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.
Autism Spectrum Disorder in Children with Down Syndrome: Perspectives and Experiences of Healthcare Practitioners and Caregivers in Canada
Early intervention is essential for children diagnosed with both Down Syndrome (DS) and Autism Spectrum Disorder (ASD); a condition known as DS-ASD. However, the complex challenges involved in distinguishing ASD in the presence of DS often lead to significant diagnosis delays.
This study aims to identify the factors contributing to diagnosis delays within the Canadian healthcare system and seeks to explore physicians’ current practices regarding DS-ASD and understand the challenges faced by caregivers. As a mother of a child with DS, my advocacy for equitable healthcare is driven by personal experience and commitment to research in the field.
Background
Autism Spectrum Disorder (ASD) and Down Syndrome (DS) are independently well-documented, each with distinct developmental trajectories. However, the cooccurrence of ASD in individuals with DS, known as DS-ASD, remains under-researched and poorly understood. Recent findings indicating a higher prevalence of ASD among children with DS challenge prior views that these two conditions are mutually exclusive and emphasize the need for more focused research in this area.
A significant concern is the delay in diagnosing ASD in children with DS compared to their neurotypical peers. Neurotypical children are diagnosed with ASD around the age of three. However, children with DS tend to be suspected of having ASD between the ages of 4-5 and are often not diagnosed until around the age of 10. This delay can result in critical missed opportunities for early interventions, which are most effective at an early age. The delay in diagnosing ASD is multifaceted, involving factors such as overlapping symptoms leading to diagnostic overshadowing, where behaviors typical of ASD are mistakenly attributed to DS; a lack of specialized training among healthcare professionals about DS-ASD cooccurrence; and a lack of ASD screening tools that accommodate the unique presentation of children with DS, often leading to underdiagnosis or misdiagnosis.
Without a timely diagnosis of ASD, children with DS are at risk of exacerbated behavioral problems and increased difficulties in communication and social interactions, impeding their educational and personal development. Addressing these challenges requires increased awareness, early and accurate screening, and tailored interventions to ensure that children receive the support they need on time.
This study adopts a comprehensive approach by integrating insights from both caregivers and healthcare professionals, offering a more complete understanding of the challenges and dynamics within the Canadian healthcare context. The objectives are threefold: 1) Identify the obstacles healthcare practitioners encounter in diagnosing ASD in children with DS; 2) Assess their awareness of DS-ASD cooccurrence; and 3) Examine the experiences of caregivers navigating the diagnostic and care pathways for children with cooccurring DS-ASD.
Project team
- Dr. Julija Atanasova
TRP supervisors
Project advisory committee
- Dr. Jennifer Crowson, President, Canadian Down Syndrome Society
- Dr. Kerry Boyd, Associate Clinical Professor, Department of Psychiatry & Behavioural Neurosciences, McMaster University
- Dr. Rudaina Banihani, Developmental Pediatrician Sunnybrook Hospital; Assistant Professor University of Toronto
See our community directory for more on committee members.
Watch Dr. Atanasova's Capstone Defense presentation
Black Women Health Equity – Perinatal Health
The term health equity follows as the pursuit for the removal of avoidable health disparities from affected populations, particularly Black communities within this context. Canada does not track race-based health data (Canadian Institute for Health Information, 2020). Other countries like the United Kingdom and the United States that have a large percentage of the African diaspora and other communities of people of colour (POC) that may be impacted by social and systemic structures use race data to analyze health disparities disproportionately affecting these populations.
Without access to data that underscores the severity of the disparities, it is impossible to gain an understanding of predispositions to certain diseases, lower screening rates, and increased morbidity and mortality within these populations. Therefore, there is a need for more studies examining the intersection of race in health outcomes to understand Canadian health disparities for the Black population.
In a study comparing preterm birth rates between women of different races in the US and Canada, researchers found that Canadian women were less at risk of preterm birth than women in the US. However, even though there was a decreased risk overall in Canada for both Black and Caucasian women compared to the US, the disproportionate risk of delivering a preterm infant for Black women in the US was mirrored in Canada.
The purpose of this project:
- To bring awareness to Black health issues in a Canadian context
- To highlight health disparities experienced by the Black Canadian community
- To push for more studies that include racial data in health contexts
- To educate non-Black Canadians about the health disparities experienced by Black communities
Find out more
TRP Alumni Create Self-Advocacy Handbook for Black Patients Navigating Perinatal Care
Project team
- Gabrielle Retta
- Gemma Kabeya
TRP supervisors
Project advisory committee
- Ms. Althea Jones, Founder, CEO, Registered midwife, Ancestral Hands Midwives and Womb & Wellness
- Dr. Notisha Massaquoi, Assistant Professor, Department of Health and Society, University of Toronto, Scarborough
- Dr. Sume Ndumbe-Eyoh, Assistant Professor, Dalla Lana School of Public Health at the University of Toronto
See our community directory for more on committee members.
Cancer Outpatient Nutritional Status
Despite the existence of nutrition education programs, many cancer patients are not implementing recommendations into their daily lives.
Background
Nutrition plays a key role in the recovery and treatment experience for cancer patients. Multiple programs exist in Toronto to educate patients as to what they should eat to improve their recovery. These programs also provide meal preparation tips that consider treatment side effects, ingredient seasonality, convenience, and more.
Project team
- Julia Antolovich
- Razan (Rosie) Bouzeineddine
- Craig Madho
- Kathleen Mounce
TRP supervisors
See our community directory for more on committee members.
Community Engagement in Lower Central Hamilton: Resident Health Needs and Key Considerations for the Delivery of Health and Social Services
In Lower Central Hamilton (LCH), a region in Hamilton, Ontario, residents are disproportionately affected by the social determinants of health (SDH).
This project aims to understand the health needs of LCH residents and key considerations that facilitate the context-appropriate and sustainable delivery of health services in this community. This research enhances ongoing initiatives aimed at improving the health and social outcomes of LCH residents through engagement at the neighborhood level.
Project team
- Carolyn Kelly-Ruetz
- Subiksha Nagaratnam
- Morgan Porteous
TRP supervisors
Comprehensive perioperative care program to improve same-day discharge after minimally invasive gynecologic oncology surgery (MIGOS)
A quality improvement program significantly increased same-day discharge rates after minimally invasive hysterectomy from 29% to 75% at a cancer centre without compromising safety or patient experience.
Background
Objectives: Same-day discharge (SDD) after minimally invasive hysterectomy for gynecologic conditions has been shown to be safe and feasible, but remains challenging to implement. We designed and implemented a quality improvement perioperative program to improve SDD rate from 30% to 75% over a 12-month period.
Methods: We included 102 consecutive patients undergoing minimally invasive hysterectomy at a single cancer centre during the 12-month implementation period. A historical cohort of 100 was identified for comparison of clinicodemographic variables and discharge outcomes. A team of gynecologic oncologists, anesthesiologists, and nurses developed a comprehensive perioperative care program based on Early Recover after Surgery (ERAS) principles and met bi-weekly for plan-do-study-act (PDSA) cycles. Patients were followed for 30 days after discharge. We used a run chart to monitor the effects of our interventions on outcomes and conducted a pre-post analysis to evaluate SDD rates and perioperative outcomes.
Results: Median SDD rates increased from 29% to 75% after implementation (p Conclusions: Following implementation of a perioperative quality improvement program targeted towards minimally invasive gynecologic oncology surgery, our interventions significantly improved SDD rates while maintaining low 30-day perioperative complications and excellent patient experience.
Project team
- Rachel Soyoun Kim
TRP supervisors
Project advisory committee
- Dr. Andrea Simpson, St. Michael's Hospital
- Dr. Tomer Feigenbert, Credit Valley Hospital
See our community directory for more on committee members.
Considerations for the reimbursement of Pharmacogenomic testing in Ontario Psychiatry
This report examines the potential of pharmacogenomic testing to improve psychiatric care in Ontario, highlighting patient experiences, clinical utility, and policy considerations for future reimbursement strategies.
Background
For 34-year-old Gwen1, a long-time patient of Ontario, Canada’s mental healthcare services, genetic testing was a final hope: “I was diagnosed nearly 12 years ago during a dark and scary time. Over the next decade, I tried every treatment imaginable – including dozens of medications and electroconvulsive therapy – before running out of options. I felt hopeless and alone. I started to think it was pointless to put so much effort into recovery when nothing seemed to help...I have personally tried at least 25 medications over the years…I can speak to the time and suffering saved by genetic testing…[.]”2 Unfortunately, stories such as Gwen’s are not uncommon among those suffering from mental illness. Despite incredible advances in the neurosciences and psychological sciences, many of the most essential operations of the human brain remain enigmas. Among these mysteries are the precise ways in which many medications, especially those used to treat mental illnesses, or, ‘psychotropics’, affect the brain, body, and behaviour of humans. Consequently, many psychiatrists, as well as physicians in other clinical disciplines, adopt a ‘trial-and-error’ approach to prescribing medications. Trial-and-error combines the physician’s professional experience with their knowledge of existing medications and standards of care to determine the most appropriate medication for a given patient. Thereafter, physicians adjust the dose of the medication — or, in many cases, alter the prescription itself — based on the patient’s response thereto (Mrazek, 2010). Medication trials stop either when the patient is deemed to be a ‘non-responder’ or when intolerable side effects occur. Pharmacogenomics is the study of the influence of genetic variants on individual responses and side effects to medication. Since its inception in the 1950s, pharmacogenomic testing has become an increasingly viable mitigator of trial-and-error prescriptions. Pharmacogenomic testing has significant potential to improve psychiatric treatment by increasing the likelihood that a patient will receive an effective and suitable medication early in their treatment journey. Accordingly, there is significant potential for these tests to improve psychiatric patients’ treatment experience. This report discusses the evidence in support of pharmacogenomic testing, including cost-effectiveness and clinical utility, and describes a study that will assess the Ontario patient need for pharmacogenomic testing.
The two phases of this study present opportunities for:
- Patient engagement regarding their need(s) for pharmacogenomic testing in present and future psychiatric treatment and
- Strategic ideation with key stakeholders in pharmacogenomics concerning ways in which to address these needs collaboratively
Ultimately, we expect these data to provide important reference material for companies that sell pharmacogenomic tests in Ontario (and beyond), as well as psychiatrists, other physicians, and policymakers.
Project team
- Catherine Virelli
TRP supervisors
Project advisory committee
- James Kennedy
- Melanie Barwick
- Jennifer Bell
- Kwamie Mackenzie
See our community directory for more on committee members.
Creating Social Connectedness Programming for Seniors: Design Principles and Actionable Steps
This guide supports organizations in designing or improving community programming to enhance social connectedness among seniors, especially post-COVID-19.
Background
Social isolation disproportionately affects one of the most vulnerable groups in society: seniors. [1,2] It is characterized by a low quantity and quality of contact with others.[1] Currently, 30% of Canadian seniors are at risk of becoming socially isolated.[2] Due to the COVID-19 pandemic and required physical distancing measures, social isolation amongst seniors is on the rise.[3,4] Social isolation can lead to an increased risk of falls, depression, heart attacks and strokes, as well as increased healthcare costs.[5,6] Being socially isolated results in an increased risk of morbidity and premature mortality more than other individual risk factors, including obesity, smoking, and alcohol consumption.[7] The preventable risk associated with social isolation require interventions which promote social connectedness. Social connectedness can be considered a preventative measure against social isolation.[8,9] Defined as a “sense of belonging and subjective psychological bond that people feel in relation to individuals and groups of others”,[10] social connectedness consists of an individual's social network and level of social support. Being socially connected is linked to many positive health outcomes including better cognitive health, increased engagement in productive health behaviours (e.g., eating well and exercising), and decreased anxiety and loneliness.[10,11] Social connectedness has been shown to result in economic benefit and improved quality of life across various populations, including breast cancer patients and new mothers. Being socially connected is also associated with better adherence to medical recommendations.[12] Thus, the impacts of social connectedness extend beyond the individual and benefit the healthcare system as a whole. Maintaining and creating social connections becomes a challenge for individuals as they age due to a natural decline in their social networks. Factors related to this decline include age-related loss of friends and family, mobility restrictions, and life transitions such as retirement.[13,14] This reduction in social network is exacerbated by barriers to using technology and increasing mobility limitations with age. COVID-19 has further magnified these barriers by forcing governments to impose lockdown measures which disproportionately affect many seniors’ ability to create or maintain social connections. As an example, modern technology is praised for its ability to maintain social connections during the pandemic, but a lack of technology literacy can mean that some seniors are left behind.[15] The current state indicates a pressing need for social connectedness in the senior population. Community organized programming is one way to address the lack of social connectedness in seniors (see Appendix A and B). Adult Day Centres provide programming for seniors and are well positioned to address this need. Many of the community programs they offer aim to provide seniors with opportunities for socialization; however, the impact of COVID-19, specifically the abrupt shift from in-person to remote-based delivery, has resulted in programs that do not fulfill seniors’ need for connection.[16] This research project focused on improving community programming to address the need for social connectedness in seniors. This guide is for organizations hoping to provide seniors with programming that facilitates social connectedness, referred to in this guide as “social connectedness programming” or SCP. Whether you are creating a new program, or want to improve upon existing programs, this guide provides evidence-based approaches to program design that helps the seniors you are working with feel more connected.
This document will:
- Help define social connectedness from the perspective of seniors
- List design principles (i.e., key considerations) for creating SCP; and
- Provide action items and program ideas for the application of design principles.
Project team
- Neerjah Skantharajah
- Carly Thrower
- Joanna Law
- Rabail Siddiqui
TRP supervisors
Project advisory committee
- Rosalee Berlin
- Jim Slotta
- Alekhya Johnson
See our community directory for more on committee members.
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
Eliciting educational perspectives of oncology patients, caregivers and clinicians in the context of the COVID-19 pandemic
This study evaluates cancer patient, caregiver, and clinician experiences with the Digital Education Prescription (DEP) platform to improve virtual patient education delivery.
Background
Despite all the advancements, cancer can have devastating effects on different aspects of the patient’s life. Regardless of increased survival rates, cancer patients may have a poor quality-of-life due to various physical incapacities and mental health challenges secondary to their disease-related complications. Existing data links patient education with its role in improving self-care, self-efficacy, adaptability of the patients by teaching them how to modify their lifestyle, approach their health-related problems and, successfully reach their treatment goals. Literature shows that patient education-driven lifestyle modifications lead to remarkable outcomes in treatment. n the context of the COVID-19 pandemic, rapid implementation of virtual healthcare has shown promise for streamlining patient care and education. Although virtual care is vital in these circumstances, there are significant challenges in maintaining patient education standards in the virtual environment, including the patient’s ability to optimally benefitting from the digital education materials on one hand and HCP’s ability to effectively deliver the educational materials on the other hand. Several needs assessments exploring patient education have shown that the patients prefer an in-person delivery of educational materials through their health care provider (HCP).
In response to the COVID-19 pandemic and the rapid scaling up of virtual care, the Cancer Education Program at Princess Margaret (PM) in Toronto launched a virtual educational gateway called the 'Digital Education Prescription' (DEP) to potentially enhance HCP provision of patient education materials in the virtual context. DEP is a digital doorway to a database of over 1500 patient education materials, including videos, pamphlets, eLearning modules & drug information sheets. The DEP allows HCPs to select and directly email tailored educational materials to patients and their caregivers. tudy Goal: This project's primary purpose is to engage patients, caregivers and clinicians to elicit their educational preferences. This project will also evaluate DEP in coordination with the Cancer Education Program of PM to optimize DEP implementation to facilitate the provision of patient educational materials to cancer patients. The evaluation will provide further insight into the clinicians' perception of patient education, including DEP and patients' satisfaction with education through DEP. The data from this study may inform enhancements to the use of DEP. Methods: The study is divided into 3 phases and is a mixed-method study with a collection of quantitative data in phase 1 and qualitative data in phase 2.
Project team
- Mohammad Sami Al-Katari
- Fatima Naeem
- Shayan Bashir
- Shazmeen Shahed
TRP supervisors
Project advisory committee
- Dr. Janet Papadakos, PMH
- Mr. Mike Lovas, PMH
See our community directory for more on committee members.