11 big ideas to transform patient care and develop new treatments: ELEVATE competition results

Sandhya Goge, Dawn Stacey, Christopher Tran, Krystina B. Lewis, Dominique Gendron

People living with type 1 diabetes (T1D) are faced with many health-care decisions, including choosing an insulin delivery method. They can continue injecting insulin via multiple daily injections (MDI), or they can switch to an insulin pump – a wearable device that continuously infuses insulin. As both options have their benefits and risks, it is often difficult for people to decide which option best aligns with their preferences and values. For equity-deserving groups, this decision is more difficult as they face more barriers to accessing insulin pump. 

At TOH Diabetes Clinic, we support people with T1D as they decide between MDI or insulin pump. Little is known about what part of decision-making process poses a challenge. To date, no existing studies have examined their decisional needs, and no effective interventions are available to support them in making this decision. 

Our study aims to identify decision-making needs of people with T1D who are considering an insulin pump. Our team of clinicians, a patient partner, and researchers propose conducting a mixed-methods study. We aim to recruit 50 participants with T1D, including those on MDI and those using an insulin pump. Participants will be asked to complete a survey to measure their decisional needs, including decisional conflict, decision regret, and decision self-efficacy. Upon completion of the survey, they will be invited to participate in an interview. Qualitative one-on-one interviews will explore common themes related to (a) perceived benefits and risks associated with options; (b) decisional needs; and (c) ways to better support them. We will use purposeful sampling to include people from equity-deserving populations. Analysis of data will identify decision-making needs (decisional conflict, uninformed, unclear values, inadequate support, decision regret) and self-efficacy, with a sub-analysis focused on equity-deserving populations. Findings from this study will inform the creation of interventions to support people facing this decision.

Vidhyalakshmi Veeraragavan, Ryan Hughes, Mark Kaluzienski, Amanda Vandyk, Nicole Edgar

Violence, aggression, and self-harm are common in acute mental health inpatient settings, posing risks to both patients and staff. Physical restraints are sometimes necessary to prevent imminent harm, but they can cause injury, emotional trauma, and damage therapeutic relationships. The Ottawa Hospital (TOH) enforces a hospital-wide “least restraint” policy emphasizing patient autonomy and safety; however, staff report challenges balancing safety and therapeutic intent, and post-restraint debriefing is inconsistently completed. Rising workplace violence further complicates clinical decision-making and highlights the need for structured, actionable interventions. 

This project will pilot an adapted Six Core Strategies (SCS) framework on an acute mental health unit at TOH, to enhance consistency, appropriateness, and trauma-informed application of restraint practices. SCS is an evidence-based organizational approach encompassing leadership engagement, systematic data use, workforce development in trauma-informed care and de-escalation, proactive prevention tools (e.g., individualized safety/crisis plans), inclusion of individuals with lived experience, and structured post-restraint debriefing. 

The 12-month project follows a phased, participatory design. Phase 1 will establish baseline restraint practices via chart review and administrative data. Phase 2 involves co-designing practical tools with staff and a person with lived experience, including simplified debriefing workflows, crisis plans, visual tracking tools (Safety Crosses, Mood Boards), and sensory supports, refined through focus groups and thematic analysis. Phase 3 will pilot the adapted framework, with fidelity assessed via documentation completeness, crisis plan utilization, and debriefing participation, and acceptability evaluated through staff surveys and interviews. Quantitative data will be analyzed descriptively, and qualitative feedback presented narratively. 

Expected outcomes include improved patient safety, dignity, and early de-escalation practices; increased staff confidence and unit cohesion; and consistent, trauma-informed restraint practices. This pilot will establish a sustainable model for restraint reduction, inform broader TOH implementation, and support organizational learning.

Susan Ward, Stephanie Frisch, Hayley Mills, Louise Overington, Cristin Kargus, Jaclyn Switzer, Zhiwei Lin

Chronic pain affects millions of Canadians, leading to high health-care costs, disability, and long wait times for effective treatment. At The Ottawa Hospital Pain Clinic (TOHPC), 2,800 new patients are referred annually, creating long delays for access to evidence-based, non-drug therapies. This forces many patients to wait months or even years for help. We need a way to quickly and effectively deliver high-impact treatments to more people. We propose a pilot study of an innovative solution: a four-hour, single-session delivery model of Pain Reprocessing Therapy (PRT). PRT is a powerful, evidence-based psychological treatment grounded in the science of neuroplasticity — the brain’s ability to change. It teaches patients to retrain the brain to interpret chronic pain signals through a lens of safety, viewing pain not as permanent structural damage, but as a reversible, over-protective signal generated by the nervous system. By condensing this therapy into a single structured session, led by a PRT-trained social worker, we aim to make it rapidly accessible and highly scalable. This new model is designed to drastically cut down wait times and fit easily within the existing clinic structure. This project will involve 80 patients and will primarily test two things: 1. Feasibility: Can we successfully deliver the four-hour session within the clinic’s daily flow, and will patients complete it? 2. Preliminary Effectiveness: Does this rapid treatment reduce pain interference and improve pain self-efficacy? Success will provide the essential proof-of-concept to integrate this model into TOHPC's standard care. This will ensure hundreds of patients can quickly access this neuroplasticity-based path to significant pain reduction and functional improvement, transforming our ability to deliver timely, non-pharmacological chronic pain relief.

Blair Gage, David Cook

The goal of this project is to investigate how cells of the liver communicate to achieve the hundreds of functions that are essential to daily life. Focusing on the liver’s blood vessel endothelial cells, which produce proteins known as “angiocrines” that instruct adjacent hepatocytes to perform key reactions of drug metabolism, the Gage lab is developing high-throughput methods to understand what controls angiocrine production. They will test and validate a new genetic method known as direct-capture Perturb-seq where single genes can be linked to individual endothelial functions and mapped to specific locations in the liver. This work will eventually allow thousands of genes to be tested quickly and economically to identify druggable therapeutic targets to restore liver endothelial functions during the acute and chronic liver disease that plagues one in four Canadians.

Hesham Abdelbary, John Bell, Simon Garceau, Frank Oechslin

The overall goal of this research is to initiate establishing an alternative therapeutic platform that uses bacteriophages (phages) for the treatment of implant associated infection (IAI). The current therapy for IAI involves using antibiotics combined with surgeries. This approach has high rates of failure due to numerous limitations. One of the main limitations is that antibiotics can’t reach the infection because a layer of ‘slime’ called biofilm sticks to the surface of the implant and shields the bacteria from antibiotics. Therefore, we propose to develop a therapeutic strategy to address this clinical need for patients with IAI. Phages are viruses that can penetrate biofilm and kill the hidden bacteria. The first step in using phages to treat IAI is to create a library of phage candidates that we can choose from to treat patients. This library can also be modified overtime time to enhance phage efficacy and coverage.

Luc Sabourin, Michael Rudnicki, David Cook, Daniel Schramek

Our lab investigates the mechanisms regulating cancer stem cell function. The Sox10 protein binds DNA and controls multiple genes associated with mammary stem cell activity. High Sox10 expression is observed in a high proportion of human breast cancers and Sox10+ cohorts are also associated with a worse outcome, suggesting that Sox10-expressing tumours represent a more aggressive stem-like subtype.  

We have found that Sox10 deletion in a mouse model completely stops tumour formation and prevents further seeding of tumour cells. We believe that this is due to the loss of the tumour stem cell content. Studies suggest that tumour stem cells play a critical role in cancer persistence and the establishment metastatic niches. The eradication of those cell populations remains a major challenge as they are often in low number and resistant to therapy. Our data show that Sox10 is crucial for the function of those cells and the proposed studies will identify regulators of Sox10 activity and expression. Potential therapeutics targeting Sox10 will have a major impact on eliminating tumour stem cells in breast cancers. The targeting of Sox10 activity will have major impacts on all breast cancer subtypes, especially those where no specific therapies exist.

Stuart Nicholls, Alexandre Tran

We will build a team and program of research to support and improve patient engagement in trauma research, something that is urgently needed. Trauma is defined by sudden, life-threatening injury requiring urgent surgical interventions. Patients may not have the ability to consent because they lack capacity, and studies may be exempt from requiring informed consent at the time of intervention, or at all.  Notably trauma disproportionately affects marginalized groups who are underrepresented in research, raising equity concerns. Patient and community engagement has been identified as way to identify safeguards for study participants in trauma research, particularly when prospective individual consent cannot be feasibility obtained. However, patient and community engagement can be challenging in trauma research due to a broad patient population, limited contact with patients (resulting often a single interaction), and a lack of preexisting relationships and fragmented follow-up care. 

Yi Liu, David Cook, David Picketts, Pierre Mattar

Neurodevelopmental disorders remain poorly understood because current models cannot capture the full complexity of the human brain. Microglia, the brain’s resident immune cells, are critical regulators of neuronal growth, synaptic pruning, and circuit maturation, yet their contributions to disease are challenging to study with existing systems. This project will establish humanized mouse models by transplanting human iPSC-derived neurons and microglia into the developing mouse brain, allowing us to directly observe how these cells interact in vivo. Using patient-derived cells, we will identify disease-related changes in microglial function and neuron-microglia communication that drive abnormal brain development. By revealing how disrupted neuroimmune interactions contribute to disorders, these models will uncover disease mechanisms that cannot be recapitulated in vitro or traditional animal models. In the long term, this platform can be extended to study neurodegenerative diseases, accelerating the discovery of targeted treatments and offering new opportunities for personalized therapies in brain disease.

Daniel McIsaac, Gregory Knoll, Leandra Amado, Chelsia Gillis, Stephanie Hoar

Many Canadians are waiting for a kidney transplant. Using this wait time to improve health before surgery could mean better outcomes. Proactive rehabilitation (pro-hab) is an approach where people are supported to exercise, improve their diet, and have emotional support before surgery, and during their recovery at home. 

People waiting for transplant, and recovering afterward, could be ideal candidates for pro-hab because having kidney problems can make people weak and decrease their appetite. Early stage studies suggest that when people are supported to exercise before kidney transplant they may have better recovery. But so far, people have had to come to hospital regularly for their exercise, and we don't know for sure how likely patients will be to benefit.

We will test an approach where people are supported to exercise, improve diet, and receive emotional support at home before and after surgery to understand the ideal process and benefits. 

Dylan Burger, Carolina Ilkow, Robert Myette, Suresh Gadde

Kidney failure, a life-threatening condition requiring dialysis or transplantation for survival, affects approximately 40,000 Canadians. A major reason why kidneys fail is that nearly all forms of kidney disease lead to fibrosis, a scarring process that can progressively destroy normal functioning kidney tissue. Because of this, drugs that prevent fibrosis could delay or prevent kidney failure. Unfortunately, fibrosis is also a normal part of wound healing so use of these drugs could stop beneficial tissue repair in the heart, liver, lungs, and skin leading to additional health challenges. In this proposal we will create a "Hybrid Vesicle Nanocarrier Platform" (HVNPs) that is designed to carry drugs that prevent fibrosis directly to the kidney. By bringing the drugs directly to the kidney the HVNP will ensure that the beneficial effects of drugs on fibrosis will be maximized while avoiding side effects on other tissues.

Edward Clark, Christopher McCudden, Ryan Chan

Acute kidney injury (AKI) is the term for when patients' kidneys suddenly stop working, causing waste to build up in the blood. It affects up to half of patients admitted to intensive care units (ICUs) and increases the risk of long-term kidney problems, heart disease, or death. Many ICU patients with AKI need renal replacement therapy (RRT), treatment that temporarily replaces kidney function.

Patients with AKI who need RRT may be at high risk of deficiency in a nutrient called carnitine, although this has been poorly studied. This is because RRT may remove carnitine from the blood. Carnitine is important because it helps the body produce energy and may also reduce inflammation. 

In this study, we will collect blood samples from ICU patients with AKI on RRT to measure carnitine levels. Our goal is to understand whether carnitine deficiency contributes to worse outcomes and to guide future treatment studies.