ORCID Profile
0000-0002-5722-6364
Current Organisations
Toronto Western Hospital
,
McEwen Centre for Regenerative Medicine
,
University Health Network
,
University of Toronto
,
Krembil Research Institute
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Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
Date: 12-2010
Publisher: JMIR Publications Inc.
Date: 09-10-2023
DOI: 10.2196/46809
Publisher: JMIR Publications Inc.
Date: 09-03-2023
Abstract: ealth outcomes are deeply influenced by the quality of healthcare management decisions. This connection is lified in the context of chronic illness, where self-management and decisional support considerably shape the evolution of a disease. Shared decision-making (SDM) is an approach to clinical care where clinicians and patients collaborate to reach evidence-based choices centred on the unique circumstances, values, and preferences of each in idual. When embedded in chronic care management, SDM can lead personalised treatment plans that enhance health prospects. Its impact in the oversight of degenerative cervical myelopathy (DCM), a type of non-traumatic spinal cord injury, is potentially substantial. With its chronicity, heterogenous clinical presentation, complex management, and variable disease course, DCM engenders an imperative for a patient-centric approach that accounts for each patients’ unique needs and priorities. Inadequate patient knowledge about the condition and an incomplete understanding of the critical decision points that arise along the course of care currently hinder the fruitful participation of healthcare providers and patients in SDM. This study protocol presents the rationale for deploying SDM in DCM and delineates the groundwork required to achieve this. he study’s primary outcome is the development of a comprehensive checklist to be implemented upon diagnosis that provides patients with essential information necessary to support their onward informed decision-making. This is known as a Core Information Set (CIS). The secondary outcome is the creation of a detailed process map (PM) that provides a diagrammatic representation of the global care workflows and cognitive processes involved in DCM care. Characterising the critical decision points along a patient's journey will allow an effective exploration of SDM tools for routine clinical practice towards enhancing patient-centred care and improving clinical outcomes. oth CISs and PMs are coproduced iteratively, through a collaborative process involving the input and consensus of key stakeholders. This will be facilitated by Myelopathy.org, a global DCM Charity, through its Research Objectives and Common Data Elements for Degenerative Cervical Myelopathy (RECODE-DCM) community. To develop the CIS, a three-round, web-based Delphi process will be employed, starting with a baseline list of information items derived from a recent scoping review of educational materials in DCM, patient interviews, and a qualitative survey of professionals. A priori criteria for achieving consensus are specified. The PM will be developed iteratively using semi-structured interviews with patients and professionals and validated by key stakeholders. ecruitment for the Delphi consensus study began in April 2023. Concurrently, the pilot testing of PM interview subjects started at the same time, with the formulation of an initial baseline map underway. his study protocol marks the first attempt to provide a starting point for the investigation of SDM in DCM. The primary work centres on developing an educational tool for use at diagnosis, to enable enhanced onward decision-making. The wider objective is to aid stakeholders in developing SDM tools by identifying critical decision junctures in DCM care. Jointly, through these approaches we aim to provide an exhaustive launchpad for formulating SDM tools in the wider DCM community. >
Publisher: Oxford University Press (OUP)
Date: 15-05-2015
Abstract: Gain-of-function/loss-of-function techniques were used to examine the mechanistic importance of graft-derived remyelination following thoracic spinal cord injury (SCI). The novel findings of this study include the first use of neural stem cells (NSCs) from induced pluripotent stem cells (iPSCs) derived using the clonal neurosphere expansion conditions, for the treatment of SCI, the first characterization and in vivo application of iPSCs from Shiverer mouse fibroblasts, and the first evidence of the importance of remyelination by pluripotent-sourced NSCs for SCI repair and regeneration.
Publisher: Springer Science and Business Media LLC
Date: 2004
DOI: 10.1186/JBIOL16
Publisher: Informa UK Limited
Date: 16-10-2017
Publisher: Journal of Neurosurgery Publishing Group (JNSPG)
Date: 05-2011
Publisher: SAGE Publications
Date: 02-2022
DOI: 10.1177/21925682211057546
Abstract: Literature Review (Narrative) To propose a new framework, to support the investigation and understanding of the pathobiology of DCM, AO Spine RECODE-DCM research priority number 5. Degenerative cervical myelopathy is a common and disabling spinal cord disorder. In this perspective, we review key knowledge gaps between the clinical phenotype and our biological models. We then propose a reappraisal of the key driving forces behind DCM and an in idual’s susceptibility, including the proposal of a new framework. Present pathobiological and mechanistic knowledge does not adequately explain the disease phenotype why only a subset of patients with visualized cord compression show clinical myelopathy, and the amount of cord compression only weakly correlates with disability. We propose that DCM is better represented as a function of several interacting mechanical forces, such as shear, tension and compression, alongside an in idual’s vulnerability to spinal cord injury, influenced by factors such as age, genetics, their cardiovascular, gastrointestinal and nervous system status, and time. Understanding the disease pathobiology is a fundamental research priority. We believe a framework of mechanical stress, vulnerability, and time may better represent the disease as a whole. Whilst this remains theoretical, we hope that at the very least it will inspire new avenues of research that better encapsulate the full spectrum of disease.
Publisher: Elsevier BV
Date: 10-2013
DOI: 10.1016/J.EXPNEUROL.2013.05.012
Abstract: Cellular therapies represent a novel treatment approach for spinal cord injury (SCI), with many different cellular substrates showing promise in preclinical animal models of SCI. Considerable interest therefore exists to translate such cellular interventions into human clinical trials. Balanced against the urgency for clinical translation is the desire to establish the robustness of a cellular therapy's efficacy in preclinical studies, thereby optimizing its chances of succeeding in human trials. Uncertainty exists, however, on the extent to which a therapy needs to demonstrate efficacy in the preclinical setting in order to justify the initiation of a lengthy, expensive, and potentially risky clinical trial. The purpose of this initiative was to seek perspectives on the level of evidence required in experimental studies of cellular therapies before proceeding with clinical trials of SCI. We conducted a survey of 27 SCI researchers actively involved in either preclinical and/or clinical research of cellular interventions for SCI, and then held a focus group meeting to facilitate more in-depth discussion around a number of translational issues. These included: the use of animal models, the use of injury models and mechanisms, the window for demonstrating efficacy, independent replication, defining "relevant, meaningful efficacy" in preclinical studies, and the expectation of therapeutic benefits for cellular interventions. Here we present the key findings from both the survey and focus group meeting in order to summarize and underscore the areas of consensus and disagreement amongst the s led researchers. It is anticipated that the knowledge generated from this initiative will help to incite future scientific discussions and expert guidelines towards translation of a cell therapy for persons with SCI.
Publisher: Mary Ann Liebert Inc
Date: 08-2014
Publisher: Mary Ann Liebert Inc
Date: 02-2013
No related grants have been discovered for Michael G. Fehlings.