Angels Den

Michael Page

Director, AI Commercialization, St. Michael’s Hospital

Dr. Jennifer Watt

Geriatrician and Clinician-Scientist, Li Ka Shing Knowledge Institute, St. Michael’s Hospital

The Challenge: One in six hospital beds in Canada are occupied by patients who no longer need hospital care but are waiting for rehab, long-term care, or social supports. This backlog is partly caused by challenges in collecting key data in busy emergency departments, and doctors not
always being able to recognize patients at risk of extended stays.

The Solution: Dr. Jennifer Watt and Michael Page are leading the development of an innovative AI-driven tool that identifies elderly patients at risk of prolonged hospital stays. This technology will empower care teams to intervene earlier, helping to shorten hospital stays and improve
patient outcomes through safer, more coordinated discharge processes.

Dr. Johannes von Vopelius-Feldt

Emergency and EMS Physician, and Clinician-Scientist, Li Ka Shing Knowledge Institute, St. Michael’s Hospital

Dr. Sheldon Cheskes

Emergency and EMS Physician, and Clinician-Scientist, Li Ka Shing Knowledge Institute, St. Michael’s Hospital

The Challenge: Trauma is the leading cause of death for Canadians under 40, with 60 percent of major trauma patients dying before ever reaching a hospital. Emergency doctors can save lives, but only once patients arrive in the ED. In the GTA, that trip takes an average of 43 minutes for severely injured patients—and every minute counts.

The Solution: Drs. Johannes von Vopelius-Feldt and Sheldon Cheskes are reimagining emergency medicine with Critical Care Response Units that bring the ER to the scene. These specialized physician-paramedic teams can be dispatched directly to critically injured patients, delivering faster trauma care and saving lives.

Dr. Kelsie Thu

Scientist, Keenan Research Centre for Biomedical Science, St. Michael's Hospital

Scientists have identified a protein called CD47 that is commonly found on cancer tumours, but existing therapies have been unable to target it effectively. To address this challenge, Dr. Kelsie Thu has developed custom-engineered viruses that can target CD47 on cancer tumours—a potentially groundbreaking new approach to immunotherapy, which stimulates the immune system to attack tumours. Through this study, the team will test the viruses in tumour models with the aim of establishing this treatment as the next transformative immunotherapy for cancer patients.

THE CHALLENGE: Sepsis is a life-threatening medical emergency caused when the body’s response to an infection injures its own tissues and organs. Worldwide, there are 50 million cases each year. As the only treatments are antibiotics, which aren’t always effective, and organ support, one in five people will die from this common hospital complication.

THE SOLUTION: Dr. Claudia dos Santos and Dr. Amin Ektesabi have developed a breakthrough drug to block inflammation, supercharge the white blood cells’ ability to kill bacteria, and protect against heart and lung failure. Now they want to test it in pre-clinical trials–so they can move quickly to save lives.

THE CHALLENGE: Chronic kidney disease – caused when diabetes or high blood pressure irreversibly damages the organs by scarring them – affects one in 10 Canadians. The usual way to diagnose kidney disease is by a needle biopsy. Not only is the procedure painful, it can be dangerous: it may cause bleeding, sending patients to the ICU.

THE SOLUTION: Dr. Darren Yuen has developed a simple, non-invasive ultrasound scan that can take a picture of the kidney to see if there is scarring and how extensive it is. This first-of-its-kind innovation will revolutionize care for people around the world who are living with chronic kidney disease.

THE CHALLENGE: 165,000 Canadians will suffer a traumatic brain injury (TBI) this year. TBIs can cause serious long-term disability and even death. In fact, it’s the leading cause of death in young people. A rapid diagnosis and transfer to a hospital with a neurosurgeon are critical to save lives. But only one in five cases will end up needing surgery – and as it is, neurosurgeons are overwhelmed by the volume of consults.

THE SOLUTION: Dr. Christopher Witiw and Dr. Alun Ackery have developed an AI-based tool trained using brain imaging from thousands of TBI patients to help doctors decide who will need to undergo surgery. Now they want to test it at community hospitals without a neurosurgeon on staff to see if they can improve system-wide efficiencies.

THE CHALLENGE: Meningiomas are the most common type of primary brain tumour in adults. They begin in the brain and spinal cord. The standard protocol is surgery to remove as much of the tumour as possible, followed by radiation therapy. However, open brain surgery is an extremely high-risk procedure and standard radiation therapy is not precise leading to side effects of exposing health brain tissue. We need new non-invasive ways to provide targeted treatment for brain tumours.

THE SOLUTION: Dr. Vitor Pereira has designed a procedure that delivers a radioactive particle directly to the site of the tumour through a series of tiny catheters. The catheters enter the body through the wrist or groin, instead of through the skull. This procedure has shown promise for liver cancer. Now, they want to determine if it is safe and effective for brain cancer.

THE CHALLENGE: Cardiovascular disease is a leading cause of death globally. Although millions of people are prescribed medications to treat their condition, more than 30 percent don’t get the right dosages or medication. One reason is that factors such as weight and genetics that impact how well a medication performs are normally not considered.

THE SOLUTION: Dr. Mohammad Qadura and Muzammil Syed have developed Cardio MedCheck. The device is a convenient urine test that measures the amount of cardiovascular drugs in your system to assess whether your body can absorb the medication, if you have the right amount, or if you need a different medication.

THE CHALLENGE: Delirium is a state of confusion that affects one in three hospitalized adults. Patients experiencing delirium have two times the mortality rate and stay in the hospital for an average of eight days longer. Up to 40 percent of delirium cases can be prevented through interventions that improve sleep, mobility, cognition and nutrition. However, our overburdened healthcare staff often do not know who is at high risk of developing delirium.

THE SOLUTION: Dr. Amol Verma and Dr. Fahad Razak want to develop an AI tool that predicts which patients are at high risk of developing delirium. The tool will alert healthcare workers in real-time so they can intervene and prevent delirium from occurring. Not only will patients fare better, but costs to the healthcare system will be significantly reduced.

THE CHALLENGE: Every year, over 85,000 people in North America are diagnosed with kidney cancer. It’s a silent killer that can go undetected for years; one in four will die. Since there are many different types of kidney cancer, each with its unique biology, the current one-size-fits-all approach to therapy doesn’t work.

THE SOLUTION: Dr. Rola Saleeb and Dr. Kelsie Thu want to tailor kidney cancer treatment. They have identified a gene that defines the second most common type of kidney cancer which may make these tumours respond to a safe and Health Canada approved allergy medication. By testing this therapy, they hope to slow down kidney cancer growth and provide an alternative to chemotherapy.

THE CHALLENEGE: Thirty to 50 percent of patients with breast cancer will develop intracranial metastatic disease (IMD), which occurs when a cancer that starts in one part of the body spreads (metastasizes) to the brain. The development of IMD has a significant impact on a patient’s survival and their quality of life. Women with metastatic HER2-positive (HER2+) breast cancer, in particular, are at a higher risk of developing IMD. The big question is why?

THE SOLUTION: We will analyze tumour tissue from patients with HER2+ breast cancer and IMD in order to determine if the development of brain metastasis is associated with loss of HER2 expression or resistance to medicines that target HER2. The study will give us insight into disease mechanisms that lead to IMD in these patients, and help researchers identify new targets for more effective treatments.

THE CHALLENGE: Endometriosis is an agonizing pelvic disease that afflicts 10 percent of women and people assigned female at birth. Diagnosis is often delayed by 5-10 years and surgery may take years to book, leaving women to suffer with chronic pain, infertility, and significantly impaired quality of life. First-line treatments, like mindfulness and pelvic floor physiotherapy, are effective but often not accessible. They can be too costly for some, since they’re not covered by OHIP, and providers are few and far between.

THE SOLUTION: Dr. Carmen McCaffrey and Dr. Elizabeth Miazga have already developed a basic MyEndo app, which hosts a mindfulness course for patients with endometriosis that eases pain. Now they want to expand the app to include a wide range of online treatments and educational resources, making it free and open access, so women everywhere can get the care they desperately need and deserve.

THE CHALLENGE: The pain of kidney stones is excruciating and 10 percent of adults have an attack in their lifetime. While surgeons can remove kidney stones by breaking them with lasers, the process leaves tiny fragments, like sand, that can create new stones over time. With too many recurrences, people can lose their kidney function altogether.

​THE SOLUTION: Dr. Monica Farcas has invented a device that sucks up the kidney stone fragments during surgery leaving the patient completely stone free. Now they want to take the prototype to the next level. For the patient, the innovation means healthy kidneys and a pain-free life. And for the health-care system, it means fewer emergency visits and operations.

THE CHALLENGE: Mechanical ventilation saves lives. But if it’s not matched to each patient, it can further damage lungs, cause anxiety, pain and discomfort, and even injure other organs. For too many patients, that can mean prolonged stays in hospital, and lead to long-term disability or even death. Not surprisingly, each patient needs different levels of ventilation. How can clinicians make sure a patient gets the full benefit of mechanical ventilation, with none of its bad effects?

THE SOLUTION: Dr. Laurent Brochard and Dr. Muhammad Mamdani will create and deploy into practice AI algorithms that analyze a patient’s status, minute-by-minute. The clinicians then use this information to adjust the ventilation based on patients’ real-time needs which results in less sedation, fewer complications and deaths, and quicker recovery. And for hospitals, that means ICU beds are freed up faster to care for other critically ill patients.

THE CHALLENGE: Not all broken bones heal on their own, leaving patients with debilitating pain and disability.

THE SOLUTION: Orthopedic surgeon and fracture specialist Dr. Aaron Nauth and researcher Ikran Ali have discovered how to dramatically improve fracture healing by injecting supercharged stem cells into the bones. The dream is to give patients back a life that's pain-free and fully independent.

THE CHALLENGE: Getting an accurate cancer diagnosis can take days in pathology. That means surgeons can’t make treatment decisions on the spot, and patients wait anxiously to find out whether they have cancer – and just how serious it is.

THE SOLUTION: Neurosurgeon and biomedical engineer Dr. Howard Ginsberg and scientist Dr. Arash Zarrine-Afsar are developing a rapid tumour diagnostic system that tells surgeons in 10 seconds whether the tumour is in fact cancer, and if so, what type it is.

THE CHALLENGE: Stroke and heart disease are a major cause of death among Canadians. Every second a blood vessel is blocked, millions of heart and brain cells die. So intervening fast is crucial. But many people don’t live close enough to a medical centre to get the immediate treatment they need.

THE SOLUTION: Using robotic technology, neurosurgeons Dr. Vitor Pereira and Dr. Julian Spears have performed minimally invasive surgery for stroke patients who aren’t in the same room. Now they’re getting ready to test the technology nationwide, so that one day patients hundreds of kilometres away from the nearest experts will have access to life-saving surgery.

THE CHALLENGE: Intensive Care Unit-Acquired Weakness (ICUAW) is a muscle-wasting condition common in the critically ill. Neuromuscular electrical stimulation (NMES) can help prevent this condition, but current technology is unfeasible from a practical and economic standpoint.

THE SOLUTION: “Smart textile” garments, like leg stockings and arm sleeves, that automate NMES stimulation through the power of AI.

THE CHALLENGE: COVID-19 survivors, even those who’ve had only a mild case, may develop chronic or permanent lung scarring that leads to long-term breathing complications.

THE SOLUTIONS: 1. To rapidly diagnose lung scarring in COVID-19 survivors using a bedside ultrasound tool. 2. To test a new drug to treat COVID-19-induced lung damage.

THE CHALLENGE: Rates of pressure injuries, or bed sores, in Canadian healthcare are among the highest in the world, particularly in long-term care. Yet this painful and potentially life-threatening condition is completely preventable.

THE SOLUTION: SkIP (Skin Imaging for Pressure Injuries) technology that enables non-specialist healthcare practitioners, for the first time ever, to monitor patients at risk of developing pressure injuries.

THE CHALLENGE: Peripheral arterial disease (PAD), which is the hardening of the arteries in the legs, affects 200 million people worldwide. It can lead to amputation and even death. Yet because we lack diagnostic tools and blood tests, PAD goes undiagnosed in 75% of patients.

THE SOLUTION: A biomarker (blood-based test) to screen blood and diagnose PAD.

THE CHALLENGE: The liver is the most frequently injured abdominal organ in trauma, yet there is no device to control bleeding without impairing the physician’s view of the liver.

THE SOLUTION: An inflatable, transparent and non-adherent liver airbag that allows surgeons to see and control bleeding, and safely remove the surgical packing.

THE CHALLENGE: Canada has the highest rate of multiple sclerosis in the world. While there are more treatment options, doctors still don’t have the tools to predict the course of the disease in an individual patient.

THE SOLUTION: An artificial intelligence (AI) tool to predict a specific patient’s risk of relapse and personalize their treatments.

Current methods of testing for prostate cancer have led to widespread over-treatment, with thousands of men left impotent and incontinent after surgery they didn’t need, or subjected to unnecessary biopsies. Many men diagnosed with prostate cancer have a clinically harmless form of cancer that will never kill them and they don’t need surgery or biopsies at all. However, it is often difficult for doctors to predict these ‘low-risk’ patients.

Artificial intelligence (AI) has moved from SciFi to reality in all areas of our lives, but health care has so far been slow to embrace it. This is partly because medicine is traditionally viewed as an art as much as a science: many worry that technology and programming are no substitute for clinical expertise.

Influenza pandemics kill millions of people and we are due for the next
“big one.”

The virus mutates rapidly and we’ve already seen cases where traditional flu drugs no longer work. Vaccines take months to develop. We urgently need new drugs against influenza.

Our answer to this urgent need is to rapidly screen a large chemical library, looking for new compounds that prevent death from the virus. We will do this using zebrafish. These tiny fish are easy to grow and inexpensive, allowing us to cheaply screen thousands of potential flu drugs, while simultaneously evaluating toxicity. Once we find drugs that protect the fish, we will then confirm their effectiveness in pre-clinical influenza models and study how they work. By testing promising compounds in both fish and relevant pre- clinical models, our project will quickly identify drugs with great potential forprotecting humans from the next influenza pandemic."

We want to improve care for pregnant women and their babies through a
project we call IRON MOM.

Without iron the body can’t make red blood cells, this is called anemia.
The body uses a lot of iron to make a baby, so anemia is very common in
pregnancy and it can cause big problems, including premature delivery, lowbirth weight, childhood anemia, postpartum depression and even death. The good news is that low iron is easy to detect and almost as easy to treat. The bad news is that it’s often not recognized or managed.

IRON MOM will help both clinicians and families. It offers tools to make it easy for a medical team to recognize and treat low iron before it becomes severe. IRON MOM also educates moms about low iron and empowers women in their own health care.

IRON MOM will make pregnancies safer and babies healthier.

Canadians with diabetes are 23 times more likely than the general population to end up in the hospital for a leg amputation because of a diabetic foot ulcer. These patients lack feeling in their feet because of poor blood flow, so something as simple as a wrinkle in a sock can cause a blister that turns into a wound in the skin. Patients requiring amputation have a 30% risk of dying within the year, which is more than the lifetime risk of dying from common cancers such as colon or breast cancer. Saving limbs and preventing amputations is critical in improving health for patients with diabetes. The challenge is that there are no early warning signs of tissue damage. This means that patients come to the hospital in many cases too late to save their foot or leg. Home- or outpatient-based regular screening of tissue health would save diabetic limbs through early treatment and intervention. This screening also has the potential to reduce health care costs as many patients do not get the appropriate investigations when first diagnosed with a diabetic foot ulcer.

Magnetic resonance imaging (MRI) is a very powerful imaging tool. It can see blockages in arteries, measuring blood flow to tissue. Unfortunately, MRI is fairly expensive, and is not a good screening tool. We know that patients usually come to the hospital late, and by the time a doctor sees a patient, there may already be a foot wound. It is then usually too late to order an MRI.

If there were an early warning tool, we might be able to see disease earlier, intervene earlier, save more limbs and improve these patients’ lives.

We are developing such an early warning tool in our laboratories, a device called Multispectral Imaging (MSID). The MSID device takes pictures of tissue using different “colours” of infrared light. By comparing these pictures, we can see the extent of blood and tissue damage in the legs and feet of patients with diabetes. In our studies, we will first see how well our device is able to measure these signals of tissue damage in standardized laboratory models. Then we will see how well the early warning device compares to MRI for tissue injury. Finally, we will test our early warning device in a group of patients who have normal blood flow, blocked blood flow, as well as patients with foot wounds. The information obtained from the patient study will then be used to design the next generation device, the “MultIspectral MObile tiSsue Assessment” device or the MIMOSA, which we envision as handheld and able to assess tissue health at home.

We think that this device could eventually integrate with a cell phone, giving patients the ability to “check their feet” for early signs of tissue problems. In addition, it will provide us with unique insight into diabetic limb health and, perhaps, in the future, let us develop treatment to help prevent the poor blood flow from occurring. We may be able to save limbs and lives by early recognition and detection of tissue problems.