Improving clinical practice guidelines for antenatal corticosteroids: Incorporating a decision support tool to impact clinical counselling

Antenatal corticosteroids are a medication given to women who are at risk of an early delivery to reduce the chance of breathing problems for their baby after birth. Current guidelines recommend giving antenatal corticosteroids to pregnant women who might have their baby before 34 weeks of pregnancy. This medication may also help those at risk of an early delivery at 34-36 weeks of pregnancy but the balance between the benefits and harms of this treatment is less clear at these ages. Guidelines for giving this medication at 34-36 weeks of pregnancy are also unclear, making it difficult for doctors and patients to decide whether to use it. We will find out if including a decision support tool in clinical guidelines will improve how doctors discuss antenatal corticosteroids with patients at 34-36 weeks of pregnancy. We will ask patients whether they had better discussions with their doctor about this treatment after their doctor had access to the decision support tool within the clinical guideline, and we will ask doctors how this decision support tool impacted their counselling. This project could improve communication between doctors and patients, especially when it is unclear whether a treatment’s benefits outweigh its harms.

Treatment of Pediatric Mental Health Problems: Unravelling the Role of Patient and Family Motivation in Eating Disorder Outcomes

My goal is to improve treatment for children and youth with eating disorders (ages 8-24 years). Eating disorders typically develop during adolescence. Eating disorders can become lifelong, and cause permanent health problems and even death. Making sure that each child gets the right kind of treatment can lead to the best outcomes. But, current guidelines do not consider how to match a child to the best type of treatment.

Knowing about motivation to change in children and families can help clinicians match a child to the best treatment. People who are motivated to change recognize there is a problem and are willing to work on this problem. Higher motivation leads to better eating disorder treatment outcomes in adults. Yet, motivation is not well-studied in youth. In fact, youth are often brought to treatment by their parents. So, parents’ motivation to help their child may be one of the most important features to measure.  

This project will tell us how youth and family motivation affect eating disorder outcomes. It will also tell us how clinicians use information about motivation. At the end of the project, I will be able to update guidelines about how to match a child to the best treatment.

Novel metabolomics approach for the diagnosis of infectious diseases

Tests to determine whether an individual has a disease or not are often expensive and performed on complex instruments in laboratories. As such, there is currently an important unmet need for tests to diagnose infectious diseases with highly accurate, inexpensive and simple methods that could be performed nearer to the patient.

We have developed a method that can identify the metabolites (small molecules) that change in response to infection. As a proof-of-concept, we demonstrated its successful use for the highly accurate detection of respiratory viruses directly from swabs taken from the nasopharynx (upper part of the throat behind the nose).

We now aim to expand this method to a new testing instrument at the BC Centre for Disease Control and assess its test performance for the detection of other infectious diseases like human papillomavirus (HPV) and tuberculosis (TB). Identification of a limited set of metabolites for each condition will enable the adaptation of the method to a simpler, near-patient diagnostic test. Such a test has the potential to reduce the time it takes to obtain an accurate diagnosis and improve clinical outcomes at a population level.

Optimizing post-procedural pain trajectories through patient-oriented research and artificial intelligence

Our goal is to use smartphones and artificial intelligence to improve pain management for children having surgery. This is needed because many children still have a lot of pain even a year after surgery. The pain affects their daily life, and might cause them to return to hospital. A child’s pain is affected by many things, like their biological sex, anxiety, coping skills, pain level, and type of surgery. Importantly, some of these can be altered.

We will collect data to identify patterns that predict which children

  1. do well after surgery, so we can learn from them or
  2. do not do well/have significant pain, so we can help sooner or even prevent it. We will involve families and children having surgery now, to collect data for a pain risk score to help future children.

We will design a tool to share pain risk data with families and doctors and test these tools in children coming to hospital for spine, tonsil or dental surgery. We hope that using these tools (pain prediction models) will improve the child’s individual care. Identifying children at high pain risk will allow us to intervene before their surgery. This will lead to quicker recovery, less time in hospital, and less chance of addiction to painkillers (opioids).

Building a provincial public health agenda for addressing geographic contributors to overdose

Research co-leads: 

  • Amanda Slaunwhite
    Provincial Health Services Authority 

Research user co-lead:

  • Gillian McLeod
    City of Delta

Team members:

  • Dr. Aamir Bharmal
    Fraser Health Authority
  • Jennifer Hawkins 
    Fraser Health Authority
  • Dr. Michael Schwandt
    British Columbia Centre for Disease Control, University of British Columbia
  • Amy Salmon
    Centre for Health Evaluation and Outcomes Sciences
  • Marinel Kniseley
    Centre for Health Evaluation and Outcomes Sciences
  • Dr. Alexis Crabtree
    University of British Columbia
  • Dr. Jesse Kancir
    University of British Columbia

Illicit drug overdose is the central provincial public health challenge in British Columbia (BC). All communities in BC have been affected by the overdose crisis, however little is known about how harm reduction and addictions treatment interventions can be adapted to rural and remote places that do not have supervised consumption/overdose prevention sites or addiction medicine providers.

We aim to address this significant gap in knowledge by convening a diverse group of persons with lived experience, policy makers, clinicians, and researchers from across BC to develop a public health action and research agenda for addressing geographic and place-based contributors to overdose that leverages existing data sources such as the Provincial Overdose Cohort. The objectives of this project are to:  

  1. Determine knowledge gaps and identify opportunities to collaborate across organizations and regions to better understand (a) geographic variations in overdose and (b) access to harm reduction, addictions treatment and acute care services outside of urban centers;  
  2. Identify immediate (6 month), short-term (1 year) and medium term (2 year) priorities for action in addressing overdose deaths in sparsely populated places with an emphasis on scaling up existing networks, programs and services;  
  3. Develop an interactive concept map and lay language publication that synthesizes the results of (1) and (2) for public release.   


Towards TB elimination in Canada: Optimizing tuberculosis screening and prevention

The World Health Organization (WHO) aims to eliminate TB by 2050, but Canada is not on target to meet that goal. To reach our national TB elimination targets, we must reduce TB rates by 10% per year but we are only reducing TB rates by 2% per year. My research program is aimed at developing evidence to improve TB screening, prevention and treatment policies in order to accelerate TB elimination in British Columbia (BC) and Canada.  

In my primary research project, my team is using provincial health databases to describe TB epidemiology in the foreign-born population of Canada. Our goal is to develop a TB risk score and to create evidence that informs cost-effective TB screening policy. My team is also using TB genome sequencing data to understand TB transmission networks and to find areas for public health intervention. Lastly, we are developing evidence to improve treatment outcomes for people affected by TB.   

Protein-energy wasting: prevalence and treatment outcomes among patients with advanced chronic kidney disease in British Columbia

People with or approaching kidney failure requiring dialysis often develop protein-energy wasting (PEW), which is characterized by loss of body stores of protein and energy fuels, and is associated with increased risk of death, heart disease, infections, and poor quality of life. The extent of PEW, its consequences, and its management have not been previously characterized among kidney patients in Canada, yet nutritional management remains a top research priority from the patient perspective.

Utilizing an existing database of chronic kidney disease patients in BC, the aims of the proposed study are:

  1. to determine the number and characteristics of adult kidney patients with PEW in BC, using several nutritional parameters and their changes over time to define PEW;
  2. to assess the impact of PEW treatment with nutritional supplementation (according to the BC Renal Nutritional Supplement Policy) on outcomes, including death, hospitalizations, nutritional lab parameters, and patient-reported functional status.

This research will:

  1. identify patients at risk of adverse outcomes from PEW in order to improve treatment policy and resource allocation, and
  2. inform future studies of dietary/self-management strategies for kidney patients

Individual disposition and mHealth: Personalized care to improve outcomes

Today the greatest barrier to optimal health among persons living with HIV (PLWH) is antiretroviral (ART) adherence. The WelTel program uses weekly text-messages to improve ART adherence and HIV viral suppression among PLWH, but does not work for everyone. The literature states that personality traits and sense of purpose (dispositional traits) play a role in HIV-related outcomes. Measuring disposition is simple and rapid, and could be used to personalize adherence supports for clients with relative ease. 

We will enrol 300 PLWH from three Vancouver HIV clinics into the WelTel program. Participants will receive a basic cell phone and phone plan if they do not have one, and receive a weekly (two-way) text message for 12 months asking 'How are you?'. Problem responses will be triaged by a nurse. 

We will use existing validated tools to measure disposition at baseline/over time to determine whether we can predict who is most likely to benefit from the WelTel program, and how WelTel works to enact behaviour change. In this way we hope to provide a means by which limited resources could be triaged in vulnerable populations struggling with adherence to provide well-suited programs to the greatest number of individuals possible.

Improving outcomes through precision medicine for adults with primary immunodeficiency

Primary immunodeficiencies (PIDs) are a group of conditions in which part of the immune system is either missing or does not function normally. Those affected by PIDs may suffer from recurrent infections, autoimmune disease (where the immune system attacks the body's own tissues), and certain cancers. These conditions are not rare; affecting 1:2,000 to 1:10,000 people, with nearly half of cases diagnosed in adulthood. Too often, adults with PIDs undergo a painful journey that spans decades in search of a diagnosis. Without knowing the cause of their immune deficiency, adults with PIDs may not receive life-changing treatment. 

Our research program will address these challenges using precision medicine: an exciting way of identifying the cause of the disease and finding treatments that specifically target the underlying problem. We will perform next generation sequencing, a method to quickly read genetic material, on adults with PIDs where the underlying cause is undiagnosed. If a new change in a gene (mutation) is identified, we will perform specialized experiments to prove that the mutation is indeed responsible for the patient's symptoms. We will then look for targeted treatments to address the specific cause of that patient's illness. 

By harnessing the power of personalized genetics and precision medicine, our goal is to improve outcomes for adults suffering from PIDs.

Towards a provincial policy framework for substance use services in BC

Opioid use disorder is one of the most challenging forms of addiction facing the health care system in BC and is a major driver of the recent surge in illicit drug overdose deaths in the province. In the context of the current public health emergency, Provincial Health Services Authority agencies the BC Centre for Disease Control (BCCDC) and BC Mental Health & Substance Use Services (BCMHSUS) have identified an urgent need for a policy framework articulating the full range of therapeutic options for the optimal treatment and harm reduction measures those with opioid use disorder.

Drawing on his expertise on substance use, first responder support and policy development, Adam Vaughan will work with experts and researchers at BCCDC and BCMHSUS, senior decision makers in the BC Ministry of Health and regional health authorities, and various addiction-related departments at UBC and SFU to develop a provincial policy framework that outlines a proposed continuum of care for those who require harm reduction, overdose prevention and opioid treatment services.

Vaughan's work on an opioid use disorder continuum of care will also contribute to the current development of an overarching provincial substance use policy framework and ultimately help advance BC drug policy.