Research by Division
The more than 100 faculty in the Division of Cardiology at the University of Toronto are engaged in a large variety of basic and clinical science, including observational and epidemiologic/health services research studies, and randomized clinical trials. Below are some examples of our collaborative bench to bedside initiatives.
Pre-clinical basic science researchers include: Dr. Kim Connelly (research on diabetes and cardiac remodeling); Dr. Nantha Nanthakumar (ventricular fibrillation, and modulation of cardiac arrhythmias); Dr. Slava Epelman (immune cell function in cardiac remodeling); Dr. Phyllis Billia (control of cardiac regeneration) Dr. Mansoor Husain (control of cardiac regeneration and hypertrophy, effect of incretins on the heart); and Dr. Michael Kutryk (molecular therapies to prevent graft and stent thrombosis and occlusion).
The division has an extremely active Clinical Trials Unit, led by Dr. Michael Farkouh, chair of the Division of Cardiology Research Committee, and head of the Heart & Stroke/Richard Lewar Centre of Excellence in Cardiovascular Research - in collaboration with many researchers, including Dr. Jay Udell at Women’s College Hospital, Drs. Kim Connelly and Shaun Goodman at St. Michael’s Hospital, and Drs. Brad Strauss and Harindra Wijeysundera at Sunnybrook Health Sciences Centre, often with the support of the Applied Health Research Centre (AHRC). This group is engaged in many medium and large scale national and international collaborative clinical trials in a wide variety of cardiovascular disorders, including acute coronary syndromes, heart failure, primary and secondary prevention of heart disease (e.g., therapies directed against inflammation, utilization of vaccines, etc.), and many others.
Special areas of expertise of the division include the methodology and clinical benefits of treating chronic total occlusions of coronary arteries (Drs. Brad Strauss and Chris Buller); interventions in life-threatening acute coronary syndromes (Drs. Vlad Dzavik, Asim Cheema, Akshay Bagai, and others); onco-cardiology, and the risks and management of chemotherapy-induced cardiac disease (Dr. Dinesh Thavendiranathan), and advanced devices to reduce cardiac stent thrombosis (Dr. Michael Kutryk).
The Division of Cardiology has internationally renowned clinical epidemiologists and health services researchers, with extensive experience in assessing health outcomes in large populations, including the appropriateness and quality of investigations, management, and therapy for a wide variety of cardiovascular disorders using administrative databases (Drs. Jack Tu, Douglas Lee, Dennis Ko, and Harindra Wijeysundera).
A growing group of researchers are investigating quality of care in cardiology, including randomized clinical trials aiming to improve appropriateness of investigations performed, and therapeutic interventions (Drs. Sacha Bhatia and Heather Ross, and others).
Details of the various research projects will be found under the individual clinician-scientist and clinician-investigators within the division, as well as on the website of the Heart and Stroke/Richard Lewar Centre.
CLINICAL IMMUNOLOGY & ALLERGY
The Division of Clinical Immunology and Allergy’s research programs involve many areas of clinical immunology and allergy.
Our faculty members have identified PAF acetylhydrolase deficiency, which predisposes to severe life-threatening and fatal anaphylactic reactions and as a result a new rapid drug desensitization program for the induction of immunologic tolerance makes possible the use of medication in patients with previous severe reactions.
Our faculty members have developed research with novel desensitization techniques for milk and peanut anaphylaxis, and expertise in primary immune deficiency and gammaglobulin replacement treatment. Our divisional faculty members are leading an international collaborative team examining the role of sequestered auto-antigens in inducible forms of physical urticaria (ie: cholinergic, exercise and cold-induced urticaria).
Innovative research discoveries, when put into practice in a clinical setting, allow patients with lifelong debilitating diseases to receive the treatment they need to live normal lives. We will continue to expand new knowledge and research areas of all aspects of the immunologic and allergic diseases.
CLINICAL PHARMACOLOGY & TOXICOLOGY
Research in our division focuses on clinical epidemiology and health services research, with the bulk of it conducted at the Institute for Clinical Evaluative Sciences. Most of this research focuses on the safety of drugs in real-world clinical practice, the consequences of drug-drug interactions, and the health status of individuals after an episode of self-harm.
The Division of Dermatology has a strong clinical research focus. Capacity in clinical epidemiology has been built over the past five years, with emphasis on cutaneous malignancy, transplant dermatology and clinical trial quality. In 2014-15, faculty members published 64 peer reviewed papers, with 10 additional papers currently in press. Over the past five years, 24 peer review grants and one industry-funded grant have been obtained; most of this funding has been from extramural agencies, including the Canadian Institutes of Health Research and the Canadian Dermatology Foundation.
The core research sites (Medical Sciences Building, University of Toronto, etc.) and the hospital-based research institutes have traditionally supported basic wet-bench researchers over those conducting clinical and health services research.
TCIHR is changing its direction and emphasis, and this could fit well with the direction of the division in Toronto. Some perceive dermatology as a “service” need, much like house-cleaning services. We do not!
The Division of Emergency Medicine is home to a dynamic network of research and innovation. The division continues to experience growth in academic productivity and is recognized internationally as a leader in advancing emergency medicine.
Directed by Dr. Laurie Morrison, Rescu is the largest research program of its kind in Canada. Rescu works with emergency responders, both land and air, to develop and evaluate processes of care and timely interventions to improve outcomes for patients suffering life threatening trauma and cardiac emergencies in the out-of-hospital setting. Rescu is interconnected both nationally (CanROC) and internationally (ROC) and is devoted to producing high impact research that can be translated into improved care and improved outcomes for patients.
Dr. Michael Schull, president, CEO and senior scientist at the Institute for Clinical and Evaluative Sciences (ICES), leads a vibrant program of research that focuses on health service utilization, quality of care and patient outcomes as they relate to emergency care, and the study of interventions designed to reduce emergency department waiting times. His studies use administrative datasets and linkages with clinical data, and examine the causes and consequences of emergency department overcrowding, variations in patient waiting times and pre-hospital care. His work has been influential on health policy decisions at local, national and international levels.
The division also prioritizes scholarship in medical education, international health, injury prevention and geriatric health.
ENDOCRINOLOGY & METABOLISM
The Division of Endocrinology and Metabolism is best known for its diabetes research, with foci of excellence in other areas of endocrinological disorders including endocrine oncology, thyroidology and osteoporosis. The integration of diabetes research across multiple hospitals and basic science departments is actively supported by the Banting and Best Diabetes Centre, University of Toronto, an extra-departmental unit of the Faculty of Medicine at the University of Toronto (U of T). The centre is directed by the director of the Division of Endocrinology and Metabolism, Dr. Gary Lewis (since 2011). Diabetes research at U of T spans the gamut from basic bench discovery research through clinical trials to population research and knowledge translation.
The division has a world class osteoporosis clinical research program, with leaders in osteoporosis research based at three of our teaching hospitals – University Health Network (UHN), Women’s College Hospital and St. Michael’s Hospital. An extensive network of endocrine oncology clinical researchers, consisting of endocrinologists, surgeons, radiation oncologists and pathologists, is centered at Princess Margaret Hospital with foci of pituitary clinical interest at St. Michael’s and the Toronto Western Hospitals. Members of our division are leaders in thyroid clinical research, with very active foci of thyroidology research excellence at our UHN, Mount Sinai and Women’s College hospital sites.
At the University of Toronto, Division of Gastroenterology, it is our goal to be at the forefront of research in our specialty by advancing current knowledge, from basic science to clinical practice, particularly in areas such as inflammatory bowel disease, liver diseases and transplantation, pancreas function, nutrition and metabolism as well as outcome and quality improvement research related to all aspects of clinical practice and therapeutic endoscopy.
These research programs are well funded and include residents, fellows, MSc and PhD students who work in an environment that is well structured and very collaborative. From these programs, discoveries and applications lead to meaningful improvements in the health care of people in Canada and throughout the world.
To foster academic medicine, our overall research program also includes a residency research training program that is mandatory. Under the mentorship of our faculty, all the residents have to select a research project to complete by the end of their training and present at our academic Gastroenterology Research Day. They are encouraged to attend and present their work at national and international meetings as well. This opportunity along with a strong mentorship will allow them to embrace further career in academic medicine.
GENERAL INTERNAL MEDICINE
Our division has the strongest research program in general internal medicine in Canada and is among the top universities in the world in general internal medicine research. Seventeen clinician-scientists and numerous other faculty members in our division are engaged in high-impact research. In keeping with our expertise as generalists, our research spans numerous disciplines and methodologies, including health services research, clinical epidemiology and decision science, and population and public health. Areas of research foci include quality improvement, transitions in care, stroke, osteoporosis and women’s health, obstetrical medicine, HIV, substance use, health equity and inner-city health, health technology assessment, pharmacoepidemiology, and global health.
Researchers in our division focus on clinical epidemiology and health services research. Particular areas of interest include geriatric oncology, quality of life and driving issues in persons with mild cognitive impairment and dementia, medication use in older people, women’s health, models of care for older patients, and knowledge translation. We have considerable methodological expertise in quantitative methods such as randomized controlled trials, observational studies, and knowledge syntheses amongst others. Our division is fortunate to have three endowed research chairs (Mary Trimmer Chair, Gordon Hunt Chair, and the Retired Teachers of Ontario/ERO Chair). As well, one of our division members holds a Tier 1 Canada Research Chair.
The vibrant research programs in the Division of Hematology include fundamental discovery, translational research, and clinical trials. We have world-class research teams in both benign and malignant hematology. Landmark lab-based discoveries relating to mechanisms of hematopoiesis, the biology of malignant and normal stem cells, platelet function, and mechanisms of drug sensitivity and resistance have been made in Toronto. In addition, practice-changing clinical trials in benign and malignant hematology have been led by Toronto clinician-investigators.
The residents in the Hematology Residency Training Program learn research methodology from international experts and opinion leaders. Whatever your research interest, you are likely to find an expert on that topic in the city.
In the context of the training program, we strive to train the next generation of academic hematologists who will be world-leaders in research, education, and teaching. Our hematology residents are encouraged and expected to conduct scholarly activity during their training and present this work in international forums.
For faculty members, we offer support, guidance and mentorship in establishing and maintaining an active research program. We attempt to foster multidisciplinary research that will advance the field of hematology.
The Division of Infectious Diseases has a strong focus on translational research, with almost half of our 41 full-time faculty appointed as clinician-scientists or investigators. Our research interests span the infectious disease spectrum from population-based epidemiology studies assessing the impact of antibiotic use and antimicrobial resistance, through clinical research developing novel therapies and diagnostics, to fundamental research understanding pathogenesis at a molecular level. Global health is an important aspect of research for many of our faculty, who run internationally-recognized programs in emerging and neglected pathogens such as malaria, leishmaniasis, HIV, Ebola, MERS and Zika virus. Over the past two years our faculty has produced over 700 papers with support from almost 300 grants.
Hands-on exposure to research is part of the training experience for all infectious diseases subspecialty trainees, and the tremendous range of faculty expertise, resources and topics around the city provide excellent opportunities in areas of interest for virtually all our trainees.
The Division of Neurology has a very active research program. Our faculty members conduct a wide range of research from basic molecular and genetic studies, animal models of diseases, drug discovery, human physiological and imaging studies, clinical trials (all phases) to clinical epidemiology and health services research. This research covers all major subspecialities in neurology including dementia, movement disorders, stroke, multiple sclerosis, epilepsy, sleep, pain and neuromuscular diseases.
Our faculty have been very successful in publishing world leading research in their fields, and obtaining external grant funding for their research. Residents in our training program are expected not only to learn the practice of neurology but also to learn research methodology from these faculty members. In fact, residents are mandated to do research projects during the course of their training. With the diverse interests of our faculty in different specialties across the division, residents have the opportunity to pursue their research interests in virtually any topic in neurology.
The Division of Occupational Medicine is actively engaged in research focused on occupational disease that is housed in the Centre for Research Expertise in Occupational Disease (CREOD). The centre was founded in 2004 and has been funded continuously since, initially by the Workplace Safety and Insurance Board and since 2004 by the Ontario Ministry of Labour. More information about CREOD can be found at www.creod.on.ca.
Our research spans the prevention spectrum from primary prevention by regulation and workplace culture and practices, through secondary prevention by screening and early identification of occupational disease, to tertiary prevention through diagnosis and management including return to work and other outcomes. Our activities focus on particular groups of diseases or exposures including occupational skin disease, occupational respiratory disease, hand-arm vibration syndrome and infectious disease. We also carry out research on other aspects of occupational health and safety from the challenge of occupational history taking in clinical practice, through specific components of our health and safety system such as the effective functioning of joint health and safety committees, to particular workplace challenges for marginalized workers.
Our research is characterized as intra-disciplinary including teams composed of several different subspecialities and other disciplines including occupational hygiene, epidemiology, rehabilitation science and social scientists. Our projects often involve undergraduate and graduate students and postgraduate trainees. Another key component of our research is the active involvement of occupational health and safety system partners including other research centres, government agencies and community groups.
The Division of Palliative Medicine has an internationally recognized research program that encourages interdisciplinary and international collaboration, as well as research education. Our researchers have diverse areas of interest including early palliative care intervention, palliative care for vulnerable populations, prevention of opioid misuse and diversion, validation of palliative care outcome measures, and palliative care for patients with cancer and non-cancer illnesses. Research disciplines and designs include health services research, randomized controlled trials, qualitative research, observational studies and longitudinal designs. Collaborative city-wide research is fostered through yearly competitions for Divisional seed grants, which require participation of at least two sites. We aim to increase international research capacity and collaboration through our international palliative care research fellowship program, which has included trainees from Australia, Brazil, Egypt, France, Ireland, Israel, Jordan, Serbia, Saudi Arabia, Thailand, and the United Kingdom. Partnerships exist with other centres and institutes, such as the Global Institute for Palliative, Psychosocial, and End-of-life Care, the European Palliative Care Research Centre and the European Association for Palliative Care Research Network.
PHYSICAL MEDICINE & REHABILITATION
The Division of Physical Medicine and Rehabilitation has a strong clinical focus across a wide breadth of research areas. Our research spans a number of physical locations across the Greater Toronto Area.
At a systems level, we have led the development of important national guidelines around delivery of care in stroke, brain injury, and spinal cord injury. We have developed a number of Cochrane reviews addressing musculoskeletal pain and disability. We are leading an educational model called Extension for Community Healthcare Outcomes (Project ECHO Ontario) in which we teach primary care physicians how to best care for patients with pain and other disabilities.
We have a strong group of faculty focused on quality improvement and patient safety. This includes areas such as introduction of morbidity and mortality rounds into the rehabilitation arena, shortening the length of time between transitions in care and improving patient education.
Our faculty and residents have active research programs in treatment of specific clinical disorders including: spasticity, myofascial pain, amputee rehabilitation, cardiac rehabilitation and peripheral nervous system injuries.
We are continuing to make innovative research discoveries and translating that knowledge into the clinical setting, so that patients with disabilities can improve function and community participation after serious illness and injury.
The University of Toronto, Division of Respirology, is a leader in world-class research that aims to improve all areas of respiratory medicine. We are world renowned for our programs in lung transplantation, sleep-related breathing disorders, cystic fibrosis and lung injury/critical care. A seamless connection exists between ground-breaking research and the rapid transfer of new developments to patient care. Investments in our faculty and their research efforts have had a huge impact on the quality of care provided to tens of thousands of patients.
The Division of Respirology is committed to ensuring that our research excellence continues through future generations. Under the leadership of current director, Dr. Doug Bradley, the division has instituted a mandatory research rotation for trainees to inform them of research opportunities, to encourage them to get involved in research, and pave the road to an academic career with a research component.