Tag: Cost effectiveness Analysis

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Engaging Primary Care in Research: Not Always an Easy Task

Stella Song ROP Summer 2016

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

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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

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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

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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
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MRA Is More Cost-Effective than the Current Strategy for Testing > 70% Carotid Stenosis

ROP Research Forum March 5th, 2015 – Kevin Chen





Kevin Chen is a 2nd year research opportunity program student studying neuroscience and
physiology in the University of Toronto Life Sciences Program. His main goal is to get into
medical school and to enjoy the UofT experience as much as possible!

Kevin’s ROP project consisted
of cost effectiveness analysis modeling to explore whether MRA could be a
cost-effective measure in testing and treating patients with carotid stenosis.
Preliminary results showed that in a subset of the population at risk for
carotid stenosis (> 70 %), MRA was dominant over the current strategy of testing with
Doppler Ultrasound. By reducing MRA scan time and by tailoring MRA sequences we believe it possible to extend these findings to include a larger sub-population (> 50 %). More to follow…

Well done, Kevin!

See you in the blogosphere,

Pascal Tyrrell