Firestone Clinic
St. Joseph's Healthcare
50 Charlton Avenue East
Hamilton, Ontario
Canada L8N 4A6
905.522.1155 x36000
Firestone Research
St. Joseph's Healthcare
50 Charlton Avenue East
Hamilton, Ontario
Canada L8N 4A6
905.522.1155 x33140
Firestone Institute for Respiratory Health
Innovative Education, Translational Research, Exemplary Clinical Services
Description
The Firestone Institute provides comprehensive outpatient and inpatient respiratory care as the regional respiratory service for the City of Hamilton and the Hamilton Niagara Haldimand Brant Local Health Integrated Network (LHIN).
FIRH has a unique Chest Programme that encompasses respiratory medicine together with affiliated head-and-neck and thoracic surgery services; all are located on one site.
The Institute is supported by state-of-the-art pulmonary function and sleep laboratories, an induced sputum analysis laboratory, an aerosol laboratory, a gastrointestinal motility laboratory, the departments of diagnostic imaging, critical care and endoscopy, and a regional laboratory-medicine programme.
FIRH is located in a purpose built new facility at St. Joseph’s Hospital. Its faculty comprises a collegial mix of clinician-educators, clinician-scientists and basic researchers working in close proximity, which again helps to facilitate the research agenda.
Mission / Values
The purpose of the Firestone Institute for Respiratory Health is to conduct research to increase understanding of respiratory health and disease across the life cycle through collaborative basic and clinical investigations with the expectation of improving patient care.
FIRH research faculty train young investigators to become independent researchers, encourage partnerships across disciplines nationally and internationally, and create synergies with the public and private sectors.
Annual Report 2010 / 2011
Innovative Education, Translational Research, Exemplary Clinical Services
FIRH’s patient-centred focus on care is achieved through the tremendous efforts of allied health care professionals, including nurses, respiratory therapists and technicians, and through the efforts of FIRH’s administrative staff.
In 2010 / 2011, 41 physicians saw 38,800 patients, totalling 63,160 visits and procedures. Additional tests not connected to these physicians, but conducted in the FIRH labs, totalled an additional 23,340 procedures. Therefore, the total number of procedures and visits captured at FIRH was 86,504.
The proximity of research teams to clinical services has, on the one hand, allowed conduct of highly relevant and well-powered clinical studies, and on the other, has ensured rapid incorporation of new knowledge into the care of patients. This integration also strongly influences the education of physicians and allied health care professionals.
In 2010 / 2011, the McMaster University Adult Respirology Training Program in association with FIRH provided training to 9 respirology residents, 49 medical residents (on rotation), 28 medical students and 1 clinical fellow. FIRH research faculty supervised 15 full-time graduate students (candidates for Masters and for Ph.D.) along with 5 postdoctoral fellows. In addition, FIRH hosted numerous placements for nursing students, respiratory therapist students, undergraduate and post secondary work placements as well as countless hours of high school students earning mandatory community service hours.
FIRH conducts research to increase understanding of respiratory health and disease across the life cycle through collaborative basic and clinical investigations with the expectation of improving patient care. Research is wide-ranging, from studies of smooth muscle physiology and intracellular signalling through experimental disease models to clinical trials which enhance patient quality-of-life and extends not only from bench to bedside, but to population health and policy. The research productivity of FIRH is attested to by the high quality and impact of the peer-reviewed publications.
In 2010, FIRH faculty was listed as authors on 109 peer-reviewed publications, including several in high impact international publications. Since 2009, current FIRH faculty were listed as an author on over 245 peer reviewed publications. In 2010-2011, FIRH faculty had over 40 “open” studies that had been approved by the St. Joseph’s Research Ethics Board. Many of these studies (12) were investigator initiated and self-funded.
Sadly, a dear colleague and friend to many, Dr. Freddy Hargreave, died suddenly on June 15, 2011. Dr. Hargreave was one of the founding members of the Division of Respiratory Medicine at McMaster University and helped develop the Firestone Institute for Respiratory Health at McMaster University as a world centre in the investigation and treatment of asthma. The studies that Freddy Hargreave led changed the way that asthma was diagnosed and treated, particularly through his development and validation of the methacholine inhalation challenge test as a method of measuring airway responsiveness in asthma and subsequently with his pioneering work in using induced sputum to measure airway inflammation and make clinical decisions on treatment based on this outcome.
Dr. Hargreave trained many of the world leaders in asthma research, some of whom are based in Canada and many others in more than 20 countries around the world. Freddy Hargreave will be deeply missed by his colleagues at the Firestone Institute and McMaster University. His mentorship and collegiality were legendary and his passion for clinical care, particularly for patients with difficult to treat asthma, was quite unique.
Providing leadership and strategic direction for the Firestone Institute in 2010-11 were Dr. Paul O’Byrne, Executive Director; Dr. Stewart Pugsley, Clinical Director; and Dr. Martin Kolb, Research Director. Members of the FIRH faculty hold important administrative posts locally, including Dr. Paul O’Byrne, who is the current Chair of the Department of Medicine at McMaster University; Dr. Gerard Cox, who is the Division Director of Respiratory Medicine; Dr. Lori Whitehead, who is the Program Director for Adult Respiratory residency training at McMaster University; and Dr. Malcolm Sears, who is the Principal Investigator for the national Canadian Healthy Infant Longitudinal Development (CHILD) Study.
Faculty and staff wish to acknowledge and thank those who continue to support the efforts of the Institute. In particular, we thank the St. Joseph’s Hospital Foundation and the many people who contributed to support our clinical, research and educational initiatives this past academic year.
History
The Firestone Regional Chest and Allergy Clinic (FRCAU) was established in 1978 at St Joseph's Hospital (now part of St Joseph's Healthcare Hamilton) and was designated as the Regional Referral Centre by the District Health Council at that time. The guiding principal behind the formation of the FRCAU was to provide exemplary clinical services and research excellence. Success in this endeavour was key to St Joseph’s Hospital, Hamilton being re-designated in 1999 as the regional centre for a coordinated network of respirology services among the area’s hospitals. By 2006, the regional referral centre was serving the Hamilton Niagara Haldimand Brant Local Health Integrated Network a community of 1.4 million people.
From the outset, FRCAU was the main contributor to McMaster University’s Respirology Programme which embodied the principles that have characterized McMaster University’s innovative approaches to clinical medicine, education and research. The programme was the first clinical subspecialty programme to be established in the then-fledgling Department of Medicine, and very early on attracted highly qualified and productive research fellows and clinical trainees from Canada and from across the world. These trainees have made major contributions to research; some joined the clinical staff and academic department at McMaster, while many others achieved clinical and academic distinction elsewhere.
When the respirology programme was established, the foundation for a respiratory intensive-care unit, ambulatory clinics for asthma and chronic respiratory disease, and a clinical pulmonary-function assessment service was laid. The programme allowed the early development of accredited specialty residency training based at St Joseph’s Healthcare, utilizing the clinical expertise from all the area hospitals. An innovative undergraduate teaching unit was introduced, incorporating problem-based learning, a computer-simulation of cardiorespiratory function, and a variety of other learning aids.
Initial research was driven by the clinical programmes. For example, a system for exercise testing was developed, normal standards were established, and studies of inter-laboratory and intra-subject variability led to more-sophisticated quality-control techniques. Access to an established nuclear medicine laboratory and a gamma camera led to studies of aerosol particle distribution in the lung by Dr. Michael Newhouse and Professor Myrna Dolovich. Studies of disordered distribution and clearance in smokers, and the factors influencing distribution of inhaled bronchodilators followed. Dr Stewart Pugsley and Dr Gordon Guyatt developed standardized techniques for the assessment of severity and progression of chronic airflow limitation, including the six-minute walk test and assessment of quality of life in the chronic respiratory care clinic. Other investigations included studies of lung mechanics during exercise, exercise-induced bronchoconstriction and its control, and the effects of hypoxia in exercise. An early epidemiological study showed a relationship between hospital admissions for respiratory illnesses and indices of air pollution.
With the arrival of the late Dr Freddy Hargreave, a number of asthma initiatives began and the succeeding years saw the development of a leading centre for asthma research. Foremost in the early research by his group was the development of histamine and methacholine challenge studies to quantify airway responsiveness, leading to the index of PC20. The technique was especially helpful in patients with asthma symptoms, but normal spirometry PC20 was shown to correlate with measures of variability of airflow limitation, and to be clinically useful in indicating the need for escalating treatment modalities. In addition, the first validated Asthma Quality of Life Questionnaire and Asthma Control Questionnaire were developed by Ms Elizabeth Juniper. The group hosted a conference on airway responsiveness in 1979, and the First Canadian Consensus Conference on asthma management, leading to the publication of first Canadian Asthma Guidelines in 1989, one of the first in the world.
Dr Hargreave and the late Dr Jerry Dolovich merged immunological techniques that assessed allergic responses with measures of airway responsiveness, in order to quantify factors contributing to asthma severity. The early and late allergen-induced asthmatic responses were studied and shown to represent different immunological mechanisms. Dr. Dolovich’s research on nasal mucosa suggested ways in which the cellular response to antigen challenge might be studied in bronchial mucosa and sputum; the technique of inflammatory cell counts in induced sputum was developed and validated in 1989.
More recently, Dr Paul O’Byrne, as well as members of the Division of Immunology in the Department of Medicine at McMaster University have expanded the usefulness of sputum induction to include measurement of cell progenitors and mediator concentrations. During the past 10 to 15 years, the FIRH group has standardized techniques related to symptom assessment, physiological impairment, allergen challenge, methacholine responsiveness, and the cellular and mediator changes in induced sputum. These techniques have proved to be powerful tools in the investigation of biological mechanisms contributing to asthma, and in selecting management strategies.
In 2004 and 2005, FIRH moved into four floors within St Joseph's Hospital’s new 10-storey Juravinski Innovation Tower, in which modern and expanded clinical and research facilities allow FIRH to continue to move forward to support the vision of providing world-class “bench-to-bedside” research.
Accomplishments
The strength of FIRH continues to be its focus on improving patient outcomes. Clinical, research and educational activities are closely integrated and largely collaborative within FIRH with the intent of creating a synergy between patient care, basic and translational research and training of health care professionals.
The proximity of research teams to clinical services has, on the one hand, allowed highly relevant and well-powered clinical studies, and on the other, has ensured rapid incorporation of new knowledge into the care of patients. This integration strongly influences the education of physicians and allied health care professionals.
Notable achievements by FIRH scientists in the respiratory field include:
Leadership
Providing leadership and strategic direction for the Firestone Institute in 2011 are; Dr. Paul O’Byrne, Executive Director, Dr. Stewart Pugsley, Clinical Director, and Dr. Martin Kolb, Research Director,.
Members of the FIRH faculty hold important administrative posts locally, including Dr. Paul O’Byrne, the Chair of the Department of Medicine at McMaster University, , the Division Director of Respiratory Medicine, Dr. Gerard Cox, the Program Director for Respiratory Training at McMaster University, Dr. Lori Whitehead , the Principal Investigator for the national Canadian Healthy Infant Longitudinal Development Study, Dr. Malcolm Sears and Dr. Mark Inman Scientific Officer for FIRH.
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Dr. O'Byrne |
Dr. Pugsley |
Dr. Kolb |
Executive Director |
Clinical Director |
Research Director |
Firestone Institute for Respiratory Health Leadership |
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