Capstone research projects database
The Capstone research project is where students work on real-world issues.
See the Capstone projects TRP students have worked on over the years.
A framework for applied AI in Healthcare
This project examines barriers to implementing AI decision-aids in clinical care and proposes a framework and interface design to support adoption in healthcare settings.
Background
As technology advances and the use of artificial intelligence (AI) technology is adopted in various fields, there are increasing efforts to develop AI technology for healthcare applications to improve care delivery and patient outcomes. However, there are few examples of AI technology currently being used in clinical settings. Thus in the formation of this project, the team wanted to understand why this disparity exists. The objective of this project is to explore the challenges and considerations for implementing AI predictive technologies in clinical settings. To explore this problem space, the team surveyed the academic and grey literature, and consulted with subject-matter experts. With this broadened understanding, the current and desired states of the problem space were established and existing gaps defined. To further explore these gaps, a qualitative research study with primary stakeholders and user-centered design tools were used to frame the elements at play in the specific context of an AI risk prediction tool for use as a clinician decision-aid. Learnings from stakeholder perspectives were synthesized as the project entered its ideation phase, where a preliminary framework for implementing AI decision-aids into clinical setting was developed and a user interface for an example of an AI decision-aid was designed.
Project team
- Paige Gilbank
- Kaleigh Johnson-Cover
- Tran Truong
TRP supervisors
Project advisory committee
- Jennifer Bell
- Jennifer Jones
- Mike Carter
- Greg Jamieson
See our community directory for more on committee members.
A Journey of Re-Search and Re-Discovery: Lessons Learned in Reflexivity, Reciprocity, and Relationship Building
This project reflects on the challenges and ethical imperatives of implementing a digital heart failure program in partnership with Indigenous communities through a decolonizing, community-led research approach.
Background
“From an Indigenous research perspective, the relational is viewed as an aspect of methodology whereas within western constructs the relational is viewed as bias, and thus, outside methodology.” Margaret Kovach, Conversational Method in Indigenous Research; Bringing the cardiovascular disease burden in the Indigenous population in line with other Canadians by 2020 was one of the five targets set by the 29-member Steering Committee overseeing the Canadian Heart Health Strategy and Action Plan in 2009 (Smith, 2009). While the prevalence of cardiovascular disease and associated risk factors have decreased among the general Canadian population since this report was published, Indigenous Peoples (First Nations, Inuit, and Métis) in Canada continue to experience a growing burden of cardiovascular disease morbidity and mortality (Donio et al., 2019; J. Reading, 2015; Smylie, Firestone, & Spiller, 2018). In the Fall of 2019, a team from the Peter Munk Cardiac Centre was invited to visit the Weeneebayko Area Health Authority with the intention of forming a partnership to increase equitable access to heart failure care. The need for forming such a partnership appeared to be clear and well-defined: First Nation communities in the Weeneebayko region are more likely to have a history of heart failure than Ontario residents in every age group with limited access to timely diagnostic and specialized services (Mamow Ahyamowen, 2020; Office of the Auditor General of Canada, 2015).
We hypothesized that digital health interventions developed at the Peter Munk Cardiac Centre could offer a way by which to improve health and health access to heart failure care. Upon return to Toronto, preparations were made to initiate a clinical care partnership between the Peter Munk Cardiac Centre and the Weeneebayko Area Health Authority supported by the use of the Medly Program. The Medly Program is a remote monitoring program that enables heart failure patients to self-monitor and connect with their care team virtually (Ware et al., 2019). Our expectation was that patients enrolled in the Medly Program in the Weeneebayko region would demonstrate improvements in quality-of-life and self-care, reproducing results from previous evaluations completed at the Peter Munk Cardiac Centre (Ware et al., 2020). The aim was to perform user-centred design to adapt the Medly Program as deemed necessary for heart failure patients in the Weeneebayko region. Further plans were made to visit in March 2020 to meet with health care providers and community members. Even the best laid plans do not always work out the way they are intended to. With the onset of the COVID-19 pandemic, strict infection prevention and control measures were put in place by regional public health authorities and our team was prevented from any further visits to the Weeneebayko region.
However, in the midst of every crisis, one must try and find opportunity. Afforded the time to reflect, did our proposed approach respectfully consider the societal and historical impacts of colonization that has led to widening health disparities in the Indigenous population? Was the imposition of such technology an extension of Canada’s colonial history in proposing a solution rooted in Western ontological and epistemological paradigms? Were we taking a decolonizing approach to the research process that would restore power and control to the communities in the Weeneebayko region, or was the research process extractive in nature? Finally, whose research agenda were we promoting? We use the terms Re-search and Re-discovery to illuminate a learning continuum within this report. We accept our own cultural biases and seek to produce knowledge in a true spirit of reconciliation that aims to decolonize the research process with Indigenous communities by placing Indigenous voices and epistemologies at the centre. We describe the challenges, competing interests of academia, and the steps that are necessary through the application of community-based participatory research principles to conduct research that reflects a sincere investment in the community. In addition to ongoing efforts with the Weeneebayko Area Health Authority, we also highlight how these principles have been successfully applied in achieving the signing of a Relationship Accord with Nishnawbe Aski Nation and devising a framework for the implementation of a strategic plan between the Indigenous Health Program and Peter Munk Cardiac Centre at the University Health Network.
Project team
- Yasbanoo Moayedi
- Kailey Steinhausenm
- Stefan Superina
TRP supervisors
Project advisory committee
- Heather Ross
- Melanie Jeffrey
See our community directory for more on committee members.
A Pilot Study of Cystic Volume Reduction by Foam Sclerotherapy in Autosomal Dominant Polycystic Kidney Disease
Tolvaptan is not able to address existing cyst burden in patients with autosomal dominant polycystic kidney disease (ADPKD).
Background
ADPKD is the most common inherited kidney disorder worldwide with a prevalence between 1:400 and 1:1000. Patients eventually develop kidney failure and require dialysis.
Tolvaptan is the only treatment approved in Canada. Tolvaptan reduces further growth of cysts but does not reduce the cyst burden. Foam sclerotherapy is a novel treatment able to permanently shrink the size of cysts with minimal reported side effects.
From 2014 to 2016, more than 60 patients underwent an experimental foam sclerotherapy procedure at Toronto General Hospital (TGH) with promising results!
Project team
- Dr. Ioan-Andrei Iliuta
TRP supervisors
Project advisory committee
- Dr. Anna Gagliardi, Senior Scientist, Toronto General Hospital Research Institute (TGHRI)
- Dr. Eran Shlomovitz, Assistant Professor, University of Toronto Department of Surgery
- Dr. York P-C Pei, Senior Scientist, Toronto General Hospital Research Institute (TGHRI)
See our community directory for more on committee members.
Access to Upper Limb Reconstruction for Cervical Spinal Cord Injury: Understanding and Addressing Healthcare Provider Barriers
This study explores healthcare provider barriers to upper extremity reconstruction in cervical spinal cord injury (SCI) and designs a prototype intervention to improve access.
Background
There are an estimated 25,000 people with traumatic cervical spinal cord injury (SCI, tetraplegia) living in Canada, with nearly 800 new injuries each year.1 The average lifetime cost of cervical SCI is estimated to be $3 million CAD per person, with an annual cost of $2.7 billion CAD across Canada.2 People living with cervical SCI have identified improvement of upper limb function as a top priority over other essential functions like bowel and bladder function.3–5 Upper limb reconstructive surgery has the potential to substantially improve quality of life and independence, and reduce caregiver burden as well as personal and societal costs. Options include traditional tendon transfer techniques and novel nerve transfer surgery. Nerve transfers provide unique advantages including a less restrictive rehabilitation program and the ability for a single donor nerve to restore more than one function.6 While small gains in upper extremity function can occur with rehabilitation during the first year after injury, nerve and tendon transfer surgery is currently the only successful, widely translatable, safe, and affordable treatment option to improve upper limb function in cervical SCI. Unfortunately, surgery to improve upper limb function in this population remains severely under-utilized around the world.7 In the United States, 10-14% of individuals that would benefit from upper limb reconstruction receive care.8 Utilization in Canada is unknown, but hypothesized to be similarly low. Previous studies of tendon transfer surgery in SCI have highlighted a complex array of interrelated individual-, provider- and system-level barriers that prevent people with cervical SCI from accessing upper limb reconstruction.9 Barriers to nerve transfer surgery have not been widely studied. While some barriers to tendon transfer surgery are applicable to nerve transfer surgery (poor interdisciplinary working relationships, lack of specialized centres), nerve transfer surgery has unique advantages, challenges, and post-operative rehabilitation programs that individuals with cervical SCI and healthcare providers may consider differently. The overall aim of this project is to establish the current landscape of upper extremity reconstruction (UER) in Canada, understand and verify healthcare provider barriers that may be preventing utilization of UER, and design a prototype of an intervention to help address one of these barriers. “Healthcare providers” include all those that interact with the cervical SCI patient along their care journey: physical medicine and rehabilitation physicians, occupational and physical therapists, social workers, psychologists, general practitioners, neurosurgeons, urologists, orthopedic surgeons, plastic surgeons and other allied health professionals.
Project team
- Jana Dengler
- Maytal Perlman
- Michelle Jennett
TRP supervisors
Project advisory committee
- Sander Hitzig
- Melanie Barwick
- Anita Kaiser
- Kristen Musselman
See our community directory for more on committee members.
Acute myeloid leukemia research in the era of advanced genetic sequencing: an exercise in knowledge translation
The identified need is the reduction of occurrence of relapse of acute myeloid leukemia (AML) following allogeneic hematopoietic cell transplantation (HCT), as the prognosis of this patient group is very poor.
Background
Allogeneic hematopoietic cell transplantation (HCT) may offer survival benefit to patients with acute myeloid leukemia (AML) (Koreth et al, 2009, Cornelissen et al, 2007). A major challenge when treating AML patients with allogeneic HCT is disease relapse, with a one-year post-relapse survival less than 20% (Devillier et al, 2013).
An even bigger challenge is predicting relapse, as AML is a genetically complex disease and there are currently no widely established sensitive tools.
The gold standard for determining treatment response in AML is by microscopic examination of bone marrow and assessment of irregular, immature “blast” cells, with less than 5% blasts considered to demonstrate remission.
Leukemia-associated immunophenotypes (LAIPs), which are defined at diagnosis by multi-parameter flow cytometry (MFC), can be used for monitoring in patients with AML (Kern et al, 2010).
Studies using MFC on marrow samples pre-allogeneic HCT show that any level of detectable minimal residual disease (MRD) is associated with an increased risk of relapse (Walter et al, 2013). However the routine use of MFC may be complicated by issues such as the possible shift in antigen expression post-allogeneic HCT as well as the issue of standardization of the method in that particular setting.
Project team
- Frank Michelis
TRP supervisors
AID Parkinson’s Disease Patients: Decreasing psychological stress associated with the recent diagnosis of PD
Parkinson’s Disease (PD) is a movement disorder that affects the nervous system. Its symptoms occur due to low dopamine levels in the brain. Symptoms tend to worsen over time, but the disease progression can vary among patients. Thus, the unexpected nature of PD is associated with a decline in mental health. Such disease uncertainties raise questions of what the future may hold for these patients in terms of disease diagnosis, prognosis, treatment outcome, functional decline, and how it may adversely affect their career. Thus, patients become apprehensive and anxious about the future.
We found three gaps and problems in our in-depth search for the root cause of heightened psychological stress of recently diagnosed PD patients. The problems are:
- diagnostic uncertainties of the disease
- prognostic uncertainties
- uncertainty of treatment outcomes.
The next problem is prognostic uncertainties related to the uncertainty these patients may have regarding the accumulative damage their unique disease progression may yield - whether that damage be personal, professional, or social difficulties. Among these problems, we chose to focus on prognostic uncertainties as our main problem to the possibility of further exploration of this problem, possible interventions, and resulting tangible outcomes.
Background
Our project aims to broaden our understanding of the experience of recently diagnosed PD patients. We aim to delve deeper into the etiology of the main stressors affecting recently diagnosed PD patients. One of these main stressors that we have identified through conducting several discussions with key stakeholders is the prognostic uncertainties associated with the recent diagnosis of the disease.
Project team
- Azadeh Bojmehrani
- Yasmin Aboelzahab
- Yomna Elsheikh Ahmed
TRP supervisors
Project advisory committee
- Ms. Heather Beim, Employer Liaison to provide service to new Canadians
- Dr. Connie Marras, Faculty Member, Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto
- Dr. Heather Boon, Vice-Provost, Faculty & Academic Life, University of Toronto
See our community directory for more on committee members.
Anestheffi Optima: Prototyping the use of a Digital Assistant to Improve Pre-Anesthesia Clinic Efficiency and Experience for the Obstetrical Population
At the heart of academic hospitals, we’re on a mission to transform the Pre-Anesthesia Clinic setting. Our focus is to enhance workflow efficiency to lift the burden from Anesthesiologists and amplify patient satisfaction. We’re not just reimagining; we’re revolutionizing.
We propose integrating “Patient Empowerment Resources” through a Large Language Model tailored and designed for this specific purpose. By uniquely delivering easily accessible resources through a Digital Assistant in the PAC, we aim to enhance the patient experience and reduce the workload of healthcare professionals.
Project team
- Dr. Elio Belfiore
- Shalini Jaisankar
TRP supervisors
Project advisory committee
- Dr. Daniel McIsaac, Professor, University of Ottawa
- Dr. Angela Jerath, Associate Professor, Department of Anesthesiology and Pain Medicine, University of Toronto
- Dr. Fabricio Zasso, Staff Anesthesiologist at Mount Sinai Hospital, Assistant Professor in the Department of Anesthesiology and Pain Medicine, University of Toronto
See our community directory for more on committee members
Assessing the implementation of TickiT® during group clinic sessions with patients who have neonatal brachial plexus injury (NBPI): a quality improvement study
Lack of consistency in how the tool was introduced into the clinic and evaluated over time in terms of its feasibility - It was often unclear how the clinicians would use TickiT® to improve or inform clinical practices in terms of translating the survey results into actions or innovations in their clinic area.
Background
This quality improvement (QI) study assessed the implementation of TickiT® (the pre-clinic survey) using an observational approach to learn of facilitators and barriers associated with e-health adoption and to identify areas of improvement. Observations were performed during three NBPI clinics.
Results showed that TickiT® was adopted gradually overtime and that someone acting as an early facilitator was instrumental in encouraging clinician engagement with the tool. Barriers and facilitators to e-health implementation should be considered before initiating the adoption of a novel tool.
Project team
- Beth Cruchley
TRP supervisors
Assessing the Usability of DataDay - A Self-Management App for Individuals with Mild-to-Moderate Dementia and Mild Cognitive Impairment (MCI)
Many people living with dementia and MCI manage their condition at home without ongoing access to health services, resulting in poorer health outcomes, loss of empowerment, and caregiver burden. Notably, people living with mild-to-moderate dementia & MCI lack effective tools to self-manage their condition.
Therefore, there is a need for an evidence-based tool that enables patients to self-manage their condition and improve their quality of life.
Our study aims to assess the usability of DataDay, a self-management application, and its ability to improve the quality of life of people living with mild-to-moderate dementia or MCI and their caregivers.
Background
Over 55 million people are living with dementia globally, with this number expected to reach 139 million by 2050 - 1.7 million of which will be in Canada. Therefore, accessible tools for daily support are more crucial than ever.
Dementia and MCI impacts memory and daily functioning, making consistent self-management difficult. Many individuals manage their condition at home, often seeking healthcare only in times of crisis, increasing their risk of hospitalization and emergency room visits. These acute care visits are often associated with a greater risk of poor health outcomes related to delirium, behavioural problems, reduced physical function, and increased mortality.
DataDay is a digital self-management app developed by Dr. Arlene Astell at the Dementia Ageing Technology Engagement (DATE) Lab. It aims to provide daily support to people living with mild-to-moderate dementia or MCI in order to slow decline and dependency, subsequently improving the quality of life and autonomy of patients and their caregivers.
The app combines the Novel Assessment of Nutrition and Ageing, or NANA, toolkit with ReMind, a reminding and scheduling app co-created with people with dementia. DataDay consists of four modules, each featuring games and data entry logs to track cognition, physical activity, mood, and nutrition.
To test the current iteration of DataDay, we conducted a 6-week longitudinal intervention study in which patient-caregiver dyads used the app and provided feedback. We subsequently conducted focus groups with caregivers to enrich our findings of the barriers and facilitators to the DataDay's use. Lastly, we created a comprehensive guide on inclusive research in individuals living with dementia and MCI, using DataDay and the Toronto Translational Thinking Framework.
Project team
TRP supervisors
Project advisory committee
See our community directory for more on committee members.
Assisting IBD Mothers on Breastfeeding
To develop a patient-centric educational tool that provides information and resources that can aid mothers with Inflammatory bowel disease (IBD) in breastfeeding.
Project team
- Stella Rho
TRP supervisors
Project advisory committee
- Dr. Peter Habashi, Director, IBD Clinic at Mount Sinai Hospital
- Laura Bradbury, Nurse Practitioner and Psychotherapist
- Keri-Ann Berga
See our community directory for more on committee members.