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Canadian researchers working to improve military and Veteran health met at St. Joseph’s Health Care London’s (St. Joseph’s) Parkwood Institute on December 4, 2017 for their fifth Research Consortium meeting.

The Research Consortium group, established in 2015, is led by Lawson researcher Dr. Don Richardson, Physician Clinical Lead at St. Joseph’s Operational Stress Injury Clinic (OSI Clinic). The group meets two to three times a year to provide updates on their projects and foster collaborative research partnerships, rotating between London, Hamilton and Toronto as host sites.

“Members of the military and Veterans have unique symptoms and treatment needs so it’s important that we engage in knowledge transfer with other researchers working with the same group of patients,” says Dr. Richardson. “The Research Consortium meetings are a great way to learn about recent projects from our peers and identify new avenues for collaboration with the goal of providing the best possible treatment outcomes for our patients.”

In addition to researchers from St. Joseph’s OSI Clinic, the Research Consortium group includes representatives from Defence Research and Development Canada, the Canadian Institute for Military & Veteran Health Research, the Canadian Armed Forces, the Centre for Addiction and Mental Health, Homewood Research Institute, Western University, University of Manitoba, McMaster University, University of Toronto, Ryerson University and Queens University.

St. Joseph’s OSI Clinic provides specialized mental health services to Veterans, members of the Canadian Armed Forces, the Royal Canadian Mounted Police (RCMP) and their families who are experiencing mental health challenges as a result of service. The OSI Clinic is one of ten outpatient clinics in a national network across the country funded by Veterans Affairs Canada.

At the meeting, Dr. Richardson provided an update on recent projects at St. Joseph’s OSI Clinic, including research to enhance the understanding of moral injury.

Moral injury refers to lasting emotional distress that can occur when military men and women are exposed to events that disturb or undermine moral beliefs about how people can be expected to behave. OSI clinicians reported that exposure to these events drastically changes their patients’ views of the world; causes them to question their religion, spirituality or human nature; and often leaves them feeling disconnected from their loved ones. The researchers will now collect additional data from clinicians across the OSI national network and from the Research Consortium group. Part of their investigation will explore the relationship between different kinds of traumatic events and moral injuries, and mental well-being.

The COVID-19 pandemic is proving to be one of the most pressing health challenges of our time. With a rising number of cases and deaths worldwide, there’s a global urgency to finding a solution.

As the research institute of London Health Sciences Centre (LHSC) and St. Joseph’s Health Care London, Lawson Health Research Institute excels in rapid response research and is uniquely positioned to tackle this problem from within hospital walls.

Our researchers belong to a health system at the forefront of the pandemic. With close proximity to patients and access to samples, they are mobilizing to address COVID-19.

“Lawson researchers include clinicians directly involved in the treatment of COVID-19 patients, as well as laboratory-based scientists and those with other expertise related to the pandemic response,” says Dr. David Hill, Scientific Director at Lawson and Integrated Vice President at LHSC and St. Joseph’s. “They are eager to contribute a solution and are combining their knowledge to address this issue from all angles.”

Already, Lawson research teams are initiating projects ranging from pre-clinical studies to clinical trials. They are planning to explore diagnosis, prevention and treatment of the disease, as well as long-term and mental health impacts. An immediate goal is to partner with other research hospitals to improve outcomes for COVID-19 patients around the world.

There are numerous COVID-19 studies underway at Lawson and many more going through the necessary approval processes. Recognizing the importance of a rapid response to this pandemic, Lawson’s Administration team is working to fast-track approval of the studies.

Lawson also offered a special internal COVID-19 funding competition to assist our researchers in their efforts. Lawson’s COVID-19 Pandemic Response Internal Research Fund supports projects that are identified as having the potential to impact the management of this pandemic and those that enhance our understanding of the pathophysiology of COVID-19. See the results of this competition and the 14 funded projects, for a total of more than $202,000 invested. 

While there is much to learn about COVID-19 and its impact on human health and our health care system, Lawson researchers are tackling the disease head-on.

How can you support COVID-19 research and clinical care?

Research at Lawson can be supported through three hospital foundations. With an outpouring of support from our community, the foundations are collecting donations to support our hospitals through this challenging time. Learn more about donating:

• St. Joseph’s Health Care Foundation – St. Joseph’s Health Crisis Fund
• London Health Sciences Foundation - COVID-19 Response Fund 
• Children’s Health Foundation - COVID-19 Response Fund

Learn more about COVID-19 research at Lawson:

• London researchers join global initiative to study loss of smell in COVID-19 patients
• Study to examine inflammatory response in patients with COVID-19
• Local COVID-19 research supported by St. Joseph's Health Crisis Fund

A Canadian consortium, which includes Lawson Health Research Institute (Lawson), TRIUMF, BC Cancer and Centre for Probe Development and Commercialization, is the first in the world to receive regulatory approval to produce the world’s most commonly used medical isotope, technetium-99m (Tc-99m), using small particle accelerators known as cyclotrons. 

Tc-99m is used in tens of millions of nuclear medicine procedures globally each year. These include cancer scans, cardiac tests, as well as several other diagnostic procedures. As the world moves away from uranium-based nuclear reactors, there has been growing concern in the medical community of a global shortage of these life-saving compounds. This development helps secure a domestic supply of Tc-99m for Canadian patients.

For over a decade, Dr. Michael Kovacs, Director, Lawson Cyclotron & PET Radiochemistry Facility, and Steven Foster, Business Manager, Lawson Imaging, have been working on research that has contributed significantly to this major development. They have demonstrated the successful production of Tc-99m on a standard hospital-based cyclotron at Lawson, confirming that this technology can be used by almost half of the world’s already installed cyclotrons. Clinical trials were conducted across Canada and locally at St. Joseph’s Health Care London.

“In 2011, we received federal funding to see if we could develop a technology to produce Tc-99m in hospital cyclotrons,” explains Dr. Kovacs. “Canada’s Chalk River nuclear reactor was one of the world’s largest suppliers, and it was set to close in 2016. Cyclotron facilities offer a greener, safer, more sustainable approach for producing critical medical isotopes. Our goal was to find an alternative to the traditional means of producing this isotope, and we have been successful.”

Nuclear medicine is a functional imaging technique, meaning that it images biological function. Medical isotopes are converted to radiopharmaceuticals which get injected into the patient during a procedure. According to the specific biological properties of the isotope, they move throughout the body, rendering a 3D map of where the isotope has gone. This gives researchers and medical professionals valuable information of how various physiological processes are performing.

“Canada is a global leader in nuclear imaging technology. With the help of our collaborators across the country, we have home-grown technology to produce commercial quantities of Tc-99m on common cyclotrons,” adds Mr. Foster.  “This technology has been patented and licensed to ARTMS Inc., a spin-off from the consortium, and is now being commercialized and sold throughout the world.”

The process was approved by Health Canada in November, 2020, and is expected to be deployed in British Columbia by 2022. 

Two new interventional studies have been brought to London, focused on improving quality of life for patients with Alzheimer’s disease and their caregivers. Both hope to improve upon standard approaches to treating agitation, a core symptom of Alzheimer’s.

Agitation is a significant source of stress for patients and caregivers. It is complex and difficult to treat. Often, families do not know about this particular symptom of Alzheimer’s and are not properly trained on how to manage care while dealing with agitation. 

“These studies are designed to have a direct impact on patients, families and care providers, to improve quality of life and function in those suffering from agitation due to Alzheimer’s,” says Dr. Amer Burhan, Associate Scientist at Lawson Health Research Institute (Lawson) and Geriatric Neuropsychiatrist, St. Joseph’s Health Care London (St. Joseph’s).

Parkwood Institute, a part of St. Joseph’s, is one of multiple sites participating in these studies across Canada and the United States.

One study aims to identify patients early in their diagnosis, while they are living at home or in the community, and apply a comprehensive psychosocial approach, with or without medication, to help with the management of agitation. “We hope to identify participants and have them participating in our program before they experience a crisis due to agitation,” explains Dr. Burhan.

Psychosocial intervention is a way of helping patients and caregivers understand the reasons for agitation. Agitation can develop due to a wide range of causes. For example, patients may just be bored and need help to find something meaningful to occupy their time, they could be upset about something in their current environment, or may be suffering from physical discomfort or pain.

Interventions can include communicating with patients in a manner that creates calm, scheduling meaningful activities, and maintaining routine and rhythm in life. The research team will connect with families early after diagnosis to give them the tools and support they need.

Initially, participants will be treated using structured psychosocial intervention to help reduce and manage their agitation. After three weeks, they will be reassessed and if significant agitation continues to persist, the patient will be randomly selected to receive either a placebo, or medication known as S-Citalopram to treat agitation while they continue to receive psychosocial care.

Sylvia Wilson is the wife of one of the study participants. By enrolling in this trial, she feels she has gained a much better understanding of her husband’s disease, and is grateful for the support that study participants receive.

“My husband typically does not like going to visit doctors, but Dr. Burhan and his team are great,” says Wilson. “They understand agitation, and other symptoms of the disease very well, and I notice a difference in his mood with the treatment he receives through the study.”

Participants are still able to receive care from their primary physician and care teams, with the study providing an added layer of support.

Another study is focused on Alzheimer’s patients who are admitted to hospital or living in long-term care. The aim is to standardize the approach to care for agitation related to Alzheimer’s. After baseline assessment, participants will be randomized to receive the current treatment as per usual, or an integrated care pathway derived from evidence-informed treatment guidelines. These include washing out medications that have not helped, adding individualized behavioral and environmental support, and if medications are needed, use a specific set of medications and dosages based on best evidence. 

“Better understanding agitation is a growing area of interest in geriatric research. The work being done locally is part of an international effort to create a paradigm shift in treating patients with Alzheimer’s disease and agitation,” explains Dr. Burhan.

Researchers are ready to offer these studies to patients and their families, hoping to make these treatment protocols an integral part of care for patients with agitation due to Alzheimer’s disease. Those interested in learning more about these studies can contact Dr. Burhan at @email or call 519-646-6100 x. 48170.

View the trial brochure

In the media: Study on 'agitation' in Alzheimer's patients seeks participants