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Researchers looking to better personalize treatment for PTSD

MEDIA RELEASE
For immediate release
January 25^th, 2022

LONDON, ON – Post-traumatic stress disorder (PTSD) is a condition that often develops in those who have experienced a traumatic event. PTSD affects close to 10 per cent of Canadians, and in some cases, can be difficult to treat. 
In a new study through Lawson Health Research Institute and Western University’s Schulich School of Medicine & Dentistry, scientists are looking at a form of treatment called deep brain reorienting (DBR) for those suffering from PTSD.

“In our study we are looking at ways of trauma processing at the foundation of the stress response,” explains Dr. Ruth Lanius, Associate Scientist at Lawson and Professor at Western’s Schulich School of Medicine & Dentistry. “When you are faced with a stressor the first thing you do is turn your attention to it, and when you do that you engage your head and neck muscles.”

DBR was developed by Scottish psychiatrist Dr. Frank Corrigan and focuses on the muscles of the shoulders, neck, head and face of patients when recalling a traumatic event. This form of trauma processing starts right at the moment the stressor is noticed by the individual, which is often quickly followed by a moment of shock.  By addressing the stressor at this level, doctors can target the foundation of where the stress response begins.

“When patients bring up a trigger in their mind, we look at what happens in terms of the tension in their head and neck.  We process that gently by asking the patient to notice and stay with that tension without trying to release it, and over time the tension usually decreases,” explains Dr. Lanius, who is also a Psychiatrist at London Health Sciences Centre. “The second part involves addressing the shock response. You turn your attention to the stressor and then notice any moments of shock that follows, which is often associated with tension behind the eyes and in the shoulders. Finally, you address the visceral sensations associated with feelings and emotions associated with the stressor.”

Dr. Lanius believes that by using DBR and focusing on muscle and visceral responses, it will help patients suffering from PTSD to process the visceral feelings associated with the trauma and its triggers.

“After this form of treatment, patients often say they feel safer and don’t see themselves negatively, like they did in the past,” says Dr. Lanius. “This is because we change those intense visceral feelings and it allows the person to reevaluate who they are and how they interact with the world.”

The research team is hoping to recruit approximately 60 people to take part in the DBR study.  Participants will undergo a psychological interview and an MRI, then eight sessions of treatments. Following those sessions, participants will have another interview and MRI to assess if any positive changes were made within the neurological networks and/or in psychological systems.

“Our hopes are to really personalize treatment for those living with PTSD,” says Dr. Lanius. “Some people have difficulty tolerating some forms of trauma processing and in my experience this treatment is a gentler approach for those individuals.”

Interested participants who have been diagnosed with PTSD can contact Suzy Southwell, Research Coordinator, at 519-685-8500 ext. 35186 or @email.

                                                                                                                                                  

MEDIA CONTACT

Celine Zadorsky, Communications & External Relations, Lawson Health Research Institute, T: 519-685-8500 ext. 75664, C: 519-619-3872

ABOUT LAWSON HEALTH RESEARCH INSTITUTE
Lawson Health Research Institute is one of Canada’s top hospital-based research institutes, tackling the most pressing challenges in health care. As the research institute of London Health Sciences Centre and St. Joseph’s Health Care London, our innovation happens where care is delivered. Lawson research teams are at the leading-edge of science with the goal of improving health and the delivery of care for patients. Working in partnership with Western University, our researchers are encouraged to pursue their curiosity, collaborate often and share their discoveries widely. Research conducted through Lawson makes a difference in the lives of patients, families and communities around the world.

ABOUT WESTERN 
Western delivers an academic experience second to none. Since 1878, The Western Experience has combined academic excellence with life-long opportunities for intellectual, social and cultural growth in order to better serve our communities. Our research excellence expands knowledge and drives discovery with real-world application. Western attracts individuals with a broad worldview, seeking to study, influence and lead in the international community.

ABOUT THE SCHULICH SCHOOL OF MEDICINE & DENTISTRY
The Schulich School of Medicine & Dentistry at Western University is one of Canada’s preeminent medical and dental schools. Established in 1881, it was one of the founding schools of Western University and is known for being the birthplace of family medicine in Canada. For more than 130 years, the School has demonstrated a commitment to academic excellence and a passion for scientific discovery. 

LONDON, ON – For many health care workers, the past year and a half of the COVID-19 pandemic has taken a toll on their mental health. Recognizing this is a growing concern, a London research team from Lawson Health Research Institute and Western University’s Schulich School of Medicine & Dentistry is examining moral injury amongst health care workers by imaging the effects on the brain.

“We are trying to look closely at what happens in the brain when a person recalls a moral injury event,” says Dr. Ruth Lanius, Associate Scientist at Lawson and Professor at Western’s Schulich School of Medicine & Dentistry. “By understanding the changes happening in the brain, we may be better able to treat individuals suffering from moral injury.”

Moral injury refers to an injury to an individual’s moral conscious which can produce profound emotional guilt and shame. During this ongoing pandemic, some health care workers have experienced emotionally difficult situations that resulted in moral injury.

“Those suffering from moral injury have a cognitive or thinking component which may include repeated thoughts that they didn’t provide the best care for example, or that they let their family down do to their intense work schedule or need to self-isolated,” explains Dr. Lanius, who is also a psychiatrist at London Health Sciences Centre (LHSC). ‘These thoughts are coupled with intense visceral distress, a gnawing sensation in the stomach or the feeling like one is being eaten up inside. I think once we help resolve the visceral distress, we will also see the negative thinking patterns settle down.”

The new study will involve around 60 health care workers. These research participants will undergo a functional MRI scan at St. Joseph's Health Care London at the beginning of the study and have the option to receive eight weeks of treatment. Then, another MRI scan will be done to see if and how the moral injury changes and possibly resolves within the brain. “This can be very validating for the health care workers since brain scans can make the invisible wound of moral injury visible,” adds Dr. Lanius.

The research team’s goal is to better understand what networks of the brain are activated with moral injury. Dr. Lanius hopes this would help establish more neuroscientifically guided treatments. “We have to help our health care workers heal from the tremendous hardships they often endure.”

Health care workers are still being recruited for this study. Interested participants can contact Research Coordinator Suzy Southwell 519-685-8500 ext. 35186 or @email.


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LONDON, ONTARIO - A new study from Lawson Health Research Institute, Western University and University of Alberta suggests that COVID-19 affects the human body’s blood concentration levels of specific metabolites – small molecules broken down in the human body through the process of metabolism. Three specific metabolites identified in this study could act as biomarkers and one day be measured through an inexpensive blood test to quickly screen patients for the disease and predict which patients will become most critically ill. The team also suspects those metabolites depleted by the virus could be delivered to patients as dietary supplements, acting as a secondary therapy. Published in Critical Care Explorations, the early findings add to the research team’s growing body of evidence on the bodily changes caused by the SARS-CoV-2 virus.  

“As the second wave progresses and COVID-19 cases rise, there is an overwhelming demand for testing,” says Dr. Douglas Fraser, lead researcher from Lawson and Western’s Schulich School of Medicine & Dentistry, and Critical Care Physician at London Health Sciences Centre (LHSC). “While our findings need to be confirmed in a larger group of patients, they could lead to a rapid, cost-effective screening tool as a first line of testing in the community and in-hospital.”

The study was conducted by performing metabolomics profiling on blood samples from 30 participants at LHSC: 10 COVID-19 patients and 10 patients with other infections admitted to LHSC’s ICU, as well as 10 healthy control participants. Samples were sent to The Metabolomics Innovation Centre (TMIC) at University of Alberta where a team measured plasma concentrations of 162 metabolites.

“Metabolites are the final breakdown products in the human body and play key roles in cellular activity and physiology. By studying them, we can understand chemical processes that are occurring at any given moment, including those that regulate biological functions related to health and disease,” explains Dr. David Wishart, Codirector of TMIC and Professor of Biological Sciences, Computing Science and Laboratory Medicine & Pathology with the University of Alberta. “Because the human metabolome responds very quickly to environmental factors like pathogens, metabolomics can play an important role in early-stage disease detection, including for COVID-19.”

The team discovered four metabolites of importance to COVID-19 disease detection. The concentration of one metabolite called kynurenine was elevated in COVID-19 patients while concentrations of the other three metabolites (arginine, sarcosine and lysophosphatidylcholines) were decreased. After further analysis, they discovered that by studying the concentrations of only two metabolites – kynurenine and arginine – they could distinguish COVID-19 patients from healthy participants and other critically ill patients with 98 per cent accuracy. 

The team also discovered that concentrations of two metabolites (creatinine and arginine) could be used to predict which critically-ill COVID-19 patients were most at risk of dying. When measured on a patient’s first and third day in ICU, these metabolites predicted COVID-19-associated death with 100 per cent accuracy. 

“It’s our hope these findings can be validated in larger patient populations and then used to develop a simple blood test that shows high likelihood of infection and disease severity, providing rapid results in as little as 20 minutes,” explains Dr. Fraser. “This could ease the demand for current testing methods, perhaps being used as a portable, first-line screening tool in the community and for when undiagnosed patients present to hospital.”

The team also notes the reduction of key metabolites reflects changes to biochemical pathways or functions in the body which are important to maintaining health and fighting disease. They suggest their findings warrant further study to determine whether certain metabolites could be boosted through dietary supplements. A precision health approach like this could lead to repaired biochemical pathways and improved disease outcomes. 

“Providing dietary supplements could be a simple adjunctive or secondary therapy with meaningful outcomes,” says Dr. Fraser. “For example, the metabolite arginine is essential to tissue repair while the metabolite sarcosine activates a process to remove damaged cells. Knowing that COVID-19 causes hyperinflammation that can damage cells and tissue, particularly in the lungs, supporting these processes may prove critical.”

In an earlier study, the team was the first to profile the body’s immune response to the SARS-CoV-2 virus and discover six potential therapeutic targets to improve outcomes. In other studies, they have discovered additional biomarkers that could be used to predict how severely ill a COVID-19 patient will become and uncovered a mechanism causing blood clots in COVID-19 patients and potential ways to treat them.

“We’re working to uncover hard evidence about how the virus invades the body. Ultimately, we hope our combined findings can lead to faster diagnosis, ways to identify patients most at risk of poor outcomes and targets for novel treatments,” notes Dr. Fraser.

This study was made possible through generous donor support. London Health Sciences Foundation is the lead funder with an investment of $90,800 through a significant estate donation and existing funds. Additional funding came from Lawson, Western and the AMOSO Innovation Fund.

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Dr. Douglas Fraser, Researcher from Lawson Health Research Institute and Western University’s Schulich School of Medicine & Dentistry

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Dr. David Wishart, Codirector of TMIC and Professor of Biological Sciences, Computing Science and Laboratory Medicine & Pathology with the University of Alberta

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LONDON, ONTARIO - A team from Lawson Health Research Institute and Western University are the first in the world to profile the body’s immune response to COVID-19. By studying blood samples from critically ill patients at London Health Sciences Centre (LHSC), the research team identified a unique pattern of six molecules that could be used as therapeutic targets to treat the virus. The study is published this week in Critical Care Explorations. 

Since the pandemic’s start there have been reports that the immune system can overreact to the virus and cause a cytokine storm – elevated levels of inflammatory molecules that damage healthy cells.

“Clinicians have been trying to address this hyperinflammation but without evidence of what to target,” explains Dr. Douglas Fraser, lead researcher from Lawson and Western’s Schulich School of Medicine & Dentistry and Critical Care Physician at LHSC. “Our study takes away the guessing by identifying potential therapeutic targets for the first time.”

The study included 30 participants: 10 COVID-19 patients and 10 patients with other infections admitted to LHSC’s intensive care unit (ICU), as well as 10 healthy control participants. Blood was drawn daily for the first seven days of ICU admission, processed in a lab and then analyzed using statistical methods and artificial intelligence (AI). 

The research team studied 57 inflammatory molecules. They found that six molecules were uniquely elevated in COVID-19 ICU patients (tumor necrosis factor, granzyme B, heat shock protein 70, interleukin-18, interferon-gamma-inducible protein 10 and elastase 2). 

The team also used AI to validate their results. They found that inflammation profiling was able to predict the presence of COVID-19 in critically ill patients with 98 per cent accuracy. They also found that one of the molecules (heat shock protein 70) was strongly associated with an increased risk of death when measured in the blood early during the illness.

“Understanding the immune response is paramount to finding the best treatments,” says Dr. Fraser “Our next step is to test drugs that block the harmful effects of several of these molecules while still allowing the immune system to fight the virus.”

The study was made possible with donor support to London Health Sciences Foundation. It also received additional funding from Lawson, Western and the AMOSO Innovation Fund.

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Above: Blood samples from critically ill COVID-19 patients.

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Above: A blood sample from a critically ill COVID-19 patient is collected at London Health Sciences Centre. 

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MEDIA RELEASE

For immediate release
February 16^th, 2022

LONDON, ON – In newly-published findings from Lawson Health Research Institute, more than half of Canadian Veterans report a decline in their mental health over the course of the COVID-19 pandemic.

When it comes to mental health conditions, Veterans are an at-risk population, often having higher rates of depression and post-traumatic stress disorder (PTSD). When the COVID-19 pandemic hit, scientists at Lawson wanted to understand its effects on this already at-risk population.

“We anticipated the ongoing pandemic would have impacts to multiple domains of life such as loneliness, isolation, depression and PTSD,” says Associate Scientist at Lawson and the MacDonald Franklin Operational Stress Injury (OSI) Research Centre, Dr. Anthony Nazarov.

To examine the potential impacts the research team launched a longitudinal study in early 2021, recruiting Canadian Veterans and spouses of Canadian Veterans. A total of 1,136 Veterans have participated in the study which spans over 18 months. Participants complete online questionnaires every three months, with questions focused on mental health and virtual health care services.

“We looked at use of care services, including virtual care services, which we know have been on the rise during the pandemic,” says Lawson Associate Scientist and Scientific Director of the Macdonald Franklin OSI Research Centre, Dr. Don Richardson.

The team recently published preliminary findings based on the Veterans portion of the study, which confirm a decline in mental health amongst the Veterans that took part.

“One of the important preliminary findings demonstrated a little more than 55 per cent of Veterans (55.9 per cent) have indicated that their mental health has worsened over the pandemic.” explains Dr. Richardson.

The findings also revealed that nearly one in five Veterans used virtual health care and telepsychiatry services and found them to be helpful.

“Veterans have been having positive experiences with virtual care for mental health support,” adds Dr. Nazarov. “Most found it helpful, and more importantly, many would like to continue to use this form of health care services even post pandemic.”

The preliminary study findings have been published in the European Journal of Psychotraumatology. The longitudinal study will wrap up this summer, and then the team hopes to use the information to improve and innovate different forms of mental health supports for Veterans and their spouses in the future.
 
 

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About Lawson Health Research Institute: Lawson Health Research Institute is one of Canada’s top hospital-based research institutes, tackling the most pressing challenges in health care. As the research institute of London Health Sciences Centre and St. Joseph’s Health Care London, our innovation happens where care is delivered. Lawson research teams are at the leading-edge of science with the goal of improving health and the delivery of care for patients. Working in partnership with Western University, our researchers are encouraged to pursue their curiosity, collaborate often and share their discoveries widely. Research conducted through Lawson makes a difference in the lives of patients, families and communities around the world. To learn more, visit www.lawsonresearch.ca.

For more information, please contact:
Celine Zadorsky
Communications Consultant & External Relations
Lawson Health Research Institute
T: 519-685-8500 ext. 75664
C. 519-619-3872
@email
www.lawsonresearch.ca/news-events

MEDIA RELEASE
FOR IMMEDIATE RELEASE
Sunnybrook Health Sciences Centre and Lawson Health Research Institute
April 14, 2022
 

LONDON,ON - Five high-dose radiation treatments targeting uterine cancer rather than the current standard 25 treatments are safe and well-tolerated by patients, a new study published in JAMA Oncology has found.

SPARTACUS (Stereotactic Pelvic Adjuvant Radiation Therapy in Cancers of the Uterus) — a multi-institutional non-randomized controlled trial — looked to assess the feasibility and safety of using a specialized technique called stereotactic body radiation therapy (SBRT) for women with uterine cancer where instead of 25 treatments over five weeks, five treatments can be delivered over 1.5 weeks.

SBRT uses many precise beams of radiation to target tumours or cancerous cells. It uses a higher dose of radiation in a smaller number of treatments. It can be done on a standard linear accelerator, the machine that delivers radiation treatments.

Sixty-one women were enrolled in SPARTACUS at two centres — Sunnybrook Health Sciences Centre and the London Regional Cancer Program (LRCP) at London Health Sciences Centre (LHSC).

“Uterine cancer is a common cancer in women, usually treated with surgical removal followed by radiation and/or chemotherapy to reduce the risk of recurrence,” said Dr. Eric Leung, radiation oncologist at Sunnybrook’s Odette Cancer Centre. “External beam radiation is usually given over five weeks, and that can place a heavy burden on women who have to travel to a radiation centre every day, spend time away from home and work, and incur the financial burden of these factors as well.”

With a median follow-up of nine months, the patients enrolled in SPARTACUS reported an acceptable level of side effects from the radiation that resolved, and also reported a reasonable quality of life during treatment, Dr. Leung said.

“We were interested in examining the toxicity of the higher dose – would it affect the nearby bowels or bladder and place a heavy symptom burden on patients? We were pleased to find that patients reported their symptoms as manageable.”

“This study represents a novel way of treating uterine cancer in a shorter time. It was conducted mainly through the COVID pandemic and gave women a chance to receive treatment in less time with fewer visits to our centres,” said Dr. David D’Souza, radiation oncologist at LHSC and the study co-lead through Lawson Health Research Institute.

Patients will continue to be followed on the study for late side effects and further research is planned to further compare this more convenient schedule to the standard five-week course of radiation. 

“This novel treatment could lead to a practice change that places less burden on patients and on the healthcare system,” Dr. Leung said. “Delivering radiation over the course of a week and half rather than over five weeks for patients facing uterine cancer would open up healthcare resources by reducing visits and usage of the linear accelerators.”

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ADDIONAL QUOTES – Dr. David D’Souza:

“Giving radiation in a shorter time can have several advantages for both the patient and the health care system."

“Our study assessed the safety of delivering a higher dose of radiation in fewer treatments for patients with uterine cancer by adapting what has successfully been done for other types of cancer in the pelvis like prostate and rectal cancer.”

“This study was made possible with advances in treatment planning, radiation machine capabilities, and an outstanding radiation therapy program at LRCP.”
                                                                                  
ABOUT LAWSON HEALTH RESEARCH INSTITUTE
Lawson Health Research Institute is one of Canada’s top hospital-based research institutes, tackling the most pressing challenges in health care. As the research institute of London Health Sciences Centre and St. Joseph’s Health Care London, our innovation happens where care is delivered. Lawson research teams are at the leading-edge of science with the goal of improving health and the delivery of care for patients. Working in partnership with Western University, our researchers are encouraged to pursue their curiosity, collaborate often and share their discoveries widely. Research conducted through Lawson makes a difference in the lives of patients, families and communities around the world. To learn more, visit www.lawsonresearch.ca.

ABOUT SUNNYBROOK HEALTH SCIENCES CENTRE
Sunnybrook Health Sciences Centre is inventing the future of health care for the 1.2 million patients the hospital cares for each year through the dedication of its more than 10,000 staff and volunteers. An internationally recognized leader in research and education and a full affiliation with the University of Toronto distinguishes Sunnybrook as one of Canada’s premier academic health sciences centres. Sunnybrook specializes in caring for high-risk pregnancies, critically-ill newborns and adults, offering specialized rehabilitation and treating and preventing cancer, cardiovascular disease, neurological and psychiatric disorders, orthopaedic and arthritic conditions and traumatic injuries. The Hospital also has a unique and national leading program for the care of Canada’s war veterans. 

Media Contacts:
Celine Zadorsky
Communications & External Relations
Lawson Health Research Institute
T: 519-685-8500 ext. 75664
C: 519-619-3872
@email

Sunnybrook Health Sciences Centre
Communications & Stakeholder Relations
416-480-4040

LONDON, ON – Hospital-based research is uniquely positioned to tackle the unprecedented COVID-19 challenge and quickly translate results into illness prevention and care for patients. Lawson Health Research Institute, the research institute of London Health Sciences Centre (LHSC) and St. Joseph’s Health Care London, has awarded more than $202,000 to its research teams to support critical discoveries during the pandemic. 

Over 14 projects ranging from improved diagnostics to understanding the impact of the COVID-19 pandemic on frontline health-care workers have been funded through Lawson’s Internal Research Fund (IRF) COVID-19 Pandemic Response Competition. 

“Lawson researchers are an intrinsic part of health care in London. Our research community has mobilized quickly to the COVID-19 pandemic and has come forth with innovative ideas to prevent infections, aid recovery and reduce the likelihood of mortality in those most seriously affected,” says Dr. David Hill, Scientific Director for Lawson. “Lawson has reallocated internal granting resources to enable some of the most exciting and credible ideas to be explored.”

Launched in March, this rapid response competition was focused on funding projects, such as two described below, that could impact the management of the pandemic and enhance our understanding of the novel coronavirus. 

Using genetic therapy to block entry of the virus 

Progression of COVID-19 depends on human proteins that the virus uses to escort itself into lung cells to cause disease. “There are three such ‘virus entry’ proteins that are particularly important for infection. We see them as potential targets for drugs to prevent and treat COVID-19,” explains Dr. James Koropatnick, Lawson Scientist and Principal Investigator for one of the funded studies. 

There could be dangers in targeting these proteins, particularly for patients taking certain blood pressure-reducing drugs. The team is studying the safe use of a new type of drug – powerful “antisense” agents that block messenger RNAs which are the biological “blueprints” for the target virus entry proteins – to stop the virus from using those proteins to infect lung cells. They are testing two types of antisense molecules that reduce the amount of the virus entry proteins. “With our existing knowledge and infrastructure in place, this testing could rapidly lead to new, non-vaccine agents to prevent and treat COVID-19, as well as future coronaviruses with pandemic potential,” adds Dr. Koropatnick.  

The impact of the pandemic response for those with disabilities 

The COVID-19 pandemic has disrupted the daily lives of Canadians, with worsening mental health as people adapt to different stressors. “While many are struggling with this new normal, the degree of disruption resulting from the pandemic presents unique challenges for those with spinal cord injury and brain injury,” says Dr. Eldon Loh, Lawson Associate Scientist also leading one of the funded studies.  
 
Relatively simple tasks such as frequent hand washing can be challenging for those with disability, and they may be more vulnerable to poor outcomes because of the decreased respiratory function many already face. The research team will document and evaluate the effect of the pandemic on the physical and mental health of those with spinal cord and brain injuries. “We plan to use our findings to provide guidance to those living with spinal cord and brain injury, and improve their quality of life during this challenging time. We expect that this study will not only help those with spinal cord and brain injuries, but also people living with other disabilities as well,” notes Dr. Loh. He is also a Physical Medicine and Rehabilitation Specialist at St. Joseph’s.  

The IRF competition is supported with funding from clinical departments at LHSC and St. Joseph’s, and from London Health Sciences Foundation and St. Joseph’s Health Care Foundation.
 

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Patients undergoing common surgeries in teaching hospitals experience significantly longer surgical times, with durations that are 22 per cent longer on average in these academic centres. This is among the findings of a new study from the Institute for Clinical Evaluative Sciences (ICES) and the Lawson Health Research Institute that was published today in theCanadian Journal of Surgery.

“The ability to train new surgeons is undeniably an essential part of a sustainable healthcare system,” says Christopher Vinden, the study’s lead author who is an adjunct scientist at ICES and a surgeon at the London Health Sciences Centre. “However, we see that surgical instruction significantly lengthens the duration of a range of common procedures, raising important questions such as how to minimize patient risk during teaching procedures, and how to address Ontario funding models that currently don’t adjust for academic versus non-academic centres.”

The researchers examined anonymized records for all adult residents of Ontario who underwent any of 14 common surgical procedures from 2002 to 2012. Of the more than 700,000 surgeries looked at, 21 per cent were performed in a teaching hospital. Previous research has shown that teaching can be associated with longer surgeries, but the authors say this is the first study to examine the magnitude of this increase at a population level, and the first to adjust for patient, procedure and surgeon-related factors such as the experience of the attending surgeon.

They found that of the 14 procedures, hip and knee replacements were least impacted by teaching status, respectively taking 8 and 9 per cent longer (less than 10 minutes longer) in academic centres. However, for the more complex laparoscopic right hemicolectomy (removing the right side of the bowel, usually due to colon cancer) the procedure took 33 per cent longer (62 minutes longer) in teaching hospitals.

Overall, every procedure took longer in teaching hospitals, at a mean of 22 per cent longer duration.

To choose which procedures to investigate, the authors consulted a panel of experts who selected representative procedures that are common in both teaching and community settings. Procedures included laparoscopic cholecystectomy, right hemicolectomy, appendectomy, unilateral inguinal hernia repair, hysterectomy, hip hemiarthroplasty, open reduction and internal fixation for hip fracture, hip and knee arthroplasty, and tonsillectomy. Where applicable, they considered open and laparoscopic procedures separately.

The study authors note that academic centres tend to use dedicated surgical teams for hip and knee replacements, compared to community hospitals where these procedures are typically performed by general orthopedic surgeons in non-dedicated units. They say it’s likely that this team-based specialist approach is helping to shave off that excess teaching time for knee and hip surgeries, and suggest that it may be useful to explore whether these efficiencies can be achieved for other common surgeries in teaching hospitals by adopting specialized units.

Noting that longer surgical durations have been linked to negative patient outcomes, Vinden adds: “In addition to addressing funding gaps created by longer procedure durations at teaching hospitals, it will be vitally important to identify at what point, for each type of surgery, this longer duration due to teaching introduces excess patient risk, and to find ways to minimize this risk. Training the next generation of surgeons should not negatively impact the funding of a teaching hospital, or the health of our patients.”

The study “Teaching surgery takes time: the impact of surgical education on time in the operating room” was published today in the Canadian Journal of Surgery.

Author block: Christopher Vinden, Richard Malthaner, Jacob McGee, J Andrew McClure, Jennifer Winick-Ng, Kuan Liu, Danielle M Nash, Blayne Welk, Luc Dubois.

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