Collaboration is at the heart of everything we do at The Ottawa Hospital, and this year’s first ever joint Chrétien Researcher of the Year award recipients are the perfect example of that idea in action. Senior clinician scientist and critical care physician Dr. Lauralyn McIntyre and senior scientist and biostatistician Dr. Monica Taljaard have been working closely for more than a decade, and their recent research could keep patients even safer in our ICUs. By blending clinical work with research skills and fine-tuned statistics, the two recipients are using data to improve outcomes.
Keep reading to learn more about their backgrounds and their joint award. To learn more about Dr. McIntyre’s independent work, head over to her dedicated Q&A!
MT: I was born in South Africa and grew up in a small rural farming community with five siblings. We spoke German and Afrikaans at home. I attended a very small school where I also met my husband. Classical music was a big part of my childhood. I studied piano, and while keeping up with my schoolwork, practiced piano for at least six hours a day. I also played netball, though sport was never my strength.
LM: My father was in sales, and so we moved around a lot. I was born in Sudbury, then we lived in Winnipeg, Montreal, and Toronto. A big part of my early life was figure skating. Skating was sort of dominant until I was 14, when due to long term injuries, I had to stop. I also grew and became five-foot-nine, which is not so compatible with skating!
MT: I went to university in Pretoria, South Africa, to study performing arts. As I thought about my future, I began to wonder what career opportunities there would be for a pianist in South Africa, so I changed direction. I didn’t immediately know what alternative to pursue but I took courses in statistics, mathematics, and economics. I found that statistics brought together two things that I enjoyed: mathematics and solving practical problems. I also discovered that I liked explaining complex concepts to my fellow students. Teaching came naturally to me and that drew me toward academia. I was fortunate to receive a Commonwealth Scholarship to pursue a PhD at Western University in Canada. We left South Africa on December 31, 1999, and were in the air when the new millennium began! Talk about new beginnings!
At Western, I was fortunate to study with Dr. Alan Donner, a biostatistician widely recognized as a pioneer of cluster randomized trials. Dr. Donner had a huge influence on my life. His mentorship introduced me to a field with many unanswered questions and helped set the course for my career in health research at The Ottawa Hospital and the University of Ottawa.
What I love about biostatistics is the opportunity to work with people across so many areas of medicine. As a collaborative biostatistician, I work with teams in anesthesiology, emergency medicine, infectious diseases, surgery, primary care, public health, and so on. Every study brings a different question and a new opportunity to learn.
LM: From a very young age, I knew I wanted to do medicine. I started volunteering when I was young. At 15, I started volunteering at a spinal cord centre in downtown Toronto and did that through high school. I guess I always knew I wanted to be in some kind of helping profession.
But I was a bit of a “free spirit” when I was younger — and maybe even now! I needed to just go live in the world for a bit first. So, after my first degree in Guelph, I diverted and went out to Whistler and taught skiing for a year and a half. Then I went back to school, I got into medical school and went to McMaster.
MT: Biostatistics uses data to answer questions related to health. That might mean studying whether a new type of medicine works, tracking how a virus spreads, or finding out what contributes to a disease. People might see biostatistics as just analysis once the data has arrived, but biostatisticians also help design studies so they can answer the questions researchers are asking. Part of a biostatistician’s role in the study design phase is determining how many patients are needed to produce a reliable answer. If we include too few patients, we might miss a real effect; if we include too many, we may use time and resources unnecessarily. My specialization is in more complex types of study designs that can be used to answer questions about quality of healthcare, and treatment policies and strategies.
LM: For many, many years, we’ve been using fluids that we give intravenously to stabilize patients’ blood pressure in the ICU, where we treat the sickest patients. Two of these fluids are salt-like fluids, and for many years, we had no idea whether one was superior. The trial that we designed and conducted was to try and answer whether the one salt fluid versus the other salt fluid was better for treating patients throughout the hospital, not just in the ICU.
MT: Traditionally, to answer that type of question you’d conduct a clinical trial where each patient would be randomly assigned to receive one type of fluid or the other. But a patient may receive fluids in several parts of the hospital during their stay, so it wasn’t practical to randomize patients individually within a hospital. Instead, we randomly assigned entire hospitals to use only one type of fluid at a time in all their hospitalized patients. This is called a cluster randomized trial. These types of trial designs can be very complex and very expensive, so we used a cross-over design: this means that half of the hospitals started with the one fluid and then switched to the other, while the remaining hospitals used them in the opposite order. This allowed us to compare the fluids within the same hospital and helped make a large, complex trial more feasible. In a way, the hospital, rather than the individual patient, becomes the unit we’re studying. Another distinctive feature of the trial was that we didn’t need to collect data separately for the research: we used hospital data that were already being collected as part of routine care, accessed through ICES. That made it possible to study patients across multiple hospitals without adding a separate data collection process.
LM: There was not a statistically significant improvement for one fluid over another. COVID halted the trial early, which may have impacted our ability to detect a statistically significant difference. The trial was very influential however. It illustrated a powerful and efficient approach for doing comparative clinical trials and was published in the New England Journal of Medicine. We estimate that it cost less than $10 to enroll a single patient in ours, whereas a traditional trial would have cost more than $1,000 per patient.
MT: We’ve presented the initial results, but there is more to learn from this trial. Although our findings did not provide enough evidence to conclude that one fluid is better than the other, we are now looking at additional questions, including whether the effects might differ for particular groups of patients.
LM: We’re like Frick and Frack. It’s always collaborative, and we’re always open to hearing different perspectives. Monica comes with a methodological point of a view, but she contributes to the clinical side of things as well, she helps design the trial based on the cluster method. A lot of investigators think the statistician is just there to do the analysis, but this was so much more. She was involved in the whole method of the trial. It’s probably the biggest collaboration for me that I’ve ever engaged in.
MT: It’s been wonderful to work with Lauralyn. She’s a superstar and an exceptionally effective principal investigator. We started working together in 2014, and this trial was particularly complex and innovative. Getting it off the ground took an enormous team effort. I was especially impressed by how Lauralyn brought together and worked collaboratively with a large group of experienced trialists, intensive care physicians, ethicists, methodologists, data scientists from ICES, and patient partners, allowing everyone to contribute their unique expertise. That collaboration was essential to making the trial possible.
LM: It’s always about the patients. The research is always about them. We just want to ensure they receive the best care they can based on the evidence and always double checking that evidence.
LM: We have a number of studies within the trial that we still want to do. There’s data that suggest one fluid is potentially better, so we’re in the midst of conducting that analysis. We’re also looking at some subgroups and some economic analysis. We have many plans that are cooking.
LM: We’re so honoured. We never ever expected this to happen. For me, what’s extra special is that a methodologist is being recognized appropriately. I hope it paves the way for this to happen more. Our methodologists are critical to everything we do.
MT: It’s a tremendous honour, and sharing the award with Lauralyn makes it especially meaningful. From the beginning, she treated me as a partner in the study. Together, we’ve designed the trial, worked through its challenges, and presented the results as a team. It means a great deal to have that collaboration recognized.
MT: You will often find me outdoors — hiking, camping, or simply enjoying nature with my husband. I also love reading, going to the ballet, and baking. My sourdough starter is about five years old and makes wonderful loaves on a weekly basis!
LM: I love being outside, in the forest, just going for hikes. You could call the forest my soul food. I love not hearing anything, just being. We have a cottage in Tenaga (near Chelsea, Quebec) where a lot of my hikes span from.
