Evaluative Clinical Sciences

Researchers in the evaluative clinical sciences platform at Sunnybrook Research Institute explore the causes, consequences and treatment of disease, with the aims of improving patient care and ensuring health care resources are used efficiently.

Scientists working in evaluative clinical sciences use a range of methods, including randomized controlled trials, meta-analyses, survey studies, economic evaluations, administrative database studies and computer simulation studies.

Main areas of study include understanding disease incidence and its geographical distribution, evaluating the efficacy of treatments and diagnostic tests, analyzing health policy, and investigating the economic impact of disease and intervention. Scientists also communicate important information to policy makers in the federal and provincial governments to help them make informed decisions. Research within this platform applies to numerous clinical areas.

Select advances in evaluative clinical sciences include the following:

Dr. Jon Barrett is leading an international multicentre clinical trial to determine the best method to deliver twins. Twin and other multiple pregnancies are high risk, and their numbers are soaring. This is because more women are choosing to have babies at an older age, which makes it more likely that they will have multiples; and because couples are choosing to have fertility treatments. Twin births have much higher rates of premature birth and growth abnormalities than do singletons. Even when babies have reached full-term without problems and the first twin is presenting head down, twins still have a threefold higher chance of dying.

Dr. David Gladstone is leading clinical trials evaluating stroke treatment. In one, he showed that rushing acute stroke patients to the Sunnybrook Regional Stroke Centre where they can get tissue plasminogen activator (tPA) therapy, which if quickly given reverses the signs and symptoms of stroke within minutes, works. Four times as many patients were treated with tPA after the stroke protocol was implemented, thereby achieving one of the highest stroke treatment rates in North America.

Dr. Colin McCartney is pioneering a new pain relief technique: low-volume, ultrasound-guided interscalene block. He has found that this technique reduces the amount of local anesthetic needed in patients who have undergone shoulder surgery, and that patients benefit from this method. They have less pain, fewer respiratory complications and improved mobility of their upper arm and shoulder. This technique is being used clinically worldwide.

Dr. Jack Tu led a practice-changing study showing that drug-eluting stents are as safe as bare metal stents in patients who had the mesh tubes implanted during angioplasty to keep their blood vessels from closing again. Patients given the drug-coated stents with blood-thinner medication for one year after surgery had the same risk of a postoperative heart attack as did patients who received bare metal stents. Moreover, the rate of death was lower for patients who had drug-coated stents. These findings led to a surge in the usage of drug-eluting stents.