Dr. Emil Schemitsch

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Aligned with a focus on research relevant to patient care, I am grateful to have been generously funded by the PSI Foundation throughout my career. These grants have been instrumental in allowing me to pursue diverse musculoskeletal research endeavors, both at the basic science and clinical levels. My first PSI Health Research Grant back in 1995 allowed for the evaluation of a clinically relevant method of bone blood flow assessment utilizing laser Doppler flowmetry, and lead to further investigations of cortical circulation and bone perfusion. More recent PSI-supported investigations of cell and tissue engineering strategies have led to the development of a successful genetic approach to stimulate fracture healing, as well as numerous publications on stem cell therapies in orthopaedics. This work continues in our basic musculoskeletal laboratory today, and a recent PSI Resident Research Grant awarded last year has allowed the application of this cell therapy to the augmentation of rotator cuff injuries as well. The PSI Foundation was instrumental in funding a pilot study examining fluid lavage in the treatment of open wounds (FLOW), and currently supports a multi-centre randomized controlled trial examining operative versus non-operative treatment of acute unstable chest wall injuries as well as an Ontario-based multi-centre prospective cohort study examining abuse and intimate partner violence surgical evaluation (PRAISE-2). As demonstrated by this diverse funding support, the Foundation remains true to their mission of improving the “health of Ontarians” through numerous health research funding opportunities, for which I am truly indebted.

Dr. Mohit Bhandari

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My collaborators and I are incredibly grateful for the support received from Physician Services Inc. (PSI) over the past 7 years. More recently, the Foundation provided funding for the highly important HIP ATTACK trial, which will provide us the opportunity to understand, and to clearly answer the question of whether early surgery for hip fracture patients will improve post-operative outcomes and quality of life. The trial is well underway at both the Juravinski Hospital and St. Joseph’s Healthcare in Hamilton with over 100 participants enrolled to date.

The support from PSI has allowed us to offset both, research personnel costs and nursing costs required to facilitate accelerated surgery for hip fracture patients at participating sites. In addition, the funding is being used to support research staff and costs associated with central coordination of the trial at the Population Health Research Institute. Ultimately, the funding received from PSI will be crucial to supporting our recruitment goal of 200 patients in Hamilton by June 2016.

The publications related to this and my other projects that are in-part funded by PSI include the following:

HIP ATTACK Investigators. Accelerated care versus standard care among patients with hip fracture: the HIP ATTACK pilot trial. CMAJ. 2014;186(1):E52-60.

Chiavaras MM, Jacobson JA, Carlos R, Maida E, Bentley T, Simunovic N, Swinton M, Bhandari M. IMpact of Platelet Rich plasma OVer alternative therapies in patients with lateral Epicondylitis (IMPROVE): protocol for a multicenter randomized controlled study: a multicenter, randomized trial comparing autologous platelet-rich plasma, autologous whole blood, dry needle tendon fenestration, and physical therapy exercises alone on pain and quality of life in patients with lateral epicondylitis. Acad Radiol. 2014;21(9):1144-55.

FAITH Investigators. Fixation using alternative implants for the treatment of hip fractures (FAITH): design and rationale for a multi-centre randomized trial comparing sliding hip screws and cancellous screws on revision surgery rates and quality of life in the treatment of femoral neck fractures. BMC Musculoskelet Disord. 2014;15:219.

Bio

Dr. Mohit Bhandari immigrated from India with his family to Canada in 1970 and has resided in Ontario ever since. He attended primary and secondary school in Hamilton, Ontario, began his Bachelors Degree in Biology at McMaster University and transitioned to the University of Toronto after 2 years as an early entry admission to Medical School in 1994. He began his sub-speciality training in Orthopaedic Surgery at McMaster University thereafter and completed a Masters Degree in Clinical Epidemiology and Biostatistics at McMaster University during his specialty training in orthopaedic surgery. He travelled for a brief period to United States to obtain super-specialized training in trauma surgery with world experts and returned to McMaster University as a Faculty member in 2004. While running a busy practice, Dr. Bhandari successfully completed his Doctorate (PhD) of Clinical Sciences at Goteburg University in Sweden.

By 2012, Dr. Bhandari was a full Professor and Academic Chair of the Division of Orthopaedic Surgery at McMaster University and a distinguished Canada Research Chair in Musculoskeletal Trauma.
His research interests include the management of patients with traumatic injuries, and most recently, he has shifted his focus to identifying and assisting women with these injuries resulting from intimate partner violence. Most regard Dr. Bhandari as the foremost authority in the translation of knowledge from orthopaedic research to clinical practice (Evidence-Based Orthopaedics).

Dr. Charmaine Lok

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The Physician’s Services Incorporated Foundation (PSI) has positively influenced my career path and has had a significant impact on direct patient care through the research they have supported.

I was first encouraged to pursue clinical research as an internal medicine resident when I was awarded a Resident Research Award from PSI for “The Accuracy and Interobserver Agreement in Detecting the ‘Gallop Rhythm’ by Cardiac Auscultation”1. Through this research, the importance of evidence based evaluation of patient bedside diagnostic manoeuvres and tests were highlighted.

Later on, the PSI supported “The Hemodialysis Infection Prevention with Polysporin Ointment (HIPPO) Study” – a double blinded multi-centre, randomized control trial that I designed and implemented in conjunction with my degree in Clinical Epidemiology at Harvard University. In this way, the PSI contributed in a significant manner to my continuing education. More importantly, however, this study has impacted not only patients in Ontario, but worldwide. This study evaluated the effect of a topical polyantibiotic ointment, Polysporin Triple ointment (PTO), on preventing catheter-related infection in patients on hemodialysis. Why is this important?

The prevalence of endstage kidney disease requiring dialysis or transplantation is increasing. Once on hemodialysis, patients depend on a vascular access (central venous catheter, arteriovenous fistula or synthetic graft) to connect their blood to the dialysis machine so it can be “cleaned” and processed. This vascular access is their lifeline; as such, vascular access complications can have a dramatic impact on their quality of life and overall survival. Catheter related infections are a leading cause of morbidity and mortality in hemodialysis patients. The HIPPO Study demonstrated that only 1 in 7 patients needed to be treated with prophylactic application of PTO to prevent a serious bloodstream infection and only 1 in 8 patients needed to be treated to prevent a death2. Subsequent related studies have found these findings to be both long lasting with continual low rates of infection as well as cost effective3, 4. The use of prophylactic polyantibiotic ointment to prevent hemodialysis catheter related infections is a Grade “A” recommendation in the Canadian Society of Nephrology and other Hemodialysis Practice Guidelines and it is supported by Infectious Diseases Societies with a recommendation in CDC guidelines.

Since the publication of this early research, I have continued to focus my research efforts on practical strategies to improve clinical outcomes of patients with chronic and endstage kidney disease. This work would not have been possible without the generous and continual support of the PSI.

This blog is an opportunity for me to thank the PSI for all their tremendous support of my research – for enabling both new and established researchers to conduct clinically relevant and necessary research through a fair and rigorous peer review process, and for helping patients who have benefitted directly from this research.

  1. Lok CE, Morgan CD, Ranganathan N: The accuracy and interobserver agreement in detecting the ‘gallop sounds’ by cardiac auscultation. Chest, 114: 1283-1288, 1998
  2. Lok CE, Stanley KE, Hux JE, Richardson R, Tobe SW, Conly J: Hemodialysis Infection Prevention with Polysporin Ointment. Journal of the American Society of Nephrology : JASN, 14: 169-179, 2003
  3. Battistella M, Bhola C, Lok CE: Long-term follow-up of the Hemodialysis Infection Prevention with Polysporin Ointment (HIPPO) Study: a quality improvement report. Am J Kidney Dis, 57: 432-441, 2011
  4. Daisy Kosa S, Lok CE: The economics of hemodialysis catheter-related infection prophylaxis. Semin Dial, 26: 482-493, 2013

Dr. Charmaine Lok is a Professor of Medicine, Faculty of Medicine, at the University of Toronto and Senior Scientist at the Toronto General Hospital Research Institute. She is also associated with the Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University. Dr. Lok is the medical director of both the chronic kidney diseases and hemodialysis programs at the Toronto General Hospital, Toronto, Canada. She is active in raising awareness of CKD and ESRD and its importance in population health. Dr. Lok is involved in a variety of local and international scientific and educational programs, including CIHR, KFOC, DOPPS, NKF, ASN, VASA and ASDIN.

Dr. Robin Green and Dr. David Mikulis

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In a series of papers focusing on volumetric imaging, DTI and neuropsychological correlates, they demonstrated that the brain shows progressive losses during the chronic stages of injury, and moreover that such losses are ubiquitous across patients. They also showed that some of these losses (in the hippocampi in particular) are correlated with reduced cognitive stimulation, which opens new avenues of research for offsetting these losses and improving clinical outcomes, on which they are currently focused. They have also recently uncovered behavioral correlates of hippocampal losses and a further mechanism of volume loss, leading again to novel avenues of treatment to improve patient outcomes. Finally, the funding has also helped to create a database that is unique in the world – a longitudinal database of neuroimaging, cognitive and functional findings of nearly 200 patients assessed from 2 months to 2 years post-injury. The database is leading to a much clearer picture of the evolution of change in moderate-severe TBI patients in Canada, including, for example, increasing depression and anxiety across time. The database also allows for excellent retrospective research opportunities for trainees in the field of brain injury. Some of our findings have policy implications, including a redistribution of resources to encompass the chronic stages of injury, where there is scope for offsetting the accelerated aging and poor clinical outcomes currently seen, and which have importantly shown response to treatment. The findings also support a need for novel approaches to the delivery of treatment to patients in the chronic stages of injury in order to get treatment to patients all over Canada after they have left in-patient therapies, regardless of where they live.

These achievements were made possible by early work on the part of Dr. Mikulis who established one of the first functional neuroimaging labs in Canada in 1993. His lab embraced and supported numerous investigators including Dr. Green, who went on to develop a very successful neuroimaging lab focused on neurotrauma. Both researchers have “veteran” labs with unique strengths and capabilities. However, in today’s research environment, information growth is presenting significant challenges to this model of individual principle investigator driven research. In addition, it is becoming increasingly difficult to acquire and maintain all of the necessary skills to remain competitive. Furthermore, duplication of skills is expensive and inefficient. Forming collaborations has therefore become a key element to success. This is exactly the opportunity Dr. Green and Mikulis pursued enabled by PSI funding. Once started, it soon became obvious that the sum of their capabilities was greater than that of the individual parts. It did not take long for the collaboration to show productivity with 7 publications in only 2 years. This is a terrific example of how support for this paradigm of collaborative research can enhance the efficiency of the financial commitment all of which was made possible by support and sponsorship on the part of the PSI. Dr. Mikulis and Dr. Green are most grateful for the continuing support of the PSI.

Dr Green is a Canada Research Chair (tier II) in traumatic brain injury (TBI) and a senior scientist at Toronto Rehab – University Health Network, where she is head of the Brain Recovery and Discovery Team; she is also a clinical neuropsychologist. Her research focuses on the causes and treatments of neurodegeneration and its behavioural correlates in chronic TBI.

Dr. Mikulis is a Professor in the Dept. of Medical Imaging at the University of Toronto and the University Health Network, Director of the Functional Neuroimaging Research of the Joint Department of Medical Imaging. He is most recently Past President of the American Society of Functional Neuroradiology. His research has focused on translating advanced structural, functional, and neurovascular imaging methods into clinical applications. Several PSI grants have allowed for a very productive collaboration between Drs. Green and Mikulis. Their primary area of joint research funded by PSI has focused on a reconceptualization of traumatic brain injury as a progressive and neurodegenerative disorder.

Dr. Avery Nathens

nathens-photoMy history with the PSI foundation dates back to 1994, when I received my first grant as a doctoral student in the Surgical Sepsis Laboratories at the Toronto General Hospital in the Surgical Scientist Training Program at the University of Toronto. At that time I was studying the host response to infection and the inflammatory response. The success in that environment led me to pursue an academic track focusing on traumatic injury and emergency surgical care.

I moved on to start my career in Seattle, WA where I pursued an MPH and refocused my efforts on health services research and injury. I returned to Canada in 2006 and shortly thereafter collaborated with Dr. Vicki Leblanc, a psychologist with an interested in how stress among health care providers might impact clinical performance. This was a perfect opportunity to study the resuscitation of severely injured trauma patients, a high stakes, high pressure clinical setting. We received funding from PSI in 2007 to study the stress response in trainees in simulated trauma scenarios. We demonstrated that critically injured patients provoke a considerable stress response as demonstrated by high levels of circulating cortisol. Further, this level of stress was associated with impaired performance. This work resulted in the two publications below and set the stage for an interest in evaluating performance in the trauma bay using novel technologies.

1. Harvey A, Bandiera G, Nathens AB, LeBlanc VR. Impact of stress on resident performance in simulated trauma scenarios. J Trauma Acute Care Surg. 2012
Feb;72(2):497-503.

2. Harvey A, Nathens AB, Bandiera G, Leblanc VR. Threat and challenge: cognitive appraisal and stress responses in simulated trauma resuscitations. Med Educ. 2010
Jun;44(6):587-94.

I also have an interest in injury prevention and to this end, PSI funding has been used to evaluate risks for recurrent intentional injury among youth. My personal experience and that supported by several lines of evidence indicate that many patients who are victims of interpersonal violence have prior visits to the emergency department. In 2008, Dr. Carolyn Snider and I were interested in designing brief interventions to prevent this cycle of violence among youth and received a PSI grant to study this further. We first used a mixed methods approach (concept mapping) to evaluate what type of interventions and/or services would offer the most value from the perspective of high risk youth and their community partners. This work laid the foundation for conceptualizing a hospital based violence prevention intervention and to identify outcomes relevant to the community. Next, we evaluated the optimal hospital setting to implement these programs. Our work in this domain demonstrated that over 80% of injured person present to non-trauma centres. This finding is important as most injury prevention programs are implemented in trauma centres, but this work clearly demonstrated that violence prevention initiatives implemented in this environment will not achieve the goals of preventing recurrent injury on a population basis.

1. Snider CE, Nathens AB. Where should we implement emergency department secondary prevention programs for youth injured by violence? J Trauma. 2010 Oct;69(4):991-4.

2. Snider CE, Kirst M, Abubakar S, Ahmad F, Nathens AB. Community-based participatory research: development of an emergency department-based youth violence intervention using concept mapping. Acad Emerg Med. 2010 Aug;17(8):877-85.

As part of my research program evaluating emergency surgical care, my doctoral student, Dr. Charles de Mestral received PSI funding to evaluate strategies related to the management of acute cholecystitis. This work, carried out at the Institute for Clinical Evaluative Sciences allowed us to follow a cohort of Ontario residents with this common diagnosis. We demonstrated significant benefit to patients receiving early surgical intervention with fewer complications, better quality of life, less health care resource utilization and lower costs. This work caught the attention of the MOHLTC, where incentives to perform earlier operation are being considered. This work resulted in the the 4 publications below, with one more in press:

1. de Mestral C, Rotstein OD, Laupacis A, Hoch JS, Zagorski B, Alali AS, Nathens AB. Comparative operative outcomes of early and delayed cholecystectomy for acute
cholecystitis: a population-based propensity score analysis. Ann Surg. 2014 Jan;259(1):10-5.

2. de Mestral C, Laupacis A, Rotstein OD, Hoch JS, Haas B, Gomez D, Zagorski B, Nathens AB. Early cholecystectomy for acute cholecystitis: a population-based retrospective cohort study of variation in practice. CMAJ Open. 2013 May 16;1(2):E62-7.

3. de Mestral C, Gomez D, Haas B, Zagorski B, Rotstein OD, Nathens AB. Cholecystostomy: a bridge to hospital discharge but not delayed cholecystectomy. J Trauma Acute Care Surg. 2013 Jan;74(1):175-9.

4. de Mestral C, Rotstein OD, Laupacis A, Hoch JS, Zagorski B, Nathens AB. A population-based analysis of the clinical course of 10,304 patients with acute
cholecystitis, discharged without cholecystectomy. J Trauma Acute Care Surg. 2013 Jan;74(1):26-30.

Dr. Aziz AlAli is another one of my graduate students who as a neurosurgeon, was interested in exploring strategies related to care of the patient with brain injuries. As the director of the American College of Surgeons Trauma Quality Improvement Program, I had an interest in how we can capitalize at exploring variations in practice to evaluate optimal care strategies. In work funded through the PSI foundation, we used data from almost 200 trauma centres across North America to explore the impact of tracheostomy timing in patients with severe traumatic brain injury. This is an area of considerable controversy where biases are so great that randomized controlled trials are almost impossible. We demonstrated a significant benefit to early (within 7 days) tracheostomy. This work was cited as one of the top 10 publications that are likely to change practice at the largest trauma conferencesin the world (Annual Las Vegas Trauma, Critical Care & Acute Care Surgery, March 2015, 
Las Vegas, NV). The PSI funding was also used to explore other variations in practice to gain insights into other care strategies that might improve outcomes in this critically ill population. Altogether, PSI funding led to the three publications below:

1. Alali AS, Scales DC, Fowler RA, Mainprize TG, Ray JG, Kiss A, de Mestral C, Nathens AB. Tracheostomy timing in traumatic brain injury: a propensity-matched
cohort study. J Trauma Acute Care Surg. 2014 Jan;76(1):70-6; discussion 76-8.

2. Alali AS, Fowler RA, Mainprize TG, Scales DC, Kiss A, de Mestral C, Ray JG, Nathens AB. Intracranial pressure monitoring in severe traumatic brain injury:
results from the American College of Surgeons Trauma Quality Improvement Program.
J Neurotrauma. 2013 Oct 15;30(20):1737-46.

3. Alali AS, Naimark DM, Wilson JR, Fowler RA, Scales DC, Golan E, Mainprize TG, Ray JG, Nathens AB. Economic evaluation of decompressive craniectomy versus barbiturate coma for refractory intracranial hypertension following traumatic brain injury. Crit Care Med. 2014 Oct;42(10):2235-43.

The PSI Foundation has been remarkably supportive and as is evident above, not only provided funding to begin my career, but also initiated the career of several promising graduate students and/or junior faculty under my supervision in fields as diverse as emergency medicine to neurosurgery. The Foundation is critically important in supporting physicians’ asking the right scientific questions to improve the quality of care and bringing innovation to the bedside.

Dr. Nathens is a trauma surgeon and the Surgeon in Chief of Sunnybrook Health Sciences Centre, Canada¹s largest Level 1 trauma centre. He is also an epidemiologist with a focus on trauma system design. He is an active member of the American College of Surgeons Committee on Trauma and is Director of the American College of Surgeons Trauma Quality Improvement Program. He holds the DeSouza Chair in Trauma Research and has published many landmark peer-reviewed papers in the Lancet, NEJM and JAMA focusing on trauma system design and implementation. Dr. Nathens has had extensive experience evaluating quality of care and trauma system effectiveness and translated much of this work into tangible changes at the patient level.

Dr. Kevin Katz

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I completed my training in infectious diseases and medical microbiology, as well as a Master’s degree in Laboratory Medicine and Pathobiology, at the University of Toronto in 2004. I developed a special interest in the epidemiology of antibiotic resistant organisms and infection prevention and control. A renewed focus on patient and occupational safety emerged as a result of the Toronto SARS epidemic, and created unique opportunities in community hospitals. I joined North York General Hospital as their medical Director of IPAC in 2004, aspiring to create an academic program with the potential to impact more broadly. After all, by some measures, 80% of all care is delivered in community hospitals.

Over the last decade there has been a major shift in the epidemiology of Methicillin Resistant Staphylococcus aureus, with the emergence of new MRSA strains that transmit in community settings (schools/daycare, jails, gyms, homeless shelters, etc.). I was lucky enough to be granted PSI funding for a project to assess the risk of Methicillin Resistant Staphylococcus aureus in household settings and to compare this risk based on strain type (community MRSA strain versus healthcare MRSA strain). This led to a successful multi-site study which demonstrated, contrary to common belief, that both CA- and HA-MRSA strains transmit equally well in the household setting. This study was the foundation for numerous other projects and publications focussing on various facets of the emergence of community-associated MRSA strains, including defining at-risk groups, outbreak investigations, delineating the most appropriate laboratory screening technique to detect colonization, and conducting point prevalence studies of CA-MRSA in purulent skin and soft tissue infections presenting to emergency departments across Canada.

The Physician Services Incorporated Foundation has given me opportunities that other granting agencies could not. PSI’s emphasis on ‘health research that is relevant to patient care’ and a preference for new investigator proposals make PSI Foundation a unique gem. The PSI Foundation is also unique in its willingness to fund research by community physicians in community settings. I am very thankful to PSI Foundation for getting my academic career off the ground, and positioning me for success.

Dr. Kevin Katz is the Medical Director of Infection Prevention and Control at North York General Hospital. He is a Medical Microbiologist and Infectious Diseases specialist and an Associate Professor in the Department of Laboratory Medicine and Pathobiology at the University of Toronto. He has special research interests in healthcare-acquired infections and multidrug resistant organisms.

Dr. Graham JW King

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Elbow dislocations are the second most common dislocation in adults. These dislocations are often associated with fractures, which have a great influence on elbow stability and patient outcomes. Excessive joint laxity and re-dislocation are frequently encountered due to the loss of these secondary osseous constraints. Prolonged immobilization may reduce the incidence of late instability; however, permanent stiffness is the usual consequence. As a result, stiffness and later arthritic changes are common sequelae of elbow dislocations both with and without associated fractures. Furthermore elbow fractures are second in frequency only to the wrist. With the advancing age of our population the incidence of these fractures has been rising rapidly and are becoming a significant financial burden for the health care system. Despite advances in our understanding the biomechanics of the elbow and in the diagnosis and treatment of its disorders, there are many questions that have yet to be resolved and their management remains unsatisfactory.

The Roth McFarlane Hand and Upper Limb Centre Bioengineering Laboratory has been advancing our understanding of elbow biomechanics over the last twenty years. Located in the Lawson Research Health Institute at St. Joseph’s Health Centre in London, this laboratory is a major hub of biomechanics research in the Departments of Surgery and Mechanical Engineering at Western University. A variety of projects are conducted by a team comprised of engineering and medical trainees, residents and fellows. This research encompasses the application of engineering-based studies to address clinical problems such as fracture fixation, soft-tissue and ligament repair, and implant replacement. These studies range from the employment of basic bench-top approaches to the use of advanced state of the art testing systems and simulators that permit the experimental-based reproduction of joint function. In addition, implant development is a major thrust of this research; more recently with the development and testing of reverse-engineered patient-specific implants. In collaboration with industrial partners, new implant systems have been developed and these are now commercially available. Also, improved surgical and rehabilitation techniques, that have been evaluated in the laboratory, have been implemented clinically. More recently, intra-operative measurement and guidance systems have been developed as components of computer-assisted surgery.

As part of our research program we have been interested in developing the next generation of clinician-scientists. In partnership with the Physicians Services Incorporated we have received funding for four resident research projects over the last eight years. These types of grants are not currently not provided by CIHR or NSERC. Three of these projects are now complete and each of the residents who were awarded these grants have published their work and obtained Masters Degrees. Two are now working in academic medical centres while the third is completing advanced fellowship training.

In 2007 we were awarded a Resident Grant entitled “The Development and Application of a Forearm Testing Apparatus”. This novel device has allowed us to gain a better understanding of the role of the interosseous membrane in forearm stability and its relationship to radial head excision and replacement. This knowledge will assist surgeons in deciding the optimal diameter and thickness of radial head prostheses, the commonest joint replacement of the elbow. Furthermore the role of the interosseous membrane in load transfer and the effect of radial head excision and replacement provides a rationale for optimal patient care. In addition to presentations at a number of national and international meetings, three papers have been published, in part, as a result of this grant support.

  1. Lanting BA, Ferreira LM, Johnson JA, Athwal GS, King GJ. The effect of excision of the radial head and metallic radial head replacement on the tension in the interosseous membrane. Bone Joint J. 95-B:1383-7, 2013. PubMed PMID: 24078536.
  2. Lanting BA, Ferreira LM, Johnson JA, King GJ, Athwal GS. The Effect of Radial Head Implant Length on Radiocapitellar Articular Properties and Load Transfer within the Forearm. J Orthop Trauma. 28(6):348-53, 2014. PubMed PMID: 24088774.
  3. Lanting BA, Ferreira LM, Johnson JA, King GJ, Athwal GS. Radial head implant diameter: A biomechanical assessment of the forgotten dimension. Clin Biomech (Bristol, Avon). 2015 Mar 16. pii: S0268-0033(15)00077-7. doi: 10.1016/j.clinbiomech.2015.03.012. [Epub ahead of print] PubMed PMID: 25800117.

In 2010 we received a resident research grant entitled “Coronoid Fracture Repair and Reconstruction of the Elbow”. This study evaluated optimal techniques in coronoid fracture repair and reconstruction. The development of a coronoid prosthesis is a major advance of this research which was in part supported by the PSI. This has already been implanted in a patient as a custom device and we hope that this will be commercialized to provide a solution to a very challenging clinical problem, coronoid process insufficiency. We also validated the concept of transfer of the coronoid process as an autogenous solution to lesser magnitudes of coronoid deficiency. In addition to presentations at a number of national and international meetings, four papers have been published, in part, as a result of this grant support. Publication is pending for two additional papers.

  1. Alolabi B, Gray A, Ferreira LM, Johnson JA, Athwal GS, King GJ. Reconstruction of the coronoid using an extended prosthesis: an in vitro biomechanical study. J Shoulder Elbow Surg 21:969-76, 2012. PubMed PMID: 21782472.
  2. Alolabi B, Gray A, Ferreira LM, Johnson JA, Athwal GS, King GJ. Rehabilitation of the Medial- and Lateral Collateral Ligament-deficient Elbow: An In Vitro Biomechanical Study. J Hand Ther. 25:363-73, 2012. PubMed PMID: 22959533.
  3. Gray AB, Alolabi B, Ferreira LM, Athwal GS, King GJ, Johnson JA. The Effect of a Coronoid Prosthesis on Restoring Stability to the Coronoid-Deficient Elbow: A Biomechanical Study. J Hand Surg 38A1753-1761, 2013. PubMed PMID: 23830677.
  4. Alolabi B, Gray A, Ferreira LM, Johnson JA, Athwal GS, King GJ. Reconstruction of the coronoid process using the tip of the ipsilateral olecranon. J Bone Joint Surg 96A:590-6, 2014. PubMed PMID: 24695926.

In 2011 we received a resident research entitled “Distal Humeral Hemiarthroplasty of the Elbow”. This study was focussed on optimizing the design of distal humeral hemiarthroplasty, a developing option for the management of fragility fractures of the distal humerus. We were able to demonstrate some of the current challenges with distal humeral hemiarthroplasty including implant sizing, materials and the potential for cartilage wear due to altered joint contact. While further research is needed and remains ongoing, this novel project has advanced our understanding of hemiarthroplasty of the elbow and has the potential to influence hemiarthroplasty designs of other joints. Two papers have been published and publication is pending for one additional paper.

  1. Desai SJ, Deluce S, Johnson JA, Ferreira LM, Leclerc AE, Athwal GS, King GJ. An anthropometric study of the distal humerus. J Shoulder Elbow Surg. 23:463-9, 2014. PubMed PMID: 24560468.
  2. Desai SJ, Athwal GS, Ferreira LM, Lalone EA, Johnson JA, King GJ. Hemiarthroplasty of the elbow: the effect of implant size on kinematics and stability. J Shoulder Elbow Surg. 23(7):946-54, 2014.PubMed PMID: 24766788.

In 2014 we received a resident research grant entitled “Rehabilitation of the Ligament Deficient Elbow: A Biomechanical Study”. This study is ongoing is focussing on improving rehabilitation techniques for unstable fractures and dislocation. In addition providing an evidence based rationale for physiotherapists to provide safe and effective exercise programs, we are also evaluating the effectiveness of bracing which are often prescribed for these injuries.

In summary the resident research support provided by PSI is a novel granting program which in spite of the relatively small financial commitment is leading to significant advances in patient care. By encouraging residents in their training to gain skills in grant applications and translational research I expect this will encourage the physicians of tomorrow to remain engaged in research during their future careers which should improve the health of Ontarians.

Dr. Graham JW King received his MD degree at the University of British Columbia. After completing a rotating internship at the University of Alberta he went to the University of Toronto to train in orthopaedic surgery. During a research year in Toronto he became interested in orthopaedic biomechanics and soft tissue healing. After qualifying as an orthopaedic surgeon in 1989 he completed a clinical fellowship in hand and wrist surgery and a Master’s of Science degree at the University of Calgary. He then travelled to the Mayo Clinic to gain further clinical experience in wrist and elbow surgery and additional research experience in upper extremity bioengineering. In 1992 he joined the Department of Surgery at the University of Western Ontario. He established the Bioengineering Laboratory at the Hand and Upper Limb Centre at St. Joseph’s Health Centre. With his collaborators, Drs. David Chess, Louis Ferreira and James Johnson they have developed linkages with the Departments of Medical Biophysics, Mechanical Engineering and Biomedical Engineering. Over the past 20 years the laboratory has been successful in attracting extensive peer review funding including CIHR, CAS, CAN and NSERC and has numerous industry collaborations. His current research interests focus on the biomechanics of the wrist and elbow as well as computer and image guided surgery. He has received the Premier’s Research Excellence Award from the Government of Ontario and the J. Edouard Samson Research Award from the Canadian Orthopaedic Research Society. He has represented the Canadian Orthopaedic Association as a North American Travelling Fellow and an American, British and Canadian Travelling Fellow. He has also served as the president of the Canadian Orthopaedic Research Society. He is currently a Professor in the Department of Surgery at Western University and the Chief of Surgery at St. Joseph’s Health Centre. Dr. King was awarded a 2010 Dean’s Award of Excellence for his contributions to the Schulich School of Medicine and Dentistry.