SMHCF Liaison clinical-research

liaisonPublished by:ST. MARY’S HOSPITAL FOUNDATIONEditor: Paulanne Jushkevich, M.A., CFRE3830 Lacombe Avenue, Montreal (Québec) H3T 1M5Tel.: (514) 734-2694 • Fax: (514) 734-2655E-mail: [email protected]

St. Mary's Hospital Center has always sought true Harmony. In the people we serve, the professional staffwho serve them, the administrative staff who supports them, and the wonderful plethora of volunteers -from the Board members, to the Auxiliary members, to the blue-smocked volunteers who put in hourupon hour of invaluable labor - we strive toward a harmony within our walls that is immediately

perceived by our patients, to their ultimate benefit. And because Harmony is not a stagnant,inanimate object, but is rather a thriving entity, our Harmony has evolved and continues to evolve.

On Friday, November 2nd, 2007, 600 members of the Montreal Business and medical communitiesconverged at the Windsor Station to celebrate the Evolution of Harmony at the 70th Annual St. Mary'sBall. Music and video, spanning all eras and genres from 1937 to today, highlighted the evolution of songand dance over the past 70 years. And the renowned jazz vocalist Ranée Lee joined us to represent musicreminiscent of the 50's.This year’s event raised over $921,000 net, to be directed toward the acquisition of surgical equipmentfor our state-of-the-art surgical unit. The Hospital currently performs over 12,500 surgeries per year,leading the way in Endoscopic Surgical Procedures - a specialized procedure that uses a “buttonhole”incision and minimally invasive techniques, significantly accelerating patient recovery and reducinghospital stay. In recognition and celebration of the multi-ethnic, multi-faith character of St. Mary's Hospital Center,we welcomed La Chorale des jeunes d'Outremont - a francophone, Haitian gospel choir - who belted outthe “blessing” in a manner true to our theme of Harmony: through song. Foundation Board MemberJean Aucoin gave a moving and very personal account of his experience undergoing emergency surgeryto save his life, bringing into very real perspective the importance of continued support to this crucial area of our Hospital.

“Tonight we celebrate Harmony. We celebrate each tone, each key, every cadence and consonance. We celebrate how they sound togetherbecause we respect their differences, and honour their individuality. And because we respect and honour what is unique and distinctive,

we evolve in Harmony, for the sake of Harmony, and invite every person who enters our doors to join this wonderful and ever-evolving chorus.”

www.stmaryshospitalfoundation.ca

FALL 2007

CLINICAL RESEARCH: Where the rubberhits the road for patient care

In examining the difference between clinical and bench research, I fell upon an online chatsession between med-students discussing this very issue. “Bench” (or basic) research is whatmost organizations refer to, charities in particular, when they talk about raising money for

research. It involves laboratories, technicians in white smocks, test tubes, Bunsen burners - allof that exciting stuff. Clinical research, also known as Epidemiology, is a branch of medicalscience that deals with the incidence, distribution, and control of disease in a population.There are no Bunsen burners, per say, but there is a lot of patient contact. Because clinicalresearch requires the measurement, in direct human variables, of what diseases and disorders -physical or psychological - are prevalent; to what degree; affecting whom in particular; and whythat particular population more than another, etc. To illustrate the point, bench research mayseek to find a cure for cancer, whereas clinical research may endeavor to determine whatsegment of the population is more likely to be afflicted with cancer, what the contributing

environmental factors are, and what the psychosocial repercussions may be for those afflicted and their families.

In their online chat, one med student asks if bench research is considered “more impressive”, and another med studentconcedes that, for the most part, bench research does tend to turn the heads a bit more than the clinical. But that samestudent goes on to say, “With that said, there's no way I'd ever switch to basic research . . . I'm sure a lot of collaborationgoes on in basic research, but you don't work with people to the same extent as you do in clinical research. I love interactingwith patients, research assistants, nurses,doctors, etc, on a daily basis. I also like thateven though I'm not discovering some amazingcure for something, I am making a big directimpact on numerous people.”

In fact, clinical research has a powerful andoften understated impact on very many people.In the early 1990's, St. Mary's Hospital Centermade a crucial decision to formally augmentour clinical research profile. As it was - and is -very many of our medical professionals arealready highly respected clinical researchers. Infact, thousands of research papers, directlyaffecting healthcare strategies for improvedpatient care, have emanated from this veryHospital over the past decade. Many of thesepapers have focused on areas includingGeriatric Psychiatry, Emergency RoomGeriatric Care, General Oncology, andHaematology.

liaisonliaison

Celebrating the Evolution of Harmony at the 70th AnnualfàA `tÜçËá UtÄÄ

On September 25th, over 3,000 young women from six private Montreal girl's schoolswalked up Mount Royal in a gesture of solidarity and support in the fight against BreastCancer, for the 12th Girls for the Cure march. This year's event was held in lovinghonour of the late Shelagh Dwyer Coinner, who, for many years, inspired the Girlswith motivational speeches about her own experiences living with cancer. The march is always preceded by weeks of enthusiastic preparation by the girls, manyof whose lives have been personally touched by breast cancer. Students from ECS,Queen of Angels Academy, Sacred Heart School of Montreal, The Study, TrafalgarSchool for Girls and Villa Maria walk five kilometers from their school campuses andup Mount Royal, wearing a T-shirt that reads “Heartfelt Thanks” on the front andhonouring a loved one on the back.In her commemorative speech at the top of the mountain, Shelagh's daughterShawna honoured her mother's courage and vision, saying “I feel as though everyperson she touched, every person who shared who she is and what she was about,now carries with them a piece of her. And so I am surrounded by my mother. I amsurrounded by her everyday, but especially today.”

CJAD's Laurie and Olga made powerful testimonials about how devastating a cancer diagnosis can be. Laurie MacDonald underwent breast cancertreatment, and is currently cancer-free, but Olga reminded all of us that a cancer diagnosis affects not only the patient, but those who love her, in amost devastating manner.100% of the $168,919 net proceeds of the Girls for the Cure event were gifted toward the St, Mary's Hospital Community Cancer Care Centre tobenefit the largest Breast Cancer Patient population in the Island. To date, the initiative has raised over $1,7 million for patient care and services. Tohonour the admirable efforts of these girls, and the amazing strides they have empowered St. Mary's to make through their generosity, the Girls forthe Cure Resource Room will be a central part of the newly renovated Community Cancer Care Centre, which will be patient-ready in the new year.

Z|ÜÄá yÉÜ à{xVâÜx Event honours longtime champion, Shelagh Dwyer Coinner

Ball co-chairs Martin Cauchonand Dorine Perron.

36 butterflies were released at the event, in honour ofShelagh Dwyer Coinner, who always wore a butterfly pin.

2575 St. Mary's LIAISON eng 12/7/07 11:05 AM Page 1

Indeed, much of the information that has been gathered

through clinical researchmay have already filtereddown to you, withoutyour having even beenaware. For example,studies on the use ofEmergency Services are

quite topical: how many people useEmergency; what is it being used for; whyaren't alternative (often more appropriate)health services being employed to alleviatethe volume? These are all issues that wouldbe involved in Clinical Research.

Arguably one of the most powerful subjectsthat have been addressed through clinicalresearch at St. Mary's is that of Elder Abuse.Dr. Mark Yaffe - whose leadership as thepast chief of our Family Medicine Centretruly put St. Mary's on the map - haspublished extensively on the compellingand increasingly prevalent issue of ElderAbuse. One of thehottest topics in themedia, and top-of-mind in the health-care scene, ElderAbuse has onlyrecently been giventhe spotlight that itdeserves, according to Yaffe. Even so, itcontinues to be one of the mostinadequately researched topics in health-care. In fact, elder abuse is currently wherethe topic of child abuse was 20 to 30 yearsago - not well known or understood, andnot given the attention it deserves.

And there are no test tubes or Bunsenburners that could possibly assist us inmaking any headway toward and under-standing of elder abuse, much less asolution. The answer, if there is one, canonly be revealed through Clinical Research.

In 2002, the World Health Organization(WHO) officially recognized Elder Abuseas a global concern. The WHO defineselder abuse as "a single, or repeated act, orlack of appropriate action, occurring withinany relationship where there is anexpectation of trust which causes harm ordistress to an older person." The abuse canbe physical, psychological/emotional,

sexual or financial, or anycombination. One of themost difficult forms of Elderabuse takes the form ofintentional or unintentionalneglect.

According to Dr. Yaffe (2007recipient of the QuebecCollege of Family PhysiciansAward of Excellence), whose extensiveresearch on the subject has made him one ofthe most sought-after experts in the field,most international estimates set theprevalence of elder abuse at 4-10% of thepopulation. It is approximated that forevery reported incident of elder abuse, asmany as 5 cases go unreported. If accurate,this statistic suggests that potentiallyhundreds of thousands of older Canadianssuffer from some form of abuse. Littlewonder it has been described by the CLSCRene-Cassin Elder Abuse ConsultationCentre as “the most hidden form ofviolence,” permeating all ethnicities,

cultures, and socio-economic lineswith complete indiscretion. And thebiggest culprits in keeping it hiddenare the victims themselves, most ofwhom either do not report the abuseor even go so far as to deny it whenconfronted.

From his studies over the years, Dr. Yaffesuggests that the estimations are far toomodest, calculating that as much as 25% ofthe elderly population may suffer someform of abuse at some point in their lives.

For those who are abused, knowingly orotherwise, the death rate increases by 40%.As such, it is one of the most preventableforms of mortality in our community.

The most alarming information to emanatefrom Dr. Yaffe's research may be thatdoctors are statistically the least likely toidentify and report elder abuse than anyother medical professional. This in spite ofthe fact that elders typically visit theirdoctor 5-6 times a year. To combat thischallenge, tools are being developed andprovided to family doctors to assist them inrecognizing elder abuse, and inform themof what resources are available to deal withany suspected cases.

One of the toolsdeveloped is a shortquestionnaire that thedoctor can use withhis/her patient. Thequestionnaire, knownas Elder AbuseSuspicion Index, is likea “barometer for risk,”as Dr. Yaffe puts it, that

won't necessarily provide doctors with adefinitive diagnosis, but it will indicatewhether further investigation is necessary.

Dr. Yaffe's influence in this field stretches farbeyond the boundaries of this province. Infact, his reputation is such that the WHOapproached St. Mary's to conduct contentvalidity studies for the Elder AbuseSuspicion Index in 7 countries: Australia,Chile, Costa Rica, Kenya, Spain, Singaporeand Switzerland. They hoped to determineif the Index would be valid and relevantacross this ethnically diverse group whenused in different geographical and culturalcontexts. As a result, it was determined thatthis tool is, in fact, “portable” and can beused in a variety of cultural and geographicalsettings. The exercise also served to high-light however, the degree to which ElderAbuse is an international problem.

Yaffe's research work appears in severalpapers which are pending publication, andone of them will even be appearing in aspecial resource book dedicated to ElderAbuse.

Another St. Mary's physician who is forgingnew paths in healthcare through hisextensive clinical research is Dr. RobertHemmings, Chief of Obstetrics andGynecology. Dr. Hemmings heads up theChrysalis Initiative for Women's Health &Wellness at St. Mary's, which was profiledin the spring Liaison.One of his areas ofresearch has involved theuse of Black Cohosh torelieve symptoms ofMenopause.

The use of so-called“natural remedies” formedicinal purposesintroduces an entirelyother realm of research in which

Dr. Hemmings has taken anavid interest: Complementaryand Alternative Medicine(CAM). His research hasbrought to light that womenare particularly open to andinterested in the use of CAM,which encompasses a widevariety of areas including“natural” or herbal remedies, exercise, diet,acupuncture, meditation, etc.

In response to the increasing interest inCAM, and the need to establish andunderstand its place in contemporarymedicine, St. Mary's Hospital Centerhosted a CAM Symposium on November29th. The event included celebratedphysicians from St. Mary's and the JewishGeneral Hospital, and brought in severalChinese physicians from Beijing andShanghai to compare notes on the use oftraditional Chinese medicine and thechallenges of integrating the two worlds ofthought to the ultimate benefit of ourpatients.

Dr. Hemmings' own, demonstratedcommitment to the realm of possibilitiesopen to us through the integration of CAMhas made him the only physician in Canadato have successfully used acupuncturethrough childbirth to stimulate labor andrelieve pain.

Dr. Maida Sewitch has also studied theeffect and possible benefits of alternativemedicine, although her work has beendone primarily in the context of cancer.In 2006, Sewitch was awarded TheDorothy J. Lamont Award, which isgiven by the National CancerInstitute of Canada and theCanadian Institutes of HealthResearch to a top-rankinginvestigator in the researchcategory of behavioural/psychosocial/cancer control.Colorectal cancer is the fourthmost common cancer in Canada

and the secondleading cause ofcancer death, andSewitch's research isfocused on enhancingthe delivery and useof colorectal cancerscreening.

Sewitch's work involves the collection ofdata from physicians, patients and StatisticsCanada to track whether doctors arefollowing guidelines in recommendingcolonoscopies and other colorectal cancerscreening tests to their patients.Additionally, she is tracking patientadherence to these recommendations. Andfinally, she and her team are developing away to identify colorectal cancer screeningin Canadian health care databases. Thisinformation will provide another way forresearchers and decision-makers to ensurethat the patients who need the screeningtests actually receive them.

Sewitch's work is a prime example of howclinical research saves lives. Her efforts will invariably lead to improved screening,which will translate immediately into earlierdetection and treatment, and fewer deaths.

In another of her researchinitiatives, this one done incollaboration with Dr. Yaffeand with Epidemiology ChiefJane McCusker, Sewitch looksat patient behaviour vis-à-vistheir gastroenterological ill-ness and the affect of majordepression. For both Yaffeand Sewitch, depression inthe elderly is a continuingfocus for research to whichmany precious hours arededicated.

As chief of Epidemiology,McCusker ensures thatSt. Mary's continues to lead the

pack in clinical research, to ensure that our patientsgain the maximum benefitfrom our research efforts, inthe shortest delay possible.A quick sampling of some ofher own research workincludes a wide varietyof topics, from "Neo-

natal Sucking, Maternal

Characteristics, and Non-organic Failure toThrive" (in collaboration with PrincipalInvestigator Maria Ramsay), and"Paroxetine versus St. John's Wort in theOutpatient Treatment of DepressiveDisorder" (in collaboration with PrincipalInvestigator: Gerald VanGurp), all the wayto the very controversial subject of "SeniorsDischarged from Hospital EmergencyDepartments At Risk of AdverseOutcomes."

Vice President of Professional Services, Dr. Bruce Brown captures the core of St. Mary's dedication to ClinicalResearch: “As a University Hospital, St. Mary's is committed to furtheringClinical Research to contribute toinnovations in patient care, to foster an environment of inquiry, and to remain at the forefront of medicalknowledge.”

In a telling remark on the online chatsession, one med-student warns anotherthat those who pursue clinical research “facea general lack of appreciation andunderstanding,” and another studentconcurs that “bench researchers get most ofthe glory.”

It is impossible to deny the outstandingmerit of bench research, and the accoladesthat those researchers deserve. But clinicalresearch is the Cinderella cousin that is often underestimated, overlooked (in terms of importance and support), and misunderstood. Fortunately forMontreal, however, St. Mary's continuesto consider Epidemiology to be where the research rubber hits the patient-services road. And by all accounts, the work that lies ahead of us will dwarf the enormous strides we've alreadymade.

Continued from 1st page...

2575 St. Mary's LIAISON eng 12/7/07 11:05 AM Page 3

Indeed, much of the information that has been gathered

through clinical researchmay have already filtereddown to you, withoutyour having even beenaware. For example,studies on the use ofEmergency Services are

quite topical: how many people useEmergency; what is it being used for; whyaren't alternative (often more appropriate)health services being employed to alleviatethe volume? These are all issues that wouldbe involved in Clinical Research.

Arguably one of the most powerful subjectsthat have been addressed through clinicalresearch at St. Mary's is that of Elder Abuse.Dr. Mark Yaffe - whose leadership as thepast chief of our Family Medicine Centretruly put St. Mary's on the map - haspublished extensively on the compellingand increasingly prevalent issue of ElderAbuse. One of thehottest topics in themedia, and top-of-mind in the health-care scene, ElderAbuse has onlyrecently been giventhe spotlight that itdeserves, according to Yaffe. Even so, itcontinues to be one of the mostinadequately researched topics in health-care. In fact, elder abuse is currently wherethe topic of child abuse was 20 to 30 yearsago - not well known or understood, andnot given the attention it deserves.

And there are no test tubes or Bunsenburners that could possibly assist us inmaking any headway toward and under-standing of elder abuse, much less asolution. The answer, if there is one, canonly be revealed through Clinical Research.

In 2002, the World Health Organization(WHO) officially recognized Elder Abuseas a global concern. The WHO defineselder abuse as "a single, or repeated act, orlack of appropriate action, occurring withinany relationship where there is anexpectation of trust which causes harm ordistress to an older person." The abuse canbe physical, psychological/emotional,

sexual or financial, or anycombination. One of themost difficult forms of Elderabuse takes the form ofintentional or unintentionalneglect.

According to Dr. Yaffe (2007recipient of the QuebecCollege of Family PhysiciansAward of Excellence), whose extensiveresearch on the subject has made him one ofthe most sought-after experts in the field,most international estimates set theprevalence of elder abuse at 4-10% of thepopulation. It is approximated that forevery reported incident of elder abuse, asmany as 5 cases go unreported. If accurate,this statistic suggests that potentiallyhundreds of thousands of older Canadianssuffer from some form of abuse. Littlewonder it has been described by the CLSCRene-Cassin Elder Abuse ConsultationCentre as “the most hidden form ofviolence,” permeating all ethnicities,

cultures, and socio-economic lineswith complete indiscretion. And thebiggest culprits in keeping it hiddenare the victims themselves, most ofwhom either do not report the abuseor even go so far as to deny it whenconfronted.

From his studies over the years, Dr. Yaffesuggests that the estimations are far toomodest, calculating that as much as 25% ofthe elderly population may suffer someform of abuse at some point in their lives.

For those who are abused, knowingly orotherwise, the death rate increases by 40%.As such, it is one of the most preventableforms of mortality in our community.

The most alarming information to emanatefrom Dr. Yaffe's research may be thatdoctors are statistically the least likely toidentify and report elder abuse than anyother medical professional. This in spite ofthe fact that elders typically visit theirdoctor 5-6 times a year. To combat thischallenge, tools are being developed andprovided to family doctors to assist them inrecognizing elder abuse, and inform themof what resources are available to deal withany suspected cases.

One of the toolsdeveloped is a shortquestionnaire that thedoctor can use withhis/her patient. Thequestionnaire, knownas Elder AbuseSuspicion Index, is likea “barometer for risk,”as Dr. Yaffe puts it, that

won't necessarily provide doctors with adefinitive diagnosis, but it will indicatewhether further investigation is necessary.

Dr. Yaffe's influence in this field stretches farbeyond the boundaries of this province. Infact, his reputation is such that the WHOapproached St. Mary's to conduct contentvalidity studies for the Elder AbuseSuspicion Index in 7 countries: Australia,Chile, Costa Rica, Kenya, Spain, Singaporeand Switzerland. They hoped to determineif the Index would be valid and relevantacross this ethnically diverse group whenused in different geographical and culturalcontexts. As a result, it was determined thatthis tool is, in fact, “portable” and can beused in a variety of cultural and geographicalsettings. The exercise also served to high-light however, the degree to which ElderAbuse is an international problem.

Yaffe's research work appears in severalpapers which are pending publication, andone of them will even be appearing in aspecial resource book dedicated to ElderAbuse.

Another St. Mary's physician who is forgingnew paths in healthcare through hisextensive clinical research is Dr. RobertHemmings, Chief of Obstetrics andGynecology. Dr. Hemmings heads up theChrysalis Initiative for Women's Health &Wellness at St. Mary's, which was profiledin the spring Liaison.One of his areas ofresearch has involved theuse of Black Cohosh torelieve symptoms ofMenopause.

The use of so-called“natural remedies” formedicinal purposesintroduces an entirelyother realm of research in which

Dr. Hemmings has taken anavid interest: Complementaryand Alternative Medicine(CAM). His research hasbrought to light that womenare particularly open to andinterested in the use of CAM,which encompasses a widevariety of areas including“natural” or herbal remedies, exercise, diet,acupuncture, meditation, etc.

In response to the increasing interest inCAM, and the need to establish andunderstand its place in contemporarymedicine, St. Mary's Hospital Centerhosted a CAM Symposium on November29th. The event included celebratedphysicians from St. Mary's and the JewishGeneral Hospital, and brought in severalChinese physicians from Beijing andShanghai to compare notes on the use oftraditional Chinese medicine and thechallenges of integrating the two worlds ofthought to the ultimate benefit of ourpatients.

Dr. Hemmings' own, demonstratedcommitment to the realm of possibilitiesopen to us through the integration of CAMhas made him the only physician in Canadato have successfully used acupuncturethrough childbirth to stimulate labor andrelieve pain.

Dr. Maida Sewitch has also studied theeffect and possible benefits of alternativemedicine, although her work has beendone primarily in the context of cancer.In 2006, Sewitch was awarded TheDorothy J. Lamont Award, which isgiven by the National CancerInstitute of Canada and theCanadian Institutes of HealthResearch to a top-rankinginvestigator in the researchcategory of behavioural/psychosocial/cancer control.Colorectal cancer is the fourthmost common cancer in Canada

and the secondleading cause ofcancer death, andSewitch's research isfocused on enhancingthe delivery and useof colorectal cancerscreening.

Sewitch's work involves the collection ofdata from physicians, patients and StatisticsCanada to track whether doctors arefollowing guidelines in recommendingcolonoscopies and other colorectal cancerscreening tests to their patients.Additionally, she is tracking patientadherence to these recommendations. Andfinally, she and her team are developing away to identify colorectal cancer screeningin Canadian health care databases. Thisinformation will provide another way forresearchers and decision-makers to ensurethat the patients who need the screeningtests actually receive them.

Sewitch's work is a prime example of howclinical research saves lives. Her efforts will invariably lead to improved screening,which will translate immediately into earlierdetection and treatment, and fewer deaths.

In another of her researchinitiatives, this one done incollaboration with Dr. Yaffeand with Epidemiology ChiefJane McCusker, Sewitch looksat patient behaviour vis-à-vistheir gastroenterological ill-ness and the affect of majordepression. For both Yaffeand Sewitch, depression inthe elderly is a continuingfocus for research to whichmany precious hours arededicated.

As chief of Epidemiology,McCusker ensures thatSt. Mary's continues to lead the

pack in clinical research, to ensure that our patientsgain the maximum benefitfrom our research efforts, inthe shortest delay possible.A quick sampling of some ofher own research workincludes a wide varietyof topics, from "Neo-

natal Sucking, Maternal

Characteristics, and Non-organic Failure toThrive" (in collaboration with PrincipalInvestigator Maria Ramsay), and"Paroxetine versus St. John's Wort in theOutpatient Treatment of DepressiveDisorder" (in collaboration with PrincipalInvestigator: Gerald VanGurp), all the wayto the very controversial subject of "SeniorsDischarged from Hospital EmergencyDepartments At Risk of AdverseOutcomes."

Vice President of Professional Services, Dr. Bruce Brown captures the core of St. Mary's dedication to ClinicalResearch: “As a University Hospital, St. Mary's is committed to furtheringClinical Research to contribute toinnovations in patient care, to foster an environment of inquiry, and to remain at the forefront of medicalknowledge.”

In a telling remark on the online chatsession, one med-student warns anotherthat those who pursue clinical research “facea general lack of appreciation andunderstanding,” and another studentconcurs that “bench researchers get most ofthe glory.”

It is impossible to deny the outstandingmerit of bench research, and the accoladesthat those researchers deserve. But clinicalresearch is the Cinderella cousin that is often underestimated, overlooked (in terms of importance and support), and misunderstood. Fortunately forMontreal, however, St. Mary's continuesto consider Epidemiology to be where the research rubber hits the patient-services road. And by all accounts, the work that lies ahead of us will dwarf the enormous strides we've alreadymade.

Continued from 1st page...

2575 St. Mary's LIAISON eng 12/7/07 11:05 AM Page 3