The patient first

“The patient’s perspective is vital in the quest to improve care. Since my lung-liver transplant in 2012, I have remained very physically active. I believe that exercise and a healthy lifestyle have helped control my diabetes and keep me in shape. I am now participating as a patient partner in all the stages of a research program seeking to improve the physical health of patients following a kidney or liver transplant. We are recruiting participants. My role will be to act as a coach for patients in this adventure.”

Alexandre Grégoire, lung-liver transplant recipient and patient-partner

Exercise before and after a transplant

People with kidney and liver failure can now hope for a new lease on life through transplants, but their risk of cardiovascular mortality remains high. While physical exercise shows promise, the benefits have never been proven in this population. This is what Agnès Räkel’s team hopes to demonstrate, by working closely with Alexandre Grégoire, a CHUM patient who received a lung-liver transplant in October 2012.

Since the project was launched in January 2015, Alexandre Grégoire has become involved in various participant training and recruiting activities for this research. He has formed a small group of patients to help him recruit 100 transplant recipients over the coming year. He is taking part in all stages of the research protocol, from development of the initial assumptions to release of the findings.

Patient-oriented research

The patient is the central focus of our research activities. Over the past year, CRCHUM has drawn up a patient-oriented research development plan.

At the intersect of basic research and public health research, patient-oriented research is defined as biomedical research based on data gathered from human participants. It includes clinical trials to demonstrate the effectiveness and safety of a new drug or medical device, as well as evaluative research to prevent and treat diseases. The goal is to compare discoveries with existing treatments in an effort to determine which procedures are the most beneficial, so this new knowledge can then be transferred to the healthcare system and clinical practice.

“With the forthcoming opening of the new CHUM, care, research and teaching will be centralized in a single cutting-edge hospital complex. We must seize this opportunity to develop patient-oriented research at CHUM, to accelerate the transfer of knowledge generated by this unique synergy to patients. This is the key to ensuring innovative research integrated into clinical practice. Our ambition is to become one of the leading clinical research centres in Canada within the next 10 years. This is the goal of the action plan we have rolled out this year. Physicians, researchers and all healthcare professionals will work together more than ever to find innovative solutions for preventing diseases and promoting health.”

Dr. Paul Hébert, Associate Scientific Director – Clinical Research

Public investment

The Governments of Quebec and Canada are focusing on patient-oriented research by forging networks and funding projects that pool the expertise of the best researchers in their field in Quebec and Canada.

CHUM is taking part in initiatives emerging from Canada’s Strategy for Patient-Oriented Research (SPOR), a national coalition of partners dedicated to integrating research findings into care, to improve its quality and accessibility. CHUM and Université de Montréal are also piloting the real-world clinical studies component of the SPOR Québec support unit. Under the direction of Janusz Kaczorowski, CRCHUM researcher and head of the Assessment, Care System and Services segment, this support unit is developing procedures and methodological tools adapted to the issues of world-class clinical research.

Three innovative patient-oriented initiatives

CRCHUM is providing national leadership in intervention research, supported by grants from the Government of Canada.

“We have set up an addiction research network focused on generating knowledge that will transform substance abuse practices and treatment, primarily for illicit drugs and non-medical use of pharmaceutical drugs.”

Dr. Julie Bruneau, Researcher and Head, Department of General Medicine, CHUM

“By integrating research into clinical services, we give our patients the benefit of the latest treatments in the field. They have first access to new drugs and new approaches, and we provide them with quality psychosocial treatments.”

Dr. Didier Jutras-Aswad, Psychiatrist and Researcher at CRCHUM

Addiction

Since February 2015, Dr. Julie Bruneau, Physician and Researcher at CRCHUM, has been heading the Quebec/Maritimes component of the Canadian Research Initiative in Substance Misuse. This national research program is dedicated to the prevention and treatment of addiction. Dr. Bruneau has obtained $1.8 million in funding over five years to coordinate a team of 61 addiction researchers and experts.

In February 2016, Drs. Julie Bruneau and Didier Jutras-Aswad launched the first major research project under this initiative, the OPTIMA study: “Optimizing patient-oriented care: A pragmatic controlled random trial comparing care models for treatment of misuse of prescription opioids.”

This vast clinical study seeks more effective treatment for people dependent on prescription opioids. Abuse of pain drugs such as morphine, hydromorphone, oxycodone or fentanyl poses a real burden on public health. To counter the epidemic of overdose deaths and provide better care for people struggling with addiction, researchers will compare the effectiveness of two treatment modalities, using methadone or buprenorphine-naloxone. Researchers seek to determine which of these two treatments, initially developed for heroin addicts, is more appropriate for the now more complex reality of the various people who have developed a dependency on prescription opioids. Recruiting of 240 patients will start in the fall of 2016 across Canada and the findings will be released in the fall of 2018.

 

Hepatitis C

In July 2015, researcher Naglaa Shoukry obtain a $4.5 million grant to head the Canadian Network on Hepatitis C (CanHepC), jointly with Dr. Julie Bruneau.

The ultimate goal of this network is total eradication of hepatitis C in Canada. Some 220,000 Canadians suffer from this infection, which can have serious consequences such as liver failure or liver cancer. Naglaa Shoukry and her team of 60 researchers, healthcare professionals and partners across the country are working to upgrade prevention strategies, improve access to and compliance with treatment, and finally to better understand the health challenges faced by people with hepatitis C. “We want to reduce transmission of the virus, develop vaccines, increase the number of infections cured—especially in vulnerable populations—and improve the health of people living with hepatitis C, through innovative treatment strategies and a broad range of care options,” says Naglaa Shoukry, the network’s lead investigator.

 

eHealth

In February 2016, researcher Shalini Lal obtained a $1,075,000 grant to pilot a demonstration program to improve access for teens and young adults to mental health services in the public system using new technology. This project is funded by the Government of Canada through the eHealth Innovations Partnership Program and the Graham Boeckh Foundation.

One in every five people will be affected by mental illness in the course of their life and most mental illness appears before the age of 25, so young people are especially vulnerable. “New technology can be useful to ensure that the initial experience with access to care is positive,” Shalini Lal explains. “If young people reach an answering machine or must explain the reason for their call several times to various people, this can aggravate their psychological distress and discourage them from seeking the help they need.” To tackle this problem, Shalini Lal is directing development and assessment of a new self-referral and communication request management system, to promote fast, direct access to mental health services for young people aged 11 to 25.