Examples of Research Happening in the Department of Surgery

1. Examples of Research Happening in the Department of Surgery

2. CADENCE Research Group – Our Mission Founded and directed by Dr. Andre Lamy in 2000 Our mission is as its name stated: Cardiac Diseases: Economic Analysis and Clinical Evaluation We have participated in many clinical trials, conducted and published economic analysis such as HOPE, CURE, MEDENOX, Canadian Off-pump CABG Registry. CORNARY trial (CABG Off or On Pump Revascularization Study), funded by the CHIR, is the the largest, multi-nation, randomized clinical trial in surgical patient populations.

3. CADENCE Research Group – Our People From left to right: Dr. Andre Lamy (Director); Parvaz Khatib (Study coordinator), Helen Shing (Research nurse), Sherry Wang (Health Economist), Rosanne Kent (former manager), Patti Schneider (Secretary), Lisa Trombetta (Database), Toni Rizzo (Research nurse), Kamil Malikov (Project Manager). Not in picture: Cathy Ther (DataFax), Kristina Novosel (Research Nurse).

4. MacHANdMcMaster University Hand, Arm, Nerve What is MacHANd? MacHANd is a new initiative promoting excellence in education, clinical service, and research for hand and upper limb injuries, diseases, and disorders. Core Members Dr. J. Bain (Plastic Surgery) Dr. J. MacDermid (Rehabilitation Science) Dr. F. Farrokhyar (Surgery) Dr. J. Moro (Orthopaedic Surgery) Dr. N. Hynes (Plastic Surgery) Dr. K. Rajaratnam (Orthopaedic Surgery) Dr. C. Levis (Plastic Surgery) Dr. A. Thoma (Plastic Surgery) Current Projects: • The Impact of Waiting for Carpal Tunnel Surgery • Health-Related Quality of Life (HRQoL) in Patients with Dupuytren's Disease: A Prospective Cohort Study (NCT00468949)

5. Research Themes hand wrist elbow shoulder nerve occupational disorders articles/resources for EBP systematic reviews economic analyses utilities randomized controlled trials outcome measures For More Information: Margaret Lomotan, Research Assistant E-mail: lomotam@mcmaster.ca Phone: 905-525-9140 Ext. 27328 Website: http://www.machand.ca MacHANdMcMaster University Hand, Arm, Nerve

6. Dr. Sheila Singh’s Laboratory Lab overview Research Overview Wednesday July 16, 2008 Operating since August 2007 Located at the Stem Cell & Cancer Research Institute at McMaster Main Campus Personnel includes: one post doctoral fellow, one undergraduate student & a research technician Dr. Singh is a pediatric neurosurgeon and scientist This is a basic science laboratory with a strong clinical focus The overall research goal is to further elucidate the cancer stem cell hypothesis in brain tumours and to characterize the Brain Tumour Initiating Cell (BTIC) Our work includes tissue culture work, molecular lab work and in vivo animal work

7. Cancer Stem Cell Hypothesis & the BTIC Neural stem cells (found in brain) are tightly regulated & differentiate into normal cells of brain tissue Cancer neural stem cells, by virtue of mutations, are dysregulated, & self renew & differentiate aberrantly, generating the abnormal cells that make up the brain cancer The BTIC was identified by its cell surface protein expression of CD133 In 2004, Singh et. al identified an abnormal stem cell (termed the BTIC) that drove the formation of brain tumours (Nature, 2004;432(7015):396-401) BTIC’s represent a small fraction of the whole tumour, but these cells alone may be entirely responsible for the continued growth of the tumour Clinical implications: therapies that focus on killing the bulk of the tumour may miss the rare stem cell fraction, allowing the tumour to continue to grow & potentially metastasize to form secondary tumours Nature. 2004;432(7015):281-2

8. Not recruiting residents for 2008-09 Core program Please contact us for more info: Monika Lenkiewicz lenkiew@mcmaster.ca Sheila Singh ssingh@mcmaster.ca Tumor spheres of Anaplastic medulloblastoma in vitro 100x 200x 400x 0.05mm 0.05mm 0.05mm 0.05mm Tumor spheres of Metastatic Melanoma in vitro 200x 200x 100x 0.05mm 0.05mm 0.05mm 0.05mm

9. Dr. Peter J. Lovrics Clinical Associate Professor, McMaster University General Surgeon, specializing in breast oncology

10. Dr. Lovrics - Research Projects • A randomized, multisite, controlled trial of radioguided seed localization versus standard needle localization in early stage breast carcinomas – funded by CBCF • Practice patterns and perceptions of breast conserving surgery in early stage breast cancer: Survey of Canadian General Surgeons and Radiation Oncologists – funded by CBCRA • A prospective cohort study to evaluate the impact of preoperative breast magnetic resonance imaging (MRI) on surgical decision-making in young patients with breast cancer – funded by JCC Foundation

11. Dr. Lovrics – Research Projects • Long term quality of life assessment of patients with early stage breast cancer using the Health Utilities Index • Systematic review of radioguided breast surgery for nonpalpable lesions • Technical and surgical factors affecting surgical margin status in breast conserving surgery (BCS) – funded by JCC Foundation

12. Dr. Marko Simunovic Associate Professor, Department of Surgery Surgical Oncologist, Juravinski Cancer Centre Research Coordinator: Angela Coates Email: coatesa@mcmaster.ca Research office: 905-527-4322 x42472 • Clinical research area is colorectal cancer surgery • Primary research focus - health services research • Specific research interests: • Quality improvement - addressing quality gaps in surgery, CQI, surgeon-directed quality initiatives • Knowledge translation

13. Dr. Simunovic - Current projects • Quality Initiative in Rectal Cancer (QIRC) Trial • Protocol: Simunovic et al. BMC Surg. 2008 Feb 15;8:4. • Cluster randomized trial to test if a KT strategy can improve patient outcomes - permanent colostomy & local recurrence • 16 Ontario hospitals, 105 surgeons, 1015 patients • Experimental arm surgeons – received KT strategy - workshop, audit & feedback, operative demonstrations, post-op questionnaires • Patient data - diagnostic tests, surgery (procedure type, audit of OR note), pathology, pre & post radiation/chemo • Secondary analyses: • Pathology reporting – radial margin distance • Participation of experimental arm surgeons in the KT components • Operative demonstrations – surgeon satisfaction and perceived changes in surgical practice • ** Project ideas: Assess a quality marker, use of diagnostic tests, chemo/rads

14. Dr. Simunovic - Current projects Evaluating a knowledge translation strategy for pancreatic surgery in Ontario (in progress) • To determine if care was transferred to high-volume providers and if rates of operative mortality improved after release of recommendations (1999) • Chart review data on 800+ patients to assess surgeon, hospital and treatment measures • ** Project idea: Use chart review data to assess a process of care measure • Other projects: • Assessing the uptake and effectiveness of laparoscopic surgery for colorectal cancer in Ontario - begins Fall 2008 • Improving the quality of colorectal and breast cancer surgery in LHIN 4 (Audit & Feedback,Tailoring) – colorectal is in progress; breast to begin Fall 2008

15. CLARITY Orthopaedic Research Group • Dr. Mohit Bhandari MD, MSc, FRCSCCanadian Research Chair in Musculoskeletal Trauma • Department of Surgery • Department of Clinical Epidemiology and BiostatisticsMcMaster University

16. Current Trials • FLOW: Fluid Lavage of Open Wounds: A Multi-Center, Blinded, Factorial Trial Comparing Alternative Irrigating Solutions and Pressures in Patients with Open Fractures • TRUST: Trial to Evaluate Ultrasound in the Treatment of Tibial Fractures

17. Current Trials • FAITH: Fixation using Alternative Implants for Treatment of Hip Fractures: A Multi-Centre Randomized Trial Comparing Sliding Hip Screw and Cancellous Screws on Revision Surgery Rates and Quality of Life in the Treatment of Femoral Neck Fractures. • HEALTH: Hip Fracture Evaluation with Alternatives of Total Hip Arthroplasty versus Hemi-Arthroplasty: A Multi-Centre Randomized Trial Comparing Total Hip Arthroplasty and Hemi-Arthroplasty on Revision Surgery and Quality of life in Patients with Displaced Femoral Neck Fractures

18. If you have any questions, some of the research assistants in the department are here today or feel free to contact them at any time.