Led by principal investigator Dr. Peter Liu from uOttawa’s Faculty of Medicine and the University of Ottawa Heart Institute (UOHI), a team of multidisciplinary researchers are recipients of a highly competitive $2.9M Heart-Brain Connection IMPACT Award.
The medical profession has traditionally imposed an artificial separation between the heart and the brain, treating them with separate specialties and isolated priorities. But emerging research shows these all-important vascular organs are deeply interconnected: What impacts an individual’s heart can set into motion a cascade of damaging effects on the brain, as well as the other way around.
Now, innovative investigators from the uOttawa Faculty of Medicine and partner institutes are joining forces to forge a paradigm shift for neurocardiac care, essentially bridging the heart-brain divide in modern medicine. It has the potential to revolutionize patient care for millions here in Canada, and many more around the world.
Led by principal investigator Dr. Peter Liu, a team of multidisciplinary researchers are proud recipients of the inaugural Heart-Brain Connection IMPACT Award from the Heart and Stroke Foundation of Canada in partnership with Brain Canada. After a rigorous assessment, the uOttawa-led team is being awarded a $2.9M grant to study critical questions linking heart and brain health, one of just two groups across the country to receive this major new award.
The four-year project will work on matters connecting heart and brain health with the goal of improving patient outcomes. Among other things, the team aims to develop new diagnostic blood tests and novel ways to capture cutting-edge imaging of the heart and the brain. With patient partners, Dr. Liu says they will also test new treatments that can be used to protect both organs.
Receiving this highly competitive grant is the latest external validation and financial support for Dr. Liu and Dr. Ruth Slack, uOttawa Faculty of Medicine professors who are leaders in unraveling the two-way dialogue between the heart and brain. They have set their sights on nothing less than unveiling how our heart and brain systems interact, coordinate and co-regulate each other, banishing a historic disconnect and potentially transforming care for a dizzying number of disorders in the process.
Dr. Slack describes this latest grant success as a “critical stepping-stone to advancing toward global leadership” in understanding the complex heart-brain connection and bringing together top talent from across Canada and the world.
“The brain and the heart have been completely separated over the years so there’s limited knowledge as to how they interact. We’re going to bring them together with the goal of really understanding how they’re connected as a functional unit,” Dr. Slack says. “We think this is the key to treating chronic brain-heart linked conditions.”
Both professors in the uOttawa Faculty of Medicine’s Department of Cellular and Molecular Medicine, Dr. Liu is the Chief Scientific Officer and Vice President of Research at the University of Ottawa Heart Institute (UOHI), and Dr. Slack is Director of the University of Ottawa Brain and Mind Research Institute (uOBMRI).
The impact of brain and heart disorders on patients and health systems couldn’t be more profound. From cognitive impairment to heart failure, they pose one of the world’s biggest healthcare challenges, accounting for 32% of all global deaths and 50% of all disease-related disabilities. In Canada alone, one person dies every five minutes from heart disease, stroke or vascular cognitive impairment.
Dr. Liu says the latest support from two prominent Canadian organizations couldn’t come at a better time.
“It sets up the foundation for more opportunities in bringing together top research leaders and helps us advance the network that we’re building brick by brick,” he says. “It’s really quite exciting.”
Indeed, when it comes to exploring the heart-brain connection, momentum is building at uOttawa and its affiliated institutes.
In recent years, Dr. Liu and Dr. Slack spearheaded the creation of the groundbreaking Hub of Excellence for Cardio-Neuro-Mind Research (HCNMR), which in 2021 was awarded $5.8M from the Canada Foundation for Innovation (CFI). This was subsequently matched by another $5.8M from the Ontario Research Fund.
Hosted at uOttawa, it’s Canada’s first multi-disciplinary, multi-specialty research group investigating the shared mechanisms underlying heart and brain health challenges. It includes leading experts at the UOHI, the uOBMRI, the Royal’s Institute of Mental Health Research, the Ottawa Hospital Research Institute (OHRI), and other prominent research institutions across Canada.
To be sure, there’s a palpable all-hands-on-deck attitude here in the nation’s capital with unveiling the intricacies of the heart-brain connection. “In the city of Ottawa, we basically have every hospital-based institute, the university and multiple faculties all engaged, excited and working on this program,” Dr. Slack says.
Collaborating to improve health is the team’s vision, according to Dr. Liu. And at the end of the day, solving the mysteries of the brain-heart connection is always about boosting patient outcomes.
“Our patients are the key to telling us what’s important so we’re equal partners with them when working toward solving these problems,” Dr. Liu says. “That’s really why we do what we do.”
Subject of Research
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‘Debilitating’ heart palpitations could be sign of Long Covid – do you have the condition? – Express
Heart palpitations can be a sign of several different problems – both mental and physical. Often, they’re caused by stress and anxiety. But over the course of the last few years, Long Covid has reportedly caused palpitations. A recent study has explored why this might happen.
Long Covid is when people suffer ongoing symptoms of Covid, 12 weeks after infection.
Some people with the condition have struggled with heart palpitations, chest pain, dizziness, or feeling faint.
Researchers, observing their patients, have concluded that these symptoms could be caused by problems with the autonomic nervous system – the part of your nervous system that monitors automatic activities such as heart rate, breathing, and blood pressure.
Doctors and nurses at Hammersmith Hospital and Imperial College London believe that the “debilitating” palpitations and other symptoms were caused by “orthostatic intolerance syndrome”.
Orthostatic intolerance syndromes are when moving from a sitting or lying position to an upright position causes a low blood pressure in your arteries.
The British Heart Foundation explains: “When a healthy person stands up, some of the blood in the body will flow downwards with the pull of gravity.
“The body responds to prevent blood pressure falling – blood vessels narrow and there is a slight increase in heart rate.
“But in people with orthostatic problems, these automatic changes don’t happen.
“Moving to an upright position causes a drop in the blood supply to the heart and brain and a fast heart rate as the body tries to compensate.”
For people that struggle with these issues with moving to an upright position, the study by Hammersmith Hospital and Imperial College London made recommendations.
It suggested: “Non-upright exercise such as cycling on a recumbent exercise bike and swimming are encouraged.”
It added: “The patient should be advised on rising cautiously from a lying or seated position and avoiding exacerbating factors such as prolonged standing, warm environments, and dehydration.”
Shingles, memory loss, tinnitus, itchy skin, and tremors were among the more abnormal symptoms experienced.
Some studies have suggested that long Covid is an autoimmune disease, similar to Parkinson’s disease. An autoimmune disease is when the body’s immune system attacks itself.
The body cannot tell the difference between your own cells and foreign cells so causes the body to attack healthy cells.
According to one small study from 2021, 44 percent of long Covid patients involved had high levels of a type of antibody connected with other autoimmune diseases and lupus.
Genomic testing and medico-legal risk | InSight+ – MJA Insight
INTEGRATING genomics into mainstream health care has many benefits, but also presents challenges. One challenge is ensuring that doctors and patients can safely and sustainably benefit from genomic medicine without increased medico-legal risk.
While the number of legal cases in Australia is still relatively small, this moment in time represents an opportunity to develop tools, training and support so doctors and their patients can safely and sustainably benefit from the advancing capabilities without increased medico-legal risk.
Over the past 2 years, we have been exploring the practical and medico-legal risks associated with genomic medicine, particularly in the context of antenatal care. Through our work, we identified that informed consent to test and workforce and funding issues are significant barriers to more effective use of genomics in health care. What we are seeing and how these medico-legal risks can be addressed through tools, training and support are explored below.
Informed consent to test
At the centre of consultations involving genomic medicine are individuals and families grappling with complex and often life-altering decisions. Many people need support both to understand the issues involved and to deal with the consequences of their decisions.
The consent process for people considering genomic testing presents specific challenges compared with other testing and treatments.
Advancing technologies and the increasing availability of expanded screening and testing mean that the practitioner and the pregnant person need to discuss and understand more complex information and face value-laden choices even before deciding whether to go ahead with a test.
Concepts such as “chance” of a condition developing (and the severity of that condition) or “variants of uncertain significance” are somewhat unique to the field of genomics and can be difficult for doctors to explain and for patients to understand.
To put this issue into the antenatal context, guidelines from the Royal Australian and New Zealand College of Obstetricians and Gynaecologists and the Royal Australian College of General Practitioners (RACGP) state that information on carrier screening for the most frequent autosomal or X-linked genetic conditions should be offered to all women planning a pregnancy or in the first trimester of pregnancy. The Colleges also state that all women should be provided with information and have timely access to screening tests for fetal chromosome and genetic conditions.
Guidelines play an important role in outlining the standard of care expected of doctors. Therefore, it is incumbent on practitioners working in this field to be equipped with the knowledge, expertise and tools to have comprehensive and comprehensible consent discussions with their patients about genomic testing.
An additional challenge for the consent process is that technology often develops at a much quicker pace than laws and guidelines. The emergence of expanded screening for autosomal and X-linked conditions and for fetal chromosome conditions can present challenges for doctors and their patients. “Expanded” screening can test for over a thousand conditions, many of which would have very little impact on a person. Explaining the potential impact of a variant of uncertain significance in terms of the chance of a condition developing in a person is inherently difficult.
The well established principles of consent require a doctor to give the person enough information for them to make an informed decision about the test or treatment being offered. This is a patient-centred test, requiring a doctor to discuss not only what a reasonable person in the patient’s position would want to know but also what the particular patient wants to know. The doctor is also ethically and legally obliged to recognise whether the patient has understood this information.
It is also important to ensure that a patient’s choice to have genomic testing is voluntary. An article published in the MJA in 2021 noted that patients may feel foolish to reject a test that is on offer and that a “normalisation” of testing has begun.
This was echoed in a recent Avant webinar, where medical and legal experts discussed issues of genetic testing and pregnancy. There was sentiment from the doctors who attended the webinar that the concept of voluntariness in genetic testing in pregnancy may be eroded by an “expectation” or social “normalisation” that women will accept each test offered. One participant said:
“… practitioners need to be careful to convey respect to women who choose against genetic screening in pregnancy. There is a risk that repeated discussion and repeated offers of testing sends a message that the woman has made an incorrect decision.”
We support the development of standard information and forms to be used as part of the consent process for genetic testing in pregnancy. This would help patients to understand what is involved and assist in their decision making, as well as alleviate some of the medico-legal risk for doctors.
Standard information used in consent discussions also helps to ensure information to patients is balanced, evidence-based and informative. This would lessen the burden on practitioners and means there is less room for allegations of bias in the information they were providing. It also has the potential to make clearer the blurred lines between clinical and research use of genomic test findings, which could, for example, add to the body of information that informs the significance of a rare variant that may have been identified.
It is therefore pleasing to see the National Model of Consent for Clinical Genomics Testing developed by the NSW Ministry of Health in accordance with Action 4A of the implementation plan for the National Health Genomics Policy Framework, on behalf of the Australian Health Minister’s Advisory Council Project Reference Group on Health Genomics. The Clinical Genomic Testing Consent Form developed to support the model can be adapted across jurisdictions and can be used in conjunction with patient information materials to assist patient understanding during the consent discussion. Consent material has also been developed by Australian Genomics.
Workforce and funding issues
Avant has also identified significant workforce pressures and gaps in funding for timely and sustainable care in genomic medicine.
We welcome the Medicare funding announced for genetic carrier screening for all couples, testing for carriers of cystic fibrosis, spinal muscular atrophy and fragile X syndrome from 2023. However, as genetic carrier screening becomes more accessible, there are some practical and medico-legal issues to consider.
With Medicare-funded testing available, the standards for carrier screening could change, with testing becoming the standard professional practice of doctors. More doctors will need to be equipped with the knowledge and communication skills to discuss carrier screening with their patients.
The complexity of these discussions should be reflected in appropriate Medicare item numbers for the consultations. The RACGP is calling for Medicare Benefits Schedule amendments to better support longer consultations for antenatal care that would support the use of time-based level C and D Medicare items for longer antenatal consultations. Such changes would better allow time for the detailed discussions that are required to take place around genetic screening. An alternative would be to introduce an additional cobilled item number specific to genomic testing and counselling which would recognise the complexity of these discussions with patients.
We believe Medicare-funded testing is likely to lead to more testing and, therefore, more people receiving positive results. Doctors we spoke with noted the importance of being able to engage with genetic specialists and counsellors. They reported that patients may need genomic expertise and mental health support. Currently, there can be lengthy delays and challenges accessing these practitioners. Time is of the essence in pregnancy, and workforce constraints could add pressure and stress to patients and doctors. Also, it is not clear that the newly announced funding for carrier screening includes costs associated with genetic counselling to discuss the results.
Research from the Deeble Institute has found that the workforce shortages in clinical genetics and genetic counselling are partly due to constraints on numbers of professionals being trained, which in turn are linked to limited workplace rotations available. While this may be the case with many specialties, particularly following the COVID-19 pandemic and workforce shortages due to burnout, the increased availability of and funding for genomic testing means that workforce shortages in clinical genetics and genetic counselling need to be addressed as a matter of urgency. This will help ensure that patients are given the information they need and alleviate doctors’ concerns about medico-legal risk.
The potential for genomic medicine is great, but the challenges it presents are also significant. Keeping up to date with rapidly advancing knowledge and ensuring patients have enough information so they are making informed decisions about testing are key concerns of doctors practising in this area.
Now is the time to develop tools, training and support so doctors and their patients can safely and sustainably benefit from the advancing capabilities without increased medico-legal risk.
Rocky Ruperto is a solicitor and Legal and Policy Adviser at Avant.
Dr Sally Parsons is a Medical Advisor and Claims Manager at Avant and Clinical Director and GP in Adelaide. Avant is Australia’s largest medical defence organisation.
Disclaimer: This article is intended to provide commentary and general information. It does not constitute legal or medical advice. You should seek legal or other professional advice before relying on any content, and practise proper clinical decision making with regard to the individual circumstances.
The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.
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COVID Outbreak at Meno-Ya-Win in Sioux Lookout – ckdr.net
Sioux Lookout’s Meno Ya Win Health Centre has declared a Covid-19 Outbreak after two patients were diagnosed with the virus.
Both patients have been in-patients for a long period of time, which indicates they contracted COVID-19 while at the hospital.
Effective immediately, visitation will be limited at SLMHC to two (2) designated visitors per patient.
Contact tracing is also underway at SLMHC. Anyone who is identified as a risk has been contacted.
“We have processes in place to provide the safest possible environment for our patients, staff and physicians. Our priority is to see this outbreak contained quickly,” says Douglas Semple, SLMHC President and CEO.
In addition to continuing daily screening and adherence to personal protective equipment standards, such as masks and eye protection,
SLMHC’s housekeeping department is following policies relating to increased cleaning and proper handling of an outbreak.
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