2016 Summer Student Research Program

2016 SSRP Projects List

2016 Summer Student Research Program

TABLE OF CONTENTS 1. 2016-Chang-01 Dr. Thomas Chang - Regulation of Gene Expression in Human Colon Adenocarcinoma Cells 2. 2016-Frankel-01 Dr. Adam Frankel - Increased symmetric dimethylarginine in yeast proteins during stationary phase growth

3. 2016-DeVera-01 Dr. Mary DeVera - Facilitating and Supporting Pharmacy Practice Research: A Survey of Pharmacists in British Columbia 4. 2016-DeVera-02 Dr. Mary DeVera - Inflammatory arthritis patients’ perspectives on medication use: A thematic synthesis to inform evidence-based, patient-centered adherence interventions 5. 2016-KimSing-01 Ms. Frances Simpson, Dr. Angela Kim-Sing, Ms. Aileen Mira - To develop and implement an APPE practicum in residential care in British Columbia. 6. 2016-KimSing-02 Ms. Frances Simpson, Dr. Angela Kim-Sing, Mr. Paolo Tchen - Evaluating peer-learning in community pharmacy practice sites and its potential benefit to learners and practice educators in the Entry-to-Practice Pharm D Program. 7. 2016-Albon-01 Mr. Jon Paul Marchand, Mr. Frank Fucile, Dr. Simon Albon - Lecture Capture in Pharmacy Education at UBC: Has Anything Changed? 8. 2016-Harrison-01 Dr. Mark Harrison, Dr. Simon Albon - Evaluating the investment in technology in the new Entry-to-Practice (E2P) Doctor of Pharmacy (PharmD) program at UBC. 9. 2016-Harrison-02 Dr. Mark Harrison, Dr. Nick Bansback - Presenting uncertainty around risks and benefit estimates in prognostic tools: supporting decisions for the delivery of sustainable health care. 10. 2016-Lynd-01 Dr. Larry Lynd - Economic Evaluation of the CAUSES Clinic

2016 Summer Student Research Program

Project 1: 2016-Chang-01

Supervisor(s): Dr. Thomas Chang Project Title: Regulation of Gene Expression in Human Colon Adenocarcinoma Cells Project Description: The research project is to investigate the impact of modulating gene expression on the development of colon cell carcinogenesis. The SRRP student will assist a senior doctoral student to characterize the constitutive expression of candidate genes in a panel of human colon adenocarcinoma cells and investigate the effect of drugs and other chemicals on the expression of candidate genes and growth of these colon tumor cells. Specific duties and responsibilities include culturing tumor cells, treating cultured tumor cells in with drugs or other chemicals, performing gene expression and tumor cell growth assays, disseminating experimental results, and conducting search of the scientific literature. The SSRP student will be supervised by the principal investigator and a doctoral student. Training will be provided to the SSRP student on all facets of the research project, including laboratory chemical safety and biosafety, proper conduct of bioassays, and use of instrumentation. Feedback to the SSRP student will be provided at regularly scheduled meetings. Profile of the SSRP Student for the Proposed Project: The proposed SSRP project is particular suitable for a student with at least 3 years of study in a B.Sc. program majoring in biochemistry, cell biology, biotechnology, physiology, or a related academic discipline. Previous laboratory experience or cell culture experience would be an asset. Demonstrated skills in time-management, oral and written communication, database management, and on-line search of the scientific literature would be ideal. Interest in applying his/her classroom learning to real-life situations in a research environment will be valued. The experiences gained from this position will serve the SSRP student well as he/she pursues further education in biomedical research.

2016 Summer Student Research Program

Project 2: 2016-Frankel-01

Supervisor(s): Dr. Adam Frankel

Project Title: Increased symmetric dimethylarginine in yeast proteins during stationary phase growth

Project Description: Arginine methylation within proteins is a eukaryotic post-translational modification (PTM), catalyzed by a family of methyltransferase enzymes. This PTM, which occurs in the form of mono-, symmetric and asymmetric di-methylation (MMA, SDMA, and ADMA, respectively), is found in many chromatin-associated and RNA-binding proteins where it serves to regulate transcription, DNA repair, RNA processing, and cell signaling. Arginine methyltransferase activities have also been implicated as contributing factors in specific cancers and other diseases. Our laboratory has recently used baker’s yeast Saccharomyces cerevisiae as a model organism to study this PTM under the stress conditions of heat shock and stationary phase growth (Lakowski et al., 2015). Using a mass spectrometry-based (LC-MS/MS) assay capable of differentiating all methylarginine species, we demonstrated for the first time that SDMA is formed on yeast proteins, and found that stationary-phase growth conditions cause as much as a 20-fold increase in SDMA levels while ADMA levels decreased 10-fold, suggesting that the SDMA modification is important in a cell’s stress response.

The goal of this SSRP project is to identify SDMA-containing proteins in yeast grown in stationary-phase as compared to log-phase growth so that we can begin to understand how arginine methylation affects a cell’s response to stress. The first part of this project will focus on optimizing stationary-phase growth conditions to maximize SDMA production, which will be determined by our mass spectrometry assay for methyarginine analysis. The second part of this project will be dedicated to finding an appropriate enrichment strategy for SDMA-containing proteins either by using anti-SDMA antibodies or fractionation methods (e.g., subcellular or protein fractionation). The third part of the project will employ LC-MS/MS proteomic analysis of yeast proteins from log-phase and stationary-phase growth samples to identify SDMA-containing proteins. These results will provide a first step toward understanding the role in which SDMA formation occurs during cell stress. It can be envisioned that similar mechanisms for the regulation of SDMA also exist in human cells and that the functions of this PTM is conserved on a subset of proteins. The results of the proposed work may help to shed light on the role of arginine methylation in cancer and other diseases.

2016 Summer Student Research Program

Project 3: 2016-DeVera-01 Supervisor(s): Dr. Mary DeVera Project Title: Facilitating and Supporting Pharmacy Practice Research: A Survey of Pharmacists in British Columbia

BACKGROUND: Drug-related morbidity and mortality are critical issues in our healthcare environment, costing Canada more than $4 billion yearly in avoidable medical costs. These issues have called for novel models of care mobilizing community pharmacists as accessible primary health care providers, especially given their training, skills, and frequent contact with patients. It is, unfortunately, a recognized fact that pharmacists' expertise and training are remarkably underutilized, in a role hitherto often focused on dispensing. Pharmacy practice research is an area of health services research that deals with the assessment and evaluation of pharmacy practice and provide data on the positive impact of pharmaceutical care on patient management and outcomes. However, with much of pharmacy practice research in Canada being done in isolation, a structured, coordinated, and centralized effort between researchers and pharmacists is needed to support continued growth and promote the importance and value of pharmacy practice research. One solution is implementation of a practice-based research network, a mainstay in medicine for over 30 years, with over 100 active primary care networks across the US and Canada demonstrating that research findings are more readily applied to practice when clinicians are integrated in research activities. Furthermore, with growing emphasis on translational and comparative effectiveness research to improve patient outcomes, practice-based research networks have an unprecedented opportunity to become effective “real-world” laboratories to address high priority research questions. To facilitate the establishment of a practice-based pharmacy practice research network at UBC’s Faculty of Pharmaceutical Sciences, it is important to understand pharmacists’ attitudes and knowledge towards pharmacy practice research and motivators and barriers to being part of a practice-based research network.

PROJECT OVERVIEW: The proposed SSRP project is a survey to pharmacists and pharmacists-in-training to understand: 1) knowledge of, and prior involvement in being involved in pharmacy practice research; 2) motivators and barriers to becoming part of a pharmacy practice-based research network.

METHODS: Survey: The survey will be developed based on: 1) findings from a prior qualitative study by our research team involving qualitative interviews with pharmacists about their experiences with conducting a pharmacy practice research study; and 2) input and feedback from knowledge users including faculty members and collaborating pharmacists. The survey will consist of the following sections: 1) Background and Practice; 2) Knowledge of/Experience with Pharmacy Practice Research; 3) Motivators and Barriers for Conducting Pharmacy Practice Research; and 4) Resources and Support for Conducting Pharmacy Practice Research. Target Sample: We will target currently practising pharmacists in various settings across BC (e.g. community, hospital) as well as pharmacists-in-training, including UBC BSc(Pharm) and PharmD students as well as pharmacy residents. Survey Administration: The survey will be hosted on LimeSurvey, which is a user-friendly online survey software. The LimeSurvey application on the UBC Virtual Server Services (VSS) is hosted behind a customer managed virtual firewall and virtual private network. For the proposed project, the survey will be hosted and stored on the Collaboration for Outcomes Research and Evaluation (CORE) secure server. Analyses: Descriptive statistics will be generated to summarize responses to survey items.

ROLE OF THE SUMMER STUDENT: The summer student (SS) will be trained on developing an on-line survey using the LimeSurvey application. The SS will be responsible for sending the survey to target pharmacists, managing responses on the LimeSurvey application, performing analyses, and writing up the results.

EXPECTED OUTCOMES: Better understanding of pharmacists’ attitudes and knowledge towards pharmacy practice research along with motivators and barriers will be used to inform the establishment of a pharmacy practice-based research network at UBC’s Faculty of Pharmaceutical Sciences. With currently no network of this kind, this project will contribute to our Faculty being a leader in pharmacy practice research in Canada.

2016 Summer Student Research Program

Project 4: 2016-DeVera-02 Supervisor(s): Dr. Mary DeVera Project Title: Inflammatory arthritis patients’ perspectives on medication use: A thematic synthesis to inform evidence-based, patient-centered adherence interventions

BACKGROUND: For many patients living with lifelong diseases, managing conditions and taking medications as prescribed (“adherence”) is a challenge, and those with inflammatory arthritis are no exception; indeed, our prior research has shown sub-optimal medication adherence among patients, including those with rheumatoid arthritis, systemic lupus erythematosus, and gout. Also alarming is disappointing and inconsistent research on interventions to help inflammatory arthritis patients take their medications. Qualitative research on patients’ views, beliefs, and attitudes offers insight on what it is like to live with and manage a particular condition. However, individual qualitative studies are characterized by small sample sizes and limited generalizability. Applying novel methods to synthesize the rich body of primary qualitative research on inflammatory arthritis patients’ experiences, attitudes, and opinions on medication use, will not only augment the body of information, but also provide a mechanism for informing interventions that support medication adherence with the patient perspective.

PROJECT OVERVIEW: The proposed SSRP project is nested within a larger project involving the systematic synthesis of qualitative research studies examining inflammatory arthritis patients’ perspectives on medication use and adherence which involves: 1) a systematic review of the literature to identify primary qualitative research studies (Completed) and 2) applying thematic synthesis, a method that brings together and integrates findings across multiple qualitative studies through the identification of important or recurrent themes (To be conducted for the SSRP).

METHODS: Thematic synthesis will be comprise of three steps – 1) line-by-line coding, 2) identifying descriptive themes, and 3) generating analytical themes - as follows. In Step 1, each line of extracted data from included studies from the systematic review will be coded according to its meaning and content. As subsequent studies are similarly analyzed so begins Step 2 whereby concepts from one study are translated to the next as codes emerge or new codes are developed when necessary. In Step 3, the interrelation between the ‘data-driven’ descriptive themes will be mapped to generate ‘theory-driven’ analytical themes. To guide this step, we will apply two conceptual frameworks: 1) the Necessity-Concerns Framework, a useful conceptual model for understanding patients’ perspectives on prescribed medications as it postulates that adherence is influenced by implicit judgements of personal need for, and concerns about potentially adverse consequences; and 2) the World Health Organization’s Five Dimensions of Adherence, particularly, Patient-Related Factors, which represent attitudes, beliefs, perceptions and expectations of the patient with respect to disease management and adherence behaviour. Using these frameworks, barriers and facilitators of medication adherence will be inferred from attitudes, opinions, and beliefs on medication use captured by the descriptive themes.

ROLE OF THE SUMMER STUDENT: The summer student (SS) will be trained on how to conduct thematic synthesis from the supervisor. As thematic synthesis is to be conducted by more than one researcher independently, the SS will conduct thematic synthesis alongside a research assistant (RA). The SS and RA will regularly meet with the supervisor to discuss progress and findings of the thematic synthesis throughout this iterative process.

EXPECTED OUTCOMES: With a better understanding of inflammatory arthritis patients’ perspectives of medication use and adherence that will be gained from this proposal, findings will ultimately help elucidate essential components of interventions to support medication adherence. Altogether, we expect our research to improve medication adherence and outcomes among patients with inflammatory arthritis

2016 Summer Student Research Program

Project 5: 2016-KimSing-01 Supervisor(s): Ms. Frances Simpson (604-827-2278, frances.simpson@ubc.ca), Dr. Angela Kim-Sing, Ms. Aileen Mira

Project Title: To develop and implement an APPE practicum in residential care in British Columbia. Project Description: The Office of Experiential Education (OEE) currently coordinates 1000 clerkships a year in the outgoing BSc Pharm and International Pharmacy Graduate programs. The number of placements has increased to 2700 clerkships with the new experiential education curriculum in the Entry to Practice Pharm D Program. The OEE relies on volunteer pharmacists to coach and teach learners at practice sites, and works to support pharmacists and students to ensure a high level of site and preceptor quality.

With this increased demand the OEE is examining ways in which to increase capacity, and Residential-Subacute Care and Community Facilities have been identified as an area of potential growth. A pilot project is currently underway which includes an elder care orientation module and modified learning portfolio for students completing their PHAR 489 rotations in a residential care site. The goal of this project is to analyze the data (from the revised learning portfolios and current sites), and use it to identify ways to improve practicums at residential care sites and develop the capacity at these sites.

The student should work within well-defined guidelines, but is expected to exercise some initiative and judgment in establishing priorities and carrying tasks through to completion. The student should be proficient in the use of Microsoft Word and Excel.

Project activities:

1. Conduct a literature search 2. Analyze data (student and preceptor feedback) from the revised learning portfolios and elder care

orientation modules 3. Measure the impact of the revised evaluation methods on the attitudes of both students and

preceptors toward residential care placements 4. Measure the impact (value) of students on rotation in these sites 5. Determine methods to improve the learning portfolios and to increase the number of placements

at PHAR 489 sites in general (and residential care sites specifically) 6. Provide a written report outlining strategies to build practice educator and site capacity 7. Prepare a poster presentation summarizing your findings, and present in September 2016

2016 Summer Student Research Program

Project 6: 2016-KimSing-02 Supervisor(s): Ms. Frances Simpson (604-827-2278, frances.simpson@ubc.ca), Dr. Angela Kim-Sing, Mr. Paolo Tchen

Project Title: Evaluating peer-learning in community pharmacy practice sites and its potential benefit to learners and practice educators in the Entry-to-Practice Pharm D Program.

Project Description: The Office of Experiential Education (OEE) currently coordinates 1000 clerkships a year in the outgoing BSc Pharm and International Pharmacy Graduate programs. The number of placements has increased to 2700 clerkships with the new experiential education curriculum in the Entry to Practice Pharm D Program. The OEE relies on volunteer pharmacists to coach and teach learners at practice sites, and works to support pharmacists and students to ensure a high level of site and preceptor quality.

With this increased demand, the OEE is examining ways in which to increase its site capacity. The goals of this project are to identify who is doing peer learning in the community, to analyze what is being done at those sites, and to use this information to identify opportunities for its expansion and its potential impact on capacity.

The student should work within well-defined guidelines, but is expected to exercise some initiative and judgment in establishing priorities and carrying tasks through to completion. The student should be proficient in the use of Microsoft Word and Excel.

Project activities:

1. Conduct a literature search 2. Assist with the design and implementation of interviews with current practice educators using

peer learning 3. Use the literature and interview data to identify the program’s benefits and drawbacks 4. Identify ways in which the program can be expanded and measure its potential impact on

practicum site capacity 5. Provide a written report outlining strategies to build practice educator and site capacity 6. Prepare a poster presentation summarizing your findings, and present in September 2016 7. Assist with the preparation of a short video on the benefit of peer learning from the practice

educator perspective

2016 Summer Student Research Program

Project 7: 2016-Albon-01 Supervisor(s): Mr. Jon Paul Marchand, Mr. Frank Fucile and Dr. Simon Albon Project Title: Lecture Capture in Pharmacy Education at UBC: Has Anything Changed? Project Description: The Faculty of Pharmaceutical Sciences at the University of British Columbia has a long history of technology innovation and usage to support and enhance student learning and educational development in its entry-to-practice programs.1 Lecture capture, implemented in the fall of 2010, is now in its sixth year of use as a central learning tool and study aid for students. In 2014 we published a study examining faculty members’ and students’ use and perceptions of lecture recordings in the first two years of the lecture capture initiative.2 Major findings from that study indicated that students and faculty were aware of and appreciated the recordings and that students’ patterns of use changed as the novelty wore off. In addition, students felt that the recordings enhanced their learning, improved their in-class engagement, and had little effect on their attendance. Faculty members, on the other hand, saw little difference in students’ grades or in-class engagement but noted increased absenteeism. The purpose of this study is to reexamine our initial understandings of lecture capture to see if and how perspectives have changed.

Project Objectives: Three objectives guide this project:

1) To reexamine the patterns of students’ usage of lecture recordings? 2) To determine the value of lecture recordings to students and faculty members currently? 3) To build our understanding of the effects of lecture recordings, if any, on student attendance?

Project Activities: The project will provide you with experience in the Scholarship of Teaching and Learning (SoTL) and research methods including literature review, qualitative and quantitative data collection and analysis, peer review, and dissemination. SoTL is emerging as a critical area of scholarly activity within the Faculty, and research of this kind provides an evidence-based contribution to improve teaching and curriculum in the E2P PharmD program.

The student undertaking this project will be expected to work effectively within general guidelines but with minimal direct supervision and to have excellent verbal and written communication skills. 1. Albon SP, Hubball H. A learning-centered course in pharmaceutical analysis. Am J Pharm Educ. 2004;68(5): Article 114. 2. Marchand J, Pearson ML, Albon SP. Student and faculty member perspectives on lecture capture in pharmacy education. Am J Pharm Educ.

2014;78:Article 74.

2016 Summer Student Research Program

Project 8: 2016-Harrison-01 Supervisor(s): Dr. Mark Harrison, Dr. Simon Albon

Project Title: Evaluating the investment in technology in the new Entry-to-Practice (E2P) Doctor of Pharmacy (PharmD) program at UBC.

Background: There is increasing focus and expectations that faculty use technology to improve teaching practices, student learning, and the student experience. Studies have shown that adoption of technology by faculty is complex and related, in part, to technology availability, the comfort-levels of faculty using it, and the generation gap. Despite these challenges the provision of technology and related infrastructure represents a key investment by Universities and Faculties to enhance the quality of teaching. Increasingly, post-secondary administrators are expected to demonstrate return on investment (ROI) for technology expenditures. Difficult to substantiate, an alternative to ROI arguments focusses on the value of investment (VOI) for achieving institutional educational aims. The VOI question allows a broader definition of benefit measured by contributions to important teaching competencies such as improving teacher-learner communication, enhancing teaching practices in large lecture courses, and enabling more flexible learning. Despite this discrepancy, there are virtually no examples of studies in the literature evaluating either the ROI or VOI of investment in technology.

Aim: In an age defined by financial austerity, sustainability and accountability, the cost-effectiveness of technology-based investments in teaching and learning improvements should be evaluated. The goal of this project is to evaluate how the Faculty of Pharmaceutical Sciences has attempted to introduce technology to support student learning, curriculum design, and teaching. This quantification of ‘value’ will then be contrasted with the investment that has been required. The study will aim to help others involved in curriculum design and leadership learn from the experiences of the systematic approach to the implementation of technology

Importance: This study intends to explore the critical factors affecting the integration of learning technology into the curriculum and teaching practices of faculty teaching in the Faculty’s new 6 year E2P PharmD program. More specifically issues of the extent of technology use amongst faculty will be examined in light of initial technology infrastructure investments by the Faculty. In addition to developing greater understanding of how and the extent to which existing technology is being incorporated into the teaching practices of faculty, notions of VOI will be developed along with avenues for further faculty development. The project will provide you with experience in the Scholarship of Teaching and Learning (SoTL) and research methods including literature review, qualitative and quantitative data collection and analysis, peer review and dissemination. SoTL is emerging as a critical area of scholarly activity within the Faculty, and research of this kind provides an evidence-based contribution to improve teaching and curriculum in the E2P PharmD program.

2016 Summer Student Research Program

Project 9: 2016-Harrison-02 Supervisor(s): Dr. Mark Harrison, Dr. Nick Bansback

Project Title: Presenting uncertainty around risks and benefit estimates in prognostic tools: supporting decisions for the delivery of sustainable health care.

Background: There is a movement within health care to involve patients more comprehensively in making choices about their treatment options and other medical choices. Shared decision making between physicians and patients can be thought of a “an approach where physicians and patients share the best available evidence when faced with the task of making decisions, and where patients are supported to consider options, to achieve informed preferences.” Future risks and benefits are subject to two orders of uncertainty, firstly the fundamental indeterminacy or randomness of their occurrence, and secondly the lack of reliability, credibility, or adequacy of information in our evidence base about their occurrence. The way in which either type of uncertainty is presented can influence a patient’s understanding of the information and therefore, his or her treatment preference. If patients misinterpret the information due a misconception of the uncertainty, they are at a higher risk of making a medical decision unrepresentative of what they truly want. This ties to the overtreatment section of Berwick’s ‘Wedge’ model of waste in health care – treatment contrary to evidence or preference.

Prognostic tools have been developed to guide patient–physician communication and decision-making, but it is unclear how these tools represent uncertainty to patients. Given the proliferation of the types of prognostic tools, it is timely to review the communication of uncertainty and discuss implications for their use in clinical settings.

Aim: To summarise and understand how uncertainty is being described in currently available prognostic tools and to examine the extent to which uncertainty is presented in accordance with the available recommendations from the literature. The overall aim is to describe any consequent heterogeneity in approach as a result of a lack of clear recommendations and provide recommendations for a future research agenda. The project will offer a combination of key research methods including systematic reviewing and quantitative analysis.

Importance: The outputs of this project will be highly relevant and timely contributions to an area of growing importance in the risk communication and shared-decision making fields. The outputs have a direct impact on tools to support patients to make decisions more aligned with their needs and preferences, which has benefits for both patients and the health care system in reducing the waste associated with unwanted or inappropriate treatment. This project offers the opportunity to work in a local team with input from an external expert in the field of risk communication from the US.

2016 Summer Student Research Program

Project 10: 2016-Lynd-01 Supervisor(s): Dr. Larry Lynd

Project Title: Economic Evaluation of the CAUSES Clinic

Background: Together with researchers at UBC’s Department of Medical Genetics, we are conducting an economic evaluation of the CAUSES Clinic, a pilot program at B.C. Children’s Hospital that offers genome-wide sequencing (GWS) to families of children who have complex, undiagnosed disorders and are unable to obtain a diagnosis by standard testing. While similar clinical programs have been conducted elsewhere and have shown that GWS can succeed in identifying causal variants for a substantial proportion of patients, the impact of using GWS as a diagnostic test on health outcomes, on patients’ and their families’ quality of life, and on healthcare utilization has not been studied comprehensively to date. The economic evaluation of the CAUSES Clinic aims to measure the broad economic and humanistic impact of the program and to estimate the likely impact of expanding the program to use GWS as a first-line diagnostic test for eligible patients in B.C.

Project Objectives: A crucial component of the evaluation is to measure the costs associated with the use of the healthcare system by children enrolled in the study. To do this, we need to be able to build a dataset of patients’ healthcare utilization and the associated costs.

Project Activities: The project will involve: 1) entering relevant data (including physician visits, surgical procedures, and diagnostic imaging and lab tests) drawn from patients’ medical records into a data sheet in accordance with established guidelines and procedures; 2) researching the cost of the various procedures, tests, and visits contained in the utilization dataset; 3) providing input on how to improve the data collection process. Additional elements may include summarizing health care resource utilization data for the CAUSES patient population and assisting with literature reviews related to healthcare utilization costs.

The student undertaking this project will work under established data collection procedures, but should be able to work with minimal direct supervision under these guidelines while exercising sound judgment on when to refer problems to the supervisor.