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Crchum.chumontreal.qc.ca






Vol. 3 - No 1 - June 2011 CRCHUM — Research Centre - University of Montreal Hospital Centre CRCHUM: at the forefront of clinical research "Being able to ask questions and improve treatments lies at the heart of the mission of a tertiary and quaternary care hospital like the CHUM," notes Jacques Turgeon, Director of the CHUM's research centre (CRCHUM). In other words, research is an essential ingredient of health care.
as imaging, biostatistics, transgenics labora- tory, phenotyping, biochips, flow cytometry and Research in the health sector is either basic, that containment facilities, the CRCHUM is the Uni- is, research that seeks to understand the cel- versity of Montreal's largest affiliated research lular or biological mechanisms of diseases or to discover promising molecules for tomorrow's drugs, or it is clinical, with its activities centered At the heArt of clinic reseArch:
around human subjects. It also includes a third humAn beings
major thrust: population health, a significant "Clinical research evaluates the effects of drugs, strength at the CRCHUM. Among other things, procedures and diagnoses on people," explains population health research looks at health risks François Lespérance, the CRCHUM's Associate and the organization of health care and services Director, Clinical Research, "our clinical research in terms of quality, access, clinical practices and activities are concentrated in five major themes, health policy both here and in developing coun- each with several sub-themes: cancer, cardiome- tabolic, infection-immunity-inflammation, mus- Clinical research at the CRCHUM can take on culoskeletal diseases, and neuroscience." three forms: contractual research funded by The CRCHUM is also very active in clinical trials, pharmaceutical companies looking to assess that is, the study of the effect of a given drug or a the efficacy of new drugs; research into new new treatment strategy on a well-defined patient treatments funded by granting agencies such population. For the most part, these studies are as the Canadian Institutes for Health Research "phase III" studies, the step before a drug is com- (CIHR), the Fonds de la recherche en santé du mercialized. Products are tested on hundreds, if Québec or other organizations such as the Heart not thousands of patients and then compared in and Stroke Foundation; and lastly, research ini- a randomized manner to standard treatments or tiated by physicians and researchers into areas to patients receiving a placebo. This step occurs of importance. In the fall of 2010, more than once the tolerance to the product and its toxicity 1,000 research projects were in progress: 314 has been tested on a small number of patients contractual research, 495 funded by granting (phase I trials) and maximal and minimal doses agencies and 329 research initiated projects.
have been measured (phase II trials). Phase IV With its 362 researchers, graduate students, trials study the action of drugs once they are on postgraduate fellows, its large patient cohorts the market and available to large populations. and cutting-edge technological platforms such Continued on page 10



Physiotherapy for the soul — treating psychosis Psychosis is a disorder that alters our perception of reality. It is associated with various psychiatric disorders that profoundly impact our quality of life, to the point where we can no longer function normally. It is important to intervene quickly because lengthy delays before treatment result in a less favourable prognosis. But what kind of intervention? What treatments should be used? What are their conditions of success? These questions lie at the heart of Dr Amal Abdel-Baki's research.
By Andréa Sirhan-Daneau The primary cause of relapse and increased se- Treating psychosis is a long-term process requiring focus on dAy-to-dAy life
verity of psychotic disorders among patients is complete and specialized support. Dr Abdel-Baki the failure to take the prescribed medication. The CHUM's Young Adult Psychotics Clinic makes the following comparison: "a long-dis- However, the reasons for this failure are poorly (JAP) is made up of an interdisciplinary team tance runner with a damaged knee cannot run a documented. The current research project of devoted to early detection and treatment of marathon the next day. He or she first needs to Dr Abdel-Baki and her colleague Dr Laurence psychosis among young adults (18-30 years undergo physiotherapy to relearn how to walk. Artaud seeks to understand what motivates pa- old). Patients are seen quickly and often, which At our clinic, that's what we do, you could call it tients to take or not take their medication. Her in many cases means daily visits during the first physiotherapy for the soul." As a researcher and approach involves studying how patients view weeks to develop a personalized treatment pro- physician, her work consists of refining treat- their treatment as well as their disorder.
gram. Whatever the program, therapy is both ment strategies to help wounded souls. intensive and specialized. Many of these thera-pies are part of a clinical research program di-rected by the CRCHUM's Dr Abdel-Baki that seeks to help patients in all aspects of their lives treating psychosis
rather than relying solely on medication. One as-pect of this approach — vocational intervention is a long-term
— seeks to support patients in their efforts to process requiring
remain productive, be it with regard to their job, complete and spe-
school or as a parent at home. "Untreated psy- cialized support.
chosis has a major psychosocial impact," notes At our clinic, that's
Dr Abdel-Baki, "people lose their job and friends what we do, you
because of their symptoms, which in turn affects how they function." Simply put, helping patients could call it phy-
maintain a significant social role in their day- siotherapy for
to-day lives goes a long way to managing their the soul.
The results of Abdel-Baki‘s study, which mea-sured the effectiveness of this therapy with re-gard to the rate of productive activity, revealed that this rate went from 47.5% to 70% in 24 months, reaching a level comparable to that of the general population in Montreal for the same age group. Another aspect studied by Dr Abdel-Baki is drug and alcohol consumption before and dur-ing treatment, especially among the 55% of patients with a substance use problem. Her re-sults reveal that drug or alcohol consumption prior to treatment has fewer consequences than continued use during therapy. Patients with a substance use problem do not respond as well to treatment and have to be hospitalized more often than patients who have never consumed drugs or alcohol or who have ceased while be-ing treated. "It is clear that special intervention strategies have to be developed for these pa- dr Amal Abdel-baki
tients," notes Dr Abdel-Baki.


Treating advanced prostate cancer — a world first One out every six of the roughly 25,000 Canadians with prostate cancer will not survive. each year in Canada, this disease takes 4,300 lives, and most of these patients die in considerable agony. This alarming reality has spurred the research efforts of the CRCHUM's Dr Fred Saad, urological surgeon and researcher. throughout the world were in vain. enter Deno-sumab, a drug that has proved to be effective in treating osteoporosis as well as metastases. This drug had been known for its ability to prevent fractures. "It struck us as obvious to try to use its properties to protect and even strengthen bones for cases of prostate cancer that no longer res-ponded to hormone therapy," notes Dr Saad.
An innovAtive reseArch proJect
"it's absolutely
In light of this idea, Saad and his colleagues fantastic that after
conducted a clinical trial with 1,432 men with so many failures,
prostate cancer. Some were administered Deno- we finally came
sumab while others received a placebo. The idea up with positive
was to see whether Denosumab could delay the appearance of bone metastases. The patients results," declares
were subsequently monitored with X-rays.
saad. Along with his
harvard colleague,

The results were more than encouraging. In the trial group of men who received the drug, metas- dr matthew smith,
tasis was delayed significantly compared to the saad will soon take
placebo group. For the first time ever, a drug was to the road to pre-
found that worked. "It's absolutely fantastic that sent these unique
after so many failures, we finally came up with findings at various
positive results," declares Saad. Along with his Harvard colleague, Dr Matthew Smith, Saad will soon take to the road to present these unique findings at various international conferences.
from despAir to hope
These research findings will have a dramatic impact throughout the world. not only does Denosumab delay the appearance of bone me-tastases, it also helps in controlling the acute pain that accompanies them. However, research will continue, to better target at-risk patients and to identify the best strategy for using this new "therapeutic weapon." Although the drug is dr fred saad
not yet available in Canada and several steps lie ahead, Dr Saad is quite happy to be in a position to offer a glimmer of hope to his patients. no therapy available. The only thing that can be By Dalila Benhaberou-Brun done "is to wait for the metastases to reach the bones," says Dr Saad. Depending on various risk factors, it can take anywhere between 12 and 24 Some of the cases of prostate cancer diagnosed months for metastases to appear, after which every year progress to an advanced stage. The the end is inevitable.
usual treatment consists of hormone therapy. Although it is effective for the majority of pa- from osteoporosis to cAncer
tients, some of the men will become resistant to the therapy and will develop metastases. In For the past several years, all attempts to find a this event, there are treatments that can help. way of reducing the appearance of metastases However, when there are no metastases, there is have failed. Indeed, the five major projects Chronic shoulder pain: Understanding biomechanics to ensure more effective treatments Do you have chronic shoulder pain? If so, you are not alone. In 2000, the cost of treating this problem in the United States amounted to no less than $7 billion. This pain can be caused by several factors. Dr nathalie Bureau, a CRCHUM radiologist and clinical researcher, studies acromiohumeral disorders, a pathology that produces shoulder impingement that may lead to tendinopathy or tears of the tendons that control shoulder movements. More precisely, her work focuses on improving the evaluation of this condition in order to enhance treatment effectiveness.
By Andréa Sirhan-Daneau other orthopaedists and a physiatrist (Drs Pa-trice Tétreault, Dominique Rouleau, and André dynAmic ultrAsound – An efficient
Roy). They are working on the development of reliable radiological indicators to better predict the risk for developing chronic shoulder disabi- Dr Bureau concentrated her study on the use lity among workers. The goal of this of dynamic ultrasound in the evaluation of ac- multidisciplinary team is to iden- romiohumeral syndrome. This technique held tify the cause of loss of shoulder the promise of making it possible to observe a function and eventually to be able larger range of anomalies associated with this to predict the outcome of a given disorder as well as helping to diagnose the syn- treatment strategy. Some patients drome at an earlier stage. The goal of the study have torn shoulder tendons but still was to compare dynamic ultrasound to other, retain good upper-arm movements, more generally used techniques, in particular whereas others, with less serious magnetic resonance imaging (MRI). Ultrasound lesions, experience greater limita- does not rely on radiation and does not lead to tions. "We are looking to identify harmful side effects. It also makes it possible to ways of distinguishing patients in observe structures during active shoulder mo- this regard so we can gain a better tion, in contrast with MRI, which can only pro- understanding of the pathology," duce a static image. notes Dr Bureau. The information "Most people think that ultrasound is used pri- obtained will not only improve in- marily to study the foetus. However, it also has jury assessment and patient treat- many other clinical applications," ment in hospitals and notes Dr Bureau. The results of the in outside clinics, but study on 13 patients were conclusive. the goal of the
will also help in opti- not only does dynamic ultrasound study was to
mizing rehabilitation provide direct observation of the compare dynamic
various joint structures in motion, ultrasound to
it also provides important informa- bench to bedside
other, more gene-
tion about the possible intrinsic and rally used techni-
In addition to advan- extrinsic causes of this syndrome, cing patient care, the which facilitates a more accurate ques, in particular
current project exem- diagnosis. Ultimately, dynamic ultra- magnetic resonance plifies the importance
sound may serve as a valuable tool of creating closer ties for the development of more appro- between clinical re- priate and more effective treatment searchers, physicians dr nathalie bureau
and basic researchers. "most people think
"It is a unique collabo- toWArds better prediction
that ultrasound is
rative effort between basic re- Dr Bureau is currently collaborating used primarily to
searchers and clinicians, one that with the CRCHUM's Imaging and study the foetus.
is generating extremely interesting Orthopaedics Laboratory (LIO), in however, it also has work and that broadens clinical re-
particular with nicola Hagemeis- many other clinical
search in a very positive way. This ter and Jacques de Guise of the type of research model should be applications," notes
CRCHUM and the ecole de tech- encouraged," notes Dr Bureau. dr bureau.
nologie supérieure, and their team of biomedical engineers, as well as with Improving lung cancer diagnosis Of the 25,000 Canadians diagnosed with lung cancer in 2010, 20,000 will die. Since lung cancer is a deadly disease (leading cause of cancer-related deaths) and difficult to accurately diagnose and to treat, Dr Moishe Liberman, a researcher and thoracic surgeon, decided to compare two techniques for evaluating the stage of the cancer's development. His ultimate goal is to improve treatment strategies.
tion obtained. Drawing on a cohort of 166 cancer By Dalila Benhaberou-Brun patients, Dr Liberman is currently conducting a While the study is still ongoing, early data have clinical research project aimed at comparing tra- revealed some advantages of endoscopic pro- toWArds less invAsive
ditional surgical approaches to cancer staging cedures over surgery. eBUS and eUS make it to two endoscopic procedures, endobronchial possible to see more of the lung and, more im- ultrasound (eBUS) and endoscopic ultrasound At present, patients suspected of having lung portantly, to get a better picture of the cancer's cancer must undergo several examinations to extent and spread than would be obtained with determine the stage of their disease. In general, endoscopic procedures involve inserting a tube surgical diagnosis. "Moreover," notes Liberman, these procedures involve surgery under general equipped with a camera into a body cavity. eBUS "if we ask patients whether they prefer general anaesthesia. However, the risks to the patients, and eUS use this technique with the addition of anaesthesia and associated side effects or to not to mention the associated costs, are quite ultrasound to examine respiratory and digestive undergo less invasive tests, they will invariably high. Finding less invasive diagnostic techniques pathways. The ultrasound components provide choose the latter without a second thought." could limit these dangers and also improve the a more in-depth image to evaluate the extent of "Our goal," says Liberman, "is to eliminate surgery quality and reliability of the diagnostic informa- damage to the lymph nodes that drain the cancer as a means of evaluating lung cancer stages." cells from the lungs.
There is less pain and suffering and no need Although these techniques for general anaesthesia. There are also fewer have been studied in the past, complications requiring hospitalisation, reduced Liberman's project is the first demands on operating rooms, and, more impor- to examine a large number of tantly, patients are better off as a result. "We patients using both traditio- already have everything we need for eBUS and nal surgical procedures and eUS," notes Liberman, "and if our study results endoscopic approaches. The show that they are better than surgery, they will advantage: there are no "false be used daily in our practice and will radically negatives"; that is, there is no alter lung cancer staging procedures throughout error since the cancer stage is the world." They will also have equally profound determined by both methods implications for the quality of life of cancer pa- for all patients. The goal is to see not only whether en- doscopic procedures can replace surgery, but also While the study
to improve diagnostic ac- curacy and thereby se- is still ongoing,
lect the best treatment early data have
strategy: surgery, che- revealed some
motherapy and/or radio- advantages of
endoscopic pro-
cedures over

liberman's project
surgery.
is the first to
examine a large
number of patients
using both tradi-
tional surgical
procedures and
endoscopic
approaches.

dr moishe liberman
Stemming HIV transmission in an at-risk population The many dangers related to injection drug use, especially among individuals who share needles with other users, are well known. This practice opens the door to the transmission of serious diseases, in particular HIV, and has consequences for the public in general. However, a new study led by Dr Julie Bruneau, a CRCHUM physician and researcher, has revealed that transmission rates have declined among injection drug users (IDU) in Montreal.
it enables benefits not only from a large pool A Word of WArning
By Richard Ashby and Dalila Benhaberou-Brun of subjects but also the possibility of following notwithstanding the observed progress, Bru- them over long periods of time. The data ob- neau is quick to point out that the epidemic Funded by the Canadian Institutes for Health tained are crucial to our understanding of the has yet to be controlled: "needle exchange and Research, the United States national Institute transmission dynamics and the impact of inter- distribution programs are not enough because on Drug Abuse and the Fonds de la recherche ventions. They also contribute to the application they have to be part of a larger strategy." A bet- en santé du Québec, this epidemiological study of scientific knowledge to improving the health ter understanding of the mechanisms of HIV shows that the rate of new HIV infections among of the population, as the present recently pub- transmission allow for adjustments to be made IDUs in Montreal has gradually declined since lished study reveals.
to existing measures. The results of Bruneau's 1992 but that the downward trend has displayed study argue in favour of a diversity of means for a fourfold increase since 2001. "This finding sug- reaching out to and equipping IDUs, including gests a favourable impact of Montreal's needle montreal was
safe injection sites and innovative drug addic- distribution program," notes Bruneau. Drawing among the first
tion treatment programs. on observations of more than 2,000 drug ad-dicts between 1992 and 2008, the study also re- north American
vealed that needle sharing, cocaine injection and cities to set up
unstable housing conditions are among the main needle exchange
drivers of the HIV epidemic among IDUs.
programs in the
late 1980s. With

montreAl leAding the WAy
support from public
Montreal was among the first north American health authorities,
cities to set up needle exchange programs in montreal now has
the late 1980s. With support from public health authorities, Montreal now has one of the most one of the most
liberal needle distribution programs in north liberal needle dis-
America. Based on an exchange program, IDUs tribution programs
can obtain an unlimited number of syringes and in north America.
other injection materials are supplied by com-munity workers and by local community service centres. Also, a network of pharmacies that sell needles at low cost to IDUs was set up.
the sAint luc cohort
— An indispensAble resource

The observed decline in infections and its rela-tionship to Montreal's HIV prevention programs was made possible thanks to the existence of the Saint Luc Cohort. This cohort has been re-cruiting IDUs since 1988, and over time has be-come one of the only cohorts in the world able to provide information about the natural history, etiology, transmission and pathogenesis of HIV and HCV in this population. The research that dr Julie bruneau
Innovations in liver cancer treatments Liver resection is the only curative approach for hepatic metastases of colorectal origin, with a survival rate of 50% after five years. This operation involves removing the region of the liver that contains tumours and then allowing what remains of the liver to regenerate itself over time. But just which portion of the liver needs be removed, and can we intervene at an earlier stage of the disease to limit the extent of the intervention? The CRCHUM's Dr Réal Lapointe and Dr Franck Vandenbroucke-Menu devote their clinical research activities to finding answers to these questions.
tion. Lapointe and Vandenbroucke-Menu con-ducted a study in collaboration with the IRCAD (Institut de Recherche contre les Cancers de l'Appareil Digestif) in France to validate a new 3D imaging technology that evaluates the total volume of the tumours and the remaining liver. The idea was to simulate the liver resection using a 3D reconstruction of the patient's liver, tumours and blood vessels and to determine the volume of the remaining liver. This study was the first of its kind to compare this technology to the A 3d image pro-
manual measures obtained by ra- vides a better
diology. The results demonstrated that the two techniques are practi- of what the sur-
cally equivalent to one another. For Dr Vandenbroucke-Menu, the new geon finds in the
technique is promising: "a 3D image provides a better representation of what the surgeon finds in the ope-rating room." Since 2010, Dr Lapointe and Dr Vandenbroucke-Menu have been developing a human tissue bank with samples from patients with liver or pancreatic cancer. At the same time, they have been working on a clinical data bank containing patient information that will make it possible to drs réal lapointe and franck vandenbroucke-menu
consolidate the work of basic scientists and cli-nicians in a single data bank. Indeed, one the dif-ficulties faced by basic scientists is that of corre- than preoperative imaging had led us to believe Par Andréa Sirhan-Daneau lating their findings with clinical data. With this and to modify the planned surgical intervention biobank, establishing a link between patients accordingly. This makes it an extremely impor- improving tumour detection
and tissues will be easier, will happen more tant tool for liver surgery." quickly, and will improve both early liver cancer The two researchers undertook a clinical re- This soon-to-be-published study is the most detection and its treatment. Moreover, it should search project aimed at evaluating the relevance important to date given that its conclusions are also contribute to research into new treatments of using ultrasound on the liver during surgery based on observations of 400 patients at the for pancreatic cancer through work on tumour as a means of tumour detection. The results University of Montreal Hospital Centre (CHUM). infiltrating lymphocytes and thereby improve were unequivocal: in 10% of cases ultrasound A cohort of this size lends considerable weight the possibilities for the development of vaccine detected tumours that had gone unnoticed by to the study's findings. "Most publications on therapies or for the injection of "specific" lym- magnetic resonance imaging. More importantly, this subject," explains Dr Lapointe, "focus more phocytes. "early detection translates into more in 16% of cases the liver resection was altered on the number of tumours and have many fewer effective therapies, which in turn increases the in light of this new data. The removal of the ad- chance of success and survival," notes Lapointe; ditional tumours found by ultrasound conside- "with this resource we hope to make conside- rably improves the survival rate of patients. As preoperAtive 3d simulAtions
rable advances in this direction." Dr Vandenbroucke-Menu notes, "using ultra-sound make it possible for us not only to dis- Another important aspect of liver resection cover additional tumours, but also to see that involves ensuring that the patient is left with the targeted tumour is closer to blood vessels enough of his or her liver following the opera- Detecting and treating prediabetes Systematic screening for prediabetes is not performed in Canada even though several studies have shown that treatment with or without medication can decrease the risk of developing diabetes. Since January 2009, Dr Jean-Louis Chiasson, an endocrinologist and researcher at the CRCHUM, has been working on this issue with his european colleagues within the framework of an important clinical research project in China.
By Dalila Benhaberou-Brun WhAt is prediAbetes?
Prediabetes is a condition in which a person displays a high fasting blood sugar level (6.1 to 6.9 mmol/L) or a blood sugar level between 7.8 and 11 mmol/L two hours after an oral glucose tolerance test (75 g of glucose). Dr Chiasson is concerned because this condition carries an in-creased risk not only of progressing to diabetes, but also of causing cardiovascular problems. In his view, patients need to be treated at this stage. To this end, he is participating in the ACe study, a major new clinical research project.
Ace, A good cArd?
Funded by Bayer Laboratories, the ACe study is an original research project including 7,500 pa-tients with prediabetes who have experienced a cardiovascular event. The study's objective is to assess the efficacy of the drug acarbose in pre-venting the incidence of mortality, myocardial infarction and cerebrovascular accidents as well as the development of type 2 diabetes in predia-betes patients.
An earlier international study directed by Dr Chiasson demonstrated that acarbose reduced the risk of developing diabetes by 36% by re- dr Jean-louis chiasson
ducing blood sugar levels after meals. Acarbose also reduced the risk of cardiovascular events by 49%. encouraged by these re- Why chinA?
toWArds systemAtic screening
sults, Dr Chiasson has undertaken If the starting point of Chiasson's If the ACe study provides the necessary confir- this new study to confirm the car- dr chiasson re-
concerns is in Canada, why con- mation of the effectiveness of Acarbose in re- diovascular effects of acarbose in a mains optimistic:
duct research on the other side of ducing the development of cardiovascular com- much larger population. "Our hope "to the extent that
the globe? "For two reasons," notes plications in at-risk populations, Chiasson feels is that the ACe study will prove that the results of this
Chiasson: "Given the size of China's that it will also provide convincing arguments in acarbose can prevent cardiovas- study and others
population, it is much easier to as- favour of adopting preventive measures. In his cular events as well as the progres- semble the very large study group view, these measures should include systematic sion from prediabetes to diabetes," throughout the
(7,500 subjects) we need to confirm screening and preventive treatments. The stakes says Chiasson.
world find their
our results beyond a shadow of a are quite high. The WHO estimates that if un- way into public
doubt. And secondly, type 2 diabetes checked, type 2 diabetes will affect more than health measures,
is on the rise in this country and is 300 million people worldwide by 2020. never- there is no reason
well on the way to assuming epide- theless, Dr Chiasson remains optimistic: "To the why we cannot
mic proportions." The project's find- extent that the results of this study and others ings will be equally valid for Canada throughout the world find their way into public stem this epi-
and other countries because the health measures, there is no reason why we can- cause of type 2 diabetes is the same not stem this epidemic." regardless of national or ethnic origin.
Improved monitoring of women with cervical pre-cancer Women with severe precancerous changes of the cervix — the stage preceding cancer — are treated by surgery. They are then monitored for two years with colposcopy, a medical procedure that involves a visual examination of the cervix with a special magnifying device. Unfortunately, the treatment fails in around 15% of cases and the pre-cancer could go unseen since colposcopy, the main method used in Canada, does not detect certain precancerous lesions that persist after surgery.
cancer). Fortunately, because of the systematic to see and therefore risk remaining untreated. By Dalila Benhaberou-Brun use of Pap tests as means of screening, this As such, it is important to validate another more Dr Marie-Hélène Mayrand, a gynaecologist and cancer has dropped to 13th place in Canada. sensitive and reliable technique.
researcher at the CRCHUM, heads up a pan- This method is generally effective since cervical Canadian clinical research project funded by the cancer develops very slowly and remains at a A vAst pAn-cAnAdiAn study
Terry Fox Foundation. Her research focuses on precancerous stage for several years, thereby Over the coming years, ten Canadian research patients treated for pre-cancer of the cervix and making it possible to identify it with a Pap test, teams will recruit 2,250 women who have been seeks to identify the most effective way of de- to treat it when necessary, and more importantly, treated for pre-cancer and will monitor them for tecting treatment failures.
to prevent the onset of cancer.
two years. Six months after the initial treatment, Caused by the human papilloma virus (HPV), cer- Although colposcopy makes it possible to see half the women will be monitored by colposcopy vical cancer is the second leading cause of cancer and remove precancerous lesions, some of these and the other half by an HPV test which looks for among women in the world (following breast lesions go undetected because they are difficult the virus in cervical secretions. If new lesions are detected, whatever the monitoring technique used, the women will be treated. The goal is to compare the two types of follow-up and to de-termine which of the two best detects treatment failure or relapse.
Dr Mayrand is convinced that results of this research project will have a positive impact on medical practice this study will
since at present there are no guide-lines concerning the best monitoring draw on the lar-
method. This study will draw on the gest cohort of
largest cohort of patients ever as- patients ever as-
sembled, thereby ensuring the reli- sembled, thereby
ability of the findings. "Projects of ensuring the relia-
this kind generate interest among patients and gynaecologists alike," bility of the find-
notes Dr Mayrand. Treatment fail- ings. "projects
ures will be detected more quickly of this kind ge-
and the appropriate measures will nerate interest
be taken without delay. "As well," among patients
adds Mayrand, "our study will make and gynaecolo-
it possible to identify women who are cured and as such can avoid gists alike," notes
lengthy follow-ups and unnecessary dr mayrand.
procedures." In short, there will be immediate benefits for patients. dr marie-hélène mayrand
CRCHUM: at the forefront of clinical research Continued from page 1 "The depth of our clinical activities attracts research, which means that it will be easier to major experts," boasts Lespérance, "we can meet government requirements. Studies that do things that others can't." For example, the are performed well and without problems avoid CHUM is Quebec's most important centre for costly delays, a feature that is appreciated by cancer treatment and has the province's largest our private-sector partners." neuroscience clinic. It is home to cutting-edge expertise in epilepsy, multiple scle- The new CRCHUM will enable a rosis, cerebrovascular accidents, as giant step forward, making it pos- well as diabetes and hypertension, sible to increase clinical research the chum is
to name only a few. "Being able to activities by 20% in the coming quebec's most
combine this kind of advanced ex- years and to substantially increase important centre
pertise with an immense pool of pa- the number of phase I, II and III cli- tients gives us a huge advantage over for cancer treat-
nical trials. Moreover, the new faci- other centres," adds Lespérance.
lity will enhance the creativity, talent, ment and has the
expertise and entrepreneurship of province's largest
the CRCHUM's researchers, "which A neW high-performAnce
neuroscience clinic.
will translate into more fruitful part- it is home to cutting-
nerships with the pharmaceutical As part of a major hospital mo- edge expertise in
industry," notes Lespérance.
dernization program in Quebec, the epilepsy, multiple
CRCHUM will soon have a new synergy And depth
home. Indeed, construction has be- vascular accidents,
gun on a new state-of-the art centre By bringing its top-notch research- that will make it possible for the as well as diabetes
ers together in a single facility, the CRCHUM to consolidate its clinical new CRCHUM will also become a and hypertension,
dr françois lespérance
research activities at a single site. very stimulating and enviable envi- to name only a few.
Clinical research is currently con- ronment. "Among other things, we stage shed light on the environmental, genetic ducted at three different sites. In have strengths in basic research, and biological factors contributing to the emer- the new centre, it will be easier for clinical research and population gence of diseases and also identify promising patients initially treated in various departments health research. By enabling these treatment avenues. Informed by these disco- of the CHUM to come to the research centre for researchers to work together — another major veries, clinical research develops and tests new their subsequent follow-up visits rather than vis- strength of the new CRCHUM — we will develop treatments and therapies with patients, and iting various dispersed clinics as is the case at a winning synergy relative to other, less-devel- the results of this research often provide new oped centres," explains Lespérance, "the enor-mous advantage of the depth of our research insights for refining research at the discovery The private sector wants to work with high- activities constitutes our added value, and we stage. Lastly, population health experts conduct performance research centres able not only to plan to fully develop this edge by creating net- evaluative research into health systems, health recruit patients quickly and efficiently, but also works of researchers." policy and quality of and access to care both in to select patients who meet all criteria of their Canada and abroad.
research protocols. In this way, data quality This depth of expertise and potential is largely So who are the CRCHUM's clinical researchers remains constant and infallible. This is where the result of the CRCHUM's commitment to and what kind of research are they conducting? the number and diversity of patients who visit covering the full continuum of biomedical re- The following pages provide a few interesting a hospital the size of the CHUM — more than search. Basic research and population studies 500,000 visits annually — is a major advantage (epidemiological research) at the discovery for researchers who need large cohorts.
"This is precisely what the new CRCHUM will be able to offer," notes Turgeon: "a controlled en-vironment with standard operating procedures in compliance with good laboratory and clinical practices that are required by major regula- tory agencies such as the FDA (Food and Drug Agency) in the United States. Day-to-day clinical research crchum is published three times a year by the
activities will not interfere with this cutting-edge CRCHUM — University of Montreal Hospital Centre's Research Centre. editor: Richard Ashby design: Production multimédia CHUM photographs: Production multimédia CHUM
contributors: Dalila Benhaberou-Brun, Francine Cartier, Anne Cohen,
Mireille Chalifour, Guy Sabourin, Andréa Sirhan-Daneau free subscription (paper and/or PDF copy): info.cr.chum@ssss.gouv.qc.ca
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ZYPREXA (OLANZAPINE) CLASS ACTION NOTICE OF SETTLEMENT APPROVAL TO ALL CLASS To all Canadian residents who took ZYPREXA ("Primary Claimants") on or before June 6, 2007 or their personal MEMBERS: representatives, heirs, assigns and trustees ("Representative Claimants"), and any other residents of Canada asserting the right to sue the Defendants by reason of their familial relationship with a Primary Claimant, including spouses, common law spouses, same-sex partners, as well as parents and children by birth, marriage or adoption ("Derivative Claimants").

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Skin Infection Manual Franklin Marshall College Skin Infection Manual Table of Contents 1. Introduction1. Herpes Simplex1. Tinea (Ringworm)1. Bacterial Infections (Impetigo, Staphylcoccus, Folliculitis)1. Molluscum Contagiosum The purpose of this manual is to educate people on the various forms of skin infectionsand their treatment. In addition, the NCAA rules and regulations for skin infections inwrestling will be explained.