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London - A new study underway through Lawson Health Research Institute and Children’s Hospital at London Health Sciences Centre (LHSC), using virtual reality (VR) to help pediatric patients during painful and distressing procedures.

“Technology holds immense potential for improving the experience of our young patients and their families,” explains Dr. Naveen Poonai, Lawson Scientist, principal investigator and Emergency Department Physician at Children’s Hospital. “VR is becoming increasingly popular amongst young people and some early research shows VR has been helpful in painful procedures, even in adults.”

The study is focusing on pediatric patients who need port access. A port is a little reservoir that sits underneath the skin that allows access to blood or medication with the use of a needle. Ports are most commonly used in pediatric cancer patients.

“This can be very distressing for a patient and it can set the tone for their entire clinic day and course of treatment,” says Dr. Alexandra Zorzi, Lawson Associate Scientist and Pediatric Oncologist at Children’s Hospital. “Minimizing the stress, anxiety, and pain of the procedure is key to avoiding a negative experience.” 

The study team is recruiting 90 pediatric patients with existing medical ports.  Participants will be randomized into three groups.  One group will be using a VR headset that will allow them to play interactive games. The second group will have access to tablet technology, and the final group will be provided with non-technology distractions. Each procedure and the patient’s response will be recorded. Responses will then be compared using a tool called the ‘Observational Scale of Behavioral Distress’ to determine which intervention leads to the best outcomes.  

“My hopes are that we develop a variety of skills we can tailor to patients,” adds Dr. Zorzi. “There are patients who receive all kinds of support but still struggle, so having a variety of techniques available to see what works best is a positive step forward.”

The study is expected to be completed by the end of this year. The research team is already collaborating with Children’s Hospital staff and leadership to use VR as a clinical tool if the study proves the technology to be effective.

“We have plans in place to allow whatever we find as the best option to be part of routine care for kids needing port access,” notes Dr. Poonai. “We are also speaking with various medical teams to determine how we can incorporate this into practices across the hospital.”

The use of the VR devices has been made possible with generous support from the Children’s Health Foundation.

LONDON, ON- A team at Lawson Health Research Institute are testing a new form of artificial intelligence (AI), paired with portable ultrasound machines, to image and identify lung concerns in real time, right at the beside of critically ill patients.

Approximately 100 critical care patients at London Health Sciences Centre (LHSC) will be part of this study which will test whether an AI model can automatically determine the presence of abnormal lung signals. Past studies have suggested that the AI model is very accurate in reading stored images, but this study will evaluate if it retains accuracy when asked to interpret live images being generated at the beside.

The study is made possible through the use of novel hardware created in Waterloo, Ontario by startup tech company, Wavebase.

“The (WaveBase) device attaches to the ultrasound machine and mirrors the ultrasound image in a second screen,” explains Dr. Robert Arntfield, Lawson researcher and Medical Director of the Critical Care Trauma Centre at LHSC. “The AI model searches the images for patterns in real time and predicts whether it is ‘seeing’ normal or abnormal lung tissue.”

Although bedside lung ultrasounds are commonly used in critical care to detect concerns such as infections, pneumonia or a collapsed lung, the pairing with real time diagnostic AI is a research milestone. It could expand the usage of bedside ultrasounds by enabling those with little or no ultrasound training to use the device.

“Bedside lung ultrasounds in critical care can often have a large impact in identifying life-threatening conditions within minutes,” says Dr. Chintan Dave, Critical Care Medicine Fellow at LHSC and Western University. “We would like to see members of the healthcare team, like critical care nurses or respiratory therapists, be able to use AI to accurately determine the health of the lungs rapidly at the bedside. Employing AI into the clinical workflow, could improve access to immediate diagnoses and treatments.”

In order to be certain that the AI’s predictions are accurate, the phase one study will compare its interpretations to a gold standard experts’ interpretation of the same lung ultrasound scans. Once this accuracy is assured, the team will proceed with a second phase to assess the device with non-expert users and customized settings for more in-depth diagnostics.

“We see a bright future for lung ultrasound imaging with AI within the critical care environment,” adds Dr. Arntfield. “We are trying to write the first chapter of this meaningful AI story here at LHSC and Lawson.”
 

LONDON, ON- In a world first, researchers at Lawson Health Research Institute, together with scientists from Defence Research and Development Canada, have developed a breath test that could be used to diagnose repetitive blast injury – a mild traumatic brain injury resulting from pressure changes that occur during explosions. The device will soon go through clinical trials to validate its efficacy. 

“A pressure wave is sent through the head and brain after an explosion, resulting in effects similar to a concussion,” says Dr. Douglas Fraser, Scientist at Lawson and Professor at Western University’s Schulich School of Medicine and Dentistry. “Examples of individuals who are most at risk of this condition include military personnel, police, individuals in the mining industry and tragically the public, who are currently experiencing this first hand through the war in Ukraine.”

The test leverages findings from a new peer-reviewed study in the Journal, Frontiers in Neurology. The research team examined blood biomarkers in members of the Canadian Armed Forces who have experienced repetitive blasts.

“When we looked at these service personnel there were certain metabolites in their blood that had changed quite dramatically compared to those who had not been exposed to blast injury,” explains Dr. Fraser, who is also a Paediatric Critical Care Physician at London Health Sciences Centre. “What was remarkable about these metabolites is that some of them are expelled in a person’s breath.”

Currently there is no accurate way to diagnose repetitive blast injury other than relying on a patient’s history and symptoms. Using their findings, the research team has identified a combination of metabolites that can be measured in breath as a diagnostic test.

“The individual would blow into what looks like a straw and the breath would go into a device which would measure the metabolites of interest,” adds Dr. Fraser. “The device would then determine if the person is in the danger zone, or if they have been exposed to too many blasts.”

Dr. Vivian McAllister, Director of the Office of Military Academic Medicine at Schulich Medicine & Dentistry says this discovery could be a game changer when it comes to this condition.

“The symptoms of blast injury overlap with other neurological conditions, especially depression, so accurate diagnosis is essential,” says Dr. McAllister. “Early diagnosis allows for interventions that we know to be successful in reducing the symptoms and consequences of mild traumatic brain injury.”

The test has been developed and patented with WORLDiscoveries, the technology transfer and business development office for Lawson and Western, and licensed to Neuroltixs Inc. for development. The next steps will be to confirm the efficacy of the test through upcoming clinical trials.

“We hope to validate the breath aspect of the test, which could then be used as a health surveillance tool,” says Dr. Fraser. “Once validated through clinical trials, this portable device could be easily developed and it will allow us to determine who has been over exposed to blast injuries and how we can protect them in the future.”

LONDON, ON – A clinical trial named “EpiSign-CAN,” led by researchers at Lawson Health Research Institute (Lawson) has been awarded $4.8 million to measure the clinical impact of a new molecular genomics test for diagnosing genetic neurodevelopmental conditions.

Developed at Lawson, the diagnostic test, called EpiSign, uses machine learning to analyze the EpiSign Knowledge Database. This database compiles information on rare genetic diseases using laboratory analyses of the entire genome, referred to as the epigenome, from patients with suspected genetic abnormalities.

A recent paper describes the newly discovered biomarkers for over 50 neurodevelopmental conditions. Dr. Bekim Sadikovic, Lawson Scientist and Head of the Molecular Diagnostics Division at London Health Sciences Centre (LHSC) explains, “before this study, many such conditions required targeted, and often labour intensive and costly assays for a diagnosis, which in many cases provided no conclusive answers. Now, using our EpiSign Knowledge Database which includes the epigenomic information of thousands of patients and controls, we are able to diagnose over 50 conditions with a single test, including in patients where targeted genetic testing was inconclusive.”

The upcoming clinical trial hopes to validate the use of this test in the first-line of diagnosing rare genetic disorders across Canada. “Patients and families typically wait years, and undergo multiple exams and lab tests in search of a definitive diagnosis. With EpiSign, we estimate that we will be able to increase the number of people who receive a diagnoses by five per cent, or more in the future as the database develops” explains Dr. Sadikovic. “Though individual genetic conditions are rare, there are over 4,000 recognized genetic disorders which affect thousands of patients in Canada.”

EpiSign-CAN will study 4,000 patients, who will either receive EpiSign testing as part of the initial diagnostic workup or after classical genetic testing approaches have been exhausted. The goal is to assess the impact of using EpiSign in the first stage of diagnosis vs. after other tests have failed to provide answers in this patient population.

Timely diagnosis will prevent the so called “diagnostic odyssey,” and by doing so has the potential to improve healthcare outcomes for these patients and decrease cost to the health system.

As the EpiSign Knowledge Database continues to grow, researchers are finding correlations between specific episignatures, or molecular DNA markers, and related physiological features across a syndrome.

This research is co-funded through the collaboration of three partners; LHSC, Illumina, and Genome Canada. This is the first time researchers at Lawson have been awarded a Genome Canada Genomic Applications Partnership Program (GAPP) grant. “Genome Canada focuses its resources on new innovation that has a strong likelihood of translating directly to patient care. Their support of our work is extremely meaningful,” says Dr. Sadikovic.

The study describing the most recent advancements in EpiSign technology, “Evaluation of DNA methylation episignatures for diagnosis and phenotype correlations in 42 Mendelian neurodevelopmental disorders,” is published in The American Journal of Human Genetics.

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LONDON, ON - During a virtual event for Londoners hosted by Lawson Health Research Institute and the City of London, a multi-sectoral research team announced two projects representing a collaborative approach to preventing homelessness from within hospital walls. 

Built on the unique and successful No Fixed Address (NFA) strategy, these projects are being tested as a potential best practice for preventing hospital discharge to homelessness. NFA seeks to stop the cycle between hospital admissions and homelessness by providing timely and accessible supports to patients who would otherwise be discharged into homelessness.  It brings housing and financial supports into the health-care system, starting as soon as upon admission, to assist in finding appropriate housing and supports or avoiding a potential eviction. 

“Canada lacks a validated and coordinated service model to address the issue of hospital stay to no fixed address, which can often be the beginning of an individual’s experience with homelessness,” explains Dr. Cheryl Forchuk, Beryl and Richard Ivey Research Chair in Aging, Mental Health, Rehabilitation and Recovery, and Assistant Scientific Director at Lawson. “There are multiple factors that cause people to be discharged into homelessness - systemic, organizational and personal. We need a collaborative and coordinated approach that honours housing as a basic human right.” 

Several departments at London Health Sciences Centre (LHSC) and St. Joseph’s Health Care London collaborate with staff from the City of London, Canadian Mental Health Association (CMHA) Elgin-Middlesex, Youth Opportunities Unlimited (YOU), Salvation Army’s Housing Stability Bank and Ontario Works in the City of London to provide direct, on-site (or virtual) support for patients at risk of homelessness.

“Implementing a coordinated approach to addressing homelessness allows our staff to actively work alongside our partners in health care to prevent and divert individuals and families from an experience of homelessness by assessing their needs and connecting them to the housing supports.,” says John D’Oria, Coordinated Access Manager, City of London. “Whether it’s financial, social service or mental health support, this partnership and approach allows for a holistic approach to client care at the right time.”

Patients discharged from hospital to homelessness in Canada face many challenges that make recovery more difficult. They often experience higher readmission rates and emergency department visits. This is particularly concerning for youth, who have been found to be the fastest growing segment of the homeless population.

NFA was initially tested with strong success for mental health patients across the city and the second version of the project was extended to medical units at LHSC’s University and Victoria Hospitals.

PROJECT 1: Collaboration to Address Homelessness - Health, Housing and Income (H2I) 

This research study will evaluate the City of London’s Coordinated Access Outreach program at hospital sites. A Coordinated Access Outreach worker will support individuals at risk of homelessness to maintain or obtain housing. Ontario Works will assist with the provision of income and employment supports and the Salvation Army Housing Stability Bank may be accessed for needed financial resources to secure or maintain housing.  

Over two years, 106 participants will be interviewed in hospital and again six months post-discharge. Focus groups with participants, health care providers and community partners will provide further insight into the effectiveness of NFA. This project is funded by the Canada Mortgage and Housing Corporation (CMHC)’s National Housing Strategy. 

PROJECT 2: Preventing discharge to No Fixed Address – Youth (NFA-Y) 

This research study will customize, implement and evaluate the NFA strategy for vulnerable youth ages 16-24. The unique health and housing needs of youth at-risk will be explored by streamlining housing and financial support into a coordinated system of care, with additional support provided by Youth Opportunities Unlimited and Children’s Aid Society London and Middlesex. 

Over 3-4 years, data to be collected from 93 youth at three time points. Focus groups with youth participants, health care providers, and community agency partners will help enhance the NFA strategy to meet the unique needs of youth. This project is funded by the National Centres of Excellence (NCE) Making the Shift (MtS) Youth Social Innovation Lab. 

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