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.
- Lok CE, Morgan CD, Ranganathan N: The accuracy and interobserver agreement in detecting the ‘gallop sounds’ by cardiac auscultation. Chest, 114: 1283-1288, 1998
- 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
- 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
- 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.