SREMI Research Chair

Jacques LeeWith its focus on best-practices in Geriatric Emergency Medicine (GEM) and GEM Education, existing research infrastructure, stable long-term funding, and potential for the advancement of GEM Research, the SREMI Inaugural Research Chair in Geriatric Emergency Medicine was an excellent fit for Dr. Jacques Lee. Since joining SREMI in July, Dr. Lee has worked to transition his existing research program while maintaining forward momentum. 

TECHNOLOGY AND DELIRIUM

Delirium, or acute confusion, is unrecognized in the emergency department (ED) in up to 75% of cases. Dr. Lee collaboratively developed technology to help improve the clinical recognition of delirium. Similar to the whack-a-mole carnival game, it uses patient performance to assess delirium risk. In July 2019, he published the results of his study (Lee et al., JAGS, 2019) and showed the tablet game could identify all older people with high risk of delirium. Dr. Lee was subsequently funded to conduct a national multicenter randomized trial to assess whether the PrEDDICT application can improve delirium recognition. This study finished enrollment of 1588 subjects in 5 EDs in 4 provinces in September and is currently being analyzed. 

Dr. Lee is also supervising a MSc student, Jose Estrada-Codecido, to assess inexpensive technology to measure mobility in the ED. Mobility is an evidence-based intervention known to prevent loss of functional ability, but manually measuring mobility is labour-intensive.

The Emergency Department Use of Regional Anesthesia to Prevent Incident Delirium (EDU-RAPID) trial.

Jacques LeeDr. Lee is leading this CIHR funded trial to reduce delirium. Unfortunately, older people with hip fractures are less able to benefit from interventions known to reduce delirium, including mobilization. The EDU-RAPID trial is testing whether teaching and encouraging emergency physicians to perform ultrasound guided regional anesthesia (USGRA) or “freezing” can reduce delirium by improving pain without the need for sedating narcotics. The trial has reached 97% of sample size and will be completed in the next few months.
Jacques Lee

Jacques LeeFUTURE DIRECTIONS

Dr. Lee’s vision is for the SREMI Geriatric Emergency Medicine Research program to lead the way globally in discovering how to better care for older people who need the ED through knowledge creation, training the next generation of GEM researchers and advocacy. 

Dr. Lee will leverage his existing research network focused on delirium in older hip fracture patients to develop a clinical test or biomarker to identify delirium rapidly and accurately. New research partnerships with basic science colleagues will permit the use of a novel technique, urine metabolomics, to accomplish this. This program of research has the potential to greatly expand our understanding of delirium as well as developing a biomarker to identify those at greatest risk for delirium. Dr. Lee is collaborating to explore the use of neural networks to improve the diagnostic accuracy of the PrEDDICT application.

In the coming year, Dr. Lee will initiate an international search for best and brightest geriatric emergency medicine researchers to offer research mentorship and collaborative academic activities.