Caring for you, innovating for the world
Over the course of LHSC's 139-year history, research has been an important mandate that has led to groundbreaking medical innovations and discoveries that have elevated patient care around the world. However, many are still surprised to learn that almost 10 per cent of all personnel (1,000 people) at LHSC, including technicians, nurses, allied health, physicians, surgeons and many others, work in research.
Why research and patient care go hand-in-hand
Research within LHSC begins and ends with patients, keeping quality of life and care at the heart of all endeavours. Within a hospital, researchers are able to recognize health problems or care challenges during daily practice and form questions such as "How can I be sure my patient is receiving the correct dose of medicine?" or, "How can I improve the way care is being delivered?" With these questions, researchers can start working on solutions.
Because LHSC provides the broadest range of patient services of any hospital in Ontario, researchers have access to a host of resources such as imaging equipment and data banks and a wide variety of medical experts, both within and outside of the researchers' areas of practice.
In this rich research environment, researchers are able to examine questions from all angles, meaning problem solving and brainstorming can move forward, solutions can be found earlier, and ultimately, delivered to patients faster. This cycle is referred to as the 'bench to bedside' approach.
What are the different types of research?
Depending on the health question, scientists may explore problems on a variety of fronts, from the tiniest molecule level to the Canadian health-care system at large. Essentially, all research happening at LHSC falls into two categories: basic science and clinical research.
Basic science typically happens in a lab environment. Picture the traditional stainless steel bench, test tubes, beakers and microscopes. Based on theories and predictions, basic science explores the domains of cells and molecules and dissects a disease process down to its fundamental parts.
Within the hospital setting, basic science often investigates questions surrounding what causes disease, how it spreads, and how best to treat it. The goal is to improve understanding of how diseases and disorders work in order to develop new, more effective therapies.
At LHSC, Lawson scientists use basic science to explore a variety of different bodily systems (e.g. kidneys, heart, lungs, brain, etc.) and the conditions that impact them.
Real-life example: LHSC's Dr. Alison Allan investigates how breast cancer spreads
Breast cancer is the number one diagnosed cancer and the number two cause of cancer related death among Canadian women. If detected early, traditional chemotherapy and radiation have a high success rate, but once the cancer metastasizes (spreads) beyond the breast, many conventional treatments are less effective. Research has shown that the lungs are one of the most commons sites of breast cancer metastasis and can be difficult to treat. Once the cancer has spread to the lungs, it has a significant impact on patient quality of life and survival.
Dr. Alison Alan is an oncology scientist with LHSC's London Regional Cancer Program. Her research focuses on the reasons for, and mechanisms behind, the spread of cancer. Although the majority of deaths from cancer occur due to the physiological effects of the secondary tumours, rather than from the primary tumour, how and why this happens remains poorly understood.
Dr. Allan and her team want to change that. In their lab, they have created a model to analyze the properties of breast tumour cells, and looked for characteristics that might cause them to spread. They have identified a type of aggressive breast cancer cell that causes the cancer to migrate to other organs, particularly the lung. At the same time, they discovered that the lung produces specific proteins that are attractive to breast cancer stem cells and provides a comfortable environment for them to establish themselves.
Dr. Allan believes this could be the result of a theory called 'seed and soil.' Picture a dandelion going to seed: the wind blows and the seeds are carried far and wide - but they don't necessarily grow everywhere they land. The seeds only grow in soil that has the right nutrients to support new blooms. With the spread of cancer, the tumour cells ('seeds') are believed to have some inherent factors that determine if and how aggressively they can spread. The organs in the body ('soil') are believed to possess factors that determine if and how strongly they attract tumour cells and help support their growth.
According to Dr. Allan, there hasn't been a lot of research into understanding this 'soil factor.' Her lab is one of the few focused on this phenomenon.
This knowledge has important implications for cancer treatment. Knowing how breast cancer spreads will help scientists predict which organs might be most vulnerable. most importantly, it can help them devise new strategies for treatment, early detection and even prevention.
As their knowledge base grows and their understanding improves, researchers will begin to formulate solutions that are ready to be tested on patients. This is where research shifts focus into the other category: clinical research.
Clinical research involves people. It can explore their tissues, their bodily functions, or their behaviours. It can also involve studies looking at patient data, such as local or national trends.
Some people may be familiar with clinical research through clinical trials. These studies follow a pre-defined protocol and typically test the effectiveness of new treatments or medications. By participating in these trials, patients can gain access to the latest innovations in care, treatment and medical devices - an option not necessarily available to patients visiting non-research hospitals. At LHSC, there are currently more than 2,300 clinical trials taking place. As researchers are embedded in the hospital, many of their studies start with phenomena they see when caring for their own patients.
Real-life example: LHSC's Dr. Amit Garg investigates the link between fibrate medications and loss of kidney function
Dr. Amit Garg is a nephrologist (kidney specialist) at LHSC. Through the hospital's outpatient Kidney Care Centre, he sees about 500 patients a year.
Many older patients take fibrates, a group of medications commonly used to treat high cholesterol. As part of their care, kidney specialists monitor patients' blood chemical levels and routinely check their blood to measure how well their kidneys are working.
Over time nephrologists at LHSC's Kidney Clinical Research Unit noticed that kidney function was below the normal range for a number of patients taking fibrates. Intrigued and concerned by this trend, the nephrologists discussed this as a group.
Dr. Garg and his colleagues decided to explore the issue further. Data from other clinical trials reported some side effects of fibrates; however, the effects described from the trials were minimal and inconclusive. The doctors needed more information.
In order to truly understand the effects of fibrates on kidney health, the research team decided to do a real-world study. Using a data-base, they examined the health records of more than 20,000 older Ontario residents who had recently started taking fibrates. During the first 90 days of their prescription, the research team examined changes in kidney function. Next, they compared their findings to a group of similar patients who had just started taking a similar drug not associated with kidney side effects.
The results were substantial. One in 10 patients taking fibrates demonstrated a change in kidney function within the first 90 days. As a result, these patients were more likely to consult a kidney specialist or to be hospitalized during this time.
Through this study, Dr. Garg was able to gather strong evidence that fibrates have important rapid effects on kidney function. He was then able to share his findings with the medical community through medical publications and conferences.
Based on the results, Dr. Garg recommends that physicians closely monitor their patients if they are prescribing them a fibrate, and if they see a change in kidney function, either lower the dose or discontinue the drug completely.
Without studies like these occurring within the hospital, these incredibly important results for patient care may never have been discovered.
Where does research happen?
For researchers at LHSC, where they do their work is just as important as how they do their work. LHSC provides an environment where scientists can safely store specimens and medications. They can perform diagnostic imaging tests, radiation or surgery and can ensure the highest degree of patient safety. Research at LHSC occurs throughout the hospital, but there are dedicated spaces too.
In partnership with Lawson, LHSC has invested in a number of specialized research facilities. These areas are equipped with unique tools and resources to help research move forward quickly and more efficiently than ever.
Children's Health Research Institute (CHRI) is the third-largest child, youth and maternal health research institute in Canada. It is also the largest program within Lawson, with over 100 researchers focusing on the origins, long-term effects and prevention of childhood illnesses and diseases. CHRI has two major research themes: the impact of environment on children's health and development and optimizing health and quality of life in children and youth.
The Gerald C. Baines Centre for Translational Cancer Research is a think-tank for cancer researchers. Located right beside the London Regional Cancer Program, this facility combines scientists and staff from different backgrounds to approach challenges from all angles. In addition to shared meetings and workspace for 'meetings of the minds,' there is lab space for analyzing the biological and molecular signatures of cancer, and enhances clinical trials space to safely test new drugs in patients.
The Institute for Clinical Evaluative Sciences (ICES) Western, located at Victoria Hospital, is a powerhouse for patient data and one of five ICES satellites in Ontario. This giant database contains more than 20 billion records of linked patient and population information, including surveys, individual patient records and major clinical and administrative databases. Researchers input their data with others across the province to the secure ICES system, recognized as an international leader in maintaining the privacy and security of patient health information.
From there, they can turn raw information into valuable knowledge on health-care issues, create recommendations to decision-makers, and influence how care is provided across the system.
The Lindros Legacy Research building is located adjacent to clinical areas at LHSC's University Hospital. It is a five-storey centre for translational research. Translational research transforms discoveries made through basic or clinical research into innovative new treatments for patients. The building is home to:
- The Matthew Mailing Centre for Translational Transplant Studies, where basic scientists and clinicians work on novel immune therapies and anti-rejection drugs and therapies
- The Centre for Clinical Investigation and Therapeutics, a dedicated, centralized hub for researchers conducting patient-oriented clinical research studies
- The Dr. Sandy Kirkley Musculoskeletal Research Centre, where research is focused on bone and joint disease, sport medicine, joint replacement surgery, musculoskeletal imaging and physical therapy
- Canadian Surgical Technology and Advanced Robotics (CSTAR), a world-leading centre for researching, developing, testing and delivery of simulation training of minimally invasive surgical technologies and techniques
- The Brent & Marilyn Kelman Centre for Advanced Learning, which is a state-of-the-art simulation training facility for surgeons and is part of CSTAR.
These research environments, with their advanced equipment and state-of-the-art facilities are helping to produce the treatments of the future and contribute to LHSC's research legacy.
The future of research at LHSC
Today, LHSC continues to be a leader in health research. In the last 10 years, health-care workers may have learned more about the fundamental biology underlying health and disease than in the previous 100 years combined. However, it is the research of the next 10 years that will allow us to use this knowledge to truly transform health care.
Strengthening collaboration between basic lab researchers, clinicians and other health-care workers in the hospital so that fundamental discoveries can be harnessed to improve patient care is integral to success. Moving along this path will ensure that the people of London and the surrounding region continue to be among the first to benefit from advances in health research.
The many exciting developments in care and research that continue to unfold at LHSC are helping to keep up the momentum for future advancements.
Dr. Richard Kim is one of the world leaders in the field of personalized medicine. Personalized medicine recognizes that genetic variations make people vulnerable to certain diseases, and therefore, the most effective treatments should work with an individual's unique genetic code.
Dr. Kim and his team were the first in Canada to start a personalized medicine clinic for the blood thinner warfarin. Since the clinic opened in 2008, it has treated hundreds of LHSC patients, resulting in better care, less side effects and fewer emergency visits. LHSC now also offers personalized medicine clinics for cholesterol lowering drugs called statins and for different cancer treatment drugs.
Radiation oncologists at LHSC are conducting studies on the use of a new precision radiation technique, called stereostatic radiation.
Older radiation techniques often require the patient to receive daily radiation treatments over a number of weeks and there is some concern about the risk of causing harm to the surrounding healthy tissue. Stereostatic radiation is different. It is delivered in only three-to-eight treatments and precisely delivers very high doses of radiation to the tumour, while leaving the surrounding tissues practically free of radiation. This reduces the risk of harming healthy tissue, thereby improving the ability of the patient to tolerate treatment.
These are only a few examples of the groundbreaking work being done as, each and every day, researchers in London, in labs and in hospitals, will continue to help create a future of better care for patients and their families.