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.
Defining and designing a remote monitoring tool for CAR T-cell therapy patients in Canada
Effective at-home monitoring of patients after CAR T-cell therapy requires that patients are able to easily report vital data and symptoms to physicians frequently, fast and reliably; and that physicians are able to respond to these data effectively.
The purpose of our capstone project is to prototype an app to monitor patients for parameters associated with potential adverse effects of CAR T-cell therapy, including cytokine release syndrome, neurotoxicity, and infection.
Background
Chimeric antigen receptor (CAR) T-cell therapy is a cell-based immunotherapy that utilizes genetically modified T-cells to combat cancer (National Cancer Institute, 2022). The standard therapies for treating blood cancers such as lymphocytic leukemias and lymphomas involve radiation, high-dose chemotherapy, and often autologous stem cell transplantation (National Cancer Institute, 2022). Having failed standard treatment, many patients become eligible for CAR T-cell therapy, which uses the patient’s genetically modified T-cells to destroy their leukemia or lymphoma (Cordeiro et al., 2020). Specifically, CD19-directed CAR T-cell therapy targets the CD19 antigen, a surface protein found in lymphatic malignancies with a B-cell phenotype (Cordeiro et al., 2020).
Side effects of this cellular treatment can be severe and include long-term B-cell deficiency, substantial neurotoxicity, and Cytokine Release Syndrome (CRS) (Mcnulty, 2022). CRS is an inflammatory response caused by infused CAR T-cells (Cordeiro et al., 2020). Upon their activation, T-cells release proinflammatory cytokines that can lead to multiorgan dysfunction, which has previously been described as sterile sepsis (Cordeiro et al., 2020). Immune effector cell-associated neurotoxicity syndrome (ICANS) is a type of toxic encephalopathy that may cause tremors, confusion, and dysgraphia, and develops in 20 to 70% of patients within a median of 4–6 days after CAR T-cell infusion (Tallantyre et al., 2020).
After CD19 CAR T-cell infusion, symptom monitoring (temperature, blood pressure, and cognitive function tests), blood count checks, and diagnostic imaging are used to track symptoms and side effects for 30 to 40 days (Los-Arcos et al., 2020). This monitoring involves frequent hospital visits, which is costly for both the patient and the healthcare provider, and significantly impacts the patient’s quality of life (Chacim et al., 2022). There is a need to improve the current process for follow-up care after CAR T-cell therapy to reduce the burden of follow-up on the patients, physicians, and healthcare system, ultimately improving patient outcomes.
The purpose of the project is to develop a mobile phone-based application that will allow patients who have received CD19-directed CAR T-cell therapy to easily report symptoms and enable real-time remote monitoring of these patients by physicians after patients are discharged from the hospital. This study will address the following research question: What elements and functionalities should be included in a mobile phone application to provide effective data collection and remote monitoring of CAR T-cell therapy patients after discharge from the hospital?
The objective of this research project is to gather input on app requirements and functionality from CAR T-cell therapy patients and physicians through:
- interviews with patients and physicians to inform app development, and
- a survey to gather feedback on the app prototype from patients and physicians.
Project team
- Amena Ali
- Shayna Kay
- Kelly Oyiliagu
TRP supervisors
Watch their Capstone defense
Developing an implementation strategy for a systematic hepatitis C screening program in hospital inpatient units
This capstone project is in collaboration with the Toronto Viral Hepatitis Care Network (VIRCAN), a program based out of the Toronto Centre for Liver Disease that aims to address and eliminate barriers in the diagnosis and treatment of viral hepatitis.
Our research team brings together VIRCAN’s expertise and resources in viral hepatitis diagnosis and treatment with the Translational Research Program’s patient-centred approach to problem-solving, to develop a model of point-of-care hepatitis C screening that is well-aligned with patient needs and values and integrates effectively into existing clinical workflows.
Background
Hepatitis C virus (HCV) infection is an important health challenge in Canada that has been associated with more years of life lost than any other infectious disease. Left untreated, chronic HCV infection can result in liver cirrhosis, liver failure, and hepatocellular carcinoma. Currently, direct-acting antiviral (DAA) medications offer greater than 95% cure rates for HCV infection with limited side effects. However, HCV infections often remain asymptomatic until the development of advanced liver disease or liver cancer. As such, screening for hepatitis C is critical for enabling the opportunity to cure individuals of HCV before the development of advanced liver disease.
In Canada, there are significant gaps in the diagnosis and treatment of hepatitis C: in 2019, 25% of people who have ever had hepatitis C were not aware of their infection, and only 30% of people living with chronic hepatitis C were treated. To address these gaps, increased HCV testing and improved linkage-to-care are needed.
In order to address this public health challenge, this capstone project will support the potential introduction of a systematic point-of-care hepatitis C screening program in inpatient units at the Toronto General Hospital and Toronto Western Hospital, through the development of a proposed hepatitis C screening test model and strategy.
Project team
- Christina Wong
TRP supervisors
Enhancing Youth Engagement Through Measurement-Based Care
The purpose of this project is to enhance the implementation of Measurement-Based Care (MBC) within Youth Wellness Hubs Ontario (YWHO) Networks, with a focus on youth accessing counselling services.
Recognizing challenges in the standardized practice of MBC, this project aims to co-develop and evaluate a youth-friendly tool that fosters engagement and shared decision-making of youth in MBC.
By actively involving youth advisors and employing a comprehensive methodology, the project seeks to improve treatment engagement, increase MBC uptake, and ultimately enhance the quality of counselling services for youth within the YWHO Networks.
Background
This project addresses the challenges surrounding the implementation of Measurement-Based Care (MBC) within the Youth Wellness Hubs Ontario (YWHO) Networks, particularly focusing on integrated counselling services for youth aged 12-25. MBC, the routine use of validated measures to tailor treatment and promote shared decision-making, faces low rates of implementation in practice. The project’s inception stemmed from a comprehensive environmental scan, including a preliminary survey of youth with lived/living experience accessing counselling services. Despite familiarity with MBC, respondents expressed a lack of understanding of its impact, highlighting a crucial gap in engagement.
The YWHO’s Integrated Youth Services (IYS) model, aimed at delivering timely and relevant services, forms the contextual framework for the project. MBC is a vital tool used within IYS, especially in counselling. The project’s overarching goal is to design and evaluate a tool that bridges the identified gaps in youth engagement with MBC. This youth-friendly tool seeks to foster dialogue, active involvement, and shared decision-making in counselling. The expected beneficiaries encompass YWHO partners, including clients, families, staff, and policy makers, with the potential to positively impact health outcomes and service delivery.
The environmental scan, involving a preliminary survey distributed through community networks and organizations, provided valuable insights. Contrary to assumptions that low implementation of MBC was due to youth’s lack of understanding or interest, youth respondents understood the purpose of and were interested in MBC, but reported feeling disconnected from the processes and its impact on their counselling journey. This underscored the need for a targeted intervention to enhance youth engagement in MBC practices. The project’s methodology involves the active participation of youth, youth advisors, and project partners, aligning with the collaborative spirit ingrained in the culture of YWHO.
Together with youth advisors with lived/living experience of accessing counselling services, a tool will be co-developed to foster engagement and shared decision-making in MBC. To understand if the tool may be effective in increasing engagement in care, this tool will be evaluated with a survey and focus groups with youth aged 12-25 who report having accessed counselling services at YWHO presently or in the past. Counsellors who provide counselling services at YWHO will also be asked to evaluate the tool through a survey. The findings of the survey and focus groups will be used to refine the tool for implementation in counselling services at YWHO and wider dissemination.
In summary, this project represents a significant step towards enhancing the quality of counselling services for youth within the YWHO Networks. By co-designing and evaluating a youth-friendly tool, the project strives to empower youth in their counselling experiences, fostering a culture of shared decision-making and improved treatment engagement. The findings are expected to contribute not only to individual treatment plans but also to the broader body of evidence on youth perspectives within integrated youth services in Ontario.
Find out more
Read about the team presenting their research at the #FRAYME2024 Learning Institute.
The team won 'Best poster: Translational Research Program (TRP)' at the Laboratory Medicine & Pathobiology Research Conference (LMPRC) 2024: find out more about award winners.
Project team
- Brianna Dunstan
- Matthew Prebeg
- Izzar Linares
TRP supervisors
Watch their Capstone defense
Fall risk assessment at a geriatric rehab hospital
The Fall Risk Screening Tool (FRST) used at Providence Healthcare (PHC) does not accurately reflect the risk profile of older patients who may be the most likely to fall post-admission.
Background
The objective of this study was to identify gaps in and to improve the falls prevention strategy (FPS) of an inpatient rehabilitation facility (IRF) in Toronto, Canada.
Project team
- Catherine Rivers
- Haley Roher
TRP supervisors
See our community directory for more on committee members.
Increasing Awareness of Functional Neurological Disorder (FND) among Various Stakeholder Groups to Enhance Patient Care
Through our capstone, we aim to improve the knowledge and perceptions of various stakeholders regarding FND, assess gaps in FND care, and determine areas for collaboration and support ultimately for the benefit of this severely underserved population.
Background
Functional Neurological Disorder (FND) is the most common neurological diagnosis that you might have never heard of. It is the 2nd most common reason to see a neurologist, representing up to one-third of outpatient Neurology visits. Unfortunately, society at large and many healthcare providers lack awareness regarding this highly stigmatized and misunderstood disorder, contributing to further distress of patients and families.
Patients with FND often exhibit a combination of various neurological symptoms from motor and sensory deficits to seizures and cognitive decline that are not compatible or congruent with other known medical conditions. The hallmark of FND is its fluctuating or waxing and waning pattern of symptoms, resulting from abnormal communication of neural networks. As symptoms of FND come and go, patients are unfortunately suspected to be malingering or faking their symptoms.
Diagnosis relies on clinical assessment by a limited number of FND-trained experts in Neurology and Psychiatry. As a result, the majority of patients endure a lengthy diagnostic journey (6-8 years), perpetuating patients’ diagnostic uncertainty and feelings of invalidation, while increasing healthcare utilization and costs.
A family member of a patient with FND has told us, “When you’re diagnosed with Parkinson’s, the world is kind to you. When you’re diagnosed with FND, the world is not nice to you,” reflecting the various medical, psychosocial, economic, and systemic issues surrounding FND.
Project team
TRP supervisors
See our community directory for more on committee members.
Invasive Placentation
Few opportunities exist for healthcare professionals who provide maternity care to gain expertise in invasive placentation.
Background
Management of invasive placentation is medically and surgically complex. As such, it is primarily performed in high-risk tertiary care centres, which limits the opportunities for healthcare professionals to gain experience and expertise in the diagnosis and management of this condition.
Project team
- Kate Kazlovich
- Julia Kfouri
- Conner Janeteas
TRP supervisors
See our community directory for more on committee members.
MedMarket Mavericks
We want to help patients. There are numerous patients with horror stories about the care available within our country, and there are many individuals that partake in medical tourism to receive the best possible care for their illness.
We want to reduce that medical disparity between our country and the wider world. Patients within Canada should be able to access the best possible care that exists. Often, patients are fighting for their lives. We want to help and give them a fighting chance.
Background
The healthcare system is rampant with challenges, from the emergency room to the doctor’s office. Everyone involved is doing their best to improve the lives of thousands to millions of patients in Canada. With ongoing conversations that our healthcare system is heavily strained, there needs to be pathways that allow for the adoption of proven, and better health innovations into our healthcare system.
Different healthcare systems have specific rules, regulations, and nuances that are not readily apparent to new market entrants. We decided to focus on Ontario, as it is the most populous Canadian province and a major health innovation hub. Furthermore, we hope to leverage the expertise within the province to connect and collaborate with stakeholders to help address the issue of startup procurement within Ontario.
We will create design requirements which reflect the needs that the final intervention must address to be successful. These design requirements will be created through a co-design process with stakeholders from startups, startup supporting organizations, healthcare organizations, and procurement organizations. With key players and decision makers able to ideate on the challenges of startup procurement, we hope to filter out the “wants” and hone down on underlying needs.
Contact us if you are interested in having a discussion!
Inclusion criteria
1. Leadership from small and medium-sized start-ups in Ontario that have a market-ready product and have passed verification and preliminary trials and testing. This includes:
- Start-ups with current or previous attempts at adoption by Ontario healthcare organizations regardless of their success
- Start-ups with a medical device and/or digital health solutions
2. Individuals from start-up supporting organizations operating in Ontario including:
- Start-up incubators, or accelerators ex: H2I, MaRS DD, CanHealth, OBIO
3. Individuals from Ontario healthcare organizations involved in the procurement process:
- Procurement teams, or decision-makers at healthcare organizations such as hospitals
- Individuals from group purchasing organizations or procurement experts
Exclusion criteria
- Start-ups without a market-ready product and larger well-established companies that no longer face the challenges of small or medium-sized start-ups
- Healthcare organizations outside of Ontario or start-ups outside of Ontario
- Start-ups with biotechnology and drug solutions, and consumer health products and solutions are excluded from this study.
Project team
- Zoya Aziz Bhatti
- Derek Sheunghei Choi
TRP supervisors
Optimizing Patient Experiences in Ketamine-Assisted Psychotherapy: A Journey Mapping Approach
Accessing ketamine-assisted psychotherapy for treatment-resistant depression is hindered by stigma, high costs, and fragmented care pathways. Additionally, there is a critical lack of data on patient experiences during ketamine-assisted psychotherapy, making it challenging to optimize care. Our project addresses this need by using patient journey mapping to systematically capture the experiences of individuals undergoing ketamine-assisted psychotherapy, identify barriers, and co-create strategies to enhance accessibility, care quality, and patient outcomes.
Background
Ketamine-assisted psychotherapy offers a transformative treatment for individuals with treatment-resistant depression. Despite its promise, many patients face significant barriers, such as stigma, limited provider knowledge, and high costs. Our project bridges this gap by focusing on patient journey mapping, a visual and qualitative method that captures patient experiences across the care pathway—from initial awareness of ketamine-assisted psychotherapy to post-treatment integration.
The study involves two phases:
- Phase One: Conducting semi-structured interviews with individuals undergoing or having undergone ketamine-assisted psychotherapy to create patient journey maps.
- Phase Two: Hosting a collaborative workshop with healthcare providers within the ketamine or psychedelic therapy field to translate findings into actionable, patient-centered strategies.
This study combines qualitative insights with expert collaboration to propose strategies for improving overall patient satisfaction, enhancing accessibility, and fostering tailored and equitable mental health care. The outcomes will guide advancements in ketamine-assisted psychotherapy and inform best practices for psychedelic-assisted therapies in Ontario and beyond.
Project team
TRP supervisors
See our community directory for more on committee members.
PAT-a-CAKE: Pediatric Assessment Tools and Clinical Advances in Kids Evaluation
Evaluating the methods used by physicians, nurses, and physician assistants for assessing pain in pediatric patients.
Background
Pain is a universal and distressing experience for hospitalized children, with lifelong implications if inadequately recognized or managed. Timely and accurate pain assessment is essential in pediatric emergency departments (EDs) to guide appropriate interventions, alleviate suffering, and lower the risk of both immediate and long-term psychosocial repercussions.
At present time, there is limited evidence describing the actual pain assessment practices within pediatric EDs in Ontario, and no data on the degree to which recommended protocols are being followed at Humber River Hospital. Without a clear understanding of the current state of practice and the factors driving variations in care, the development and implementation of effective quality improvement initiatives are hindered.
The proposed study would identify existing pain assessment procedures for children ages two to twelve who arrive at the emergency room of Humber River Hospital in order to fill this important knowledge gap. This project will investigate the explicit and implicit factors impacting adherence to recommended guidelines using qualitative methodologies with a varied range of healthcare practitioners, including physician assistants, nurse practitioners, and physicians. Through examining these concerns from the perspectives of healthcare professionals, this study seeks to pinpoint the obstacles and enablers that impact clinical judgment, the choice and application of standardized instruments, and the recording of pain assessment procedures. Ultimately, the insights received will inform the development of tailored interventions and support evidence-based improvements in pediatric pain assessment practices, ensuring more consistent and effective pain management for children in the emergency care setting.
Project team
TRP supervisors
See our community directory for more on committee members.
Perineal Model with 4th-Degree Tear for Obstetrics Resident Training
Severe perineal tears are rare events, making it difficult for residents to receive adequate training.
Background
Up to 65% of vaginal deliveries are complicated by some form of tear or episiotomy. Severe tears can lead to long-term complications; however, they are rare enough that residents have few opportunities to receive training from experienced obstetricians. Residents who receive simulation-based training have improved performance, but we do not currently have a model for 4th degree perineal tears.
Project team
- Shirley Hutchinson
TRP supervisors
See our community directory for more on committee members.