Dr. Selina Liu: Finding a New Approach to Improve Screening for Diabetic Eye Disease

“This was my first successful grant as a new investigator, so it really jumpstarted my research career.… Getting that first grant and being able to do this research led to other opportunities, and I’m very grateful to PSI Foundation for their support.” – Dr. Selina Liu, Western University, Lawson Health Research Institute and St. Joseph’s Health Care, London, Ontario

Recent estimates from Diabetes Canada indicate that 5.7 million Canadians are living with diabetes. Many of these people do or will experience eye damage, called diabetic retinopathy, which is a major cause of vision loss. As a result, practice guidelines recommend that people with diabetes undergo screening for diabetic retinopathy once a year.

People with diabetes have their eye exams covered through OHIP, but they may face other barriers to getting an exam, such as simply remembering to make the appointment, taking additional time off work for the exam, and taking eye drops that make it difficult to see and drive for some time after the exam.

“Prior research showed that about 50% of people with diabetes in Ontario weren’t having their eyes checked regularly, and that’s a major problem. We know that diabetic retinopathy is the main cause of blindness in working-age adults in Canada and has a drastic effect on quality of life,” says Dr. Selina Liu, Assistant Professor, Department of Medicine at Western University, Associate Scientist at Lawson Health Research Institute and Endocrinologist, Centre for Diabetes, Endocrinology and Metabolism at St. Joseph’s Health Care London, Ontario. “Vision loss due to diabetic retinopathy is preventable through early detection and treatment. Developing strategies to improve retinopathy screening seemed to be a major area that deserved further research.”

One strategy uses a new technology to potentially make screening more accessible.

Non-mydriatic ultra-widefield (UWF) retinal imaging, which uses a specialized camera to take a wide-angle image of the retina, offers a few advantages over the usual screening methods used by optometrists. It only takes a few minutes and does not require eye drops, and images can be taken by trained staff and provided to an ophthalmologist to be read later. For these reasons, UWF imaging has potential to be incorporated into the regular diabetes clinic visits.

“What if we could integrate screening into a diabetes clinic visit?” says Dr. Liu. “If we could screen for retinopathy on the same day and in the same location where our patients are already coming for diabetes care, some of the barriers to getting screening done would be taken away.”

In 2016, Dr. Liu and a multidisciplinary team received funding from PSI Foundation for a randomized clinical trial called Clearsight to examine whether UWF imaging could detect more patients with eye disease that needed closer monitoring or treatment compared to usual screening.

“As a new investigator, embarking on a full 740-person randomized controlled trial was a bit daunting at first,” she says.  “But having funding from PSI Foundation was essential for this trial and gave me confidence as I went down this path.”

The research team recruited 740 patients with diabetes to participate in the trial, with half being screened through UWF imaging and half receiving usual care. The trial mimicked how screening is or could be done in a real-world setting: the patients enrolled in the UWF group were offered screening at the same clinic visit with the images read by an ophthalmologist later, while those receiving usual screening were responsible for making their own optometrist appointment. Patients in the UWF group were also still advised to visit their optometrist for usual screening, as per standard of care.

The team found that on-site screening significantly increased detection of diabetic eye disease that required either increased surveillance (more than annually) or referral to an ophthalmologist for further assessment. They also found that on-site screening resulted in significantly higher screening adherence than usual screening. The study did not look at patients’ vision outcomes as a result of the screening (since a much larger and longer trial would be required), but they expect that if more patients who require closer monitoring or ophthalmology referral are identified early, the rates of vision-threatening diabetic eye disease would ultimately decrease.

While the results were promising, screening with UWF imaging does come with significant costs, and Dr. Liu plans to complete a cost-effectiveness analysis of the imaging compared to usual screening. She is also undertaking research on other approaches to identify patients at risk of diabetic eye disease, including the use of artificial intelligence to read UWF images and the use of blood biomarkers for retinopathy screening.

Ultimately, she hopes that the Clearsight trial and other related work will provide evidence that can be incorporated into diabetes clinical practice guidelines to improve screening and vision care for people with diabetes, in Canada and worldwide.

“We hope that having this study will provide the high-quality evidence that this approach can improve retinopathy screening and detection rates, and perhaps it could be implemented in clinical practice guidelines so that the diabetes clinic could be a one-stop shop for diabetes care, including eyes,” says Dr. Liu. “We have more work to do to get there, but we hope our work can influence changes to health policy and clinical practice in how screening for diabetic eye disease in Canada is performed.”

Dr. Brian Hummel: Bringing Forward Indigenous Voices to Improve Inuit Child Health

First Nations, Inuit and Métis people in Canada have poorer health outcomes than non-Indigenous people due to historical and ongoing systems of discrimination, and these disparities can start in childhood, with Inuit children experiencing higher rates of respiratory infections, iron deficiency anemia, and other conditions.

A team of researchers in Ottawa – home to the largest Inuit population in Canada outside of the traditional Inuit homeland of Inuit Nunangat – recently completed a study funded by the PSI Foundation that aims to arm caregivers of Inuit children with the knowledge they want and need to improve child health outcomes.

“Our colonial history, historical and ongoing systems of discrimination, and the unique challenges that Inuit people face when they have to move from the north to an urban Ottawa community result in a lot of cultural dissonance and tensions that are challenging for this community,” says Dr. Brian Hummel, currently a pediatric infectious disease fellow at the Children’s Hospital of Eastern Ontario (CHEO). “We wanted to better understand what those challenges are and what can be done to help support child health for this community.”

Recognizing the need for better knowledge sharing around child health, Dr. Hummel and co-investigator Dr. Daniel Bierstone, along with supervisor Dr. Radha Jetty, the physician lead for Inuit Child Health and the Nunavut Program at CHEO, partnered with the Inuuqatigiit Centre for Inuit Children, Youth and Families to better understand the experiences of caregivers of Inuit children related to child health.

Supported by a PSI Foundation Resident Research Grant, Dr. Hummel and the team conducted focus groups with 24 caregivers of Inuit children. In the focus groups, they discussed where caregivers go for child health knowledge, the topics they felt they needed more knowledge about, and how they prefer to learn about child health.

Dr. Hummel says that the qualitative approach to the study, as opposed to conducting a survey or other quantitative method, was essential to collecting data that would directly represent the voices of the caregivers.

“This approach allowed us to collect data that was more rich, raw and real, and it allowed Indigenous voices to be more directly represented in the research,” he says. “As non-Indigenous researchers, we viewed our role as being vessels to bring forward Indigenous insights, very much in the spirit of ‘never about us without us.’”

Knowledge-sharing programs should include both Indigenous and Western ways of knowing

In the focus groups, caregivers said they needed more support and information about parenting and development, adolescent mental and sexual health, common childhood illnesses, infant care and nutrition – topics where there can be tension between Indigenous and non-Indigenous ways of knowing.

Caregivers also said that they often turned to their families, friends, community members and Indigenous health services for child health information, largely because of previous negative experiences with Western medical institutions and lack of trust of these institutions.

While caregivers strongly preferred in-person knowledge-sharing sessions for their supportive environment and opportunity to build community, importantly, they identified that involving both Inuit Elders and health care providers in these sessions was important.

“One of the interesting themes that came out in the focus groups was this idea of synergy between Indigenous ways of knowing and Western medicine ways of knowing, and how those two things don’t need to compete with each other but can instead work synergistically together to support Inuit child health,” says Dr. Hummel. “There are things that are valued more in the cultural understandings of health, such as nutrition, child-rearing and development. But there were also things they valued about western medicine approaches.”

“Ultimately knowledge-sharing programs should include both Inuit and Western knowledge and traditions, while empowering families to engage in Indigenous child-rearing practices,” he adds.

The study is the first of its kind to explore caregivers’ perspectives on urban Inuit child health knowledge, and it has been presented at national pediatric and Indigenous health conferences and published in the peer-reviewed journal International Journal of Circumpolar Health. Dr. Hummel and the research team hope that these findings can now be used to help develop programs and other knowledge-sharing initiatives to benefit caregivers and ultimately improve Inuit children’s health.

As Dr. Hummel finishes his fellowship and moves to the next stage of his career, he plans to continue being involved in research and education on top of his clinical practice. And he says the PSI Resident Research Award has helped prepare him by giving him a rare opportunity to lead a larger project.

“As residents, there aren’t a lot of funding opportunities for these kinds of larger projects,” he says. “PSI funding is really important for those of us who want to do larger projects to have these opportunities.”

PSI Visiting Scholars Program Open for Applications

The PSI Visiting Scholars Program is now open to all eligible medical universities, hospitals, and research institutes in Ontario.

PSI’s Visiting Scholar Program aims to support specific priorities identified by a given hospital/research institute in Ontario and PSI’s Grants Committee. This program provides funds ($15,000 per year) for a hospital/research institute in Ontario to attract an external expert to address such priorities.

For more information, email psif@psifoundation.org or check out the brochure for the PSI Visiting Scholar Program.

Dr. Victoria Siu: Clinical Trial of Histidine Supplementation Changes Management of Rare Genetic Condition

A clinical trial funded by the PSI Foundation is changing the management of a rare genetic condition found in the Amish communities of southwestern Ontario. A research team led by Dr. Victoria Siu, a medical geneticist at London Health Science Centre and associate professor at Western University’s Schulich School of Medicine and Dentistry, found that histidine supplementation was effective in reducing the complications in children with the condition.

“The positive effects of histidine supplementation in patients with this condition open up the possibility of an inexpensive treatment to prevent loss of vision and hearing,” says Dr. Siu. “It’s very difficult to find funding for a clinical trial of a natural health product like histidine. We couldn’t have done this trial without PSI funding, and I’m very grateful.”

Dr. Siu began her career in London, Ontario, which is close to the majority of Ontario’s Amish and Mennonite communities, and she often sees patients from these communities as part of her practice.

In the early 2000s, she and her colleague, Dr. Tony Rupar, received funding from the PSI Foundation to lay the groundwork for a newborn and early childhood screening program in the Amish and Mennonite communities that would test for four treatable genetic disorders. In addition to helping identify children who could benefit from early treatment, the newborn screening program also helped Dr. Siu and other researchers examine the genetic conditions that affect this community.

“In a way, that grant was really seed funding for many other new discoveries,” she says. “The community, the public health nurses and midwives, started letting us know about other children with medical conditions, which enabled us to identify several new genes that caused some of these disorders in the community.”

More than 15 years after her first PSI grant, Dr. Siu received another PSI grant to examine a potential treatment for one such genetic disorder ­– HARS syndrome.

HARS syndrome is an extremely rare autosomal recessive genetic disorder, but it is much more common in the Amish community in southwestern Ontario where approximately one in five individuals in in the Amish community is a carrier of the gene and approximately one in 100 babies in the community are affected.

The HARS gene codes for an enzyme that links histidine to transfer RNA (tRNA), a process essential for protein translation. When this gene is mutated, the enzyme’s function is altered.

Affected children are often somewhat smaller than unaffected children, but are otherwise healthy and develop appropriately; however, when the child is infected with even common childhood viruses such as influenza or RSV, they often need hospitalization and can develop acute respiratory distress syndrome (ARDS). Following infection, their balance becomes unsteady, and their hearing and vision deteriorates. Historically, the mortality rate for affected children has been quite high due to ARDS. Children who do survive often need cochlear implants for their hearing and continue to lose their vision.

Children in histidine study stayed healthy through COVID-19 pandemic

With PSI funding, Dr. Siu and her research team examined 14 children with HARS ranging from one to 17 years old who were given a daily histidine supplement to determine whether it could be used to keep these children healthy and prevent further hearing and vision loss. Histidine is a relatively inexpensive supplement, costing around $100 a month for the oldest participants and much less for the younger children taking a lower dose.

Over the three-year study, the researchers monitored the children’s growth and overall health and periodically assessed the children’s vision and hearing.

The research team found that none of the children experienced any significant deterioration in their vision or hearing over the course of the study. And, importantly, the children also maintained overall good health during the study period, which took place during the COVID-19 pandemic.

The children were not vaccinated against COVID-19 and researchers found antibody levels in the blood indicating that they had been infected with SARS-CoV-2, yet none of the children were hospitalized.

“We saw that the children stayed healthy through this study period, and that was quite incredible to us because it was during the pandemic,” says Dr. Siu. “When these children had influenza, rhinovirus, RSV or any of those common viral illnesses, they have historically been hospitalized in the intensive care unit and needed to be ventilated, and some of them have died. We felt that for these children to stay healthy through COVID was really quite remarkable.”

With the study apparently showing the benefit of histidine supplementation in these children, management of HARS syndrome has already changed. The children are continuing to receive daily histidine supplementation and, when they are hospitalized with illness, they receive extra histidine and anti-inflammatory drugs and reduced fluids, all of which seem to reduce the risk of ARDS.

“Most clinical trials have big sponsors, and there’s really no place for a small trial like this. We also had additional costs for transportation and medical appointments because of the nature of working with this community,” says Dr. Siu. “The funding from PSI was very important and much appreciated as it  allowed us to do work that will make a difference for these children.”

Dr. Tea Rosic: 2023 PSI Graham Farquharson Knowledge Translation Fellowship Recipient

 “As a Child Psychiatrist, I see firsthand the impact of the COVID-19 pandemic on youth mental health and the gaps that currently exist in mental health service delivery. Youth experience the highest rates of co-occurring substance health and mental health problems (“concurrent disorders”) compared to other age groups, yet many do not receive the integrated services they need. Through knowledge mobilization and capacity-building, my program of research aims to bridge these gaps. I will work with community organizations in Eastern Ontario to identify needs and disseminate knowledge to improve concurrent disorders care, develop an integrated substance health and mental health program at the Children’s Hospital of Eastern Ontario, and lead and contribute to national standards implementation for paediatric concurrent disorders. Most importantly, my time will be spent mobilizing and translating research evidence, moving knowledge into our daily practice to improve health outcomes for children and youth. I am delighted to receive this PSI Knowledge Translation Fellowship to start my early research career dedicated to improving services in child mental health.” – Dr. Tea Rosic

PSI Foundation is pleased to announce Dr. Tea Rosic as the recipient of the 2023 PSI Graham Farquharson Knowledge Translation Fellowship.

About Dr. Tea Rosic

Dr. Tea Rosic is a Child and Adolescent Psychiatrist at the Children’s Hospital of Eastern Ontario (CHEO) and Lecturer in the Department of Psychiatry at the University of Ottawa. Her research examines the impact and management of co-occurring mental health and substance use disorders (concurrent disorders). She has published 30 peer-reviewed manuscripts (11 first-authored) since 2016 and given 16 oral presentations in national and international settings.

Dr. Rosic has won numerous awards for her research, including several best poster and best paper awards, and additionally won awards for her clinical work (2019 Outstanding Resident Award, Hamilton Health Sciences) and for student mentorship (2018 Resident Mentor Award, McMaster). At CHEO, she was ranked first in the Children’s Hospital Academic Medical Organization (CHAMO) Fellowship Competition in 2020.

Dr. Rosic completed her medical training and Psychiatry residency at McMaster University, followed by a fellowship in Child and Adolescent Psychiatry at the University of Ottawa. She is in her final year of PhD training in Health Research Methodology and in the Clinician Investigator Program at McMaster.

About the 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 new clinician investigator’s research time, allowing the Fellow to undertake high-impact translational research in Ontario.

Fellowship Funds to be Used for Synthesis, Dissemination, and Application of Evidence to Improve the Care of Youth with Concurrent Disorders

This Fellowship will allow Dr. Rosic, a Child Psychiatrist and researcher, to synthesize, disseminate and apply evidence to improve the care of youth who have both substance use and other mental health disorders.

Compared to other age groups, youth have the highest rates of co-occurring addiction and mental health problems, also known as “concurrent disorders.” Substance use is related to higher severity of other mental health symptoms and lower chances of receiving treatment. When concurrent disorders go untreated, youth are at risk of dropping out of school, having family conflicts, engaging in risky activities, and dying. There are gaps in our healthcare services in Ontario and in Canada that can be addressed through knowledge translation and capacity-building.

Dr. Rosic will work to mobilize knowledge and build capacity for assessment and treatment of youth concurrent disorders within Eastern Ontario and beyond. Her research program includes working with community organizations to identify needs and disseminate knowledge, developing a specialized child concurrent disorders program at the Children’s Hospital of Eastern Ontario, and leading and contributing to guideline development and national standards implementation for concurrent disorders care.

Dr. Krishan Yadav: 2023 PSI Graham Farquharson Knowledge Translation Fellowship Recipient

“Skin and soft tissue infections (SSTIs) are one of the top 10 reasons to visit a Canadian emergency department. Despite being so common, care is not standardized which has resulted in high treatment failure rates, overuse of intravenous antibiotics and unnecessary hospitalization. As a PSI Graham Farquharson Knowledge Translation Fellow, I will be afforded the critical support necessary to use multimethod, multidisciplinary approaches to develop and implement a best practices checklist for the diagnosis and management of SSTIs in the emergency department setting. This will standardize management of these common infections with the potential to reduce treatment failure, intravenous antibiotic use, and hospitalization. With support from the PSI Foundation, Ontario will be positioned as a leader in improving the care of Canadians with SSTIs.” – Dr. Krishan Yadav

PSI Foundation is pleased to announce Dr. Krishan Yadav as the recipient of the 2023 PSI Graham Farquharson Knowledge Translation Fellowship.

About Dr. Krishan Yadav

Dr. Krishan Yadav is an Associate Scientist at the Ottawa Hospital Research Institute with a focused area of expertise in the management of skin and soft tissue infections (SSTIs; cellulitis; abscess) in the emergency department. He is an Assistant Professor with the Department of Emergency Medicine at the University of Ottawa. His research has been recognized nationally twice (in 2018 and 2022) with the Top New Investigator Abstract Award at the Canadian Association of Emergency Physicians Annual Meeting. In 2020, he received the Junior Clinical Research Chair in Skin and Soft Tissue Infections at the University of Ottawa. To date, he has 52 publications in peer reviewed journals (12 as first author, 5 as senior author) and has 35 published abstracts at conference proceedings.

About the 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 new clinician investigator’s research time, allowing the Fellow to undertake high-impact translational research in Ontario.

Fellowship Funds to be Used for Development and Implementation of a Best Practices Checklist for Emergency Department Management of Skin and Soft Tissue Infections

Skin and soft tissue infections (SSTIs) are bacterial infections affecting the skin and underlying tissues. SSTIs are one of the top 10 most common reasons to visit an emergency department in Canada. Patients with SSTIs have pain, redness and swelling (i.e., cellulitis) or boggy painful red skin due to underlying pus (i.e., abscess). For abscesses, the treatment is a bedside surgical drainage procedure, and some patients are prescribed antibiotics. For cellulitis, patients are treated with antibiotics.

The current treatment of SSTIs in emergency departments is not standardized and up to 20% fail treatment. Existing guidelines are not designed for use in the emergency department setting. Dr. Yadav’s overall goal is to design and implement an evidence-based, user-friendly best practices checklist for diagnosis and management of SSTIs in the emergency department. He will use robust KT approaches to: (1) Create a best practices checklist with engagement of key stakeholders; (2) Assess barriers and facilitators to checklist use in the emergency department; and (3) Conduct a pilot implementation trial in three Ontario emergency departments. This work has the potential to improve patient outcomes and reduce costs by standardizing care and reducing unnecessary intravenous antibiotic use, minimizing treatment failures, and lowering hospitalization.

Dr. Daniel McIsaac: 2023 PSI Mid-Career Knowledge Translation Fellowship Recipient

“As an anesthesiologist, I care for hundreds of patients preparing for, having, and recovering from surgery each year. While most benefit from their operation, many experience complications and struggle to recover their strength and function after surgery. Prehabilitation is an approach where we use the wait time before surgery to a patient’s advantage. We support them in completing evidence-based exercises, help to improve their nutrition and manage the stress of preparing for a major operation. The idea is that because they go to the operating room in better health, they are less likely to experience a complication and will have better recovery after surgery. With the support of the PSI Mid-Career Knowledge Translation Fellowship, I will be able to work with my team, our patient partners, and collaborators to understand the most effective approaches to prehabilitation, and how to implement prehabilitation into routine care to the benefit of the hundreds of thousands of Ontarians who need surgery each year.” – Dr. Daniel McIsaac

PSI Foundation is pleased to announce Dr. Daniel McIsaac as the recipient of the 2023 PSI Mid-Career Knowledge Translation Fellowship.

About Dr. Daniel McIsaac

Dr. Daniel McIsaac is an Associate Professor and Anesthesiologist in the Department of Anesthesiology and Pain Medicine at the University of Ottawa. He is also a Scientist at the Clinical Epidemiology Program of Ottawa Hospital Research Institute, and an Adjunct Scientist at the Institute for Clinical Evaluative Sciences (ICES). To date, Dr. McIsaac has published more than 160 peer-reviewed papers and secured over $10 million in peer-reviewed research funding. He currently holds six Canadian Institutes of Health Research (CIHR) grants as principal applicant, four of which focus on prehabilitation.

Dr. Daniel McIsaac’s Research Program

More than 300,000 Ontarians have major surgery each year. These patients, their physicians, and health system leaders have made it clear that they desire access to effective prehabilitation so that Ontarians who need surgery can improve their health before their operation to avoid complications and enhance recovery after surgery. Dr. McIsaac’s research aims to implement routine prehabilitation, an approach that supports and motivates patients in exercising and improving their nutrition in preparation for surgery, in Ontario’s healthcare system. Working with his team, patient partners, and collaborators, Dr. McIsaac’s program focuses on developing practical and effective prehabilitation programs and evaluating them in real-world settings. His overarching objective is to translate the findings of these real-world experiments into routine care to the benefit of surgical patients in Ontario.

About the PSI Mid-Career Knowledge Translation Fellowship

The PSI Mid-Career Knowledge Translation Fellowship is intended to provide salary support for a mid-career clinician investigator in Ontario, who has demonstrated the ability to successfully complete high impact knowledge translation research. The total amount of the award is $400,000 over two or three years, with the sponsoring institution providing matching funding, contributing to 50% of the total award.

PSI acknowledges that mid-career can be a challenging time for physician researchers. During this phase, there are often additional academic roles and responsibilities including committee work, leadership positions, and mentoring of junior investigators, while clinical work continues. PSI recognizes the importance in supporting this phase of an investigator’s trajectory.

Fellowship Funds to be Used for Translating Prehabilitation Evidence into Practice to Improve Surgical Recovery in Ontario

In Ontario, more than 300,000 people have major surgery each year, such as joint replacement, heart bypass, or cancer operations. While more than 98 of every 100 patients survive their operation, recovery after surgery can be very difficult. This is because major complications such as bleeding, infections, heart attacks, weakness and/or loss of one’s ability to complete day-to-day activities happen to about 1 in 5 people who have surgery.

Prehabilitation means doing exercise, improving diet, and receiving structured motivational care before surgery to improve a person’s recovery after surgery. Patients in Ontario and across the world are keen to have access to prehabilitation, as it makes sense that this approach would lead to better recovery after surgery.

Unfortunately, the science supporting prehabilitation’s impact is still at an early stage. For Ontarians to benefit from prehabilitation, patients, clinicians, and scientists must work in partnership to understand what types of prehabilitation work best, test strategies to deliver prehabilitation across the province, and develop plans to move prehabilitation into day-to-day care for all Ontario surgical patients. Dr. McIsaac proposes to lead such work, building on partnerships and expertise already in place to deliver effective prehabilitation to Ontarians.

Dr. Matt Sibbald: Using Technology to Reduce Diagnostic Errors

A novice physician working in a busy emergency department in the middle of the night may be challenged to diagnose a patient presenting undifferentiated symptoms.

An electronic differential diagnostic (EDS) support system could assist by providing diagnostic hypotheses for the physician to consider – but only if the system is easy to use and fits into the clinician’s workflow.

Dr. Matt Sibbald, associate professor of medicine at McMaster University and cardiologist at Hamilton Health Sciences and Niagara Health System, led PSI Foundation–funded research to examine whether technology and artificial intelligence could improve diagnostic accuracy and when it should be used.

“With the challenge of busy clinical environments, technology might have something to offer to make our lives simpler as clinicians and bring more value and be more effective for patients,” says Dr. Sibbald. “Technology and artificial intelligence could leverage clinicians’ expertise and extend their cognitive capacity. But it needs to be accessible at the point of care without physicians having to modify their workflow.”

EDS support systems have been available for decades and have the potential to reduce diagnostic errors by providing a list of diagnostic hypotheses for the physician to consider. However, the value of the technology has always been limited by the amount of time that physicians needed to spend inputting data into the system – ranging from 20 minutes to even hours per patient.

A platform called Isabel may have greater potential to fit within clinicians’ workflows. After the clinician inputs the patient’s age and just a couple of key symptoms, taking only a minute or two – though Dr. Sibbald notes that this still represents a significant amount of a typical seven-minute emergency department triage visit – the system provides a list of the most common diagnosis differentials.

“It helps with quick decision-making around undifferentiated illness to make sure that you’ve at least thought about the different possibilities,” says Dr. Sibbald. “Some of these hypotheses might not be relevant to the patient in front of you, but that’s for the clinician to dismiss. A system like this is expected to diagnose, but to suggest.”

In 2020, Dr. Sibbald and his team received PSI funding to examine the Isabel EDS system under “sterile” conditions, not a working clinic, as a first step to gauge whether the system could improve the diagnostic process. Clinicians with different levels of experience completed cases through an online platform, with half using EDS early in the process, when only the main patient complaint was available, and half using EDS later, when all patient information including medical history and a physical, was available.

The research team found that the system increased the number of diagnostic hypotheses and the likelihood of the correct diagnosis being included in the list. When Isabel was used early, it generated significantly more diagnostic hypotheses, and when it was used later, the correct diagnosis was included more often in the list of hypotheses. But, ultimately, the researchers found that the system improved the diagnostic process regardless of when it was used and who was using it, though novices benefited the most.

“Electronic differential diagnosis does contribute to physician diagnosis. It adds rigor and length to the differential, and it adds different things for a physician to consider,” says Dr. Sibbald. “We actually saw the most benefit with simplest diagnoses for relatively novice clinicians. We expected that the system would be most helpful with the complex cases, but it helps by pointing to things that you know but haven’t necessarily thought of in the moment.”

Following these positive results, published in BMJ Quality and Safety, Dr. Sibbald and his team have continued to examine how EDS could be used in real-life clinical settings where physicians see patients with undifferentiated illness, such as primary care and the emergency department. They recently published a follow-up study that examined EDS in the context of the emergency room, with a research associate using the technology to simulate how the system could be integrated into the workflow. The results of this study, published in JMIR Human Factors, suggested that the technology needs to be customized to account for the scope and context of the emergency department and the clinician’s experience.

Though there is still a lot of work to be done before EDS is routinely used in clinical settings, Dr. Sibbald says that the potential value of these systems in reducing diagnostic errors is worth the effort. And funding from PSI has been key to the work they have done so far.

“It’s important for PSI to have a broad mandate and scope and to support this type of research that might not be top of mind on the needs spectrum but is still vital for our health care system to grow and adapt,” says Dr. Sibbald. “We can’t keep doing things the same way we’ve been doing them. There’s so much to challenge and to change, and this field can be a key part of that change management. But it needs to be driven by scholarship, research and understanding.”

Alice Cavanagh: Understanding How Physicians Learn About Intimate Partner Violence

As a volunteer at a sexual assault crisis centre before starting medical school, Alice Cavanagh would occasionally accompany people who had experienced sexual violence to access emergency health care. While health care professionals’ roles include the important and difficult tasks of collecting samples and evidence, their interactions with the survivor were very different from hers as a volunteer trained primarily to listen and be supportive.

“I became interested in what physicians are actually learning in the course of their professional training about intimate partner violence and sexual violence, and how that shapes their practice,” says Cavanagh. “There is research that quantifies how much education Canadian medical students get on intimate partner violence, but I was really interested in looking at the impact of that education. How are physicians experiencing that training and what are they taking from it?”

When Cavanagh started the MD/PhD program at McMaster University a short time later, she was able to examine these questions, receiving a PSI Research Trainee Award to support her research. With supervision from Dr. Meredith Vanstone and mentorship from Dr. Harriet MacMillan, she led research on how physicians learn about intimate partner violence (IPV) and how that affects the support they provide to patients, and recently defended her dissertation.

In the first part of the study, Cavanagh examined policy and training materials for physicians related to IPV. She then collaborated with the RISE project, a study funded by the Public Health Agency of Canada examining the family violence learning needs and preferences of Canadian social workers and physicians, interviewing physicians and residents across Canada from five medical specialties (emergency medicine, family medicine, obstetrics and gynecology, psychiatry and pediatrics) about their IPV education and the support they provide to patients. She also interviewed health and social service providers outside of medicine about their perceptions of the IPV training that physicians receive.

Physicians often feel unprepared to support people experiencing violence

Cavanagh’s analysis of physician’s training materials found that IPV has become increasingly medicalized, where it is often viewed solely as a health issue, instead of a structural issue with many facets, including poverty, racism, ablism and other forms of oppression. She also found that physicians are taught to identify patients experiencing IPV, provide them with support, and direct them to resources.

At the same time, physicians and residents revealed during the interviews that, while they understood IPV is important to their patients’ health, they largely felt unprepared to support their patients. However, they also spoke about how much they valued experiential learning, which Cavanagh says may offer opportunities to collaborate with IPV experts in other fields to learn directly from patients and other IPV experts.

Interviews with experts outside of medicine confirmed that physicians need to understand IPV and be prepared to support their patients. But they also highlighted that physicians need to be more aware of power dynamics in intimate partner violence, both in terms of the power dynamics between the person who is enacting violence and the person experiencing violence, but also the power that physicians hold in society to make a difference for individual patients and in dismantling the structures that uphold violence.

“It’s not just about understanding, it’s also about engaging with power to move from knowledge to action,” says Cavanagh. “This is a problem that can’t only be addressed by the health care system. By creating opportunities for health care providers to learn about IPV as an issue that is complex and connected to lots of different facets of people’s lives, my hope is health care providers will have opportunities to engage with the type of collective action that is critical to address complex, structural issues like IPV.”

PSI support was instrumental to kickstarting research career

With her dissertation complete and one more year of medical school remaining, Cavanagh is looking forward to continuing research that will improve health policy.

“My goal for my career is to be able to use my clinical work to look at questions about policy and health and to be able to use my research skill set to answer and think through those questions,” she says. “I really believe in the value of clinician-scientists, including those who work outside traditional bench-to-bedside research, and funding from PSI was really instrumental to me in being able to do my work and kickstart my career.”

Cavanagh says the PSI Research Trainee Award provided important financial support during her studies, and PSI meetings gave her important opportunities to connect and collaborate with other researchers.

“In very practical ways, being a part of the community has been really helpful to me in finding and developing new opportunities to grow, which is so important at this stage of my career,” she says.

Cavanagh hopes that the results from her research will help to inform medical education about IPV, particularly in developing opportunities to collaborate with experts from other fields and fostering physicians’ connections with community resources and services to support people experiencing IPV. With more than one quarter of women worldwide having experienced violence, she emphasizes that this issue affects people from all communities, including physicians.

“Violence and structural oppression are pervasive and touch every corner of our lives,” she says. “In health care, if we can have more sensitive conversations about these issues that acknowledge that this isn’t an issue that only affects ‘other’ people, that it affects everyone, I think that we can come toward creating safer places for both patients and providers.”

PSI Profiles: Meet the PSI Team 

Behind the scenes and beyond the hardworking committees and volunteers who contribute to our organization, PSI Foundation is currently run by a tight-knit team of five staff.

Here is a glimpse into each of our team members’ roles, and what we do to deliver funding opportunities to our grantees who contribute their expertise in order to better the health of Ontarians.

Samuel Moore: Executive Director

How long have you worked at PSI?

I have been working at PSI since 2010, so 12 years.

What are the main responsibilities for your job?

To keep staff, physicians, and happy, and to keep everyone (e.g. Board, all Committees, and staff) pulling in the same direction, all working towards meeting PSI’s goals. I focus on both big picture small details, which is always a new challenge. I am expected to evolve in my role as Executive Director.

What is your favourite part of your job as Executive Director at PSI?

My favourite part is working with great people, and working in a wide variety of areas at PSI. For example, I’ll focus on finance one day, then move on to grants the next, then on to governance. Working to make a difference and constantly learning and innovating is another favourite.

What are the most memorable moments from your career?

The most memorable moments are getting PSI to be the first non-American member to join the Health Research Alliance (HRA) , and launching our Knowledge Translation (KT) fellowships.

What did you study in post-secondary?

History, with an emphasis on the history of medicine in Canada.

What are your future plans for PSI as Executive Director?

To see our new PSI strategic plan executed and implemented, as well as to enhance physician-researcher involvement to create an even deeper pool of experts. We are constantly innovating PSI’s current grants programs to meet our goals. Seeing PSI evolve from a smaller regional organization to a larger funder is my ultimate goal.

Jessica Haxton: Grants Coordinator

How long have you been working at PSI?

I have worked at PSI for 11 years.

What are the main responsibilities for your job?

My responsibilities include screening applications, finding external peer reviewers, and getting application ready for internal Grants Committee review.

What did you study in post-secondary?

I studied Molecular Biology and Art History.


Heather Bruder: Administrative Coordinator

How long have you worked at PSI?

I have been working at PSI for 4 years.

What are the main responsibilities for your job?

Representing business as first point of contact for all enquiries, support grants funding program activities, by managing external peer review requests, tracking and processing peer reviews. Manage grant payments, including following up with grantees and maintaining payment schedule. Providing administrative support to the Executive Director, Board and Committee members. Organize and coordinate and facilitate several annual meetings and other events with internal/external stakeholders.

What did you study in post-secondary?



Asumi Matsumoto: Programs Coordinator

How long have you worked at PSI?

I’ve been working at PSI at since September 2016 – so 6 years!

What are the main responsibilities for your job?

My responsibilities adapt depending on the needs of PSI, however, my current ones include:

  • Coordinate the application process for salary support awards
  • Manage the post-award process for all funding streams
  • Maintain PSI’s communication channels
  • Prepare committee meeting material, including dashboards and reports
  • Assist with special projects as assigned

What did you study in post-secondary?

I received my undergraduate degree in Nutritional Sciences and Psychology at the University of Toronto.

Eunice Lee: Administrative and Communications Assistant

How long have you worked at PSI?

I worked at PSI since May 2019, so for 3.5 years.

What are the main responsibilities for your job?

My job involves designing visuals and writing for PSI through reports, infographics, and social media management, as well as administrative tasks for post-meeting cleanup and our grants system (SmartSimple).

What did you study in post-secondary?

I majored in Journalism with a minor in English.

To read more about PSI’s history, funding, Board of Directors and Management, click here.

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