Five Clinician Researchers Awarded: 2022 PSI Graham Farquharson Knowledge Translation Fellowship

Knowledge translation research aims at transitioning research discoveries to the real world to improve health outcomes. The PSI Graham Farquharson Knowledge Translation Fellowship – valued at $300,000 for over two or three years – helps protect a promising clinician’s research time, allowing the Fellow to undertake high-impact translational research in Ontario.

5 Clinician Researchers Awarded with the 2022 PSI Graham Farquharson Knowledge Translation Fellowship

PSI Foundation is pleased to name five clinician researchers as the 2022 PSI Graham Farquharson Knowledge Translation Fellowship recipients:

Dr. Imaan Bayoumi – Queen’s University (Recipient Biography)

Dr. Andrea Gershon – Sunnybrook Research Institute (Recipient Biography)

Dr. Shawn Mondoux – McMaster University (Recipient Biography)

Dr. Brodie Nolan – St. Michael’s Hospital, Unity Health Toronto (Recipient Biography)

Dr. Derek Roberts – University of Ottawa (Recipient Biography)

Please visit their recipient biographies for more information on each of these Fellows and how they will be using PSI funds to conduct high-impact knowledge translation research. We thank all stakeholders for supporting PSI with the 2022 competition.

About the 2022 PSI Graham Farquharson Knowledge Translation Fellowship Competition

In May 2021, PSI launched the 2022 competition through a Letter of Intent (LOI) process. This was PSI’s first time launching this award through such process, which opened up the competition to more stakeholders by allowing candidates to directly apply to PSI.

The LOIs were reviewed by an internal sub-committee in late August 2021; successful applicants were invited to submit their full applications to PSI. Full applications were reviewed by the PSI Grants Committee in early December 2021.

The Committee approved $1.5 million in new funding for the 2022 PSI Graham Farquharson Knowledge Fellowship. Samuel Moore, Executive Director of PSI Foundation, comments: “This investment of $1.5 million in five Ontario clinician-researchers represents PSI’s largest commitment to any new program in decades. This is the largest amount that PSI has ever funded for this award in a single competition.”

One of the major enhancements made to this award for this competition was the stronger emphasis on knowledge translation. Throughout announcements, guidelines, and application forms for this award, PSI had repeatedly stated that knowledge translation must be the fundamental purpose of this Fellowship and must be demonstrated in the application.

PSI Foundation’s Commitment to Funding Knowledge Translation Research

Since the launch of this award in 2012, PSI invested $5.7 million in funding the PSI Graham Farquharson Knowledge Translation Fellowship. Together with other awards including the 2020 Mental Health Knowledge Translation Fellowship, PSI has invested a total of $6.3 million in knowledge translation research, providing salary support and protecting the research time of 21 clinician researchers in Ontario.

This funding portfolio demonstrates PSI’s strong commitment to support the physician of Ontario to advance translational research in Ontario.

“I am so proud of PSI’s commitment to knowledge translation by supporting the research programs of physicians in Ontario,” says Samuel Moore. “I look forward to seeing the tremendous impact these clinician-researchers make on the health care system and for all of us through their research.”

PSI has funded research in many surgical and medical areas resulting in changes to clinical bedside practice. PSI’s investment in knowledge translation research is one of the pillars in achieving its mission of improving the health of all Ontarians.

Dr. Derek Roberts – 2022 PSI Graham Farquharson Knowledge Translation Fellowship

“Being awarded the PSI Fellowship will allow me to spend more time to build my research program on improving the quality of healthcare for the millions of Canadians with peripheral artery disease. As a new investigator, it would jump start my career by giving me the time to focus on completing some early, high-impact, and potentially practice-changing work related to this goal. It would therefore catalyze my transition from being a trained surgeon and researcher into an independent surgeon-scientist who hopes to help transform peripheral artery disease care in Canada and internationally.

Approximately 10% of Canadians have peripheral artery disease (hardening, narrowing, and occlusion of the leg arteries). People with peripheral artery disease have a high risk of lower limb amputation, heart attack, stroke, and death. Clinical practice guidelines strongly recommend providing certain blood thinner, cholesterol reducing, and blood pressure lowering medications to people with peripheral artery disease because these medications reduce the risk of these adverse outcomes. However, international studies have reported that these medications are often markedly underprescribed to people with peripheral artery disease.

As the 2022 PSI Graham Farquharson KT Fellow, I aim to conduct a multi-phased, mixed-methods study to: 1) understand gaps in the prescription of and adherence to guideline-recommended cardiovascular medications among Ontarians with peripheral artery disease; 2) identify factors that may influence the prescription of guideline-recommended medications to Ontarians with peripheral artery disease; and 3) develop a tailored and evidence-informed implementation intervention to improve medication prescription by doctors and nurses. Ultimately, this implementation intervention could then be used as a template for other provinces and countries interested in performing similar interventions. My research team and I believe these types of interventions will significantly improve the health outcomes of people with peripheral artery disease and reduce their overall health resource use.” – Dr. Derek Roberts

Dr. Derek Roberts Awarded: 2022 PSI Graham Farquharson Knowledge Translation Fellowship

PSI Foundation is delighted to announce Dr. Derek Roberts of University of Ottawa as the 2022 PSI Graham Farquharson Knowledge Translation Fellow.

About Dr. Derek Roberts

Dr. Derek Roberts is a vascular and endovascular surgeon and new investigator based in the Division of Vascular and Endovascular Surgery at The Ottawa Hospital and University of Ottawa. He completed a pharmacy degree (and practiced as a pharmacist) and an MD with Distinction at Dalhousie University; a residency in general surgery, the Clinician-Investigator and Surgeon-Scientist Programs, and a PhD in epidemiology with a focus on KT at the University of Calgary; the KT Canada Strategic Training in Health Research (STIHR) fellowship; and a fellowship in vascular and endovascular surgery at the University of Ottawa. The KT Canada STIHR Fellowship provided Dr. Roberts with rigorous graduate training in the science and practice of KT and made him one of the first surgeons or surgical trainees to complete formal training in KT in Canada. This training included completion of a KT-related PhD thesis and attendance or completion of monthly KT Canada seminars, twice-monthly research operations seminars, the annual KT Canada Summer Institute (two consecutive summers), and KT-related graduate courses.

Dr. Roberts was appointed as an Assistant Professor in the Department of Surgery on January 1st, 2021. He was then cross-appointed to the School of Epidemiology and Public Health at the University of Ottawa on September 1st, 2021 where he is approved to supervise MSc students and co-supervise PhD students. He currently spends 30% of his time conducting research (during which he has no clinical responsibilities) and 70% practicing vascular and endovascular surgery and providing direct patient care to patients with peripheral artery disease and other vascular surgical problems.

About Dr. Derek Roberts’ Research Program

The overarching objective of Dr. Roberts’ research program is to improve the quality of healthcare and outcomes for people with peripheral artery disease and several other vascular surgery problems. He began his career by using his research training to attempt to improve the perioperative outcomes of people with peripheral artery disease who require lower limb revascularization surgery. These surgeries are commonly-performed, high-risk, and costly procedures performed to improve quality of life and prevent leg amputation in people with peripheral artery disease. Dr. Roberts recently studied 20,988 patients who underwent lower limb revascularization surgery in Ontario. Study results were published in the prestigious British Medical Journal (BMJ). Use of neuraxial instead of general anesthesia was associated with decreased mortality, health care costs, and length of hospital stay. He is now using an integrated KT approach to involve stakeholders across Canada in the design of a multicenter pilot and then Canada-wide randomized controlled trial to test whether use of neuraxial instead of general anesthesia may improve the outcomes of PAD patients undergoing lower limb revascularization surgery.

Dr. Roberts now seeks to use his training in pharmacy, epidemiology, vascular and endovascular surgery, and KT to understand and subsequently reduce gaps in the use of guideline-recommended medications for people with peripheral artery disease. He will be conducting these studies alongside colleagues in the Division of Vascular and Endovascular Surgery at the University of Ottawa, members of the Canadian Society for Vascular Surgery, and world experts in KT at the University of Ottawa, including members of the Centre for Implementation Research ( http://www.ohri.ca/cir/) at the Ottawa Hospital Research Institute.

About the PSI Graham Farquharson Knowledge Translation Fellowship

Knowledge translation research aims at transitioning research discoveries to the real world to improve health outcomes. This prestigious fellowship – valued at $300,000 for over three years – helps protect a promising clinician’s research time, allowing the Fellow to undertake high-impact translational research.

Dr. Andrea Gershon – 2022 PSI Graham Farquharson Knowledge Translation Fellowship

“I am delighted to receive a PSI KT Fellowship that will support the cutting edge work we are doing to help patients and health care providers maintain and improve lung health. I am impressed by the PSI Foundations forward-thinking dedication to knowledge translation – not just research, as well as its commitment to innovation and new ideas.” – Dr. Andrea Gershon

Dr. Andrea Gershon Awarded: 2022 PSI Graham Farquharson Knowledge Translation Fellowship

PSI Foundation is delighted to announce Dr. Andrea Gershon of Sunnybrook Research Institute as the 2022 PSI Graham Farquharson Knowledge Translation Fellow.

This Fellowship will allow Dr. Gershon to further advance her research and knowledge translation program, Canadian Best Respiratory Research Evaluation and Analyst Team of Health Experts (CanBREATHE), conducting research and translating it to improved care for people with respiratory disease in Canada. She leads a diverse team of more than 70 researchers, clinicians, patients and other stakeholders to conduct such research and knowledge translation. Importantly, she also works closely with government, health districts, hospitals, health care providers and patients to translate their findings to quality, equitable care to improve lung health for all.

About Dr. Andrea Gershon

Dr. Andrea Gershon is a Respirologist and Senior Scientist at Sunnybrook Health Sciences Centre, University of Toronto and ICES. She is a well published CIHR-funded researcher as well as the COPD Associate Editor of the high impact journal CHEST.

Dr. Gershon’s award winning research investigates health outcomes, health services, and drug safety and effectiveness in individuals with respiratory disease. Her research and knowledge translation program uses real world data from millions of people to learn about the experiences of people with lung disease with a focus on vulnerable groups, including the elderly, those of lower socioeconomic status, and aboriginal peoples.

Dr. Gershon has published over 200 peer-reviewed articles. She has been an invited speaker at international meetings, universities, and medical centres worldwide. Her work is used by government and non-profit organizations where it informs international guideline and policy documents.

Dr. Gershon works with junior faculty, postgraduate fellows, graduate candidates, and other students at all levels of training. She loves supporting these future leaders, researchers and clinicians who will be central to the discovery and use of health-related knowledge to keep people well.

About the PSI Graham Farquharson Knowledge Translation Fellowship

Knowledge translation research aims at transitioning research discoveries to the real world to improve health outcomes. This prestigious fellowship – valued at $300,000 for over three years – helps protect a promising clinician’s research time, allowing the Fellow to undertake high-impact translational research.

Dr. Imaan Bayoumi – 2022 PSI Graham Farquharson Knowledge Translation Fellowship

“Poverty and other social determinants have enormous negative impacts on the health of young children and their families, which have been worsened during the COVID-19 pandemic. Based on the long-term trusting relationships primary care providers develop with families, they are in a unique position to address social determinants of children’s health. The PSI Graham Farquharson Knowledge Translation Fellowship will allow me to study primary care-embedded interventions addressing poverty, as well as the impacts of the COVID-19 pandemic on primary preventive care and health outcomes for young children.” – Dr. Imaan Bayoumi

Dr. Imaan Bayoumi Awarded: 2022 PSI Graham Farquharson Knowledge Translation Fellowship

PSI Foundation is delighted to announce Dr. Imaan Bayoumi of Queen’s University as the 2022 PSI Graham Farquharson Knowledge Translation Fellow.

This Fellowship will allow Dr. Bayoumi to generate and disseminate evidence about impacts of the COVID-19 pandemic on primary preventive care and health outcomes for young children and of primary care embedded
interventions (e.g. social service navigation) on parent and child health.

Poverty and other social determinants have a profound negative impact on the health of parents, children and families, contributing to substantial health disparities in parenting stress, mental health, and children’s general and social-emotional development. Primary preventive care in early childhood is fundamental to early detection and prevention of future health problems. As the first contact with the health system for most families, primary care providers are in a unique position to develop long-term trusting relationships, and to intervene to address social determinants of children’s health in clinical settings. During the COVID-19 pandemic, families have experienced increased stress with social isolation, increased food insecurity, disruptions to work, daycare and schools, and worsening parent mental health, all factors which are associated with poor child health and which create barriers to accessing preventive care.

About Dr. Imaan Bayoumi

Dr. Imaan Bayoumi is a Family Physician and Assistant Professor of Family Medicine at Queen’s University. She completed her MD at Queen’s University, Family Medicine training at McMaster University, and a Masters of Science in Health Research Methodology at McMaster University. She is an investigator with the TARGet Kids! primary care practice based research network for children ( https://www.targetkids.ca/) and a fellow at ICES. She is a member of the executive team of the Rourke Baby Record, the evidence-informed guide to preventive primary care for young children in Canada. She also co-leads Innovations for Community Resilience Equity and Advocacy (I-CREAte, https://www.queensu.ca/i-create/), a community based participatory action research initiative aimed at conducting action-oriented research to improve health and wellbeing of children and families. She is committed to collaborating with parents, community partners, professional bodies and policy makers to carry out equity oriented, meaningful research.

About the PSI Graham Farquharson Knowledge Translation Fellowship

Knowledge translation research aims at transitioning research discoveries to the real world to improve health outcomes. This prestigious fellowship – valued at $300,000 for over three years – helps protect a promising clinician’s research time, allowing the Fellow to undertake high-impact translational research.

Dr. Shawn Mondoux – 2022 PSI Graham Farquharson Knowledge Translation Fellowship

“There is somewhat of a disconnect between medical training and consultant level work. While a trainee, we constantly evaluate individual performance to move clinicians towards better habits and more robust practice. With competency-based education, this focused is heightened. Yet once physicians enter practice, this formative feedback comes to an abrupt end. Providing clinicians with their individual practice data is an essential beginning yet falls short of meaningful and sustained practice change. If we are going to improve clinical practice, we must design peer exchange experiences, educational interventions and coaching which bring practice data to the next level. It is not enough to know things should change, it’s about providing clarity on how this could be done.” – Dr. Shawn Mondoux

Dr. Shawn Mondoux Awarded: 2022 PSI Graham Farquharson Knowledge Translation Fellowship

PSI Foundation is delighted to announce Dr. Shawn Mondoux of McMaster University as the 2022 PSI Graham Farquharson Knowledge Translation Fellow.

Through this Fellowship, Dr. Mondoux aims to change clinical practice through augmented data feedback, using interviews, peer learning methods, and clinical coaching to improve clinical care metrics.

Making healthcare safer and a doctor’s practice better starts with providing each doctor with good quality data about their medical practice. Dr. Mondoux has created such a system that compares a doctor’s practice with peer doctor who work in the same setting. But improvement needs more than data. This Fellowship will allow Dr. Mondoux to develop new education, peer coaching and data sharing programs to make sure that the data is used as best as possible.

About Dr. Shawn Mondoux

Dr. Shawn Mondoux is an Emergency Physician at St. Joseph’s Healthcare Hamilton (SJHH) and an Assistant Professor at McMaster University. He graduated with a B.Eng. in Aerospace Engineering, completed his medical training at the University of Ottawa in the Royal College stream of Emergency Medicine and completed a MSc of Quality Improvement and Patient Safety at the University of Toronto. Dr. Mondoux currently serves as the Quality and Safety Lead of the Emergency Department and is a corporate Innovation Lead at SJHH.

About the PSI Graham Farquharson Knowledge Translation Fellowship

Knowledge translation research aims at transitioning research discoveries to the real world to improve health outcomes. This prestigious fellowship – valued at $300,000 for over three years – helps protect a promising clinician’s research time, allowing the Fellow to undertake high-impact translational research.

Dr. Brodie Nolan – 2022 PSI Graham Farquharson Knowledge Translation Fellowship

“Injuries are the leading cause of death for young Canadians. Early stabilization and timely transport to a specialized trauma centre gives patients the best chance for survival. Support from the PSI Graham Farquharson Knowledge Translation Fellowship will allow me to study how we can improve our current approach to prehospital trauma care in Ontario.

Through this fellowship we will look at the creation and implementation of a Prehospital Code Blood to reduce the time to blood transfusion, explore limitations of our current trauma triage protocols, and update prehospital trauma practices to ensure they are following the most recent evidence.” – Dr. Brodie Nolan

Dr. Brodie Nolan Awarded: 2022 PSI Graham Farquharson Knowledge Translation Fellowship

PSI Foundation is delighted to announce Dr. Brodie Nolan of St. Michael’s Hospital, Unity Health Toronto as the 2022 PSI Graham Farquharson Knowledge Translation Fellow.

Through this Fellowship, Dr. Nolan aims to deliver a much-needed reform to prehospital trauma care in Ontario.

Injuries are the leading cause of death for young Canadians. Annually in Ontario, injuries result in the death of nearly 6,000 people, over 75,000 hospitalizations and almost 6 billion dollars in direct health care costs. The role of prehospital care in a trauma system is to facilitate prompt transport to a trauma centre and initiate stabilization of the patient. These are complex tasks performed by paramedics in austere environments with incomplete information and minimal therapies available. The current approach to trauma care in Ontario is outdated and worse, there is evidence that some trauma practices are leading to patient harm.

About Dr. Brodie Nolan

Dr. Nolan is an emergency physician and trauma team leader at St. Michael’s Hospital, Unity Health Toronto and a transport medicine physician for Ornge, Ontario’s air ambulance and critical care transport service. He is an Assistant Professor and clinician scientist in the Department of Medicine at the University of Toronto and a scientist at the Li Ka Shing Knowledge Institute.

Dr. Nolan completed his medical school and emergency medicine residency training at the University of Toronto. He completed his MSc in Clinical Epidemiology and Health Care Research through the Institute of Health Policy, Management and Evaluation at the University of Toronto. Dr. Nolan’s research interests are in trauma, prehospital care, and patient safety. His work focuses on improving timely access to trauma care for injured patients in Ontario and the role of the provincial air ambulance system.

About the PSI Graham Farquharson Knowledge Translation Fellowship

Knowledge translation research aims at transitioning research discoveries to the real world to improve health outcomes. This prestigious fellowship – valued at $300,000 for over three years – helps protect a promising clinician’s research time, allowing the Fellow to undertake high-impact translational research.

Dr. Carrie Bernard: New Family Medicine Ethics Curriculum Helps Learners See Ethical Principles in Everyday Clinical Work

As a community-based family physician, Dr. Carrie Bernard examines research questions that are directly relevant to her patients and practice.

“All of my research has come out of the clinical world, and for me, that’s what makes research meaningful,” says Dr. Bernard, physician at William Osler Health Centre in Brampton. “I see myself as firmly planted in the community as a physician. That is my home, and that is what matters to me. I am most interested in research that is going to help my patients in the long run.”

Since she started to undertake research projects over the last decade, she has partnered with researchers to work on projects ranging from humanitarian health care ethics to advanced care planning. One of her most recent projects, funded by a PSI Foundation grant for Medical Education Research that the Post-MD Level, focused on how ethics curriculum is taught to postgraduate family medicine trainees.

Dr. Bernard says that PSI’s support of family physicians and their understanding of their unique research approach helped her feel valued as a researcher.

“PSI felt like the right place to go for this funding because it represents who I am as a physician first and a researcher,” she says. “They understand and expect that as an MD, you will need to partner with a PhD researcher on your project. You’re not viewed as a lesser researcher because of that.”

New ethics curriculum aimed to increase confidence with challenging situations

Dr. Bernard’s transition to doing research was a gradual one. She had been practising as a family physician for several years when she volunteered on a humanitarian trip to northern Uganda with Médicins Sans Frontières (Doctors Without Borders). The experience left her with many questions about how to do humanitarian medical work ethically, but she realized she needed a research-focused education to properly answer the questions.

So, while continuing to practice family medicine fulltime, she earned a master’s degree in public health at the University of Toronto, focusing on global health and ethics.

Her master’s degree opened up new opportunities in academia, and in 2014, she joined U of T’s Department of Family and Community Medicine as Associate Program Director, Curriculum and Remediation. As part of her role, she began working with a team of physicians, ethicists and education experts to re-design how ethics is taught during family medicine residencies.

“One of the main reasons doctors run afoul with regulatory bodies is because of unprofessional behaviour and understanding how to manage these fraught and ethically challenging situations. It’s incredibly important to make sure you have strong ethical judgment to build trusting relationships with patients,” she says. Yet, “Family medicine trainees and even many practising family physicians feel underprepared and unconfident when it comes to ethics.”

Dr. Bernard worked closely on the new curriculum with Dr. Mahan Kulasegaram, director in the Office of Education Scholarship in the Department of Family and Community Medicine and an expert in learning sciences. They, along with the rest of their team, spent more than a year developing a new ethics curriculum that relied on family physicians – not trained ethicists – to teach the curriculum, as well as deliberately integrated ethical principles with the day-to-day work of family medicine.

“You can do a lecture on the principles of ethics, but if it’s not integrated within a realistic case that learners can understand in a clinical way, it seems remote,” she explains. “Our whole interest was really on grounding it in integration in family medicine and basing it on learning principles.”

Dr. Bernard and Dr. Kulasegaram then applied to PSI Foundation to evaluate the new curriculum. They worked with physician teachers at four teaching sites to teach the new curriculum, interviewed residents before and after they completed the curriculum, and evaluated the residents’ performance in the objective structured clinical examination (OSCE).

Positive pilot results help curriculum become self-sustaining

Dr. Bernard says that she and the team were “blown away” by the results. Residents from the pilot sites performed significantly better in a five-station OSCE focused on ethical issues compared to their peers who learned from the standard curriculum. And in the interviews, residents said they had greater awareness of ethical principles and could use a formal ethical deliberation process in challenging situations, which gave them more confidence to act and incorporate patients’ values into ethical deliberations.

Dr. Bernard says she was most pleased with what happened next: based on these results, the pilot sites not only continued using the new curriculum, but also supported the other training sites in implementing it. Having the curriculum become self-sustaining at the training sites was exactly the kind of result that the curriculum redesign team had hoped for.

“Now every single training site in our department is teaching it, and the original sites are acting as helpers,” she says. “We had hoped this would become a ‘train the trainer’ mentorship community of practice, and it just happened naturally that as these teachers became empowered and confident, they started teaching others.”

Having demonstrated these positive results in one department, the team hopes to generate more awareness of the curriculum results among physician teachers and residency program directors at medical schools across the country. In the long-term, she hopes that the curriculum will help more family physicians be more confident in their ethical deliberations and build positive patient relationships.

“Funding good educational research means we’re going to have good doctors in the future,” she says. “PSI’s support of this project is amazing because it directly affects the people – that is, the medical residents – who are going to make a difference in the future.”

Dr. Joel Fish: Laser Therapy Improves New and Mature Severe Burn Scars in Children

“PSI Foundation It is one of the few granting agencies that funds clinical research. Its reviewers understand good science and good methodological design, but as clinicians, they also see the clinical problems. I feel that, as a clinician, I can be competitive with PSI because they understand that type of work.” – Dr. Joel Fish, plastic surgeon and Medical Director of the Burn Program at the Hospital for Sick Children, Toronto

Hypertrophic scars – thick and stiff severe scars that are often the result of burns – can affect children’s lives in many ways, interfering with a child’s growth, mobility and even confidence. And children with these scars haven’t had many effective treatment options to reduce the scar’s appearance and size.

But a new laser therapy may help to treat these scars, whether they are new or even several years old.

Dr. Joel Fish, a plastic surgeon and Medical Director of the Burn Program at the Hospital for Sick Children (SickKids) in Toronto, led a PSI Foundation–funded clinical trial that has provided some of the strongest evidence so far supporting the use of a new laser therapy to treat hypertrophic scars in children.

Lasers have been used in medical treatment for many years, particularly for cosmetic procedures, but recent research had suggested that two specific kinds of lasers, pulsed dye laser (PDL) and carbon dioxide laser, could be particularly useful for treating burn scars – even scars that are more than 10 years old.

“It’s one of the few therapies to come along in many years that has real benefits, not just on new scars but on mature scars, so it’s quite unique,” says Dr. Fish.

But more definitive research about the effectiveness of laser therapy, especially in children, was needed. Dr. Fish and his research team designed a clinical trial to determine whether laser therapy could improve hypertrophic scars in children, and received PSI funding in 2016 to conduct the trial.

Approximately 25 children with hypertrophic scars were treated with three laser therapy sessions over the course of a year. To determine whether the scars improved over the course of treatment, between sessions Dr. Fish and his team measured the scar’s height and thickness, stiffness, vascularity and colour, using validated subjective scar assessment scales and objective tools, such as conventional ultrasound and ultrasound elastography.

After all of the laser therapy treatments, the team found that the height of the scars improved, the thickness and colour improved, and the scars were less itchy, demonstrating that the therapy was highly effective.

“It really did have measurable effects, and not only were they measurable, the scars don’t go back to the way they were,” says Dr. Fish. “Once you achieve the scar being a little bit flatter or softer or less red or less itchy, it doesn’t go back.”

With these positive results, the team now plans to do further work to understand when treatment should start and how many sessions are optimal, as well as examine how the treatment works, all of which will help to refine the therapy.

SickKids has the largest pediatric burn program in the country by a large margin, and children from across the country have been treated in Toronto instead of closer to home. In fact, it is one of the few centres in Canada to use laser therapy to treat scars in children.

But Dr. Fish’s study, along with a handful of other trials, is generating interest in the health care community about the potential for this treatment. Directors of burn programs from different countries have learned from Dr. Fish’s team how to treat children with laser therapy to implement their own programs, and more hospitals across the country are beginning to invest in the technology.

“To our knowledge, this is the most comprehensive study to date that demonstrates that laser treatment leads to significant improvements in children with burn scars,” says Dr. Fish. “We hope that our findings will encourage other providers to invest in this valuable therapy for their patients.”

Dr. Joanna Dionne: International Study Increases Understanding of Diarrhea in Critical Care Patients

A clinical study supported in part through PSI has examined one of the most common complications faced by patients in critical care – diarrhea. Dr. Joanna Dionne, who is leading the Diarrhea, Interventions, Consequences and Epidemiology in the Intensive Care Unit (DICE-ICU) study, says that PSI support was essential to the study, which aims to improve care for patients experiencing diarrhea while in the ICU.

“My Resident Research Grant from PSI was truly transformative. It provided not only financial support, but also encouragement that my physician community in Ontario believed in me and this research,” she says. “This topic may not be ‘flashy,’ but diarrhea certainly affects many critically ill Ontarians, and we could certainly change care and impact our patients if we understood it better.”

Dr. Dionne is a gastroenterologist, intensivist and internist at Hamilton Health Sciences and assistant professor at McMaster University. As a trainee in critical care with her mentor, Dr. Deborah Cook, she realized that not much information was available about the incidence of diarrhea in the ICU and its causes.

This realization eventually led to the DICE-ICU pilot study, a prospective cohort study to establish the prevalence of diarrhea in patients in critical care, identify risk factors and document its consequences on clinical decisions and outcomes. The pilot study began with four sites in Ontario, then added two sites in the US. In 2016, Dr. Dionne received a PSI Resident Research Grant to expand the study to another three Ontario sites, which mean that nearly 900 critical care patients in total participated in the study.

Residents are the principal investigators on PSI Resident Research Grants, helping them gain key research skills to help prepare them for careers as independent clinician scientists.

“Early support will make or break someone’s career and will lead them to becoming a researcher or not,” says Dr. Dionne. “It’s not just about the science, but also getting experience with the administrative work of leading a study that is so vital for your career development. It’s absolutely fundamental.”


DICE-ICU study will provide foundational information about understudied topic


The DICE-ICU pilot study used three different definitions of diarrhea to estimate the incidence in critical care patients, which ranged from 40% to 77% depending on the definition. It also identified the risk factors most strongly associated with diarrhea, which included the number of days a patient was prescribed antibiotics. And, importantly, the study suggested that Clostridium difficile, which has been thought to be major cause of diarrhea in critical care patients, is actually responsible for only a small proportion of cases.

Based on these pilot results, Dr. Dionne initiated a larger DICE-ICU study, which includes more than 1,000 patients at 12 centres in four countries – the largest study of its kind in the world. The results will provide foundational information on the cause and impact of diarrhea in the ICU and may influence treatments that increase risk of diarrhea, such as antibiotic prescribing and enteral feeding practices in ICU patients.

In 2019, Dr. Dionne received a PSI Research Trainee Award, a two-year award that provides support to protect 75% of her time for research and allowed her to further the DICE-ICU study.

“The funding I received from PSI has been the building blocks of a research program that otherwise may not have been funded,” she says. “And importantly, PSI is able to support you as you grow as an investigator. It supports junior and early career investigators and has different programs to support you over time. That longitudinal support is absolutely transformative.”

Dr. Dionne says that it was challenging to get the DICU-ICU study underway, in part because there hasn’t been much interest in studying diarrhea in critical care patients or recognition of its clinical importance. But mentorship from Dr. Cook and support from PSI encouraged her to continue pursuing this question. This support inspires her to give back to younger trainees now and in the future.

“It makes me want to give back to my province, to PSI which has been incredibly instrumental to my career, and to give those opportunities to the next generation of young investigators,” she says.

Despite the challenges young clinicians may face, especially when trying to undertake a new research program, she encourages them to persevere to examine important clinical questions that can change patient care.

“It’s a true honour to work with patients and serve my community and my province, but when you’re working at the bedside, there’s always a question you cannot answer. That curiosity always drives me back to research,” she says. “As a physician, I can do my best for my patients, but as a researcher I can help patients that I will never meet, and I think that’s pretty powerful.”

Dr. Jeffrey Pernica: SAFER Clinical Trial Demonstrates Short-Course of Antibiotics is Comparable to Long-Course to Treat Pediatric Pneumonia

A recent clinical trial, supported in part by PSI Foundation, is challenging the dogma around antibiotic use to treat community-acquired pneumonia in children. 

Physicians have traditionally prescribed a 10-day course of antibiotics, but this has been based more on convention rather than evidence. Dr. Jeffrey Pernica, a pediatrician and infectious diseases specialist at McMaster Children’s Hospital, recently led a clinical trial to determine whether a five-day course of antibiotics is as effective as the longer course.

“As medicine has transitioned to relying more on evidence rather than convention, we’re all trying to be more rational with antibiotic courses in order to make patient management plans that carry the most potential benefit and the least potential harm,” says Dr. Pernica. “As physicians, we all have a responsibility to make sure that when we use antibiotics, the courses we select are based on the best evidence so that our patients receive just the amount of antibiotics that they require – and no more.”

Potential antibiotic-associated harms include increasing rates of circulating antibiotic-resistant bacteria, medication costs to the families, short-term side effects, as well as longer-term health effects from disrupting the microbiome, including obesity and allergic disease.

Dr. Pernica first led a pilot study comparing a 10-day course of amoxicillin to a five-day course of amoxicillin for community-acquired pneumonia as part of his master’s degree in health research methodology. Based on the pilot study’s results, he received a PSI Foundation Clinical Research Grant in 2015 to expand the study and launch the SAFER (Short-Course Antimicrobial Therapy for Pediatric Respiratory Infections) trial.

“PSI feels like a collegial organization, and the grant reviewers are really my peers,” says Dr. Pernica. “They have the best interests of Ontarians at heart and a good idea of what studies are actually going to be useful for Ontario citizens, academics and clinicians.”

With PSI support, Dr. Pernica and his team recruited 281 children from six months to 10 years old who were diagnosed with pneumonia in the emergency departments at McMaster Children’s Hospital and the Children’s Hospital of Eastern Ontario. The children received either the full 10-day course of antibiotics or five days of antibiotics and five days of placebo and were followed closely until they were assessed two to three weeks after diagnosis.

The trial results, published in JAMA Pediatrics in March 2021, demonstrate that the short course of antibiotics was comparable to the standard course in treating children with community-acquired pneumonia. At 14 to 21 days after enrollment, 85.7% of children on the short course of antibiotics were “clinically cured” based on the study’s strict definition, compared to 84.1% of children on the longer course. The researchers then did a post hoc analysis to examine how many of the children clinically improved without needing additional antibacterials: 93.5% of children on the short course and 90.4% on the longer course fit this criteria. Taken together, the results suggest that the short course of antibiotics is just as effective as the longer.

Dr. Pernica says the trial did not require any special tests for physicians to order or onerous follow-up for patients, reflecting real-world conditions of how pneumonia in children is diagnosed and treated, which should allow the results to be quickly integrated into practice. 

“The patients in this study are very similar to patients that doctors see every day in Canadian emergency departments and diagnose with pneumonia,” says Dr. Pernica. “For that reason, we think that this evidence is generalizable to the vast majority of children being diagnosed with pneumonia in Ontario emergency departments and will be of practical use for Ontario-based physicians.” 

Given the urgency and scale of the challenge of antibiotic resistance, Dr. Pernica and his team are now focused on knowledge translation to incorporate the results into prescribing practices. They are working with research groups such as Pediatric Emergency Research Canada to integrate the results into practice and reduce antibiotic use where possible.

“Antibiotic resistance has become so important, not just in other places in the world, but here in Canada as well. We all need to do our part to use antibiotics responsibly so that we are still able to control bacterial infections in our population,” says Dr. Pernica. “It’s going to be critical to make sure that clinicians in Canada use only as much antibiotics that are needed to cure a patient, but no more.”

Stay Informed

Grant and foundation updates straight to your inbox.