The Graham Farquharson Knowledge Translation Fellowship: An Incredible Opportunity for Researchers
I feel extremely fortunate to have been the first recipient of the Graham Farquharson Knowledge Translation Fellowship. This award is truly cutting edge and unique for 2 important reasons: First, it is large enough to truly help clinician scientists free themselves from clinical work, so that their time can be devoted to research. Second, it focuses on knowledge translation, targeting research innovations that will truly improve the outcomes of real patients.
Why focus on Knowledge Translation?
Knowledge translation research is the discovery of novel strategies that can be widely disseminated to ensure that patients actually receive the treatments that work. In contrast to the routine quality improvement and continuing medical education activities that occur regularly throughout Canadian hospitals, knowledge translation research employs rigorous study design, standardized measurement of outcome, the generation of scientific knowledge about how to transform medical practice to incorporate best practices, and the skills to engage public policy leaders to sustain these changes.
My Specific Focus: Translating Evidence into Practice for Patients with Anoxic Brain Injury
The specific focus of my fellowship has been on translating evidence into practice for patients with anoxic brain injury. Anoxic brain injury occurs when there is interruption to the flow of blood and hence the delivery of oxygen to the brain. The most common event that leads to diffuse anoxic brain injury is cardiopulmonary arrest, but there are other causes, among them, severe haemorrhage, severe hypotension, traumatic injury, poisonings, and asphyxiation. In all cases, acute severe anoxic brain injury is characterized by diffuse damage to brain tissue and is associated with a high risk of death or disability.
My knowledge translation research has sought to improve how clinicians make predictions about prognosis and treatment recommendations for patients who are in a coma after suffering anoxic brain injury. I have designed and conducted The PremaTOR Trial to test the effectiveness of my knowledge translation approach, which focuses on delivering standardized education, common protocols and pathways, and reminders to help bedside clinicians – nurses and physicians – to make the very best decisions for these vulnerable patients. The ultimate goal is to prevent deaths due to premature termination of life-sustaining treatments yet also to improve the number of patients that survive with good neurological outcomes.
The PremaTOR trial is a stepped-wedge cluster randomized trial (funded jointly by the Canadian Institutes of Health Research and Heart and Stroke Foundation) to evaluate a collaborative network of hospitals that are all using our common strategies to improving the application of evidence-based decision-making for patients who have suffered anoxic brain injury. The trial involved the 18 hospitals that admit the highest annual volume of anoxic brain injury patients in Southern Ontario. Enrolment commenced in November 2011 and concluded in December 2013. We are currently collecting outcome data on all enrolled patients, and anticipate that we will be able to close the study database in June 2014. We will then begin our analyses, and anticipate having a study manuscript ready for peer-reviewed publication before January 2015. This translational research should help increase the proportion of patients that survive with good neurological function, yet also help clinicians more accurately identify patients that are predicted to have no meaningful recovery. The Fellowship funding from Physicians’ Services Incorporated has therefore had 2 direct and very important benefits: it allowed me to have dedicated and protected time to conduct this important knowledge translation research, and it targeted care improvements for more than 800 patients with anoxic brain injury admitted to a large number of Ontario hospitals.
Other Research Catalyzed by The Fellowship
In addition to helping me to complete the PremaTOR Knowledge Translation Trial, The Fellowship has catalyzed my research productivity in several additional ways. It has allowed me to complete and publish more than 25 peer-reviewed manuscripts in the scientific literature during the past 2 years. My notable accomplishments have included a study showing that intravenous magnesium decreases vasospasm yet does not improve clinical neurological outcomes after aneurysmal subarachnoid hemorrhage (J Crit Care 2012); a study demonstrating that routinely obtaining daily chest x-rays for critically ill patients (the usual practice in most ICUs) confers no benefit compared to a more restrictive approach (Crit Care 2012); and a study to identify the most accurate predictors of neurological outcome after anoxic brain injury (Crit Care Med 2014). I also completed and published a population-based cohort study of organ donation patterns in Ontario during the past 17 years. This latter study had important policy implications because it documented wide variation in rates of organ donation after devastating neurological injury across Ontario hospitals, suggesting that strategies are urgently needed to help target low-performing hospitals (CMAJ 2013). The findings of this research were highlighted on the CBC Radio Series White Coat, Black Art in December 2013.
Finally, I have continued to enrol patients into the ICE-PACS trial. This is an individual patient randomized trial to evaluate whether having paramedics start therapeutic hypothermia (i.e. cooling a patient’s body) sooner for patients at high risk of anoxic brain injury after cardiac arrest can lead to better patient outcomes. The underlying premise is that patients should receive treatments that we know are helpful based on when they need them, rather than based on where the patient is located, for example in a hospital versus in an ambulance. The ultimate goal of this translational research study is to increase the number of patients with anoxic brain injury that subsequently survive to hospital discharge with good neurological outcome. The study involves 4 paramedic Emergency Medical Services and 41 destination hospitals in Southern Ontario. This will be one of the largest trials of pre-hospital hypothermia ever conducted and will conclude in December 2015.
Knowledge Translation In Ontario and Beyond
Thanks to the research that the Fellowship has made possible, I have been invited to present my research and ideas at more than 70 local, national, and international meetings, including in the United States, the United Kingdom, and most recently Saudi Arabia. While these presentations have frequently focused on strategies for improving clinical practice, I have more often been asked to speak about the very nature of knowledge translation research, and about how knowledge translation studies should and can be conducted using much more rigorous study designs and evaluations. I believe that this is perhaps the most important unanticipated benefit of my Fellowship funding: it has allowed me to raise awareness of the importance of knowledge translation research, and about the scientific methodologies that can be used to advance our understanding of what works and what doesn’t when seeking to improve clinical practice.
In summary, the Graham Farquharson Knowledge Translation Fellowship has had a profound impact on my own development as a scientist and knowledge translation researcher, and has helped ensure that my large multicentre and collaborative PremaTOR trial could be successfully completed. More importantly, I believe that this prestigious award from the PSIF has helped raise awareness about the importance of scientific study targeting knowledge translation interventions. This research is absolutely essential for ensuring that our patients actually receive the treatments that are proven to work.