Opioids play an important role in surgical pain management, but recent information has shown that overuse can lead to longer term abuse known as persistent opioid use (POU). There is growing concern that the overuse of opioids after surgery is contributing to the opioid crisis.

Estimates have found that one in 10 patients have long-term problems with ongoing dependency on opioid medications, particularly people who have rarely used these medications before surgery. The incidence and long-term impacts of POU after cardiac surgery in Manitoba is unknown.

Manitoba has a unique and world- class database at the Manitoba Centre for Health Policy (MCHP). We seek to study POU in what will be one of the largest studies in Canada. We will look back from 1995 to 2016 to see how common POU has been and its effects on patients and the healthcare system. We will take a deep look at the health, environmental, and social factors that affect these patients.

This study will provide important information on how routine hospital pain management after heart surgery has affected patients in the past and how providers can develop new methods – including non-opioid methods to enhance a patient’s recovery. The results will be used to develop safer prescribing practices in hospitals and inform healthcare policy in Manitoba and the broader global surgical community.

Last winter, Manitoba experienced a bad season of respiratory syncytial virus (RSV), with many cases in children. RSV is a major cause of respiratory illness in young children. The virus usually causes a common cold, but children under a year old are most at risk of developing a serious and even life-threatening infection in the small airways of the lungs.

There is no vaccine or effective antiviral treatment for children. Manitoba does have an RSV prophylaxis program that provides a treatment (palivizumab) against RSV infection. However, since the treatment is very expensive, it’s only given to those young children at the highest risk for a severe disease.

Therefore, we need a better way to treat and stop the spread of RSV in young children. A method known as drug repurposing identifies existing drugs that can be used to treat diseases other than those for which they were intended. This saves money and time in developing new treatments.

Here, we will study the repurposing of disulfiram, a drug used to treat alcoholism, against RSV infection.  Our preliminary results show that disulfiram reduced RSV infection of lung cells. We will study the antiviral effects of disulfiram against RSV infection using cells collected from healthy volunteers , and a mouse model of RSV infection.

We will test the efficacy of different treatment times with disulfiram and whether it decreases inflammation and viral spread. Drug repurposing using disulfiram could lead to a novel strategy to treat RSV infection in young children.

Glomerulonephritis (GN) is a group of kidney diseases caused by the immune system that affect individuals at a younger age compared to other kidney diseases. GN affects millions of people worldwide, and in Canada, it’s the second leading cause of kidney failure.

For people with GN, treatment aimed at preventing kidney failure involves the use of medicines that lower the immune system.  These medicines have serious side effects, including the development of severe infections and cancers. Currently, doctors do not have a good understanding of which patients can benefit from more or less treatment, potentially leading to harmful over-treatment in some individuals and under-treatment in others.

By examining data from large groups of patients, we can better understand the factors that can cause some people to be more likely to reach kidney failure, as well as gain a better understanding of medication side effects and who can best benefit from treatment.

The goal of this project is to create and maintain a registry containing information from all patients with GN in Manitoba, which will improve our understanding of who gets GN and, their characteristics, including who progresses to kidney failure. Further, we will collect a blood and urine sample from each new patient undergoing a kidney biopsy. This will help identify new blood and urine tests which can tell doctors whether the patient needs more or less treatment.

This project will improve our ability to identify patients earlier in their disease and individualize treatment, reducing kidney failure risk while also reducing side effects, thus improving the care and quality of life for patients with GN.

Inflammatory bowel diseases (IBD) are serious and lifelong, affecting one in 150 Canadians. Current drugs used for IBD do not work in all patients, and they mostly block the immune system. This increases the risk of infection and can cause side effects.

Immune proteins called interferon(IFN)-lambdas are different. IFN-lambdas help gut health in IBD mouse studies, but studies about human IFN-lambdas in the gut are lacking.

We found that the IFN-lambda system does not work properly in people with IBD. This means a key part of the immune system needed for gut health may be missing in IBD patients. A safe IFN-lambda drug already exists for viral infections and could be used in IBD if we find out how it could be helpful.

To study IFN-lambda biology, we need to set up human gut biopsy methods. We can take biopsies during a regular colonoscopy and expose them to IFN-lambdas in the lab, instead of needing to test in animals or people first.

We will find out what kinds of gut cells respond to IFN-lambdas, and how these interactions affect gut health. Our long-term goal is to find out if IFN-lambda pathways can be promoted as a new and safe therapy for IBD to help heal the gut and decrease symptoms to promote remission without suppressing the immune system.

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Our emergency departments (EDs) are facing severe overcrowding issues and delays in timely care. To tackle this problem, we propose using artificial intelligence (AI) and machine learning to develop a data-driven patient flow model to help healthcare providers optimize resources, reduce wait times, and improve patient outcomes. This project makes a significant impact on several critical aspects of healthcare delivery, including:

• Reduced ED crowding and improved patient outcomes: The proposed model can potentially enhance the quality of care and overall patient outcomes by optimizing patient flow. For example, if our EDs can provide timely and appropriate care, patients will be less likely to face complications or require follow-up visits.
• More efficient use of resources: By identifying bottlenecks in the patient-flow process and optimizing resource allocation, the model can help healthcare providers make more efficient use of their resources, reducing costs and improving efficiency.
• Structured decision-making: The AI-based tool can help decision-makers make more informed and effective patient-care and resource-allocation decisions by using real-time data and predictive analytics.
• Better capacity planning: By predicting peak hours and allocating resources accordingly, the model can help healthcare providers plan for capacity needs more effectively, improving overall efficiency and reducing wait times.

We believe that the impact of this project is significant, and it has the potential to improve the quality of care, reduce costs and enhance the overall efficiency of healthcare delivery.

Given the significant and rapid increase in the number of children diagnosed with autism spectrum disorder (ASD), studies are needed to understand what factors could be contributing to this rise. A possible association between ASD and immigration has been studied in many countries, but not in Canada.

Concerned about a potential link between immigration and ASD in Manitoba, we recently completed a study that showed an over representation of immigrant families among children who were diagnosed with ASD at the primary site for evaluation of ASD in Manitoba. Since the information used for this study was taken retrospectively, we found limited information on immigration characteristics, family composition factors and educational outcomes.

We are now aiming to link our ASD data to the Manitoba Population Data Repository, which contains health, education, and sociodemographic (including immigration) data from all Manitoba residents. Using the Manitoba Population Data Repository, we will determine provincial-level differences in the number of ASD diagnosis between Manitoba children who belong to immigrants versus non-immigrants families. We will also compare demographic characteristics and the presence of associated medical diagnosis as well as kindergarten-readiness between them.

This will be the first study that looks at a possible link between immigration and ASD at a provincial level in Canada. We hope this work leads to a better understanding of how and what aspects of parental immigration may increase vulnerability to ASD so that interventions can be targeted to at-risk communities in our province.

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The COVID-19 pandemic has caused significant increases to the surgical backlog, with patients waiting months and even years for surgery. Men’s Health Clinic Manitoba has been created to be an outflow to the healthcare system. By diverting certain urologic surgical procedures out of hospital, the clinic helps unburden the healthcare system and make efficient use of the current main hospital resources for more invasive procedures.

We believe outpatient procedures are safe and effective for a number of urologic issues, with limited complications and visits to the healthcare system after a procedure (less than five per cent), with high rates of patient satisfaction.

We have been performing urologic procedures at the clinic since August 2022. In this study, we aim to determine the rate of post-procedure complications, healthcare visits and patient-related tolerability, as well as create a prospective registry that tracks all post-procedure complications and healthcare visits of all procedures performed at the clinic.

We anticipate that we will demonstrate a low rate of surgical complications and healthcare visits after procedures performed at the clinic (less than five per cent) with high patient tolerability (over 90 per cent). Additionally, by creating a prospective registry for complications and healthcare visits, this will allow us to ensure the safety of procedures performed at our facility in real-time and provide meaningful contributions to the literature.

Inflammatory bowel disease (IBD) affects 11,000 Manitobans. An estimated 40 per cent of people affected also have mental health disorders, including anxiety and depression, a rate that is significantly higher than in the general population.

The reason why both IBD and mental health disorders tend to appear together is unknown but thought to be related to genetics. Although there has been some success in understanding the genetic factors underlying each condition separately, understanding their co-appearance requires more powerful detection tools.

We propose a new statistical method that detects when a pair of genetic factors interact. It will also determine, how much having both factors increases the risk of an IBD patient developing mental health complications.

To discover these associations, we will use data from the UK Biobank, a large study from the United Kingdom of over 500,000 people. We will compare the genetics from participants affected by both IBD and mental health disorders with IBD patients without mental health complications, as well as with healthy controls.

To ensure the validity of our results, we will cross-check our findings in a similar cohort of patients from Manitoba. By identifying the genetic factors underlying complications in IBD, we can use these genetic factors to determine which IBD patients are at high risk of developing mental health disorders, leading to preventative measures or earlier treatment.

Chronic knee pain affects many people globally. Current treatments can be ineffective and/or very expensive. Ultrasound-guided nerve injection shows promise in alleviating this pain by delivering chemicals that kill nerves transmitting pain signals from the knee. However, ultrasound landmarks for these nerves and the spread of injected chemicals in tissue are not well understood.

To address this, we plan to find nerves of the knee joint in human cadavers using ultrasound-guided injection and dissection. We will preserve the cadavers using a method that maintains life-like tissue properties and allows the body to be imaged by ultrasound. We will inject a nerve-killing chemical mixed with a stain at five points around the knee, targeting nine different nerves. Then, the skin and muscles will be carefully cut open to reveal the areas stained by injections and nerves of the knee joint.

We aim to describe differences in the distribution of these nerves between people. We will evaluate the spread of the injected chemical in terms of its coverage over nerves and its leakage to surrounding structures. We’ll identify accurate injections that cover target  nerves, and we’ll determine which factors lead to inaccurate injections and potential leakage to neighboring structures.

The study's anticipated results will show how to use ultrasound on the nerves that transmit pain signals from the knee. We hope to demonstrate that ultrasound-guided nerve injections around the knee are effective and safe. This knowledge will encourage more physicians to use this treatment to relieve chronic knee pain for patients.

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