“The PSI Research Trainee Fellowship Award has been instrumental in shaping my career as a clinician-scientist by providing the resources needed to investigate the neurocognitive outcomes of critically ill patients undergoing acute kidney replacement therapy (KRT).” -Natasha Jawa

About Natasha Jawa

Natasha (Tasha) Jawa is a MD candidate at Queen’s University. She recently completed her PhD and is now entering clinical clerkship in the sixth year of her MD/PhD program. Before her doctoral studies, she earned an HBSc in Neuroscience and Psychology and an MSc in Neuroscience & Quality Improvement/Patient Safety at the University of Toronto.

Her research focuses on the pathophysiological mechanisms underlying delirium in critically ill adults who are treated for acute kidney injury with kidney replacement therapy (KRT). She also examines the long-term consequences of ICU delirium on both cognitive function and structural brain pathology. In addition, Natasha seeks to evaluate whether a post-ICU follow-up bundle of care can improve long-term cognitive and psychosocial outcomes for ICU survivors and their caregivers.

About the Funded Study

With support from PSI, Natasha and her research supervisor, Dr. Gordon Boyd, set out to explore how acute kidney replacement therapy in the intensive care unit affects brain function. Although patients who undergo dialysis while critically ill often experience cognitive impairment, the relationship between dialysis and neurological outcomes is still poorly understood.

In their PSI-funded study, Identifying Neurocognitive Outcomes and Cerebral Oxygenation in Critically Ill Adults on Acute Kidney Replacement Therapy (INCOGNITO-AKI), Natasha and Dr. Boyd investigated how fluctuations in brain oxygenation during dialysis may influence short-term and long-term neurological outcomes.

While the study was limited by patient survival rates, the findings confirm tracking cerebral oxygenation in critically ill patients is feasible. This work emphasizes the importance of larger-scale studies to better gauge long-term cognitive outcomes and guide clinical strategies to minimize neurological impairments in patients undergoing dialysis.

Looking ahead, Natasha and Dr. Boyd plan to expand recruitment by enrolling patients earlier in their ICU stay and building multi-centre collaborations. They also aim to streamline enrollment using a deferred consent model and will continue investigating interventions to improve cerebral oxygenation during dialysis, with the goal of preventing cognitive decline.

“This funding has allowed me to establish and execute the INCOGNITO-AKI feasibility study, which has significantly contributed to my development in clinical research methodology, data analysis, and interdisciplinary collaboration,” says Natasha. “Furthermore, the award facilitated high-impact presentations at international and national conferences, increasing the visibility of my work within the nephrology, neuroscience, and critical care communities.”

Impact of the Funded Study

The INCOGNITO-AKI study has kickstarted an important discussion about an often overlooked aspect of patient care: neurocognitive function in critically ill patients receiving KRT. By highlighting the link between dialysis, brain oxygenation, and cognition, this research adds to a growing body of work on post-ICU cognitive impairment and supports efforts to improve care after critical illness.

Their future research hopes to expand to larger, multi-centre cohort studies to validate their results and identify modifiable risk factors. A longitudinal follow-up will be essential for them to assess persistent impairments after ICU discharge and guide rehabilitation. Natasha and Dr. Boyd also plan to test interventions such as optimized dialysis protocols and cognitive rehabilitation programs, while advanced neuroimaging will be used to study structural and functional brain changes in this patient population.

“Through this support, I have been able to advance my expertise in neurocognitive impairment, delirium, and various assessment tools for the longitudinal evaluation of neurological impairment in critically ill patients, positioning me for future research in this domain,” says Natasha.

Looking forward, Natasha’s work represents an important first step toward improving neurological outcomes in critically ill patients. By integrating neurocognitive monitoring into the management of KRT in the ICU, clinicians can move closer to treatment strategies that enhance both recovery and quality of life.

“The PSI Resident Research award enabled me to engage in high impact academic research during my residency — allowing me to explore how older adults from minority language groups experience different outcomes after hip fracture surgery.” –Dr. Christina Reppas-Rindlisbacher

About Dr. Christina Reppas-Rindlisbacher

Dr. Christina Reppas-Rindlisbacher is a Research Fellow at Women’s College Research Institute, and pursuing Geriatric Medicine at the University of Toronto. Currently, she is completing a PhD in Clinical Epidemiology & Health Care Research at the Institute of Health Policy, Management and Evaluation (IHPME). She received her medical degree from the University of Toronto, then completed her Internal Medicine residency at McMaster University.

Dr. Reppas-Rindlisbacher’s research interests includes uses of large administrative databases to study practice patterns and long-term adverse outcomes after delirium, with a focus on addressing the unmet needs of older adults who have immigrated to Canada or who have a preferred language other than English. Her work is supported by the University of Toronto Department of Medicine’s Eliot Phillipson Clinician-Scientist Training Program, and the CIHR Canadian Graduate Scholarships Masters Program award. Clinically, Dr. Reppas-Rindlisbacher focuses on acute geriatrics and attends on both the inpatient Geriatric Medicine Consultation Service and the Internal Medicine Clinical Teaching Units.

About the Funded Study

Hip fracture repair is the most common urgent surgery among older adults, making up more than 13,000 hospital admissions in Ontario each year. Hip fractures are often a catastrophic event associated with loss of independence and disability. As a result, hip fractures have been identified as a priority area for health quality improvement. Delays in surgeries to treat this are linked to increased complications, and even death–making timely access a provincial priority.

While longer waits are often associated with delays in diagnosis, consent, or administrative processes, Dr. Reppas-Rindlisbacher suspected another factor: language differences between patients and the healthcare system. Previous studies show that patients who speak a non-English language in predominantly English-speaking settings face more medical errors and receive lower quality of care.

With her PSI-funded study, Resident Researcher Dr. Reppas-Rindlisbacher, under the supervision of Dr. Paula Rochon, set out to explore how language barriers may contribute to longer wait times for hip fracture surgery. Their study, Association between language proficiency and wait time for hip fracture surgery in Ontario: a population-based study, addresses this gap by examining the impact of language preference on surgical wait times and care outcomes.

The study investigated whether non-English language preference affected time to surgery, as well as complications after the operation and discharge destination. Their findings revealed that older adults with a non-English language preference experienced longer waits and were at higher risk of delirium, myocardial infarction, prolonged hospital stays, and more often discharged to a nursing home post-surgery. These results are the first to show inequities in hip fracture care and treatment relating to language differences.

“It is crucial that older patients who speak non-English languages have the same opportunity for functional recovery and discharge home after hip fracture,” says Dr. Reppas-Rindlisbacher.

Impact of the Funded Study

The study’s findings and results highlight the disproportionate burden of harm faced by patients who do not speak or struggle to speak English. “Our findings are a call to action for hospitals to develop standards for language accessible care,” says Dr. Reppas-Rindlisbacher.

Moving forward, she identified steps that would improve care for hip fracture patients. This includes collecting patient language preference data; flagging those who require interpretation; training staff in the effective use of interpretation services; and expanding access to professional interpreters via video, phone, or in-person support.

Their research has already made a significant impact, including major accomplishments such as an oral abstract presentation at the American Geriatrics Society Annual Scientific Meeting, an Op-Ed in Healthing titled “Opinion: The language you speak shouldn’t impact the healthcare you receive,” and publication in JAMA Network Open.

Beyond publications and presentations, the study contributes to a growing body of evidence incentivizing hospitals to invest in interpretation services. It also lays the foundation for quality improvement initiatives aimed at reducing preventable complications and ensuring equitable recovery for patients from linguistically diverse backgrounds.

Looking ahead, the research team plans additional peer-reviewed publications, national and international conference presentations with complimentary Op-Eds. In addition, they aim to achieve knowledge translation through traditional media, social platforms, and collaborations with organizations like RTOERO–helping to share these findings with more than 81,000 members across Canada who may be directly impacted by hip fracture or language-differing care.

“The PSI Resident Research award enabled me to engage in high-impact academic research during my residency–allowing me to explore how older adults from minority language groups experience different outcomes after hip fracture surgery,” says Dr. Reppas-Rindlisbacher. “This project led to collaborations, conference presentations, and a high-impact publication in JAMA Network Open–all milestones that have shaped my career as a future geriatrician clinician scientist.”

“PSI Foundation’s support has been pivotal in advancing my research and shaping my career as a clinician-scientist in reproductive medicine.” -Dr. Isabelle Létourneau

About Dr. Isabelle Létourneau

Dr. Isabelle Létourneau is a Reproductive Endocrinology and Infertility Fellow at the University of Ottawa. Her research focuses on IVF (In Vitro Fertilization) outcomes, recurrent pregnancy loss, and population-based studies using large health registries.

About the Funded Study

As a PSI Resident Research grantee, Dr. Létourneau, alongside research project supervisors Dr. Jenna Gale and Dr. Mark Walker, set out to answer an important question: does a prior cesarean delivery affect fertility outcomes for patients undergoing IVF? Previous research had shown mixed results, and patients and clinicians were in need of clearer evidence.

Using data from more than 7,000 patients in Ontario, the research team compared fertility outcomes between individuals who had previously delivered by cesarean section and those who had a vaginal delivery. Their analysis revealed a consistent pattern: patients with a cesarean history were less likely to achieve successful outcomes across nearly every measure–including pregnancy test results, implantation, ongoing pregnancy, and live birth rates. These trends were most pronounced in patients under the age of 40, and were observed across both frozen-thawed and fresh embryo transfers. The study suggests cesarean delivery may play a role in reducing IVF success, reinforcing findings from earlier studies while also pointing to the need for further research to uncover the biological mechanisms involved.

Impact of the Funded Study

For patients and fertility specialists, these findings can assist in more informed reproductive care decisions. The study emphasizes the importance of considering delivery history when predicting IVF success rates and tailoring treatment plans. It also supports more open, evidence-based discussions with patients who have had or are considering a cesarean delivery, helping them understand the potential long-term implications for fertility.

“Each patient’s story is unique,” says Dr. Létourneau. “The key to improving reproductive health lies in recognizing and understanding the factors that shape their journey—because every decision made today influences the possibilities of tomorrow.”

At the same time, the results highlight the need for more research. Large, multicenter trials could help confirm these associations and identify whether they stem from factors such as cesarean scar defects, changes in uterine blood flow, or pre-existing conditions like endometriosis. The study also demonstrates the value of large-scale data registries such as BORN Ontario and CARTR Plus in producing research that directly informs patient care.

Moving forward, Dr. Létourneau continues to translate these findings into practice by educating clinicians, counselling patients, and collaborating with fertility clinics to integrate delivery history into reproductive care. She also shares her research widely through conferences, publications, and collaborations with advocacy groups to raise public awareness about the link between cesarean delivery and fertility outcomes.

“PSI Foundation’s support has been instrumental in my development as a clinician-scientist, enabling me to pursue research on how prior cesarean delivery can affect IVF outcomes,” says Dr. Létourneau. “This funding provided the opportunity to generate evidence that guides patient counseling and reproductive planning, while also fostering the growth of my academic career and future contributions to reproductive medicine.”

Her ultimate goal is to ensure that research findings lead to meaningful improvements in patient care, helping individuals and families make more informed decisions about reproductive health.

“The PSI 50th Anniversary Clinical Research Award was exceedingly helpful in launching my program of research into a novel area of investigation. I am grateful for the support of the PSI Foundation.” -Dr. Karen Burns

About Dr. Karen Burns

Dr. Karen Burns is a Critical Care Practitioner and Staff Physician at St. Michael’s Hospital/Unity Health Toronto; an Associate Professor of Medicine and Clinician Scientist at the University of Toronto; a Clinician Scientist at the Li Ka Shing Knowledge Institute; and an Associate Member of the Department of Clinical Epidemiology and a part-time faculty member in the Department of Research Methods, Evidence, and Impact at McMaster University.

Her research focuses on strategies to liberate critically ill patients from mechanical ventilation and understanding practice variation in weaning. This work spans large-scale observational studies, international surveys, meta-analyses, and randomized trials. She also studies consent processes in critical care, while her other research interests include AI in weaning, helmet NIV, acute kidney injury, noninvasive ventilation strategies, and research methodology. Most recently, Dr. Burns’ research program focuses on advancing the conduct and reporting of Sex and Gender Based Analyses (SGBA) in critical care research.

About the Funded Study

In celebration of PSI Foundation’s 50th anniversary, the PSI-50 Mid-Career Clinical Research Award was created as a one-time award which provided up to $300,000 in funding over three or four years. The award was designed for a clinician-researcher between five and 15 years of their first academic appointment. This award recognizes that this phase of a researcher’s career is particularly challenging, with additional academic roles and responsibilities as well as the ongoing clinical work, and it will protect at least 50% of a recipient’s time for research that aligns with PSI Foundation priorities.

With this support, Dr. Burns focused her research time on advancing Sex and Gender Based Analyses (SGBA) in critical care. Over the past four years, she was a co-applicant or principal applicant for 34 grants, including in the Canadian Critical Care Trials Group (CCCTG) Team Grant. Additionally, she was a co-applicant on the Accelerating Clinical Trials (ACT) Canada Consortium grant – a Pan Canadian Clinical Trials Consortium Grant.

During her award period, Dr. Burns’ research activity included 127 publications (14 first authored papers, 18 senior authored papers, and 4 book chapters), 16 abstracts, and 41 presentations. Her contributions were recognized through multiple awards, ranging from the 2024 Margaret Herridge Award from the University of Toronto Interdepartmental Division of Critical Care for Advance Equity, Diversity, and Inclusion (EDI), and the 2023 ATS Recognition Award for Scientific Accomplishments from the American Thoracic Society – Critical Care Assembly.

“This award marries my passion for critical care research and research methodology,” says Dr. Burns. With this award, she strived to enhance the visibility of sex and gender based analyses and to grow the science of sex and gender research in acute care.

Impact of the Funded Study

Dr. Burns’ work has significantly advanced awareness of the need for transparent and consistent reporting of diversity metrics and SGBA in critical care studies. With her CCCTG colleagues, she helped identify core sociodemographic variables for research reporting and co-developed a glossary of sociodemographic determinants of health in critical care medicine.

Her advocacy extends beyond publications to leadership and knowledge translation. As Past President of the Canadian Critical Care Society (CCCS), she co-led the organization’s Equity, Diversity, Decolonization, and Inclusion Policy and supported its dissemination through webinars for CCCS members and trainees across Canada.

Looking ahead, Dr. Burns continues to collaborate with CCCTG, the International Forum of Acute Care Trialists, as well as international critical care societies to strengthen Sex and Gender Based Analyses (SGBA) and Equity, Diversity, and Inclusion (EDI) in acute care research.

“The results of these studies are expected to inform policy, improve future study design and reporting, and catalyze secondary analyses of previously published studies,” she says. “Most importantly, this work will build capacity in SGBA and position Canada as a leader in ‘sex and gender science’ in critical care.”

“This study helped us confirm that at a local level, consistent infection control, community protective measures and vaccines were effective at halting the spread of SARS-CoV-2 for almost a full year. It also reminded us that a pandemic respiratory virus can mutate and overcome many of the prevention measures we introduced as the Omicron variant did in late 2021. We are indebted to the PSI Foundation for funding this study which is unique in Canada.” -Dr. Jorge Martinez-Cajas

About Dr. Jorge Martinez-Cajas

Dr. Jorge Martinez-Cajas is an Associate Professor in the Division of Infectious Diseases in the Department of Medicine at Queen’s University, with a cross-appointment in the Department of Biomedical and Molecular Sciences. He completed a three-year CIHR Canadian HIV Trials Network (CTN) research fellowship at the McGill AIDS Centre, where he studied antiretroviral drug resistance.

Dr. Martinez-Cajas leads the Canada-Colombia Collaboration Against HIV and AIDS, a recently established network of Canadian and Colombian institutions dedicated to HIV and AIDS research and care. His research focuses on the treatment of HIV infection in resource-limited settings, the implementation of HIV pre-exposure prophylaxis (PrEP) in Latin America, and outpatient parenteral antimicrobial treatments.

About the Funded Study

At the beginning of the COVID-19 pandemic, Dr. Martinez-Cajas recognized the need to assess infection risk among Ontario healthcare workers and the patients they served. At the time, over 71,000 cases and more than 5,000 deaths had been reported in Canada, with the majority occurring in older adults–particularly in long-term care facilities. In Ontario, 13% of all cases were in long-term care residents, yet they accounted for 70% of provincial deaths.

The PSI-funded study examined how healthcare workers’ roles in long-term and acute care facilities in Southeastern Ontario shaped outbreak risk and antibody development. It also assessed risk and protective factors for SARS-CoV-2 infection, including whether vaccination correlated with reduced infection rates.

Dr. Martinez-Cajas and Co-Investigator Dr. Yanping Gong recruited 205 healthcare workers from four facilities, including one acute care hospital and three long-term care homes. With the arrival of the Omicron wave in fall 2021, the research team followed up with participants to track infection risk before and after Omicron. By measuring antibody levels in healthcare workers exposed during outbreaks; those who cared for COVID-19 patients; and control groups with no direct exposure, the funded study identified proportions of susceptible versus protected workers.

Impact of the Funded Study

This study’s findings established a cohort model that can inform not only COVID-19 research, but also preparedness for future influenza or respiratory outbreaks. Dr. Martinez-Cajas highlighted areas for improvement in building larger cohorts, strengthening infrastructure and healthcare system readiness, and prioritizing resources during pandemics. Using the data from the study, Dr. Martinez-Cajas and his team developed computer simulations to test how reorganizing care within healthcare facilities might reduce outbreak risk, particularly in long-term care settings.

Reflecting on the findings, Dr. Martinez-Cajas explains: “this report examines the risk of infection by SARS-CoV-2 infection in a cohort or healthcare workers in a low-prevalence region in Ontario,” says Dr. Martinez-Cajas. “Its findings include infections driven by occupational exposures before Omicron but driven by community exposures after Omicron, protective effect of booster doses of vaccines, and additional protective effects against community infection by consistent adherence to mask use and social distancing even during the omicron waves. These findings are relevant for future pandemic preparedness.”

The study’s impact extends beyond just a single project, supporting future research and strengthening future pandemic preparedness in Ontario and beyond.

“The funding we received from PSI has helped researchers in the community hospitals, like ourselves, to connect with each other, learn from each other and build research programs in our own respectively community hospitals. The data that came from the work that was funded by PSI were by and large drawn from frontline clinicians and researchers in community hospitals.” -Dr. Jennifer Tsang

About Dr. Jennifer Tsang

Dr. Jennifer Tsang is a Physician Research Lead, Intensivist, and Co-Director of Critical Care Research at Niagara Health; Regional Deputy Research Director of the Internal Medicine Residency Program at McMaster University; School of Medicine Research Lead at McMaster University’s Niagara Regional Campus; and Associate Professor of Medicine at McMaster University. Dr. Tsang’s research focuses on research capacity building in community hospitals and community-based distributive medical education.

Her medical training began at University of Ottawa, where she completed her MD in Internal Medicine–followed by a Critical Care fellowship at the University of Toronto. In 2013, she obtained her PhD in molecular biology and completed the Royal College Clinician Investigator Program at the University of Toronto.

About the Funded Study

Working as a community physician in the Niagara region, Dr. Tsang noticed a disparity between community hospitals versus academic hospitals when it came to health research output and participation in the research world — especially within intensive care units (ICUs).

With her PSI Healthcare Research by Community Physicians grant, Dr. Tsang and Co-Principal Investigator Dr. Alexandra Binnie set out to break down these barriers and to learn how to engage community researchers. As the cofounders of the Canadian Community ICU Research Network (CCIRNet), the two partnered with the network with the end-goals of fostering a community of practice, offering mentorship and training, and building research capacity in community hospital ICUs.

Digging deeper, Dr. Tsang and her team wanted to explore the factors that influence community ICU research participation and program development; and what was essential for implementing and sustaining a community ICU research program.

Impact of the Funded Study

With support from PSI, the results of this qualitative, descriptive study produced a research toolkit to support community ICU physicians interested in implementing a research program within their hospitals.

Following the principles of integrated knowledge translation (iKT), Drs. Tsang and Binnie worked with physicians who represented the toolkit’s intended users, including: CCIRNet members, community ICU clinicians, research staff, and administrators. Drawing on members’ lived experiences in developing community ICU research programs, along with preliminary findings from participant interviews, they compiled practical recommendations for launching, implementing, and sustaining these programs.

Yet, Dr. Tsang notes there is more work to be done on a systematic level. “Findings from this study highlight the need for more support from leaders at policy makers at the local community hospital level, the provincial level and the national level,” says Dr. Tsang.

“While the current study identified key strategies for strengthening community hospital research at an individual and organizational level, less is known about the strategies required at a systems level. These gaps have highlighted the need to now explore the perspectives of leaders from community hospitals as well as those at provincial and national levels to inform policy recommendations for strengthening community hospital research capacity at a systems level.”

With the online toolkit now available for use through the Canadian Journal of Anesthesia, Ontario physicians and policymakers alike can have a helping hand in filling essential gaps within the medical research space of community ICUs.

“PSI Foundation support enabled us to better understand the impact of antibiotic treatment duration for bacteremia on the gut microbiome and antimicrobial resistance, and has helped us develop an ongoing clinical trial microbiome substudy pipeline which will continue to uncover important off-target effects of antibiotics on microbiomes and antimicrobial resistance in humans.” -Dr. Nick Daneman

About Dr. Nick Daneman

Dr. Nick Daneman is a Clinician Scientist and Division Head of Infectious Diseases at the Sunnybrook Research Institute, Senior Adjunct Scientist at ICES, and a Professor of Medicine at the University of Toronto. Dr. Daneman’s research focuses on antibiotic stewardship and resistance; hospital-acquired and critical care infections; with a specific focus on bloodstream infections. His training began at University of Toronto, where he completed his masters in Clinical Epidemiology and later completed his medical training with a specialty in Infectious Diseases and Internal Medicine.

About the Funded Study

As co-leads of the BALANCE research program, Drs. Nick Daneman and Rob Fowler collaborated with Dr. Bryan Coburn — a translational infectious diseases clinician scientist focused on the microbiome to embed a microbiome and antimicrobial resistance outcome in a large international clinical trial of an antimicrobial stewardship intervention.  Along with their research team, they set out to address the healthcare needs of patients who needed to consume antibiotics to fight off infection, while facing the off-target effects of antibiotic resistance and potential damage to one’s microbiome and the healthy bacteria in the body. The ‘BALANCE of the microbiome’ study enrolled a subgroup of the 3,600 worldwide participants in the BALANCE randomized controlled trial.

The results of the randomized controlled trial revealed that for those who need to take antibiotics to treat blood infections, 7 days of taking antibiotics was just as effective as 14 days — reducing the potential damage caused by long-term antibiotic use.

“PSI Foundation support has directly informed ongoing clinical trial and microbiome sub-study design, in particular in trials designed and initiated by this group, such as the BALANCE+ platform,” Dr. Daneman says. Dr. Coburn adds, “our goal is to continue to embed microbiome and antimicrobial-resistance assessments into clinical trials, to determine not only the clinical outcomes of study comparisons, but also their biological effects.”

Impact of the Funded Study

Moving forward, this PSI-funded study allowed the research team to develop a platform for future microbiome sub-studies of large international trials, including the ongoing BALANCE+ adaptive platform trial of bacteremia.

“Our goal is to develop and implement the methods required for microbiome analyses in clinically-actionable time for scenarios where microbiome and resistance status can inform clinical decisions,” says Dr. Coburn.

The implications of this study for Ontarians are major reductions in antibiotic treatments and harms across Ontario. With the data from this research, Drs. Daneman, Fowler, and Coburn’s goal is to incorporate microbiome and resistome considerations into clinical and stewardship practices in infectious disease by generating the data required to do so from human studies.

“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.”

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.”