Fall 2011 - Institute of Medical Science - University of Toronto

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CLOSE UP Interdisciplinary Collaboration in Critical Care The holistic approach is greater than the sum of the scientist and the clinician By S. Amanda Ali Interdisciplinary collaborations between science and medicine are growing in recognition, for justified reasons. The comprehensive and holistic approach offered by a team of experts is more successful than the sum of each individual effort when striving to cure disease, improve patient care, and reduce health care expenditure. Encouraging a collaborative atmosphere among professionals discourages the competitive environments that are so frequently encountered in research and medicine, and augments scientific discovery and quality of patient care. An exceptional group of women investigating the long-term sequelae after critical illness offer an example of interdisciplinary collaboration within the University of Toronto. This group works on the RECOVER Program of Research, and is lead by Dr. Jane Batt, Dr. Claudia dos Santos, Dr. Jill Cameron, and Dr. Margaret Herridge. Their overarching aims are to identify the molecular mechanisms underlying neuromuscular disability, to determine disruption of quality of life, and to assess the economic burden placed on families and society at large. The various educational backgrounds of the collaborators give them each a unique perspective on how to achieve the aims of the RECOVER Program. Batt and dos Santos are both Assistant Professors of Medicine at the University of Toronto, and Clinician- Scientists at St. Michael’s Hospital, specializing in internal medicine and respirology, and critical care medicine, respectively. Cameron completed her graduate training in the IMS and is now a tenure stream faculty member in the Department of Occupational Science and Occupational Therapy in the Faculty of Medicine at the University of Toronto. Herridge is an Associate Professor of Medicine and Clinician-Scientist at University Health Network, focusing in critical care medicine. Despite their diverse career paths, their common interest in understanding the molecular mediation and social implications of skeletal muscle atrophy has united this group into an interdisciplinary collaborative team. Dr. Jane Batt Critical illness and prolonged life support is associated with the development of severe muscle weakness. This association is known as intensive care unit (ICU) acquired muscle dysfunction. Dos Santos works to understand the molecular mechanism behind mechanical ventilation-induced lung injury and multi-organ failure, including failure of the musculoskeletalsystem. This is largely attributable to loss of muscle tissue, or polymyopathy, but can also be due to nerve damage, or polyneuropathy. Batt is interested in the molecular regulation of muscle atrophy in acute illness and end-stage respiratory diseases. Among other techniques, microarray analysis is used to identify differentially expressed genes and signalling networks in healthy versus diseased muscle biopsies from a single patient. According to Batt, “It now seems Dr. Claudia dos Santos Photos by Yekta Dowlati 27 | IMS MAGAZINE FALL 2011 PROSTATE CANCER
CLOSE UP Dr. Jill Cameron many of the cellular signalling mechanisms that induce muscle atrophy across a myriad of disease processes are the same. Working to understand this process for the purpose of introducing interventions to combat muscle atrophy and loss of independence will be applicable across many disease states. Muscle weakness and dysfunction in respiratory disease are key causes of poor quality of life, which massively increase health resource utilization and rob people of independence.” critical illness. Herridge’s collaborative efforts include other intensivists across the University of Toronto, province, and country, as well as other professional team members, such as physiotherapists and physiatrists at Toronto Rehabilitation Institute. Working together on the RECOVER Program of Research, this team studies the neuromuscular disability incurred by long term ventilation in the ICU and its impact on the individual and the family. Their achievements have been recognized by the prestigious Canadian Institutes of Health Research (CIHR). The current RECOVER Program was initiated in 2008 with funding from CIHR, and Batt, dos Santos, and Cameron each hold a CIHR Career Scientist award. Conducted with the Canadian Critical Care Trials Group, the RECOVER Program involves 11 centres across Canada, and exemplifies a successful model of collaborative, translational, and interdisciplinary research. Inter-professional leadership of core projects is encouraged, for example, one sub-study that examines early mobility and electrical muscle stimulation is lead by physiotherapists. The objective of the RECOVER Program is to serve as a national and international model of effectively integrated professionals working to enhance rehabilitation for patients and families following critical illness. When asked about the factors that are necessary to facilitate collaborative projects across disciplines and medical specialties, dos Santos replied, “Although as critical care intensivists we train as subspecialists – we treat patients as a whole, we take care of all the organs. Consequently, we have a tradition of multidisciplinary medicine that is engrained in the fabric of our practice. Our daily patient assessment rounds are multidisciplinary: doctors, nurses, pharmacists, physiotherapists, social workers, dieticians, respiratory therapists, chaplains, as well as others. This strong collaborative and entrepreneurial spirit, combined with our clear sense of purpose (excellence in patient care) and respect for the work and contribution of each member of the team provides the foundation for all the work we do: patient care, research, and teaching.” As clinicians and scientists specializing in biomedical and socioeconomic aspects of ICU acquired muscle dysfunction, the collaborative effort of this team is stronger than any one of the individual projects. Because their multidisciplinary training facilitates understanding from the bench to bedside and beyond, they are able to synergistically focus their efforts on maximizing recovery and rehabilitation for patients and their families. Dr. Margaret Herridge Photos by Yekta Dowlati Having a family member in critical care can be devastating to relatives, as it can trigger shock, anxiety, depression, and stress - all of which can have detrimental health effects over time. Cameron’s primary research interest is to examine the experiences of family members who assume the role of caregiver for individuals with disability, with the goal of improving the health outcomes of the care-giving population. She aims to understand caregivers’ needs, and develop timely and relevant programs to assist them as they provide support to patients undergoing longterm recovery and rehabilitation. Herridge’s interest stems from earlier work done by her group on long-term outcomes in survivors of severe lung injury. Along with Cameron, the goal is to build a rehabilitation and educational strategy for ICU patients, one which effectively meets the needs of a family after IMS MAGAZINE FALL 2011 PROSTATE CANCER | 28
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Fall 2011 - Institute of Medical Science - University of Toronto

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