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Hospital researchers from Lawson Health Research Institute have published a recent study that assessed the use of a specialized treatment for chronic pain and its impact on health care use and opioid prescribing.   

Paravertebral blocks (PVBs) belong to a broader group of procedures called “nerve blocks.” A recent Toronto Star report noted that OHIP has been billed $420 million for nerve block procedures since 2011. PVBs involve injecting medication around the nerves where they exit the bones of the spine, at different locations depending on the patient and the chronic pain they are experiencing.  

The regular use of these procedures has been questioned by health care providers due to the high cost and limited evidence of their benefit in reducing chronic pain. While the effectiveness of PVBs has been examined in trauma, cancer pain and regional anesthesia during surgery, they have not been evaluated for use in chronic pain despite widespread use in Ontario.  

It is estimated that one in five Canadians live with chronic pain. Pain that persists can affect all aspects of someone’s life and health, particularly when it is not being managed.  

“Frequent use of PVB is common. Initiating treatment with PVCs is associated with marked increases in health care utilization, which includes physician visits and other injection procedures,” explains Dr. Eldon Loh, Lawson Associate Scientist and Physiatrist at St. Joseph’s Health Care London. 

This research provides a broad perspective on the use of PVBs in Ontario, and on the use of nerve blocking treatments in general. There has been a concern for several years about the over use of these procedures; however, this is the first study to systematically document the impact on health care utilization and opioid use. 

"We hope that from this study, the appropriate use of PVBs and other pain interventions will be re-evaluated at a provincial level to ensure the use of health resources is being properly managed and we achieve the best outcome for patients,” Dr. Loh adds. 

Widespread pesticide-use and diminished floral diversity in the environment have contributed to the worsening susceptibility of honeybees to infectious disease, threatening their support of adequate pollination of food crops. With the aim of tackling honeybee decline, a collaborative team including researchers at Lawson Health Research Institute and Western University have shown certain probiotic bacteria can be used to help ward off disease and promote overall hive health.

A new study published today in the journal ISME used two methods to deliver probiotics to hives within large commercial apiaries in California – a probiotic pollen patty and a spray-based delivery system – demonstrating a range of health benefits associated with the supplementation.

“We tend to think of bees just as organisms in themselves. But actually, bees have co-evolved with a lot of other organisms, the plants they feed on, and the bacteria that live inside their guts,” said Graham Thompson, biology professor at Western who has been studying honeybees for over two decades. “Those bacteria are functionally very important to the bees, for digestion and acquiring nutrients. It’s a symbiotic arrangement.”

Testing in a real-world setting

The teams have led research on three probiotic strains and shown they benefit honeybees, this latest research is the largest field study of its kind to date.

“Seeing an effect in the lab is one thing but seeing it in the real world is quite another,” said Thompson. “After treating the hives with probiotics using a BioPatty and a novel topical spray, we monitored them for all kinds of downstream effects and found lasting effects in their ability to withstand a variety of very common diseases.”

The probiotics developed by the researchers at Lawson and Western are specifically designed to enhance the honeybee’s core gut microbiota to boost their immunity and provide a viable alternative to antibiotics.

“Right now, most beekeepers treat their hives with antibiotics to prevent infectious disease,” said Brendan Daisley, a former PhD student at Western and now a postdoctoral researcher at the University of Guelph. “Unfortunately, there are a lot of negative side effects associated with treating hives with antibiotics, including development of resistance, and off-target health effects due to the drugs harming beneficial microbes, in addition to the pathogens of interest. We need different solutions to improve honeybee health, especially in a sustainable way, and we believe probiotics could be a feasible option.”

The researchers say part of the goal of testing the delivery methods of the probiotics is ensuring the research can be easily translated to the real world.

“A beekeeper has to go to the hive and be able to apply the probiotics, so we’re trying to make it easier for them to do that,” said Gregor Reid, professor emeritus at the Schulich School of Medicine & Dentistry, retired Lawson scientist and an international expert on probiotics. “We aim to make the solution practical, easy to use and proven to work, which is the essence of translational science. Not every bacterial strain works and even some commercial products have not been proven to be effective, so we can’t generalize. The key is selecting the right strains and proving they are effective in the real world.”

The team is working closely with SeedLabs to promote their research with major players in the beekeeping world.

Bee research on campus

The next phase of this research is continuing this summer on Western’s campus in the university’s experimental apiaries. Students Anna Chernyshova and Sophie Killam will be looking at how the probiotics influence the bees’ social behaviour, to understand what is referenced as the ‘gut-brain-axis’. In other words, how probiotic bacteria influence the brain.

“The idea is fascinating because it shows that the gut and the brain are actually communicating with each other through millions of bacteria releasing or inducing specific chemicals and neuro-compounds that influence the activity of the brain, including behaviour such as grooming or cleaning,” said Chernyshova, a PhD student in Biology. “Previously, this has only been studied at the individual level. And as we know, honeybees are social. So, we are looking to see if and how probiotic organisms can improve foraging and hygienic behaviour.”

The researchers are also comparing the hives treated with probiotics to those that have been treated with antibiotics to see which performs better. Using pollen traps, they can assess overall pollen production and determine which hives have bees that go to more diverse flowers. 

Killam, a master’s student in Thompson’s lab, is looking specifically at how these manipulations of the bees’ gut microbiomes influence where worker bees detect and remove diseased brood from the hive. She’ll spend the summer alongside the bees using video, radio tags and other observations to monitor the insects’ behaviour.

“I’ve really enjoyed taking care of the colonies here and am excited to do the field work this summer,” said Killam. “Bees are both an economically and ecologically important insect, for plants, animals and humans. And because they live in these large and close-knit colonies close to humans and industry, they are susceptible to disease. Looking at how we can support their health and wellbeing through natural mechanisms is really important.”

From falls prevention to depression therapies, scientists at Lawson Health Research Institute are conducting important mental health studies. Held on Thursday, September 15, the 17^th Annual Mental Health Research Half Day at the Parkwood Institute Mental Health Program was a chance to share and celebrate this research.

The Mental Health Research Half Day featured poster and oral presentations, as well as the 12^th Annual Tony Cerenzia Research Lecture. Clinical, administrative and research staff attended to learn more about research happening at Parkwood Institute and the Southwest Centre for Forensic Mental Health Care, part of the St. Joseph’s Health Care London family.

“The Mental Health Research Half Day provides an opportunity for researchers at Parkwood Institute and the Southwest Centre for Forensic Mental Health Care to present their research findings to clinical and administrative staff,” said Dr. Richard O’Reilly, Director of Psychiatric Research at Parkwood Institute & Southwest Centre and a Scientist at Lawson. “It is important that all clinical staff, who may not be directly involved in research, know what studies are being conducted and their impact on patient care.”

The 12^th Annual Tony Cerenzia Research Lecture was delivered by Dr. Nathan Herrmann, Associate Scientist, Evaluative Clinical Sciences, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute and Head of the Division of Geriatric Psychiatry at Sunnybrook Health Sciences Centre. Dr. Herrmann delivered an engaging lecture titled “Managing Neuropsychiatric Symptoms in Dementia: An Evidence-Based Approach”.

Attendees were engaged not only by this highly informative lecture but also by the poster and oral presentations which covered a broad range of research topics. Presenters were also enthusiastic about  the day and the opportunities it provided.

“The Mental Health Research Half Day is a great event which provides networking opportunities here at Parkwood Institute. It allows staff from across St. Joseph’s to learn about different research happening across program areas,” said Erin Finley, an Occupational Therapist (OT) in Geriatric Psychology at Parkwood Institute.

Finley and her colleagues were one of seven poster presentations. Their research project, titled “Fall prevention initiative in geriatric psychiatry”, aimed to reduce the rate of falls with injury among patients with dementia in a behavioural health unit. Within an 18-bed unit, they were able to significantly reduce falls with injury with zero incidences in the last two months of their data collection period.

Researchers at Lawson Health Research Institute (Lawson) are developing a hand-held photoacoustic imaging probe to be used during breast conserving surgery to quickly and accurately verify if all cancerous tissue has been removed.

Surgeons currently do not have real-time technology to guide tumour removal during surgery.

Using current tools, there is a 20 per cent chance that cancerous cells will be left behind, risking recurrence and repeat surgery.

Breast cancer represents 25 per cent of all new cancer diagnoses in women and 13 per cent of all cancer related deaths in women. Treatment for breast cancer often requires either complete breast removal in severe cases, or surgical removal of the cancerous tumour in combination with other therapies. Removing only the tumour is called breast conserving surgery.

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Photoacoustic Screening

The new device is an extension of the photoacoustic screening (iPAS) technology developed in the laboratory of Dr. Jeffrey Carson, Principal Investigator and Lawson Scientist. The technique uses light and sound to capture 3D images of surgically removed breast tissue. Their studies show that iPAS can catch up to 75 per cent of missed tumour cells, decreasing the odds of failed surgery to five per cent.

Dr. Muriel Brackstone, Associate Scientist at Lawson, Head of the Breast Care Clinic at St. Joseph’s Hospital London, and Surgical Oncologist at London Health Sciences Centre, brings her clinical expertise to the project.

“With the first generation iPAS technology, we would remove the tumour, take it to the lab for imaging and wait to see if there was a rim of normal tissue around the removed tumour so we knew it was removed completely. The wait was anywhere from 20 minutes to an hour. During that time, the patient is under anesthesia, the surgical team is idle and precious OR time is being used,” explains Dr. Brackstone.

A hand-held tool that surgeons can use

Creation of a hand-held probe to be used in the operating room is the next step in the advancement of this new technology. Elina Rascevska, biomedical engineering student at Western University, recently joined the Lawson team to convert lab-based iPAS technology into a hand-held device.

“We have developed a prototype of the iPAS probe, and once we can verify the quality of the images it produces, we will give it to Dr. Brackstone to test in the OR,” says Rascevska.

The iPAS probe does not need a trained operator and would be used by the surgical team. Instead of imaging the removed tissue, it scans the surgical cavity in real time to give the team a faster and more accurate indication as to whether the cancerous tissue has been removed.

“If we can progress this technology to a point where physicians can use it as part of standard protocols, we will have reduced the amount of time each patient needs to spend in the OR, the amount of call-backs and repeat surgeries, and ultimately improve quality of life for patients with breast cancer,” adds Dr. Carson.

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Researchers from Lawson Health Research Institute and the Centre of Excellence on PTSD and Related Mental Health Conditions are seeking 500 Canadian health care workers to participate in a study on moral distress and psychological wellbeing during the COVID-19 pandemic. Participants will complete online surveys once every three months for a total of 18 months. The goal is to better understand the pandemic’s impact on health care workers in order to minimize moral distress and support wellbeing during future pandemic events.  

Moral distress is a form of psychological distress that occurs following an event that conflicts with a person’s moral values or standards. Through previous research with military populations, moral distress has been linked to an increased risk of post-traumatic stress disorder (PTSD) and depression.

“Health care workers are facing unprecedented demands as a result of the pandemic and many may be working under extreme physical and psychological stress,” says Dr. Don Richardson, Lawson Associate Scientist and Director of the MacDonald Franklin Operational Stress Injury (OSI) Research Centre. “Health care workers may face difficult moral-ethical decisions including those around patient care and shortages of personal protective equipment (PPE), which could lead to moral distress.”

The study will consist of a series of surveys to assess moral distress during the pandemic. Participating health care workers will answer questions about moral-ethical dilemmas and symptoms of depression, PTSD, general anxiety, and burnout. 

“Moral-ethical dilemmas must be considered in the context of other difficulties faced by health care workers during the pandemic, such as increased workloads, reduced social activities, and evolving work environments and health care delivery models,” explains Dr. Anthony Nazarov, Associate Scientist at Lawson and the MacDonald Franklin OSI Research Centre. 

The team hopes that results can be used to cultivate wellness at the outset of future pandemics. This might include guiding emergency preparedness policies and moral-ethical decision-making training modules. They hope that by tracking psychological outcomes over time, they can identify early warning signs of distress that can be targeted with early interventions. 

The researchers will also ask questions that explore how the pandemic is impacting health care delivery, such as increased reliance on virtual care appointments, and whether health care workers are satisfied with these changes. 

“It is necessary to provide a voice to health care workers during this pandemic,” adds Dr. Richardson. “This is the first study to measure the moral-ethical dilemmas faced in a pandemic and the impacts of such dilemmas on moral distress. It is also the first to measure health care worker perceptions on the virtual migration of patient care.”

Researchers at Lawson Health Research Institute are the first in the world conducting a clinical trial to test a triple intervention aimed at treating Mild Cognitive Impairment (MCI) and delaying the onset of dementia. The Mobility, Exercise and Cognition (MEC) team will be incorporating physical exercises, cognitive training and vitamin D supplementation to determine the best treatment for improving mobility and cognition.

“We have learned the brain processes involved in motor-control - for example how a person walks - and cognition - for example how that person solves a problem - share similar locations and networks in the brain,” explains Dr. Manuel Montero Odasso, Lawson Scientist and Geriatrician at St. Joseph’s Health Care London. “Problems with mobility are connected to lowering function in the mind, and so can be a good indicator of future progression into dementia.”

Dr. Montero Odasso is also an Associate Professor in the departments of Medicine and Epidemiology and Biostatistics at the Schulich School of Medicine & Dentistry, Western University. 

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MCI is an intermediate stage between the expected cognitive decline of normal aging and the more serious decline of dementia. It can involve problems with memory, language, thinking and judgment. While many older individuals experience decline in both mobility and cognition, each are assessed and treated separately with no specific recommendations available for physicians.

The SYNERGIC Trial will combine physical exercises, cognitive training and vitamin D to test how these interventions work together to improve cognition in older adults at risk for dementia. The trial is targeting cognitive decline at the earliest stage, individuals with MCI, where interventions are more likely to have an effect and can be monitored.

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Dr. Montero Odasso explains that both physical and cognitive exercises have shown promising effects for maintaining cognition, while vitamin D deficiency is associated with cognitive decline. A key feature of this trial is that participants will receive individualized and progressive training.

“By delaying declines in cognition, we can improve a person’s quality of life. This research will help to support a more comprehensive preventative treatment with clinical guidelines for physicians whose patients are at risk of developing dementia,” states Dr. Montero Odasso. “Even more, each one year delay of progression to dementia in older individuals at risk has the opportunity to save billions of dollars for the Canadian health care system.”

Individuals over 60 years old with mild cognitive impairment without dementia are eligible for this clinical trial. Those interested in participating are encouraged to contact Research Coordinator Alanna Black at 519.685.4292 ext. 42179.

Participants will be asked to complete a routine of exercises and cognitive training three times a week for six months, with one final assessment at 12 months. The main site for the study is Parkwood Institute with physical exercises taking place at the Labatt Health Sciences Building at Western University, in Dr. Kevin Shoemaker’s Laboratory for Brain and Heart Health.

This study has been funded by the Canadian Consortium on Neurodegenerative in Aging (CCNA) which represents Canada-wide research aimed at enhancing the quality of life and services for individuals diagnosed with a neurodegenerative disease. The MEC team in London, led by Dr. Montero Odasso, includes expert researchers in the field of mobility who aim to develop common assessments for the interaction of cognition and mobility for older people to aid as a diagnostic tool for detecting dementia. 

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