types of donors: living-related, cadaveric, and
donation after cardiac death. We also aimed to correlate mRNA and protein
expression in donor liver tissue with post-transplant liver function. METHODS:
This is a prospective, investigator-blinded study. All LT recipients received our
standard level of care. On induction, patients received cisatracurium at 0.1
mg/kg. After insertion of the new liver, 0.6 mg/kg ROC and 2.0 mg/kg MID was
administered. Collection of 5 ml blood samples were performed at predetermined time points post-bolus administration. Analysis was performed
using both solid-phase microextraction and plasma protein precipitation/LCMS/MS. A two compartment model was used to fit ROC and MID using
ADAPT5®. RESULTS: We have recruited a total of 13 participants into the
study and recruitment is ongoing. DISCUSSION: If our hypothesis is correct, a
point-of-care tool can be developed to measure ROC and MID concentrations
at patients’ bedside and used to monitor early liver function in liver transplant
recipients.
C-12
TRANSITIONAL PAIN SERVICE: EFFECTS OF PAIN MEDICATIONS ON
POST-OPERATIVE OPIOID WEANING IN OPIOID-NAÏVE PATIENTS AND
PATIENTS ON PRE-OPERATIVE OPIOIDS
B. Cheung1, J. Montbriand2,3, A. Mu3, and H. Clarke1,3
1
Faculty of Medicine, University of Toronto
Department of Psychology, York University
Department of Anesthesia and Pain Management, Pain Research Unit,
Toronto General Hospital
2
3
BACKGROUND: Chronic post-surgical pain (CPSP) is a common surgical
complication that severely impacts a patient’s quality of life, and has been
associated with increased risk for prolonged opioid use. The use of other pain
medications pre- and post-operatively may be associated with prolonged
opioid use. OBJECTIVE: To determine which pain medications are associated
with opioid weaning in opioid-naïve patients and patients on pre-operative
opioids. METHODS: A single-centre retrospective cohort study was conducted
using an ongoing database of surgical patients (n=186, aged 51.9 ± 14.6 years)
enrolled in the Transitional Pain Service (TPS) at Toronto General Hospital.
The main outcome measure is opioid weaning, defined as patients who have
undergone at least two TPS visits and who have reduced their morphine use
to 0 from post-surgical discharge to their last recorded TPS visit. Patients with
two or more TPS visits are divided into opioid-naïve and pre-operative opioid
users. Within each of the two groups, univariate or multivariate analysis, as
appropriate, will be conducted to determine the association between opioid
weaning and the use of pain medications pre-operatively, at discharge, and
post-discharge throughout their TPS visits. RESULTS: Results of the analysis
are still pending. DISCUSSION: Understanding the mechanisms that lead to
prolonged opioid use is fundamental in developing suitable interventions to
decrease opioid use in the future. Additional studies will be required to further
explain the mechanisms by which medications influence opioid use.
ABSTRACTS
C-13
UMBILICAL CORD GAS VALUES IN NEONATES OF MOTHERS WITH
SICKLE CELL DISEASE IN COMPARISON TO NEONATES OF NONAFFECTED MOTHERS
P. Cheung1, N. Shehata2, K. E. Murphy3, A. Malinowski3
1
MD Candidate, University of Toronto 2Division of Hematology, Mt. Sinai
Hospital
3
Department of Maternal-Fetal Medicine, Mt. Sinai Hospital
C-14
CHARACTERISTICS OF RHEUMATOID ARTHRITIS PATIENTS WITH AND
WITHOUT CARDIOVASCULAR DISEASES
K. Cui1, B. Jacob1, J. Widdifield2, J. Pope3, X. Li1, B. Kuriya4, C.
Bombardier1,4 and OBRI Investigators
1
Toronto General Hospital Research Institute, 2Institute for Clinical
Evaluative Science, 3Division of Rheumatology, Schulich School of
Medicine & Dentistry, University of Western Ontario, London, 4Division of
Rheumatology, Mount Sinai Hospital, Toronto, Canada.
BACKGROUND: Sickle cell disease (SCD) is amongst the most common
hereditary hemoglobinopathies, and pregnancies of women with SCD have
been shown to be at significant risk of adverse fetal outcomes. Majority may
be placentally-mediated, as sickling can have a pathologic effect on the
formation and function of the placenta, thereby impairing its ability to provide
the fetus with appropriate oxygenation. However, the current literature lacks
information on umbilical cord blood gas values in mothers with SCD, which
could offer further insight into fetal baseline oxygenation status. OBJECTIVE:
We seek to determine whether there is a difference in umbilical cord blood gas
values in neonates of mothers with SCD compared to neonates of non-affected
mothers. METHODS: Single- center retrospective cohort study of all pregnant
women with SCD who attended the Special Pregnancy Program at Mt. Sinai
Hospital from 2004 to 2014. Controls were matched to cases in a 2:1 ratio by
various factors, including maternal age and type of delivery. RESULTS: 86
cases and 172 matched controls were included. Baseline characteristics were
similar between the two groups with the exception of BMI (cases: 27.4 ± 4.1
vs. controls: 30.3 ± 5.8, p<0.01). Cases and controls differed in arterial pH
(7.23 ± 0.7 vs. 7.25 ± 0.06, p<0.02), arterial base deficit (5.06 ± 3.19 vs. 3.83
± 2.31, p<0.002) and venous base deficit (4.03 ± 2.57 vs. 3.32 ± 2.13,
p<0.019). Logistic regression controlling for potential confounding variables is
planned. CONCLUSIONS: Preliminary analysis suggests that the umbilical
cord gas values in neonates of mothers with SCD differ from neonates of nonaffected mothers. This supports the hypothesis that the pathologic effect of
sickling on the formation and function of the placenta affects optimal fetal
oxygenation, resulting in relative hypoxemia. Further analysis may affect
conclusions and clinical significance of results.
BACKGROUND: Cardiovascular disease (CVD) is a major comorbidity and the
leading cause of death among patients with rheumatoid arthritis (RA).
OBJECTIVE: To compare the characteristics RA patients with and without CVD
at cohort entry and 12 months of follow-up. METHODS: Data were collected from
the Ontario Best Practices Research Initiative, a clinical registry of RA patients
followed in routine care. CVD was defined as the presence of coronary artery
disease, congestive heart failure, arrhythmia, or stroke/TIA at registry entry.
Characteristics between CVD and non-CVD patients were compared using Chisquare and t-tests. Disease activity and functional status at cohort entry and
12 months of follow-up were estimated by generalized linear regression,
adjusting for confounders, including age, sex, smoking, socioeconomic factors,
RA duration, and/or baseline disease activity. RESULTS: Among 2226 RA
patients, 360 (16.2%) had CVD at cohort entry, 415 (18.6%) had CVD risk
factors and 55 (0.25%) developed CVD during the duration of follow-up.
Patients with CVD were older (66.7±10.1 vs. 53.6±12.9yrs, p<0.0001), had
longer RA duration (10.6±11.8 vs. 8.1±9.0yrs, p<0.0001) and more extraarticular features (35.0% vs. 26.3%, p<0.05). Male sex, lower education and
income, lack of private insurance, and smokers were more frequent among
CVD patients (p<0.001 for all). After adjusting for confounders, CVD patients
had higher disease activity (RADAI) and functional status (HAQ-DI) at cohort
entry. At 12 months, disease activity (DAS28) remained worse while ESR was
elevated among CVD patients. CONCLUSIONS: Disease severity and
functional status appeared to be worse in RA patients with CVD. This may be
related to the heightened systemic inflammation as evidenced by ESR
elevation.
C-15
THE IMPACT OF PRE-OPERATIVE CT IMAGING ON THE MANAGEMENT
OF PATIENTS DIAGNOSED WITH HIGH GRADE ENDOMETRIAL
CANCER
S. Dai1, S. Nahas1,2, J. K Murphy1,3, T. May1,3, T. Feigenberg1,2.
C-16
DECOMPOSING THE HETEROGENEITY OF SUBJECTIVE COGNITIVE
COMPLAINTS AMONG OLDER ADULTS WITH CEREBRAL SMALL
VESSEL DISEASE USING FUNCTIONAL NEUROIMAGING
A.K. Dey1,2,4, A. Bacopulos2, N. Jeyakumar2, V. Stamenova2,4 , S.E.
Black1,2,3,4, & B. Levine1,2
1
Faculty of Medicine, University of Toronto, Toronto, ON, Canada. 2Division
of Gynecologic Oncology, Credit Valley Hospital, Mississauga, ON, Canada.
32
Division of Gynecologic Oncology, Princess Margaret Hospital, Toronto,
ON, Canada.
INTRODUCTION: Endometrial cancer is the most common gynecologic
malignancy in women in developed countries. High-grade endometrial cancer
(HGEC) is a rare aggressive disease entity with an estimated 30% of patients
diagnosed who will present with extra uterine disease. OBJECTIVE: To
determine the efficacy of pre-operative CT in finding extra-uterine disease, and
assess its impact on the surgical management of patients diagnosed with
HGEC. METHODS: Patients with HGEC who underwent pre-operative CT
imaging prior to surgical staging and treatment at Credit Valley Hospital and
Princess Margaret Hospital were included in this retrospective study. Data
collected from the records of 179 patients who met the inclusion criteria
between 2003 and 2015 was analyzed, including the rate of incidental
unrelated findings that required follow-up and the rate in which imaging results
altered surgical management. RESULTS: Of the 179 patients, 30 (16.8%)
patients’ imaging showed findings suspicions of metastatic disease, however
these findings resulted in change of planned surgical procedure in only 9
patients (5%). A total of 57 (31.9%) patients were found to have advanced
disease post-operatively (staged III or higher). In 16 (8.9%) cases, there was
a significant discrepancy between the CT results and surgical findings
suggestive of obvious metastatic disease. CT results showed incidental
findings that required follow up imaging in 80 (44.7%) of cases. 140 patients
(78.2%) required adjuvant therapy. CONCLUSION: Pre-op CT imaging is
efficacious in finding extra-uterine disease in patients with high grade
endometrial cancer, although it rarely alters surgical management of these
patients. A significant proportion of these CT scans will pick up incidental
findings that will require further surveillance and future imaging.
1
University of Toronto
Rotman Research Institute, Baycrest Hospital
LC Campbell Cognitive Neurology Research Unit, Sunnybrook Health
Sciences Centre 4 Heart and Stroke Foundation Canadian Partnership for
Stroke Recovery, Sunnybrook Health Sciences Centre
2
3
BACKGROUND: Damage to white matter tracts observed in Cerebral Small
Vessel Disease (CSVD) may accelerate age- related cognitive decline
contributing to dementia through interruption of neural networks mediating
attention and other executive functions. There is a need to better understand
determinants of clinical expression of CSVD, beyond possible threshold
effects, as not all individuals with lesions have cognitive complaints.
OBJECTIVE: This study investigated whether functional connectivity differed
between older adults with CSVD who self-reported high versus low levels of
executive dysfunction in their daily lives. METHODS: Cognitively intact older
adults with no CSVD, older adults with CSVD and minimal cognitive complaints
and older adults with CSVD and substantial cognitive complaints, as indexed
by the dysexecutive function questionnaire (DEX) and the cognitive failures
questionnaire (CFQ), underwent comprehensive neuropsychological testing,
structural and resting functional MRI. The relationship between subjective
cognitive complaints, neuropsychological test performance and differences in
intrinsic functional connectivity were explored. RESULTS: Relative to healthy
older adults those with symptomatic CSVD demonstrated reduced Default
Mode Network (DMN) connectivity and weaker anti-correlations between the
DMN and the Dorsal Attention Network (DAN) at rest. CONCLUSION: This
provides early evidence that differences in network connectivity may underlie
differences in cognitive impairment in sporadic CSVD.
25
ABSTRACTS
C-17
PULMONARY FUNCTION POST PULMONARY EMBOLISM IN CHILDREN
S. Williams1 and E. A. Fung2
C-18
Postoperative Positive Fluid Balance as a Predictor of Increased Length
of Stay in Intensive Care following Spinal Surgery.
A.M. Gazendam1, J. Cape1, S.J. Lewis2, J.M. Singh2
1
Division of Haematology/Oncology, The Hospital for Sick Children, Toronto,
Ontario, Canada 2MD Program, University of Toronto, Toronto, Ontario,
Canada
1
University of Toronto, Toronto, Ontario, Canada. 2Toronto Western Hospital,
Toronto, Ontario, Canada.
BACKGROUND: Thrombotic diseases including pulmonary embolism (PE)
have become increasingly prevalent in children. This can be attributed to
medical advances that have led to an increase in the survival of previously fatal
childhood diseases, an increase in central venous catheters use, and an
improved availability of diagnostic imaging. Studies have documented
abnormalities in pulmonary function and echocardiogram findings in adults
diagnosed with acute PE in follow-up after the acute events. OBJECTIVE: The
objective of this study was to assess the pulmonary function, exercise
tolerance, and echocardiogram findings of children who have been diagnosed
with acute PE. METHODS: Eleven children ranging in age from 4 to 17 years
were identified as having a previous diagnosis of acute PE. Data about the
participants was retrospectively collected from electronic health records at their
initial presentation, 3 month, 6 month and most recent follow-up:
demographics, respiratory and cardiovascular signs and symptoms, computed
tomography with contrast findings (extent of PE, presence of pulmonary
infarction), electrocardiogram findings, chest x-ray findings, pulmonary
function testing, exercise testing, and treatment history (anticoagulation, time
in therapeutic range). Regression analysis was completed to identify predictors
for aerobic fitness (VO2 max) on exercise testing. RESULTS: Bicycle
ergometry exercise testing revealed that 10/11 (91%) patients had VO2 max
results that were below 80% of their predicted individual values. Clinical
symptoms, extent of PE, treatment duration, and time in therapeutic range
were not predictive of the degree of abnormality on exercise testing.
CONCLUSION: The majority of children had decreased aerobic fitness as
measured by VO2 max, following a PE. As aerobic fitness has the potential to
impact daily life and sport activities, follow-up exercise testing may be a useful
clinical assessment in children with PE.
BACKGROUND: The increasing complexity of spinal fusion surgeries has
increased the need for postoperative care in the ICU. The management of
patients during and immediately following surgery can impact their
postoperative course. OBJECTIVE: To ascertain intraoperative and
perioperative management factors that impact the clinical outcomes in patients
undergoing spinal surgery admitted to the ICU. METHODS: Retrospective
medical chart review of 102 consecutive patients who underwent elective
spinal fusion and were admitted to the ICU. Demographic, intraoperative and
perioperative data were collected. The postoperative fluid balance was
calculated following day 1 and day 2 in the ICU. Patients were stratified based
on ICU length of stay (LOS); Group 1 consisted of patients with a 1-2 day ICU
LOS. Group 2 consisted of patients with an ICU LOS ≥3 days. Statistical
analysis determined factors that contributed to ICU LOS and duration of
mechanical ventilation. RESULTS: There were 41 patients in Group 1 and 58
patients in Group 2. There was no difference in demographics or procedural
data between groups. Intraoperative blood loss was significantly higher in
group 2 (median 2.5L vs 3.7L P=0.019). However, there was no difference in
perioperative transfusion amounts. Postoperatively, the cumulative ICU fluid
balance on day 2 in the ICU was significantly greater in Group 2 (2.3L vs 3.9L
P=0.003). Group 2 also had significantly greater duration of mechanical
ventilation (1[0.8-2] vs. 0[0-1] days; P=0.001). Multivariate analysis
demonstrated that cumulative ICU fluid balance on day 2 was the only
independent predictor of ICU LOS (adjusted OR 1.17; 95% CI, 1.01-1.36).
CONCLUSION: Postoperative day 2 cumulative ICU fluid balance is an
independent predictor of increased ICU LOS following spinal surgery.
Alternatives to fluid should be considered when attempting to maintain a target
postoperative MAP to protect spinal cord perfusion.
C-19
PRENATAL VERSUS POSTNATAL DIAGNOSIS OF TRANSPOSITION OF
THE GREAT ARTERIES
L. Glick1, H. Nagata1,2, J. Lougheed3, S. Schwartz1,2, E. Jaeggi1,2
C-20
CHANGES IN ANEMIA MARKER LEVELS FOLLOWING LAPAROSCOPIC
ADJUSTABLE GASTRIC BANDING VERSUS SLEEVE GASTRECTOMY
IN OBESE ADOLESCENT PATIENTS
H. R. Goldberg1, J. L. Zitsman2, D. J. McMahon3, I. Fennoy4
University of Toronto, 2Sick Kids Hospital, 3Children’s Hospital of Eastern
Ontario
1
BACKGROUND: Transposition of the great arteries (TGA) is a cardiac
condition that requires immediate care after birth and neonatal surgery. While
a prenatal diagnosis of TGA facilitates perinatal care, the impact on morbidity
and mortality is unclear. OBJECTIVES: To compare the presentation,
management and outcomes for newborns diagnosed with a fetal versus
neonatal diagnosis of TGA from 2009 to 2014 at a large tertiary care center.
METHODS: Eligible patients were identified in our prospective cardiac
databases. Data was reviewed to determine the timing of diagnosis, time to
interventions, pre-operative medical status, post-operative morbidity, survival
and long term outcomes. Student’s t-test was used to compare outcomes
between prenatal and postnatal cohorts. Survival was analyzed using Kaplan
Meier. RESULTS: In total, 174 neonates were diagnosed with TGA over the
study period, with 54% receiving a prenatal diagnosis (prenatal N=94,
postnatal N=80). Mean distance of neonatal transportation to Sick Kids for
treatment (8.91±79 versus 126.3±149.9 km; P<0.001) including time from birth
to hospital admission (2.2±5.7 versus 63.9±137.5 hours; P<0.001) were
significantly shorter for the fetal vs. neonatal patient cohorts. Time intervals to
prostaglandin initiation (12.3±73.3 versus 95.6±174.8 hours; P<0.001) and to
balloon atrioseptostomy (57.4±158.7 versus 130.6±190.4 hours; P<0.001)
were also significantly shorter in the fetal compared with the neonatal cohort.
There were, however, no significant differences in pre-operative state including
the pre-ductal saturation, pH, lactate and multi-organ failure. One year survival
rates were 95% in the prenatal and 92% in the postnatal group (not significant).
CONCLUSION: Prenatal diagnosis of TGA significantly impacted time to
hospitalization and intervention, but does not affect pre-operative clinical status
or survival. Future analysis will investigate TGA diagnosis and outcomes
among areas across Ontario.
26
1
2
4
Institute of Human Nutrition, Columbia University Medical Center (CUMC);
Department of Surgery, CUMC; 3Department of Medicine, CUMC; and
Division of Pediatric Endocrinology, CUMC, New York, New York.
BACKGROUND: Anemia following bariatric surgery is a known complication.
Nutritional deficiencies are greater following malabsorptive compared to
restrictive procedures. Sleeve gastrectomy (SG) is considered restrictive yet
the fundus is removed with loss of gastric acid and intrinsic factor secreting
parietal cells. Thus, SG may encompass malabsorptive features. OBJECTIVE:
We compared iron, ferritin, B12, folate, hemoglobin (hgb) and hematocrit (hct)
levels following laparoscopic adjustable gastric banding (LAGB) to SG.
METHODS: We conducted a retrospective review of medical records of
pediatric patients who underwent SG and LAGB (1/2006-12/2013). We
examined anemia marker levels at first visit, 2 weeks(wk), 3 months(mo), 6 mo
and 12 mo post-surgery by repeated measures analysis adjusting for weight
loss. RESULTS: There were no differences in anemia marker levels between
groups pre-surgery. There was no difference in iron between groups postsurgery. Ferritin and B12 increased in both groups at 2 wk. SG patients had
higher ferritin (114.3±131.9 vs 73.9±81.4 ng/mL,p<.001) and B12 (997±941.4
vs 824.1±567.0 pg/mL,p=.001) than LAGB patients at 2 wk, though showed no
differences at 3, 6 or 12 mo. SG patients had lower folate than LAGB at 3
(7.5±24.3 vs 12.7±11.3 ng/mL,p<.001) and 6 mo (9.1±25.7 vs 13.1±9.8
ng/mL,p=.003), though showed no differences at 2 wk or 12 mo. There were
no differences between groups in hgb or hct. In a sample of 29 matched pairs,
a higher proportion of SG compared to LAGB patients took iron (21.3 vs 3.8%),
B12 (22.5 vs 1.3%) and folate (10 vs 0%) supplements. CONCLUSION:
Anemia marker levels after bariatric surgery differ by procedure. SG was
associated with lower folate compared to LAGB despite higher intake of
supplements. Our results highlight the importance of early folate
supplementation after SG.
ABSTRACTS
C-21
TREATING PSORIATIC ARTHRITIS (PsA) TO TARGET: DEFINING A
TARGET PSORIATIC ARTHRITIS DISEASE ACTIVITY SCORE (PASDAS)
THAT REFLECTS MINIMAL DISEASE ACTIVITY IN PsA
M. Got1, S. Li2, A. Perruccio12, D. Gladman12 and V. Chandran12
1
University of Toronto; 2Toronto Western Hospital
C-22
PEDIATRIC SUDEP: PRELIMINARY ANALYSIS FOR CANADIAN COHORT
J. Gupta 1, S. Anne-Li 2, Dr. E. Donner 2,3
1
PeRCS/MD Program, University of Toronto, Toronto, ON, Canada 2Division
of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
3
Department of Pediatrics, University of Toronto, Toronto, ON, Canada
BACKGROUND: Psoriatic Arthritis (PsA) is an inflammatory arthritis
associated with psoriasis. Heterogeneous manifestations make assessing
disease activity difficult. Recently, PASDAS, a composite disease activity
measure (range 0–10) was developed. A state of minimal disease activity
(MDA) that reflects remission or minimally active disease was also recently
defined as a target for treatment. OBJECTIVE: We aim to establish a cutoff
value of PASDAS that reflects a state of MDA since this has not yet been
defined. METHODS: 178 PsA patients were recruited from the University of
Toronto PsA clinic and evaluated using a standard protocol that includes all
elements required to calculate the PASDAS and MDA. Using receiveroperating characteristic (ROC) curve analysis, the optimal cut-point of
PASDAS that best discriminates patients in MDA from those not in MDA was
determined. RESULTS: An analysis of 178 patients [54% male, mean (SD)
age 56.8 (12.8) years, mean (SD) disease duration 17.6 (12.7) years] revealed
that the mean (SD) PASDAS score was 3.29 (1.29) and 48.9% of patients were
in MDA. A PASDAS score of 3.2 optimized the ROC curve [area under the
curve- 0.96 (95%CI: 0.94-0.99), sensitivity- 88% (95% CI: 80-93%), specificity92% (95%CI: 94-99%), Youden index- 0.80]. CONCLUSION: This analysis
has showed that the PASDAS score that differentiates patients in MDA state
from those not in MDA is 3.2. A PASDAS score of <3.2 may be used as a target
for treatment.
BACKGROUND: The most devastating outcome in a child with epilepsy is
sudden death. SUDEP (Sudden Unexpected Death in Epilepsy) is defined as
sudden, unexpected, nontraumatic and nondrowning death in patients with
epilepsy, with/without evidence of a seizure and excluding documented status
epilepticus, and where post-mortem examination does not reveal a
toxicological/anatomical cause of death. In an adult population, literature
suggests that risk factors for SUDEP include high frequency generalized tonicclonic seizures (GTC), male gender, and prone positioning in bed. However,
no controlled studies have identified SUDEP risk factors in children.
OBJECTIVE: The aims of this preliminary study are to verify the incidence of
SUDEP in children and identify the frequency of potential risk factors for
SUDEP in children in preparation for a case-control study. The long-term goal
is to recognize children at the greatest risk for SUDEP and implement
protective measures to prevent deaths. METHODS: SUDEP cases in children
were identified and studied through parental interviews, primary physician
questionnaires, database exploitation, clinical chart abstraction and postmortem report analysis. RESULTS: 18 cases of SUDEP in children were
identified (9 Canadian cases in 2014), 39% in males. Of the data available,
66% were on AED polytherapy and 56% had global developmental delay. 70%
had nocturnal seizures, 80% had apneic seizures and 100% had a significant
GTC history. 69% of children were found deceased in bed and of these
children, 56% were found on their side. ½ families had not heard about SUDEP
until its occurrence in their child. DISCUSSION: GTC combined with global
developmental delay and AED polytherapy correspond to severe refractory
epilepsy and SUDEP. As most children were found in bed, enhanced nocturnal
monitoring may be a worthwhile investment. Next steps include comparing
SUDEP cases to age-matched controls.
C-23
THE IMPACT OF ANESTHETIC INHALATIONAL AGENT ON SHORTTERM OUTCOMES AFTER LIVER RESECTION
R. Habashi1, M. Lemke2, J. Khan3, Y. LeManach3, J. Hallet 2, S.S. Hanna 2,
N.G. Coburn 2, C. H.L. Law 2, and P. J. Karanicolas 2
C-24
IMPACT OF POSTNATAL INFECTION ON FUNCTIONAL CONNECTIVITY
PATTERNS IN THE VERY PRETERM BORN NEONATE
S. Halani*1,2, E. Duerden2, J. Foong2, T. J. Guo2, J. Kouptsova2, and S. P.
Miller2,3
1
1
MD Program, University of Toronto, Toronto, Ontario, Canada 2 Department
of Neuroscience, Peter Giligan Centre for Research and Learning, Toronto,
Ontario, Canada and 3Divison of Neurology, The Hopsital for Sick Children,
Toronto, Ontario, Canada
Faculty of Medicine, University of Toronto, Toronto, ON; 2Division of
Surgical Oncology, Odette Cancer Centre, Toronto, ON; and 3Department of
Aesthesia, McMaster University, Hamilton, ON.
INTRODUCTION: Postoperative liver failure (PHLF) represents a significant
complication of hepatectomy. Previous studies suggested that the type of
anesthetic inhalational agent (AIA) used during hepatectomy may influence the
development of PHLF and other morbidities. OBJECTIVE: We compared the
association of two commonly used AIA, desflurane and sevoflurane, during
liver resection on post-hepatectomy outcomes. METHODS: We conducted a
comparative cohort study analysis on a prospectively maintained hepatectomy
database. Data was supplemented by manual chart review. Primary outcome
was PHLF defined as derangements in INR and bilirubin. Secondary outcomes
included re-admission, 30-day overall morbidity (Clavien1-2), and major
morbidity (Clavien 3-5). The impact of AIA on outcomes was assessed using
propensity-score (PS) matched analysis. The probability to receive
sevoflurane was estimated by logistic regression on baseline comorbidities,
preoperative biomarkers, and intraoperative factors. We then performed 1:1
matching with a nearest neighbour strategy. T-test or chi-square tests were
used to examine the association between AIA and outcomes. RESULTS: Of
the 749 hepatectomy patients during the study period, 616 (82%) received
desflurane or sevoflurane. After PS matching, 474 patients were included (237
patients in each group). PHLF was not different with sevoflurane (50.9%)
compared to desflurane (49.1%) (OR 1.07, 95% CI: 0.71 to 1.59). No difference
was observed in major morbidity between sevoflurane (50.0%) and desflurane
(50.0%) (OR 1.01, 95% CI: 0.64 to 1.61). Re-admission and length of stay did
not differ by AIA. CONCLUSION: In summary, the choice of AIA has little
impact on short-term outcomes following hepatectomy. The selection of AIA
should be based on patient co-morbidities, AIA availability and costs.
BACKGROUND: Resting-state functional connectivity magnetic resonance
imaging measures neural activity during rest by examining low frequency
changes in the blood oxygen level dependent signal measured by MRI.
Functionally connected brain regions can be defined as spatially distinct areas
in the brain that show correlations between their time series. Preterm infants
are more susceptible to acquiring infections in the intensive care unit and
postnatal infections are associated with widespread abnormalities of brain
maturation. Epigenetic mechanisms may also contribute to the markedly
different reaction to bacteria exposure, and motor and cognitive impairments.
OBJECTIVES: This study involves evaluating novel pipelines for the analysis
of functional connectivity in the neonate. We hypothesize that functional
connectivity within brain networks will be diminished in preterm infants with
sepsis relative to milder clinical infections. The study will explore whether
infection-related changes in the epigenome modify the alterations in brain
maturation. METHODS: 12 preterm infants were scanned within a few weeks
of birth and at term-equivalent age. Blood and saliva samples were used to
extract epigenomic information. Resting state MRI data was preprocessed and
registered. Seed-based analysis was performed using the left and right motor
cortices to see if there is an interaction between the infection level and the
functional correlation between the ROI and other brain areas. RESULTS: In
both cortices, there was more clustering of activated voxels in contralateral
regions once the infants reached term age. This was the case for both the
infants in the mild and severe infection groups. DISCUSSION: Further work is
being done to add in the DNA methylation data and increase the sample size.
27
ABSTRACTS
C-25
ELIMINATING DIGESTIVE IRREGULARITIES CAUSED BY LATE
EFFECTS OF ABDOMINOPELVIC RADIATION (EDIBLE): A PILOT STUDY
OF A NUTRITION AND CULINARY INTERVENTION
C. Han1,2, S. Shah2, C. Brissette2,3, G.Capone2, S.Ferguson4, C.Han4,
W.Levin4, S. Buchanan4, J. Jones1,2
C-26
OPEN SOURCE PLANNING SOFTWARE FOR CUSTOM
NEUROSURGICAL TOOL DESIGN
M. Hess1,2, K. Eastwood2, B. Linder1, V. Bodani2, A. Lasso1, T. Looi2, G.
Fichtinger1, J. Drake2
1
2
INTRODUCTION: Pelvic radiation is commonly used to treat endometrial and
cervical cancers, but it is associated with prolonged gastrointestinal (GI) side
effects. While many patients try to manage symptoms using dietary
modifications, there are currently no clear guidelines or support programs
available. OBJECTIVE: We have developed a structured dietary intervention
to improve symptoms of late GI toxicity. This pilot study evaluated the feasibility
and efficacy of the intervention. METHODS: Patients diagnosed with nonmetastatic cervical or endometrial cancer who have been treated with pelvic
radiation at least one year prior and are experiencing late GI toxicity were
recruited from the Princess Margaret Cancer Centre during follow-up. The
intervention consisted of (1) two hands-on nutritional/culinary classes led by a
Wellness Chef and a Registered Dietician and (2) weekly emails reinforcing
the dietary/culinary concepts. Feasibility was assessed using recruitment and
retention rates, capture of outcomes, and qualitative interviews. Intervention
efficacy was assessed using pre- and post-intervention questionnaires on
bowel symptoms, quality of life, nutritional knowledge, and food intake
behaviour. RESULTS: We are currently delivering the intervention to the
second cohort of study participants. Due to the limited size of each cohort (510 participants) and the length of time between the two classes (7 weeks), we
do not have results to present yet. DISCUSSION: The nutrition and symptom
management intervention may help gynecological cancer survivors better
manage their GI symptoms and improve their QoL.
INTRODUCTION: Many minimally invasive neurosurgical (MIN) procedures
require surgeons to perform complex maneuvers within small, convoluted
workspaces using straight instruments with limited dexterity. For example,
patients with pineal region tumors and swelling of the cerebral ventricles are
treated through a single entry point with a rigid tool. It is difficult for surgeons
to reach the multiple surgical targets required for treatment. OBJECTIVE: To
address this problem, continuum tools made from multiple pre-curved tubes
are under development to create highly dexterous instruments. Designing
these devices is not trivial and relies heavily upon surgeon input. Thus, a
user-friendly design process is essential, in which surgeons are able to input
anatomical landmarks, visually simulate surgeries, and receive feedback on
physical limitations. METHODS: We propose a method to design patient and
procedure specific continuum tools through simulation, allowing visual
verification. Our software allows for input and visualization of pre-operative
scans and patient models. In the virtual patient, a trocar with multiple
continuum tools is modeled. Design parameters for the tools, such as
segment number, can be specified in the user interface. By modifying points
on the tool models, the tools are automatically reshaped and reconfigured.
This allows real-time visual feedback on tool design. The tool shape and
entry points are then optimized, minimizing the number of tools required and
the strain on the tool materials while considering surgeon identified
anatomical landmarks. RESULTS: Tool models were designed for two
intraventricular endoscopic procedures. The software was tested and
validated by two neurosurgeons. CONCLUSION: Our software enables userfriendly visual design and verification of custom MIN instruments.
Department of Medicine, University of Toronto, Toronto, Ontario, Canada
2
Cancer Rehabilitation and Survivorship Centre, Princess Margaret Cancer
Centre, Toronto, Ontario, Canada. 3Department of Nutritional Sciences,
University of Toronto, Toronto, Ontario, Canada. 4Division of Gynecologic
Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
C-27
DECREASING COMPLICATIONS AFTER TRANSRECTAL ULTRASOUND
(TRUS) PROSTATE BIOPSY
B. Ho1, A. Sarabia2, F. Papanikolaou3
1
MD Program, University of Toronto, Toronto, Ontario, Canada 2Department
of Medicine, University of Toronto, Mississauga, Ontario, Canada
3
Department of Urology, Credit Valley Hospital, Mississauga, Ontario,
Canada
INTRODUCTION: Various infectious complications may occur following a
TRUS prostate biopsy, from asymptomatic bacteriuria to severe sepsis.
Incidence of UTIs after a TRUS biopsy is between 2-6%, a four-fold increase
since 1996. This is compounded by increasing rates of bacterial resistance to
antibiotics, which raises the concern that incidence of TRUS-related
complications will also continue to increase. The most commonly used
antibiotic for TRUS biopsies is currently ciprofloxacin (cipro), but though we
knew the rate of resistance was increasing, we couldn’t determine who was
resistant and had no alternative antibiotics for resistant patients. OBJECTIVE:
We aim to streamline and improve aspects of the TRUS biopsy by determining
the patients’ antibiotic-resistance status before the procedure and alternative
antibiotics that can be used. METHODS: We recruited patients scheduled for
prostate biopsies and asked them a pre-biopsy questionnaire, which included
patient risk factors such as occupation and recent travel. Concurrently, the
study nurse swabbed their rectum to test for cipro-resistant bacteria, which
determined their course of prophylaxis for the procedure. Six weeks postbiopsy, we contacted them for a second questionnaire, which asked if they had
any complications or experienced any symptoms of infection. Furthermore, we
gathered data retrospectively from prostate biopsy patients at the Mississauga
Hospital to use as controls. RESULTS: Implementation of our protocol
decreased incidence of post-biopsy complications (1-5%), compared to the
regional average (6%). Moreover, meropenem (incidence of post-biopsy
complications: 25.81%) and amikacin (21.35%) are two antibiotics that are as
effective as cipro (23.81%) in reducing infections. CONCLUSION:
Complication rates decreased in pre-swabbed patients. Next steps include
delineating patient risk factors that can predispose to complications.
28
1
Laboratory for Percutaneous Surgery, Queen’s University, Kingston, Canada
Centre for Image Guided Innovation and Therapeutic Intervention, The
Hospital for Sick Children, Toronto, Canada
C-28
Birth Outcomes in HIV-Positive Pregnant Women on PI versus non-PI
cART
N. Kanga±1, N. Dogra±1, S. Mumba2, M. Chandwe2, M. Ngoma2, Serghides L3
and M. Silverman4
Equal contributors 1MD Program, University of Toronto, Canada
Department of Paediatrics and Child Health, University of Zambia, Zambia
3
University Health Network, University of Toronto, 4Department of Medicine,
Western University, Canada
±
2
Background: The utility of antenatal cART in the reduction of vertical
transmission of HIV has been shown. Recent research found an association
between protease inhibitor (PI) antenatal cART, low birth weights (LBW), and
decreased maternal serum progesterone, providing a potential mechanism
for fetal growth restriction. Objectives: Compare birth outcomes (mean birth
weight-MBW; incidence of LBW <2500 g and pre-term delivery-PTD <37
weeks gestation) in pregnant women who are HIV-, HIV infected on PI cART,
or on non-PI cART. Methods: Patients were recruited from the Chelstone
District Health Centre in Lusaka, Zambia. Data for the HIV- controls, and the
HIV-infected pregnant women on non-PI cART (EFV+TDF+3TC/FTV) is from
an ongoing prospective double cohort study. Data on women using PI (LPV/r)
and Combivir (ZDV+3TC) cART were from a previous study. Chi
Square/Fishers, and ANOVA analysis was used for categorical and
continuous variables, respectively. Results: Infant MBWs and LBW incidence
was significantly different across all three groups (p=0.034; p=0.043,
respectively). HIV- women had the highest MBW (3095.6 g; n=36) and lowest
incidence of LBW (3.0%; n=36). The HIV+ non-PI group followed with MBW
(2961.3 g; n=36) and incidence of LBW (12.0%; n=36). The lowest MBW
(2845.0 g; n=230) and highest incidence of LBW (18.3%; n=230) was in HIV+
women on PI cART. No post-hoc differences were found for MBW; HIV+
women on PI cART had a significantly (p=0.015) higher incidence of LBW
infants than HIV- women. The incidence of PTD was similar across all groups
(p>0.05). Conclusions: The interim results indicate a trend towards lower
MBW with non-PI and PI cART compared to the HIV- group. PI cART is
associated with a higher incidence of LBW infants. Re-analysis is required
upon completion of the study to improve the power.
ABSTRACTS
C-29
ULTRASOUND ELASTOGRAPHY FOR EVALUATING THE RESPONSE
OF LOCALLY ADVANCED BREAST CANCER TO NEOADJUVANT
CHEMOTHERAPY
A. Koven1, W. Tran2 and G.J. Czarnota2
1
MD Program, University of Toronto, Toronto, Ont., Canada
2
Dept. of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto,
Ont., Canada
BACKGROUND: Clinically, most breast cancer tumors are stiffer than
surrounding normal tissue and become softer with effective treatment.
However, palpation by touch to assess stiffness is imprecise. Ultrasound
elastography (UE) is an imaging technique that aims to quantitatively measure
tissue stiffness. It has been hypothesized that UE may be used to calculate
tissue stiffness parameters (i.e. strain ratio) to monitor chemotherapy response
in real-time and predict the clinical and pathologic response early after
treatment initiation. Currently, patients with locally advanced breast cancer
(LABC) undergo neoadjuvant chemotherapy prior to surgery and wait weeks
to months after its completion to establish the degree of response via
pathological assessment. Early prediction of response with UE could enable
ineffective treatments to be switched to more efficacious ones and reduce
unnecessary side effects. OBJECTIVE: To investigate the potential of using
UE for evaluating and predicting treatment response of LABC patients
undergoing neoadjuvant chemotherapy. METHODS: 66 women receiving
neoadjuvant chemotherapy for LABC had their affected breast scanned using
UE before, 1, 4, 8 and 12 weeks following therapy initiation, and then before
surgery. Changes in elastographic parameters were calculated and compared
to pathologic assessments. RESULTS: Patients who had a pathological
response to therapy showed a significant decrease (P<0.01) in strain ratios at
8 weeks into treatment compared to the non-responding patient group. It was
determined that a strain ratio of 1.1, or a 5% decrease from baseline, was the
optimal cut-off point and could be used to predict responder status with a
sensitivity of 83% and specificity of 82% at 8 weeks. CONCLUSION: UE may
be used to predict response in LABC patients as early as 8 weeks into
treatment. The methodology used is non-invasive, inexpensive and has the
potential of being applied clinically.
C-30
EFFICACY OF INFERTILITY TREATMENTS IN FRAGILE X PREMUTATION
CARRIERS WITH PRIMARY OVARIAN INSUFFICIENCY
L. Krichevsky1, L.Y. Tan2, P. Sharma3, C. Librach3
1
MD Program, University of Toronto 2Ob/Gyn Residency Program, University
of Toronto 3CReATe Fertility Center, Toronto
BACKGROUND: Primary ovarian insufficiency (POI) is a condition of ovarian
dysfunction caused by a process originating within the ovary itself that leads to
infertility. Premutation of the Fragile X Mental Retardation 1 (FMR1) gene,
defined by the presence of 55-200 CGG repeats in the 5’UTR, predisposes
women to develop POI. There are currently no standard protocols to treat
women with Fragile X-associated primary ovarian insufficiency (FXPOI).
OBJECTIVE: The study aimed to identify the most optimal fertility treatment
protocols for females with FXPOI and to determine whether treatment success
differs between females with FXPOI to those with POI due to other causes.
METHODS: The study group consisted of FXPOI patients <40 years of age.
The control group consisted of POI patients <40 years old, with a normal FMR1
gene status. The premutation and control patients were grouped and matched
by age and by ovarian reserve. Treatment outcome was assessed by
stimulation success, defined by the presence of at least a single dominant
follicle, and pregnancy rate. RESULTS: A total of 19 premutation patients, who
have undergone 70 treatments, and a total of 76 control patients, who have
undergone 217 treatments, were identified. The premutation group
experienced a slightly lower rate of stimulation success than the control group
(56.9% vs. 73%, respectively), but the pregnancy rate was nearly the same in
both groups (20% vs. 20.8%, respectively). In both groups, donor cycles were
most successful at achieving a pregnancy (60% and 40.6% in the premutation
and control groups, respectively) while natural cycles achieved moderate
stimulation (58.9% and 68.5%) and pregnancy success (17.9% and 20.5%).
CONCLUSION: Unsurprisingly, donor oocyte cycles were most successful in
achieving a pregnancy in both groups. Statistical analysis results are pending.
Small sample size was a major hindering factor in this project.
C-31
A COMPARISON OF THE METABOLIC, HORMONAL AND ADVERSE
EFFECTS OF SPIRONOLACTONE AND CYPROTERONE ACETATE IN
THE TREATMENT OF TRANSGENDER FEMALES
M. Hellstern Layefsky1, C. Tastenhoye2, L. S. Steele3, R. Fung4
C-32
THE INCIDENCE OF NEUROPATHIC PAIN IN BONE METASTASES
PATIENTS REFERRED FOR PALLIATIVE RADIOTHERAPY
B. Lechner, S. Chow, R. Chow, L. Zhang, M. Tsao, C. Danjoux, E. Barnes,
E. Chow
1
Faculty of Medicine, University of Toronto, Toronto Canada 2Faculty of
Medicine, Royal College of Surgeons, Dublin Ireland 3Division of
Endocrinology, Toronto East General Hospital, Toronto Canada 4Division of
Family and Community Medicine, St. Michael’s Hospital, Toronto Canada
Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON,
Canada
BACKGROUND: Recent data indicates that up to 0.5% of the population
identify as transgender; however, little data exists comparing the long-term
effects of the cross-sex hormones used in transition. Within Canada there are
two main medications used for feminization in male-to-female transgender
patients (transgender females), spironolactone and cyproterone acetate
(CPA). To our knowledge this is the first study directly comparing these two
medications within the same patient population. OBJECTIVES: To compare
the effects of spironolactone and CPA on HDL and prolactin serum
concentrations when used as cross-sex hormone therapy in transgender
females. METHODS: A clinical chart review (n=1003) was conducted at three
clinical care sites in Toronto. Patients were selected based on the following
criteria: 1) identified as transgender female, and 2) a new start of either
spironolactone or CPA or re-starting spironolactone or CPA after a washout
period of at least 6 months, and 3) not concurrently taking nor consumed other
anti-androgens within the previous 6 months. Serum HDL and prolactin
concentrations were compared between the two treatment groups at baseline
and 12 months. RESULTS: Preliminary results indicate that spironolactone
resulted in a larger increase from baseline of serum HDL and a greater
decrease from baseline of serum prolactin compared to the use of CPA.
Currently more factors are being considered to eliminate confounding
variables. CONCLUSION: Preliminary evidence indicates that the use of
spironolactone is associated with more favourable serum HDL and prolactin
concentrations compared to that of CPA. Further investigations are needed to
confirm this potential advantage of spironolactone over CPA.
INTRODUCTION: Patients with symptomatic bone metastases frequently
experience pain. Neuropathic pain is characterized as pain in an area
attributable to compression or injury of the somatosensory nervous system.
Palliative radiotherapy is an effective treatment option for symptomatic bone
metastases. OBJECTIVE: Estimate the prevalence of neuropathic pain in
patients with bone metastases referred for palliative radiotherapy. METHODS:
A prospective study was conducted. Patients referred for palliative
radiotherapy completed the Self-Reported Leeds Assessment of Neuropathic
Symptoms and Signs (S-LANSS) questionnaire to assess for neuropathic pain.
Patient demographics, medication use, and radiotherapy prescribed were
collected. Statistical approaches to identify relationships between the presence
of neuropathic and other patient factors were conducted. RESULTS: 62
patients completed the S-LANSS and 16 (25.8%) patients had a score
suggesting neuropathic pain. Fifty-nine (95.2%) patients received radiotherapy
with total of 81 sites treated, the most common sites were spine and pelvis. No
statistically significant difference in fractionation was found between patients
with and without neuropathic pain. Of the 16 patients with neuropathic pain,
only 2 were prescribed analgesics specific for treating neuropathic pain. No
significant difference between demographic factors or radiation treatments
between patients with and without neuropathic pain was found. There was
significant difference in worst pain score between these two groups (p=0.045;
OR=1.38). Patients with higher worst pain score were more likely to have
higher probabilities of neuropathic pain (mean worst pain: 7.8 vs. 6.4). These
results indicate pain with neuropathic features remains prevalent in a
population of patients referred for palliative radiotherapy. More frequent
prescription of pain medications targeting neuropathic pain may be warranted
in this patient population.
29
ABSTRACTS
C-33
POSTOPERATIVE INCIDENCE OF GASTROESOPHAGEAL REFLUX IN
288 LUNG TRANSPLANT PATIENTS EVALUATED WITH 24 H PHIMPEDANCE MONITORING
O. M. Crespin1, J. Yeung1, M. C. Jimenez1, S. Leem2, L. Miller1, G. Lebovic2,
A. Okrainec1, G. E. Darling1, S. Keshavjee1, L. W. C. Liu1
C-34
INVESTIGATING THE PREVALENCE AND CLINICAL CORRELATES OF
METABOLIC SYNDROME AND ITS COMPONENTS IN YOUTH WITH
BIPOLAR DISORDER.
C.T. Li1 and Dr. B. I. Goldstein2
1
2
Research and Clinical Fellow in Minimally Invasive Surgery, University
Health Network-University of Toronto, Toronto, Ontario, Canada; 2University
of Toronto, Toronto, Ontario, Canada
BACKGROUND: Prior studies have recognized acidic gastroesophageal
reflux disease (GERD) as a factor that negatively impacts lung transplant
survival. Thus, anti-secretory therapy is now common in lung transplant
patients. The impact of non-acid reflux, particularly of bile acids on lung
transplant outcomes is less clear. In this study, we utilized 24h pH-impedance
(Z) studies to assess acid and non-acid reflux in the post-lung transplant
population. OBJECTIVE: To evaluate the incidence of GERD in post-lung
transplant patients utilizing esophageal manometry and 24-hr pH-Z monitoring.
METHODS: We performed a review of all consecutive lung transplant patients
who were evaluated with manometry and 24-hr pH-Z study from a regional lung
transplant center between 2008 and 2015. Using cumulative incidence
functions with subdistribution estimates to account for competing risk, the 5-yr
cumulative incidence of GERD was estimated. RESULTS: 288 patients (mean
age 56, 55% males) were identified in our lung transplant database to have
had postoperative pH-Z studies. All 288 patients were on double dose PPI
therapy. Of those, 70 had abnormal pH-Z studies postoperatively; the 5-yr
cumulative incidence was 33±4%. More than half (51%) of the patients with
abnormal pH-Z studies also had esophageal hypomotility. CONCLUSIONS:
This is one of the largest series that evaluates non-acid gastroesophageal
reflux while on PPI in a cohort of post-lung transplant patients using pHimpedance studies. Gastroesophageal reflux is common in post lung transplant
patients with a 5-yr cumulative incidence of 33±4%. Esophageal hypomotility
appears to be associated with abnormal pH-impedance. Further studies are
needed to determine if minimizing the risk of gastroesophageal reflux will
improve graft survival.
C-35
PATIENT-REPORTED ADVERSE EVENTS IN MULTIPLE SCLEROSIS
DISEASE-MODIFYING THERAPIES IN AN URBAN TERTIARY MS CLINIC
Z. Liao1, L. Lee2, K. Carr2
1
MD program, University of Toronto, Toronto, Canada. 2Division of
Neurology, Sunnybrook Health Sciences Centre, Toronto, Canada
INTRODUCTION: In recent decades, disease-modifying therapies (DMT) have
been shown to reduce relapses and delay disability in individuals with
relapsing-remitting MS. However, these medication can cause adverse events
(AE) that lead to poor adherence. OBJECTIVE: To better understand their
clinical utility, this study examined real-life experiences with DMT in a tertiary
MS clinic. METHODS: A retrospective chart review (1999-2015) was
conducted to evaluate the prevalence of AE and drug discontinuation rates of
Health Canada approved first-line MS DMT. RESULTS: 445 patients who have
used at least one DMT in their lifetime were reviewed. Among injectable
therapies, 45.1% (51/113) of interferon beta (IFNβ) 1- α SC users, 49.6%
(69/139) of IFNβ 1-α IM users, 46.6% (28/60) of IFNβ 1- β users and 19.9%
(37/186) glatiramer acetate (GA) users reported at least one AE. Flu-like
reactions and injection site reactions were the most commonly reported.
Among oral therapies, 20.5% (8/39) of teriflunomide users and 58.5% (31/53)
of BG-12 users reported an AE. The former was associated with hair thinning
and diarrhea, the latter with flushing and GI upset. DMT that were most
frequently discontinued as a result of AE were IFNβ 1- α IM (17.3%), IFNβ 1α SC (15.0%) and BG-12 (16.9%). GA (5.9%) and teriflunomide (2.6%) were
least likely to be discontinued due to an AE. ANALYSIS: In comparison to
recent literature, the overall prevalence of AE was lower but the discontinuation
rates were equivocal or higher. This could represent a reporting bias or a more
realistic depiction of the impact DMT AE has on patients. CONCLUSION: The
AE and discontinuation rate of MS DMT were highly congruent. Patients taking
IFNβ 1-α injections and BG-12 were most likely to report an AE and discontinue
the DMT as a result of an AE. GA and teriflunomide, however, were associated
with the lowest frequencies of AE and the lowest likelihood of discontinuation.
30
1
Department of Psychiatry, Sunnybrook Health Sciences Centre. Associate
Professor, University of Toronto, Toronto, Ontario, Canada
BACKGROUND: Many studies have demonstrated a high prevalence of
metabolic syndrome (MetS) in adult bipolar disorder (BD) patients and the
presence of MetS and its components are associated with important clinical
characteristics, such as more psychiatric hospitalization and suicide attempts.
However, little is known about MetS among adolescents and young adults with
BD. OBJECTIVE: To study the prevalence of MetS and its components, as
well as their clinical correlates, in a large sample of adolescents and young
adults with BD. METHODS: The study used a large sample (n=162) of
adolescents and young adults with BD enrolled in the COBY (course and
Outcome of Bipolar Illness in Youth) study in Pittsburgh. MetS and its
components were measured and correlated with demographic characteristics,
lifetime diagnoses of comorbidities, family psychiatric history, and prospective
course variables during 6 months before medical assessment. RESULTS: The
overall prevalence of MetS in the sample is 13.6%. Low HDL (56.2%) and
abdominal obesity (30.3%) are the most common MetS components. There is
significant association between the presence of MetS and female gender (p=
0.0225), as well as certain prospective course variables during 6 months
before medical assessment, such as % of weeks with full threshold mood state
and % of weeks receiving psychotropic medication. CONCLUSION: The
prevalence of MetS found in this study is lower than those found among adult
BD patients, but is higher than the prevalence in the general youth population.
This suggests that MetS components and the risk factors for cardiovascular
disease (CVD) and diabetes start developing early in BD patients. The findings
call for the need to implement preventative strategies for CVD risk-factor
modification among youth with BD.
C-36
HAPTOGLOBIN 2-2 GENOTYPE IS ASSOCIATED WITH PRESENCE AND
PROGRESSION OF MRI DEPICTED CAROTID INTRAPLAQUE
HEMORRHAGE
T. Binesh Marvasti1, A.R. Moody1
1
Sunnybrook Health Sciences Center, Medical Imaging, Toronto, Ontario
BACKGROUND AND OBJECTIVE: Intraplaque hemorrhage (IPH) -a
component of atherosclerotic plaque- is a source of free hemoglobin (Hb) that
binds the haptoglobin (Hp) protein and forms a complex cleared by tissue
macrophages. There are three Hp genotypes: Hp1-1, Hp2-2 and Hp1-2. The
Hb-Hp2-2 complex has a lower binding affinity for macrophages, resulting in
retention of Hb and oxidative burden. Studies have shown a higher risk of CV
events in Hp2-2 individuals. METHODS AND MATERIALS: Patients with
carotid artery disease (30-95% stenosis) underwent 3T carotid MRI (Philips
Achieva) annually from 2010 to 2014. MRIPH uses a T1weighted inversion
recovery fat suppressed 3D Fast Field Echo sequence in the coronal plane to
detect IPH which appears of high signal due to methemoglobin. IPH was
defined as a signal intensity 1.5x the adjacent sternocleidomastoid muscle.
IPH volume was quantified using VesselMass software. Hp genotypes were
identified using an established PCR protocol. Descriptive statistics and mixed
effects model longitudinal regression analyses were performed. RESULTS:
The study cohort consisted of 80 patients (mean age, 72.8 years; range 52100) with 160 carotid images. Patients homozygote for the Hp2 allele had a
significantly higher prevalence of IPH at baseline (BL) compared to those
carrying an Hp1allele (57%vs.34%, OR=2.52, 95%CI=1.23–5.144, p=0.01).
IPH volume at BL did not differ significantly between the two groups
(0.27vs.0.23 mL respectively, p=0.836). Longitudinal analysis of 18 IPH
positive carotids with two years follow up data indicated a significant
progression of IPH volume over time in Hp2 homozygote patients (β=0.12,
SE=0.04, p<0.01) and regression of IPH volume in patients carrying an Hp1
allele (β=-0.09, SE=0.03, p=0.01). CONCLUSION: Hp2-2 patients had a
significantly higher prevalence of carotid BL-IPH at which worsened over a
two year period. Hp2-2 genotype is a biomarker of high risk vascular disease
(IPH) that when detected using simple genotyping methods can identify atrisk populations.
ABSTRACTS
C-37
OXIDATIVE STRESS PREDICTS DEPRESSIVE SYMPTOM TRAJECTORY
IN OMEGA-3 FATTY ACID TREATED CORONARY ARTERY DISEASE
PATIENTS
G. Mazereeuw1,2, N. Herrmann1,2, A.C. Andreazza1,3, G. Scola1,3, L.M.
Hillyer4, D.W.L. Ma4, P.I. Oh1,2,5, K.L. Lanctôt1,2,5
University of Toronto, 2Sunnybrook Research Institute, 3Centre for Addition
and Mental Health, 4University of Guelph, 5University Health Network.
1
BACKGROUND: Omega-3 fatty acid (O-3 FA) supplements may have
antidepressant efficacy, but benefits in coronary artery disease (CAD) patients
are unclear. O-3 FAs are highly susceptible to oxidative damage, which is
common in CAD, and can alter their metabolism, generating harmful proinflammatory mediators. Oxidative status prior to O-3 FA treatment may
determine its antidepressant benefits in CAD. OBJECTIVE: Investigate
whether baseline oxidative status, measured by serum lipid hydroperoxide
(LPH) concentrations, predicts antidepressant benefits from O-3 FA treatment
in CAD. METHODS: Patient demographics and medical characteristics were
collected. Depressive symptoms were measured using the 17-item Hamilton
Depression Rating Scale (HAM-D). Patients were then randomized to receive
1.9 g/day O-3 FAs or placebo for 12 weeks. HAM-D scores were reassessed
after 12 weeks. Baseline serum LPH concentrations and plasma O-3 FA
concentrations were analysed from fasting blood. Repeated measures linear
models were used (p value significant at <.05). RESULTS: Sixty-two patients
(age=61.4±8.3, 74.2% male, mean baseline HAM-D=6.7±5.8, 38.7% meeting
DSM-IV depression criteria) completed the study (n=36 placebo, n=26 O-3
FA). O-3 FA treatment did not demonstrate antidepressant efficacy over 12
weeks (F1,61=0.24, p=.63). In the O-3 FA treated group, higher baseline LPH
concentrations significantly predicted worsening of HAM-D total score over 12
weeks (F1,25=7.55, p=.01; adj-R2=0.39, B=0.12, p=.02) after adjusting for
baseline O-3 FA concentrations. No associations were observed in the placebo
group. CONCLUSION: Variations in oxidative status might underlie
inconsistencies in O-3 FA antidepressant efficacy in those with CAD and other
co-morbid populations.
C-39
ASSESSING CEREBRAL HEMODYNAMICS AFTER CONGENITAL
HEART DISEASE REPAIR
S. Moghimi 1,2,3, C. Caldarone 2,3, S. Merklinger 2,3, D.J. Kim 1,3 , H. Holtby 2,3,
H. Frndova 1,2,3, S. Schwartz 2,3, G. Van Arsdell 1,2,3 , A.M. Guerguerian 1,2,3
Neuroscience and Mental Health Research Program1, Division of Critical
Care Medicine2, The Hospital for Sick Children3
BACKGROUND: Neonates undergoing congenital heart disease repair are at
risk of neurological complications. Early detection of such neurological
complications can prevent long-term neurodevelopmental problems and may
be possible using non-invasive bed-side monitors. We hypothesized that the
interrelationship between the physiological and cerebral variables can be used
to characterize the cerebral hemodynamics. OBJECTIVE: Our goal was to use
dynamic modeling for characterizing hemodynamic signatures as a means of
assessing cerebral integrity. METHODS: In this prospective observational
study, we investigated the hemodynamic response in six children following first
stage palliation of hypoplastic left heart syndrome. We monitored arterial blood
pressure, blood flow velocity, and regional cerebral oxygen saturation using
ABP sensors, transcranial Doppler of the middle cerebral artery and nearinfrared spectroscopy, respectively. We used linear and nonlinear dynamic
modeling to uncover the underlying interactions between variables. We also
estimated global principle dynamic modes (PDMs) to identify hemodynamic
signatures for each subject. RESULTS: The results revealed a significant
reduction in estimation error when using a nonlinear model (64.7 ± 15.0)
compared to a linear model (73.2 ± 14.1%). Importantly, the number of crossterms varied across time windows which confirmed the dynamic nature of the
interrelationships among the measured variables. CONCLUSION: The current
study demonstrated the use of nonlinear dynamic modeling to capture the
interrelationships
between
physiological
and
cerebral
variables.
Understanding how the identified hemodynamic signatures compare to longterm neurodevelopmental assessments may reveal patterns associated with
neurological complications and may improve early diagnosis of adverse
neurological events.
C-38
ANALYSIS OF HEART RATE VARIABILITY IN A SURGICAL
POPULATION OF NEONATES
J. Milenkovic1, N. Bressan2, C. McGregor3, A. James1,2
1
University of Toronto, Toronto, Ontario, Canada 2Divison of Neonatology,
The Hospital for Sick Children, Toronto, Ontario, Canada 3Faculty of
Business and Information Technology, UOIT, Oshawa, Ontario, Canada
BACKGROUND: Abrupt deterioration of ill neonates indicates that objective
data is essential to determine optimal timing for surgery. Heart rate variability
(HRV) is the oscillation in the interval between consecutive heartbeats.
Abnormal HRV has been associated with neonatal morbidity and mortality.
However, due to interindividual variability and condition complexity, data
contextualization could influence HRV. OBJECTIVES: To contextualize and
analyze HRV to (i)determine optimal timing for surgery; (ii)characterize the
recovery of the neonate after surgery. METHODS: Neonates admitted to the
NICU at The Hospital for Sick Children from 2010-2011, enrolled in a REB
approved late onset infection study were eligible subjects. HR was captured
from the bedside monitor every second. Contextual data was extracted from
the Clinical Information Management System. This data was classified as
exogenous (e.g. intubation) or endogenous (e.g. mood). Exogenous data were
considered artifacts and removed, while endogenous data were accounted to
explain HRV. Analysis was performed with Matlab®. A distribution tool was
used to define the probability plot; HRV variance (HRVv) and index of
dispersion (ID) were calculated. Descriptive statistics were performed with
Microsoft Excel. Analyses were considered before (BS) and after surgery (AS).
RESULTS: Six preterm infants, gestational age 29-39 weeks (34.67 ± 3.94),
birth weight 950-3720 grams (2276.67 ± 922.69) were the subjects of this
study. BS results were: mean HRV 29.76; HRVv 127.93; ID 4.30; AS results
were: mean HRV 35.63; HRVv 154.97; ID 4.35. Figure 1 shows the BS and AS
probability plots for continuing deterioration. CONCLUSION: The BS and AS
probability plots suggest that HRV may aid clinicians in determining optimal
timing for surgery and provide information about recovery, however, HRV must
be individualized for each patient.
C-40
ESTROGEN VS. CONSERVATIVE THERAPY FOR LABIAL
AGGLUTINATION IN PREPUBERTAL GIRLS
J.K. Multani1, Dr. S. Kives M.D. MSc (FRCSC) 2, Dr. L. Allen M.D. (FRCSC) 2
1
MD Program, University of Toronto, Toronto, ON, Canada 2Obstetrics and
Gynecology, University of Toronto, ON, Canada
Background: Labial agglutination (LA) is a dermatologic finding among
prepubescent girls in which tissues of the labia minora fuse together. There is
a lack of standardization for its treatment and thus we examined the difference
between conservative management and estrogen therapy. Objective: We seek
to compare patient demographics, clinical presentation, and success rates with
conservative management or estrogen treatment in prepubertal girls with LA
referred to a tertiary care center. Methods: A retrospective chart review was
performed in 435 girls with LA treated at a gynecology clinic between 2004–
2014. The treatment group received topical estrogen (TE) in the form of
conjugated equine estrogen. TE was prescribed in an inconsistent manner
dependent on the physician. The other group received conservative therapy
(CT) such as education on vulvar hygiene. Results: To date, 200 patients have
been reviewed: 100 who were given TE and 100 who were treated with CT. Of
those patients who were given TE, the mean age was 3.9 years as compared
to 3.1 years in the CT group. 39% of the TE group was symptomatic with
irritation, redness, or urinary symptoms, compared to only 20% of the CT
group. The median time the patients were followed in the clinic was 167 days
for those with TE and 105 days for those with CT. 40% of patients given TE
had complete resolution of their LA and 40% experienced improvements. The
rest did not see any improvement. In the CT group, only 26 of the girls were
followed after the initial visit. 35% of those experienced complete resolution,
42% had some improvements, and 23% saw no improvement. Conclusion: In
this analysis the treatment group presented with a higher average age, worse
clinical presentation, and longer follow-up time. Resolution and improvement
rates of both groups are comparable. Once full data collection has been
completed, our intention is to use appropriate statistics to further compare the
two patient cohorts.
31
ABSTRACTS
C-41
MOTOR AND SENSORY MORBIDITY ASSOCIATED WITH THE
ANTEROLATERAL THIGH PERFORATOR FREE FLAP
C. W. Noel1* and D. J. Enepekides2
1
Faculty of Medicine, University of Toronto.
Department of Otolaryngology - Head and Neck Surgery, Sunnybrook Health
Sciences Centre, University of Toronto
2
INTRODUCTION: While the ALT free flap has experienced substantial
success, our understanding of the functional outcomes associated with donor
site morbidity is limited by a lack of robust clinical data. OBJECTIVES: To
objectively quantify changes in motor function, sensation and lower extremity
quality of life following anterior lateral thigh free flap (ALT) resection.
METHODS: A cross-sectional observational study was conducted with both a
prospective (n=20) and retrospective arm (n=20). In both arms, patients
underwent formal motor and sensation testing of the ipsilateral and
contralateral thigh though the use of a sphygomomanometer and monofilament
testing. Patients also completed the lower extremity functional scale (LEFS)
and the patient and observer scar assessment scale. In the prospective cohort,
data was collected preoperatively and at the 6-month and 1-year follow-up
visits. In the retrospective cohort, consecutive patients with a minimum of 6
months postoperative follow-up were enrolled. RESULTS: 40 ALT flaps were
performed in 40 patients. Primary closure was achieved in 37 cases.
Dissection of intramuscular perforators occurred in 31 cases.
In the retrospective arm, donor thighs demonstrated a similar peak isometric
quadriceps contraction (47 +/- 20 mmHg) to the contralateral operated thighs
(43mmHg+/- 23, p=0.49). The mean score for the LEFS was 77% (SD 17
range 43-100) and 17 (SD 10 range 6-40) for the patient scar assessment
questionnaire. In the prospective arm, no significant change in donor thigh
strength was noted between preoperative values and at 12-months
postoperatively. Donor thighs demonstrated significantly reduced 2-point
discrimination sensitivity when compared to the contralateral leg.
CONCLUSIONS: Reduced sensibility of the anterolateral thigh is a common
occurrence. Thigh strength is not significantly affected by an ALT resection.
C-43
UPDATE ON CLINICAL DIFFERENCES BETWEEN ALPHA SYNUCLEIN
MUTATIONS IN AUTOSOMAL DOMINANT PARKINSON’S DISEASE
N. Patel1,2, L. Kalia1,2
1
Department of Neurology, Toronto Western Hospital, 2University of Toronto
Faculty of Medicine
BACKGROUND: The alpha synuclein (SNCA) gene has become one of the
most widely studied forms of monogenic Parkinson’s Disease (PD) in the last
2 decades. To date 6 point mutations on the SNCA gene have been
discovered: A53T, A30P, E46K, G51D, H50Q and A53E. The aim of this study
is to create a comparison chart for clinicians to assess the differences between
patients with each of the 6 point mutations, including average age at onset
(AAO), disease duration, countries of origin, motor symptoms, non- motor
symptoms and responsiveness to antiparkinsonian therapy. METHODS: The
Pubmed database was queried using the following search terms: 1)
Parkinson’s Disease 2) alpha synuclein 3) A53T, 4) A30P, 5) E46K, 6) H50Q,
7) G51D and 8) A53E. Results were examined by two independent assessors
until consensus was reached. RESULTS: The initial Pubmed search yielded
251 Abstracts, of which 18 were selected after the final screen. In summary,
A53T and G51D carriers demonstrated early AAO and severe and rapidly
progressive PD. Interestingly, 15/16 of the A53T mutation carrier families were
of Greek origin. E46K patients had similar clinical features, except for a notably
higher AAO. These patients also demonstrated a high prevalence of agitated
nocturnal sleep preceding PD diagnosis compared to the other mutation
carriers. A30P carriers had a much milder phenotype in comparison, with late
onset PD and late and mild dementia. H50Q carriers demonstrated late onset
PD with rapid onset dementia, and A53E patients had variable AAO and clinical
picture. E46K and G51D carriers demonstrated poor response to levodopa,
including marked levodopa induced dyskinesia and motor fluctuations.
CONCLUSION: This clinical tool can be used to identify patients with PD who
should be considered for genetic testing based on their initial symptom pattern.
Furthermore, for patients diagnosed with a particular point mutation, this chart
can be used to assess patient prognosis and responsiveness to antiparkinsonian therapy.
32
C-42
EXAMINING DEPRESSION AND QUALITY OF LIFE IN PATIENTS WITH
THALASSEMIA IN SRI LANKA
P. Beamish*, P. Patel *, T. da Silva, D. Kaushalya, S. Williams and A.
Ravindran
Department of Psychiatry
Centre for Addiction and Mental Health, Toronto, ON;
National Thalassemia Unit of the University of Kelaniya Teaching Hospital,
Ragama, Sri Lanka
INTRODUCTION: With the decline in mortality rates in thalassemia due to
improved treatment strategies, research has begun to focus on psychological
morbidities and quality of life in patients. Similar to other childhood chronic
diseases, psychosocial health and daily functioning are affected by the
comorbidities of the disease and its treatment. While there is published
research in this area from other countries, there is little information specific to
the patient population in Sri Lanka. OBJECTIVE: Our project aimed to assess
psychiatric morbidity and quality of life in patients with thalassemia in Sri Lanka,
and the correlation with demographic and illness-related variables. METHODS:
A cross-sectional descriptive study was conducted at the National Thalassemia
Unit, the only adult treatment facility for thalassemia in the country. Patients
with thalassemia major, minor or intermedia (Eβ), above 12 years of age, and
in stable medical condition (n=120) were recruited. Participants were assessed
using a general demographic questionnaire, the Beck Depression Index and
the WHO Quality of Life BREF. RESULTS: Family support, gender and length
of stay were significant determinants of depression in our patient population.
However, there was no correlation between type of thalassemia and
depressive scores. In addition, quality of life was significantly influenced by
family and peer support. There were also significant differences in quality of
life between male and female patients. CONCLUSIONS: Overall, study results
show that several factors influence depression and quality of life among
patients with thalassemia, and these factors vary by gender. Development of
psychosocial interventions that address these factors and the gender
differences could be highly useful in improving function and reducing disability
in this population.
C-44
EVALUATING CARDIAC DISEASE IN PREGNANY AT A NATIONAL
REFERRAL HOSPITAL IN WESTERN KENYA, A RETROSPECTIVE
REVIEW OF 2011-2015
A. Rosen1, R. Lumsden3, C Parks4, H Millar1,4, G. Bloomfield3,4, F. Barasa5 , A.
Christoffersen-Deb1,4
1
Faculty of Medicine, University of Toronto, Toronto, Canada 2Department of
Pediatrics, Indiana University, Indiana, USA, 3University of Massachusetts,
3
Duke University, 4AMPATH (Academic Model Providing Access to
Healthcare), Eldoret, Kenya and 5Moi University School of Medicine, Eldoret,
Kenya
BACKGROUND: Without access to skilled and timely care, cardiac disease in
pregnancy is associated with severe maternal and neonatal morbidity and mortality.
Despite the high prevalence of cardiac disease in women of reproductive age in
western Kenya, little has been done to evaluate the outcomes and needs of this highrisk population in pregnancy. The proposed study reviews all women presenting to
Moi Teaching and Referral Hospital (MTRH), a large referral hospital in western
Kenya, between 2011 and 2015 with diagnosed cardiac disease in pregnancy. This
multi-pronged and mixed methods study examines: 1) the spectrum of disease seen,
including number of cases, proportion of specific diagnoses, and disease severity; 2)
the burden of disease these women pose to the healthcare system, looking at
obstetric and neonatal outcomes compared to a reference population; 3) the sociodemographic characteristics of women affected by cardiac disease in pregnancy 4)
the level of utilization of health services in the care for these women; and 5) the careseeking practices of women with cardiac disease in pregnancy as they engage in the
health system. METHODOLOGY: In the proposed study, we will review the charts of
approximately 200 women with cardiac disease in pregnancy and collect data on
patient demographics, clinical history, the course of pregnancy and cardiac,
obstetrical and neonatal outcomes. We will compare these women to a reference
population of approximately 400 pregnant women without known cardiac disease.
This will be complemented by in-depth interviews with 20 women with cardiac
disease who have completed their pregnancies in 2015. SIGNIFICANCE: This
retrospective evaluation of care practices for women with cardiac disease in
pregnancy is part of a larger effort by the Divisions of Reproductive Health and
Medicine (Cardiology) at MTRH to improve the accessibility and standard of care for
such women. This study will provide the necessary information to complete a needs
assessment of this population, a vital step in designing care strategies for this patient
population.
ABSTRACTS
C-45
CHANGE IN PRESURGICAL DIAGNOSTIC IMAGING EVALUATION
AFFECTS SUBSEQUENT PEDIATRIC EPILEPSY SURGERY OUTCOME
1
L. Rubinger, 1C. Chan, 2F. D’Arco, 3R. Moineddin, 4O. Muthaffar, 5J.T.
Rutka, 4O.C. Snead, 6M.L. Smith, 2,4E. Widjaja
1
Neuroscience & Mental Health, 2Diagnostic Imaging, 4Division of Neurology,
5
Department of Neurosurgery, Hospital for Sick Children, Toronto;
3
Department of Family & Community Medicine and 6Department of
Psychology, University of Toronto, Toronto, Canada
OBJECTIVE: We changed our presurgical diagnostic evaluation for medically
refractory focal epilepsy in 2008 to include high-resolution epilepsy protocol on
3T MRI, and combined magnetoencephalography and FDG-PET in selected
patients with normal or subtle changes on MRI or discordant diagnostic tests.
The aim of this study was to evaluate the effectiveness of the change in
imaging practice on epilepsy surgery outcome in a tertiary pediatric epilepsy
surgery center. METHODS: Patients were classified based on the old or new
imaging practices. The patient characteristics, surgical variables, and seizurefree surgical outcome were compared, and the trend in seizure-free outcome
over time was assessed. RESULTS: There was a trend for increased abnormal
MRI (92% versus 86% respectively, p=0.062), and increased utilization of
FDG-PET (34% versus 3% respectively, p<0.001) with new relative to old
practice. There were no significant differences in invasive monitoring, location
and type of surgery and histology (all p>0.05). During the old practice, there
was no significant change in yearly trend of seizure-free outcome (OR=0.960,
p=0.386). The change in practice in 2008 was associated with a significant
improvement in seizure-free outcome (OR=1.535, p=0.012). During the new
practice, there was a significant positive trend in yearly seizure-free outcome
(OR=1.219, p=0.008), after adjusting for age at seizure onset, invasive
monitoring, location of surgery, type of surgery, histology, MRI, MEG and FDGPET. CONCLUSION: We have found an improvement in seizure-free surgical
outcome following the change in imaging practice. This study highlights the
importance of optimizing and improving presurgical diagnostic imaging
evaluation to improve surgical outcome.
C-47
POSTOPERATIVE DAY ONE NEUTROPHIL-TO-LYMPHOCYTE RATIO AS
A PREDICTOR OF 30-DAY OUTCOMES IN BARIATRIC SURGERY
PATIENTS
M. Da Silva1, A. Elnahas2,3, M. C. Cleghorn3, T. D. Jackson2,3, A. Okrainec2,3,
F. A. Quereshy2,3
1
Department of Medicine, University of Toronto, Toronto, Ontario, Canada
Department of Surgery, University of Toronto, Toronto, Ontario, Canada
Division of General Surgery, University Health Network, Toronto, Ontario,
Canada
2
3
INTRODUCTION: The neutrophil-to-lymphocyte ratio (NLR) is a marker that
reflects systemic inflammation and organ dysfunction. Its use as a prognostic
marker to predict complications following surgery has been recently described
in the literature. OBJECTIVE: The objective of our study was to evaluate the
use of a high postoperative day one (POD1) NLR as a predictor for 30-day
outcomes in patients undergoing bariatric surgery. METHODS: We performed
a retrospective chart review of 792 patients who underwent bariatric surgery
between March 2012 and May 2014. Data was collected from medical charts,
the National Surgical Quality Improvement Program and the Metabolic and
Bariatric Surgery Accreditation and Quality Improvement Program databases.
POD1 NLR values were obtained from complete blood counts along with a
variety of 30-day clinical outcomes. Univariate and multivariate analyses were
conducted to determine if POD1 NLR ≥ 10 could predict 30-day outcomes.
RESULTS: 699 Roux-en-Y gastric bypass surgeries and 93 sleeve
gastrectomy surgeries were performed. All surgeries were performed
laparoscopically. A total of 86 complications occurred in our study population,
with 47 considered to be major. After covariate adjustment, POD1 NLR was
found to be significantly associated with overall complications, major
complications, reoperation, and a postoperative length of stay greater than 2
days. CONCLUSION: In our review of a large number of patients undergoing
bariatric surgery, a POD1 NLR ≥ 10 was able to independently predict 30-day
outcomes. This easily obtained inflammatory marker may help identify patients
with a higher risk of developing early complications who may require longer
hospital stay or reoperation.
C-46
THE DURATION OF BISPHOSPHONATE THERAPY IN RHEUMATIC
DISEASE PATIENTS AND RISK OF ATYPICAL FEMUR FRACTURE
L.J. Saldanha1, and M.J. Bell2
1
Department of Medicine, University of Toronto, Toronto, Ontario, Canada,
Department of Rheumatology, Sunnybrook Health Sciences Centre, Toronto,
Ontario, Canada
2
INTRODUCTION: Increased risk of atypical femur fracture (AFF) is associated
with long-term bisphosphonate use (BP). To minimize AFFs, it is
recommended that patients switch to another anti-osteoporosis drug after 5
years. It may be possible to prevent AFFs in the rheumatic disease patient
population if duration of BP use is known and change of anti-osteoporosis
medication occurs in a timely manner. Therefore, adequate documentation of
BP duration is necessary to decrease adverse events. OBJECTIVES: To
determine the duration of BP therapy in 100 patients in an academic
rheumatology practice. It is hypothesized that a significant number of patients
will have used BPs for longer than the recommended 5 years, and no change
to the mode of drug therapy will have been initiated. METHODS: The
Sunnybrook Research Ethics Board approved this chart audit. Rheumatic
disease patients were included if they were older than 18 years with
documented BP use ± osteoporosis or low bone mass. There were no
exclusion criteria. A data collection tool was developed to assess patient chart
documentation. RESULTS: The mean duration of BP use was 3.2 years, with
at least 13 patients using a BP for over 5 years. BP duration was not
documented in 38% of patient charts. 69% of included patients were currently
using a BP; for previous BP users, the reason for cessation was not
documented in 32.2% of charts. Three patients had an AFF (3%), following 8
years, 9 years, and 15 years of BP therapy respectively. CONCLUSIONS:
There is inadequate documentation of initiative, duration, and cessation of BP
therapy in rheumatic disease patients. As BP related adverse events are
dependent on treatment duration and increase after 5 years, this could
compromise patient safety through preventable AFFs. Implementation of a BP
checklist could be beneficial in ensuring reliable documentation and improve
quality patient care.
C-48
BREASTFEEDING IN WOMEN ON OPIOID MAINTENANCE THERAPY
S. Sinha1, M. Nader2, S. Turner3, L. Graves4
1
MD Program, University of Toronto
Department of Family and Community Medicine, St. Michael’s Hospital
Department of Family and Community Medicine, University of Toronto
2,3
4
INTRODUCTION: Breastfeeding decreases neonatal abstinence syndrome
and increases attachment in infants born to mothers taking methadone or
buprenorphine. Despite research demonstrating the safety and benefit of
breastfeeding, proportionally fewer women in this population breastfeed. There
is little research describing factors that influence infant feeding choice or
breastfeeding experiences in women on opioid maintenance therapy.
OBJECTIVES: To better understand infant feeding choices and breast feeding
experiences in women on opioid maintenance therapy. METHODS: A
systematic review was conducted of five databases: 1) Ovid MEDLINE(R)
without Revisions 2) Ovid MEDLINE(R) In-Process & Other Non-Indexed
Citations, 3) EMBASE, 4) CINAHL, and 5) FRANCIS. The key search
combined 1) infant feeding terms, including “breast feeding”, “breast milk” and
“bottle feeding”, with 2) substance use terms, including “methadone”,
“buprenorphine”, “cocaine”, and “heroin”. From 1081 articles, 45 articles were
reviewed using the GRADE method. RESULTS: The populations studied are
extremely heterogeneous. There are fewer articles from primary literature
compared to non-systematic reviews. Articles from primary literature find low
transfer of methadone and buprenorphine to breastmilk. Articles demonstrate
the beneficial effects of breastfeeding but cannot elucidate whether this is due
to the act of breastfeeding, the breastmilk itself, or a combination. Two
qualitative studies explored women’s experiences using a small sample of
heterogeneous women. They suggest many women with substance use feel
stigmatized about breastfeeding by friends, family, and health care providers.
CONCLUSIONS: Literature supports the safety of breastfeeding on opioid
maintenance therapy. Barriers to breastfeeding from a health care provider
standpoint include poor understanding of the mothers’ experiences and a lack
of education around the benefits of breastfeeding on opioid maintenance
therapy.
33
ABSTRACTS
C-49
SHIFTING TRENDS IN BACTERIAL KERATITIS IN TORONTO: A 15-YEAR
REVIEW
A. Tam1, E. Cote1, M. Saldanha1, A. Lichtinger1, A. Slomovic1
1
Corneal Service, TWH, UHN
INTRODUCTION: Bacterial keratitis is a significant cause of ocular morbidity
which may result in corneal blindness. Identifying the correct microorganisms
and their antibiotic sensitivities is essential to effective treatment. Microbial
susceptibility to antibiotics may have changed due to widespread usage of
broad-spectrum antibiotics. Local epidemiological studies to reflect current
trends in antibiotic sensitivities is crucial in disease management.
OBJECTIVE: To review the incidence, distribution, current trends, and
resistance patterns of bacterial keratitis isolates in Toronto over the last 15
years. METHODS: Patients with suspected bacterial keratitis that underwent a
diagnostic corneal scraping and cultures from January 1, 2000, through
December 31, 2014, were included. Culture results and antibiotic sensitivity
profiles were reviewed and analyzed. Statistical analysis was performed using
SAS. Linear regression was used to test for significant trend (P<0.05).
RESULTS: A total of 2202 corneal scrapings were performed. A pathogen was
recovered in 1257 samples (57.1%). Bacterial keratitis accounted for 1122 of
the positive cultures (89.3%). The total number of Gram-positive (GP) and
Gram-negative (GN) isolates was 895 and 305, respectively. We identified an
increasing trend in GN isolates (P=0.0006) and in the most common GP
isolates - coagulase-negative Staphylococcus (P=0.024), Staphylococcus
aureus (P<0.0001), and Streptococcus species (P=0.0009). An increasing
trend in antibiotic resistance was observed in Erythromycin (P=0.039),
Ceftazidime
(P=0.0094)
and
Piperacillin/Tazobactam
(P=0.025).
CONCLUSION: There was a significant increasing trend in the percentage of
GN, and various GP microorganisms over the last 15 years. An increasing
trend in resistance for various antibiotics against GN and GP isolates were
observed. Vancomycin and moxifloxacin, however, remained 100% effective
against tested microorganisms, suggesting that the empiric use of these
antibiotics in the setting of severe suspected bacterial keratitis may be justified.
C-51
ALCOHOL USE DISORDER: REDUCED WHITE MATTER INTEGRITY IN
ABSTINENCE
T. Tse, M. Juhas, J. Benoit, M. Brown, A. J. Greenshaw, S. Dursun
Department of Psychiatry, University of Alberta
INTRODUCTION: Many neuroimaging studies investigating alcohol use
disorder (AUD) have observed changes in gray and white matter. Diffusion
tensor imaging (DTI) utilizes water molecule diffusion to image white matter
structure. DTI studies on AUD have noted decreased white matter integrity
through several measurements (e.g. mean diffusivity, fractional anisotropy).
Notably, many neuroimaging studies scan participants after months or years
of abstinence, which may affect results since relapsed patients may be
unintentionally excluded from these studies, providing an incomplete view of
patients with AUD. OBJECTIVE & METHODS: We compared the white matter
structure of 19 male AUD patients (mean abstinence duration 9+/-2 days) with
13 male healthy controls using fractional anisotropy (FA) values. By scanning
after relatively brief periods of abstinence, we hope to improve understanding
of the effects of AUD on white matter. RESULTS: Compared to healthy
controls, AUD patients had decreased FA values (p<0.05) in several regions
including: segments of the corona radiata, cingulum, forceps major, forceps
minor, occipital white matter, superior longitudinal fasciculus, and corpus
callosum. CONCLUSION: Reduced FA values can indicate loss of white
matter integrity, potentially due to reduced neuronal or glial health. Our results
corroborate findings of previous studies that observed functional deficits in
AUD. Damage in these regions were associated with impaired emotional
regulation, executive function, and visual function, which are commonly
observed in AUD. Therefore, the results observed may underlie functional
impairments commonly observed in AUD. Notably, damage in similar regions
has also been observed in studies investigating other addictions, which may
indicate common mechanisms. Additionally, damage in these regions has
been observed prior to the onset of addiction, and may act as a risk marker.
Further investigations are required to refine knowledge about changes in brain
structure during AUD, while excluding the effects of other addictions.
34
C-50
EFFECT OF SPERM DNA FRAGMENTATION INDEX ON EMBRYO
ANEUPLOIDY RATE IN PREIMPLANTATION GENETIC SCREENING
K. Tang1,4, I. Gat4, V. Kuznyetsov4, R. Abramov4, R. Antes4, M. Filice4, S.
Mokovtsev4, A. Gauthier-Fisher4, C. Librach2,3,4
1
Faculty of Medicine, 2Department of Obstetrics and Gynecology, University
of Toronto 3Department of Gynecology, Women’s College Hospital, Toronto,
Canada, 4CReATe Fertility Clinic, Toronto, Canada
BACKGROUND: Male infertility is a common complaint of growing incidence
among conceiving couples in developed countries. Sperm DNA Fragmentation
Index (DFI) measures the DNA integrity of ejaculated sperm and is used to
assess male infertility. Preimplantation Genetic Screening (PGS) is used to
determine the ploidy status of IVF-ICSI embryos. Embryo aneuploidy arise
largely due to maternal factors such as advanced age, high BMI and abnormal
hormonal profiles. However, existing literature studying the role of male factor
contribution to embryo aneuploidy yields conflicting results. OBJECTIVE: To
evaluate the association between sperm DFI and embryo aneuploidy rate in
IVF-ICSI cycles. METHODS: Retrospective patient data from CReATe
between May 2010-July 2015 were collected. Couples were categorized into
two groups: DFI ≥30% for high degree of DNA damage and DFI <30% for low
to moderate degree of DNA damage. Maternal factors of both groups were
matched for age, BMI, ovarian reserve (AMH, AFC) and Day 3 FSH to isolate
the effects of male factor. Embryo ploidy status was assessed using PGS
comparative genomic hybridization (CGH). RESULTS: In the high DFI group,
78 embryos from 14 couples undergoing PGS were evaluated; 40.0% of the
embryos were euploid. In the moderate to low DFI group, 315 embryos from
68 couples undergoing PGS were evaluated; 40.0% of the embryos were
euploid. No statistically significant difference was found in the embryo
aneuploidy rate between the two DFI groups. CONCLUSION: Embryo
aneuploidy rate in IVF-ICSI as determined by PGS-CGH reveals that sperm
with high DFI ≥30% is not associated with higher aneuploidy rates compared
to sperm with moderate to low DFI <30%. Further work will aim to increase the
sample size and to investigate potential corrective mechanisms against high
DFI.
C-52
THE INFLUENCE OF MEDICAL BURDEN AND COGNITION ON
FUNCTIONAL COMPETENCE IN OLDER INDIVIDUALS WITH
SCHIZOPHRENIA
C. Tsoutsoulas1,2, B.H. Mulsant1,2, S.M. Kalache1,2, S. Kumar1,2, A.N.
Voineskos1,2, M.A. Butters3, M. Menon1,2, and T.K. Rajji1,2
1:
Division of Geriatric Psychiatry, Centre for Addiction and Mental Health,
Canada
Department of Psychiatry, University of Toronto, Canada
3
: Department of Psychiatry, University of Pittsburgh, USA
2:
BACKGROUND: Cognition predicts functional competence among individuals
with schizophrenia across the lifespan. However, as these individuals age,
increasing levels of medical burden may also contribute to functional deficits
both directly and indirectly through cognition. OBJECTIVE: To assess the
relationship among, cognition, medical burden, and functional competence in
older individuals with schizophrenia. METHODS: Data was obtained from 60
schizophrenia and 30 control participants aged 50 or above. Cognition was
assessed using the MATRICS Consensus Cognitive Battery, functional
competence was assessed using the USCD Performance-based Skills
Assessment, and medical burden was assessed using the Cumulative Illness
Rating Scale for Geriatrics. Group differences were assessed using
independent samples t-tests. Mediation analyses were used to assess whether
cognition mediated the effects of medical burden on functional competence.
RESULTS: Participants with schizophrenia had higher levels of medical
burden, cognitive deficits, and functional impairments. In participants with
schizophrenia, cognition, but not medical burden, predicted functional
competence after adjusting for age, education, gender, and clinical symptoms.
In control participants, cognition and medical burden both predicted functional
competence after adjusting for age, education, and gender. Further, cognition
was found to fully mediate the association between medical burden and
functional competence in control participants. CONCLUSION: Cognition is a
robust predictor of functional competence among older individuals with
schizophrenia, regardless of medical burden. Cognitive deficits associated with
schizophrenia may mask any further cognitive impairment associated with
medical burden and its impact on function.
ABSTRACTS
C-53
CLINICAL OUTCOMES OF STAPHYLOCOCCUS AUREUS BACTEREMIA
FOLLOWING INTRODUCTION OF MANDATORY INFECTIOUS DISEASE
SPECIALIST CONSULTATIONS
V. Valbuena1, A. Bai4, A. Showler1 M. Steinberg2, A.M. Morris2,3,
C-54
A SURVEY OF CANADIAN UROLOGIST OPINIONS AND PRESCRIBING
PATTERNS OF TESTOSTERONE REPLACEMENT THERAPY IN MEN ON
ACTIVE SURVEILLANCE FOR LOW GRADE PROSTATE CANCER
A. C. Millar2, D. S. Elterman2, L. Goldenberg2, B. Van Asseldonk1, K. A. Jarvi2
1
University of Toronto, Faculty of Medicine 2Mount Sinai Hospital 3University
Health Network, Toronto, ON, Canada 4University of Ottawa, Ottawa, ON,
Canada
1
MD Program University of Toronto, 2Department of Medicine University of Toronto
BACKGROUND: A previous cohort study identified that infectious disease (ID)
consultation was associated with reduced mortality from SAB. In patients that
received ID consultation (IDC), 21% died compared to 29% of patients that did
not (NIDC). It also increased use of quality measures of management, with
73% of IDC receiving echocardiogram versus 56% of NIDC. ID consultation
became mandatory for any patients with SAB at MSH and UHN in November
2014. OBJECTIVES: We examined if mandatory ID consultation results in
reduced mortality for patients with a first episode of SAB. METHODS: A
retrospective study was conducted at 3 academic hospitals between
December 2014 and May 2015. Patient records were included if the patient
had ≥1 positive blood culture for S. aureus. Patients were excluded if within 2
days of blood culture they: died, were deemed palliative, or left against medical
advice. Patient records were assessed using the same methods as were used
prior to introduction of mandatory consultation including a standardized data
collection form. Primary outcome was in-hospital mortality. Secondary
outcomes included adherence to quality measures, such as echocardiogram
and source control. RESULTS: 124 patients with Staphylococcus aureus
bacteremia were identified. 12 patients were excluded based on exclusion
criteria. 108 of 112 (96%) patients received ID consults. Total in-hospital
mortality rate was 19.6% (22/112) with site-specific mortality: MSH 2/22 (9%),
TWH 9/28 (32%), TGH 11/62 (18%). 96 patients (85%) received an
echocardiogram and 63 patients (56%) had removal of their foci of infection.
Average time to discharge was 45 days. CONCLUSIONS: Our study
demonstrates that compared to previous outcomes for NIDC, mandatory ID
consultation as a hospital policy is associated with better adherence to quality
measures and reduced in-hospital mortality in SAB patients.
INTRODUCTION: Attitudes regarding the safety of testosterone replacement
therapy (TRT) in hypogonadal men with prostate cancer have changed over the past
few years with the emergence of studies suggesting lower risk of cancer progression
than previously believed. Original studies raising concern with TRT in men with a
history of prostate cancer have been questioned and new results are expected to
change clinical practice. OBJECTIVE: Assess the current opinion regarding TRT
among Canadian urologists. METHODS: Active members of the Canadian Urological
Association were surveyed regarding their opinions on TRT in men with low grade
prostate cancer and their prescribing habits. RESULTS: Of the 57 responding
physicians, 53 (93%) actively treated men with prostate cancer, and 54 (95%) used
active surveillance as one technique to manage men with low grade/low stage
disease. 49 (86%) physicians actively prescribed TRT for men with known
testosterone deficiency without known prostate cancer, and 37 (65%) believed it was
safe for men with prostate cancer on active surveillance to be treated with
testosterone in the presence of testosterone deficiency. Furthermore, 36 (63%)
believed that use of testosterone did not increase the risk of progression of prostate
cancer in men on active surveillance. A similar number of physicians (37,65%) said
they would offer TRT for men with testosterone deficiency syndrome who were on
active surveillance. 55 (96%) physicians believed it was safe to administer
testosterone to men who have undergone radical prostatectomy for prostate cancer
and 49 (86%) physicians believed it was safe to administer testosterone to men who
have undergone brachytherapy or external beam radiation for prostate cancer.
However, only 20 (35%) physicians had ever offered TRT for men on active
surveillance, while only 24 (42%) actually had men in their practice who were taking
testosterone while on active surveillance. CONCLUSIONS: The discrepancy
between physicians’ beliefs and their clinical practice patterns may be due to multiple
factors. Interestingly, physicians may have been accepting of the potential safety of
TRT in such men theoretically, but were not comfortable carrying out this treatment
in real-life practice. Alternatively, physicians sampled may not have these specific
patients in their practice or may not have been screening for testosterone deficiency
in patients on active surveillance. Patient preference may also have played a role in
low prescribing rates.
C-55
PREVALENCE, DEVELOPMENT AND LONG-TERM CONSEQUENCES OF
OBESITY IN A COMMON GENETIC DISORDER
S. Voll1,2, E. Boot3, N. Butcher2, T. Heung2, and A. S. Bassett2,3
C-56
THE ROLE OF THROMBOPHILIA IN VENOUS THROMBOTIC EVENTS IN
CHILDREN
L. Avila1., T. Vu2, K. Barron3., C. Deluyan4., N. Parma5., and L, Brandao1
1
1
The Division of Hematology and Oncology, the Hospital for Sick Children,
Toronto, Ontario, 2MD Program, University of Toronto, Toronto, Ontario,
Canada; 3McGill University, Montreal, Quebec; 4University of Waterloo,
Waterloo, Ontario; 5McMaster University, Hamilton, Ontario
MD program, University of Toronto, Faculty of Medicine; 2Clinical Genetics
Research Program, Centre for Addiction & Mental Health; 3Dalglish 22q Clinic
for Adults, University Health Network.
BACKGROUND: 22q11.2 deletion syndrome (22q11.2DS) is the most
common microdeletion syndrome (estimated birth prevalence 1/3000) with
major features including congenital cardiac disease (CCD) and psychotic
illness. Prenatal and pediatric growth abnormalities are also common.
However, data are limited on adult outcomes, including the contributing factors
and downstream consequences of obesity. OBJECTIVES: We sought to
characterize the prevalence, development and long-term consequences of
obesity in 22q11.2DS. METHODS: We studied lifetime medical records of 208
adults with 22q11.2DS and recorded all available lifetime measurements of
height and weight, calculating a total of 1178 adult BMI measurements. We
used regression analysis to test a model predicting maximum BMI in this
population, and assessed a common downstream consequence of obesity.
RESULTS: There were 90 (43%) patients with a lifetime history of obesity
(BMI>30), 47 (52%) of whom had BMI>35. Our regression model was
significant (p<0.0001), with age and psychotropic medications predicting
higher BMI. A trend toward higher BMI was also seen with hypothyroidism and
unexpectedly with CCD (regardless of severity). Scoliosis and smoking
predicted lower BMI. Sex did not contribute. The prevalence of type 2 diabetes
was higher in obese patients than in the remaining cohort (n=10, 11% versus
n=1, 1% p<.01). CONCLUSION: The results indicate a high prevalence of
obesity in adults with 22q11.2DS. Further investigations of contributing factors
may suggest improved management strategies to address the significant level
of obesity in these patients, thereby reducing the impact of downstream
consequences on the Canadian Healthcare system.
BACKGROUD: Venous thromboembolism (VTE) is becoming an increasingly
recognized problem in children. VTE can be: provoked and is associated with an
acquired risk factor or unprovoked and idiopathic. In children, VTE is often provoked
and is associated with underlying medical conditions such as malignancy or a
medical intervention such as central venous lines (CVL). Recent meta-analyses have
shown that some genetic variants can also increase the risk of VTE in children.
However, in evaluating the risk of inherited/acquired thrombophilia, these studies did
not differentiate between provoked and unprovoked VTE in their pediatric population.
This is an important distinction since patients with an unprovoked VTE are at a higher
risk of recurrence. Furthermore, the impact of age was not explored in these studies,
which is relevant since VTE outcomes are likely age-related. Therefore, this study
will improve our understanding of VTE in children and provide a basis for clinical
practice. OBJECTIVES: To investigate the role of acquired/inherited thrombophilia
in children aged 0 to 18 years with a CVL-related VTE. METHODS AND RESULTS:
A retrospective review of patients diagnosed with image-proven upper and/or lower
limb VTE was conducted by cross-referencing the Sick Kids Electronic Patient Chart
(EPC), KidCare and the Picture Archiving and Information Communication System
(PACS). Thrombophilia testing status and CVL-related data was extracted from the
Thrombosis Database between Jan/2000 to Jan/2015. Descriptive analysis of the
population will use measures of central tendency and dispersion, as appropriate.
Univariable and logistic regression model statistics will be entertained to examine the
potential associations between thrombophilia and VTE-related outcomes.
Cumulatively, over 300 patient electronic charts were reviewed and the data is
collected for further analysis. DISCUSSION: Our findings will develop a more
rationale approach for submitting children with provoked VTE to thrombophilia
investigation, hopefully selecting only higher risk groups to whom this practice may
be better justified.
35
ABSTRACTS
C-57
THE FEASIBILITY OF UNATTENDED PORTABLE SLEEP MONITORING
FOR SLEEP APNEA DIAGNOSIS AFTER CEREBROVASCULAR EVENTS
A. Wan, BHSc1; S. Elias, MD1; J. Im, BSc1; M. I. Boulos, MD, MSc1
C-58
INVASIVE ROTHIA INFECTIONS IN CHILDREN WITH ACUTE MYELOID
LEUKEMIA
J. Y. Wang1,2, B. Gillmeister1, M.-C. Ethier1, and L. Sung1,3
1.
1
Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto,
ON, 2Faculty of Medicine, University of Toronto, 3Division of
Haematology/Oncology, The Hospital for Sick Children, Toronto, ON
Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute,
Sunnybrook Health Sciences Centre (HSC), Toronto, Canada
BACKGROUND: Obstructive sleep apnea (OSA) is associated with stroke and
transient ischemic attacks (TIA). Portable sleep monitors (PSM) have become
available as an alternative to polysomnography for the OSA. OBJECTIVE: To
assess the feasibility of PSM as unattended screening tools for patients with
cerebrovascular events. METHODS: In this prospective observational study,
inpatients or outpatients who had sustained a stroke or TIA were screened for
OSA using a PSM in their home or hospital room. The primary outcome was
feasibility of monitoring, defined as ≥80% of patients obtaining ≥4 hours of
analyzable sleep data. Secondary outcomes included proportion with OSA
detected, time to OSA detection, and time to initiate CPAP therapy. RESULTS:
One hundred and one patients were enrolled and completed sleep monitoring.
Mean age was 68.9±13.6 years, 55.4% male, 58.4% were outpatients, and
76.2% had a stroke (23.8% with TIA). Overall, 82.2% of the patients produced
≥4 hours of analyzable data. Functional dependence (defined as a modified
Rankin Scale of >2) was independently associated with obtaining unanalyzable
data (OR 3.9, p=0.037, 95% CI 1.1-13.7). OSA was detected by PSM in 49/83
(59.0%) of patients and of those 34/49 (69.4%) initiated continuous positive
airway pressure (CPAP) therapy. The mean time from study recruitment to use
of the PSM was 5.1 days (median: 1, interquartile range [IQR]: 0-5) and CPAP
was initiated on average within 57.9 days of recruitment (IQR: 40-71).
CONCLUSION: Unattended PSM can be feasibly implemented after
stroke/TIA in both the outpatient and inpatient settings. This method facilitates
rapid diagnosis and management of OSA.
C-59
NON-INVASIVE ASSESSMENT OF COARCTATION OF THE AORTA
THROUGH COMPUTATIONAL FLUID DYNAMICS
C. Williams1, F. Ballarin2, C. Mata2, G. Rozza2, P. Triverio3, A. Crean4 and L.
Jimenez-Juan5
Department of Medicine, UofT; 2SISSA MathLab, ISAS 3Department of
Electrical and Computer Engineering, UofT; 4Department of Radiology, UHN;
5
Department of Radiology, SHSC
1
BACKGROUND: Coarctation of the aorta (CoA) is responsible for 6-8% of all
congenital heart disease cases and is associated with significant
cardiovascular morbidity and mortality. Pressure gradient across the stenosis
is a key parameter in the diagnosis and follow-up of aortic coarctation and recoarctation. Currently, cardiac catheterization is the gold standard to measure
the pressure gradient, but it comes with a 1 in 1000 risk of death or serious
injury. Computational Fluid Dynamics (CFD) has been proposed as a noninvasive alternative to extract pressure gradients from standard MR or CT
angiography images with essentially no risks to patients. OBJECTIVES: The
goal of this study is to assess the accuracy of CFD-based measurements of
pressure gradients in CoA to determine its feasibility to replace catheter-based
measurements in clinical practice. METHODS: Patients who received both
imaging and cardiac catheterization were extracted from an institutional
database. The geometry of the aorta was reconstructed from MR and CT
angiography images using state-of-the-art software (VMTK), and the
reconstructed geometry was used to generate a computational mesh. CFD
simulations were based on the Navier-Stokes equations and the computed
pressure drop across the coarctation was compared to that measured by
catheterization. INTERIM RESULTS: A 3-D finite element model was created
for the thoracic aorta of 41 patients. Preliminary CFD simulations have shown
promising results with regards to model quality and computational methods.
DISCUSSION: Continued work on this study will involve extracting clinical data
from patient charts, running full CFD simulations for all patient cases and
comparing the CFD values to the catheterization values. This study has the
potential to alter clinical practice, aid in surgical planning and ultimately
improve patient outcomes.
36
INTRODUCTION: Rothia species (previously termed Stomatococcus) are
normal flora that reside in the gastrointestinal and respiratory tracts. In
immunocompromised hosts, they can cause invasive infections. OBJECTIVE:
Our objective was to describe infection characteristics and outcomes of Rothia
spp infections in a large cohort of children with newly diagnosed acute myeloid
leukemia (AML). METHODS: This retrospective chart review is a sub-analysis
of a larger study in which the aim was to identify factors associated with
infection in pediatric patients with AML. Only sterile site infections occurring
during chemotherapy were included. RESULTS: Among 578 children with
AML, 17 (2.9%) children with at least one Rothia spp. infection were identified.
All children were neutropenic at the time of infection. Of the 17 infections, 16
were bacteremia and one was meningitis. Eight (47%) had antecedent colitis
or mucositis. Sepsis occurred in four patients and one patient died due to
infection. CONCLUSION: Rothia spp infections are rare in pediatric AML but
can cause significant morbidity and mortality. Future studies should describe
trends in incidence and resistance patterns over time.
C-60
COMPARISON OF NOVEL PREDICTORS OF BURN SEPSIS VERSUS
THE AMERICAN BURN ASSOCIATION SEPSIS CRITERIA
J. Yan1,2, M. A. Burnett2, J. Bian2, S. Shahrokhi1,2, and M. G. Jeschke1,2
1
University of Toronto, Toronto, Ontario, Canada 2Ross Tilley Burn Centre,
Sunnybrook Health Science Centre, Toronto, Ontario, Canada
INTRODUCTION: The major contributor to mortality in severe burns is sepsis.
Despite this, the diagnosis of burn sepsis remains challenging. The American Burn
Association (ABA) sepsis diagnostic criterion was developed in 2007 to enable and
standardize the definition of burn sepsis. In 2013, a study by Mann-Salinas et al.
proposed novel criteria suggested being more predictive than the ABA criteria, but
this formula has not been verified. OBJECTIVE: Our aim is to compare the sensitivity
of the ABA criteria against these novel criteria. METHODS: This study was a single
institution prospective study of 28 patients admitted to an ABA-verified burn center
between 2010-2014 with >20% TBSA burns. All patients were diagnosed as septic
by the prospective clinical diagnosis of the medical staff. Both ABA and the novel
criteria were then each applied using patient records to determine whether sepsis
could be diagnosed with these conditions. Analysis was performed using McNemar
X2, spearman correlation and logistic regression under SPSS. RESULTS: McNemar
X2 demonstrated no significant difference in sensitivity between the two sets of
criteria (p=0.180). However, the ABA criteria was able to diagnose 82.1% of the
septic patients while the novel criteria was only able to diagnose 64%. Within the
ABA criteria, spearman correlation showed that only the hyperglycemic condition
significantly correlated with sepsis (r=0.434, p=0.021). Within the novel criteria, blood
pressure <60mmHg (r=0.600, P=0.0001) and vasoactive medication use (r=0.701,
P<0.001) were found to strongly correlate with the onset of sepsis. Based on logistic
regressions, the most significant predictors for burn sepsis from both criteria were
hyperglycemia (p=0.027), hypotension (p=0.011) and vasoactive medication use
(p=0.010). CONCLUSION: Though neither set of criteria significantly differed in
sensitivity for sepsis, the novel criteria excluded 50% more patients overall than the
ABA criteria. This result suggests the ABA criteria overall could be actually more
predictive than the novel criteria. Developing the most accurate criteria clinicians
can use to diagnosis burn sepsis is the first step to prompt medical intervention and
better prognosis. Our next steps will be to expand our >20% TBSA patient pool and
also include >10% TBSA burns.
ABSTRACTS
C-61
CAN TOPICAL OXYGEN THERAPY (NATROX™) IMPROVE WOUND
HEALING IN DIABETIC FOOT ULCERS?
J.Yu1, K.Cross2
1.
2.
MD Program, University of Toronto, Toronto, Ontario, Canada
Department of Plastic Surgery, St. Michael’s Hospital, Toronto, Canada
BACKGROUND: Diabetic foot complications care represent a significant
burden to the Canadian healthcare system. Despite best standards of care for
diabetic ulcers, wounds become chronic when they do not heal. The Natrox™
system is a novel continuous oxygen device designed to deliver topical oxygen
to wounds to promote healing in recalcitrant ulcers. OBJECTIVE: This study
seeks to determine the effectiveness of the Natrox™ device in patients with
non-healing diabetic foot/leg ulceration in comparison with standard best
practice. METHODS: This pilot study is a multi-centre, international clinical trial
across two sites in the UK and Toronto. 20 patients with chronic lower leg
ulcers will be randomized into two groups; treatment group with Natrox™
Topical Oxygen device (n=10), and a control group (n=10). All patients will
attend an outpatient clinic once weekly where the wound will be cleaned using
sterile distilled water. In the Natrox treatment group (n=10), the Natrox™
device will be applied to the ulcer and standard dressings placed on top.
Control group patients will receive standard dressings. In both groups, the ulcer
will be photographed at weekly intervals for a period of 8 weeks to analyze
ulcer surface area using a standardized digital imaging software. An identical
protocol will be used at the U.K site. RESULTS: Preliminary results of 4
patients with chronic ulcers (mean duration: 28 months) show complete healing
(change in wound surface area> 50%) within 2 months. DISCUSSION: This is
the first multi-centre study utilizating Natrox™ topical oxygen therapy on
chronic diabetic ulcers to investigate wound healing. The results of our pilot
study clearly demonstrate the promising application of topical oxygen therapy
with significant wound healing. Although completion of the study numbers is
needed, preliminary results suggest Natrox™ topical oxygen therapy has the
potential to be used to heal chronic ulcers and drastically improve wound
management for many patients.
C-63
HEMATOMA VOLUMES ARE INDEPENDENT OF ELEVATED
PREHOSPITAL BLOOD PRESSURE IN PATIENTS WITH
INTRACEREBRAL HEMORRHAGE
R.T. Zewude*1,2, L.C. Gioia2, M.P. Kate2, B. Rowe2, K. Liss2, K. Butcher2
1
MD Program, University of Toronto, Toronto, Ontario, 2Faculty of Medicine,
University of Alberta, Edmonton, Alberta
BACKGROUND: Intracerebral hemorrhage(ICH), bleeding in the brain, is the
second most common type of stroke with the highest mortality rate. Blood
Pressure (BP) reduction is one of the medical interventions in ICH. We tested
the association between prehospital BP and baseline ICH volumes.
METHODS: We conducted a retrospective analysis of a prospectivelymaintained database of electronic patient reports that included serial BP
measurements of patients transported by Emergency Medical Services (EMS)
to the emergency department of a tertiary care hospital during an18-month
period. All patients with an EMS dispatch code for suspected stroke were
included. Hospital charts and neuroimaging were reviewed. The localized
bleed, hematoma, and intraventricular hemorrhage (IVH) volumes were
measured planimetrically. RESULTS: EMS transported 954 patients for
suspected stroke. ICH was diagnosed in 50 (5.2%) of them. Mean prehospital
systolic BP (SBP) was 173 ± 32 mmHg. Median baseline hematoma volume
was 31.8 (53.2) ml and median total ICH volume (hematoma + IVH) was 33.4
(58.1) ml. Mean prehospital BP was unrelated to hematoma volume (R=0.12,
p=0.42) and total ICH volume (R=0.14, p=0.34). Mean prehospital SBP in
patients with hematoma volumes <33ml (169 ± 32 mmHg) was similar to those
≥33ml (177 ± 32 mmHg, p=0.45). Similar results were found with 15ml
(p=0.82), 45ml (p=0.52), and 60ml (p=0.50) hematoma volume cutoffs. Mean
prehospital SBP in patients with total ICH volume <33ml was similar (168 ± 33
mmHg) to those ≥33ml (177 ± 31 mmHg, p=0.39). IVH was present in 16 (32%)
patients. The mean prehospital BP did not differ in patients with IVH (180 ± 27
mmHg) when compared to those without IVH (169 ± 34 mmHg, p=0.10).
CONCLUSIONS: Prehospital BP is consistently high across different ICH
volumes. Hematoma and total ICH volumes are independent of prehospital BP.
These findings do not preclude a prehospital BP treatment effect.
C-62
EFFICACY OF A COLORECTAL CANCER SCREENING EDUCATION
INTERVENTION FOR PRIMARY CARE PHYSICIANS AND PATIENTS: A
10-YEAR FOLLOW-UP.
E.M. Yung1, J.C. Carroll1,2, J. Permaul2, E. Dicks3, K. Semotiuk2, E.
Warner1,4, H. Rothenmund5, S. Blaine1,6, M.J. Esplen1, J. McLaughlin1,2,7.
1. University of Toronto, Toronto ON; 2. Mount Sinai Hospital, Toronto ON; 3.
Memorial University, St. John’s NL; 4. Sunnybrook Hospital, Toronto ON; 5.
Health Sciences Centre, Winnipeg MB; 6. STAR Family Health Team,
Stratford ON; 7. Public Health Ontario, Toronto ON
BACKGROUND: Family physicians (FPs) play a central role in the
identification and management of hereditary colorectal cancer (CRC).
Previously, we developed a CRC risk assessment/management tool for FPs,
and an information booklet for patients. The tool significantly increased FP
confidence in CRC risk assessment/management, while the booklet
significantly increased patient knowledge. OBJECTIVE: To determine selfreported use of the tools, CRC screening behaviours, and knowledge from the
same FPs and their patients in a 10-year follow-up. METHODS: 48 FPs and
169 patients in Ontario and Newfoundland were included. Primary outcomes
were correct screening recommendations by FPs on clinical vignettes, patient
knowledge of CRC, and “correct” self-reported CRC screening by patients.
RESULTS: 60% of eligible physicians and 74% of eligible patients participated.
56% of FPs reported still using the tool, and 76% rated their knowledge of
hereditary CRC as at least satisfactory. 96% of FPs reported routinely asking
their patients about family history of cancer, and 88% reported routinely
recommending FOBT for population-risk patients ≥50 years of age. While 56%
of FPs correctly identified individuals at high risk of hereditary CRC on
vignettes, only 20% and 24% correctly identified moderate and low-risk cases.
47% of patients reported using the patient booklet over the past five years; their
median knowledge score was 8 out of 15 items. CONCLUSION: The results of
this 10-year follow-up suggest that while education interventions targeted at
FPs and patients can increase knowledge, further work is needed to improve
long-term knowledge retention and correct screening behaviours.
C-64
EVALUATING DIAGNOSTIC ACCURACY OF TRANSVAGINAL SONOGRAPHY AND
SALINE INFUSION SONOHYSTEROGRAPHY IN DETECTING UTERINE CAVITY
ABNORMALITIES
P.Sharma, E.Shlush, W.Zhou
BACKGROUND: It is estimated that 10-15% of women seeking treatments for subfertility
have uterine cavity abnormalities. Therefore, the evaluation of the uterine cavity before
assisted reproductive techniques is of utmost importance. TVS is preferred as the initial
diagnostic procedure in evaluating the uterine cavity, due to its wide availability, costeffectiveness, and well-tolerated nature. SIS makes the use of saline into endometrial cavity
for distension and contrast during an ultrasonic examination. Hysteroscopy is considered to
be the gold standard investigative modality as it allows direct visualization of the endometrial
cavity. However, due to its invasive nature, it often requires local or general anesthetics, or
sedation, and also does not allow an assessment of the myometrium and adnexal
structures. TVS has traditionally been used as an initial diagnostic tool in the evaluation of
the uterine cavity, but it has been shown to have moderate accuracy. SIS has been shown
in some studies to have superior accuracy, but still not comparable to that of hysteroscopy.
We aim to perform an accurate evaluation of TVS and SIS, and hypothesize that
incorporating SIS in the initial evaluation of infertility will reduce the number of hysteroscopy
procedures that will need to be performed. OBJECTIVE: The aim of this retrospective study
was to accurately assess the diagnostic accuracies of Transvaginal sonography (TVS), and
Saline infusion sonohysterography (SIS) using the QUADAS tool to ensure an accurate
evaluation. We aimed to compare the diagnostic accuracy of Transvaginal Sonography in
uterine abnormality detection in the follicular and ovulatory/luteal phase. The last objective
involves evaluating the diagnostic accuracies of TVS and SIS in various time intervals to
hysteroscopy, to see if it is essential to perform the testing in the same menstrual cycle as
hysteroscopy, to achieve the highest detection rates. PATIENTS/METHODS: 696 subfertile patients with a mean age of 37.5 years (range 23-51) underwent TVS, and/or SIS, in
addition to hysteroscopy, between January 2009-July 2015. The presence of focal
abnormalities, as well as uterine malformations, were noted. The results of TVS and SIS
were grouped according to the time interval to hysteroscopy, whether in the same cycle,
same month, 1-3 months, or 3-6 months. Additionally, TVS that was done within the same
month as hysteroscopy was further grouped into the two phases of the menstrual cycle
during which they were performed. Statistical analysis was performed, and then sensitivity,
specificity, positive predictive value, and negative predictive value for each cohort was
calculated. RESULTS: SIS showed significantly superior diagnostic accuracy compared to
TVS. The accuracy of TVS did not vary with timeframe to hysteroscopy in the detection of
both uterine abnormalities and malformations. The accuracy of SIS was higher when done
in the same cycle as hysteroscopy in detecting uterine abnormalities. Lastly, the diagnostic
accuracy of TVS were not significantly different in the follicular and luteal phases.
CONCLUSION: Based on these results, we recommend performing SIS along with TVS as
part of the routine infertility check-up to enhance the detection rate of uterine lesions and
malformations. If hysteroscopy is needed to further confirm the findings on a positive SIS,
we recommend scheduling hysteroscopy for the same menstrual cycle.
37
ABSTRACTS
PPH-01
CARDIOVASCULAR DISEASE GUIDELINE ADHERENCE AND STATIN USE IN
LONGSTANDING TYPE 1 DIABETES: RESULTS FROM THE CANADIAN
STUDY OF LONGEVITY IN DIABETES COHORT
J. W. Bai1, G. Boulet1, E. M. Halpern1, L. E. Lovblom1, D. Eldelekli1, H. A. Keenan2,
M. Brent3, N. Paul4, V. Bril5, D. Cherney6, A. Weisman1, B. A. Perkins1
1
Division of Endocrinology and Metabolism, Department of Medicine, University of
2
Research Division, Joslin Diabetes Center, Boston, Massachusetts, USA.
3
Department of Ophthalmology and Vision Sciences, Department of Medicine,
University of Toronto, Ontario, Canada.
4
Division of Radiology, University Health Network, Toronto, Ontario, Canada.
5
Division of Neurology, Department of Medicine, University of Toronto, Ontario,
Canada.
6
Division of Nephrology, Department of Medicine, University of Toronto, Ontario,
Canada.
PPH-02
A SCOPING REVIEW OF SURGICAL REPAIR FOR CONGENITAL HEART
DISEASE IN LOW- AND MIDDLE-INCOME COUNTRIES
Z. J. Brickman1, A. J. Hunter2
1
University of Toronto, Faculty of Medicine 2 McMaster University
BACKGROUND: Older patients with longstanding type 1 diabetes have high cardiovascular
disease (CVD) risk such that statin therapy is recommended independent of prior CVD
events. OBJECTIVE: We aimed to determine adherence to CVD prevention guidelines in
patients with longstanding diabetes. RESEARCH DESIGN AND METHODS: 309
Canadians with over 50 years of type 1 diabetes completed a medical questionnaire for
presence of lifestyle and CVD pharmacological interventions and they were stratified into
primary or secondary CVD prevention subgroups based on self-reported CVD events.
Associations with statin use were analyzed using multivariable logistic regression.
RESULTS: The 309 participants were 65.7±8.5 years of age, with diabetes duration of 55.0±
6.5 years and HbA1c of 7.5±1.1%. 159(52.7%) participants reported adhering to diet
recommendations, 296(95.8%) smoking avoidance, 217(70.5%) physical activity,
218(71.5%) renin-angiotensin system inhibitor use, and 220(72.1%) statin use. Physical
activity was reported as less common in the secondary prevention subgroup, and current
statin use was lower in the primary prevention subgroup (65.5% vs. 84.8%, p=0.0004). In
multivariable logistic regression, the odds of statin use was 0.38[95% CI 0.15 to 0.95] in
members of the primary compared to the secondary prevention cohort, adjusting for age,
sex, hypertension history, body mass, HbA1c, cholesterol, microvascular complications,
acetylsalicylic acid use, and renin-angiotensin system inhibitor use. CONCLUSION: Though
statins are recommended in longstanding type 1 diabetes regardless of CVD history, statin
use was substantially lower in those without CVD history. Interventions are needed to
improve adherence in the high-risk population without a history of CVD.
INTRODUCTION: Congenital heart disease (CHD) is defined as a gross
structural abnormality of the heart and is the most common birth defect
globally. Management of CHD is a particular challenge in low- and middleincome countries (LMICs). Compared to high-income countries, LMICs have
fewer resources, established programs and quality health systems to manage
patients with CHD. These factors, combined with an increased birth rate,
places a higher CHD burden on LMICs than HICs. OBJECTIVE: We examined
the literature for surgical care programs in LMICs for CHD and the outcomes
of individuals with non-critical CHD in these areas. METHODS: Literature
searches of the MEDLINE and Global Health databases were conducted using
the standard scoping review methodology outlined by Arksey and O’Malley
(2005). Variations of the keywords ‘congenital heart disease’ and ‘low- and
middle-income countries’ were used to search these databased. Articles
published in English from January 1, 2000 to June 15, 2015 were included in
the search. RESULTS: The search strategy identified a set of 448 articles.
After screening and review, 55 of these were included in the study. The
included articles in this scoping review consisted of program descriptions,
primary data, review articles and editorials. Overall, the results showed that
inadequate care for CHD patients is multi-factorial. CONCLUSION: Based on
the findings of the scoping review, the care of CHD patients in LMICs could be
improved by: creating a global CHD database, improving collaborations
between governments and NGOs, increasing education and awareness about
CHD, and establishing hubs of CHD care called Centres of Excellence (COEs).
It would be beneficial to incorporate these into a triage model for non-critical
CHD in LMICs, thereby creating a system of priority that would result in patients
receiving surgical repair at a designated COE. Furthermore, capacity building
and infrastructure supports would allow for pre- and post-operative medical
management in the patient’s home country.
PPH-03
INCIDENCE AND SEVERITY OF BURNS IN 2 HOSPITALS IN NAIROBI
AND NAKURU, KENYA
S. Yektaa, E. Frymlb, J. Gatebic, J. Wanjerid, P. Oduore, A. Mengistec, L.
Kasraia
PPH-04
THE RELATIONSHIP BETWEEN METFORMIN AND SERUM PROSTATESPECIFIC ANTIGEN LEVELS
V.H. Jayalath MSc1,2, C. Ireland BASc1, N.E. Fleshner MD2, R.J. Hamilton
MD2, and D.J.A. Jenkins MD1
a
1
Division of Plastic and Reconstructive Surgery, U of T, bU of T, cAMREF
Kenya, dRift Valley Regional Hospital and Egerton U, eKenyatta National
Hospital and U of Nairobi
INTRODUCTION: Worldwide, burns are the 4th most common injury. Burns
severe enough to require medical attention have a worldwide incidence close
to 11 million. Burns from fires account for 310 000 deaths each year, with 95%
of injuries occurring in low- and middle-income countries (LMICs). In these
countries, the quality of acute care varies and prevention programs are not
common. Children under 5 years of age have the highest risk of burn injuries.
In Kenya, about 60-80% of urban dwellers live in slums, so socioeconomic
status is an important consideration when investigating burn injuries. However,
there is a paucity of data about the demographics of burn injuries in Kenya.
OBJECTIVE: This study aimed to better understand the demographics and
socioeconomic factors of burn victims at hospitals in Nairobi and Nakuru,
Kenya. METHODS: We recruited 359 burn victims who presented to either
Kenyatta National Hospital/U of Nairobi in Nairobi, or Rift Valley Provincial
General Hospital (RVPGH)/Egerton U in Nakuru, Kenya. We administered a
comprehensive questionnaire to assess the incidence and severity of the
burns. RESULTS: The burns patients ranged in age from 5 weeks to 80 years.
The majority (50.7%) of patients were young children below the age of five.
Burns were caused predominantly by either scalds (55.2%) or flames (37.7%).
The majority of patients reported 2nd degree burns (57.2%). Burns from flames
were more likely to be associated with greater severity relative to burns from
scalds. Adult patients were seen to have significantly higher proportion of more
severe burns in comparison to pediatric patients under age 5. CONCLUSION:
This study provides new demographic and etiologic data on Kenyan burn
injuries, which can serve to guide prevention and treatment efforts. In particular
it underscores the importance of our current cookstove barrier project in the
rural slum of Kibera.
38
2
Depts. of Nutritional Sciences & Medicine, Faculty of Medicine, UofT
Dept. of Surgical Oncology-Urology, PMCC & UHN
OBJECTIVE: Metformin is the first-line oral antihyperglycemic of choice for
individuals with type 2 diabetes. Recent evidence supports a role for metformin
in prostate cancer chemoprotection. However, whether metformin indeed
influences prostate biology is unknown. Thus, we studied the association
between metformin and serum prostate-specific antigen (PSA) levels – the
primary biomarker used in prostate cancer screening and monitoring.
METHODS: We conducted a cross-sectional study of 326 prostate cancer-free
men with type 2 diabetes recruited between 2004-2013 at St.Michael’s
Hospital. Men were excluded if they had a PSA≥10-ng/mL, or used >2550mg/d metformin or supplemental androgens. Multivariate linear regressions
quantified the association between metformin dose and log-transformed PSA.
Secondary analyses quantified the association between other
antihyperglycemics (sulfonylureas, thiazolidinediones) and serum PSA;
sensitivity analyses formally tested covariate interactions. RESULTS: Median
PSA was 0.9-ng/mL (interquartile range: 0.5 to 1.6-ng/mL). Metformin dose
associated positively with body mass index, glycated hemoglobin, diabetes
duration, and number of statin, acetylsalicylic acid, diuretic users, and number
of antihyperglycemics used, and negatively with low-density lipoprotein
cholesterol. In multivariate-adjusted regressions, PSA changed by -8%
(95%CI: -13 to -2%, p=0.011) for every 500-mg/d increase in metformin dose.
Men with diabetes for ≥6-years (n=163) saw a greater difference in PSA per
500-mg/d metformin (-12% [95%CI: -19 to -4%, p=0.002], p-interaction=0.018).
Serum PSA did not relate with other antihyperglycemics or total number of
antihyperglycemic agents used. CONCLUSIONS: Metformin dosedependently inversely associated with serum PSA, independent of other
antihyperglycemic medications. Whether metformin confers a dose-dependent
benefit on prostate tumorigenesis and progression warrants investigation.
ABSTRACTS
PPH-05
COMPARING PERCEIVED AND ACTUAL RISK OF 7 TRAVEL-RELATED
CONDITIONS AMONGST ADULT AND CHILDREN TRAVELLERS AT THE
SICKKIDS FAMILY TRAVEL CLINIC
J. Hoang1,2, L. G. Pell2, N. Akseer2,3, R. Lam4,5, D. Louch4, M. Science4,5, S.
K. Morris2,4,5
1
MD Program, University of Toronto, 2Centre for Global Child Health, The
Hospital for Sick Children, 3Dalla Lana School of Public Health, University of
Toronto, 4Division of Infectious Diseases, The Hospital for Sick Children,
5
Department of Pediatrics, University of Toronto
BACKGROUND: As global travel rises, adequately preparing travellers to
prevent travel-related conditions is crucial to promoting personal and public
health. A key factor affecting travellers’ uptake of healthy behaviours is
perceived risk. OBJECTIVES: To assess differences between perceived and
actual risk of travel-related conditions in international travellers. METHODS:
Children <18 years and adults were recruited at the SickKids Family Travel
Clinic from October 2014 to July 2015. A 7-point Likert scale gaging risk
perception of 7 travel-related conditions (traveller’s diarrhoea (TD), malaria,
yellow fever, dengue, HIV/AIDS, motor vehicle accident (MVA) and adverse
event from travel-related vaccination (AEV)) was administered to adults,
children >13 years, and adults on behalf of all children. Actual risk was
determined by a travel medicine expert. Perceived and actual risks were
analyzed using paired t-tests and ICC. RESULTS: Data were available for 33
children (self-reported n=8; adult-reported n=25) and 29 adults. For adults,
mean risk difference was significant for all conditions (p<0.05) except AEV; risk
was overestimated for all except HIV/AIDS (mean difference=0.379,
95%CI=0.067-0.691); risk agreement yielded insignificant ICC. For adultperceived child-risk, mean difference was significant (p<0.05) except for TD
and AEV; risk was overestimated except for HIV/AIDS [0.6(0.394-0.806)]; risk
agreement insignificant. For children, mean difference was significant for TD
and MVA (p<0.05); risk was overestimated for TD [1(0.368-1.632)]; risk
agreement insignificant. CONCLUSIONS: There are differences in travellers’
perceived and actual risk. These results will inform future pre-travel health
interventions. PPH-07
EARLY ONSET NEONATAL SEPSIS IN CANADA: 2011-2012
A. Kobylianskii1; M. Sgro1 MD FRCPC; K. Sankaran2 MD FRCPC; M. Yudin1
MD FRCSC; D. Tran1 MD FRCPC; D. Campbell1 MD FRCPC
1
2
University of Toronto, Toronto, Canada
University of Saskatchewan, Saskatoon, Canada
BACKGROUND: North American studies suggest that the organisms responsible for
early-onset neonatal sepsis (EONS) are changing, with an increase in Escherichia
coli (EC) and antibiotic-resistant organisms. Canadian guidelines for prevention and
treatment of EONS are based on Group B streptococcus (GBS) as the likely
organism. Population-level data may inform updates to these national strategies.
OBJECTIVES:
1. To determine the incidence, types of organisms and corresponding resistance
patterns involved in EONS in Canada.
2. To identify how the organisms are affected by maternal antibiotic prophylaxis
and other factors.
METHODS: Cases of EONS (positive blood and/or cerebrospinal fluid (CSF) culture
at <7 days of age) between January 2011 and December 2012 were identified
through the Canadian Paediatric Surveillance Program. Neonates were excluded if
they were asymptomatic with a positive culture likely to be a contaminant, or if the
CSF culture was positive as a result of an intracranial procedure. RESULTS 127
EONS cases were identified over the 2 years, and the incidence was 0.17/1000 live
births (754,849 total Canadian live births). 79.5% of cases presented within 24 h of
life, while 15% presented between 72 h-7 days. GBS accounted for 41.7% of cases,
while EC accounted for 35.4%. 33.9% of cases overall were resistant, including
55.6% of EC, of which ampicillin resistance was most common. The species of
infecting organism was significantly associated with gestational age (GA), very low
birth weight, age at presentation, the mother having received GBS prophylaxis, and
rupture of membranes lasting more than 18 h. GBS was most common in term and
EC in preterm neonates. The overall EONS case fatality rate was 11%, mostly from
EC. CONCLUSIONS: Our EONS rate is lower than historically suggested, with
differing dominant organisms based on GA, later ages at presentation, and high
resistance rates. We recommend a review of the Canadian guidelines based on our
findings.
PPH-06
IDENTIFYING EFFECTIVE BEHAVIOUR CHANGE COMMUNICATION
STRATEGIES FOR MALARIA ELIMINATION IN MACHA, ZAMBIA
J. Hoang1, H. Khan1, M. Lubasi3, E. Mweemba3, L. Lohfeld2,3
1
MD Program, University of Toronto, 2Department of Clinical Epidemiology &
Biostatistics, McMaster University, 3Johns Hopkins Malaria Institute at Macha
BACKGROUND: Zambia’s National Malaria Control Programme (NMCP) is
currently focused on eliminating malaria in low-to-moderate transmission areas
by supplementing health programs with Behaviour Change Communication
(BCC) campaigns. BCC, when relevant to local contexts, has been shown to
increase knowledge of prevention strategies and correct use of health
commodities, thereby maximizing intervention effectiveness and return on
investments. OBJECTIVE: To collect insight from frontline workers and
community leaders on effective BCC content and delivery channels for malaria
elimination in Macha, Zambia. METHODS: Participants were recruited using a
nominated sampling strategy. Semi-structured interview guides were drafted
and informed by a literature review and stakeholder consultations. Interviews
were conducted in English and Chitonga with the support of interpreters.
Thematic framework analysis was used to analyze the data. RESULTS: Data
were collected from community health workers (n=3), Macha Research Trust
staff (n=5) and community leaders (n=5). Participants indicated that BCC
content should not only describe ideal behaviours, but also highlight impact.
Participants emphasized that meetings and drama groups are effective BCC
delivery platforms. They also pinpointed that community leaders and schools
should play a key role in BCC dissemination. DISCUSSION: Participants
suggested that present strategies be combined with one-to-one interactions to
enhance information uptake. Local leaders should be involved as their opinions
are highly regarded. BCC dissemination should occur in schools to maximize
reach. Participants identified drama groups as effective forums for conveying
messages as they incorporate entertainment. The findings provide insight into
BCC content and delivery strategies most appropriate for Macha. These
findings can be used by the NMCP to enhance national malaria elimination
programs.
PPH-08
HEALTHCARE CLIMATE AND HIV PREVENTION: PERSPECTIVES FROM
HEALTHCARE PROVIDERS (HCPs) AND MEN WHO HAVE SEX WITH
MEN (MSM)
S. Kushwahaa, L. E. Nelsonb, L. Wiltoncd, M. M. Baileye, T. Agyarko-Pokuf, Y.
Adu-Sarkodief, K. H. Mayerg
a
University of Toronto, Toronto, Ontario, Canada; bUniversity of Rochester,
Rochester, New York, USA; cState University of New York at Binghamton,
Binghamton New York, USA; dUniversity of Johannesburg, Johannesburg,
South Africa; eArizona State University Tempe, Arizona, USA; fKwame
Nkrumah University of Science & Technology, Kumasi, Ashanti, Ghana; gThe
Fenway Institute, Boston, Massachusetts, USA.
BACKGROUND: In Ghana, a mixed HIV epidemic persists. The nation-wide
HIV prevalence is 1.3% compared to 17% among MSM. There is little empirical
data on healthcare climate’s role in exacerbating or mitigating this HIV crisis in
MSM. It is important to understand MSM perceptions of the Ghanaian
healthcare system and HCP attitudes towards MSM and their HIV prevention
needs. OBJECTIVE: To elucidate assets and barriers in the Ghanaian
healthcare system affecting HIV prevention efforts towards MSM. METHODS:
We applied a self-determination theory framework and an assets-based
approach to develop semi-structured focus group interviews with peer social
networks (n = 22) of MSM and conversational interviews with individual HCPs
(n = 25) in three Ghanaian communities (Accra, Kumasi, Manya Krobo). Data
were qualitatively analyzed with the aid of NVivo software. RESULTS: HIV
prevention barriers included past negative healthcare experiences, negative
attitudes towards condoms, poor condom access, and limited or stigmatized
HIV testing. Assets included positive attitudes towards condoms and HIV
testing, knowledge about condom utility, desire for healthy lives, and belief in
equitable treatment of MSM. CONCLUSION: Ghanaian MSM generally live in
an unsupportive cultural and social context, frequently reporting negative
healthcare experiences. HCPs express a desire to provide equitable care. Both
parties agree on the need for HIV prevention resources (e.g. condoms,
lubricant). These findings contribute to community stakeholder knowledge to
inform HIV prevention interventions.
39
ABSTRACTS
PPH-09
A DESCRIPTIVE ANALYSIS OF THE POSTMORTEM TOXICOLOGY
FINDINGS IN SUDDEN CARDIAC ARREST CASES OF PRIMARY
CARDIAC ETIOLOGY
G. Roshankar1, K. Allan2,3 , P. Dorian3
1
MD Program, University of Toronto, Toronto, Ontario, Canada 2Institute of
Medical Science, University of Toronto, Toronto, Ontario, Canada
3
Department of Cardiology, St. Michael’s Hospital, Toronto, Ontario, Canada
BACKGROUND: Sudden Cardiac Death (SCD) due to medication or
recreational drug overdose has been studied extensively. However, SCD
cases of primary cardiac cause with non-fatal postmortem toxicological
findings have been commonly excluded and given little attention in analysis of
this population in the existing literature. OBJECTIVES: The primary objective
of this study is to understand and describe the toxicology profile associated
with the major cardiac etiologies of SCD. METHODS: Ontario Coroners’
Registry was used to identify all Out of Hospital Cardiac Arrests (OHCA) of
primary cardiac etiology from 2009 to 2012 in individuals of age 2 to 45 within
the GTA. Information pertaining to demographics, circumstances of the SCD
event, past medical history, autopsy results, and blood and urine toxicology
results were abstracted from the coroner record of each case. Four categories
of sub-therapeutic, therapeutic, toxicologically significant, and fatal toxin levels
were defined. Statistical analysis was done to describe each of the three
common SCD cardiac etiologies in terms of toxicology findings. RESULTS:
From a total of 657 SCD cases, 28.2%, 40.5%, and 15.1% were due to
structural, ischemic, and primary arrhythmic disease, respectively. Of the
structural, ischemic, and primary arrhythmic cases 32%, 21.2% and 31.6% had
a finding on their toxicology reports, respectively. Within the primary arrhythmic
subgroup, 14.5% of all cases had recreational drug findings from which 63.6%
were found to have some level of ethanol detected in the blood.
CONCLUSIONS: We found a high proportion of sudden cardiac deaths from
all causes with some CNS active drug in the blood at time of death. Whether
these drugs contributed to the cardiac arrest or are a marker for psychiatric or
behavioral associations to sudden cardiac death needs exploration.
PPH-11
“THE FIRST STEP TO HELPING”: ASKING ABOUT POVERTY AND HOW
A CHILD POVERTY ASSESSMENT TOOL MIGHT HELP
J. Teicher1, J. Y. Qadri2, G. Bloch1,3, L. Ford-Jones1,2, J. Orkin1,2,4
1
Faculty of Medicine, University of Toronto; 2Department of Paediatrics,
Hospital for Sick Children; 3Family Medicine, St. Michael’s Hospital;
4
Associate Scientist, Centre for Research on Inner City Health, Li Ka Shing
Keenan Research Institute, St Michael's Hospital
BACKGROUND: Canadian children living in poverty are more likely to
experience poor health outcomes in childhood and beyond. Physicians have a
unique opportunity to screen for the social determinants of health (SDOH) and
intervene early to optimize an individual's health trajectory. The Child Poverty
Assessment Tool (CPAT) was developed at the Hospital for Sick Children
(HSC) to provide healthcare providers with screening questions and resources
to address identified SDOH needs. OBJECTIVE: To develop an understanding
of physicians’ current poverty screening practices and attitudes; To explore the
feasibility, accessibility, and relevance of the CPAT. METHODS: Using a
qualitative grounded theory approach, 7 paediatricians associated with HSC
were individually interviewed. Interviews were conducted using semistructured interview guides, and were digitally recorded and transcribed
verbatim. RESULTS: Three major themes emerged regarding benefits of
screening for SDOH: improved assessment, increased referrals, and
appropriate changes to treatment plans. In addition to limited billing models
and time constraints, five major themes were identified as challenges to
screening for SDOH: lack of knowledge of resources, upsetting family
expectations, the physician’s own comfort, the biomedical model of training,
and understanding of physicians’ scope of practice. The CPAT was found to
address some, but not all of these challenges. CONCLUSION: While a
structured tool (i.e. the CPAT) may provide support to physicians conducting
screening, systemic and medical cultural barriers exist. Further research is
needed to examine the effectiveness of implementing screening tools in clinical
practice, and to identify solutions for systemic barriers to screening for poverty
in paediatric populations.
40
PPH-10
AN ANALYSIS OF HIGHER PROTEIN DIETS ON RENAL FUNCTION
A. Sithamparapillai1, M. Devries1, L. Banfield2, S. Brimble3, S.M. Phillips1
Department of Kinesiology1, Faculty of Health Sciences2, and Department of
Medicine3, McMaster University, Hamilton, Canada
INTRODUCTION: Higher protein diets have seen a rise in popularity due to
potential metabolic benefits. Increased amino acid consumption may have
consequences on kidney function, particularly in expanding middle class
populations who are allocating more income towards animal sources of protein.
OBJECTIVE: This systematic review and meta-analysis evaluated the effects
of higher versus lower protein intake on glomerular filtration rate (GFR) in
adults living without renal impairment. METHODS: Search strategies were
developed and electronic databases searched: MEDLINE and EMBASE. Data
were extracted up until June 3, 2015. The main outcome measure was GFR
and a random effect model (Cochrane’s Review Manager Version 5.3) was
used to pool mean differences in GFR values. RESULTS: Database searches
yielded 25 trials from 1914 articles that were eligible for analysis based on
inclusion/exclusion criteria. 12 studies were randomized controlled trials and
11 studies were crossover trials. Due to separately presented data, 2 crossover
studies were treated as 4 trials to result in 25 total trials. A total of 810 subjects
from 25 trials were included in this systematic review and meta-analyses. The
age of participants was 24-62 years and their BMI was 21-36 kg/m2. Higher
protein compared to lower protein-containing diets were associated with
increased GFR values [mean difference (MD): 8.33 ml/min (95% CI 4.87 to
11.79), P < 0.00001] but this was less pronounced when assessing change
from baseline GFR values [MD: 4.71 ml/min (95% CI 0.06 to 9.36), P = 0.05].
In both meta-analyses, significant heterogeneity was present and funnel plot
asymmetry indicated potential publication bias. CONCLUSION: Higher protein
diets were associated with increased GFR, however, these results were
inconclusive due to significant heterogeneity and overestimation by random
effect analyses. As a result, there is still no clear evidence that high protein
diets negatively impact renal function in healthy populations.
PPH-12
EVALUATING THE SPATIAL CORRELATION OF ANTIBIOTIC
RESISTANCE IN COMMON NOSOCOMIAL PATHOGENS IN CANADA
AND UNITED STATES
A. Wang1, J. Brownstein2, D. MacFadden3
1
2
3
MD Program, University of Toronto, Toronto, Ontario, Canada
Boston Children’s Hospital, Boston, Massachusetts, United States
Division of Infectious Diseases, University of Toronto, Ontario, Canada
INTRODUCTION: Antibiotic resistance is a public health threat. Although
laboratory standards recommend that hospitals generate annual indexes of
resistance, termed antibiograms, many centres do not. There may be
significant similarities in pathogens between local institutions, which could be
used to inform therapeutic decision making in regions lacking antibiograms.
OBJECTIVE: To evaluate the spatial correlation of antibiotic resistance of
nosocomial pathogens between healthcare facilities. METHODS: Using
antibiograms from 81 healthcare facilities in Canada (19) and United States
(62), from 2011 to 2014, antibiotic resistance of the most common and
significant pathogens to common antibiotics were extracted. Using the latitude
and longitude of the facilities, semivariograms were computed to measure
spatial dependence. Regression analysis (SAS University Edition, 2015) was
also performed to assess the effect of different parameters on antibiotic
resistance. RESULTS: Positive spatial association was found for the overall
resistance of Klebsiella spp. (n=70, p<0.01), Pseudomonas aeruginosa (n=68,
p=0.04), Enterobacter spp. (n=60, p<0.01), Acinetobacter baumannii (n=38,
p=0.03), and Enterococcus faecium (n=44, p=0.05). Positive spatial
association was also found for MRSA resistance to clindamycin (n=36, p=0.01)
and tetra/doxycycline (n=33, p<0.01). The distance between healthcare
facilities was positively correlated with the difference in antibiotic resistance
(p<0.01). Similarity in resistance was significantly associated with antibiograms
produced in the same year (p<0.01), patient population (p=0.02) and sample
type (p<0.01), but not with laboratory standard (p=0.61). CONCLUSION:
Antibiotic resistance is spatially autocorrelated, where nosocomial pathogens
in nearby institutions are more likely to have similar resistance patterns than
distant institutions.
ABSTRACTS
QI-01
DIFFUSE LARGE B-CELL LYMPHOMA: A SINGLE INSTITUTION
EXPERIENCE OF PATIENT OUTCOMES
R. Chan1, R. Gupta2, S. Kanjeekal2, M. Jarrar2, A. Kay2, J. Matthews2, I.
Woldie2, C. Hamm2
QI-02
STANDARDIZATION OF ORAL CHEMOTHERAPY DELIVERY TO
IMPROVE PATIENT SAFETY – A PILOT STUDY
T. Desai1, M. Carvalho2, R. Fung2, D. Ahuja2, S. Gollee2, B. Almeida2, G.
Grewal2, and K. Enright2
1
University of Toronto, Toronto, ON; 2Windsor Regional Cancer Centre,
Windsor, ON
1
INTRODUCTION: The Windsor Regional Cancer Program (WRCP) was
determined to have consistently been a top performer in time to treatment of
diffuse large B cell lymphoma in this Canadian province [1]. OBJECTIVE: We
endeavored to determine whether faster time to diagnosis and treatment for
diffuse large B-cell lymphoma (DLBCL) influenced the IPI score (International
Prognostic Score), thereby predicting an improved clinical outcome in these
presenting patients. METHODS: The WRCP services a catchment area of
650,000 people. A retrospective chart review was conducted for patients
diagnosed with DLBCL at the Windsor Regional Cancer Program (WRCP)
between 2006-2012. Information collected included the five factors for scoring
by the International Prognostic Index (IPI) – age, performance status, LDH,
stage, and number of extranodal sites – chemotherapy regimen, relapses,
existence of second malignancies, cause of death, and dates of diagnosis, last
follow-up, and death. We analyzed the relationship between prognostic factors
and these clinical outcomes, and also compared the IPI scores for this cohort
of patients against a similar population in another Canadian province, British
Columbia. RESULTS: It is established that compared to other cancer centres
in Ontario, the WRCP is consistently reporting a shorter diagnosis to treatment
metric when compared to their counterparts in Ontario, Canada. When
compared to historical Canadian data, presenting IPI scores for DLBCL
patients were lower on average for patients treated at the WRCP than those
reported in British Columbia, Canada by Sehn et al. [2]. CONCLUSION: A
lower presenting IPI score is known to be correlated improved lymphoma
related outcome. With attention to the metric of diagnosis to treatment < 30
days for diffuse large B cell lymphoma, we expect an improved lymphoma
related outcome for our patients. We recommend ongoing attention to this
metric, in order to improve outcomes for our patients
BACKGROUND: Oral chemotherapy (OC) presents unique challenges to
patient safety. In contrast with parenteral chemotherapy, patient education and
comprehension are crucial to the safe administration of OC, appropriate toxicity
interventions and patient adherence. At Trillium Health Partners we identified
a lack of standardization to OC education and monitoring, that resulted in gaps
in patient care. Using the American Society of Clinical Oncology/Oncology
Nursing Society 2013 chemotherapy safety standards as guidance, we
developed and piloted a multi-disciplinary oral chemotherapy care pathway
(OCCP) to improve the approach to education and monitoring of patients newly
started on OC. METHODS: Patients newly started on OC between 03/15–
06/15 were enrolled by 2 participating physicians representing a predominantly
lung/GI practice. Baseline data was abstracted retrospectively in the 3 months
prior to the pilot to reflect all study participants. The OCCP included in-person
and telephone assessments by an oncology pharmacist and nurse over 2
cycles of OC. Pilot outcomes included pharmacy interventions, dose
modification for toxicity, medication errors, the percent of prescriptions on
computerized physician order entry (CPOE), adherence documentation and
comprehension of treatment plan. RESULTS: The pilot enrolled 20 patients
and compared them against 21 baseline patients. During the pilot there were
improvements in the percentage of patients who had pharmacy interventions,
documentation of adherence and assessment of comprehension of the
treatment plan as well as a reduction in dose modifications due to toxicity.
CONCLUSIONS: Use of a newly developed oral chemotherapy care pathway
demonstrated both feasibility as well as improvements in a variety of key
patient safety indicators. These results suggest that implementation of a
standardized oral chemotherapy care pathway can feasibly improve patient
safety outcomes.
QI-03
DEFINING SPATIAL DESIGN REQUIREMENTS OF DEXTEROUS
INSTRUMENTS FOR COMBINED ENDOSCOPIC THIRD
VENTRICULOSTOMY AND PINEAL REGION TUMOR BIOPSY
K. W. Eastwod1,3, V. P. Bodani1,2,3, T. Looi1,3, H. Naguib3, J. M. Drake1,2,3
QI-04
SMARTPHONES AND PATIENT CARE: EXPLORING GENERAL
SURGEONS’ USE OF INSTANT TEXT MESSAGING
Mohammed Firdouse BHSc1; Jeremy Goldfarb MD2; Karen Devon MD,
MSc, FRCSC3; Ahmed Kayssi MD4; Peter Rossos5; Tulin Cil MD, FRCPC,
MEd6
1
Center for Image Guided Innovation and Therapeutic Intervention, The
Hospital for Sick Children, Toronto, Canada 2 Department of Neurosurgery,
University of Toronto, Toronto, Canada 3 Institute of Biomaterials and
Biomedical Engineering, University of Toronto, Toronto, Canada
BACKGROUND: The procedures currently performed with a neuroendoscope are
limited. Novel curved dextrous instruments are required to increase the use and
scope of this minimally invasive technique. Such devices will address instrument
collision and triangulation challenges that currently limit existing equipment. Methods
to guide the design of the non-intuitive shape of these tools are needed. Here, a
proposed method is demonstrated using the established single burr-hole endoscopic
third ventriculostomy (ETV) and endoscopic tumor biopsy (ETB) procedure.
OBJECTIVE: To define geometric design specifications for the shape of dexterous
continuum instruments for performing collision-free single burr-hole ETV/ETB.
METHODS: MR and CT data from fifteen pediatric patients who underwent both ETV
and ETB procedures between 2006-2014 was collected. This imaging data was
segmented using the 3DSlicer software package to create virtual 3D patient models.
Anatomical structures including the foramen of Monroe (FM), the massa intermedia
(MI), width of the third ventricle (TV) and the tumor margin (TM) were measured.
Using the MATLAB software package, virtual instruments consisting of straight and
curved segments were superimposed onto the models to determine the instruments’
optimal shapes. A custom optimization algorithm varied instrument geometry and
burr-hole location to detect ideal designs, while preventing contact with
intraventricular structures. RESULTS: The diameters of the FM, MI (AnteriorPosterior & Superior-Inferior), TV and TM are 6.85mm, 4.01mm, 5.05mm, 14.2mm
and 28.51mm respectively. Dexterous instruments with straight segments of 66.3mm
and curved segments of 35.9mm and with tip radius of curvatures from straight to
36.1mm satisfied the safe workspace requirements for ETV/ETB. CONCLUSION:
We have established a platform for estimating the shape of curved dextrous tools,
capable of targeting multiple intraventricular points. This data will be used to guide
future instrument design and improve single incision bi-manual operation.
MD Program, University of Toronto, Toronto, Ontario, Canada 2Trillium Health
Partners, Mississauga, Ontario, Canada
Faculty of Medicine, University of Toronto, ON 1,2,4,5; Division of General
Surgery, University Health Network, Toronto, ON3,6
INTRODUCTION: Mobile text messaging is easy to use, quick and widely
available. Its potential role and use within a healthcare environment to improve
patient care has not been fully assessed. OBJECTIVE: To explore general
surgeons’ practices and views on texting for patient-related communication.
METHODS: An E-mail survey was distributed to all academic general surgeons
at a large Canadian university. RESULTS: Overall, 28 of the 98 (28.6%) of the
surveyed general surgeons responded. 92.9% used texting for patient related
communications. 67% of the respondents did not have encrypted phones or
did not know. Although texting was the least common way (16.7%) staff
surgeons communicated patient-related information with other staff, it was the
most common way (62.5%) for them to communicate with residents and
trainees. The majority of surgeons agreed (67.7%) that texting enhances
patient care. 44% did not know if their hospital had a policy on texting and most
(76%) did not know if it is addressed in legislation. 58.3% of the general
surgeons felt that instant text messaging is not a secure method of data
transfer with respect to patient confidentiality. CONCLUSIONS: Most general
surgeons at a large academic center use instant text messaging for patientrelated communication with trainees. They agree that texting enhances patient
care, but also acknowledge concerns regarding the security of this medium.
41
ABSTRACTS
QI-05
THE CONFOUNDING QUESTION OF CONFOUNDING CAUSES IN
RANDOMIZED TRIALS
J. Fuller*
*Faculty of Medicine, University of Toronto
Randomized controlled trials (RCTs) are considered the gold standard for
assessing the efficacy of medical interventions. In defense of the RCT’s gold
lining, several accounts of RCT causal inference in clinical epidemiology
commit to the idea that ‘randomization balances all confounding causal
variables, known and unknown’. While this statement is a hyperbole, it betrays
several crucial misunderstandings. First, and as I will show, it is improbable
that randomization will balance all confounding causes. But moreover,
balancing confounding causes is the wrong idea to begin with. I will
demonstrate that a balanced distribution of confounding causes is the wrong
logical ideal, neither necessary nor sufficient for sound causal inference. I will
propose a new variable, ‘disjunction C’, that does determine sound inference
in an RCT. The new understanding of RCT inference afforded by my account
helps us to understand why RCTs often have internal validity, and when other
(less expensive, less ethically suspect) study designs would suffice.
QI-06
QUALITY ASSESSMENT: UTILIZATION AND DOCUMENTATION OF THE
BISHOP SCORE AT THE TIME OF INDUCTION OF LABOUR.
N. Gibbings1, J. Barrett2, H. Cohen2, D. Hui2, N. Ladhani2, N. Melamed2, O.
Nevo2, A. Berndl2
1
University of Toronto, Toronto, Ontario.
Sunnybrook Health Sciences Centre, University of Toronto, Toronto,
Ontario.
2
INTRODUCTION: The rising Cesarean section rate is of significant concern to
patients and physicians. During induction of labour, a Bishop score of at least
7 describes a favorable cervix and decreases the risk of Cesarean section. The
Bishop score is a modifiable risk factor for Cesarean section, and therefore it
is valuable to know whether it is being appropriately utilized from a quality
improvement perspective. OBJECTIVE: The primary objective was to
determine how often women undergoing induction of labour (artificial rupture
of membranes or oxytocin) had a favorable cervix. The secondary objective
was to determine how often the Bishop score was documented. METHODS:
All women presenting to obstetrical triage at Sunnybrook Health Sciences
Centre for planned induction of labour from July 1, 2014 to July 1, 2015 were
identified. A retrospective chart review was performed including all patients
with 1) live fetus(es) and 2) intact membranes at the time of induction.
Descriptive statistics were used. RESULTS: Data from 364 patients were
included. Forty-nine patients (13.5%) were induced with a Bishop score of at
least seven. Forty-five patients (12.4%) were induced with a Bishop score of
less than seven. All five components of the Bishop score were reported at time
of induction in 16.5% of patients. Two-hundred-seventy patients (74.2%) were
induced with an uncertain Bishop score. CONCLUSIONS: At least 12% of
inductions were performed on an unfavorable cervix, and overall
documentation of the Bishop score at the time of induction was inadequate.
Bishop score documentation and utilization can be improved through
education.
QI-07
CLIENT SATISFACTION WITH STUDENT-RUN HEALTH CLINIC: AN
EVALUATION OF TORONTO’S IMAGINE CLINIC
Q. Huynh1, T. Hu1, J. Nyhof-Young1,2,3
QI-08
SAFETY OF LUMBAR PUNCTURES IN PATIENTS WITH
THROMBOCYTOPENIA
S. Ning1, B. Kerbel2, J. Callum3, and Y. Lin3
1
Department of Hematology, UofT1; Faculty of Medicine, UofT2; Department of
Clinical Pathology, Sunnybrook Health Sciences Centre3.
MD Program, Faculty of Medicine, University of Toronto, Canada
Department of Family and Community Medicine, University of Toronto,
Canada
3
Office of Evaluations, Undergraduate Medical Education, University of
Toronto, Canada
2
BACKGROUND: Patient/client satisfaction is a key indicator for quality of care
and patient response to care. It can also contribute insights to improving
services. The IMAGINE Clinic is a student-run free health clinic serving the
inner city population in central Toronto. Most clients are from marginalized
populations including those who are often under-housed, underinsured, and
have precarious statuses. Since 2010, more than 400 clients have been seen,
but no data exist regarding client satisfaction to the care provided at IMAGINE.
Although recent efforts have been made to document the structures, benefits,
and demographics of student-run health clinics in North America, there is a
lack of information regarding client satisfaction to student-run health clinics.
OBJECTIVES: This project aimed to profile the demographics of clients and to
explore their perceptions regarding care provided at IMAGINE. METHODS: A
two-part cross-sectional survey was developed to be completed before clients
saw the clinical team and immediately after, while at IMAGINE. Data collection
occurred in March 2015, during which time 28 clients visited the clinic, of which
there were 25 unique clients: 21 clients consented to participate and 19 clients
completed the study. Key measures included time perceptions, services and
providers, and client-staff interactions. RESULTS: Overall, clients reported
positive experiences at IMAGINE, but had difficulties recalling time estimates
and had some confusion regarding interprofessional students involved in their
care. CONCLUSION: Long-term data collection is recommended by
structuring this evaluation as part of clinic operations. This information can help
to improve clinic operations and services for clients, and to contribute to the
understanding of client satisfaction to student-run clinics.
42
BACKGROUND/OBJECTIVES: Lumbar punctures (LP) are frequently
performed in the adult oncology population. The AABB guidelines recommend
a minimum platelet count of 50 x 109/L, but evidence for this is lacking. The
objective of this study was to describe the rate of traumatic taps and
hemorrhagic complications in an adult oncology population. METHODS: A
retrospective cohort study of oncology patients receiving diagnostic and
therapeutic LPs over a 2 year period was carried out. Laboratory, clinical, and
transfusion data were extracted through the hospital information system, chart
review, and blood bank database. Bleeding risk factors captured included
anticoagulants/antiplatelets, end stage renal disease, and other bleeding
disorders; patients with coagulopathy were excluded. Pre-LP platelet counts
were collected ≤24 hours from the time of LP. Traumatic tap was defined as
≥500 RBCs/HPF in CSF. A follow up of 1 week post-LP was used to capture
hemorrhagic complications. RESULTS: 135 oncology patients underwent 369
LPs. 30.6% LPs were performed in thrombocytopenic patients (platelet count
≤ 150 x 109/L). 7.6% LPs were performed at a platelet count ≤50 x 109/L. 64%
of these patients received a platelet transfusion prior to the LP. However, a
post-transfusion platelet count was performed for only 1 of these patients.
Traumatic taps occurred in 14.2% LPs in patients with thrombocytopenia
compared to 11.1% LPs in patients with normal platelet counts. Presence of
bleeding risk factors did not increase the incidence of a traumatic tap. There
were no hemorrhagic complications. CONCLUSIONS: Among this cohort of
adult oncology patients undergoing LPs, there were no hemorrhagic
complications. Traumatic taps were not increased in patients with
thrombocytopenia or bleeding risk factors. Our findings question whether a
platelet transfusion threshold of 50 x 109/L, as recommended in recent
guidelines, is necessary for a LP.
ABSTRACTS
QI-09
A TAXONOMY TO CATEGORIZE ADVERSE EVENTS AND NEAR-MISSES
IN TRANSPORT MEDICINE
S. C. R. Lo1, BSc, S. Efrem1, N. Nawar1, M. Ahghari2, BSc, MEng, R. D.
MacDonald1,2, MD, MPH, FRCPC
QI-10
A GREATER TORONTO AREA (GTA-OBS) NETWORK STANDARDIZED
PROTOCOL FOR THE CARE OF PREGNANT WOMEN WITH A SHORT
CERVIX IN PREGNANCY
N. Ma1, M. Czikk1, N. Ladhani1, G. Seaward1 and N. Okun1
1
Division of Emergency Medicine, Department of Medicine, University of
Toronto
2
Ornge, Mississauga, Ontario, Canada
1
Faculty of Medicine, University of Toronto, Toronto, Ontario and
Department of Obstetrics and Gynaecology, University of Toronto, Toronto,
Ontario
BACKGROUND: The Institute of Medicine recommends the use of a
standardized format and terminology for the reporting of adverse events and
near-misses, yet many health care settings have not adopted a classification
hierarchy (“taxonomy”), which prevents meaningful generation of new
knowledge and improvement in patient safety. As Ontario’s air and land critical
care transport program, Ornge has initiated the development of a taxonomy for
the air and land critical care transport setting, but rigorous definitions for the
terms must be obtained prior to its adoption. OBJECTIVES: We seek to
develop a taxonomy with definitions for each term, using previous iterations as
a framework, and to test the taxonomy by classifying existing investigations
from the Ornge reporting system.METHODS: Definitions were derived from
literature searches, industry standards, and iterative consultation with
multidisciplinary experts. The inter-rater reliability of the taxonomy was
preliminarily tested. Using data from routine investigations conducted by Ornge
for all adverse events and near misses, 3 co-investigators independently
classified 40 cases using the taxonomy and compared results. RESULTS: A
taxonomy consisting of the categories Incident Type, Patient Outcomes,
Patient Characteristics, Incident Characteristics, Contributing Factors and
Hazards, Error Recognition and Detection, Organizational Outcomes,
Restitution and Rectifying Actions, and Actions to Reduce Risk, was devised
and all terms were defined. Inter-rater reliability appeared promising.
DISCUSSION: The taxonomy allows clear categorization of root cause, patient
factors, incident factors, and corrective actions, which facilitates future
analyses. It covers both aviation and clinical aspects of Ornge service. Despite
further need of quantitative testing prior to implementation, the taxonomy
appears to be a promising tool for quality improvement.
Premature birth remains the most common cause of severe perinatal morbidity
and mortality. Moreover, a short cervix by ultrasound has been shown to be a
strong predictor for preterm birth. Multiple intervention strategies have been
considered, including cervical cerclage and vaginal progesterone, with variable
outcomes. Given that prematurity is responsible for half of all neonatal deaths,
we constructed a standardized protocol to improve the care of pregnant women
with a short cervix throughout the GTA (LHINS 5 to 9). We reviewed numerous
publications, international guidelines and consulted expert opinions within the
GTA Obstetrics Network in order to determine whether there was enough
international evidence to support a standardized protocol to manage women
with a short cervix in pregnancy. We developed a framework, which would
improve patient safety, and care of these women in the community. We plan
on facilitating the implementation of this standardized protocol in community
hospitals in the GTA and tracking pre- and post-proposal indicators, which may
include frequency of preterm birth, adverse neonatal outcomes and protocol
compliance.
QI-11
PREDICTORS OF ACTIONABLE RESULTS IN ENDOBRONCHIAL
ULTRASOUND-GUIDED TRANSBRONCHIAL NEEDLE ASPIRATION
M. Mohammed1, S. Deb1, K. Soghrati2, A. Behzadi1,2
QI-12
OPTIMIZING IMAGING FOR VENOUS THROMBOEMBOLISM IN THE
EMERGENCY DEPARTMENT: CHOOSING WISELY
K. McIntyrea,b, B. Leontowicza, X. Y. Wanga and S. Vaillancourtb
1
MD Program, Faculty of Medicine, University of Toronto, Toronto, ON,
Canada
2
Department of Thoracic Surgery, Credit Valley Hospital – Trillium Health
Partners, Mississauga, ON, Canada
University of Torontoa, St. Michael’s Hospitalb
BACKGROUND. Endobronchial ultrasound guided transbronchial needle
aspiration (EBUS-TBNA) is a minimally invasive procedure to obtain
intrathoracic tissue samples. It can provide the same clinical information in a
less resource-intensive manner than traditional methods with high sensitivity
and specificity. However, factors that determine the success of the procedure
have not been established. OBJECTIVE. The objective of the study is to
determine predictors of actionability (defined as results that guide the
management decision) in EBUS-TBNA and to analyze onsite cytology and its
correlation with laboratory pathology. METHODS. We conducted a
retrospective chart analysis of EBUS-TBNA performed at a single center
between April 2013 and May 2015. A total of 191 cases were analyzed. A
multivariate model was used to determine the predictors of actionability. A
univariate analysis was also done to compare onsite cytology other variables
and a comparative analysis between the different types of operators was done.
RESULTS. Multivariate analysis revealed onsite cytology as the sole predictor
of actionability with an odds ratio of 228.3 and p = 0.0007. Univariate analysis
showed significant correlation between positive onsite cytology and diagnostic
pathology results (p = <0.0001). The type of operator (respirologist vs surgeon)
showed no significance as a predictor (odds ratio = 0.4, p = 0.14) despite
differences in number of biopsies (4.8 + 1.7 vs 3.8 + 1.6; p = 0.0002) and the
final clinical diagnosis (38.8% vs 68.6% malignant cases, p <0.0001).
CONCLUSIONS. Onsite cytology is a strong predictor of a diagnostic result
and it can be used as a reliable indicator for the success of EBUS-TBNA. The
type of operator is not a significant predictor although there were technical
differences between the two types.
2
INTRODUCTION: Venous thromboembolism (VTE) is common with an annual
incidence of 1 to 2 cases per 1000 in the general population [4]. Up to 32% of
Emergency Department (ED) patients undergo potentially avoidable imaging
for VTE [2]. In low and moderate risk patients, the use of a D-dimer assay (DD)
can potentially avoid further investigations for VTE [1,3]. OBJECTIVE: The
purpose of this local quality improvement initiative was to describe current
practice for the diagnosis of VTE in the Emergency Department (ED) at St.
Michael's Hospital. METHODS: In this retrospective chart review, we analyzed
data from 314 randomly selected patients presenting to St. Michael’s ED from
April 2013 to March 2014 who were investigated for VTE using D-dimer assay,
CT pulmonary angiogram (CTPA), V/Q scans or Venous leg Doppler ordered
in the ED. After 214 patients were reviewed chronologically, the last 100
patients were chosen using a random number generator, but distributed evenly
over the remaining 10 months to account for potential seasonal variation.
RESULTS: DD was ordered on 161 of 310 (52%) patients and VTE was
excluded in 100 (62%) based on DD result without further testing. Of 108
patients with negative DD, 8 (7%) had further imaging but no VTE was
identified, revealing no false negative results. Of 149 patients (47%) who had
no DD testing, 44 (30%) underwent a CTPA and 6 (4%) received a V/Q scan.
CONCLUSIONS: Prior literature estimates that less than 20% of patients
tested are in the high risk Wells group. Given only 52% of patients in our
population were first investigated with DD, this suggests many more patients
may benefit from DD testing for the exclusion of VTE in low and moderate risk
patients. In this chart review, DD excluded VTE in a higher proportion of
patients than previously reported, confirming its utility. An intervention to
optimize the use of DD and reduce imaging in the investigation of VTE has
been developed and is being implemented with the involvement of multiple
clinical departments.
43
ABSTRACTS
QI-13
OPENING A WINDOW: MOBILE PHONE USE AND OTHER
TECHNOLOGY IN CHRONIC RESPIRATORY DISEASE PATIENTS AT
TORONTO EAST GENERAL HOSPITAL
C. Olteanu1, I. M. Fraser1,2
1
2
Faculty of Medicine, University of Toronto, Toronto, Canada
Division of Respirology, Toronto East General Hospital, Toronto, Canada
BACKGROUND: Self-efficacy in chronic disease management is effective in
improving the quality of life and healthcare system utilization. Phone
technologies have proven useful in improving patient outcomes, including
identifying Chronic Obstructive Pulmonary Disease exacerbations.
OBJECTIVE: Our aim was to discover useful tools/information for chronic
respiratory disease patients in managing their disease on mobile phones and
how social-economic status influences these preferences. METHODS: A 16question survey was administered to participants on an i-pad through Fluid
Surveys. The independent t-test, Pearson Chi-Square Test and Pearson
correlation were used to test for significance (P value ≤ 0.05) on SPSS 22.
RESULTS: Our cohort includes 102 participants (65 F, 36 M, 1 Prefer Not to
Identify) with mean age of 57.5 +/-14.9 (median=58.5, range=20-93) years.
Participants prefer on their mobile phones: healthcare appointments
reminders (85%), medical test results (70%), and medical breakthroughs
(57%), received by text messaging (73%) and mobile app (32%). Females vs.
males prefer medical test results (71% vs. 29%; odds ratio, 2.67; 95% (CI), 1.116.40; P=0.026), symptom management support (80% vs. 20%; odds ratio, 3.39;
95% CI, 1.35-8.55; P=0.008), and exercise techniques (76% vs. 24%; odds ratio,
3.23; 95% CI, 1.38-7.55; P=0.006). College/university vs. non-college/university
educated participants prefer symptom management support (63% vs. 37%; odds
ratio, 2.49; 95% CI, 1.09-5.68; P=0.03). Younger participants prefer appointment
reminders (mean age 56.3±14.5 vs. 64.8±15.5, P=0.04) and reminders for using
breathing machines at night (mean age 51.0±16.1 vs. 59.2±14.2, P=0.022).
CONCLUSION: Results will help design an innovative mobile-based
intervention to enhance patients’ self-efficacy in chronic disease
management.
QI-14
IMPLEMENTATION OF THE AGES AND STAGES QUESTIONNAIRE:
SOCIAL-EMOTIONAL (ASQ-SE) IN AN OUTPATIENT CLINIC FOR
ADOLESCENT PARENTS AND THEIR CHILDREN: FEASIBILITY OF USE
AND CLINICAL CONTRIBUTIONS
E. Pascoal, G. Thomspon, A. Vandermorris, N. Murphy, S. Lorber, and K. Hick
1
Social Pediatrics Research Summer Scholarship (SPReSS), Adolescent
Medicine, The Hospital for Sick Children, Toronto, ON, Canada 2University of
Toronto, Toronto, ON, Canada
BACKGROUND: Infants born to adolescent mothers are at greater risk for
compromised social and emotional development. The ASQ-SE is a validated
and standardized parent-completed tool used to identify children whose socialemotional development requires further assessment. To the best of our
knowledge, its use has not been evaluated in an adolescent parent population.
OBJECTIVE: To implement the ASQ-SE as the standard of care and evaluate
its feasibility and clinical contributions within an outpatient clinic for adolescent
parents and their children. METHODS: The ASQ-SE was administered to
adolescent mothers with infants aged 3 to 24 months during scheduled wellbaby visits. Feedback regarding the usefulness of the ASQ-SE was elicited
from both clinicians and patients via a survey following each administration.
RESULTS: Preliminary results are based on 18 mother-infant dyads. Overall,
12% (n=2) of participating infants were identified as being at risk for
compromised social-emotional development by the ASQ-SE. Patient
responses indicate that 56% (n=10) of adolescent mothers learned ‘a great
deal’ and 22% (n=4) ‘a little bit’ following ASQ-SE administration. Respondents
reported the ASQ-SE allowed them to recognize problematic behaviours and
be reassured of their child’s development. Clinicians reported the ASQ-SE
enhanced the patient encounter 72% (n=13) of the time. Clinicians’ feedback
indicates that the ASQ-SE served as a platform to reflect with mothers on
behaviours of their child, reinforce parenting strengths and discuss strategies.
CONCLUSION: Clinicians and adolescent parents identify the ASQ-SE as
being of value in the objective assessment of social-emotional development of
infants and in facilitating discussion around child behaviours and parenting.
QI-15
IMPACT OF URINE CULTURE ORDERING PRACTICES ON TREATMENT
OF ASYMPTOMATIC BACTERIURIA AMONG LONG-TERM CARE
RESIDENTS
A. Rahmani1,2, J. Leis2, J. Charles2
QI-16
HANDOFF IN THE OPERATING ROOM: IMPROVING COMMUNICATION
DURING TRANSITIONS OF CARE
A. Ramjaun1,2, N. Wright2, M. Hammond-Mobilio2, S. Keshavjee3, M.
Masella4, C. Serrick5, A. Snyman6, C.A. Moulton3.
1
1. Faculty of Medicine, University of Toronto
2. The Wilson Centre, University Health Network, Toronto ON
3. Department of Surgery, University of Toronto
4. Department of Nursing, University Health Network, Toronto ON
5. Department of Perfusion, University Health Network, Toronto ON
6. Department of Anesthesia, University of Toronto
MD Program, University of Toronto 2Sunnybrook Health Sciences Center
BACKGROUND: Urine culture ordering among long-term care residents who
lack localizing symptoms of urinary tract infection is a pervasive low-value
practice. Recently, there is interest in developing laboratory policies that limit
the number of urine specimens that are processed to diminish detection and
treatment of asymptomatic bacteriuria (ASB). PURPOSE: At a large Veterans
long-term care centre, we sought to determine the proportion of urine cultures
ordered among residents lacking minimum symptoms of urinary tract infection
and the impact of these cultures on antibiotic prescriptions for ASB.
METHODS: A prospective cohort study was undertaken of consecutive longterm care residents undergoing urine cultures. Each resident was assessed
within 24 hours of a urine culture order for the presence of symptoms of urinary
tract infection based on Society of Healthcare Epidemiology of America
(SHEA) criteria. Culture results and antibiotic prescriptions were documented
72-hours later. RESULTS: Of 136 urine specimens ordered at the Veterans
Center during a two-month period, only 25% (34/136) met the minimum SHEA
criteria. These cultures were ordered by physicians in 97% (130/134) of cases.
Altered mental status among noncatheterized residents accounted for 49%
(50/102) of urine cultures lacking indication. Detection of ASB led to antibiotic
initiation in 88.9% (32/36) of cases. CONCLUSION: The majority of urine
cultures submitted from our Veterans long-term care centre lacked minimum
criteria and led to significant unnecessary antimicrobial therapy for ASB.
Developing tools for the assessment of residents with altered mental status
has the potential to greatly reduce unnecessary urine culture orders.
44
BACKGROUND: Communication has been increasingly identified as the
single most frequent cause of adverse events. The surgical safety checklist
performed at the start of procedures has been shown to reduce morbidity and
mortality by improving multidisciplinary communication. Attention is now
turning to other communication gaps, including intraoperative handoff of care
during staff changes. OBJECTIVE: To create and evaluate handoff tools for all
groups (surgery, nursing, anesthesia, perfusion: SNAP) involved in
intraoperative care. METHODS: This is a multiphase study. For the first phase,
tool creation, handoffs in the OR were observed and audio-recorded to assess
handoff content and quality. Brief on-site interviews were also conducted to
better understand the process, and contribute to the formation of preliminary
handoff tools. A multidisciplinary Delphi exercise will then be conducted to
distinguish essential vs. non-essential items for tool inclusion. To assess
whether handoff quality is improved, incoming staff receiving handoff will
complete pre- and post-intervention surveys measuring % handoff omissions.
RESULTS: Observational data was collected from 38 procedures across 5
surgical specialties, forming preliminary handoff tools for all SNAP professions.
Brief on-site interviews revealed that many individuals felt transmission of
information could be improved using handoff tools; others indicated the
intervention was unnecessary, and were concerned it may lengthen time spent
on handoff. CONCLUSION: We aim to develop handoff tools tailored to the
needs of teams (SNAP) involved in intraoperative handoff. The resulting tools
represent an important strategy to improve surgical quality of care.
ABSTRACTS
QI-17
IDENTIFYING DISPARITIES IN COMMUNITY RESOURCE UTILIZATION
AND NEURODEVELOPMENTAL OUTCOMES BETWEEN LOCAL
HEALTH INTEGRATED NETWORKS IN THE PRETERM POPULATION
S. Rangarajan, HBSca,b, M. Morency, HBSc,b, S. Miller, MDa,b,c, A. Siddiqi,
MPHd, L. Ly, MDa,b,c,
a
Faculty of Medicine, UofT bThe Hospital for Sick Children cDepartment of
Paediatrics, UofT dDalla Lana School of Public Health
BACKGROUND: Disparities in socioeconomic status have been predicted to
show an increased incidence of adverse preterm health outcomes with specific
concerns regarding neurodevelopment. Current literature demonstrates that
access to community resources can improve developmental outcomes in
children born preterm. At present, disparities in community resource utilization
between Local Health Integrated Networks (LHINs) of Ontario have not yet
been explored. OBJECTIVE: To assess whether there is a difference in
community resource utilization and neurodevelopmental outcomes between
children born preterm residing in different LHINs who have attended the
Neonatal Follow-up Clinic. METHODS: A retrospective cohort study was
conducted through evaluating all preterm infants meeting inclusion criteria who
had attended the Neonatal Follow-up Clinic between January 2007 and
February 2013. A total of 261 patients between 17-25 months of age were
included in the study and correspondingly mapped to their respective LHIN.
Data related to patient demographics, neurodevelopmental outcomes, and
community resource utilization were collected and used to compare all LHINs.
RESULTS: There were no differences with regards to baseline characteristics
of study participants between the LHINs examined. There was also no
difference with regards to community resource utilization in children born
preterm between different LHINs (p=0.38). Region of residence did not have
an impact on cognitive composite scores (p= 0.20) or concerns regarding
communication, fine motor, gross motor, problem solving, and psychosocial
skills (p>0.05). CONCLUSION: There appears to be no disparity in community
resource utilization and neurodevelopmental outcomes in children born
preterm across the five LHINs studied.
QI-19
IMPROVING ANTI-EMETICS IN CHEMOTHERAPY INDUCED NAUSEA
AND VOMITING
S. Toutounji1, R. Fung2, K. Enright3
MD Program, University of Toronto, Toronto, ON 2Trillium Health Partners,
Mississauga, ON 3Peel Regional Cancer Centre, Credit Valley Hospital,
Mississauga, ON
1
BACKGROUND: Chemotherapy induced nausea and vomiting (CINV)
remains one of the most feared treatment-related toxicities in cancer patients.
CINV has been shown to decrease quality of life and to increase dose
modifications and unplanned hospital visits. Cancer Care Ontario and the
American Society of Clinical Oncology updated their CINV guidelines in 2013.
These changes included a reclassification of many regimens from moderate
(MEC) to highly emetogenic (HEC) and a decrease in the duration of serotonin
inhibitors (5HT3i). OBJECTIVE: Uptake of the new guidelines at Trillium
Health Partners has been slow. We aimed to improve CINV by increasing the
percentage of patients who received guideline concordant anti-emetics with
their first cycle of HEC/MEC chemotherapy. METHODS: The first 25 patients
started on MEC/HEC chemotherapy during 3 time periods (pre-guidelines, 6
months post guidelines, 1.5 years post guidelines) were identified. The primary
measure of interest was the percentage of patients receiving MEC/HEC who
were treated in concordance with the updated guidelines. Secondary
measures included the percentage of MEC/HEC patients who experienced
grade 2+ CINV. The collected data was used to guide the development of
interventions to improve guideline concordance. RESULTS: The concordance
of anti-emetics on the day of chemotherapy improved from 24% to 80%, but
post-chemotherapy concordance remained at 0%. The primary driver for
concordance was the use of NK1 inhibitors on chemotherapy day, and the
duration of 5HT3i post-chemotherapy. Using quality improvement
methodology, the highest impact intervention was identified as changing the
default settings in the computerized order entry system to reflect the updated
guidelines. These changes are currently in progress. CONCLUSION:
Concordance with CINV guidelines improved over time, resulting in lower CINV
and less need for reactive CINV interventions. Further work to target duration
of 5HT3i is ongoing.
QI-18
KNOWLEDGE OF AGE-RELATED OBSTETRICAL RISKS IN
PRIMIPAROUS WOMEN
N. Carpe1, M. Sheinis1,3, S. Gold1, A. Selk1,2,3
1
Faculty of Medicine, University of Toronto; 2Department of Obstetrics &
Gynecology, University of Toronto; 3Department of Obstetrics & Gynecology,
Mount Sinai Hospital
INTRODUCTION: The average age of first-time mothers has been steadily
increasing worldwide for several decades. Women >35 years of age are at
greater risk of many complications with the potential to negatively impact the
mother, fetus, and/or the neonate. Many studies worldwide have shown that
men and women tend to overestimate the age at which a sharp decline in a
woman’s fertility begins. However, though perception of fertility with increased
age has been widely studied, perception of pregnancy risks is far scarcer in
the literature. OBJECTIVE: The objective of this study was to assess prenatal
patients’ knowledge of pregnancy complications relating to advanced maternal
age. METHODS: A cross-sectional survey at a single academic hospital
(Mount Sinai Hospital, Toronto, ON) was utilized to gather data on
demographic characteristics, knowledge, and health literacy levels.
Categorical data were analyzed via Pearson’s Chi-Square tests and
continuous data were analyzed via independent sample t-tests RESULTS:
70.2% of women had inadequate knowledge of pregnancy complications
associated with advanced maternal age (>35 years). Although women >35
years of age perceived themselves to be more knowledgeable than those
under 35 (17.3% compared to 7.9% considered themselves to have “higher
than average” knowledge) (p<0.01), there was no difference in knowledge
between the two age groups (with a power of 80% to detect a 20% difference
in knowledge, α 0.05). CONCLUSION: The majority of participants in this
sample had limited knowledge of age related pregnancy risks. Perception of
knowledge did not correlate with measured knowledge. Educating patients
about pregnancy complications associated with advanced maternal age is
crucial to close the knowledge gap and provide women with the opportunity to
make informed decisions about the timing of pregnancy.
QI-20
NEEDS ASSESSMENT: THE UTILITY OF PRENATAL PATIENT
EDUCATION RESOURCES WITHIN THE ST. MICHAEL’S HOSPITAL
ACADEMIC FAMILY HEALTH TEAM
S. Dunnigan1 and K. Swirsky2
1
MD Program, University of Toronto, Toronto, Ontario, Canada 2Academic
Family Health Team, St. Michael’s Hospital, Toronto, Ontario, Canada
BACKGROUND: Prenatal care reduces perinatal morbidity and mortality, and
supports women’s medical, social and psychological needs. Pregnant women
and unborn children, especially from at-risk, low socioeconomic or nonWestern backgrounds, are likely to utilize prenatal care and experience
improved health outcomes with prenatal education tailored specifically to their
unique healthcare needs. OBJECTIVE: This study was designed to
investigate the utility of prenatal patient education resources within the St.
Michael’s Hospital Academic Family Health Team (SMH AFHT), which serves
the inner city population in Toronto. The ultimate goal was to understand care
providers’ perspectives on strategies for enhancing prenatal patient education
resources within this setting to better meet patient needs. METHODS: This
needs assessment involved mixed methods divided into 3 phases: 1)
Environmental Scan, 2) Survey of Care Providers, and 3) Production
of Recommendations. Participants
included
staff
physicians,
nurse
practitioners and residents within the SMH AFHT.RESULTS: Of the 110 care
providers (68 Staff MD/NP and 42 Residents) in the study population, 27
completed the survey (21 Staff MD/NP and 6 Residents), providing a response
rate of 25%. From the environmental scan and survey results, 6
recommendations have been identified: 1) standardization for sites and visit
schedule, 2) identifying specific measurable clinical outcomes, 3) engaging
and educating nurses, 4) developing resources, 5) making resources publicly
available, and
6)
continuing this
work as
a
service
learning
project. CONCLUSION: This study has led to an enriched understanding of
care providers’ perspectives on specific strategies for improving prenatal
patient education within the SMH AFHT. By creating a working group to
implement these recommendations, we hope to improve prenatal patient
education resources within this setting to better meet patient’s needs.
45
ABSTRACTS
HS-01
LAPAROSCOPIC AND OPEN DISTAL GASTRECTOMIES: SURGEON
PERCEPTIONS VS. THE REALITY OF HOSPITAL SPENDING
L.Abraham1, N.Goyert2, D.J.Kagedan1, A.MacNeill1, S.Porter2, M.Cleghorn3,
J.Hallet2, F.Quereshy3, N.Coburn2
University of Toronto1 Sunnybrook Odette Cancer Centre2 University Health
Network3
INTRODUCTION: Operating room (OR) costs make up a large proportion of
hospital budgets, yet total costs of procedures are not commonly known by
surgeons. This study compares differences between surgeons’ perceptions
and actual costs of disposable equipment. OBJECTIVE: Determine the
theoretical operation costs of laparoscopic and open procedures from the
perspectives of surgeons and compare this to true costs. METHODS: A selfadministered survey was sent to surgeons at 8 Toronto hospitals with
experience performing distal gastrectomies for adenocarcinoma. Survey items
of patient-specific equipment used for gastrectomies were generated from OR
inventory lists. Respondents were asked to quantify a list of disposable surgical
supplies that they would require and give estimates of total equipment costs.
Invoices were reviewed to determine average inventory of supplies utilized per
procedure, and total costs. Aggregate dollar values are reported as
procurement agreements between hospitals and suppliers preclude the
publishing of exact dollar values. RESULTS: We received 14 of 53 survey
responses (26% response rate). 8 (57%) indicated that they performed both
laparoscopic and open gastrectomies, 4 (29%) only laparoscopic and 2 (14%)
only open. Surgeon estimates of disposable supply costs ranged from $500 to
$3000 for open, and $1300 to $5000 for laparoscopic cases. Costs of
theoretical supply lists ranged from $360 to $2150, and $1690 to $2570 for
open and laparoscopic cases, respectively. Estimates of surgical staplers and
energy devices made up the largest proportion of case costs; $620 to $2020
for open cases and $1390 to $2120 for laparoscopic. Procedure invoices show
a total cost averaging $920 for open cases and $3070 for laparoscopic.
CONCLUSION: Surgeons are unaware of true costs and rates of disposable
equipment usage; variation in costs may represent an opportunity for cost
minimization through efficient equipment selection.
HS-03
DEATHS AFTER SURGERY IN LOW-AND MIDDLE-INCOME COUNTRIES:
A GLOBAL SYSTEMATIC REVIEW AND META-ANALYSIS
S. Arya1, J. Ng-Kamstra2
University of Toronto Faculty of Medicine, Toronto, ON, Canada.2Program in
Global Surgery and Social Change, Harvard University Department of Global
Health and Social Medicine, Boston, MA, USA
1
BACKGROUND: As the delivery of surgical care gains acceptance as an
essential public health measure across all levels of economic development, the
measurement and improvement of safety and quality of care become
increasingly important.
One of the key indicators of surgical safety
recommended by The Lancet Commission on Global Surgery is perioperative
mortality rate (POMR). However, there remains a critical lack of data regarding
POMR at the hospital level in low-and middle-income countries (LMICs).
OBJECTIVE: The primary objective of this study was to provide summary
estimates of procedure - specific POMR in LMICs. Secondary objectives were
to determine which definitions of POMR are most commonly used and to
determine how risk reporting and adjustment for case mix, patient age, and
disease severity has been undertaken thus far. METHODS: Following PRISMA
and MOOSE guidelines, this systematic review evaluated any paper published
between January 1, 2009 and December 31, 2014 that reported facility-based
outcomes or mortality for patients who had undergone surgery in a LMIC.
Searches included PubMed, EMBASE, LILACS, Web of Science, African Index
Medicus, and the WHO Global Health Library. RESULTS: Thus far, data from
all studies derived from PubMed (n=373) have been analyzed. Emergent
procedures had a median mortality of 10.1% (n=182, IQR 2.5-16.2%), while
planned procedures had a lower median mortality of 1.2% (n=121, IQR 04.7%). Fewer than expected studies reported perioperative morbidities, ASA
status, and HIV status, with an even smaller proportion adjusting mortality for
these risk factors. DISCUSSION: Preliminary results from this project have
been used to inform recommendations of the Lancet Commission on Global
Surgery. Following analysis of papers extracted from remaining databases,
future work will use logistic regression analyses to examine broader factors
driving mortality.
46
HS-02
PREPARING TO INFORM: IMPROVE NURSING HOME CARE THROUGH
FEEDBACK ON PERFORMANCE DATA
L.E. Akioyamen1,2, M. Hoben1, C.A. Estabrooks1
1
University of Alberta, 2 University of Toronto
BACKGROUND: Feeding back results of health research to care providers is
essential to improving care quality. However, little is known about healthcare
aide (HCA) & Nursing Home Administrator (NHA) perspectives on features of
optimal feedback delivery. Therefore, systematic feedback is an essential
part of Translating Research in Elder Care (TREC) 2.0 – a longitudinal (20142018) observational study in 91 nursing homes (NHs) in Western Canada,
involving personal interviews with HCAs regarding organizational context &
quality of worklife & assessments of resident health. OBJECTIVES:
 Discern barriers, facilitators & preferred characteristics of feedback
delivery among HCAs & NHAs.
 Improve NH organizational context & care quality by optimizing content &
methods of feedback delivery.
METHODS: We reviewed the literature & conducted semi-structured
individual interviews with NHAs & focus groups with HCAs using
standardized interview guides to identify best practices, barriers & facilitators
to feedback delivery. Purposeful & convenience sampling were used in
selecting NHAs & HCAs. RESULTS: We included 19 NHAs & 50 HCAs from
18 & 13 unique facilities, respectively. Overall, NHAs preferred highly visual
reports, with minimal explanatory text. Bar graphs & in-person presentations
were favored feedback delivery formats & methods among both groups.
Barriers to feedback delivery included staff workload, organizational
hierarchy, & unspecific behavioral change targets. Key facilitators were staff
willingness to improve care quality, coordination with staff, & managing
expectations of performance data. CONCLUSIONS: Providing accurate
actionable performance data is essential to the success of audit & feedback
interventions. Our results demonstrate that this can be achieved in part,
through consulting those for whom feedback data is designed. Future work
should further involve these stakeholders in decision-making surrounding
knowledge translation efforts & measure the effects of greater inclusivity on
staff & resident outcomes.
HS-04
FAMILY MEDICINE RESEARCH AROUND THE WORLD
F. Sullivan1, K. Rouleau1, V. Aversa1, I. Elueze1, G. Rortveit2, J. Parks3
1
University of Toronto, Toronto, Ontario, Canada, 2University of Bergen,
Norway, 3Texas Children's Global Health Corps, Lilongwe, Malawi
BACKGROUND: The strength of primary care of all countries was recently
evaluated using a Geographical Information System (GIS) developed by Parks
in the Robert Graham Centre in Washington. However, the family medicine
research capacity, capability, and productivity of every country has not yet
been described. Research is a key component of any clinical discipline, thus
the variation in primary care strength could be partly explained by the
differences in primary care research capacity in each country. OBJECTIVE:
To determine the strength of family medicine research of every country in the
world. METHODS: A two-phase Delphi process was used to identify relevant
variables to assess primary care research strength. To gather country-specific
data for each variable, a web-based search strategy was developed using the
International Medical Education Directory and Parks’ GIS and a literature
search was conducted using PubMed. RESULTS: The following variables
were selected based on the Delphi process and were used to assign an overall
research strength score to each country: (1) Number of family medicine
publications in peer-reviewed journals over the past five years (2) Number of
family medicine researchers (3) Number of family medicine departments with
research methodological support (4) Inclusion of research methods in postgraduate training (5) Number of departments of family medicine. The scores
have been displayed on a map using the GIS. Descriptive analyses have
shown that there is variation in family medicine research capability within the
categories of primary care strength developed by Parks, as well as across
regions of the world. CONCLUSION: Further investigations are needed to
explain the observed variations. Future steps include verifying the accuracy of
the data collected with every country or region of the world.
ABSTRACTS
HS-05
ONE-YEAR MORTALITY OF INFANTS DIAGNOSED WITH BIRTH
ASPHYXIA OR LOW BIRTH WEIGHT AND ADMITTED TO THE
NEWBORN UNIT AT A LARGE REFERRAL HOSPITAL IN WESTERN
KENYA: A STUDY PROPOSAL
M. J. Brown1, M. Kunkel2,3, L. Ruhl2,3, J. Songok3,4, A. Christoffersen-Deb1,3,4
1
Faculty of Medicine, University of Toronto, Canada 2Department of
Pediatrics, Indiana University, USA, 3AMPATH (Academic Model Providing
Access to Healthcare), Eldoret, Kenya and 4Moi University School of
Medicine, Eldoret, Kenya
Birth asphyxia (BA) and low birth weight (LBW; <2500g) are major causes of
childhood morbidity and mortality, especially in low- and middle-income
countries like Kenya. Combined, they account for 60% of neonatal deaths and
increase a child’s risk of neurodevelopmental delay and growth stunting.
Improving care is one important way to avert these outcomes. However,
studies in newborn units (NBU) in Sub-Saharan Africa have found mortality
rates from 15%-47% for LBW and BA. At Moi Teaching and Referral Hospital
(MTRH), the only tertiary hospital serving all of Western Kenya, informal data
suggests the mortality rate for these conditions in the NBU is approximately
40%; however, no formal investigation has been done to confirm this. In
addition, no research in Sub-Saharan Africa has looked at mortality postdischarge for this population, despite the risks they continue to face. This
prospective cohort study will follow neonates admitted to the NBU at MTRH
with a diagnosis of BA or LBW to one year of age with the primary goal of
determining the one-year mortality rate for this population. Additional
objectives include: 1) determining the mortality rate in the NBU; 2) identifying
parental, obstetrical, neonatal, and socioeconomic characteristics and
interventions associated with better short- and long-term outcomes; 3)
calculating the follow-up rate at the NBU follow-up clinic; and 4) following the
growth of these infants by collecting anthropometric data at the follow-up clinic.
This study evaluating the impact of hospital-based newborn care will be carried
out over the next two years. Results will guide future quality improvement
efforts at MTRH and provide much needed information about the care needs
for this population post-discharge.
HS-07
IMPACT OF COMORBIDITIES AND MEDICATIONS ON FREQUENCY OF
PRIMARY CARE VISITS AMONG OLDER PATIENTS
T. Hu1, N.D. Dattani2, K.A. Cox1, B. Au2, L. Xu2, D. Melady2, L.
Jaakkimainen2, R. Jain2, J. Charles2
1
2
Primary Care Research Unit, Sunnybrook Family Health Team, Toronto,
Ontario, Canada
INTRODUCTION: The population of Canada is aging, with those over 65
expected to double over the next 25 years. Data has suggested that older
patients are likely to access primary care more often compared to younger
patients. OBJECTIVE: To determine if comorbidities and high risk medications
impact the frequency of primary care visits among older patients. METHODS:
Retrospective chart review at an academic family practice unit at Sunnybrook
Health Sciences Centre in Toronto, Ontario. Among patients aged 65 and older
seen at the family practice unit between July 1, 2013 to June 30, 2014, the 5%
that visited the family practice most frequently and the 5% that visited the family
practice least frequently were selected for the study (N = 265). Charlson
Comorbidity Index and age-adjusted Charlson Comorbidity Index were used to
assess comorbidities. Beers criteria and the Anticholinergic Risk Scale (ARS)
were used to identify high risk medications. Total number of medications was
abstracted for each patient. RESULTS: The significant predictors of being a
high frequency user of primary care were: being female (odds ratio [OR]: 2.11),
being over the age of 85 (OR: 5.35), and using a higher total number of
medications (OR: 1.51, p < 0.05 for all). Charlson Comorbidity Index, number
of Beers criteria medications, and ARS were not significant predictors (p >
0.05). CONCLUSION: Being female, over the age of 85, and using a higher
number of medications were independent significant predictors of higher
frequency of primary care visits among older patients. Tools such as the
Charlson Comorbidity Index, Beers criteria, and ARS were not able to
independently predict the frequency of visits, indicating that predicting
frequency is likely complex and there are multiple factors which lead to primary
care visits.
HS-06
PATIENT AND CAREGIVER UNDERSTANDING OF PROGNOSIS AFTER
HIP FRACTURE
R. Eikelboom1, A. Gagliardi2, R. Gandhi2,3, P. Kuzyk1,4, P. Cram1
1
MD Program, University of Toronto, 2University Health Network, 3Toronto
Western Hospital, 4Mount Sinai Hospital
BACKGROUND: Hip fracture (HF) is common among Canada’s elderly and
mortality after HF is high. Although HF patients are informed of their treatment
options and prognosis, patient understanding at time of treatment is unknown.
OBJECTIVE: We interviewed elderly patients hospitalized with HF to explore
their understanding of treatment options and prognosis. METHODS: We
developed an interview guide focusing on patient understanding of HF
treatment options, prognosis, and preferred role in HF decision making. We
interviewed older patients (>65) hospitalized with HF in May-November 2015
who passed a limited cognitive screen. Interviews occurred after patients had
provided informed consent for surgery but within 72 hours of admission.
Interviews were audio-recorded and transcribed. We also gathered
supplementary data on medical history and pre-fracture functional status. We
analysed interviews using qualitative methods, and we compared participant
assessment of HF mortality and functional outcomes to estimates from the
ACS NSQIP risk calculator. RESULTS: We interviewed 8 subjects (mean age
83, 88% women). All understood the need for HF surgery but only 2 (25%)
were aware that there were multiple treatment options. Subjects’ estimates of
time between surgery and ambulation ranged from 2 to 30 days. Subjects
expressed concerns about recovery: walking/independence (63% of subjects),
pain (38%), and death (13%). 75% perceived HF as very serious. The mean
predicted 30-day mortality using the NSQIP risk calculator was 6.8% (range
0.7-16.3%), but only 2 subjects (25%) were able to provide a numerical
estimate of mortality risk (0% reported vs. 0.7% calculated, and 0% reported
vs. 0.4% calculated). 3 subjects (38%) were not satisfied with their knowledge
about HF. CONCLUSION: Elderly patients seem to recognize that HF was
serious, but do not understand the mortality risk or prolonged recovery for
ambulation. Our results suggest tremendous opportunities for improvement in
communication.
HS-08
ASSESSMENT OF THE PEER SUPPORT NEEDS FOR POSTMASTECTOMY BREAST RECONSTRUCTION PATIENTS
S. Huynh1, N. Causarano2, and T. Zhong1,2.
1
Division of Plastic and Reconstructive Surgery, University of Toronto,
2
Breast Reconstruction Program, Plastic and Reconstructive Surgery,
University Health Network, Toronto, Ontario, Canada.
INTRODUCTION: Peer support is a supportive care method that entails
matching a recovered patient with a newly diagnosed patient to provide support
to the patient in need. This has been an effective intervention for breast cancer,
but literature about peer support for post-mastectomy breast reconstruction
(PMBR) is limited. OBJECTIVE: This study aimed to assess the peer support
needs of this patient population. METHODS: A qualitative descriptive study
design was used. A purposeful sample of 20 participants, 10 who had PMBR
and 10 who were considering PMBR, was recruited from a community breast
cancer support organization (Willow Breast and Hereditary Cancer Support).
Of the 20 who consented, 18 attended two focus groups, each lasting two
hours. Thematic analysis was used to identify prominent themes. RESULTS:
Four main themes emerged. Women distinctly identified as BRCA+ gene
carriers, cancer patients or survivors, which impacted how they approached
PMBR. Secondly, information is a powerful aid but must be delivered mindfully,
as it can distress some individuals. Thirdly, peer support can fill gaps left by
healthcare providers and social networks, through positive upward
comparison, experiential support, and information provision. Finally, while the
desire for normalcy motivates women to undergo PMBR, the views that PMBR
is not part of the treatment and that PMBR is a significant undertaking act as
barriers. CONCLUSION: PMBR peer support programs are warranted, and
may alleviate patients’ perceived barriers to treatment. Peers should be
matched on identity, and peer supporters trained to deliver information in a
balanced manner.
47
ABSTRACTS
HS-09
THE ROLE OF SOCIAL SUPPORT NETWORKS IN SATISFACTION WITH
THE SENIORS CRISIS ACCESS LINE (SCAL): AN EXPLORATORY
STUDY
K.S.P. Lai1, C. Cohen2
HS-10
CURRENT HEALTH RESOURCE UTILIZATION FOR INVESTIGATION OF
STABLE CHEST PAIN IN LOW TO INTERMEDIATE RISK WOMEN
V. Lemieux1, N. Ivers2, P. Harvey3, N.S. Paul4, and E.T. Nguyen4
Faculty of Medicine, University of Toronto, 2Department of Family and
Community Medicine, 3Department of Medicine Cardiology, Women’s College
Hospital, 4Joint Department of Medical Imaging, Women’s College Hospital &
University Health Network
1
1
Faculty of Medicine, 2Department of Psychiatry, University of Toronto
INTRODUCTION: Mental health problems affect approximately 30% of
seniors. Randomized controlled trials have demonstrated that home crisis
teams for seniors reduce hospital admissions by up to 31%. The Seniors Crisis
Access Line (SCAL) was a telephone crisis service initiated to help seniors
manage mental health and addiction crises at home. Individuals with poor
social support have been shown to have lower quality of life, and therefore
social support networks may be an important factor in determining client
satisfaction with SCAL. OBJECTIVE: To elucidate the experience of senior
clients (aged 65 and older) who had used SCAL and to explore how social
support affects client satisfaction with the SCAL service. METHODS: 7
English-speaking seniors living in Toronto who called SCAL on their own behalf
were interviewed by telephone. The Lubben Social Network Scale (LSNS) and
the Client Satisfaction Questionnaire-8 (CSQ-8) were used to measure social
support and client satisfaction respectively. 5 SCAL front-line staff were
interviewed to determine client needs, satisfaction with SCAL, and levels of
social supports. Interviews were analyzed for themes using descriptive
thematic analysis. RESULTS: Social support was found to be low (median
LSNS = 7) and client satisfaction was low (median CSQ-8 = 13). Clients valued
independence, simplicity and promptness of crisis resolution, and staff rapport.
Seniors in crisis have needs which were different from adults and necessitated
management in multiple areas to prevent future crises. Community resources
may help address these needs and may have a role to help seniors live
independently. CONCLUSION: Given the unique needs and complexity of
seniors in crisis living in the community, there is a need for a senior specific
crisis line. A crisis response system with skilled employees and effective
community partners that is aware of the needs and expectations of seniors
may help increase satisfaction with SCAL.
HS-11
HEALTHCARE
CONSUMPTION
OF
PATIENTS
BORN
WITH
ESOPHAGEAL ATRESIA +/- TRACHEOESOPHAGEAL FISTULA (EA/TEF)
- A LONGITUDINAL POPULATION-BASED ANALYSIS IN ONTARIO FROM
1998 TO 2011
T. Maqbool1, C. de Oliveira2, M. Marcon3, P. Chiu1
INTRODUCTION: Recommended first line testing of stable chest pain in low
to intermediate risk patients includes ECG exercise test, stress
echocardiography, and/or myocardial perfusion imaging (MPI) without a clearly
defined preferred diagnostic algorithm. The higher proportion of atypical chest
pain presentation and increased likelihood of false positive results in women
lead to poor risk stratification and greater use of health resources as compared
to men. OBJECTIVE: To describe current health resource utilization for
investigation of stable chest pain in low to intermediate risk women seen at the
Women’s College Hospital (WCH) Family Practice Health Centre (FPHC) and
outline the patient care pathway. METHODS: A one-year retrospective chart
review was performed with all currently recommended first-line tests as search
criteria for women with low/intermediate risk presenting with stable chest pain
to the WCH FPHC. Unstable/symptomatic cardiac conditions were excluded.
RESULTS: Retrospective review of 50 low/intermediate risk women in reverse
chronologic order (mean age 60yrs, mean risk 7.89%) was completed. The
most common first test was stress echo (n=28), followed by ECG exercise test
(n=17) and MPI (n=5). Average total number of tests to exclude/diagnose CAD
was 1.38. The mean time to exclusion/diagnosis was 81 days (median 26d)
and the mean time interval from first complaint to the first test was 43 days
(median 16d). CONCLUSION: There is variability in the diagnostic approach
and in the time to diagnosis. Stress echocardiography is the most commonly
ordered first test, however 14% of these women required repeat/further
investigations. Overall, 27% of women required repeat/further testing to
exclude CAD. In this small study, the single ICA performed was unnecessary.
These results along with current literature, support further studies to provide
evidence towards best practice guidelines for stable chest pain investigation in
low/intermediate risk women.
HS-12
PREPARING GLOBALLY COMPETENT HEALTH SYSTEM LEADERS:
AN INITIAL SCOPING OF KEY COMPETENCIES
A. C. R. Partridge1,2, G. Permanand2, J. N. Lavis3
1
Undergraduate Medical Education MD Program, University of Toronto
World Health Organization Regional Office for Europe, Denmark 3Centre for
Health Economics and Policy Analysis, McMaster University
2
1
3
Division of Pediatric General & Thoracic Surgery,
Division of
Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children;
Centre for Addiction and Mental Health, Toronto
2
BACKGROUND: Esophageal atresia (EA) and/or tracheoesophageal fistula
(TEF) is a congenital anomaly diagnosed in the neonatal period and requires
surgical repair. Up to half of the EA/TEF patients have additional anomalies,
including VACTERL associations. Following surgical repair, EA/TEF patients
continue to have complications. The objective of this project is to describe the
population incidence of EA/TEF in Ontario (ON) from 1998 to 2011, and to
determine the healthcare burden of EA/TEF. METHODS: We defined our study
population to be all patients born with EA/TEF in ON from 1998 to 2011. We
obtained inpatient and outpatient health services data on the study population
from the Institute of Clinical Evaluative Sciences. RESULTS: There were 345
EA/TEF births in ON from 1998 to 2011. 196 (56.8%) were males and 296
(85.8%) belonged to an urban neighbourhood at time of diagnosis. Patients
were almost evenly distributed across the neighbourhood income quintiles (a
measure of socioeconomic status). The population incidence over the 14-year
study period was 1 in 5446 live births. In total, there were 842 hospital
admissions in the first year of life, (average 2.4 hospital admissions/patient, 60
hospital days per patient). The need for outpatient consultations, assessments
and visits was greatest for family physicians, pediatrics, emergency physicians,
general surgeons, otolaryngologists and orthopedic surgeons. For home care
services, time-based nursing services had the highest utilization.
CONCLUSION: EA/TEF patients have a high need for healthcare resources.
There is a need to understand healthcare utilization and costs of care
associated with EA/TEF. These data would be useful to policymakers, hospital
administrators and healthcare professionals in order to develop best practices
for EA/TEF care.
48
BACKGROUND: Globalization has brought a significantly more interconnected and interdependent world,
which has catalyzed the way that education and hiring must be approached, requiring leaders that are
globally competent. It has also highlighted the need for health system reform, which can be achieved
through strengthened health leadership capacity, an area which is insufficient in Canada and in many
nations globally. The purpose of this study is to understand (i) the terms used to describe a “globally
competent student”, (ii) the competencies possessed by these types of students, and (iii) the activities
proposed to develop these students and the competencies they possess. Ultimately, we hoped to elucidate
the concept of a globally competent health system leader. METHODS: We used a critical interpretive
synthesis approach similar to Moat et al. to systematically review the heterogeneous literature on global
competence and health system leadership. Our initial set of three compass questions guided the
development of a systematic search in eleven electronic databases. We then used a grounded iterative and
inductive analysis approach to develop a model of global competence based on a “life course framework”.
RESULTS: Of the papers retrieved through systematic searching on global competence, ten were included
in the study. Three additional papers on global competence along with four health system & public health
leadership frameworks were purposively sampled to fill conceptual gaps. We identified two major
conceptual groups – global competence and global leadership. Nearly all included studies addressed
competencies innately possessed by globally competent individuals and competencies educational
institutions are trying to develop in their students. Just under half of included studies addressed
competencies employers look for in recruitment processes and attempt to hone in continuing professional
development. Areas of overlap between most frequently addressed competencies in the latter two domains
were identified. 12 studies identified various activities used to develop these competencies as well as
assessment measures. There is no consensus in the literature on terms, competencies, and activities used
for global competence. Finally, we used the prototype Global Competence Model and Global Competence
Composite that emerged from our synthesis to draw linkages with a prototype health system leadership
framework ‘LEADS in a Caring Environment’. DISCUSSION: Our study presents a first attempt at bridging
two previously independent bodies of literature, and identifies the novel concept of the globally competent
health system leader. Our findings can be used in development of educational curricula, recruiting
procedures, or continuing professional development purposes, although suggestions have been made for
future research in this area.
ABSTRACTS
HS-13
WEB-BASED EDUCATIONAL TOOL FOR RETROPERITONEAL LYMPH
NODE DISSECTION (RPLND) PATIENTS: A NEEDS ASSESSMENT
STUDY
J. Peng1, Dr. R.J. Hamilton2
1
MD Program, University of Toronto, Toronto, ON, Canada 2Department of
Surgical Oncology/Urology, Assistant Professor of Surgery, University of
Toronto, ON, Canada
HS-14
ELICITING PATIENT PREFERENCES FOR MATERNAL-FETAL HEALTH
STATES ARISING FROM THE USE OF ANTICOAGULATION IN
PREGNANCY
R. D’Souza1,2, K. Murphy2, B. Sander2, M. Krahn2, K. McKelvey1, V. Nguyen2,
W. Peterson1, D. Wuebbolt2
1
University of Toronto, 2Department of Obstetrics and Gynaecology, Mount
Sinai Hospital
BACKGROUND: RPLND is an effective treatment for early stage nonseminomatous germ cell cancer. Typically, the information regarding RPLND
is presented to patients by the surgeon with limited visual aid. Thus, there is a
critical need to provide patients with resources that offer information
concerning their care. We would like to address this is by developing a webbased educational tool (ET) that will help testicular cancer (TC) patients better
understand their treatment plan. To do this, we would like to hear from past
RPLND patients about their experiences consenting to RPLND which will help
inform the design of the ET such that it is relevant and useful to the TC patient
population. OBJECTIVES: To assess past RPLND patient experiences as a
way to inform the design of the ET. METHODS: The study population consisted
of 15 men diagnosed with histologically confirmed TC and completed RPLND
as part of their treatment plan. After written consent was obtained, a semistructured interview on the patient’s personal experience with RPLND was
conducted. Responses were subject to thematic analysis. RESULTS: Data is
currently being collected. At this point in time, responses reveal the following:
1) 100% were interested in using the ET if it was available to them; 2) 100%
agreed the ET would have been helpful to them and their families; 3) 67% did
their own research at home to learn about the treatment after their initial
consult, and of the 33% that did not do personal research, 100% had a family
member who did; and 4) 100% preferred the ET be delivered in electronic
format over other methods. DISCUSSION: The information from this study will
help design the web-based ET. Once created, the ET will be used to help TC
patients understand their treatment plan. It is hoped that this research will
facilitate the development of more ETs that are valuable to both the patients
and health care providers.
BACKGROUND: Approximately 25% of women in high-income countries enter
pregnancy with a chronic health condition requiring the use of medications.
Many of these medications cross the placenta, and can result in adverse
effects for the fetus ranging from mild abnormalities to severe
neurodevelopmental delay or death. One such high-risk group includes
pregnant women with mechanical heart valves (MHV) who require
anticoagulation therapy throughout pregnancy. Patient preferences are rarely
incorporated into medical decision-making in high-risk pregnancies, as little is
known about the trade-offs pregnant women are willing to make in order to
have a successful pregnancy. OBJECTIVE: The objective is to determine
patient and familial preferences for combined maternal-fetal health states
arising from anticoagulant use in pregnancy. METHODS: Pregnant women
attending the Special Pregnancy Program at Mount Sinai Hospital were
interviewed, all with medical disorders requiring medication use during
pregnancy. Forty-seven women were interviewed with family members – first
independently and then together – while an additional 25 women were only
interviewed independently. Participants scored 7 combined maternal-fetal
health states using 3 direct measures for eliciting health state utilities: a visual
analogue scale, standard gamble and time trade-off task. Health state scores
from each interview will be compared using analysis of variance (ANOVA) and
used to generate a utility value specific to each combined maternal-fetal health
state. RESULTS: Results are pending, as statistical analysis is currently
underway. Initial impressions are that the majority of women are willing to make
some trade off of their health for that of their fetus. Family members tend to be
less comfortable taking this risk. CONCLUSIONS: Conclusions will be
available prior to Medical Student Research Day pending completion of
statistical analysis.
HS-15
TRANSLATING EMERGENCY KNOWLEDGE FOR KIDS (TREKK): A
SOCIAL NETWORKING ANALYSIS OF A NATIONAL PEDIATRIC
EMERGENCY NETWORK
T. Klassen1,J. Curran2, J. Ripstein3, L. Hartling4, M. Jabbour5, D. Johnson6,
S. Scott7, L. Knisley1, C. Leggett1
HS-16
HEALTH HUMAN RESOURCE PLANNING TO FILL CLINICAL CARE
GAPS AT UHN
S. Doshi1 & S. Shah1, B. Hodges2
1
2
1
Children’s Hospital Research Institute of Manitoba; School of Nursing,
Dalhousie University; 3 University of Toronto; 4 Department of Pediatrics,
University of Alberta; 5 Children’s Hospital of Eastern Ontario Research
Institute; 6 Alberta Children’s Hospital Research Institute; 7 Faculty of Nursing,
University of AlbertaResults
BACKGROUND: Translating Emergency Knowledge for Kids (TREKK) is a
national network established in 2011 to ensure the latest research in pediatric
emergency medicine is applied within general emergency departments (EDs).
TREKK shares knowledge, expertise and resources about best practices in the
care of acutely ill and injured children. OBJECTIVE: Our primary objective was
to evaluate the impact of TREKK on information flow between clinicians in the
ED and identify knowledge brokers. The secondary objective was to better
understand information flow within the department. METHODS: In the spring
of 2014 and again in winter 2015 a social networking survey was sent to 37
participating TREKK site ED’s. The survey was analyzed using Microsoft
Excel, UCI Net, and Netdraw to create social networks. RESULTS: Data from
was used from 70 respondents in 2014, and 65 respondents in 2015. The three
most common primary disciplines were: medicine/pediatric medicine (37%),
clinician (26%) and nursing (22%). In 2015, all 9 of the PERC sites were
connected to at least one TREKK site, an improvement from 2014. There were
only 3 isolated sites in the 2015 analysis compared to 17 isolated sites in the
2014. The average degree for each respondent was 3 ±0.5(95%CI)
CONCLUSION: Overall information flow between clinicians in the ED appears
to create a sparse network, with a few individual Knowledge brokers much
more influential than others. While changes in the network indicate increased
information flow in 2015, these results should be interpreted with caution.
University of Toronto, Faculty of Medicine
Department of Education, University Health Network
2
BACKGROUND: Residents are a central part of clinical care in teaching
hospitals, and small changes in their hours or distribution to communities can
have significant consequences. When care gaps result from these changes,
one solution is the use of the “alternative workforce” - nurse practitioners,
physician assistants, hospitalists, and clinical fellows. OBJECTIVE: The
purpose of this study was to develop a comprehensive overview of each
professional role, and assess their integration into medical and surgical
inpatient services at UHN. METHODS: A qualitative design with semistructured open-ended interviews was used for this study. Three different
groups of individuals from General Surgery and Internal Medicine were
identified by the research team: 1) the “alternate workforce” described above;
2) key informants/expert consultants; and 3) UHN executives. Fourteen (n=14)
one-hour interviews were conducted. Consent was obtained for interviews to
be recorded. Data was analyzed using content analysis. RESULTS: Several
themes were extracted from the interviews, including: 1) there is unique value
in each of the individual health professions; 2) ambiguity exists in the
terminology used to describe these roles; 3) team tensions often exist due to
lack of role clarity; 4) Restricted scope of practice of non-physician practitioners
may be affecting patient care; 5) health human resource planning at UHN
appears to be a primarily financially motivated process. CONCLUSIONS:
Multiple recommendations emerged from this study. These include using clear
and consistent language, providing education about health profession roles,
re-examining scopes of practice, implementing needs assessments, and
developing strategies to implement new roles on a team. This study was
important to conduct as teaching hospitals are going through a drastic human
resource change due to reduced resident hours and increased clinical volume.
Understanding health human resources is critical for maximizing the quality
and efficiency of patient care.
49
ABSTRACTS
HS-17
DEVELOPMENT AND ASSESSMENT OF A CANADIAN LIST OF
ESSENTIAL MEDICINES
M. S. Taglione1,2, H. Ahmad2, M. Slater3, B. Aliarzadeh4,5, R. Glazier2,3, A.
Laupacis2,4, N. Persaud2,3,4
HS-18
A COST-EFFECTIVENESS ANALYSIS OF DIEP VERSUS MUSCLESPARING TRAM IN POST-MASTECTOMY BREAST RECONSTRUCTION
M. G. Tan1, W. Isaranuwatchai2, T. DeLyzer1, K. Butler3, S. O. P. Hofer3, and
T. Zhong3
Faculty of Medicine, University of Toronto, Toronto, Canada 2 Li Ka Shing
Knowledge Institute of St. Michael’s Hospital, Toronto, Canada 3 Department
of Family and Community Medicine, St. Michael’s Hospital, Toronto, Canada
4
Department of Family and Community Medicine, University of Toronto,
Toronto, Canada 5 University of Toronto Practice Based Research Network
1
1
BACKGROUND: The number of medications available in Canada is growing
and there is an increasing number of Canadians unable to afford them. The
growing number of medications has also created a difficult environment for
clinicians. Countries around the world have developed smaller lists that include
only essential medications. OBJECTIVE: To create and assess a
comprehensive list of essential medications for Canadians. METHODS: The
2013 WHO list of essential medications was adapted by the research team.
Canadian clinicians gave suggestions on additions, removals, and
replacements to this list. Literature was gathered and presented to three
clinician-scientists who made recommendations on whether the suggested
changes should be implemented. The final list was assessed with a chart
review of an inner city clinic (St Michael’s Hospital Academic Family Health
Team) and a large family health team (North York General). RESULTS: The
development of the list resulted in the creation of a concise list of 109
medications. The peer reviewed list of 109 medications had 83% and 85%
coverage at the inner city clinic and for the suburban sites, respectively. 84%
of the patients seen at the inner city clinic and 89% of the patients seen at the
suburban clinic had all or all but one of their medications covered by the list.
CONCLUSION: The Canadian list of essential medications is a concise list
with significant coverage in different patient populations. The development of
health policy should aim to ensure that all Canadians have access to
medications on the list to balance coverage and cost. Future studies should
evaluate cost effectiveness, health outcomes, and effect on the healthcare
system.
University of Toronto, Toronto, ON, Canada, 2St. Michael's Hospital,
Toronto, ON, Canada, 3University Health Network, Toronto, ON, Canada.
INTRODUCTION: In the current time of rapidly increasing healthcare costs,
we have the responsibility to evaluate the cost-effectiveness of commonly used
breast reconstruction methods. OBJECTIVE: To perform a cost-effectiveness
analysis (CEA) of the deep inferior epigastric perforator (DIEP) compared to
the free muscle-sparing transverse rectus abdominis myocutaneous (MSTRAM) using patient reported outcomes (PROs) from the hospital perspective.
METHODS: A CEA was conducted to compare all patients who had either
DIEP or free MS-TRAM flaps at University Health Network from 2008 - 2012.
The PROs were obtained from the 6 subscales from the BREAST-Q at oneyear follow-up. The cost outcomes were obtained from the hospital Case
Costing System including the cost of surgery, hospital admission and
complications during the two-year follow-up period. The Incremental costeffectiveness ratio (ICER) was calculated for each BREAST-Q subscale and
adjusted for confounders. Confidence ellipses were used to characterize the
uncertainty of the findings. RESULTS: A total of 226 patients (205 DIEP, 21
MS-TRAM) responded (response rate = 76%). There were no significant
differences in the six BREAST-Q domains and costs ($15,573 ± $4,718 for
DIEP and $16,308 ± $4,140 for MS-TRAM). The ICER showed that DIEP flap
was a dominant option (cost less and more effective) compared to the MSTRAM in all 6 BREAST-Q domains except satisfaction with outcome. The
confidence interval of the ICER estimate showed substantial level of
uncertainty. CONCLUSION: This analysis suggests that DIEP flaps could be
more economically attractive than MS-TRAM in post-mastectomy breast
reconstruction, and the certainty of this analysis may be strengthened by
including more MS-TRAM patients.
HS-19
COMPARING CERVICAL CANCER STAGE OF DIAGNOSIS AT
PRESENTATION IN IMMIGRANT WOMEN AND NON-IMMIGRANT
WOMEN
R. T. Voruganti1, R. Moineddin1,2,3,, N. Jembere3, L. Elit4, E. Grunfeld1,2,3,5
and A. K. Lofters1,2,3,
HS-20
HOW FUNCTION AND SOCIAL SUPPORT PREDICT FREQUENCY OF
FAMILY PRACTICE VISITS AMONG GERIATRIC PATIENTS
X. X. Yu1, N. D. Dattani2, B. Au3, K. L. Stead1, R. Jain2,3, L. Jaakkimainen2,3,
J. Charles2,3
1
2
1
Institute of Health Policy, Management and Evaluation, University of
Toronto; 2Dept. of Family and Community Medicine, University of Toronto;
3
Institute of Clinical Evaluative Sciences; 4Dept. of Oncology, McMaster
University; 5Ontario Institute for Cancer Research
INTRODUCTION: In Canada, it is estimated that 1500 new cases of cervical
cancer will be diagnosed in 2015. Cervical cancer is highly preventable with
HPV vaccination and screening. Previous work has shown that women with
poor access to healthcare resources, such as immigrants, are less likely to be
screened than non-immigrants. OBJECTIVE: Given that they are screened
less, our study aimed to examine whether immigrant women are diagnosed
with later stage cervical cancer than non-immigrants at presentation.
METHODS: We conducted a retrospective cohort study of women with cervical
cancer diagnosed from 2010 to 2014 comparing immigrants and long-term
Canadian residents as controls. The outcome of interest was stage of
diagnosis, defined as early (stage I) or late (stage II-IV). We compared
immigrants and non-immigrants on late vs. early stage adjusting for
socioeconomic measures, comorbidities and healthcare utilization. RESULTS:
We found that immigrant women were not more likely to present with late stage
cervical cancer at diagnosis than non-immigrants (OR: 1.124, adjusted pvalue= 0.57), though being previously screened or visiting a gynecologist in the
past 3 years were significant predictors. These results were confirmed with a
2007-2012 cohort. CONCLUSIONS: We found that immigrant women are not
more likely to present with later stage cervical cancer, despite their lower
likelihood of being screened. A possible explanation for this finding could be
that individuals who are selected to immigrate to Canada tend to be healthier
than those who do not, dubbed the “healthy immigrant effect”. Screening
programs targeting marginalized populations may need to consider a multitude
of factors beyond immigrant status.
50
3
Undergraduate Medical Education, University of Toronto
Department of Family and Community Medicine, University of Toronto
Primary Care Research Unit at Sunnybrook Health Sciences Centre
INTRODUCTION: The population of Canada is aging. In 2055 approximately
one quarter of Canadians will be over 65. Improvements in primary care
delivery are necessary to more efficiently care for our aging population. Current
literature shows a gap in understanding how level of function and social support
influence the frequency of visits to the family doctor. OBJECTIVE: To
determine the relationship between level of function, level of social support,
and frequency of visits to an urban academic family health team by geriatric
patients. METHODS: This was a cross-sectional descriptive study. We
identified adults aged 65 years and older who are patients of the Sunnybrook
Academic Family Health Team. We conducted structured telephone
questionnaire on the most and least frequent 5% of users as determined by
frequency of visits between July 1, 2013 to June 30, 2014. The Duke Social
Support and Stress Scale (DUSOCS), the Older American Resources and
Services (OARS) social support subscale and OARS functional assessment
were used as outcome measures. T-test was performed to compare scores
between the groups. Spearman correlation was performed to identify
correlations between social support and level of function. RESULTS: We
performed 39 interviews with 19 high users and 20 low users. The low users
group had significantly higher level of function compared to the high users
group (p = 0.02). There was no difference in social support using either the
DUSOCS or OARS scores between the two groups. There was a positive
correlation between stress and level of function in the high users group.
CONCLUSION: Low level of function was associated with increased frequency
of visits, however low social support was not. Low social support may impact
patients' overall health indirectly via its effects on emotional well-being, but
more research is needed.
ABSTRACTS
MedEd-01
FACTORS AFFECTING EDUCATIONAL VALUE OF PRE-CLERKSHIP
SURGICAL OBSERVERSHIPS
D. Axelrod1, E. Walser1, G Hoit1, J Rutka1,2, J. Lee MD1,2
MedEd -02
DEVELOPMENT OF CUSTOMIZED, LOW-COST 3D PRINTED MODELS
FOR MEDICAL EDUCATION
A.Mashari1, J.Q. Hiansen1,2, S. Zhou1, E. Aziza1, M. Ratto1,2, M. Meineri1
1
University of Toronto, Faculty of Medicine 2 University of Toronto Department
of Surgery
1
Department of Anesthesia and Pain Management, Toronto General Hospital,
UHN, University of Toronto and 2Semaphore Research Cluster, Faculty of
Information, University of Toronto
INTRODUCTION: Early positive clinical observerships play key roles in preclerkship education and surgical career selection. Factors relating to the
student, their preceptor or the case can affect the experience of observers in
the operating room (OR). OBJECTIVE: This study attempts to identify key
factors influencing the OR educational environment for observers. METHODS:
28 1st year medical students participating in an intensive 2-week surgical
program completed e-surveys characterizing each of their 8 surgical
observerships. Perceived educational value (EV), utility in career exploration
(CE), and level of personal enjoyment (PE) were self-assessed. The survey
included questions on the student’s prior surgical experience, the cases they
observed, as well as their involvement and interaction with the OR team.
RESULTS: 146 (70.9%) surveys were completed, each representing a unique
observership. 49 (36%) observers scrubbed into at least one case, and 33
(22.6%) were either 1st or 2nd assist in an operation. Mean assessments of EV,
CE and PE scored 3.64/5 (SD=1.04), 3.76/5 (SD=0.93) and 3.82/5 (SD=1.00),
respectively. Following multivariate analysis, increased surgical team
engagement with the student (1) and a positive tone of interaction (2) were
both significantly associated with improved EV (p1 = 0.013, p2 <0.001), CE
(p1=0.006, p2=0.012), and PE (p1 <0.001, p2 <0.001). Surgical subspecialty,
prior knowledge of cases or preparation, type of case and ability to scrub in
were not associated with improved experiences. CONCLUSIONS: Increased
engagement and positive interaction with the surgical team are highly
modifiable factors in a learner’s OR experience and emphasizes the
educational role of academic surgeons. Further research is needed to develop,
assess and implement strategies to improve learner engagement in the OR.
MedEd -03
THE ROLE OF ENTRUSTABLE PROFESSIONAL ACTIVITIES IN
ASSESSING RESIDENT CLINICAL COMPETENCE AND THEIR
POTENTIAL USE IN SURGICAL SPECIALTIES
L. Chow1, M. Nousiainen and UTCBC Research Group2, and V. Wadey2
INTRODUCTION: Three-dimensional (3D) printing is a developing scientific
discipline that involves creating objects using a variety of materials from digital
design. Currently, software available for the creation of medical models from
imaging is costly and largely inaccessible. However, recent free, open-source
software developments and commercially available 3D printers have opened
the potential for a cost-effective and flexible method that can be utilized in the
production of models for medical education. OBJECTIVE: To create 3D printed
parametric and patient-specific models using an open-source workflow for
teaching and skills training. METHODS: Anonymized CTs were selected for
modelling using a free image viewer. These scans were segmented using
open-source software to produce 3D digitized models. These were then
imported into 3D editing programs for finer processing. The products were then
exported into slicing programs to convert them into a .gcode file, which instructs
the 3D printer on settings such as temperature and print speed. This allows the
printer to translate the code into a physical print. RESULTS: Several
anatomical models were printed as proof of concept for the production of a lowcost, high resolution product. Arterial and venous blood pool models of the
heart, segmented heart models, thoracic spine, cricothyrotomy, and bronchial
tree airway models were amongst those produced. These ranged in cost from
$2.00 - $6.00, which is a fraction of current anatomical model market price.
CONCLUSIONS: Our workflow describes a low-cost method of generating
anatomically accurate models from CT scans. We next seek to use echogenic
print media to produce: high resolution cost-efficient ultrasound phantoms,
pathological models for educational courses, and to develop software to
facilitate the accessibility of 3D printing to healthcare professionals.
MedEd -04
BRINGING SEXY IN: THE EFFECT OF GENDER AND PERCEIVED
ATTRACTIVENESS ON HYPOTHETICAL ADMISSIONS DECISIONS
E. Landon1, M. Hanson1, N. Woods2, L. DeBruine3, & K. Kulasegaram2
Faculty of Medicine, University of Toronto, Toronto, Ontario 2The Wilson
Center, University of Toronto, Faculty of Medicine, and University Health
Network, Toronto, Ontario 3Institute of Neuroscience and Psychology,
University of Glasgow, Glasgow, Scotland
1
1
MD Program, University of Toronto, Toronto, CAN, 2Department of Surgery,
Division of Orthopaedics, University of Toronto, Toronto, CAN
BACKGROUND: There has been a significant shift across the continuum of
medical education from a time-fixed format to a competency-based curriculum
(CBC). Assessment methods in the old format have been criticized for a lack
of standardization and relevance to the clinical setting. As such, a different
approach in assessing competencies should be considered. Entrustable
professional activities (EPAs) represent a novel method of holistically
assessing the clinical competence of a trainee by linking competencies – like
the 7 CanMEDS roles – to discrete tasks performed in the daily clinical
environment. OBJECTIVE: To present a literature review on the role of EPAs
in assessing resident competence, and examine their potential utility in surgical
post-graduate programs. METHODS: Electronic searches were conducted on
the MEDLINE, Embase, PubMed and Google Scholar databases. Search
terms include ‘entrust* professional act*’, ‘assessment’, ‘evaluation’, and
‘surgical competenc*’. Both peer-reviewed and grey literature papers were
reviewed. RESULTS: Post-graduate, non-surgical medical programs in
various countries including the United States and Canada have run pilot tests
on EPAs as a novel framework in guiding the assessment of residents’ clinical
competence. EPAs are found to standardize the assessment of competence,
facilitate trainees’ gradual assumption of responsibility, and form the basis of
new assessment tools that can be used in CBC. Areas that need to be explored
include establishing the validity of these new assessment tools. DISCUSSION:
The current literature supports the use of EPAs in providing structured
feedback to the trainee. When developing EPAs, resident feedback may have
a critical role. Overall, we believe there is utility in creating an EPA-based
assessment tool for use in surgical disciplines to enhance the learning and
performance of post-graduate surgical trainees.
INTRODUCTION: Medical school selection relies on faculty and student raters
to make judgments on the suitability of applicants. Several studies have shown
cognitive biases may influence these judgments (e.g. the physical
attractiveness of applicants may affect raters’ evaluations). In an experimental
study, we manipulated mock applicant profiles for attractiveness to examine
the impact of applicant attractiveness, gender, and rater characteristics.
METHODS: Brief applicant profiles (short bios and responses to two short
answer questions on motivation and ethics) were created and then validated
by independent raters (n=21) to establish equivalency. Four profiles were then
attached to face portraits (2 female, 2 male). Faces were manipulated for
attractiveness using a previously validated protocol. Complete profiles were
distributed in an online survey to medical students and faculty for rating.
Participants were randomly assigned to one of two manipulations each
showing different attractiveness manipulations. We analyzed the relationship
between profile attractiveness and gender against rater gender and type
(faculty vs. students). RESULTS: 125 raters completed the study (faculty=30,
non-faculty=93). We detected a significant interaction between rater gender
and the gender of the profiles (F(1,119)=8.8,p<0.004) which was driven by
higher ratings of female profiles by male raters. There were no differences
between faculty and non-faculty raters. The effect was not detected in profiles
without portraits. CONCLUSION: This study builds on previous exploratory
work demonstrating attractiveness effects but locates the effect to differential
rating by male and female raters. We discuss social and evolutionary
mechanisms for this finding as well as methods of counteracting attractiveness
biases.
51
ABSTRACTS
MedEd -05
FAILURE TO FAIL: CHALLENGES TO PROVIDING MEANINGFUL
ASSESSMENT AND FEEDBACK IN MEDICAL EDUCATION
S. A. McQueen,1,2 B. Petrisor,1 M. Bhandari,1 C. Fahim,1 N. Wagner,1 & R.
Sonnadara1,2
1
2
Department of Surgery, McMaster University
Faculty of Medicine, University of Toronto
INTRODUCTION: Recent reports from the Royal College of Physicians and
Surgeons of Canada have called for programs to improve assessment
practices. Researchers have previously described a phenomenon titled “failure
to fail”, which refers to a reluctance for educators to fail poorly performing
trainees. OBJECTIVE: The present study explores the barriers perceived by
educators to providing trainees with meaningful assessment and feedback.
METHODS: Semi-structured interviews were conducted with 22 staff physician
educators. Interviews were audiotaped and transcribed verbatim. Three
researchers analyzed the transcripts using a grounded theory approach.
RESULTS: Participants expressed a reluctance to provide negative
assessments and feedback to trainees. Many were concerned about negative
repercussions for themselves or the program. Forty-five percent of participants
reported recording higher scores for trainees than they felt the trainees actually
deserved, while fifty-five percent of participants reported passing trainees
whom they felt may have benefited from additional training. CONCLUSION:
We report several perceived barriers preventing faculty from providing
accurate assessments of performance and feedback to trainees. More regular
formative assessments may provide residents with insight into their abilities
and help ease the stress of summative evaluations. As residency programs
shift towards competency-based curricula, it is imperative that these barriers
be addressed. Improving assessment and feedback in these ways will help
meet the Royal College’s mandates to enhance learning and improve patient
safety.
MedEd -07
WHERE DOES CARING LIVE? THE INTERSECTION OF EVIDENCEBASED PRACTICE AND COMPASSIONATE CARE
Y. Nasirzadeh1, D. Miller2, L. Baker2, S. Ng2,5, E. Northup3, T. Martimianakis4,
K. Gold5, F. Friesen2
MedEd -06
WHAT IS CONSIDERED “LEGITIMATE” MEDICAL EDUCATION
RESEARCH? A DISCOURSE ANALYSIS OF THE JOURNAL MEDICAL
EDUCATION
A. Kuper, A. Messinger, C. Rangel, C. Cartmill, T. Martimianakis, C.
Whitehead
BACKGROUND: By invitation of the Editor of Medical Education (ME), we
conducted a series of discourse analyses of ME for its 50th anniversary. The
articles in ME provided a compelling dataset from which to trace key debates
within the field, including the struggle over the definition of “legitimate” or
“good” medical education research (MER). OBJECTIVE: To trace discursive
shifts in the framing of “legitimate MER” throughout the first 50 years of the
journal ME and to identify the historical, social and political forces that have
contributed to changing beliefs about the definition of “legitimate MER.”
METHODS: Discourse analysis uses close reading and an analysis of
language in identifying changing beliefs and how they are influenced by
historical and social factors. We analysed all 878 editorials and commentaries
in ME from its first issue in 1966 to August 2015. We iteratively coded these
articles according to their underlying epistemological stances and
methodological assumptions, meeting often to question preliminary
categories and deepen our understanding of the data. RESULTS: Our
analysis confirmed that MER was initially framed as positivist, quantitative
research, often within the psychometric tradition. We identified and
documented an ongoing discursive shift in the framing of MER beginning in
the 1980s that has slowly brought about the inclusion of social science
theory, constructivism, and qualitative research. Nonetheless, underlying
positivist assumptions remain prevalent within the field. CONCLUSION:
Discursive shifts have already changed the circumstances of MER work by
making space for alternative points of view and different types of researchers,
but we remain in a time of flux for MER. Understanding where the points of
tension lie and how beliefs about MER have changed over time helps us
question ingrained assumptions and come to new ways of thinking about how
medical education should be researched and designed.
MedEd -08
TEACHING EMPATHY OR IRRELEVANCE? MEDICAL LEARNERS’
PERSPECTIVES ON PATIENTS WITH CHRONIC PAIN
J. Ryu1, K. Rice2, and F. Webster2.
1
1
MD Program, University of Toronto, Toronto, Ontario, Canada 2CFD,
University of Toronto, Toronto, Ontario, Canada 3Ryerson University,
Toronto, Ontario, Canada 4Dept. of Pediatrics, University of Toronto, Toronto,
Ontario, Canada and 5CACE, Women’s College Hospital, Toronto, Ontario,
Canada
BACKGROUND: In an age of evidence-based practice (EBP), health
professionals work within a hierarchy that places some forms of knowledge
above other forms of knowledge. The privileged position of research-based
knowledge in EBP discourses potentially limits health professionals’ learning
and practice in sensitive care contexts. We conducted a critical discourse
analysis to understand how EBP operates in one such context: chronic pain
management. OBJECTIVES: To examine the discourses of EBP as they
intersect with daily practices of health professionals. METHODS: Data
collection entailed 1) compilation of an archive of patient blogs and grey
literature 2) interviews with health professionals working in pain clinics. Textual
analysis of blogs, grey literature and interview transcripts identified how key
concepts of EBP and ‘compassionate care’ are defined and articulated in
relation to each other. RESULTS: Institutional documents often deploy the
concept of ‘care’ as an ‘endpoint’ of clinical work, rather than as an intrinsic
characteristic of it. Patient blogs prioritize being heard, believed and validated,
but in some cases, patients take up the language of EBP. Interviews with health
professionals indicate tension between the precepts of EBP and incorporation
of patients’ subjective experience into treatment decisions and diagnoses.
CONCLUSIONS: Findings suggest that the conception of ‘evidence,’ as it
commonly appears in connection with EBP, is challenging to learn and deploy
in all aspects of chronic pain care. Common conceptions of evidence may
obscure the realities of practice. These findings could inform approaches to
health professions education that better balance person-centered and
research-informed care.
52
MD Program, University of Toronto 2Department of Family and Community
Medicine
BACKGROUND: Chronic pain is widely acknowledged to be a growing
problem globally, due in part to its increasing prevalence, the rising cost of
chronic pain care, and risks associated with opioid prescriptions. As a result,
increasing attention is being paid to the education provided to medical students
and residents in managing chronic non-cancer pain. A previous scoping review
of the literature on medical education in chronic pain management undertaken
by the PI (FW) found that learners reported decreased empathy for pain
patients as they progressed through training. We investigated this finding
further by exploring the experiences of medical learners with patients with
chronic pain and how they perceive the role of empathy in their work.
OBJECTIVES: How is chronic pain management taught to medical trainees at
the University of Toronto? What are their reflections on the importance of
empathy in their work? METHODS: This was a descriptive qualitative study. A
total of 21 students were interviewed using a semi-structured interview guide.
Data were coded using NVIVO10 software. All researchers independently
coded the first three interviews, then collaboratively developed the coding
framework. Emergent themes were identified through regular team meetings.
RESULTS: Due to the subjective and incurable nature of pain, chronic pain
patients challenge biomedicine’s primary goals of diagnosis and cure. Chronic
pain patients were challenging for trainees because their care disrupts this
biomedical model. Through the hidden curriculum of medical education,
trainees came to perceive that their medical educators consider chronic pain
patients to be of limited educational value. DISCUSSION: Students’ professed
understanding of empathy was at odds with the description of chronic pain
patients as framed by the hidden curriculum. We propose that because the
experience of chronic pain is subjective and often incurable, these patients
may in fact present an excellent opportunity to teach empathy in the clinical
setting.
ABSTRACTS
MedEd-09
A NARRATIVE REVIEW OF CURRENT ANTIMICROBIAL STEWARDSHIP
TRAINING IN MEDICAL EDUCATION
S. Silverberg1, V. Zannella1, A. P. Ayala2, E. Lenton2, F. Friesen3, J. A. Lee1,
M. Law3-5
1
MD Program, University of Toronto, Toronto, Canada
Gerstein Science Information Centre, University of Toronto, Toronto,
Canada
3
Centre for Faculty Development, Li Ka Shing Knowledge Institute, University
of Toronto, Toronto, Canada
4
Department of Family & Community Medicine, Faculty of Medicine,
University of Toronto, Toronto, Canada
5
Toronto East General Hospital, Toronto, Canada
2
BACKGROUND: The rise in antibiotic resistance (AR) due to improper
antimicrobial use is a serious global challenge. In 2013, 1 in 12 hospitalized
Canadian patients was infected with a resistant microorganism daily, leading
to approximately 2000 deaths. Antimicrobial stewardship (AS) is integral to
fighting AR and usually targets physicians, but early intervention is desired. It
is unclear how early AS training is being conducted. OBJECTIVE: To explore
the incorporation and effectiveness of AS training in undergraduate and
postgraduate medical education. METHODS: OVID MEDLINE and EMBASE
were searched from inception to July 2015. 4069 titles and abstracts were
reviewed for research, review and opinion articles that address AS education
for undergraduate or postgraduate medical trainees. 41 articles were included
for full-text review and abstracted for intervention, purpose, study design,
participants, outcomes and Kirkpatrick's 4 levels of evaluation. RESULTS:
Historically, AS training was developed for postgraduates and only recently
emphasized undergraduates. Some articles evaluated knowledge but many
are program description without evaluation. No articles on undergraduate
teaching evaluated impact on prescribing behaviour after graduation. Most
studies were European; no Canadian articles on undergraduate teaching were
found. CONCLUSION: Our review sheds light on the current landscape of AS
training for learners, and identifies that more information on the impact of
undergraduate AS training programs on future prescribing behaviour is
needed. Such research will help identify effective ways of training responsible
prescribers in light of the global challenge of AR.
MedEd-11
DEVELOPING COGNITIVE TASK ANALYSIS-BASED EDUCATIONAL
VIDEOS FOR SURGICAL SKILLS IN PLASTIC SURGERY
C. Yeung1, C. McMillan2, P. Binhammer2
MedEd-10
T. Martimianakis, G.S.K. Tang
1
The Wilson Center 2University of Toronto
BACKGROUND: Medical Education is an internationally respected journal and
considered the leading journal of the medical education field. As such, it
provides a compelling data set with which to trace discursive changes in
medical education over the past half-century. Examination of the dominant
discourses in medical education has revealed the discourse of globalization to
have had a central role in the historical evolution of the journal and the medical
education field more broadly. RESEARCH QUESTION: This project focused
on elucidating the operations of the discourse of globalization within the journal
and traced the journal’s interest in the study of cross cultural medical
education, global health issues, the development of international standards
and competencies and other phenomena related to the formalization of a
global orientation. METHODS: A critical discourse analysis was conducted to
examine discourses of globalization in the journal Medical Education from its
inception to the present. This methodology was chosen for its strength in
illuminating power relations that underpin social practices. An archive of all
relevant articles was constructed by searching Web of Science for the
keywords ‘international’, ‘global’, ‘globalization’, ‘global health’, and
‘international health’ and limiting our search to the journal Medical Education
and the time period 1966 to 2015. RESULTS: A prominent trend throughout
the journal was the prioritization of ideas and knowledge originating from the
West (defined as predominantly English-speaking countries, but may also
include non-English-speaking countries of non-Communist Europe). This was
evident in the demographic findings and manifested in both covert and overt
ways throughout the journal’s discussions on international/global standards,
international students, pedagogies, and international/global health.
CONCLUSION: Though much of the journal’s discourse on globalization
reinforces and reproduces a hierarchy of Western dominance, some authors
attempt to challenge this trend by suggesting alternate ways of conceptualizing
globalization.
MedEd-12
AMBULATORY SURGERY EDUCATION – A NEW AREA OF FOCUS
Sara Yumeen, Cynthia Whitehead, Tulin Cil, Karen Devon, Nicole N.Woods
Women’s College Hospital, Toronto, ON
1
Faculty of Medicine, University of Toronto, Toronto, ON
Division of Plastic Surgery, Sunnybrook Health Sciences Centre, Toronto,
ON
2
BACKGROUND: The automation of procedural skills may impede knowledge
transfer from educators to trainees. Cognitive task analysis (CTA) is a method
used to understand decision-making in procedural learning, and is effective for
imparting unintentionally automated knowledge in surgical training.
OBJECTIVES: To identify surgical skills that plastic surgery residents should
be able to perform independently before entering residency, and create
educational videos using CTA. METHODS: A needs assessment survey was
sent to 78 junior plastic surgery residents in Canada to identify five important
plastic surgery skills. Three practicing plastic surgeons were videotaped
performing each skill and were asked to describe the procedure before
reviewing their video and giving a short interview. One cognitive demands table
per skill was created to compile all action decision, and check points described.
For each skill, the total number of steps identified, percentage of overlap
between surgeons, and the percentage of steps omitted were calculated.
Cognitive demands tables are currently being reviewed prior to developing
instructional videos. RESULTS: Twenty-eight junior residents responded to the
survey (36%). Videos for analysis and cognitive demands tables were created
for: subcuticular suturing, mattress suturing, hand splinting, digital nerve block,
and excisional biopsy. The number of steps identified through CTA ranged
from 20-50. Percentage of overlap by all three surgeons for each task ranged
from 11-30%, while the average percentage of steps that the surgeons
inadvertently omitted ranged from 42-50%. CONCLUSIONS: The use of CTA
is effective in identifying discrepancy between experts even for basic surgical
skills. Knowledge transfer from experts to novices may be teacher-dependent
and variable with little overlap. Data from this study is being used to identify
key teaching points in order to develop a standardized educational resource
for trainees.
INTRODUCTION: Canadian health care is shifting towards community-based
chronic care management and increasing rates of ambulatory surgery.
Increasing numbers of surgeries are being performed in the day surgery
setting compared to an inpatient hospital setting. It is the responsibility of
medical schools to ensure that the formal and informal curriculum appropriately
prepares future physicians and surgeons to practice in ambulatory settings. As
a first step towards advancing undergraduate ambulatory care education in our
local context, we must first understand the current educational landscape and
ambulatory training opportunities for medical students completing surgical
rotations. OBJECTIVE: To systematically catalogue the learning opportunities
in ambulatory care available in undergraduate surgery at the University of
Toronto. METHODS: We collated formal learning activities, teaching sites,
courses and assessments that target ambulatory care in order to gain an
understanding of types of learning experiences that might be best-suited to
ambulatory environment. RESULTS: Our review of the undergraduate medical
curriculum at the University of Toronto indicated that although ambulatory
surgery is outlined as a teaching point, there is little formal training in
ambulatory surgery. Students are required to attend ambulatory clinic as a part
of their surgery clerkship rotation, but beyond that, participation in ambulatory
surgery learning opportunities is left at the discretion of students and their
attendings. CONCLUSIONS: Currently, opportunities for formal ambulatory
education experiences on surgical rotations are limited. Dent et. al found that
students rotating through day surgery centres found it to be a useful opportunity
that is conducive to learning. Increased participation in ambulatory surgery
learning opportunities could better prepare medical students to practice in a
health care setting in which there is increasing amounts of ambulatory care.
53
INDEX
54
Author
Abstract
Page
Author
Abstract
Page
ABRAHAM, Josh
BS-01
11
DEY, Ayan
C-16
25
ABRAHAM, Liza
HS-01
46
DODINGTON, David
BS-06
12
ADAMICH, John
C-01
22
D'ORTENZIO, Robert
BS-07
12
AGNIHOTRI, Sabrina
C-02
22
DZIEGIELEWSKI, Claudia
BS-08
12
AKIOYAMEN, Leo
HS-02
46
EASTWOD, Kyle
QI-03
41
ALLMEN, Mark von
C-03
22
EIKELBOOM, Rachel
HS-06
47
ARBIV, Omri
C-04
22
ELPHINSTONE, Robyn
BS-09
13
ARYA, Sumedha
HS-03
46
FELFELI, Tina
BS-10
13
AVERSA, Vanessa
HS-04
46
FIGUEIREDO, Carlyn
BS-11
13
AXELROD, Daniel
MedEd-01
51
FIRDOUSE, Mohammed
QI-04
41
AZIZA, Eitan
MedEd-02
51
FRYML, Elise
PPH-03
38
AZIZI, Paymon
BS-02
11
FULLER, Jonathan
QI-05
42
BAI, Johnny-Wei
PPH-01
38
FUNG, Elizabeth
C-17
26
BAKER, Carmen
BS-03
11
GAZENDAM, Aaron
C-18
26
BARSCZYK, Mark
C-05
23
GIBBINGS, Nicole
QI-06
42
BETCHERMAN, Laura
C-06
23
GLICK, Lauren
C-19
26
BLICHOWSKI, Monica
C-07
23
GOLDBERG, Hanna
C-20
26
BRAR, Amanpreet
C-08
23
GOT, Matthew
C-21
27
BRICKMAN, Zane
PPH-02
38
GUPTA, Joel
C-22
27
BROWN, Morgan
HS-05
47
HABASHI, Rogeh
C-23
27
CHAN, Florence
C-09
24
HACHEM, Laureen
BS-12
13
CHAN, Justin
C-10
24
HALANI, Sheliza
C-24
27
CHAN, Ryan
QI-01
41
HAN, Carrie
C-25
28
CHEN, Marian
C-11
24
HARMSEN, Irene
BS-13
14
CHEUNG, Bonnie
C-12
24
HELSON, Erin
BS-14
14
CHEUNG, Patrina
C-13
25
HESS, Margaret
C-26
28
CHOW, Linda
MedEd-03
51
HIMELFARB, Jonah
BS-15
14
COZMA, Adrian
BS-04
11
HO, Bernard
C-27
28
CUI, Kangping
C-14
25
HOANG, Jenny
PPH-05
39
D'ABBONDANZA, Josephine
BS-05
12
HOWELL, Nicholas
BS-16
14
DAI, Serina
C-15
25
HU, Tina
HS-07
47
DESAI, Tejas
QI-02
41
HUYNH, Quynh
QI-07
42
INDEX
Author
Abstract
Page
Author
Abstract
Page
HUYNH, Sandra
HS-08
47
MOGHIMI, Saba
C-39
31
JAYALATH, Viranda
PPH-04
38
MOHAMMED, Muneeb
QI-11
43
KANGA, Neha
C-28
28
MUKOVOZOV, Ilya
BS-24
16
KERBEL, Brent
QI-08
42
MULHALL, Drew
BS-25
17
KHAN, Amanda
BS-17
15
MULTANI, Jasmine
C-40
31
KHAN, Haniya
PPH-06
39
NASIRZADEH, Yasmin
MedEd-07
52
KOBYLIANSKII, Anna
PPH-07
39
NOEL, Christopher
C-41
32
KOVEN, Alexander
C-29
29
OLTEANU, Cristina
QI-13
44
KRICHEVSKY, Liubov
C-30
29
PARTRIDGE, Arun
HS-12
48
KUMAR, Sachin
BS-18
15
PASCOAL, Erica
QI-14
44
KUSHWAHA, Sameer
PPH-08
39
PATEL, Priya
C-42
32
LAI, Ka Sing Paris
HS-09
48
PATEL, Neha
C-43
32
LANDON, Emily
MedEd-04
51
PENG, Jennifer
HS-13
49
LAYEFSKY, Miriam Hellstern
C-31
29
PERERA, Joseph Kishan
BS-26
17
LECHNER, Breanne
C-32
29
PETERSON, Wynn
HS-14
49
LEEM, Sangwoo
C-33
30
RAHMANI, Armin
QI-15
44
LEMIEUX, Valerie
HS-10
48
RAJENDRAM, Rageen
BS-27
17
LI, Christine
C-34
30
RAMJAUN, Aliya
QI-16
44
LIAO, Jane
C-35
30
RANGARAJAN, Sahaana
QI-17
45
LIONEL, Anath
BS-19
15
RIPSTEIN, Jonathan
HS-15
49
LO, Shun Chi (Ryan)
QI-09
43
ROSEN, Adam
C-44
32
LOZANO, Alexander
BS-20
15
ROSHANKAR, Golnaz
PPH-09
40
MA, Noelle
QI-10
43
RUBINGER, Luc
C-45
33
MANN, Aneet
BS-21
16
RYU, JaeEun
MedEd-08
52
MAQBOOL, Talha
HS-11
48
SAIKALEY, Kyle
BS-28
17
MARVASTI, Tina Binesh
C-36
30
SALDANHA, Lisa
C-46
33
MATTINA, Katie
BS-22
16
SCHOLL, David
BS-29
18
MAZEREEUW, Graham
C-37
31
SHAH, Ahmed
BS-30
18
MCQUEEN, Sydney
MedEd-05
52
SHAH, Sonam
HS-16
49
MESSINGER, Atara
MedEd-06
52
SHAN, Shubham
BS-31
18
MILENKOVIC, Jovana
C-38
31
SHEINIS, Michal
QI-18
45
MIRALI, Sara
BS-23
16
SILVA, Matthew Da
C-47
33
55
INDEX
56
Author
Abstract
Page
Author
Abstract
Page
SILVERBERG, Sarah
MedEd-09
53
YANG, Weining
BS-41
21
SINHA, Sucheta
C-48
33
YEUNG, Celine
MedEd-11
53
SITHAMPARAPILLAI, Arjun
PPH-10
40
YU, Janelle
C-61
37
SOLEAS, John
BS-32
18
YU, Xiao Xiong
HS-20
50
STEADMAN, Patrick
BS-33
19
YUMEEN, Sara
MedEd-12
53
STRUM, Scott
BS-34
19
YUNG, Eric
C-62
37
SZETO, Stephen
BS-35
19
ZAHR, Siraj
BS-42
21
TAGLIONE, Michael
HS-17
50
ZASLAVSKY, Kirill
BS-43
21
TAM, Alex Lai Chi
C-49
34
ZEWUDE, Rahel
C-63
37
TAN, Marcus
HS-18
50
ZHOU, WanLi
C-64
37
TANG, Katelynn
C-50
34
ZYLA, Roman
BS-44
21
TANG, Groonie Sok-Kau
MedEd-10
53
TAYLOR, Matthew
BS-36
19
TEICHER, Jessica
PPH-11
40
TOUTOUNJI, Sandra
QI-19
45
TSE, Tiffanie
C-51
34
TSOUTSOULAS, Christopher
C-52
34
VALBUENA, Venus
C-53
35
VAN ASSELDONK, Brandon
C-54
35
VANNER, Rob
BS-37
20
VOLL, Sarah
C-55
35
VORUGANTI, Teja
HS-19
50
VU, Trang
C-56
35
WALPOLE, Glenn
BS-38
20
WAN, Anthony
C-57
36
WANG, Jane
C-58
36
WANG, Annie
PPH-12
40
WANG, Xin Ye (Steven)
QI-12
43
WILLIAMS, Curtis
C-59
36
WU, Florence
BS-39
20
XU, Roland
BS-40
20
YAN, Jinhui (Bill)
C-60
36
NOTES
57
NOTES
58
NOTES
59
NOTES
60
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