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Researchers at Lawson Health Research Institute (Lawson) performed the first breast biopsy guided by Contrast Enhanced Spectral Mammography (CESM) in North America on June 12, 2020.

CESM is a novel diagnostic imaging tool that is able to detect cancerous lesions at a greater rate than standard mammography, and at close rate to MRI. Patients who undergo CESM receive an intravenous iodinated contrast liquid. This liquid acts as a dye that enhances the visibility of certain tissues during a radiographic imaging procedure, such as mammography or x-ray.

Currently, when a suspicious lesion is detected by CESM and not detected by standard mammography or ultrasound, the patient must return later for an MRI biopsy. Wait times for MRI can be lengthy, and the procedure itself is often long and uncomfortable.

CESM guided biopsy offers the ability to perform biopsy of the lesion of concern using mammography, after iodinated contrast injection. The procedure is faster and more accurate, comfortable and cost effective than an MRI biopsy.

The study will recruit 50 patients who have a suspect finding detected using CESM.

Dr. Anat Kornecki, Lawson Associate Scientist and Radiologist at St. Joseph’s Health Care London explains, “this new approach has the potential to provide rapid and accurate access for patients and reduce costs. With CESM biopsy technology we are also able to perform biopsy of lesions that are located in areas that MRI guided biopsy cannot reach.”

“Our initial experience has been very successful, and we hope to see an impact on patient care as well as breast cancer outcomes,” says Dr. Kornecki.

In Canada, about 235,000 people experience homelessness each year. The number of homeless people, and the length of time they spend homeless, continues to rise. Homelessness is not a choice and anyone can become homeless. 

Although the root cause is poverty, some underlying issues are poor physical or mental health; violence or abuse in the home; lack of employment or income; and, a shortage of affordable housing. 

A group of researchers at Lawson Health Research Institute (Lawson), working at both London Health Sciences (LHSC) and St. Joseph’s Health Care London (St. Joseph’s), are committed to tackling the issue of homelessness from within hospital walls, where some patients face the risk of being discharged into homelessness. 

“Many of our patients with lived experience of homelessness were saying that their journey started with a hospital discharge,” says Lawson clinician researcher Dr. Cheryl Forchuk. “Often, they were experiencing major transitions in their lives and then experienced a hospital stay. Normally a relatively short visit, they aren’t able to gather the information and make a plan to be able to leave the hospital with somewhere to stay.”

On September 10, Adam Vaughan, Canadian MP and Parliamentary Secretary (Housing and Urban Affairs), on behalf of the Honourable Jean-Yves Duclos, Minister of Families, Children and Social Development, announced that Lawson will receive $223,572 from the Homelessness Partnering Strategy’s (HPS) Innovative Solutions to Homelessness funding stream to support the project “No Fixed Address Version 2 Expansion” research project. 

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“This is a brilliant approach. It supports an augmented duty of care where hospitals have the means to transfer people into stable settings where they can continue to heal and move towards self-sufficiency,” says Parliamentary Secretary Vaughan. 

Taking place at London Health Sciences Centre, this research will further refine the No Fixed Address strategy for reaching and supporting patients during the crucial transitional period when they are being discharged from the hospital and re-integrated into the community. 

“Lawson’s expanded No Fixed Address research project is the first evaluation anywhere of a strategy to reduce the number of patients being discharged into homelessness. There is almost no literature on any aspect of this troublesome issue,” explains Dr. Forchuk who is the study’s Principal Investigator. Dr. Forchuk is also the Beryl and Richard Ivey Research Chair in Aging, Mental Health, Rehabilitation and Recovery and Assistant Director at Lawson.

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This project is an extension of three previous studies conducted by Dr. Forchuk’s research team, which developed and tested this novel approach. They demonstrated the efficacy, feasibility and cost-effectiveness of using the No Fixed Address strategy in acute and tertiary psychiatric care in the London region, at both LHSC and St. Joseph’s. In the first phase, they found that the interventions used prevented homelessness in 95 per cent of cases. 

The researchers are now taking a solution proven to have worked in the mental health units and applying it in selected medical departments at LHSC. Through the study, the services will be available to all patients in those units who are at risk of homelessness. There have already been 17 patients who have accessed this support since the project got underway this summer. 

Three community partners from London are supporting implementation of the strategy - Canadian Mental Health Association Middlesex, Ontario Works in the City of London and the Salvation Army’s Housing Stability Bank. They will provide assistance in areas like securing appropriate private-sector housing, provision of income and employment supports, and financial assistance. 

“In many ways London, Ontario is the high water mark of solving and tackling homelessness. This community has a lot of be proud of given the way that the municipality is stepping up to the plate and how many different organizations are working together towards a common goal,” says Parliamentary Secretary Vaughan. 

This kind of collaboration showcases the important partnership between the Canadian Government, research-intensive hospitals and community organizations to translate innovative solutions from the research stage to the front line of care. 

“The hope is that the findings will be even more robust, leading to the development of a best-practice model of hospital discharge that can be adopted throughout Canada. This will reinforce the need for a systemic change in the way hospital discharges occur and ensuring the person is transitioning to a secure housing arrangement,” says Dr. Forchuk. 

Learn more about the Government of Canada’s Homelessness Partnering Strategy. 

News Coverage

• CBC London - Helping medical patients in London avoid homelessness when they leave hospital 
• CTV London - Expanded research hopes to break the cycle of homelessness that psychiatric patients sometimes face when discharged
• Global News, AM 980 - Program that finds housing for homeless patients in hospital gets $223K in federal funding
• London Free Press - 'Brilliant approach' to homelessness gets federal grant
   

At a virtual event, a research team led by Lawson Health Research Institute announced details of a new project aimed at better understanding how many people in Canada are homeless and who they are. Developing more accurate sources of data related to homelessness helps ensure the proper supports and services are available.   

“The homeless experience varies significantly across Canada, especially within different rural and remote regions of the country,” says Dr. Cheryl Forchuk, Assistant Scientific Director at Lawson and Distinguished University Professor at Western University. 

With funding from the Public Health Agency of Canada, the Homelessness Counts research project builds on past work looking at how existing databases, such as provincial health data, could be better integrated and used as a more accurate, accessible and cost-effective way to determine homelessness.  

Many communities rely on shelter data, but not all regions have shelters and not all people who are experiencing homelessness use shelters even when available. There is also a standard “point in time” method that requires potentially hundreds of volunteers to go out and actually count the people in that area who are homeless.

“Generally, these methods will still miss people who are temporarily staying with others or living in rough or abandoned areas, and is limited to a single point in time – often just one day of counting. It’s often not feasible for smaller communities to do this due to the effort required and it’s a population often missed in our census data,” explains Dr. Richard Booth, Scientist at Lawson and Associate Professor at Western. 

In the initial stages of the project, the team is holding focus groups with several representative communities across Canada to learn more about how data is tracked and accessed. They will consult with groups providing services such as homeless serving agencies, mental health and addiction agencies, hospitals, emergency services and municipal governments. Individual interviews will also be held with people with lived experience of homelessness. 

“To offer effective and efficient services, we need to know how many people are experiencing homelessness, along with their characteristics, location and needs. Right now, it’s difficult to track if things are getting better or worse, or simply changing, and if efforts to reduce the homeless population are making a difference. We don’t fully know the unique challenges of the ‘invisible homeless’ or if different subgroups are emerging,” says Dr. Booth.  

More demographics could be regularly included in the data, for example gender, ethnicity, sexual orientation, involvement in the criminal justice system, psychiatric diagnoses, physical diagnoses and housing status.  

The team will bring together this information with existing datasets to improve the performance of an algorithm previously developed through a provincial research study, as well as insights gleaned from a rapid report on COVID-19 and homelessness. Machine learning will be used to generate enhanced risk and burden modeling.  

Dr. Forchuk adds that “homelessness is a complex social problem that touches on many different systems. It is made even more difficult to tackle when we have big gaps in the data. Our hope is to prototype a centralized surveillance system that can be scaled up across Canada to help make the right services available in the right places.”  

A team at Lawson Health Research Institute is hosting forums for communities across the country to better understand homelessness in Canada, including the number of people experiencing it. The first six forums have been scheduled in communities across Ontario, including Thunder Bay, North Bay, Kingston, Chatham-Kent, London and Brantford. These will be followed by future forums in various locations across Canada.

With funding from the Government of Canada, the Homelessness Counts research project is collecting data surrounding the homelessness situation in Canada.

The forums will allow an opportunity for members of the community to come together to discuss issues surrounding homelessness and provide feedback to the research team.

“The homelessness experience varies significantly across Canada, especially within different rural and remote regions of the country,” says Dr. Cheryl Forchuk, Assistant Scientific Director at Lawson. “Developing more accurate sources of data related to homelessness helps ensure the proper supports and services are available.”

This project builds on past work looking at how existing databases, such as provincial health data, could be better integrated and used as a more accurate, accessible and cost-effective way to determine rates of homelessness. This can allow a more accurate picture as numbers continue to rise.

This project has been made possible through funding from the Public Health Agency of Canada and Reaching Home, a community based federal program aimed at preventing and reducing homelessness across Canada.

“Homelessness has a direct impact on the health and wellbeing of every Canadian community and further marginalizes vulnerable Canadians. We value the importance of the data collection by Lawson Health Research Institute, as it helps give us a better understanding of the homelessness situation in Canada,” says The Honourable Ahmed Hussen, Minister of Housing and Diversity and Inclusion. “Our government is committed to helping Canadians who are experiencing or at risk of homelessness which is why we are pleased to support this initiative. By working with other orders of government, non-governmental organizations, Indigenous partners and communities, we can increase the availability of safe, inclusive housing options and work towards reducing chronic homelessness in Canada.”

Since January 2021, the team has collected data from 28 distinct communities with homelessness challenges. They have visited a variety of community shelters and organizations to meet with those with lived experience, as well as service providers.

“We have been to every province and territory in Canada to collect data. We have interviewed more than 400 people experiencing homelessness in each community and have had focus groups with 190 service providers,” says Dr. Forchuk.

Preliminary data being presented at the forums will highlight issues by community, however nationally the research team has found that the extent of homelessness is a growing problem and has been elevated during the pandemic. The team has also noted a number of regional differences when it comes to homelessness in respect to urban versus rural communities.

“Our ultimate goal is to gather the most accurate numbers of people experiencing homelessness across the country so we can collectively work together towards solutions, “adds Dr. Forchuk. “Solutions such as an increase of services that are targeted to address specific concerns and vulnerable populations in each unique community.”

Chaired by Dr. Manuel Montero-Odasso, Scientist at Lawson Health Research Institute, a group of 96 experts from 39 countries and 36 societies and agencies in Geriatric Medicine and Aging have come together to develop the “World Guidelines for Falls Prevention and Management for Older Adults: A Global Initiative.”

Published in Age and Ageing, the official journal of the British Geriatric Society, the guidelines provide recommendations to clinicians working with older adults to identify and assess fall risks.

“The global population is aging. Thanks to social and medical advances, some chronic conditions are diminishing proportionally. This is not the case for falls,” says Dr. Montero-Odasso, who is also a Geriatrician at St. Joseph’s Health Care London’s Parkwood Institute and a Professor at Western University’s Schulich School of Medicine & Dentistry. “Unfortunately, falls and related injuries among older adults are increasing and there is no sign of future decline.”

With new evidence and studies released since previous guidelines were published more than a decade ago, experts felt it was the right time for an update and an opportunity to incorporate a worldwide perspective

“Besides the rigorous methodology that 11 international working groups followed to provide new meta-analyses, including several new Cochrane collaborations, this World Falls Guidelines are, to the best of our knowledge, the first clinical practice guidelines in fall prevention to include a panel of older adults with lived experience in falls and mobility problems,” says Dr. Montero-Odasso. “They provided feedback, comments and opinions on our recommendations, making them considerably better and with wider applicability.”

Some key themes in the recommendations include: 

• Falls can be prevented, but it requires multidisciplinary management.
• Preventing falls has wider benefits for quality of life.
• Fall risk can be assessed by trained clinicians with simple resources. 
• A combination of interventions, including specific exercises to improve balance and strength, when delivered correctly, can effectively reduce fall risk in older adults.

Dr. Montero-Odasso says there was enough evidence to suggest that a global approach is needed to prevent falls in older adults and that “low risk does not mean no risk.” Even active older adults who are low risk should work on preventing loss of mobility and falls.

The next steps are for the guidelines to continue obtaining formalized endorsement of all the groups involved in the initiative and then for the guidelines to be fully implemented.

You can read the full guidelines here.