Engaging Primary Care in Research: Not Always an Easy Task

I am Stella Bing Xin Song, currently a second year student studying pharmacology and psychology at University of Toronto. I was fortunate to be a part of the 2016 Research Opportunity Program (ROP) supervised by Dr. Pascal Tyrrell in the Department of Medical Imaging at University of Toronto. 
My ROP project focused on evaluating the feasibility of using MRI as the primary imaging modality for carotid artery stenosis diagnosis and assessment (not sure what we are talking about? See previous posts here and here). Along with Ginni Ting, a student volunteer in Dr. Tyrrell’s lab, we surveyed physicians in the Niagara region of Ontario to learn about their perspectives on this proposal. Our community partner in this research was Heart Niagara – a fantastic local organization that has been guiding advances in cardiac health education and services since 1977.
Most of the responding physicians saw approximately 2000 or more patients per year. Physicians expressed a variety of care-related decisions for carotid artery stenosis patients, especially for those where diagnosis was less obvious with less than 70% stenosis. Most responding physicians would consider MRI over Ultrasound as the first-line diagnostic imaging modality, because of its ability to detect IPH yielding more pertinent information. IPH is bleeding within the plaques, which causes them to become more vulnerable (see vulnerable plaque). There is a 6 times greater risk of stroke in people with IPH! For those who were reluctant to consider it, they expressed that it was mostly due to their concerns for the relative cost and current wait time for MRI. 

Unfortunately, the response rate for this online survey was very low. Reasons given for the reluctance to participate were that physicians were on a tight schedule and were busy with their patients. Feedback from participants was that the online survey seemed long. Nevertheless, from the responses received, we were able to learn more about physicians’ perspectives of using MRI for carotid artery stenosis diagnosis and assessment.

In the end, it was an exciting and valuable experience to plan out and execute this research project. Most importantly, I had the pleasure to join Dr. Tyrrell’s lab and meet his team. I am grateful for all the help and support which I have received throughout my time at the lab. I look forward to continuing to work as a member of Dr. Tyrrell’s lab.

Stella Bing

U of T Research Opportunity Program – Clare Sheen

Clare Sheen is an undergraduate student at the University of Toronto, in process of completing her Bachelor of Sciences in Genomics and Microbiology/Molecular Genetics. She was a 2015-6 Research Opportunity Program (ROP) student working on designing the Medical Image Network Enterprise (MiNE) interface for Dr. Pascal Tyrrell from U of T’s Department of Medical Imaging. She is currently a social director on the Life Science Student Network exec team and a volunteer at U of T’s Agrawal Lab where she helps with Drosophila experiments. She continues to seasonally work as a student camp teacher in the summer.

At the Research Opportunity Program (ROP) fair on March 3rd, U of T ROP students from different departments came together to share their research. A mock-up of the MiNE interface was presented in PowerPoint with the goal of increasing user engagement and encouraging the development of a medical imaging research community. Some features of the interface are presented below.

Back to Basics… Midpoint Thoughts from an ROP Student

Reaching new heights? (Source: NYT)

Through the ‘Research Opportunity Program‘ (ROP) for second year students at U of T, I have been working on a project about physicians’ willingness to use MRI as the front-line diagnostic imaging technology for carotid stenosis patients. For a description see here.

After a recent discussion with Dr. Tyrrell (my supervisor), and as I approach the midpoint of my ROP project, I thought it would be a good idea to review some of my background knowledge of carotid stenosis from my work in the Fall term. Having a certain amount of independence while working on this project has been a great experience, but it also means I am responsible for keeping track of my own learning.


So, during the first week of January, I took out my notes, my Physiology textbook, and several articles in order to compile what I have learned so far and highlight areas that need further review.

Review in process!

Begrudgingly, I’ll admit that this ‘self-directed’ review process has shed new light on the usefulness of midterms in other courses. However, I still prefer this project-based review format. It has allowed me to review necessary information to make sure that it is fresh in my mind. Now I feel more prepared to begin the second half of the project. I’m looking forward to a major meeting this month and all the other exciting parts of the project to come.


Julia Robson

Ethics Schmethics?

 

Today, it may seem obvious that the first step of any research project should be to complete a proposal for ethics review. But why do we need ethical standards? While helping to complete an ethics form for a project I’m working on, I wondered if scientists perhaps made more ‘progress’ before ethical considerations became commonplace. Even if this was the case, research is certainly better now, when institutions and procedures protect patients’ and research subjects’ rights. 

It also seems that scientific research in the 18th and 19th centuries tended to be somewhat more haphazard than it is now, and almost certainly less ethical. For example, Dr. Edward Jenner tested his smallpox inoculation hypothesis for the first time on an eight-year-old
boy in 1796, with little preliminary understanding and no certainty that the patient would not be severely harmed.

Scientists were often fairly independent, acting based on their own curiosity to advance knowledge. Fortunately, research standards have evolved significantly since then. Ethics have been a major part of the transition, as ethical standards help to ensure that scientific research does not cause harm to researchers or subjects. The shocking Stanford Prison Experiment, just one example, shows that physical and psychological damage can occur if study participants’ rights are not upheld through ethics. College students with no criminal record were asked to play the role of prisoners and prison guards, the ‘guards’ became brutal and cruel, while the ‘prisoners’ became stressed and depressed. The experiment was terminated early, after only six days.

Fortunately, much has changed since the emergence of modern science in the 20th century. The current structure of research, including working in teams and undergoing peer review, helps to ensure a high standard of practice. Nevertheless, ethical issues in science remain. Researchers who work with human participants can become quite focused on the minutiae of their work, so Research Ethics Boards have an important mediating role. They provide an experienced, unbiased viewpoint that weighs the potential benefits of the research against any harm that may come to participants. Even if an ethical review sometimes slows the pace of scientific progress, it provides an essential foundation and structure for research, to the benefit of participants and researchers alike.  





Julia Robson

2nd year student at U of T

All the World’s a Stage

For journalists, authors, bloggers and tweeters, sharing articles has never been easier. Indeed, the public expects to be able to read articles about world events almost in real-time. For example,
the New York Times Twitter account was updated nine minutes ago
, and National Geographic tweeted three minutes ago. This expectation of speediness applies equally to scientific advances as it does to international affairs.
As an avid reader of online news, I would be the last to complain about being able to access such a vast amount of information. But there is something particularly noteworthy about information presented by a visible human. Perhaps that explains the persistence of televised news in the age of Twitter. 

Maybe it also explains the popularity of other media sources like TED talks, which often explain complex ideas in an engaging and understandable format. A personal favourite is “The best stats you’ve ever seen” by Hans Rosling. In his talk, Rosling explains the importance of little-known global public health data that shows the progress (or lack thereof) made by different countries over the past few decades. 

A more recent talk on a similar topic is also informative. One would be hard-pressed to find a paper or article that presents the same information with as much clarity and appeal.

In addition to numerous (maybe too numerous?!) TED talks, I have recently experienced the value of human-to-human information transfer. At the beginning of my ROP project in September, I was lucky to be able to hear about previous students’ research in person. I think it helped address the complexity of the work, but also conveyed its importance and the effort that had gone into it. Thanks Kiersten!
I’m not sure if information is generally more effective this way, but it is almost certainly more memorable. In any case, it has definitely worked for the 3.5 million subscribers to CrashCourse’s YouTube channel, where one can learn about anything from astronomy to macroeconomics.
For me, learning more about how researchers give and receive qualitative information to and from their subjects has allowed for a more well-rounded understanding of information transmission in the digital age.  But I think researchers andthe media have a lot to learn from each other. Communication is key for both, so understanding how others best absorb and respond to information can be instrumental.
That’s all for now, Julia!

Kiersten Thomas – Summer 2015 ROP at UofT: Another great student experience… part deux!

Kiersten Thomas – ROP summer 2015

Hello, I’m one of Professor Pascal Tyrrell’s summer ROP students and a second year Immunology Specialist student at the University of Toronto. I have just completed my summer research project investigating the cost-effectiveness of using MRA to evaluate asymptomatic carotid artery stenosis. 


I learned a lot and had an amazing time conducting research with Dr. Eli Lechtman and my ROP partner Indranil Balki. Using TreeAge Pro to create and analyse decision trees, we demonstrated that the additional information gained from an MRA/IPH scan increases the effectiveness of MRA when imaging carotid artery stenosis. 


Our research suggests that the additional information of the presence of intraplaque hemorrhage (IPH) would lead to better patient care, reducing long-term stroke risks. This means that MRA/IPH can be cost-effective or even dominant when compared to the current imaging strategy that uses standard ultrasound as a first-line imaging modality, for evaluating all degrees of asymptomatic carotid artery stenosis. Take a look at my timeline to see some of the highlights of my summer!


Thank you Dr. Pascal for this wonderful summer. 


Kiersten Thomas

Indranil Balki – Summer 2015 ROP at UofT: Another great student experience!

Indranil Balki – ROP Summer 2015

 

I am one of Dr.Pascal’s 2nd year ROP students at the University of Toronto.  This summer, I had an amazing experience into the realm of research working with my partner Kiersten Thomas, mentor Dr. Eli Lechtman, and supervisor Prof. Pascal Tyrrell. This timeline-cum-infographic highlights some of the especially memorable moments of this journey.
Our main project was focused on constructing a computer simulation to model the effect of choosing either MRI or US as a first line imaging modality to diagnose and treat patients with Carotid Artery Disease. This project involved comprehensive literature search, discussions with experts (including the “Trip to Cambridge”), learning computer software and presentations!
Our team’s models’ main finding was that MRI can be both more effective and no more costly than US as a first line diagnosing tool in measuring carotid artery disease.
 

Thanks to Dr. Pascal for allowing me to share my experience on his blog and I hope you enjoy the read!
 
 
Indranil Balki

Another Reason Why a Brain Boo-Boo Is Bad.

Rostam Rashidkhani – YSP 2015



Rostam Rashidkhani is a grade 12 International Baccalaureate student at the Toronto French School and he was a Meds – Youth Summer Program student with me this summer.

Rostam is intrigued by the sciences and enjoys biology, chemistry, and physics in school. He has participated in a number of University of Toronto summer programs and is looking forward to University life!



This summer Rostam looked at what causes brain problems after traumatic brain injury and how best to detect these changes with MRI. Recent brain imaging studies, including those in former professional football players, indicate that persistent brain inflammation after a single moderate head injury or repeated milder traumatic brain injury may be very common, may contribute to cognitive problems. More importantly, the chronic brain inflammation related to traumatic brain injury may be treatable. Looking for chronic traumatic brain inflammation with followup MR may be a way to reduce cognitive impairment.

Well done, Rostam!



Enjoy the read and…


… see you in the blogosphere,

Pascal Tyrrell

Some R&R with UofT YSP and Elizabeth Lehner…

Elizabeth Lehner – YSP 2015



Maybe not all rest and relaxation but certainly radiology and rheumatology! Here is a great example of why collaboration between disciplines is so important in medicine. Elizabeth recently graduated from Iroquois Ridge High School and will be a new University of Toronto student this fall. See her post below. 


Great job Elizabeth!!!

Many people are familiar with the word arthritis. This is probably because one in six Canadians aged 15 years and older report having arthritis. Rheumatoid Arthritis is a specific form of arthritis that unfortunately can lead to severe disability and joint replacement. 


Over the past several weeks, I participated in the 2015 YSP research program with the Division of Teaching Laboratories within the Faculty of Medicine at the University of Toronto and had the opportunity to look more closely at Rheumatoid Arthritis and ways to better diagnose this debilitating disease.


Under the supervision of Prof. Pascal Tyrrell and the Department of Medical Imaging at U of T, I was introduced to various imaging modalities including MRI machines, CT scanners and ultrasound machines. The work by Dr. Tyrrell was of particular interest given his studies on inflammation and the use of the various imaging modalities.


As part of this program I also participated in specific lab tasks including dissections and micropipetting and was exposed to clinical work such as suturing and operating an ultrasound machine. In addition, the program provided me with the opportunity to participate in daily workshops led by two instructors from the Division of Teaching Laboratories, Jastaran Singh and Jabir Mohamed. These workshops provided important overviews on a variety of topics relating to research that were very interesting.


The things I learned in this program provided me with a much better understanding of various research and medical issues that I think will be of use to me as I begin my studies at the University of Toronto this fall.
I would very much like to thank Prof. Pascal Tyrrell, Jastaran Singh and Jabir Mohamed for allowing me to be exposed to the various projects and for answering the many questions that I had during the program. Thank you!

 
Elizabeth Lehner

An “Egg-cellent” Journey to Investigate Carotid Artery Stenosis in Cambridge, Ontario…





Last Wednesday, my ROP students Kiersten and Indranil, and UofT medical student Eli Lechtman had the opportunity to interview the legendary (see here) Dr. Kim Tysdale – a general practitioner in Cambridge, Ontario.


Why do you ask? Well each year 50,000 Canadians suffer from a stroke with 26% due to carotid artery disease. Carotid artery stenosis is the narrowing of the carotid arteries due to plaque buildup (see atherosclerosis). These plaques can then rupture and create blood clots that travel up to the brain. In turn, these blood clots then get stuck in the brain’s smaller blood vessels, causing a stroke. So plaque = bad and ruptured plaque = worse!


What if we had a clue as to which plaque may rupture? Well, in turns out that the presence of intraplaque hemorrhage (IPH) can help us predict just that! IPH is bleeding within the plaques, which causes them to become more vulnerable (see vulnerable plaque). There is a 6 times greater risk of stroke in people with IPH! And…. a new medical imaging technique called MRIPH imaging allows for visualization of IPH. MRIPH is similar to traditional MRI but highlights the artery walls and looks at the arterial plaques. 


While in Cambridge, Kiersten, Indranil, and Eli presented Dr. Tysdale with an overview of medical imaging techniques for the assessment of carotid artery stenosis with an emphasis on the new MRIPH technique. Informing physicians like Dr. Tysdale which of his patients are more at risk of having vulnerable plaques (by providing information on IPH) could result in patients receiving more appropriate and timely treatment – thereby reducing the number of strokes! 


BTW, we had Dr Tysdale at “hello” (not sure what I am referring to? See here).


So what up with the eggs? Kiersten, Indranil, and Eli also had the chance to tour Dr. Tysdale’s beautiful country house and meet his lovely wife (and nurse!), Eva, who sent everyone home with fresh chicken eggs! Awesome.


Thank you Dr Tysdale for being such a great sport!


Here is their infographic of the trip (great job gang!). Enjoy!

Kiersten Thomas and Indranil Balki – ROP Summer 2015



Stay tuned for more ROP adventures!




Pascal Tyrrell