Carolyn Morris

A bitter truth: 30 years of child welfare data reveals systemic inequities, racism and harm

Christopher.Sorensen — Mon, 20 Mar 2023 15:00:03 +0000

A bitter truth: 30 years of child welfare data reveals systemic inequities, racism and harm

Christopher.Sorensen Mon, 03/20/2023 - 11:00

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Participants hold a banner at Dundas Square in Toronto during a National Day of Truth and Reconciliation event on Sept. 30, 2021 (Photo by Shawn Goldberg/SOPA Images/LightRocket/Getty Images)

Carolyn Morris

Topic

Breaking Research

Child Development

Collaboration

Factor-Inwentash Faculty of Social Work

Indigenous

Research & Innovation

When the first Ontario Incidence Study of Reported Child Abuse and Neglect (OIS) was published in 1993, province-wide knowledge of child welfare investigation rates and outcomes was scarce.

“Whenever I tried to go get data, I couldn’t. It literally did not exist,” said Nico Trocmé, a professor at McGill University who led the first OIS study after spending several years on the frontline at a child welfare agency.

Barbara Fallon

Researchers have since produced a new Ontario study every five years, with the seventh iteration – led by Barbara Fallon, a professor in the University of Toronto’s Factor-Inwentash Faculty of Social Work – launching later this year.

The remarkable 30-year research undertaking, which includes four Canada-wide studies and two studies specific to First Nations, has revealed hard truths related to racism and deep inequalities for First Nations as well as Black, Latin American and other racialized communities.

“These data aren’t everything, but they’re certainly foundational to understanding how we can serve children and families in a more responsive way,” says Fallon, who stepped into the role of principal investigator of OIS after serving as project manager on the 1998 study. Fallon is also �Թϱ��’s associate vice-president, research and Canada Research Chair in Child Welfare.

Working in collaboration with community partners, the studies’ researchers have shown that not only are families in racialized communities much more likely to be investigated by child welfare agencies, but their children are also removed at disproportionately higher rates than in investigations involving white families.

By compiling and analyzing hundreds of thousands of child maltreatment investigations across the province and country, the studies also show how these disparities are getting worse.

Across Canada in 2008, First Nations families were four times more likely to be investigated and almost 12 times more likely to have their children removed from the home at the conclusion of a child maltreatment-related investigation than non-Indigenous families in sampled agencies. In 2019, a First Nations child was a staggering 17 times more likely to be placed in care.

The wide-angle view of these studies has enabled researchers, community leaders and policy makers to recognize problems and needs at a societal level.

“So often in child welfare, we codify the wrongdoing at the level of the parent,” says Cindy Blackstock, executive director of the Caring Society and a professor at McGill University’s School of Social Work. Blackstock earned a PhD in social work from �Թϱ�� in 2009 and received an honorary degree from the university in 2018. “And I will hold parents’ feet to the fire for things they can change. But in so many of these cases, it’s actually things beyond their control.

“This type of data allows us to push for change at those systemic levels often held within government policies and legislation.”

Read the full story at the Factor-Inwentash Faculty of Social Work

'Chronic pain really challenges the medical model of health care': �Թϱ�� experts talk about the opioid crisis

noreen.rasbach — Mon, 06 May 2019 19:21:16 +0000

'Chronic pain really challenges the medical model of health care': �Թϱ�� experts talk about the opioid crisis

noreen.rasbach Mon, 05/06/2019 - 15:21

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Moderator André Picard with panellists from �Թϱ��, Tania Di Renna, Judith Hunter, Andrea Furlan and Abhimanyu Sud

Topic

Tania Di Renna is dressed as a firefighter to drive home the analogy she is making about chronic pain.

“There’s no more fire, but her alarm bell is still ringing,” said the University of Toronto assistant professor of anesthesia in describing a breast cancer patient whose pain after a mastectomy has turned chronic. While the patient’s tissue seems to have healed after surgery, her “stove” is no longer on fire and her body’s nervous system is still sounding the alarm.

“Three months and five opioid prescriptions later, she still has pain,” said Di Renna. “She can’t hug her husband or kids, she is irritable, anxious and short. She’s not using her stove and everyone is going hungry.”

Di Renna was part of a recent Faculty of Medicine event called UofTMedTalks, moderated by Globe and Mail public health reporter André Picard, that explored what happens when pain is no longer a symptom but becomes the disease. With an estimated 20 per cent of Canadians suffering from chronic pain – and with more than 10,300 Canadians lost to opioid overdoses since 2016 – it’s a weighty question.

At the event, �Թϱ�� pain experts from a number of specialties delved into the complexities of pain medicine, the opioid crisis and crucial advances in research, education and clinical care.

Di Renna described how the Toronto Academic Pain Medicine Institute (TAPMI), where she serves as medical director, is now the hub for chronic pain care in Toronto. “We try to get people to move again…to love their stove,” she said.

With the risk of acute pain during surgery developing into chronic pain, she stressed the key role of anesthesiologists in preventing its onset, through interventions before and during surgery.

Assistant Professor Judith Hunter of �Թϱ��'s department of physical therapy spoke of changing the curriculum to focus on cognitively targeted exercise as a way to retrain the brain and change pain. Family physician Abhimanyu Sud reflected on the importance of educating practitioners about safer opioid prescribing. Associate Professor Andrea Furlan of the department of medicine explained chronic pain as an invisible disability, and highlighted her work equipping health-care providers across Ontario to treat patients appropriately.

“What’s going on out there? Is it a war on drugs? An overdose crisis? A pain crisis? A war on pain patients?” asked Picard. “It’s one of the worst public health crises we’ve had in this country in modern times. It’s everywhere but it’s invisible at the same time.”

This invisibility struck Sud when reflecting on his time as a trainee on an emergency medicine rotation in 2008. He had been in the middle of an opioid crisis, but hadn’t realized it. It contrasted with the widespread awareness of the SARS outbreak. Now, as course director of the �Թϱ�� Continuing Professional Development safer opioid prescribing program, Sud is helping increase education around opioids with medical practitioners.

“Chronic pain really challenges the medical model of health care. Chronic pain is subjective, and it’s not always obvious using the tools that we typically use in medical care, like MRIs and blood tests,” said Sud. “We’ve moved so far away from a holistic approach in medicine. My hope is that we can learn from the opioid crisis to reform and improve our care.”

This is the type of change Hunter has led in physical therapy education, informed by her PhD in pain neuroscience. “As physical therapists, we learned that pain reflects what’s going on in the tissues, and we use that to find the tissue at fault and fix it,” she said. “That works well in acute pain, but not in chronic pain.”

With physical activity recognized as the most effective treatment for a range of chronic pain conditions, the new curriculum teaches students to use physical exercises – not just to strengthen tissues, but to actually change processing in the nervous system. “And that’s not easy because it hurts for these people to move, and most fear that moving will cause further harm,” said Hunter.

Of course, this interdisciplinary care takes much more time and resources than prescribing a pill – in the short term at least. But not only have opioids led to addiction and our current health crisis, Furlan pointed out that they can also make the pain worse.

“If you give opioids when the alarm system is broken, you can make the alarm system even worse,” said Furlan, who is also a clinician and senior scientist at the University Health Network’s Toronto Rehabilitation Institute. As a physiatrist – a medical specialist focused on rehabilitation – she led the development of Canada’s opioid guidelines, and educates health providers across Ontario through Project ECHO, a virtual knowledge-sharing network.

She pointed out how hard it is to treat chronic pain effectively: “It takes five minutes to give an opioid prescription and the patient leaves happy. But it takes 30 minutes to say ‘no’ to a prescription. And then you have to find alternatives, including self-management, exercises, retraining the pain system.”

“It is in complex areas like this where research and education become so critically important, said Darina Landa, the Faculty of Medicine's executive director of Advancement. She described �Թϱ��’s strengths as Toronto’s only Faculty of Medicine within a leading network of affiliated hospitals and health care sites.

“We’re uniquely positioned at �Թϱ�� to tackle some of health care’s most complex questions and challenges, such as pain medicine,” she said.

�Թϱ��'s Stephanie Zhou on the huge response to her essay about fitting in at medical school

noreen.rasbach — Mon, 26 Nov 2018 17:33:41 +0000

�Թϱ��'s Stephanie Zhou on the huge response to her essay about fitting in at medical school noreen.rasbach Mon, 11/26/2018 - 12:33

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Stephanie Zhou is an alumna of the Faculty of Medicine and a family medicine resident

Topic

Stephanie Zhou hit a nerve last year when the then Faculty of Medicine student wrote an opinion article in the Journal of the American Medical Association (JAMA) called “Underprivilege as Privilege.” She wrote that she grew up in poverty – and hid her identity to feel included at medical school.

“I studied hard and worked two part-time jobs during university to fund my medical school applications, but throughout the whole process, it was clear that one had to come from privilege to easily apply and assimilate into the medical culture," Zhou wrote in the essay that was reprinted in the Toronto Star.

But, she wrote, she realized she “did fit into medicine” when she left the classroom and saw patients who shared her socioeconomic background.

More than a year after her essay appeared in JAMA, Zhou spoke with Faculty of Medicine writer Carolyn Morris about the overwhelming response she received and her biggest takeaways.

What was it about your story that seemed to resonate the most with people?

I was surprised at how many people got in touch to tell me they’d been in a similar situation in medical school. It can be hard to see someone’s socioeconomic status, so it’s something that’s easy to hide. Most people who go into medical school are from well-off families – so your classmates have very different spending habits than what you’re used to.

I heard a lot of stories of people hiding their backgrounds in an attempt to fit in – whether they felt like an outsider because of socioeconomic status, or having come in with an unconventional undergraduate degree, instead of sciences.

Now that you’re a resident, have you had experiences where your socioeconomic background has helped you understand your patients?

Now that I’m in practice, I definitely find it’s helpful. I’ve been doing my family medicine residency at Sunnybrook Health Sciences Centre, and in my emergency medicine block I’ve seen a lot of people come into the ER instead of going to a family doctor, because they don’t have one. I’ve been able to help them go about finding a regular family physician, and talking to them about why it’s important. I’ve also had conversations about nutrition and how to go about getting healthy foods cheaply.

If you’ve had family members who’ve dealt with everything that comes along with financial stress, you’ll remember just how hard it can be. Just like I wrote in the JAMA article, I fit in with my patients. If you treat a patient only for chest pain, they’re not going to get better if you don’t talk about nutrition, weight, smoking, financial stress and other issues.

The Faculty of Medicine is currently focusing a lot of attention on student financial support, including providing matching opportunities for donors who support bursaries. Can you speak to how funding helped you throughout your studies?

Bursaries helped me a lot. Whereas I had worked several jobs during my undergraduate studies, I had only one during medical school, as a lab technician in the evenings. I never had to skip class to work and having less financial pressure meant I could spend time on doing things for career development and getting involved in the student community.

It was like being at a buffet – all of a sudden I had so many options available to me in my spare time. I did a master’s degree in system leadership and innovation, got involved in the faculty’s student-run IMAGINE clinic, served as producer of the student theatre production Daffydil, and got involved in �Թϱ�� Medical Society’s Pacemakers Dragon Boat Club. I could only do all of this because I was getting financial support. And the experiences were so enriching – not only to my professional development, but also being able to make a lot of friends and have such great memories of medical school.

Did your JAMA article lead to any new opportunities?

In addition to the many people reaching out and sharing their stories, another thing that’s come out of it is my current work with the Faculty of Medicine’s diversity mentorship program. I’m involved in a research project focused on how to improve the program for equity-seeking groups, especially around those factors that might not be easy to see, including socioeconomic status, religion or sexual orientation. We’re looking at ways to guide mentors and mentees through what can sometimes be awkward or sensitive conversations to begin about diversity issues.

What’s next for you?

I have a little over a year left in my family medicine residency. I’m also interested in addictions medicine and working with homeless populations. I had the opportunity to do an addictions medicine practicum at the Boston Health Care for the Homeless Program as part of my master’s degree, and I think there’s a real need for this type of care here in Canada.

�Թϱ�� brings prestigious Amgen Scholars program to Canada

noreen.rasbach — Thu, 01 Nov 2018 04:00:00 +0000

�Թϱ�� brings prestigious Amgen Scholars program to Canada

noreen.rasbach Thu, 11/01/2018 - 00:00

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“We have this incredible ecosystem of collaboration,” says Professor Leah Cowen, shown working with students in her laboratory (photo by Steve Southon)

Carolyn Morris

Topic

Global Lens

Faculty of Medicine

Leslie Dan Faculty of Pharmacy

Research & Innovation

Undergraduate Students

Subheadline

The potential for biomedical research to advance human health is huge – with stem cell science, immunotherapy, genetic technologies and other areas transforming the way we understand and treat disease. In today’s complex research landscape, diverse expertise, fresh ideas and cross-disciplinary collaboration are key to innovation.

Yet many aspiring scientists face barriers, whether due to socioeconomic status, geographical location, or belonging to historically marginalized groups. Securing work or studies in research, for instance, often hinges on prior research experience.

The Amgen Scholars Canada program aims to change that by ensuring talented, motivated students from across Canada have access to top research facilities and mentors. Beginning in 2019, 15 Canadian undergraduate students will be welcomed to Toronto for a fully funded, 10-week, hands-on research placement at the University of Toronto’s Faculty of Medicine and Leslie Dan Faculty of Pharmacy.

“We’re thrilled to be launching the Amgen Scholars Canada program here at �Թϱ��,” says Professor Vivek Goel, �Թϱ��'s vice-president of research and innovation. “By offering valuable research experience to undergraduate students and prospective researchers across the country, and fostering connections with our leading investigators, this program is fuelling tomorrow’s innovations.”

While 2019 will be its first year in Canada, the Amgen Scholars program has operated since 2006, based at top research universities in the United States, Europe and Asia, including Harvard University, the Massachusetts Institute of Technology and the Karolinska Institutet in Sweden. Close to 4,000 Amgen Scholars have participated to date, gaining laboratory experience and mentorship by leading scientists, as well as attending seminars, workshops, networking events and regional summer symposiums – career development features that are crucial components of all Amgen Scholars programs.

Many Amgen Scholars have gone on to pursue advanced graduate degrees, with alumni accolades including the NIH Director's New Innovator Award, the Rhodes Scholarship, and selection to the Forbes 30 Under 30 list in health care.

Through a total commitment of more than US$21 million over four years, Amgen Foundation is bringing the program to Canada and Australia for the first time, and to eight new partner institutions, including Johns Hopkins University and Yale University. The �Թϱ�� Amgen Scholars Canada program will be one of 24 worldwide, and the only one in Canada.

“As the pace of innovation increases, so too does the need to educate the scientists of tomorrow,” says Robert A. Bradway, chairman and chief executive officer of the biotechnology company Amgen. “We look forward to further expanding the reach of the Amgen Scholars program, which has already provided research opportunities to thousands of talented undergraduates at premier institutions around the globe, and now has the potential do much more.”

Not only will the program help talented and academically strong undergraduate students get a foot in the laboratory door, it will also lead to new networks and set the stage for future collaboration – aligning with the Amgen Foundation’s mission to empower tomorrow’s innovators and advance excellence in science education.

“Students and trainees bring so many fresh ideas and perspectives to our work,” says Stéphane Angers, associate dean of research at �Թϱ��’s Leslie Dan Faculty of Pharmacy and professor at both Leslie Dan and the Faculty of Medicine. “We often keep in touch long after they move to other institutions, and the connections often lead to research collaborations down the road.”

As an Amgen Scholars Canada program supervisor, Angers will be welcoming scholars into his lab to help study the genetic circuitry involved in diseases such as high-fatality cancers, using advanced proteomic and genomic tools.

“It’s really exciting work, especially with the advanced technologies like CRISPR-Cas9 that speed up the discovery process enormously,” says Angers. “Now that we’re able to pinpoint specific genes and proteins at play in disease processes, we are able to start developing new therapies to target them.”

Canada’s Amgen Scholars will also have the chance to experience Toronto’s unique biomedical ecosystem. �Թϱ�� is the research and educational hub within Toronto’s vibrant network of world-leading hospitals and health-care sites, and the only medical school in the diverse Greater Toronto Area of six million people.

“We have this incredible ecosystem of collaboration,” says Professor Leah Cowen, who is chair of the department of molecular genetics and will also be a supervisor in the program. “We have outstanding students, world-leading researchers and a strong interdisciplinary network that all come together to catalyze imagination, innovation and discovery.”

In her MaRS Discovery District-based lab, Amgen Scholars will help discover and develop molecules with the potential to tackle deadly fungal pathogens – estimated to kill close to 1.5 million people around the world every year.

“The world needs more talented scientists who are continually innovating, and Canada is an ideal incubator for thought leadership and scientific discovery,” says Francesco Di Marco, Amgen Canada vice-president and general manager. “We are excited to foster science education in Canada, and to collaborate with the world-class researchers at the University of Toronto through the expansion of this proven, successful Amgen Foundation program.”

By helping aspiring scientists delve into leading biomedical research, the Amgen Scholars Canada program is poised to inspire and equip a new generation of health leaders and innovative researchers.

�Թϱ�� is now accepting applications for the 2019 Amgen Scholars Canada program, until Feb. 1, 2019. For more information, or to apply, visit the website.

�Թϱ�� faculty members in Canada’s Top 40 Under 40

Romi Levine — Wed, 04 Jul 2018 17:20:03 +0000

�Թϱ�� faculty members in Canada’s Top 40 Under 40

Romi Levine Wed, 07/04/2018 - 13:20

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�Թϱ�� Associate Professor Ana Andreazza is one of Canada's Top 40 under 40 (photo courtesy of Faculty of Medicine)

Topic

Institute of Health Policy Management and Evaluation

Dalla Lana School of Public Health

Faculty of Medicine

Research & Innovation

Ana Andreazza’s research explores how mood disorders and brain diseases can be affected by malfunctioning mitochondria – the part of a cell that converts food into the chemical energy people need to live. A malfunction can wreak havoc across the body, disrupting the work of major organs.

Andreazza, who is an associate professor at the University of Toronto’s department of pharmacology and toxicology in the Faculty of Medicine, has been named one of Canada’s Top 40 under 40 – celebrated for her pioneering work and for creating a national research network to bring this poorly understood area of medicine out of the shadows.

Canada’s Top 40 Under 40 is an annual list of leaders compiled by the recruiting firm Caldwell and the accounting, tax and business consulting firm MNP. The top 40 were selected from more than 800 nominees by an independent advisory board of business leaders from across Canada. They were judged on: vision and innovation; leadership; impact and influence; and social responsibility.

Along with Andreazza, two other �Թϱ�� faculty are among the top 40: Dr. Vipan Nikore, a lecturer at the Faculty of Medicine, and Laura Rosella (pictured left), an associate professor of epidemiology at the Dalla Lana School of Public Health (DLSPH).

“Laura is quickly becoming a research powerhouse and this recognition is incredibly well deserved,” says Adalsteinn Brown, the dean of DLSPH.

Rosella’s research helps answer questions posed by provincial decision-makers by analyzing population-based health data and providing health system feedback to researchers, policy-makers and hospital administrators. Her lab develops a range of prediction models designed to support the way health data is used for a more proactive approach to health system decision-making.

Her team is now embracing artificial intelligence by expanding current data and methods used to develop predictive models for health applications. As a new faculty member in �Թϱ��’s Vector Institute for Artificial Intelligence, she is looking to make machine learning and artificial intelligence applicable and useful to guide a more equitable, sustainable and effective health system.

'The ripple effect is continually expanding': �Թϱ��’s Prakash Fellowship for global surgery

noreen.rasbach — Wed, 23 May 2018 13:32:04 +0000

'The ripple effect is continually expanding': �Թϱ��’s Prakash Fellowship for global surgery

noreen.rasbach Wed, 05/23/2018 - 09:32

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Dr. Grace Muthoni will return to Kenya after her year-long A.K. Prakash Fellowship in International Medicine at �Թϱ�� (photo by Matt Volpe)

Topic

Dr. Grace Muthoni is one of Kenya’s two formally trained pediatric neurosurgeons – for a population of more than 48 million people.

When she returns to her country after completing a year-long University of Toronto fellowship, she will bring crucial neuro-technology skills as well as access to a newly formed international professional network. All this adds to her continued resolve to transform lives.

“Children with no access to this care are dying or debilitated by otherwise curable brain tumours, drug-resistant epilepsy and other congenital abnormalities,” she says. “I’m gaining a global perspective, so I can become a local solution and make a difference in my country.”

Through the A.K. Prakash Fellowships in International Medicine, Muthoni is among a growing cohort of doctors who train in a surgical specialty at �Թϱ�� and one of the nine fully affiliated teaching hospitals for six months or a year, before returning to their low- or middle-income countries to build and strengthen clinical care and education.

This month, all current and former A.K. Prakash Fellowship recipients – from Zimbabwe, Nigeria, Ethiopia, Trinidad and Kenya – will gather in Toronto to attend the Bethune Roundtable in Global Surgery meeting.

“Hearing of the impact our fellows are having is just incredible,” says Ash Prakash, who funds the fellowships and is providing travel scholarships to bring these global surgeons to Toronto again and together for the first time. “They’re improving care, and also launching their own training programs in their countries – the ripple effect is continually expanding.”

Prakash alumni integrate specialized procedures, such as minimally invasive laparoscopic surgery and complex pelvic and hip socket fracture management, into clinical care within their countries. They also build local capacity by establishing residency and fellowship programs of their own, as well as developing regional professional associations and partnerships – multiplying the impact of their �Թϱ�� training.

Dr. Grace Muthoni and Dr. James Rutka, �Թϱ��'s chair of the department of surgery, who has supervised Prakash Fellowship recipients (photo by Matt Volpe)

As one example, Prakash orthopedic surgery alumnus Dr. Sami Hailu has created a specialized fracture management centre in Ethiopia, transforming his hospital into a regional training centre for managing pelvic and hip socket fractures. And along with another Prakash alumnus, Dr. Geletaw Tessema, he started a trauma fellowship in Ethiopia, teaching trainees from Ethiopia as well as from neighbouring countries. They’re bringing the country’s cadre of trauma surgeons up from a total of two.

For Hailu, this progress is personal. Just weeks after graduating from medical school, he was in a serious car accident, breaking multiple bones in his thigh and foot. He was told only one surgeon in the country was able to fix his bones properly. “That was when I promised myself to study orthopedics and bring about change in care,” he says.

He’s just getting started. As he builds on his clinical care and fellowship programs, he’s also working with the government to develop a nationwide trauma system and travelling internationally to give courses, including in Kenya and the United States.

Meanwhile, another Ethiopian former Prakash Fellowship recipient, Dr. Tihitena Negussie Mammo, is enhancing the country’s capacity in pediatric surgery, most notably by offering new minimally invasive laparoscopic surgeries, and launching a residency program.

“Half our population in Ethiopia lies in the pediatric age group, and yet the number of well-trained pediatric surgeons is limited,” she says. “The �Թϱ�� fellowship has allowed us to improve our postgraduate training and double the number of qualified pediatric surgeons – with some of them moving out of the capital Addis Ababa to different regions of the country.”

The Prakash Fellowship launched in 2013. One of the first recipient was Zimbabwe’s Dr. Faith C Muchemwa, who became one of the country’s two plastic surgeons and has plans to build the country’s capacity in reconstructive procedures such as burn care and congenital malformations. The other was Nigeria’s Dr. James A Balogun, who returned to train residents and medical students in pediatric neurosurgery and is leading a new professional group within the Society for Neuro-Oncology Sub-Saharan Africa focused on brain and spinal cord tumours.

“We’ve learned so much from the fellows who have come,” says Dr. James Rutka, a professor and chair of the department of surgery in �Թϱ��'s Faculty of Medicine who has supervised Prakash Fellowship recipients. “Many of them are establishing training programs and clinical centres and meeting urgent patient needs in their countries.”

For �Թϱ�� President Meric Gertler, such stories drive home the value of building international partnerships – one of the university’s top strategic priorities. “The Prakash Fellowships provide a wonderful example of the power of philanthropy in the advancement of the University of Toronto as a major force for good in our world,” he says. “We are so grateful to Ash Prakash for his tremendous generosity and vision.”

As for Muthoni, she’s optimistic about her return to Kenya – and is looking forward to meeting her Prakash Fellowship alumni community this month.

Almost two years later, medically assisted dying remains complicated, �Թϱ�� experts say

noreen.rasbach — Wed, 16 May 2018 04:00:00 +0000

Almost two years later, medically assisted dying remains complicated, �Թϱ�� experts say

noreen.rasbach Wed, 05/16/2018 - 00:00

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From left, Maureen Taylor, Camilla Zimmermann, Jeff Myers and Sandy Buchman all took part in the Faculty of Medicine's event on end-of-life care

Topic

As a journalist, Maureen Taylor remembers covering the case of Sue Rodriguez, who was denied assisted suicide through a Supreme Court decision in 1993. At the time, Taylor couldn’t have imagined that 10 years later she’d be surreptitiously investigating a way to help her own husband, Dr. Donald Low, take his life.

After a terminal cancer diagnosis in 2013, the University of Toronto professor and infectious disease specialist longed for control over how and when he would die. Frustrated at not having that choice, Low made a compelling case for the right to assisted dying in a widely viewed video, released after his death.

Taylor – who had already transitioned from award-winning health journalist to physician assistant – took on yet another vocation: assisted dying advocate. She co-chaired an expert panel making recommendations to government and has spoken out publicly for changes in legislation.

She recently joined �Թϱ�� physicians, educators and researchers at a Faculty of Medicine event called UofTMedTalks, where they delved into how end-of-life care is changing in the era of medical assistance in dying.

“It’s been almost two years since Canadians have had the right to discuss assisted dying with a health-care provider, but how is the system working?” Taylor asks. “How easy is it to navigate, for patients and for health-care providers?”

It’s complicated, was the resounding consensus.

As medical assistance in dying has shifted from controversial debate to constitutional right, there’s a clear need for more research and education to address gaps in knowledge and access, especially for the broader field of palliative care, the speakers said.

One of the big surprises was the unease among many palliative care specialists to be involved in medical assistance in dying. Having worked hard to counter the misconception that palliative care hastens death, many of these specialists found this new function at odds with their practice.

“Medical assistance in dying is 100 per cent palliative care,” says Jeff Myers, an associate professor in �Թϱ��'s Faculty of Medicine, “and at the exact same moment it’s 180 degrees opposite of palliative care.”

Myers – the W. Gifford-Jones Professor in Pain Control and Palliative Care, head of the division of palliative care in the department of family and community medicine and site lead at Sinai Health System’s Bridgepoint Palliative Care Unit – is focused on reconciling this contrast.

“Now in Canada, the end-of-life part of palliative care is inextricably linked with medical assistance in dying,” he says. He shared his own recent experiences providing the procedure, and reflected on the hope and relief it offered patients.

For Sandy Buchman, an associate professor in the department of family and community medicine, it was that relief from suffering that convinced him to provide medical assistance in dying. As a family and palliative care physician with the Sinai Health System’s Temmy Latner Centre for Palliative Care, Buchman cares for patients at end of life, in their homes.

Buchman didn’t set out to provide medical assistance in dying – or even palliative care before that. As a family physician, it was patients with HIV/AIDS who introduced him to the field of palliative care. And more recently, as he was grappling with the decision of whether he would provide medical assistance in dying when it became legal, a patient and �Թϱ�� professor and cardiologist who suffered from advanced Parkinson’s asked if Buchman would help.

“Just the hope that MAiD [medical assistance in dying] offered him was incredible to me,” he says. “I went into medicine to relieve suffering.”

Buchman came to consider medical assistance in dying as consistent with these values.

It’s not the only way to relieve suffering, however, stresses Buchman. When patients are given other options to manage pain and reduce suffering – core goals of palliative care medicine – many will no longer request medical assistance in dying.

This is one of the frustrations in the palliative care community: With so much attention on medical assistance in dying, some feel that unmet needs in palliative medicine continue to be overlooked.

“MAiD is only a choice if there’s another option,” says Myers, who worries that not enough Canadians have access to palliative care. He hopes the spotlight shining on medical assistance in dying will help illuminate the broader field of end-of-life care.

Already, researchers and palliative care specialists like Professor Camilla Zimmermann have been transforming our understanding of the field. A professor in the departments of medicine and psychiatry and palliative care physician and senior scientist at the University Health Network’s Princess Margaret Cancer Centre, Zimmermann holds the Rose Family Chair in Palliative Medicine and Supportive Care. She has shown how early access to palliative care – starting at the time of diagnosis – leads to greater quality of life.

While she recognizes there wouldn’t be enough palliative care specialists for every patient in need, she believes education is key. She says we should be training all medical students and many specialists in providing some level of palliative care.

“If you’re a specialist in lung cancer,” she gives as an example, “you should really know how to treat shortness of breath.”

While much remains to be done, there’s been major progress, in both palliative medicine education and in medical assistance in dying. Just last year, Zimmermann and Myers have helped launch a new Royal College subspecialty training program in palliative medicine at �Թϱ��. And researchers and educators have been developing guidelines and best practices about medical assistance in dying.

“It is in complex areas like this that knowledge, expertise and passion, become so essential,” says Faculty of Medicine’s Executive Director of Advancement Darina Landa, who hosted the event.

Maureen Taylor still has questions, both in her role as a health-care provider, and advocate: “If a patient doesn’t bring MAiD up as an option, can I? Is that appropriate?"

�Թϱ�� researchers and educators are committed to examining this question and the the field’s many other grey areas,

�Թϱ�� project harnesses medical data from seven affiliated hospital sites to improve care

rasbachn — Wed, 25 Oct 2017 20:55:32 +0000

�Թϱ�� project harnesses medical data from seven affiliated hospital sites to improve care

rasbachn Wed, 10/25/2017 - 16:55

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GEMINI founders Amol Verma (left) and Fahad Razak (photo by Jacklyn Atlas)

Carolyn Morris

Topic

Our Community

Faculty of Medicine

As an internal medicine resident at University of Toronto, Amol Verma realized the patients he was seeing – aging patients with multiple chronic diseases – weren’t reflected in medical literature. He and his former MD classmate, Fahad Razak, an assistant professor in �Թϱ��'s Faculty of Medicine, want to change that. They launched the General Medicine Inpatient Initiative – or GEMINI – to integrate internal medicine data from seven �Թϱ��-affiliated hospital sites, enabling ongoing research on current patients, their treatments and health outcomes.

Verma spoke with Faculty of Medicine writer Carolyn Morris about the project.

How did you notice the difference between patients in the hospital and those in medical literature?

As an internal medicine resident, I would often see aging patients with multiple chronic conditions. They might have dementia and at the same time be recovering from a stroke. Or they’d have a heart condition, a lung condition, and be suffering from kidney failure. When I’d look to the medical literature to inform clinical care, though, I realized that most of it didn’t apply to my patients. The focus would be narrow – typically involving younger populations with a single condition. The science on multiple conditions just wasn’t there, so we were looking at our patients through a bit of a black box.

As I progressed through medical school and residency, it also really felt like internal medicine wards were getting busier and facing more complex cases. But we didn’t really have the data collected or interpreted to confirm that.

How did you go from having these insights to launching GEMINI?

I got together with my friend and colleague Fahad Razak, an internist, epidemiologist and professor in the Department of Medicine, based at St. Michael's Hospital. We thought, if there’s a lack of information about patients like ours, why don’t we start studying the patients we take care of? Why don’t we try to understand and learn from them, and improve how we’re able to treat them? Fahad and I had collaborated in the past, including launching The Rounds Table, a podcast about new research in medicine hosted by Healthy Debate.

We started brainstorming ideas, and looked into how we could bring data together to research current patients and their care – and also make the data available to others for any number of research questions. We ended up launching the General Medicine Inpatient Initiative, or GEMINI. In theory, you’d think this information would be easy to access, but we’ve had to work with 20 or more information systems across seven major hospital sites to pull this data together and analyze it. While the Institute for Clinical Evaluative Sciences has done enormous and sophisticated work using administrative data, the data in this project delves into treatment decisions, resources used in hospital and patient outcomes – it’s clinical versus administrative data. We’re the first project in general medicine to pull this data together at this scale in Canada.

What have you found out so far?

First, we demonstrated there was a 30 per cent increase in the number of patients in internal medicine over five years, from 2010 to 2015. Our patients have six coexisting conditions on average, which highlights the importance of developing a new evidence base to understand the care of these patients. We’ve started to identify variations in care between different doctors and hospitals that suggest there are important opportunities to improve patient outcomes and reduce unnecessary care.

We’ve also examined cases of delirium in admitted patients and found them to be quite high – at around 18 per cent. If you only use administrative health data, you miss the vast majority of these cases. Delirium is linked to increased mortality and cost of care, so we’re continuing to study this to determine ways to improve care for these patients.

Our biggest contribution with GEMINI, though, is creating an infrastructure to share clinical data, study our patient population and continuously improve care.

You’re doing this project as a Phillipson Scholar in the department of medicine’s clinician-scientist training program. How has this program supported your work?

Immensely. I’m able to do this project because of the support I’ve gotten through the clinician-scientist training program. It allows me to dedicate 90 per cent of my time to research. And this is a big deal considering how hard it is right now for scientists to secure funding. It also connects me with supervisors in the field – I’m learning so much from Professors Muhammad Mamdani, Moira Kapral, Andreas Laupacis and other colleagues.

It’s important for clinicians to be involved in research. As an internal medicine resident, I can see opportunities and pressure points up close, from the patients I’m interacting with. The daily questions that come out of clinical care end up informing research questions and then, we’re able to bring our findings back into the clinic. We’re really well positioned to use research to improve patient care.

�Թϱ�� psychiatrists launch initiative to spot signs of psychosis early in adolescence

ullahnor — Thu, 09 Feb 2017 21:43:04 +0000

�Թϱ�� psychiatrists launch initiative to spot signs of psychosis early in adolescence

ullahnor Thu, 02/09/2017 - 16:43

Cutline

Painting by Toronto artist Jessgo at the inaugural Miner's Lamp award dinner in 2016, an initiative of IAMGOLD and partners to support �Թϱ�� psychiatry research (photo courtesy of Faculty of Medicine)

Carolyn Morris

Author legacy

Carolyn Morris

Topic

Adolescence is a challenging period for everyone, but for those with mental illness, it’s particularly sensitive.

Between the ages of 14 and 25 – known as a “transition age” – is a time when symptoms of psychosis are known to appear. It's also when people switch from child mental health services into adult care – not always a seamless process.

Joanna Henderson, an assistant professor, and Dr. Aristotle Voineskos, an associate professor, both from �Թϱ�� Faculty of Medicine's department of psychiatry and CAMH, are launching a new research project aimed at identifying early signs of psychosis. The ideas is that if we could spot the signs early, we could potentially ensure continuous care for the most vulnerable.

They spoke with �Թϱ��'s Carolyn Morris about the new initiative, which is receiving key funding from the Miner’s Lamp Innovation Fund in the Prevention and Early Detection of Severe Mental Illness, a philanthropic initiative of IAMGOLD Corp. and its partners.

How are you setting out to identify the signs of psychosis early?

Aristotle Voineskos: Due largely to the way the brain develops, symptoms of psychosis only tend to emerge in mid to late adolescence. And while we’ve found certain associated biological or social factors, for the most part, researchers haven’t yet figured out what puts certain people at higher risk of developing psychosis symptoms later on.

These are much more common in youth than people realize – up to 20 per cent in the community if you include mild symptoms. We’re not talking about risk for schizophrenia. That’s not what this study is about. Instead, we’re focused on studying the number, severity and course of psychosis symptoms over time, and how those symptoms impact functioning.

One place we often forget to look at is young people who already have a mental health condition. Early psychosis has typically been the domain of adult psychiatrists, but we really need to partner with child and youth psychiatrists to understand trajectories of development and illness.

Recent research findings have found that kids who are diagnosed with conditions like autism spectrum disorder, oppositional defiant disorder or ADHD are at a higher risk of developing symptoms of psychosis later on. But that’s still a broad group of people, and only a fraction of them will actually go on to struggle with psychosis so we’re planning to follow a group over time and try to identify other possible signs that might serve as red flags.

What happens in our current system?

Joanna Henderson: There can be a number of challenges getting access to care, but if all goes well, a young person who is experiencing difficulties would be getting the care they need for ADHD or other diagnoses.

They might get referred to a psychiatrist, receive a diagnosis and be provided with medication or other treatment. Once they are adjusting and doing well, they would stop seeing the psychiatrist, and their care would be returned to their family doctor with care focused on maintaining treatment gains and monitoring for setbacks.

So they’d be getting the appropriate set of services for ADHD. What can be missing, however, is systematic screening over time for other kinds of difficulties. For example, even though a young person might be at a statistically higher risk for developing psychosis symptoms, they would not necessarily be monitored for these. And I wouldn’t want to alarm anyone – the risk of developing severe psychosis is still very low. With this study, we’re hoping to monitor a group of approximately 200 kids with diagnosed mental health problems like disruptive disorders, keep track of how they do over time and ideally identify specific red flags associated with psychosis.

How would the ability to spot the signs of psychosis early change the quality of care?

Aristotle Voineskos: Psychosis symptoms can have devastating repercussions for the individual, his or her family and others. School performance goes down. They can become socially isolated, and have increased suicidal thinking and more. We know that the longer psychosis goes on without being treated, the greater the adverse impact on that person’s life.

So early identification makes a big difference in how these people do. We thought it would be important to understand which young people already getting mental health care for issues that emerge earlier in life such as autism, ADHD, or depression have elevated risk for psychosis symptoms.

And we’re wondering if effective care for young people with those other conditions might in fact reduce the negative effects or eliminate the chance of experiencing symptoms of psychosis altogether.

What do you hope this research will ultimately achieve?

Joanna Henderson: Ultimately we hope that any new insight into early signs of psychosis will help us build a better model of care. Our approach is focused on partnering and collaborating with different health-care teams and building capacity in the system – and these closer ties are important as we try to fill in some of the gaps in care, especially with this transition age group.

We’ll be working closely with the clinical services within the Child, Youth and Emerging Adult Program, such as the Autism Clinic and our clinical research centres at CAMH – I’m the director of the Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, and Aristotle is director of the Slaight Family Centre for Youth in Transition.

The transition period is a time associated with greater mental health issues and substance use so there’s a major need for us to build bridges between services and provide ongoing support, especially for the most vulnerable youth.

Mats Sundin Foundation to support early childhood development research

lavende4 — Mon, 26 Sep 2016 18:37:38 +0000

Mats Sundin Foundation to support early childhood development research

lavende4 Mon, 09/26/2016 - 14:37

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Mats Sundin is accelerating research into the crucial first 2000 days of life

Carolyn Morris

Author legacy

Carolyn Morris

Faculty of Medicine

Mats Sundin

early childhood development

Hockey legend Mats Sundin is accelerating research into the crucial first 2000 days of life. Through The Mats Sundin Foundation, the former Toronto Maple Leafs captain and NHL star is building on his valuable support for the Mats Sundin Fellowship — an elite research exchange between the University of Toronto and Karolinska Institutet in his native Stockholm, Sweden, launched in 2012.

“It’s an Olympic training camp for the brightest young minds,” says Sundin. Each year, two postdoctoral fellows — one in Stockholm and one in Toronto — are paired with leading scientists, scholars and clinicians from both institutions to investigate early childhood development through a two-year biomedical research placement.

The University of Toronto and Karolinska Institutet are leaders in this field — in tracing the origins of disease back to the crucial period of time from conception to age five, or the first 2000 days of life. In particular, �Թϱ�� and Karolinska scientists are examining the intricate interaction between our genes and our environment within this key timeframe. Their findings will inform efforts to promote healthy pregnancy and infancy, and ultimately improve lifelong health outcomes, and prevent disease.

“The early environment of the fetus and infant can have major influences on cardiovascular, metabolic and mental health later in life,” says �Թϱ�� Physiology Professor Stephen Matthews, the University of Toronto academic lead for the exchange.

The need for more research in this area is huge. Chronic diseases are on the rise, expected to cost the world $47 trillion and cause 25 million deaths a year by 2030, according to a 2011 World Economic Forum report. By examining the environmental drivers interacting with our genetic code and changing the “expression” of genes and our susceptibility to disease, we can learn to prevent these diseases early on. And by investing in a new generation of scientists, we can strengthen and accelerate this vital research.

“I am convinced that these students will grow to become international stars in these fields and pursue groundbreaking projects leading to improved health and health care,” says Karolinska Molecular Neurodevelopment Senior Scientist Ola Hermanson, the program’s academic lead in Stockholm.

The budding researchers are also learning a collaborative approach to science.

“The future of research is collaborative,” says �Թϱ�� Faculty of Medicine Dean Trevor Young. “Not only have the Sundin fellows already made important findings, they are becoming immersed in this collaborative network of researchers who are working together to improve human health.”

“I feel so proud to be supporting these two incredible universities,” says Sundin. As he pointed out when first launching the fellowship: “Every player knows we have a responsibility to pass on our skills and knowledge to the next generation — that’s how the sport moves forward, and science as well.”

Carolyn Morris

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