Crems Part 1 2015

CREMS SUMMER RESEARCH PROGRAM
2015 PROJECTS
PLEASE READ CAREFULLY
The following catalogue represents the projects that are available for the 2015 CREMS Summer Research Program.
You must use the contact information provided in order to set up an appointment to discuss the project in more detail
with the supervisor.
While you may contact multiple supervisors, you can only submit ONE application. Some supervisors have multiple
projects in their lab but you must choose ONE and submit an application for that.
Contact the supervisor on the project you are interested in. Once the supervisor confirms that you are the
successful applicant you must complete the 2015 Summer Research Student Application. Please request this
form from once you are the confirmed choice. We will not be giving out applications until you have been chosen by
the supervisor.
The completed application form is due by 5 pm on Friday March 27, 2015.
The application form must be sent via email ONLY to crems.programs@utoronto.ca
Good Luck!!
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Identifying genetic causes of congenital and developmental disorders in adults
Supervisor Name: Anne Bassett
Hospital/Research Institution: Centre for Addiction and Mental Health
Email: anne.bassett@utoronto.ca
Department: Psychiatry
Brief Project Description
We are studying major developmental diseases, including congenital cardiac disease and schizophrenia.
Together with colleagues at the University Health Network, Hospital for Sick Children and other
international institutions, we are clinically screening patients with these conditions to determine those
most likely to have genetic syndromes and/or other de novo or inherited forms of these diseases. Using
state-of-the-art molecular genetic methods we are identifying patients with structural (deletions or
duplications) and other mutations and studying inheritance patterns and clinical expression. We directly
translate clinically significant results to help patients and their families with anticipatory care and genetic
counselling. This is clinical and statistical research (not bench lab research - this is with our colleagues) at
the forefront of molecular medicine
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Which protocol identifies retinal toxicity associated with an antiepileptic drug used in
early childhood
Supervisor Name: Carol Westall
Hospital/Research Institution: The Hospital for Sick Children
Email: Carol.westall@sickkids.ca
Department: Ophthalmology and Vision Science
Brief Project Description:

Infants with seizure disorders are treated with the anti-epileptic drug vigabatrin. About 20% of treated
children develop retinal toxicity. This project will compare the predictive ability of the standard clinical
electroretinogram (ERG) and a structural assessment tool called ocular cohehence tomography (OCT). Over
the summer it is expected that 20 infants will be assessed clinically including electroretinogram testing and
retinal examination.
The summer student will work with a coordinator, physicians, electrophysiologists and technical staff.
Appointments will be coordinated and the student will collect clinical and study data; will evaluate data and
conduct statistical assessment using a Cox regression model with time dependent covariates. The hazard
ratio associated with the measurements on the risk of retinal damage in infants and young children will be
estimated for both test paradigms. The results of this assessment are expected to help determine the
optimal tool to assess retinal toxicity associated with the antiepileptic drug vigabatrin.
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Genome-based personalized therapy for prostate cancer
Supervisor Name: Dr. Paul C. Boutros
Hospital/Research Institution: Ontario Institute for Cancer Research & University of Toronto
Email: Paul.Boutros@oicr.on.ca
Brief Project Description:

The Canadian Prostate Cancer Genome Network (CPC-GENE) is a coordinated multi-centre effort to
identify prognostic and predictive biomarkers for intermediate-risk prostate cancer patients. Approximately
1 in 7 Canadian men will be diagnosed with prostate cancer over the course of their lifetime. About a third
of these are diagnosed with intermediate-risk disease – as determined by the clinical variables of T-
category and pre-treatment PSA and the pathological grade (Gleason score). Despite best-treatment with
precision radiotherapy or surgery, about 40% of patients will suffer relapse. CPC-GENE aims to use whole-
genome sequencing, RNA-sequencing and epigenetic profiling to identify those patients who suffer
relapse at the time of initial therapy. This project, as part of CPC-GENE, involves working with the resulting
data to develop these clinical-tools. This includes primarily clinical, biostatistical and bioinformatic data-
analysis, and working to link the clinical data to the genomic information on a per-patient basis to create a
portrait of disease risk and progression. The applicant will be directly supervised by a computational
biologist, but will work very closely with the study pathologist and overall-lead (a radiation oncologist), and
thus is designed to give a strong sense of the interactions of a large translational research program.
Magnetic Occult Lesion Localization and Imaging (MOLLI) for Non-Palpable Breast
Cancers
Supervisor Name: Nicole Look Hong / Anath Ravi
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Hospital/Research Institution: Sunnybrook Research Institute
Email: nicole.lookhong@sunnybrook.ca
Purpose:
The goal of this project is to evaluate an alternative to wire localization for surgical resection of non-palpable breast
lesions: Magnetic Occult Lesion Localization and Imaging (MOLLI). This novel approach to tumour localization,
developed at Sunnybrook Odette Cancer Centre, involves implanting non-radioactive magnetic seed(s) under
radiographic guidance to clearly define the center and extent of tumour. Seeds are completely contained within the
breast, do not pose a risk of dislodgement or movement-related discomfort, and can be implanted several days in
advance. Seeds are also non-radioactive, eliminating any need for radiation safety precautions. Using a novel and
user-friendly detection system, the surgeon can precisely identify the location of seeds, and perform skin incisions
and resection achieving both optimal cosmetic result and oncologic outcomes.
Methodology:
Pre-clinical validation studies will be performed on anthropomorphic phantoms to determine whether MOLLI can
replace wire localization. Tests will include quantifying the sensitivity and resolution of the MOLLI system to ensure
accurate detection of the magnetic seeds under clinically representative scenarios. These phantom studies will form
the basis of a pre-clinical validation study a pilot series of localizations in breast cancer patients with small non-
palpable tumors will be completed to ascertain feasibility, safety, patient acceptability, and satisfaction of all involved
clinicians.
Objectives:
At the end of this study it is expected that the student contribute to a manuscript that characterizes the performance
of the MOLLI system in phantom geometries. These results will also be presented at an international conference for
rapid knowledge translation into the surgical oncology community. Additionally, based on the outcomes from the
preliminary pre-clinical studies it is expected that the student may also participate in filing for research ethics board
approval for subsequent pilot series clinical trials.
Endo-bronchial ultrasound guided trans-bronchial biopsy; the impact of limited

resources on diagnostic accuracy
Supervisor Name: Abdollah Behzadi
Hospital/Research Institution: Credit Valley Hospital
Email: abdollah.behzadi@trilliumhealthpartners.ca
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Endo-bronchial ultrasound is a relatively new technology that is increasingly used to make pathological diagnosis of
mediastinal abnormalities. Given the high cost of the equipment and resources that this technology requires, the
wide adaptation of this procedure, which results in lesser surgical procedures on affected patients, has been
hampered.
This is a retrospective chart review study of approximately 180 patients who underwent this procedure over a 2 year
period in a university-affiliated community hospital. The goal of this project is to identify a patient cohort whose
biopsy results provide accurate and actionable clinical information hence avoiding the procedure in low yield
situations.
the With the help of supervisor, the student is responsible to develop an understanding of indications for this
procedure, write a proposal, collect clinical data, perform statistical analysis, write the initial manuscript, and present
the findings in a scientific conference. The student-candidate should have interest in outcome research,
background knowledge in statistics, and drive to work independently.
The ABCS Trial (Anesthesia for Breast Cancer Surgery): A Two-center Randomized
Controlled Comparison of the Impact of General Anesthesia with and without Thoracic
Paravertebral Blocks on the Three-month Incidence of Chronic Neuropathic Pain in
Women Undergoing Ambulatory Breast Tumor Resection
Supervisor Name: Faraj Abdallah
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Hospital/Research Institution: St. Michael’s Hospital
Email: abdallahf@smh.ca

People with breast cancer now live much longer because of better treatments. However, almost 60% of women who
have successful breast cancer operations then develop long-term pain. This pain is makes it very hard for these
women to sleep, work, interact with family, and carry out their normal daily life. If we can find better ways to stop this
pain from happening, women will be able to live a better and pain-free life after their breast cancer surgery.
Thoracic paravertebral block (PVB) is a method for using local anesthetics (drugs that ‘numb’ the nerves) to freeze or
‘block’ the nerves around the breast. Some small older studies suggest that using these nerve blocks before surgery
can help prevent long-term pain. However, we cannot be certain that these small studies are correct because they
have many problems. We therefore want to do a large study to find out if nerve blocks before breast cancer surgery
can prevent long-term pain and improve women’s quality of life.
In our study, women undergoing breast cancer surgery will be randomly chosen to have either the nerve block or no
block before surgery. We will then follow them for 3 months to see whether women who receive the nerve block are
less likely to develop long-term pain, and more likely to go back to a good quality of life.
We hope that our study will help women survive longer, and also better, after a diagnosis of breast cancer.
The INFerence from Observational Reseach Methods (INFORM) Study
Supervisor Name: David R. Urbach
Hospital/Research Institution: Toronto General Research Institute Division of Support, Systems and
Outcomes
Email: david.urbach@uhn.ca
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As part of a larger project with the overarching aim of developing methods to properly interpret non-randomized
studies of clinical interventions, we are seeking students to undertake components of the research, including:
conducting systematic reviews, developing analytic procedures to measure bias in non-randomized studies, co-
develop an interactive tool to “adjust” study findings to account for bias, and write a monograph/short book on the
problem of bias in health research, how it impacts our understanding of research findings, and how it can be
addressed. Students will take “ownership” over their parts of the research program, and will work collaboratively with
the larger research team. Research activities will be carried out in the Division of Support, Systems and Outcomes at
the Toronto General Hospital Research Institute. Students are provided excellent resources, including modern
workstations in a collaborative and interactive research environment, weekly lab meetings, weekly health services
research rounds at the Research Institute, and close supervision by their supervisor and the research team.
Clinical predictors of outcomes in patients with granulomatosis with polyangiitis with

nodular lung involvemnet
Supervisor Name: Christian Pagnoux
Hospital/Research Institution: Mount Sinai Hospital
Email: cpagnoux@mtsinai.on.ca

GPA (Wegener’s) is a rare systemic necrotizing granulomatous vasculitis, associated with anti-neutrophil cytoplasm
antibodies (ANCA). Disease onset can occur at any age, most commonly about 40 to 50 years. The main target
organs or systems are the upper respiratory tract (erosive rhinitis and sinusitis, saddle-nose deformity), lungs
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(nodules, alveolar hemorrhage) and/or kidney. Biopsy of an affected organ can support the diagnosis, as can
detection in serum of cANCA by immunofluorescence and proteinase 3 (PR3) specificity. Current therapy, based on a
staged induction–maintenance strategy, can achieve remission in most patients, but relapses are very common,
occurring in up to 50% of the patients at 5 years post-diagnosis. Already identified predictors of relapse include PR3-
ANCA, lung disease and ENT manifestations.
Lungs are involved in 70–100% of patients, with clinical manifestations ranging from mild cough, dyspnea to acute
and massive alveolar hemorrhage. Lung nodules are among the most characteristic signs, detected in 40% to 66% of
patients; nodules are unilateral or bilateral, single or multiple, measuring 0.5 to 10 cm in diameter, and excavated in
half of cases. Whether the presence of excavated nodules, which can be frightening to inexperienced physicians,
have poorer prognostic values or not, compared to only plain nodules, in term of treatment response or relapse risk
is unknown. The aim of this study is to analyze and compare the characteristics, treatment and outcomes of a cohort
of patients with GPA and lung nodules, excavated or not, at the time of disease flares. Study patients will be those
followed in the Toronto and Hamilton vasculitis clinics (around 250). Their data will be entered into a recently and
already developed and functional database, in order to facilitate this analysis for this study and, perhaps, lead to
other similar studies.
CLEAN Meds: Carefully seLected and Easily Accessible at No charge Medications
Supervisor Name: Nav Persaud
Hospital/Research Institution: St. Michael’s Hospital / Keenan Research Centre of the Li Ka Shing
Knowledge Institute
Email: nav.persaud@utoronto.ca
Background
Access to appropriate medications is an important determinant of health. Barriers to Canadians accessing
appropriate life-saving or enhancing medications include costs, inappropriate prescribing, lack of healthcare
integration and inability to physically obtain medications. Lists of carefully selected medications in the United
Kingdom, managed care settings in the United States, and in Sweden have reduced healthcare expenditures and
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harmonized prescribing behaviors. Providing free medications by mail is expected to increase medication adherence
based on clinical trials and observational studies in other countries.
Study Objectives
We are determining the effects of providing carefully selected essential medications at no charge via a centralized
dispensing program on health outcomes and costs. This will be accomplished by fulfilling three objectives:
1. Develop a Canadian list of essential primary care medications

2. Use current Canadian prescribing data to estimate effects on patient care and societal health care
expenditure of substituting currently prescribed medications with essential medications.
3. Determine the acceptability and effects of an integrated pharmacist-prescriber model of no charge essential
medication dispensing.
Student Role
Students may have the opportunity to design and perform literature reviews, perform prescribing data analyses,
develop and present poster/seminar presentations, interview study participants and/or contribute to protocol, report
and manuscript writing.
Predictors of success and outcomes for men in chronic, non-obstructive urinary

retention treated with sacral neuromodulation
Supervisor Name: Girish Kulkarni / Dean Elterman
Hospital/Research Institution: PMCC / UHN
Email: dean.elterman@uhn.ca

As men age, their prostate glands grow which may lead to blockage of urinary flow. Over time, the muscle of the
bladder may become stretched out from squeezing against the blockage and eventually lose its ability to squeeze
out urine. A surgery may be performed to open up the channel of the prostate through which urine flows, however,
many men will remain unable to void (retention) despite this procedure, as the bladder muscle is too weak. These
men will have to insert a tube (catheter) several times a day to empty their bladder. There is a technology, called
sacral neuromodulation, which acts like a bladder pacemaker. Just like a heart pacemaker, but implanted under the
skin of the lower back, it has a battery and wire that send a gentle electrical signal to the nerves controlling the
bladder, which corrects certain abnormal conditions. It is approved to treat overactive bladder, urinary leakage, and
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retention. However, no previous research has looked exclusively at men with retention using a catheter, as most
studies had >90% female participants. As only one of two physicians in Ontario performing this procedure, my
research will study predictors of success and outcomes for men in chronic urinary retention treated with sacral
neuromodulation. The goal of my study will be to show that the bladder pacemaker can lead this group of men to
urinate spontaneously and not require the use of a catheter any longer.
Taxonomy of adverse events in critical care transport: Definitions derivation and

taxonomy
Supervisor Name: Russell MacDonald
Hospital/Research Institution: Sunnybrook Health Sciences Centre / Ornge Transport Medicine
Email: rmacdonald@ornge.ca
The Institute of Medicine recommends development of taxonomy to standardize error reporting and analysis.
Despite the recommendation, many health care settings have not adopted a taxonomy or common terminology. This
prevents meaningful generation of new knowledge and improvement in patient safety.
Ornge is Ontario’s air and land critical care transport program. It has developed a taxonomy to collect, categorize
and analyze adverse events and near-misses in the air and land critical care transport setting. Two items remain: a)
derive and standardize terms and definitions for terms used in the taxonomy and b) utilize the taxonomy and its
definitions to categorize events reported to coordinator and investigations officer, all under the direct supervision of
the program’s Medical Director.
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This project is well suited to students interested in a future career path in medicine that includes quality care
processes, safety, and/or aviation. While experience is not mandatory, the ideal candidate will have some experience
in literature searches and chart review, have solid communication and computer skills, and can function well in an
interdisciplinary work setting. This summer project can be funded from an existing external grant, and would not be
dependent on the student obtaining funding from the CREMS program or other sources.
Anesthesia Practices for Laser Therapy in a Pediatric Population
Supervisor Name: Joel Fish
Hospital/Research Institution: Hospital for Sick Children
Email: joel.fish@sickkids.ca
Laser therapy is the newest form of scar modulation available for burn injured patients. At present, the Hospital for
Sick Children (SickKids) is fortunate to be the only pediatric center offering this method of scar treatment in Canada.
Since its introduction in January 2014, we have treated over 100 patients with pulsed dye and/or CO2 laser therapy.
In order to provide laser therapy, children require sedation so that the procedure can be carried out safely. Thus, we
would like to conduct a retrospective review of our current anesthesia approach for this procedure. We are
particularly interested in examining specific factors such as the type of anesthetic used, dosage, complications, etc.
The results of this study are necessary in order to help us optimize treatments and learn more about our ongoing
anesthesia practices. At present, there is no published data regarding anesthesia and laser therapy in the literature.
Thus, the student who undertakes this study will contribute to a novel area. A student who is detail-oriented and
highly independent would be an ideal candidate to complete this project.
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- NOTE: Please list the Research Coordinator for the Burn Program at SickKids as the contact person for this
project. Her information is as follows: Jennifer Zuccaro, Email: jennifer.zuccaro@sickkids.ca, Phone: 416-813-
7654 x203018
microRNA as novel biomarkers to guide adjuvant prostate radiotherapy decision-

making
Supervisor Name: Stanley Liu
Hospital/Research Institution: Sunnybrook Research Institute
Email: stanley.liu@sunnybrook.ca
Despite many studies, a clinically important need remains in the post-radical prostatectomy setting: development of
biomarkers reflective of a patient’s unique genomic status, that will allow for improved triaging based upon their risk
of developing local versus distant recurrence. Despite possessing similar clinicopathological features, some patients
are at high risk of developing local and/or distant recurrence and dying of their cancer, whereas many others will
have clinically insignificant disease and will not benefit from adjuvant radiotherapy. Determining which patients are
unlikely to derive a therapeutic benefit from RT will prevent overtreatment, removing the burden of unnecessary
therapy and side-effects from patients and healthcare systems. Conversely, the ability to accurately identify which
patients harbor residual aggressive disease requiring more intensive therapy (i.e., dose intensification or early
integration of systemic therapies) could improve patient outcomes.
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Recent studies indicate that circulating microRNAs are useful as non-invasive biomarkers for different cancers,
including PCa. miRNAs are secreted from cancer cells into body fluids such as blood and urine within exosomes.
Exosomes are small cell-derived extracellular vesicles actively shed by tumor cells, and contain tumor miRNAs which
can exert biological effects in a paracrine manner on normal and cancer cells. Recently, exosomal miRNAs have been
attracting major interest as potential diagnostic, prognostic, or even therapeutic biomarkers in urologic
malignancies.
We believe that exosomal-derived miRNA expression profiling will help to: 1) prognosticate long-term prostate
cancer behavior, and 2) predict which therapy could provide the best chance of disease control with acceptable
toxicity. This project will involve isolation of exosome-derived microRNA from radical prostatectomy patients, and
real-time PCR quantification of a panel of microRNA known to have prognostic significance.
Improving survivorship for testicular cancer patients at Princess Margaret Cancer

Centre
Supervisor Name: Robert Hamilton
Hospital/Research Institution: Princess Margaret Cancer Centre
Email: rob.hamilton@uhn.ca

Testicular cancer predominantly affects young men age 15-35. Fortunately, the cure rate is very high. Many present
with Stage I disease and the only treatment they require is removal of the affected testicle (orchiectomy) followed by
close monitoring. However, a significant proportion present with more advanced disease and require further surgery
or chemotherapy in addition to an orchiectomy. The treatments, even if only orchiectomy, can affect sexual,
reproductive, physical and emotional health. At Princess Margaret Cancer Centre, we have a multidisciplinary
testicular cancer clinic and we see the largest volume of testis cancer in Canada. Our current research interests
include improving quality of life for survivors of testicular cancer.
There are a number of research opportunities a prospective student could choose in our active research group and
the summer experience could be molded to suit their wishes. Three projects to consider include:
1) Quantifying prevalence and severity of hypogonadism among men after orchiectomy.

 Androgen and gonadotropin levels have been collected prospectively in our clinic since 2005 but have yet
been analyzed.
2) Creating an application (e.g. iPAD) that serves as a decision aid for men recommended to undergo
retroperitoneal lymphadenectomy (RPLND) for metastatic testis cancer.
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 There is a need to better explain the nature of the surgery and potential complications in a dynamic way
that can minimize decisional regret as a survivor.
3) Surveying men about uptake of testicular prosthesis insertion at the time of orchiectomy to explore barriers
and needs.
 The aim would be to learn more about the patient and physician factors determining choice of prosthesis
to address barriers.
Students will be fully integrated within the urologic oncology group at Princess Margaret and will be invited to
attend our research rounds, our multidisciplinary tumour rounds, urology rounds, renal tumour board rounds and
our testicular cancer research group rounds.
Knee Osteoarthritis Quality Improvement Project
Supervisor Name: Noah Ivers
Hospital/Research Institution: Women’s College Hospital
Email: noah.ivers@wchospital.ca

Osteoarthritis (OA) is one of the most common chronic diseases in Canada; affecting 10% of the total population (3%
more women than men). With such a large disease burden, it is important that physicians caring for these individuals
are aware of, and utilizing all available management strategies. This pilot study will audit a group of patients with a
confirmed diagnosis of knee OA and determine their individual quality of care. The gaps in care will be identified and
presented to their physicians along with evidence-based recommendations to improve management. We will assess
the impact of this audit and intervention using validated OA outcomes.
Although the avenues of OA management are well known, evidence-based solutions are not always put into practice.
By providing information to physicians about sub-optimal patient care linked to evidence-based solutions, this
project hopes to close some of the OA care gaps. In using validated questionnaires as outcome measures, as well as
patient and physician feedback, we can assess the necessity and effectiveness of this audit and feedback
intervention. By connecting patients with services of which they are in need, we will see improvement, not only in the
satisfaction with their OA care, but also in disease measures. We will pilot collecting patient-reported outcome
measures using Tablets in the waiting room. Information patients provide will be directly linked to fields in their
electronic medical record.
The medical student will participate in analyzing and summarizing the project data, develop the feedback reports to
family physicians, and assist with manuscript development and PowerPoint slide decks. They will also have the
opportunity to work with clinical team members, (e.g., rheumatologist, family physician, and allied care providers)
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involved in providing care to patients with OA to better understand the patient perspective on how health services
for patients with this condition can be improved.
Relationship between neurochemical and functional MRI measures in Substance Use

Disorder
Supervisor Name: Doris Payer
Hospital/Research Institution: Centre for Addiction and Mental Health
Email: doris.payer@camh.ca
The summer project will be part of a rich MRI research program investigating brain function, structure, and
neurochemistry in clinical samples with substance use disorders (SUD), with a focus on opioid, cocaine, alcohol, or
nicotine dependence. MRI measures include: functional activation during craving, emotion, and cognitive tasks
(fMRI); resting-state activity to be analyzed for network-wide functional connectivity; regional cerebral blood flow;
biochemistry (GABA/glutamate concentrations and neurometabolites); and tissue microstructure. The aim of the
study is to characterize the relationship of biochemical alterations to functional abnormalities commonly observed in
SUD. Analyses will test for these relationships, compare measures to healthy control samples, and investigate
longitudinal changes with abstinence or treatment.
The project may also relate MRI measures to outcomes from the lab’s PET imaging program, such as dopamine
receptor availability in Rx opiate dependence.
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Feasibility of remote administration of the Fundamentals of Laparoscopic Surgery
(FLS) skills test using Google Glass
Supervisor Name: Allan Okrainec
Hospital/Research Institution: Temetry/Change Telesimulation Centre / Toronto Western Hospital
Email: allan.okrainec@uhn.ca
The most well-known curriculum for laparoscopic surgery training is the Fundamentals of Laparoscopic Surgery (FLS),
an educational program developed by the Society of American Gastrointestinal and Endoscopic Surgeons and
endorsed by the American College of Surgeons. The FLS program is an education and assessment package
consisting of an online cognitive module and a manual skills assessment. The skills component consists of the
following 5 tasks: peg transfer; precision cutting; placement of a ligating loop; and suturing using extracorporeal and
intracorporeal knot tying. The tasks are scored for efficiency and precision, and each task has a predetermined cutoff
time.
Google Inc. has introduced Glass, a wearable computer containing a heads-up display, a speaker, a camera, a battery
and a flash drive mounted on a titanium eyeglass frame. The display allows users to pull up information as they
would on any other computer with a simple voice command. It has a camera that offers a point-of-view image and
the ability to take both photos and videos while the device is worn. Although there are reports of the potential utility
of Glass for medical doctors in the printed and online press, very little has been published in the peer-reviewed
medical literature. To our knowledge, Google Glass has not been used in the training or evaluation of FLS yet. Thus,
the purpose of this study is to assess the feasibility of evaluating the FLS skills component using Google Glass.
This study will use FLS scoring data and participant feedback to assess the administration of the FLS examination
with remote proctoring. The student will be involved with data collection, management and analysis. The student will
also have an opportunity to learn FLS skills and to test Google glass.
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The risk factors associated with foot deformity in diabetic foot ulcer patients referred to
wound care clinic at Women’s College Hospital
Supervisor Name: Afsaneh Alavi
Email: afsaneh.alavi@utoronto.ca
The relationship between foot deformity, and ulceration has been explored previously. For example, studies have
shown that foot morphology affects peak plantar pressure1 and subsequent plantar pressure is related to
ulceration.2–4 Another study found, retrospectively, that everted calcanei were associated with medial metatarsal
head ulcers, while inverted calcanei were associated with lateral metatarsal head ulcers.5 Foot deformities such as
hammer/claw toe deformity or hallux limitus have been significantly associated with ulcer incidence in a univariate
analysis.6
Thus, previous research indicates that foot morphology (foot type) and foot deformity can affect foot ulcer
occurrence and foot ulcer location directly by ulcer development5,6 or indirectly by increased plantar pressure.2–4
This study further explores the relationship between foot type or foot deformity and ulcer as prospective study. This
study will further help us understand how foot shape is associated with the development of foot ulcers.
No formal studies have been conducted to determine the prevalence of foot deformity as a risk factor in diabetic
foot ulcer patients in the Canadian population. The aim of this study is to determine such prevalence in this
population. We also aim to determine the risk factors and the comorbidity associated with diabetic foot ulcers
including neuropathic versus neuroischemic foot ulcers.
Objectives:
The primary objective of this study is:
• To determine the prevalence of foot deformity as risk factor in diabetic foot ulcer patients.
Secondary objectives in this study include:
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• To determine the risk factors associated with diabetic foot ulcers.
• To determine the characteristics of diabetic neuropathic versus diabetic neuroischemic foot ulcers.
A Study to Identify the Prevalence of, Risk Factors for, and Effect of Alternative Anti-
microbial Administration in Patients who Carry Ciprofloxacin Resistant Enteric
Organisms in a Population of Patients Undergoing Transrectal (TRUS) Biopsy of
Prostate
Supervisor Name: Frank Papanikolaou
Hospital/Research Institution: Trillium Health Partners / The Credit Valley Hospital

Email: frank.papanikolaou@trilliumhealthpartners.ca

Background
Ciprofloxacin is an antibiotic drug of the fluoroquinolone (FQ) class. It has been shown to be effective against organisms causing urinary tract
infections (UTIs) and as a result is often used in prophylactic treatment in procedures such as TRUS guided prostate biopsies. Recent studies
have shown an increase in the number of infective complications after TRUS despite ciprofloxacin prophylaxis. Researchers have traced this rise
in infections to an increase in the bacterial resistance of FQs including ciprofloxacin. This study will determine the prevalence of ciprofloxacin
resistant enteric organisms in patients undergoing TRUS and to determine risk factors for carriage of the resistant bacteria. Matching the
presence of the resistant bacteria with certain risk factors will help to predict which patients are likely to have the resistant bacteria. This will
allow tailored antibiotic prophylaxis, thus reducing the patient’s chance of becoming infected. Based on our knowledge, there have not been
any previous studies which have prospectively tried to view a wide array of potential risk factors for carriage of the resistant bacteria, in
addition to finding the prevalence of the resistant bacteria in this population.
Study Design and Methodology
The urologist will perform a Digital Rectal Examination (DRE) and PSA blood test, and will determine if the patient needs a TRUS biopsy. The
patients will be informed about the study and be given the consent form along with a brochure regarding the study. At the Urology Research
Clinic appointment, the study nurse will obtain the consent form from the patient, and collect a rectal swab sample if the patient agrees to
participate in the study. The patient will also fill out a questionnaire regarding risk factors which may be associated with Cipro resistant
bacteria. All information contained in the questionnaire will be kept confidential, via a generated participant ID, and will only be viewed by the
study team for research purposes only. The nurse will submit the swab sample to the CVH Microbiology laboratory, where it will be incubated
using a selective medium in order to identify the presence of ciprofloxacin resistant enteric organisms. The results of the swab will be disclosed
to the study team for research purposes and be recorded in the patient’s chart, so that the urologist may determine the appropriate treatment
for the patient. If the patient is found to be carrying a ciprofloxacin resistant organism, their attending urologist will determine appropriate
treatment prior to the biopsy. Patients without the ciprofloxacin resistant organisms will be given the standard prophylaxis of oral
ciprofloxacin, whereas the patients with the ciprofloxacin resistant organisms will be given a more tailored prophylactic regimen. Both groups
(patients with the resistant bacteria and patients without the resistant bacteria) will then undergo the TRUS guided biopsy under the standard
protocol. Six weeks after the biopsy all patients will be contacted to determine if they suffered any complications post biopsy.
Summary
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The study is underway at CVH and we are confident that it has the potential to change the standard of care and provide a process by which
physicians can decrease the frequency of infective complications after prostate biopsies, preventing sepsis, urinary tract infections, and
potential death.
The risk factors associated with chronic venous ulcers in Canadian Population
Supervisor Name: Afsaneh Alavi
Email: afsaneh.alavi@utoronto.ca
Venous ulcers are a common medical condition that affect up to 2% of the population in developed countries and
may
lead to devastating consequences. These ulcers typically take a long time to heal and can cause a deterioration in a
patient's quality of life. It has been estimated that the complications of venous ulcers may cost taxpayers about 1%
of a
developed nation's annual healthcare budget. Previous studies have characterized the risk factors for the
development of venous ulcers in different parts of the world. Different treatments have also been proposed for the
management of this difficult condition, with varying degrees of success. The aim of this retrospective cohort is to
examine the characteristics of a population of Canadian patients with venous ulcers and determine the risk factors
associated with chronic venous leg ulcers. We also compare the
population who received surgery in compare to patients who were managed non operatively in terms of duration of
ulcers .
The objective of this project is to determine the risk factors associated with the development of venous ulcers in our
Canadian patient population and compare the outcomes between patients who have received a surgical intervention
with those who were managed non-operatively. We hypothesize those patients who receive surgery for the
management
of venous ulcers have a better outcome than those who are managed non-operatively. A retrospective chart review
will be carried out of the included patient population. The patient charts will be mined for the data points .After the
completion of data collection, descriptive statistics will be generated using the statistical software package, SAS 9.3.
The baseline patient characteristics will be calculated and a logistic regression model will be developed to identify
the factors associated with adequate ulcer healing and assess whether surgery is a significant predictor of wound
healing.
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Are lower doses of cyproterone acetate effective in the hormonal treatment of
transgender females
Supervisor Name: Raymond Fung
Hospital/Research Institution: Toronto East General Hospital
Email: rfung@tegh.on.ca
Introduction
Though up to 0.5% of the population identifies as transgendered,1 there are very limited data examining the dosing of hormone therapy
regimens for transition from male to female. In the hormonal treatment of transgender females, an anti-androgen agent is used in
combination with estrogen to block the effects of testosterone, enabling feminization to occur. Cyproterone acetate is one of two anti-
androgen agents commonly used, the other being spironolactone. The recommended dose range of cyproterone acetate is 50-100mg daily,
according to the Endocrine Society Practice guidelines published in 2009.2 The European Network for the Investigation of Gender
Incongruence have published short term data using a standardized protocol of estradiol 4mg in combination with cyproterone at a dose of
50mg per day.3 However, doses of cyproterone lower than 50 mg per day have not been studied in this population.
Rationale
It is well known that estrogen increases thrombotic risk.4–6 Whether cyproterone acetate confers additional thrombotic risk when used in
combination with estrogen is unknown. However, looking at the oral hormonal contraceptive literature, the oral combined contraceptive
containing ethinyl estradiol and cyproterone acetate has been associated with an increased risk of thrombosis compared with other second
generation oral contraceptives with similar doses of ethinyl estradiol, suggesting that cyproterone may confer additional risk.4 Therefore, it is
important to examine whether a lower dose of cyproterone acetate is effective in the treatment of transgender females, to minimize any
possible increased thrombotic risk. Furthermore, other known risks of cyproterone, such as depression, hepatotoxicity, and fatigue may also be
minimized by using a lower dose. Dose-dependent hepatotoxicity has been reported; fatal case reports of hepatic failure with doses >100mg
per day.7
Objectives:
To determine whether a dose of less than 50 mg of cyproterone acetate daily is enough to suppress levels of testosterone into the physiologic
female range in combination with standard recommended doses of estrogen in patients who are transitioning from male to female.
An institutional ethnography of chronic pain management in family medicine (COPE)
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Supervisor Name: Fiona Webster
Hospital/Research Institution: Department of Family and Community Medicine
Email: fiona.webster@utoronto.ca
Providing cost effective care for the increasing numbers of complex patients is a global problem facing industrialized
and non-industrialized nations. With an aging population and individuals living longer lives, healthcare costs
continue to rise at rates faster than other parts of the economy. Exacerbating these challenges is the growing
numbers of individuals with chronic disease and multi-morbidities, a proportion of who became complex patients.
Arthritis, specifically osteoarthritis (OA), is one of the most common, disabling, and costly chronic diseases. Arthritis
is the most frequent cause of chronic pain, which is debilitating to the individual and extremely costly to society.
Primary care is most often the first contact for people seeking symptom relief. This CIHR-funded study will employ
the approach of institutional ethnography (IE) to investigate how primary care physicians define, encounter and
manage these complex patients. Our overarching research question will be “How do primary care physicians describe
the work they do in caring for patients with complex chronic conditions?” This question will become the starting
point, rather than the end point, to allow our team to explicate how care is put together at the level of the institution
with attention to those at the local practice. Using an expanded definition of work will allow us to understand the
many types of work that physicians do (e.g., making phone calls, filling out forms, email) and also alerts us to how
the discourses and concerns of institutions enters into the everyday language of care providers. The CREMS summer
student will have an opportunity to be involved in qualitative data collection and analysis for this project, working
with a multi-disciplinary team.
Breastfeeding and Maternal Substance Use: Women’s experience of Infant Feeding

Choices
Supervisor Name: Lisa Graves / Maya Nader / Suzanne Turner

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Email: gravesl@smh.ca / naderm@smh.ca / turners@smh.ca
This qualitative research project will explore women’s experience with breastfeeding and other infant feeding
choices. There exists a significant body of literature on how women make the decision to breast feed. What is more
poorly understood is the decision making process among socially vulnerable women. Recent data from Ontario
suggests this population is less likely to initiate and continue breastfeeding. Through brief semi-structured
interviews, we will gather data on how women with substance use feed their babies and why they choose one
method over the other. We hope to find out what information was given to these women about breastfeeding or
other feeding choices and which of that information was helpful for decision-making. We will explore both personal
and system factors that impact these choices using a woman centered lens. The collected data will later be used to
design appropriate patient and provider education about breastfeeding, infant feeding and substance use.
How does ethnicity affect the effectiveness of Ulipristal Acetate for the treatment of
uterine fibroids?
Supervisor Name: Ally Murji
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Email: amurji@mtsinai.on.ca
Fibroids are a common benign condition that can be found in over 70% of women. About half of these women
will be symptomatic from their fibroids. In June 2013, Health Canada approved a new selective progesterone
receptor modulator, ulipristal acetate (UA), for the treatment of symptoms from uterine fibroids. Health
Canada’s decision was made based on two phase III randomized controlled trials published in the New England
Journal of Medicine. The patient population in these trials consisted mainly of European descent. Due to this
significant limitation, other regulatory authorities such as the US FDA has not been so quick to approve this
drug until more ethnic-specific data is available. This data will not be available for yet another few years.
Objective: To determine how ethnicity affects the efficacy of UA in the treatment of uterine fibroids, with
respect to improvement in quality of life and change in fibroid size.
Methods: At Mount Sinai Hospital, we have started a prospective database of women who have been started
on UA. We have followed these women to assess treatment response. This is the largest Canadian database of
this kind. REB approval for this study has been obtained.
Using the F-scan to assess plantar pressure using the recumbent bike
Supervisor Name: Robyn Evans
Email: rmejones@rogers.com
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Neuropathy is the most important risk factor for the development of a diabetic foot ulcer. Ulcers occur in about 25%
of people with diabetes with most being on the plantar aspect of the foot on either the first or fifth metatarsal head.
Once these ulcers heal there is always a risk to re-ulcerate due to the ongoing challenges related to neuropathy and
pressure off-loading with foot-ware.
Patients with diabetes are encouraged to exercise in an effort to manage healthy weight and improve cardiovascular
function. There is no recommendation for what is a reasonable exercise that would allow for reduced plantar
pressure to the foot in these high-risk patients. The study is being undertaken to determine what the plantar
pressure is while using the recumbent bike. The F-scan is able to measure and record the pressure areas on the foot.
This study would evaluate the pressure areas on the plantar aspect of the foot in healthy subjects with no
neuropathy, then to extend this to patients with neuropathy if the results are encouraging. These results will be
compared to the pressure obtained on the plantar foot while walking which is the usual prescribed exercise.
Barriers to the Optimum Management of Diabetic Foot Ulcers
Supervisor Name: Carol Ott / Robyn Evans
Email: rmejones@rogers.com
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Optimum management of diabetic foot ulcers requires timely treatment at a multidisciplinary clinic. As a referral
center it is apparent that there are barriers to the delivery of optimum care to this high-risk population. Some of the
factors that will be assessed are; time to referral to a specialty clinic, availability of appropriate off-loading devices
and work accommodation to allow for modified activities.
The purpose of this study is to retrospectively review charts of patients with diabetes to assess what the barriers to
treatment are and how this can impact overall healing rates and complications. A survey will also be developed to
understand the patient perspective with regarding barriers to care.
This study will highlight the factors that are missing in the care of the diabetic patient with a foot ulcer and what can
be done to improve on the care of this high risk population.
Improving patient reported nausea and vomiting in cancer patients undergoing

moderately and highly emetogenic chemotherapy at Trillium Health Partners – A
quality improvement initiative
Supervisor Name: Katherine Enright
Hospital/Research Institution: Trillium Health Partners / Credit Valley Hospital
Email: katherine.enright@trilliumhealthpartners.ca
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Background
Chemotherapy induced nausea and vomiting (CINV) remains one of the most feared treatment related toxicities for patients undergoing
systemic therapy for cancer. CINV has been shown to both have a negative impact on patient experience and quality of life, as well as increase
the likelihood of dose delays, dose reductions and unplanned hospital visits. Advances in anti-emetic prophylaxis over the past decade have
resulted in significant improvements in CINV control, but despite this up to 70% of patients receiving moderately or highly emetogenic
chemotherapy still report some nausea and vomiting.
In 2013 Cancer Care Ontario released updated anti-emetic guidelines which included (among other recommendations), the incorporation of a
new class of anti-emetics (NK-1 antagonists) in most patients receiving moderate-highly emetogenic therapy. Due to funding restrictions,
these guidelines could not be implemented universally at time of initial publication. As of September 2014 funding of these new anti-emetic
agents is now available for most cancer patients, and can be universally be implemented.
As we work towards implementing the new anti-emetic guidelines at Trillium Health Partners we are undertaking a quality improvement
initiative to ensure that our treatment is meeting guideline recommendations and that this change is resulting in improved patient outcomes.
Through this work we aim decrease the percentage of patients who report grade 2 or higher nausea or vomiting with cycle number 1 of their
moderately-highly emetogenic chemotherapy to <10%.
Methods
Our primary outcome measure of interest will be percentage of patients undergoing moderate-highly emetogenic chemotherapy that report
grade 2 or higher nausea or vomiting with their first cycle of chemotherapy. We will also look at numerous process measures such as the
percentage of patients who are prescribed NK1 antagonists, the percentage of patients who received guideline recommended care, patient
reported compliance with prescribed anti-emetics. We will also examine the impact on unplanned hospital visits.
The updated anti-emetic guidelines will be implemented in a stepwise fashion (provider education, integration into the computerized order
entry system, surveillance and reporting). Using rapid cycle improvement methodology we will evaluate the impact of each stage and use this
to inform the next step of implementation.
Students will be exposed to data collection and analysis using standard statistics and statistical process control charts. They will collect
quantitative date (percentage of patients who develop CINV) and qualitative data (patient experience). They will also be involved in the quality
improvement process and gain exposure to Plan-Do-Study-Act cycles and other quality improvement tools such as Ishikawa diagrams, pareto
charts and process maps.
Improving hepatitis B screening rates in patients undergoing adjuvant or curative intent

cytotoxic chemotherapy at Trillium Health Partners – A quality improvement initiative
Supervisor Name: Katherine Enright
Hospital/Research Institution: Trillium Health Partners / Credit Valley Hospital
Email: katherine.enright@trilliumhealthpartners.ca
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Background
Chemotherapy induced hepatitis B viral reactivation is a serious and potentially preventable complication of cytotoxic chemotherapy
treatments. The clinical outcomes of hepatitis B reactivation can range from asymptomatic elevations in liver enzymes to hepatic failure and
even death. The risk of reactivation is dependent on both patient characteristics and the chemotherapy regimen in question. Reactivation has
been reported in up to 67% of patients with non-Hodgin’s lymphoma treated with rituximab containing regimens, and 21% of breast cancer
patients undergoing standard adjuvant treatment.
In patients with evidence of latent hepatitis B infection, prophylactic treatment with the antiviral lamivudine has been shown to decrease the
likelihood of biochemical reactivation. Cancer Care Ontario has recently released updated screening recommendations that recommends at
least hepatitis surface antigen testing prior to initiating cytotoxic chemotherapy in patients being treated with adjuvant or curative intent.
As we work towards implementing the new screening recommendations at Trillium Health Partners we are undertaking a quality improvement
initiative to ensure that our treatment is meeting guideline recommendations and that this change is resulting in improved patient outcomes.
Through this work we aim increase the number of patients who have been screened for a latent hepatitis B infection prior to starting on
adjuvant or curative intent cytotoxic chemotherapy for either solid tumours or lymphoma to 90%.
Methods
Our primary outcome measure of interest will be percentage of patients undergoing adjuvant or curative intent cytotoxic chemotherapy that
have a screening test in the medical record prior to the start date of chemotherapy. We will also look at additional measures including
percentage of patients with elevated liver enzymes and percentage of hepatitis reactivations. Balance measures such as increase use of
lamivudine, increase cost of screening and delays in treatment will also be tracked. Clinical, patient and provider factors associated with
screening will be evaluated to help target quality improvement interventions.
The first process improvement step (incorporation in pre-printed chemotherapy orders), will be initiated in March 2015. The student will
evaluate the impact of this plan-do-study-act cycle on screening rates. Based on the results of the first process improvement phase, the
student will be involved in developing and implementing further rapid cycle improvement cycles.
Students will be exposed to data collection and analysis using standard statistics and statistical process control charts. They will collect
quantitative date (percentage of patients who are screened) and qualitative data (patient experience). They will also involved in the quality
improvement process and gain exposure to Plan-Do-Study-Act cycles and other quality improvement tools such as Ishikawa diagrams, pareto
charts and process maps.
Pills or post-coital IUD? Factors associated with women’s choice of emergency

contraception
Supervisor Name: Sheila Dunn
Email: shelia.dunn@wchospital.ca
Emergency contraception reduces the risk of pregnancy after unprotected intercourse and is used by almost 4% of
women aged 20-24 each year. Emergency contraceptive pills (ECP) are by far the most commonly used method.
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However, insertion of a copper intrauterine device (IUD) is much more effective and provides reliable long term
contraception. We are conducting a study in a sexual health clinic to examine women’s knowledge and choice of
emergency contraception (either ECP or IUD), satisfaction with that choice and use of effective contraception 3
months after presentation.
The CREMS student project will help complete our study that is recruiting and following women who present for
emergency contraception at the Bay Center for Birth Control. The study determines women’s knowledge of the
methods, their choice of emergency contraception and their satisfaction and use of effective contraception 3 months
after their presentation. The student will assist in the final completion of that project and will undertake a sub-study,
done through chart review, of all women presenting for emergency contraception from July 2014-July 2015 to
examine EC choice and associated demographic and reproductive health variables.
The CREMS student will assist the research team with the following:
1. 3 month follow-up telephone surveys with women recruited into the follow-up study
2. chart reviews, data abstraction and input
3. assist with analysis and interpretation
4. assist with administrative requirements of the study
The student will provided office space and a computer at the Bay Centre for Birth Control and will be directly
supervised by Dr. Sheila Dunn, a family physician researcher and Scientist at the Women’s College Research Institute
(WCRI). There are opportunities to gain experience a clinical environment that delivers reproductive health care and
to participate in the WCRI Summer Research Student rounds and seminars.
Implementation and Evaluation of a Program for “Rapid Assessment of Febrile

Travelers” (RAFT) in Primary Care and Emergency Room Settings in Ontario
Supervisor Name: Andrea Boggild
Hospital/Research Institution: UHN / Toronto General Hospital
Email: andrea.boggild@utoronto.ca
Fever in the returned traveler is a common presentation to the emergency room (ER) and primary care, and may
herald serious and life-threatening illness, the most important of which is malaria. Thus, fever after travel warrants
prompt attention and is considered a medical emergency. Yet each year, several Canadians die of malaria due to
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delay in diagnosis and/or treatment, and many more become critically unwell. In most ERs, if a returned traveler with
fever does not need hospital admission, there is no mechanism in place for rapid follow-up assessment, and the
patient will simply wait for the next available outpatient infectious diseases appointment. Meanwhile, primary care
offices routinely send travelers with fever to the ER due to a lack of rapid, safe alternatives. We plan to scale-up a
simple health-system innovation that reduces barriers to safe and rapid care of ill returned travelers. Our "Rapid
Assessment of Febrile Travelers" (RAFT) clinic at UHN/Mount Sinai has improved delivery and efficiency of care, and
reduced emergency room bed usage at UHN/Mount Sinai. We plan to expand the RAFT program to community ERs
and primary care clinics in order to optimize the delivery of care to ill returned travelers in Ontario. The CREMS
student will work closely with our local RAFT team in the Tropical Disease Unit of TGH as well as our RAFT
collaborators at other downtown centres.
Keywords: Fever; malaria; patient-centered care; travel medicine; tropical medicine.
High Volume Foleys increasing Vaginal Birth Feasibility Trial
Supervisor Name: Anne Berndl
Hospital/Research Institution: Sunnybrook Health Sciences Centre, SRI
Email: anne.brerndl@sunnybrook.ca
The rising rate of caesarean sections is concerning to both women and physicians. One quarter of Ontario women in
their first pregnancy undergo an induction of labour, and one third of these women deliver by caesarean section.
Before inducing labour, a woman’s cervix often requires “ripening”, a process that makes it open and soft.
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Most Canadian obstetricians use prostaglandins for cervical ripening, and a minority use Foley catheters filled to 30-
60cc. Currently no method of cervical ripening has been found superior regarding risk of caesarean section.
However, a recent meta-analysis suggests Foley catheters filled to 80cc may be associated with a greater
chance of vaginal birth.
This proposed study aims to determine if it is feasible to successful insert a Foley catheter for cervical ripening
and inflate it to 80cc, and to assess the acceptability of this procedure to Ontario women and maternity care
providers. This information will inform the design of a larger clinical trial comparing cervical ripening with 80cc Foley
catheters to prostaglandins with rate of caesarean birth as the outcome. This is a first step towards clinical
practice changes that could have a significant impact on the caesarean section rate and the wellbeing of
women and babies.
Clinical Research in Adolescent Bipolar Disorder
Supervisor Name: Benjamin Goldstein
Hospital/Research Institution: Sunnybrook Health Sciences Centre, SRI
Email: benjamin.goldstein@sunnybrook.ca
The focus of this CREMS project is on adolescent bipolar disorder. The selected student will be integrated into the
overall activities of the laboratory, which includes pharmacology graduate students, undergraduate research
students, and research staff. The student will gain exposure to current methods being applied in the laboratory,
including neuroimaging (MRI), vascular imaging (ultrasound, peripheral arterial tonometry), computerized cognitive
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testing, serum biomarkers, genetics, and novel complementary therapeutics. Descriptions of current ongoing studies
can be found at the following website: http://sunnybrook.ca/content/?page=bsp-youth-bipolar-disorder-research
The selected student will have access to two archival datasets, one based on approximately 116 adolescents enrolled
in a research registry at Sunnybrook, the other based on approximately 400 adolescents and young adults
participating in a multi-site cohort study in the United States. Working together with the supervisor, the selected
student will identify a specific project based on one of the above datasets. The student will be expected to undertake
the necessary literature review and to generate one manuscript for submission to a peer-reviewed journal. Guidance
will be provided by the supervisor and other laboratory members regarding literature search and statistical methods.
Do pediatric clavicle fractures need to be managed by orthopaedic surgeons?
Supervisor Name: Mark Camp
Hospital/Research Institution: SickKids
Email: mark.camp@sickkids.ca
Clavicle fractures are one of the most common fractures sustained during childhood. In Ontario, children with
clavicle fractures are managed by orthopaedic surgeons who follow them until the fracture has healed. However, the
rate of requiring surgical intervention either at the time of injury or after healing occurs is anecdotally extremely low
which begs the question: do pediatric clavicle fractures need to be managed by orthopaedic surgeons or can they be
managed more cost-effectively by pediatricians and family doctors?
This project will include a retrospective chart review to determine the rate of surgical intervention in pediatric clavicle
fractures at the Hospital for Sick Children from 2005 to 2014. The results of this audit will provide the evidence for a
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clinical practice pathway for pediatric clavicle fractures in Ontario. This clinical practice pathway will be publically
available on the SickKids website (created as part of a separate research project). This project can be realistically
completed within the CREMS Summer Research Program. Funding is available to present this work at either the COA
meeting in Halifax in 2016 or the CAEP meeting in Quebec City in 2016. Presentation at other meetings will also be
considered.
Eliminating Digestive Irregularities caused By Late Effects (EDIBLE) of

abdominopelvic radiation: A Pilot Study of a culinary and nutrition intervention
Supervisor Name: Jennifer Jones / Sarah Ferguson
Hospital/Research Institution: Princess Margaret Cancer Centre
Email: jennifer.jones@uhn.ca / sarah.ferguson@uhn.ca
Background: Patients diagnosed with gynecological (GYN) cancers are commonly treated with radiation therapy to
the pelvic area. Exposing the pelvic area to radiation therapy can result in long-term gastrointestinal (GI) side effects.
Providing self-management support to GYN patients who suffer from GI symptoms after radiation therapy may be
an effective strategy to help them improve their QoL. The dietary management of GI symptoms resulting from
radiation therapy includes increasing soluble fibre and limiting insoluble fibre, fat and lactose. We are proposing to
conduct a pilot study to evaluate a newly developed nutrition and culinary education intervention for GYN cancer
patients (EDIBLE). The research objectives are to: 1) assess the feasibility and acceptability of the methods and the
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intervention; and 2) a preliminary estimate on the efficacy of the intervention on bowel symptoms (primary clinical
outcome); QoL, knowledge and food intake (secondary outcomes).
The summer CREMS student will assist with the pilot of EDIBLE and work closely with Drs. Jones and Ferguson and
the research and clinical team at ELLICSR (http://ellicsr.ca/) and will also take part in the ELLICSR Summer Student
Program which includes a series of seminars and presentations to introduce students to cancer survivorship and
research.
Incidence of Intracranial Hemorrhage in Pediatric Oncology Patients
Supervisor Name: Lani Lieberman
Hospital/Research Institution: Toronto General
Email: lani.lieberman@uhn.ca
Introduction
Intracranial hemorrhage (ICH) is a rare, serious bleeding complication seen in thrombocytopenic oncology patients. It is unclear why some
patients with severe thrombocytopenia develop ICH and others do not.
Objectives
1. To identify the characteristics, incidence, and risk factors for ICH development in pediatric oncology patients.
2. To assess major morbidity and mortality 30 days following the event.
Methods
This retrospective case control study (nested within a cohort) will be performed at the Hospital for Sick Children. Cases have been identified
through the Pediatric Oncology Group of Ontario Networked Information System (POGONIS). Oncology patients ≤ 19 years old, treated
between 1995-2013 and diagnosed with an ICH will be eligible. Controls will be similar to cases, except for ICH, and a maximum of 5 will be
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selected randomly from the same institution and the same diagnosis year. The original charts will be reviewed to augment information
contained within POGONIS. Variables of interest include patient demographics, laboratory results, radiological reports and patient outcome
data. ICH will be based on radiographic diagnosis.
Analysis
The incidence of ICH and the types of patients affected will be determined utilizing the entire population of pediatric oncology patients.
Characteristics of the different bleeds will be presented (clinically or radiologically overt). To assess risk factors, a multivariable logistic
regression model will be constructed where the outcome is case or control status and the variables of interest will be examined. Odds ratios
and confidence intervals will be determined.
Conclusion
Results of this study will provide an estimate of the incidence of ICH in pediatric oncology patients and attempt to link this event to risk factors
including hematologic lab values. This foundational information is required to generate hypotheses to be tested in larger, international
collaborative studies. Currently, transfusion thresholds drive ordering practice to prevent ICH. Future studies will investigate the value of using
other risk factors or a bleeding scale prior to ordering a platelet transfusion.
Thoracic CT using Low Dose Dual Energy Temporal Subtraction : A Feasibility Study
in Patients with Chronic Thromboembolic Pulmonary Hypertension
Supervisor Name: Narinder Paul
Hospital/Research Institution: University Health Network
Email: narinder.paul@uhn.ca
Acute pulmonary embolism (PE) is a life threatening condition in which a blood clot lodges in the pulmonary arteries
(PA). 1% of acute PE becomes chronic PE resulting in pulmonary artery hypertension (PAH) and eventually Chronic
Thromboembolic Pulmonary Hypertension (CTEPH). CTEPH is a significant cause of death for Canadian patients due
to right heart failure. Surgical clot removal, pulmonary thromboendarterectomy (PTA) is the only cure but has a
perioperative mortality of ~5%. The key to reduce perioperative mortality and to improve functional status is to
stratify patients at higher risk by accurately measuring the severity of PAH and pulmonary vascular resistance (PVR)
pre and post PTA. Therefore, CTEPH patients undergo multiple investigations including: 2d echocardiography, to
assess right heart pressure and function; CT pulmonary angiography (CTPA) to document severity and distribution of
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PA clot; VQ scans, to confirm severity and pattern of lung perfusion deficits; invasive cardiac/pulmonary
catheterization, to establish right heart and pulmonary pressures; and exercise tests to establish functional status.
Our team has developed a technique called low dose temporal subtraction (LD-TS) by performing low dose
computed tomography (LDCT) at the time of CTPA. The LDCT demonstrates areas of lung heterogeneity; these
correspond to the severity of PVR. The LD-TS demonstrates pulmonary blood distribution; this information can be
compared to the data from the V/Q scan and from pulmonary artery catheterization.
The purpose of this study is to test the utility of LD-TS in an established cohort of CTEPH patients in order to
evaluate whether LD-TS provides information that is useful in patient management. In particular, we will determine
whether LD-TS could replace other tests that are currently performed in CTEPH patients. If successful, LD-TS would
provide a cost effective, non-invasive, comprehensive and time efficient evaluation of CTEPH patients pre and post
PTA.
Correlation of cortical perfusion and cognitive dysfunction between Multiple Sclerosis

subtypes using a novel quantitative perfusion sequence
Supervisor Name: Richard Aviv
Hospital/Research Institution: Sunnybrook
Email: richardaviv@sunnybrook.ca
Exciting research opportunity with opportunity to lead author a manuscript if appropriately skilled. The project utilizes novel
imaging and plasma biomarkers to explore the link between cortical quantitative blood volume (CqCBV) reduction, cortical
lesion load, perivascular inflammation and cognitive impairment. Prior CqCBV localization to anatomically appropriate regions,
high correlation with individual cognitive domains and improved prediction of cognitive impairment over established indicators
support the validity of the technique as a biomarker of cortical pathology and disease progression. Our prospective data should
add to this body of data. The anticipated basic role is to facilitate data processing and analysis in a prospective study of
cognitive impairment and Multiple Sclerosis using novel MRI perfusion imaging. Ideally candidate will have a computational
sciences or engineering background. Work will be supported by an experienced research team with multidisciplinary expertise
in Radiology, engineering and computational sciences. MATLAB ability is expected.
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Is neurovascular coupling impaired in patients with concussion?
Supervisor Name: David Mikulis
Hospital/Research Institution: Toronto Western Hospital
Email: mikulis@mac.com
Recent work in patients with concussion has indicated that significant blood flow abnormalities can occur during the
recovery phase of this condition. Previous studies examining resting blood flow usually indicate that it is decreased.
However it is unclear if the decrease is appropriate for the level of brain activity that may similarly be decreased. It
would be important to know if the usual coupling of blood flow to neural activity is impaired in these patients since
it is theorized that neurovascular uncoupling may be related to symptoms.
We have developed a method for assessing the mechanism that controls brain blood flow using a device that
provides precision control over arterial levels of CO2, a potent vasodilator. A unique advantage of this device is that
it can raise arterial levels of CO2 by 10 mmHg within 2 breaths. This then provides the ability to measure the dynamic
response of the blood flow control mechanism to a vasodilatory stimulus. Transfer function analysis can then be
applied to determine the transient response and magnitude of this response. These can then be compared to our
database of age matched controls for testing of the relationship between NVU if present and symptoms.
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The Relationship between health literacy and knowledge of prenatal screening options
for trisomy 21: a needs assessment
Supervisor Name: Amanda Selk
Email: aselk@mtsinai.on.ca

This study aims to assess knowledge among pregnant women undergoing prenatal screening for Trisomy
21(prenatal screening) at Mount Sinai Hospital. The study will also examine the relationship between knowledge of
screening options and health literacy among participants. There are multiple testing options for prenatal screening
and explaining them to patients can be time consuming and difficult. Prenatal screening is considered an optional
test. After a positive test patients can undergo confirmatory testing (chorionic villous sampling, amniocentesis) and
choose to either continue or terminate the pregnancy if the positive screening result is confirmed. Mount Sinai
Hospital has recently developed a structured counseling session open to all their pregnant patients to aid in the
complexities of counselling. It is unknown whether the patients are benefiting from this counseling session or are
even aware of its existence. Of the patients who are not utilizing this counseling option, the quantity and quality of
any counseling they are receiving is unknown. Previously published literature suggests that there is a large
knowledge gap among pregnant women on crucial information pertaining to prenatal screening. Knowledge
regarding screening in Canada has not been assessed in studies for >20 years and the screening options have
changed dramatically in that period of time. This study is a cross-sectional study that utilizes a demographics
questionnaire as well as previously validated measures of knowledge regarding prenatal screening and health
literacy. REB has already been attained for this study. This study started as a DOCH-2 project in 2014 and some
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patients have already been recruited. The job of the CREMS student would be to finish recruiting, data analysis and
writing up the results for publication in an obstetrical journal.
Examining Concomitant Extensor Mechanism Injuries in the setting of Knee

Dislocations and Multi-Ligament Injuries
Supervisor Name: Dawn Pearce
Email: pearced@smh.ca
ABSTRACT
Multi-ligament knee injuries and knee dislocations are devastating injuries. Little information is present at this time
regarding concomitant extensor mechanism injuries. These injuries may involve the quadriceps, patella, patellar
tendon, medial patellar retinaculum or medial patellofemoral ligament.
STUDY HYPOTHESIS
The purpose of this study is to determine the prevalence of extensor mechanism injuries in the setting of multi-
ligament knee injuries.
STUDY DESIGN
This is a retrospective study. Dr. Daniel Whelan’s patients who have a multi-ligamentous knee injury or knee
dislocation and whom have had a Knee MRI will be recruited for this retrospective study. For patients who have
multiple MRI’s, the MRI that is performed soonest after the injury will be used. A data sheet will be used to collect
data on all of those patients. The MRI images will be evaluated by Dr. Pearce and Dr.Whelan. The images will be
evaluated independently, and disagreements resolved by consensus. The summer student will transcribe and
organize our data sheets and sit with us during read outs.
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Novel Noninvasive Assessment of Kidney Transplant Fibrosis with Magnetic Resonance
Elastography
Supervisor Name: Anish Kirpalani
Email: kirpalania@smh.ca
OBJECTIVE:
The primary objective of this study is to measure organ stiffness through a non-invasive test called Magnetic resonance elastography (MRE).
INTRODUCTION:
Kidney transplantation has greatly improved the quality of life and survival of people living with kidney failure. Unfortunately, up to 60% of
these people go on to have failure of their transplant within 10 years, in many cases requiring drugs and/or return to dialysis. The cause for
transplant failure is almost always, at least in part, due to scarring of the transplanted kidney. There is currently no good test to detect this
scarring. The best test we have is a needle biopsy, which is associated not only with significant bleeding risks, but also an inability to take
sample and analyze the entire kidney.
A new type of MRI called “MR elastography” has been proven to accurately measure scarring in the liver, but not yet in the kidney. It does not
need any injections, can be done in 30 minutes, and may be able to measure scar throughout the entire kidney without needles. Our project
aims to compare this new MRI test with needle biopsy. We will determine if it can measure scar in the transplanted kidneys of people with
both normal and abnormal transplant function. This could drastically change how a doctor treats transplant failure.
STUDY DESIGN:
The study design is entirely prospective where patients with a history of renal transplantation (more than 1 year) will be eligible for this study.
25 patients with chronic renal allograft dysfunction and 25 control patients with normal renal allograft function will be selected.
PREDICTED OUTCOMES:
1) MRE-derived stiffness measurements will be higher in scarred, dysfunctional kidneys and lower in healthy, normal functioning kidneys.
2) MRE-derived stiffness values will correlate positively with biopsy-measured fibrosis scores, and inversely with renal function.
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3) Since fibrosis often pre-dates renal dysfunction, MRE-derived stiffness values will increase prior to increases in conventional biomarkers of
renal function.
Menstrual irregularities in the obese adolescent female that has undergone bariatric
surgery
Supervisor Name: Sari Kives
Hospital/Research Institution: The Hospital for Sick Kids
Email: zarine.tilak@sickkids.ca
Student will develop a proposal for the Research Ethics Board (REB) and a data collection sheet looking at menstrual
irregularities in the obese adolescent female that has undergone bariatric surgery
Page 41 of 45
Review the results of a large cohort of ovarian torsion in the adolescent population and
its implications for intervention towards ovarian conservation
Supervisor Name: Sari Kives
Hospital/Research Institution: The Hospital for Sick Kids
Email: zarine.tilak@sickkids.ca
Student will review the results of a large cohort of ovarian torsion patients in the adolescent population and prepare
a manuscript based on findings including management and care and its implications towards ovarian conservation
Page 42 of 45
Platelet transfusion threshold prior to lumbar puncture
Supervisor Name: Yulia Lin
Hospital/Research Institution: Sunnybrook Health Sciences Centre
Email: yulia.lin@sunnybrook.ca
The most recent 2014 AABB guidelines suggest that a prophylactic platelet transfusion should be administered for
patients having elective diagnostic lumbar puncture with a platelet count less than 50 x 109/L. This is a weak
recommendation based on very low-quality evidence. However, in practice, we have noted that lumbar punctures are
often performed at lower platelet counts without platelet transfusion. The objective of this project is to determine 1)
the frequency with which lumbar punctures are performed with a platelet count less than 50 x 109/L without platelet
transfusion; 2) whether any bleeding complications occur as a result; and 3) whether bleeding complications are
increased compared to lumbar punctures performed either with a platelet count of 50 x 109/L and above or after a
prophylactic platelet transfusion. The study design will be a retrospective audit of all lumbar punctures occurring on
the inpatient hemato-oncology ward and in the outpatient Odette Cancer Centre. The results of this audit may help
to inform whether changes to the AABB guidelines are warranted. The medical student will be working with a
hematology resident and transfusion medicine specialists on this project. By participating in this project, the medical
student will have the opportunity to present the results at hematology rounds, submit an abstract to a national or
international conference and have authorship in a publication.
Page 43 of 45
Platelet transfusion threshold prior to lumbar puncture
Name: Yulia Lin
Hospital/Research Institution: Sunnybrook Health Sciences Centre
Email: yulia.lin@sunnybrook.ca
The most recent 2014 AABB guidelines suggest that a prophylactic platelet transfusion should be administered for
patients having elective diagnostic lumbar puncture with a platelet count less than 50 x 109/L. This is a weak
recommendation based on very low-quality evidence. However, in practice, we have noted that lumbar punctures are
often performed at lower platelet counts without platelet transfusion. The objective of this project is to determine 1)
the frequency with which lumbar punctures are performed with a platelet count less than 50 x 109/L without platelet
transfusion; 2) whether any bleeding complications occur as a result; and 3) whether bleeding complications are
increased compared to lumbar punctures performed either with a platelet count of 50 x 109/L and above or after a
prophylactic platelet transfusion. The study design will be a retrospective audit of all lumbar punctures occurring on
the inpatient hemato-oncology ward and in the outpatient Odette Cancer Centre. The results of this audit may help
to inform whether changes to the AABB guidelines are warranted. The medical student will be working with a
hematology resident and transfusion medicine specialists on this project. By participating in this project, the medical
student will have the opportunity to present the results at hematology rounds, submit an abstract to a national or
international conference and have authorship in a publication.
Page 44 of 45
Page 45 of 45

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CREMS SUMMER RESEARCH PROGRAM

PLEASE READ CAREFULLY

The completed application form is due by 5 pm on Friday March 27, 2015.

The application form must be sent via email ONLY to crems.programs@utoronto.ca

Supervisor Name: Anne Bassett

Hospital/Research Institution: Centre for Addiction and Mental Health

Brief Project Description

Supervisor Name: Carol Westall

Hospital/Research Institution: The Hospital for Sick Children

Department: Ophthalmology and Vision Science

Brief Project Description:

Supervisor Name: Dr. Paul C. Boutros

Brief Project Description:

Supervisor Name: Nicole Look Hong / Anath Ravi

Brief Project Description

Endo-bronchial ultrasound guided trans-bronchial biopsy; the impact of limited

Supervisor Name: Abdollah Behzadi

Hospital/Research Institution: Credit Valley Hospital

Supervisor Name: Faraj Abdallah

Brief Project Description

The INFerence from Observational Reseach Methods (INFORM) Study

Supervisor Name: David R. Urbach

Brief Project Description

Clinical predictors of outcomes in patients with granulomatosis with polyangiitis with

Supervisor Name: Christian Pagnoux

Hospital/Research Institution: Mount Sinai Hospital

Brief Project Description

CLEAN Meds: Carefully seLected and Easily Accessible at No charge Medications

Supervisor Name: Nav Persaud

Brief Project Description

1. Develop a Canadian list of essential primary care medications

Predictors of success and outcomes for men in chronic, non-obstructive urinary

Supervisor Name: Girish Kulkarni / Dean Elterman

Hospital/Research Institution: PMCC / UHN

Brief Project Description

Taxonomy of adverse events in critical care transport: Definitions derivation and

Supervisor Name: Russell MacDonald

Hospital/Research Institution: Sunnybrook Health Sciences Centre / Ornge Transport Medicine

Brief Project Description

Anesthesia Practices for Laser Therapy in a Pediatric Population

Supervisor Name: Joel Fish

Hospital/Research Institution: Hospital for Sick Children

Brief Project Description

microRNA as novel biomarkers to guide adjuvant prostate radiotherapy decision-

Supervisor Name: Stanley Liu

Hospital/Research Institution: Sunnybrook Research Institute

Brief Project Description

Improving survivorship for testicular cancer patients at Princess Margaret Cancer

Supervisor Name: Robert Hamilton

Hospital/Research Institution: Princess Margaret Cancer Centre

Brief Project Description

1) Quantifying prevalence and severity of hypogonadism among men after orchiectomy.

Knee Osteoarthritis Quality Improvement Project

Supervisor Name: Noah Ivers

Hospital/Research Institution: Women’s College Hospital

Brief Project Description

Relationship between neurochemical and functional MRI measures in Substance Use

Supervisor Name: Doris Payer

Hospital/Research Institution: Centre for Addiction and Mental Health

Brief Project Description

Supervisor Name: Allan Okrainec

Hospital/Research Institution: Temetry/Change Telesimulation Centre / Toronto Western Hospital

Brief Project Description