It sounds like a leap forward. But how many of those kids will have a recurrence of severe belly pain and other miserable symptoms – possibly with the inflamed appendix bursting the second time?

Wouldn’t it be better to have low-risk laparoscopic surgery to remove the tiny, inflamed organ and get it over with?

Then again, how would you feel if your child was one of the five per cent of all appendectomy patients who turn out to have a normal appendix, meaning that the operation – and the risks of general anesthetic – were unnecessary?

And what if antibiotics could permanently solve the problem, leaving the child with an intact appendix – an organ once viewed as “useless” but now thought to play roles in the immune system and gut health?

Dr. Richard Keijzer, a pediatric surgeon at the Health Sciences Centre Winnipeg Children’s Hospital and professor of surgery in the Max Rady College of Medicine at UM, was part of an international research team that has just published a study comparing the two treatment approaches. The project was conducted at 11 children’s hospitals across seven countries.

The six-year study, “Appendectomy versus antibiotics for acute uncomplicated appendicitis in children: an open-label, international, multicentre, randomized, non-inferiority trial,” was published in the prestigious medical journal The Lancet.

Led by researchers at Children’s Mercy in Kansas City, Mo., it’s the first large, randomized (unbiased) trial comparing the appendectomy and antibiotics approaches in children.

“We studied 936 young patients – 57 of them in Winnipeg – with their parents’ permission, randomizing them into two treatment groups,” says Keijzer, who is also affiliated with the Children’s Hospital Research Institute of Manitoba. “They ranged in age from five to 16 and had suspected non-ruptured appendicitis.”

The researchers followed up one year after each child’s episode of appendicitis.

The antibiotic treatment had a failure rate (meaning that the child needed an appendectomy during that year) of 34 per cent. The surgery had a failure rate (meaning that the removed appendix was normal when examined, or the child had a serious complication related to appendicitis during the year) of 7 per cent.

“The difference between the two was 27 percentage points, which exceeded the 20 percentage points that we had deemed acceptable,” Keijzer says. “We declared the antibiotic treatment inferior in this trial.”

The children in the surgery group spent less time in hospital (the antibiotics group had to be monitored longer), but those who got antibiotics returned to school and their normal activities faster.

Keijzer says he’s proud that local families were involved in the trial. “We knew that this was an important study, answering a question about a very common disease in children in a well-designed trial.”

The participating families varied in how they viewed the two treatment approaches, he says.

“Some just wanted to get it over with and wanted the appendectomy, whereas other families did not want to do surgery if there was a medical treatment available.

“Now that we know from this clinical trial that about one-third of patients treated with antibiotics will eventually need an appendectomy, we can have better-informed discussions with families.”

At the Winnipeg Children’s Hospital, Keijzer says, “Most kids with appendicitis currently receive a laparoscopic appendectomy, but the antibiotic option is available and can be discussed with future patients and their families.”

The Canadian Mother-Child Collaborative Training Platform (CAMCCO-L) received more than $2.5 million from the Canadian Institutes of Health Research (CIHR) to launch the project. CAMCCO-L is one of 13 interdisciplinary teams from across the country to receive CIHR funding through its new initiative called the Health Research Training Platform.

“It’s very exciting,” said Dr. Sherif Eltonsy, assistant professor at the College of Pharmacy, Rady Faculty of Health Sciences, and one of CAMCCO-L’s principal applicants and the Manitoba site lead. “It’s something we’ve worked hard to get and we’re thrilled to be one of the teams that were funded. I’m excited for the next steps.”

The training platform is led by Anick Berard from the Centre Hospitalier Universitaire Sainte-Justine, which is affiliated with the University of Montreal.

CAMCCO-L will provide year-long training in the areas of pharmacogenomics, pharmacoepidemiology, toxicology and artificial intelligence. The initiative will offer 10 bursaries each year for its four-month summer school. The bursaries are in collaboration with universities in Montreal, France, Spain and Brazil, and will cover travel costs to those locations.  

CAMCCO-L will include a standardized curriculum with modules in equity, diversity and inclusion, sex and gender, hands-on virtual and in-person training, and professional development.

“The main goal is to provide early career researchers and trainees with new skills to make them experts in their fields. It will also help us retain qualified researchers,” Eltonsy said. “You could be a pharmacoepidemiologist who is interested in machine learning, but also would love to learn more about how pharmacogenomics can help.”

In addition to the summer school, online training will be provided to even more early career researchers and trainees than the 10 bursary recipients.

“Mentors will be able to link with mentees,” Eltonsy said. “This experience wouldn’t have been possible without this program.”

Two more Rady Faculty of Health Sciences professors are involved in CIHR Health Research Training Platform projects. Dr. Amine Choukou, assistant professor of occupational therapy at the College of Rehabilitation Sciences, is part of a team working on a national platform that’s focused on the delivery of technology for older Canadians with complex health needs and their caregivers. And Dr. Richard Keijzer, Thorlakson Chair in Surgical Research and director of research for the surgery department of the Max Rady College of Medicine, belongs to a team that’s developing a platform that will offer dedicated training, personalized mentorship and experiential opportunities for Canadian research trainees and early career researchers focused on improving the health and well-being of parents, children and families.

Thirteen interdisciplinary teams across Canada will receive approximately $2.4 million each in funding through a new initiative called the Health Research Training Platform. Researchers will receive training and development opportunities to build Canada’s research capacity in several areas, including women’s health, dementia, kidney disease, diabetes and the mental health of LGBTQ/2S populations.

Participants will conduct research while receiving extensive mentorship and training that goes beyond what standard research training programs usually offer, including diverse and inclusive research, such as respecting Indigenous Ways of Knowing, sex- and gender-based considerations in research and recognizing unconscious bias.

“At CIHR, we care deeply about strengthening Canadian health research capacity, and we cannot do this without enhancing training and career support for the next generation of health researchers,” stated CIHR president Dr. Michael Strong.

Faculty members from the Rady Faculty of Health Sciences are playing roles in two of the projects funded through the new initiative.

Dr. Amine Choukou, assistant professor of occupational therapy at the College of Rehabilitation Sciences, is the prairie lead of a national platform that is focused on the delivery of technology for older Canadians with complex health needs and their caregivers.

Led by Alex Mihailidis at the University of Toronto, the Early Professionals, Inspired Careers in AgeTech (EPIC-AT) platform will provide one-year fellowships to at least 127 graduate students, postdoctoral fellows and early career researchers at Canadian institutions from 2022-2027.

The platform is an extension of the EPIC training program at AGE-WELL, a Canadian network focused on improving the quality of life for older adults and caregivers through technology. That program has educated and supported over 1,000 trainees at various levels since 2015, including Choukou when he was a postdoctoral fellow at Laval University.

“EPIC-AT will provide mentorship and support to both early career researchers and trainees working on technology for aging well,” Choukou said.

Participants will be equipped to develop, implement and evaluate digital technology solutions across areas such as information and communication technologies, telemedicine, artificial intelligence, sensors, smart environments, robotics and wearables.

“These solutions will help older Canadians age safely, independently and with dignity in the setting of their choice,” Choukou said.

Dr. Richard Keijzer, Thorlakson Chair in Surgical Research and director of research for the surgery department of the Max Rady College of Medicine, is part of a project being led by Dr. Susan Samuel at the University of Calgary that brings together 16 Canadian pediatric academic health centres, affiliated universities, research groups and networks focused on child health

The team is developing a national training and mentoring platform called Empowering Next generation Researchers In perinatal and Child Health (ENRICH). The platform will offer dedicated training, personalized mentorship, and experiential opportunities for Canadian research trainees and early career researchers focused on improving the health and well-being of mothers, fathers, infants, children, youth and families.

“We brought together multiple groups for a total of 193 collaborators – including 11 from the Rady Faculty of Health Sciences – who are all going to work on this together transnationally,” said Keijzer, who is also a researcher with the Children’s Hospital Research Institute of Manitoba.

He noted there will be different levels of training for approximately 30 to 40 trainees each year, as well as a learning management system that can be accessed by anyone interested.

“We really wanted to make this available to anyone in child health,” Keijzer said.

Both platforms will also emphasize recruitment and training of undergraduates and PhD trainees from underrepresented minorities.

A total of more than $12 million was awarded in the form of project and bridge grants, with study durations ranging from one to five years.

“Congratulations to all the dedicated UM researchers who were successful in this Spring 2021 funding competition,” said UM Vice-President (Research and International) Dr. Digvir Jayas.

“These professors have shown leadership in their fields and are advancing knowledge in several important areas of Indigenous health, as well as in illnesses such as kidney disease, heart disease, HIV, diabetes, cancer and psychiatric disorders.”

The UM project that received the largest grant, more than $1.9 million over five years, is titled Qanuinngitsiarutiksait.2: Developing tools for the wellness and safety of Inuit.

DR. JOSEE LAVOIE

Led by Dr. Josée Lavoie, professor of community health sciences and director of Ongomiizwin Research, the project builds on a previous study of service use by the thousands of Inuit from Nunavut who come to Manitoba to access services.

The new study will focus on how Inuit concepts of wellness can be used to create healing programs in Winnipeg that reflect Inuit values. The researchers plan to develop and implement several programs, such as one tailored to the needs of Inuit families involved with Child and Family Services.

A five-year grant of more than $1.4 million was awarded to the project Oral microbiome and caries risk in young First Nations and Métis children in Manitoba.

DR. ROBERT SCHROTH

A team led by Dr. Robert Schroth, professor of preventive dental science in the Dr. Gerald Niznick College of Dentistry and researcher with the Children’s Hospital Research Institute of Manitoba (CHRIM), will examine the dental microbiome that is associated with the severe form of baby-tooth decay that affects many First Nations and Métis preschoolers.

The aim is to understand why only some dental microorganisms cause tooth decay, and the environmental factors that may influence this process.

Here’s a look at the other funded studies and lead investigators. More information on the studies and research teams is available here.

Dr. Marissa Becker, associate professor, medical microbiology & infectious diseases, Max Rady College of Medicine

Grant: $200,000 (two years)

Becker’s team will study sexually transmitted and blood-borne infections (STBBI) among military personnel in Ukraine, examining how they contribute to broader STBBI epidemics amid the armed conflict in that country.

Dr. David Collister, assistant professor, internal medicine, Max Rady College of Medicine

Grant: $321,300 (three years)

Collister seeks to determine which uremic toxins are responsible for individual disease symptoms in advanced chronic kidney disease, and which symptoms respond to dialysis. The findings will inform dialysis decision-making.

Dr. Kevin Coombs, professor, medical microbiology & infectious diseases, Max Rady College of Medicine

Grant: $100,000 (one year)

Coombs will examine human cells’ susceptibility to the Zika virus, which is transmitted by a mosquito that is becoming known in Canada. He aims to understand how cellular genes and proteins work to allow or inhibit Zika growth.

Dr. Sanjiv Dhingra, associate professor, physiology & pathophysiology, Max Rady College of Medicine; principal investigator, Institute of Cardiovascular Sciences, St. Boniface Hospital Research Centre

Grant: $960,076 (five years)

Dhingra’s study relates to the potential of using transplanted stem cells from healthy donors to treat heart disease. He will investigate why transplanted stem cells are ultimately rejected by the host’s immune system, and how to prevent this.

Dr. Vernon Dolinsky, associate professor, pharmacology & therapeutics, Max Rady College of Medicine; researcher, CHRIM

Grant: $822,376 (five years)

Dolinsky’s team has found that the offspring of mothers who had gestational diabetes are at risk of later heart failure. His study will investigate the role of a cellular protein that could prevent damage to the heart and allow it to pump better.

Dr. Krista Hardy, assistant professor, surgery, Max Rady College of Medicine

Grant: $470,475 (four years)

Hardy aims to better understand the experiences of Indigenous patients who undergo bariatric surgery in Manitoba as a treatment for obesity. Her project will incorporate and assess Indigenous healing and wellness practices in bariatric surgery care.

Dr. Richard Keijzer, professor, surgery, Max Rady College of Medicine; researcher, CHRIM

Grant: $233,324 (three years)

Keijzer’s team has created a database of more than 750 Manitobans who were born with a congenital anomaly that required surgery at birth. By linking this to population data, the team will conduct a follow-up study of the patients’ medical, educational and socio-economic outcomes.

Grant: $749,700 (five years)

Keijzer will also lead an international team of experts on congenital diaphragmatic hernia (CDH) to determine the role of circular RNAs in these infants’ abnormal lung development. The results will help to better predict outcomes in babies with CDH.

Dr. Dylan MacKay, assistant professor, community health sciences, Max Rady College of Medicine

Grant: $100,000 (one year)

MacKay will enrol patients with chronic kidney disease in a one-year, randomized study comparing methods of reducing dietary acid. Half the patients will take baking soda pills, while the other half will have fruits and vegetables delivered to them to reduce acid through diet.

Dr. Lyle McKinnon, associate professor, medical microbiology & infectious diseases, Max Rady College of Medicine; researcher, CHRIM

Grant: $300,000 (three years)

McKinnon’s team has previously found that vaginal inflammation increases a woman’s risk of becoming HIV-infected if exposed. His study focuses on regulatory T cells and their potential to control female genital inflammation as an HIV prevention strategy.

Dr. James Nagy, professor, physiology & pathophysiology, Max Rady College of Medicine

Grant: $742,050 (five years)

Nagy’s study builds on his previous research on how nerve cells in the brain communicate at electrical synapses, how protein components function in this transmission, and how malfunctioning of these mechanisms contributes to neurological disorders.

Dr. Marcus Ng, associate professor, internal medicine, Max Rady College of Medicine

Grant: $548,890 (five years)

Ng will analyze data from patients with epilepsy to compare the brain zone of epileptic activity during rapid eye movement sleep, other stages of sleep, and wakefulness. Better mapping of where seizures arise could allow more patients to undergo life-changing neurosurgery.

Dr. Tabrez Siddiqui, associate professor, physiology & pathophysiology, Max Rady College of Medicine

Grant: $983,026 (five years)

Siddiqui will investigate, in mice, how a type of altered biochemical signaling affects the brain, producing deficits such as those in autism and schizophrenia. The goal is to increase understanding of neuropsychiatric disorders so that drug targets can be identified.

Dr. Jörg Stetefeld, professor, biochemistry, Faculty of Science; Canada Research Chair in structural biology and biophysics

Grant: $742,050 (five years)

Stetefeld will pursue a molecular study of connective tissue growth factor (CTGF), a protein involved in cancerous tumor development and tissue fibrosis. He aims to develop new therapeutic targets based on understanding the role of CTGF.

Dr. Julia Uhanova, associate professor, internal medicine, Max Rady College of Medicine

Grant: $573,751 (two years)

Uhanova will explore whether adherence to a traditional First Nations land-based diet decreases the severity of non-alcoholic steatohepatitis, an aggressive form of fatty liver disease. This inflammatory disease has a high prevalence among First Nations.

Dr. Jude Uzonna, professor, immunology, Max Rady College of Medicine

Grant: $990,676 (five years)

Uzonna’s study focuses on how the body maintains immunity after recovery from leishmaniasis, a parasitic disease. Understanding factors that regulate the antigen-specific memory response to the disease will aid progress toward a vaccine.

Dr. Kristy Wittmeier, associate professor, pediatrics & child health, Max Rady College of Medicine; researcher, CHRIM

Grant: $240,976 (two years)

Building on her previous research, Wittmeier will study knowledge-sharing networks in child development and rehabilitation in Canada. Her team will make recommendations to improve these networks to better serve children’s needs.

She points to a need for better access to maternity care options in rural and remote Manitoba. And she hopes for greater recognition of the benefits of midwifery care, both to childbearing families and to an efficient health-care system.

“Part of my role is clinical, so I’m aware of current issues in the maternal and child health system,” says Thiessen, who in 2017 was one of the first Canadian midwives to receive a Career Development Award from the Canadian Child Health Clinician-Scientist Program.

“This program has groomed me to think like a clinician-scientist and bridge the gap between research initiatives and clinical practice.”

The associate professor of nursing wants to see more midwives in roles that influence the profession. “We need to mentor midwives to ensure we have those voices at policy tables, in circles of research and in managerial and leadership roles,” she says.

Thiessen is originally from Wichita, Kan. She earned bachelor’s degrees in nursing and Spanish at Eastern Mennonite University in Virginia before completing a master’s in nursing with an emphasis in midwifery from Georgetown University in Washington, D.C.

In 2014, she earned her PhD at UM through the applied health sciences program and joined the College of Nursing faculty. She was also invited into the Children’s Hospital Research Institute of Manitoba mentorship program for new investigators.

She was mentored by Michelle Lobchuk [BN/92, MN/95, PhD/01], associate professor of nursing, and Dr. Richard Keijzer, research director for the department of surgery in the Max Rady College of Medicine. She says both were instrumental in helping her to overcome early challenges and navigate her clinician-scientist role.

Thiessen’s doctoral thesis analyzed the issues in Manitoba midwifery since it became a regulated profession in 2000.

“There had never been a notable health workforce strategy,” she says. “Twenty years later, midwifery still has not been fully integrated into the health-care system, and there have been many barriers precluding its expansion.”

Those barriers, she says, include negative perceptions of midwifery. Research is one way to demonstrate that negative assumptions are inaccurate.

This year, Thiessen published two studies comparing costs and outcomes associated with three types of maternity care providers in Manitoba: family doctors, obstetricians/gynecologists and registered midwives.

“Measuring the cost of maternity care is complex,” she says. “But in general, some cost efficiencies were found in midwifery because it involves fewer medical interventions and uses fewer hospital resources.

“Our studies also showed that midwifery clients had significantly shorter stays in the hospital.”

In 2019, Thiessen and a First Nation Elder received more than $800,000 from the Canadian Institutes of Health Research to study maternity systems in northern communities.

“We’re working collaboratively with Indigenous and Inuit advisory groups in four jurisdictions across Canada that include 11 northern communities,” she says. “We want to describe and compare maternity policy effects on Indigenous people and other maternity-care stakeholders, looking at their physical, social, emotional and spiritual well-being.”

Midwives are educated to have a unique skill set that helps to empower clients, Thiessen says. A midwife spends time with expectant parents, ensures that they’re informed about birth options, and respects their decisions in a way that is not often seen in health care.

“People have become dependent on the health-care system in a very dysfunctional way and, as a result, they don’t know how to have conversations with health-care providers,” Thiessen says.

“Informed choice discussions, which are part of the fundamental philosophy of the midwifery care model, are one key step in improving the health-care environment and putting the onus on the person to make more informed decisions for their own health.”

More information on the bachelor of midwifery program.

The Government of Canada is the country’s largest investor in health research through the Canadian Institutes of Health Research (CIHR).

“Some of Canada’s most important health discoveries are being made right here in Winnipeg. This announcement highlights the bright minds and the strong support for research and innovation at the University of Manitoba,” said Ouellette.

Health research leads to discoveries and knowledge that helps improve the health of Canadians through new treatments, health services and health promotion and disease prevention programs.

The funding will support the work of researchers at the University of Manitoba across the spectrum of health research areas, ranging from microbiology and nanoparticles, to healthcare delivery and population-based wellness strategies.

Two U of M researchers shared snapshots of their collaborative research projects.

Dr. Julie Ho, associate professor of internal medicine and immunology in the Max Rady College of Medicine (Rady Faculty) and a team of researchers at the U of M will lead a new clinical trial led that could change the current standard of care for monitoring kidney transplant patients and potentially increase the longevity of successful kidney transplants.

Ho, Principal investigator on the study, says many Canadians don’t realize that kidney disease is a silent killer. “It’s actually really sad.… When patients tell their families they have kidney disease, it doesn’t have the same implication as if they were to say ‘I have cancer.’ But the mortality rate with kidney disease is actually just as bad as with many cancers, although there is less public awareness about it.” [Read more about this study.]

Marissa Becker [MD/99], an associate professor in community health sciences (U of M) with cross-appointments to internal medicine and medical microbiology,  will lead a project designed to understand how the consequences of conflict, migration and disrupted health services affect risk in the context of HIV, sexually transmitted infections (STIs) and hepatitis C virus (HCV). The study is being conducted by an international, inter-disciplinary team in order to understand this complex public health issue.

The study will generate important information for its Ukrainian partners, who provide HIV prevention programs in Dnipropetrovsk, and address an important knowledge gap globally.
“We’re working with local program partners, researchers and policy makers,” Becker says. “We’ve been doing work in Ukraine for a number of years now. It’s important to us to sustain and further develop those partnerships for impactful work.” [Read more about this study.]

The following researchers also received funding:

Christopher Anderson | Rady Faculty of Health Sciences
Keith Fowke | Rady Faculty of Health Sciences
Spencer Gibson | Rady Faculty of Health Sciences
Richard Keijzer | Rady Faculty of Health Sciences
Christine Kelly | Rady Faculty of Health Sciences
Ayush Kumar | Brian Mark | Faculty of Science
Josée Lavoie | Rady Faculty of Health Sciences
Brian Mark | Faculty of Science
Lyle Mckinnon | Rady Faculty of Health Sciences
Donald Miller | Rady Faculty of Health Sciences
James Nagy | Rady Faculty of Health Sciences
Abdelilah Soussi Gounni | Rady Faculty of Health Sciences
Jude Uzonna| Rady Faculty of Health Sciences