department of pediatrics annual report - 2014

2014Department of Pediatrics Annual Report

2014 DEPARTMENT OF PEDIATRICS ANNUAL REPORT 1

Table of Contents

Contributors: Katie Buchanan, Judith Chrystal, Janet Harvey, Sandra Kinash

Photos: Edmonton Journal, Topher Seguin, Amy Hewko,

Sandra Kinash, Laughing Dog, Ross Neitz, Richard Siemens

Cover photo: Drs. Ian Adatia (l) and Shine Kumar (r) are joined by one of their young patients at the Stollery Children’s Hospital.

Mission & Vision .................................................................................................................................................................................................................................pg 2Message from the Chair ................................................................................................................................................................................................................ pg 3

EDUCATION

Celebrating Excellence ...................................................................................................................................................................................................................pg 4Providing Their Expertise ...............................................................................................................................................................................................................pg 5Contributing to the Future – Division of Dermatology ...................................................................................................................................................pg 6Teaming Up With the Community – Division of General and Community Pediatrics ....................................................................................pg 8Priorities for Learning – Division of Emergency Medicine ..........................................................................................................................................pg 10Teaching Better Doctors – Division of Critical Care .......................................................................................................................................................pg 12Learners Come From Every Corner of the Globe ............................................................................................................................................................pg 14

RESEARCH

The New Normal – Division of Neurology .........................................................................................................................................................................pg 16Predict to Prevent – Division of Nephrology .....................................................................................................................................................................pg 18Taking the OUCH Out of Pain – Division of Emergency Medicine ........................................................................................................................ pg 20Perfect Storm – Division of Cardiology ............................................................................................................................................................................... pg 22If You Plant a Seed – Division of Endocrinology/Metabolism ................................................................................................................................... pg 24A Journey of Another Kind – Division of iHOPE ............................................................................................................................................................. pg 26Pediatrics Research Day 2014 ................................................................................................................................................................................................... pg 28Graduate Students Claim National Awards ........................................................................................................................................................................ pg 29

CLINICAL CARE

Fellowship of Care – Division of Developmental Pediatrics ...................................................................................................................................... pg 30Clearing a Path – Division of Gastroenterology and Nutrition..................................................................................................................................pg 32When Two Become One – Division of Cardiology .........................................................................................................................................................pg 34Breaths of Life – Division of Neonatal-Perinatal Care ...................................................................................................................................................pg 36Into Thin Air – Division of Respiratory Medicine .............................................................................................................................................................pg 38

ADMINISTRATION

Program Promoters ....................................................................................................................................................................................................................... pg 40Developing Teachers .................................................................................................................................................................................................................... pg 42The Big Bang .................................................................................................................................................................................................................................... pg 44East Meets West............................................................................................................................................................................................................................... pg 46Improving for Excellence ............................................................................................................................................................................................................ pg 48PedsCREW .......................................................................................................................................................................................................................................... pg 49Divisional Members & Partners ................................................................................................................................................................................................ pg 50

Our VisionTo be leaders internationally by improving the

health of children, their families and communities.

Our MissionTo deliver excellence in care for infants, children,

youth and families by:

• Providing comprehensive health care

• Educating health professionals for today and the future

• Advancing knowledge through innovative research

• Advocating for vulnerable populations

• Promoting quality and patient safety

• Developing leaders in child health


Message from the ChairA year of accomplishment, success and growth

The Department of Pediatrics continues to reach out locally and internationally, leading the way in child health. In 2014, department members have accepted new leadership roles, across all four pillars, such as: Dr. Kent Stobart with the University of Alberta, provost’s office; Drs. Lawrence Richer and Samina Ali in the dean’s office; and Dr. Bob Moriartey as president of the Canadian Pediatric Society. These are just a few examples of the excellence in leadership and the positive sphere of influence our department has the privilege to contribute.

Innovation and vision have resulted in proud accomplishments in teaching, research and clinical care. Our report highlights a few from 2014, including a 3-D printer creating custom masks for infant non-invasive ventilation and pediatric cardiology hybrid procedures.

Annual reports also provide us with the venue to thank our key partners contributing to our mutual success: the University of Alberta, the Women and Children’s Health Research Institute, Alberta Health Services and the Stollery Children’s Hospital Foundation.

On behalf of the department’s leadership, I would like to congratulate all our department members, learners, support staff and faculty on a highly successful year in academic pediatrics.

Dr. Susan M. GilmourChair, Department of PediatricsUniversity of Alberta

The past year, 2014, represented another year of great accomplishments, successes and growth for the Department of Pediatrics at the University of Alberta. It was a year that also witnessed transition of university leadership and the start of an evolving organizational and governance transition at Alberta Health Services, one of our key partners. Through this, the department continues to align, adapt and move forward strategically with the Faculty of Medicine & Dentistry and our other key partners.

Early in the year, we began the process of executing our strategic plan. Many department members contributed to an updated vision and mission, began to create a comprehensive and transparent governance model, and started to construct a data-supported human resource plan. These endeavors are strong, multi-year strategies that are already being woven into the fabric of our thriving department. The dedication and efforts of all involved in planning are being put to the more intensive task of executing and actualizing the goals and plans. This is the point where many organizations fail but our department is determined and committed, and is succeeding in the realization of our shared aspirations.

Annual reports are an opportunity to reflect and celebrate all that we have accomplished throughout our diverse department. Just a few of our many novel successes of 2014 include:

• The general pediatric team created a one-of-a-kind website for prospective residents

• Developmental pediatrics developed a new fellowship in complex pediatric therapies outcomes research

• We welcomed 16 excellent new faculty members who represent our international reach, along with strong representation from all of Canada, from Newfoundland to British Columbia

• Dr. Jason Dyck’s research collaboration in discovery and translational science resulted in a $1 million grant

• The dedication and positive energy of PedsCrew has resulted in fun and morale-boosting social events, recognition and learning opportunities.

The Department of Pediatrics celebrates excellence and recognizes faculty members through an annual awards program organized by the faculty development committee. Peers nominate faculty members in categories ranging from superior research to outstanding teamwork.

An awards dinner is held each June and provides faculty members an opportunity to network, as well as celebrate their successes.

Congratulations to the following 2014 award recipients:

Celebrating ExcellenceColleagues nominate their peers for faculty awards each year

2014 DEPARTMENT OF PEDIATRICS ANNUAL REPORT4

Award Title Award Recipient(s)

Academic Faculty Research Paper Award Dr. Po-Yin Cheung and Lisa Hartling

Clinical Faculty Research Paper Award Dr. Monsarrat Quereshi

Cooperation Collaboration and Teamwork Recognition Award

Glenrose Rehabilitation Hospital Fetal Alcohol Spectrum Disorder (FASD) Clinical and Research Services

Innovation Award Geoff Ball

Mentoring Award Dr. Charlene Robertson

Pediatric Grand Rounds Award Lisa Hartling

Teaching Award by Subspecialty Pediatric Residents Dr. Cara Dosman

Faculty Undergraduate Medical Education (UGME) Awards

Best Teaching Division Award in Undergraduate Medical Education

Division of Nephrology

Excellence in Undergraduate Teaching Division of Pediatric Endocrinology/Metabolism

Top Ten Teachers Award Dr. Mohammad Ansarian

Dr. Loretta Fiorillo

Dr. Karen Forbes

Dr. Jessica Foulds

Dr. Rose Girgis

Community Undergraduate Medical Education (UGME) Awards

Best Teacher Award in Community Pediatrics Dr. Walter Szymanski

Excellence in Community Pediatrics Dr. Indra Dhunnoo and Anna Malanowska

Dr. Gail Andrew (l) and Carmen Rasmussen (r) received the Cooperation, Collaboration and Teamwork Award on behalf of Glenrose Rehabilitation Hospital Fetal Alcohol Spectrum Disorder Clinical and Research Services.

Dr. Manjula Gowrishankar

Dr. Manoj Kumar

Dr. Catherine Morgan

Dr. Hasu Rajani

Dr. Elizabeth Rosolowsky


The Department of Pediatrics develops leaders who take on roles not only within, but also outside of our department. Faculty members provide their expertise and leadership to other areas of the Faculty of Medicine & Dentistry and

the University of Alberta – and to many significant external medical and pediatric organizations.

The following is a selection of our members’ leadership roles in 2014:

Faculty Member Role and Organization

Dr. Samina Ali Associate Dean of Professionalism, Faculty of Medicine & Dentistry (FoMD), University of Alberta

Dr. Debbi Andrews Member and Past President, Mental Health and Developmental Disabilities Committee, Canadian Paediatric Society (CPS)

Dr. Khalid Aziz Assistant Editor, Paediatrics & Child Health - Editorial Board, CPS

Dr. David Eisenstat Interim Co-director, Applied Research, Cancer Research Institute of Northern Alberta (CRINA), FoMD, University of Alberta

Dr. Karen Forbes Chair, Paediatric Undergraduate Program Directors of Canada

Dr. Dawn Hartfield Annual Conference Committee, CPS

Lisa Hartling Platform Lead, Strategy for Patient-Oriented Research, SPOR Support Unit, Alberta Innovates Health Solutions (AIHS)

Dr. Chloe Joynt Secretary-Treasurer, Neonatal-Perinatal Medicine Section Executive, CPS

Dr. Melanie Lewis Associate Dean, Learner Advocacy & Wellness, FoMD, University of Alberta

Gary Lopaschuk Interim Co-director, Basic Research, Cardiovascular Translational Science Institute (CTSI), FoMD, University of Alberta

Dr. Tammy Masterson Pediatric Section President, Alberta Medical Association

Dr. Robert Moriartey President, CPS

Dr. Rabin Persad Secretary-Treasurer, Alberta Society of Gastroenterology

Dr. Maury Pinsk Pediatric Vice-Chair, Subspecialty Committee in Nephrology, Royal College of Physicians and Surgeons

Dr. Lawrence Richer Associate Dean of Health Informatics & Associate Dean of Clinical & Translational Research, FoMD, University of Alberta and Associate Director, the Women and Children’s Health Research Institute (WCHRI)

Dr. Joan Robinson Chair, Infectious Diseases and Immunization Committee & Senior Assistant Editor, Paediatrics & Child Health - Editorial Board, CPS

Dr. Kent Stobart Provost’s Fellow, One-Year-Term, University of Alberta

Dr. Wendy Vaudry Co-Chair, Canadian Immunization Monitoring Program (IMPACT), CPS

Dr. Lori West Interim Director, Alberta Transplant Institute & Director, Canadian National Transplant Research Program & Governing Council of the Canadian Institutes of Health Research, 3 Year Term, Canadian Institutes of Health Research (CIHR)

Dr. Sam Wong Chair, First Nations, Inuit and Métis Health Committee, CPS

Providing Their Expertise

Contributing to the FutureLearners keep pediatric dermatologist on her toes

The eyes may be the window to the soul but, according to Dr. Loretta Fiorillo, the skin is often the window to disease. “Skin manifestations occur in all sorts of diseases,” says the pediatric dermatologist and director of the Division of Dermatology. “The skin can provide clues to diagnosing neurological, gastroenterological and many other conditions.” Because of the skin’s importance in diagnosing so many conditions, residents from a variety of specialties and medical students at various levels in their training come to Fiorillo’s clinics to learn about dermatology.

Fiorillo is the director for the general dermatology residency program, and currently mentors 13 residents. On any given day, four or five trainees will attend Fiorillo’s clinic, including residents from both the University of Alberta and the University of Calgary (which does not offer the training), and medical students from here as well as from universities without pediatric dermatology programs.

As the division’s sole faculty member, Fiorillo’s heavy training responsibilities on top of her research and clinical work often keep her in the office until late at night. But she loves working with the students and residents. “They keep me on my toes,” she says with a smile. “One of my great joys is when they contradict me, when they surpass me in knowledge!”

Dr. Vimal Prajapati is a case in point. Prajapati was one of Fiorillo’s first residents, choosing pediatric dermatology over other much better paid branches of the field. He went on to complete a prestigious fellowship in the rare subspecialty at Harvard, then turned down a position at Harvard Medical School to set up practice in Calgary—a fact that delights Fiorillo.

“One of my contributions to health care is to help train the doctors of the future, she says. “So it means a great deal for a former resident to return to Alberta to give back to the province where he was trained.” ~ JH

Dr. Loretta Fiorillo is a pediatric dermatologist, professor and director in the Division of Dermatology.


Education

Pediatricians come from across the world to train at the University of Alberta. Because we have shown the international community the value we place on educating the next generation of doctors, we continue to be an attractive place for pediatricians to practice medicine.

We offer a fully accredited general pediatric residency training program and a wide spectrum of accredited subspecialties and fellowships, led by our excellent and dedicated teaching staff.

The department is involved with undergraduate pediatric education, general pediatrics and subspecialty programs and administers the Graduate Studies and Postdoctoral programs.

853number of teaching

hours department faculty members contribute

to undergraduate medical education*

*statistics from 2013 FoMD Chair’s Charter

10number of

general and community pediatric

residency positions*

13number of

Royal College of Physicians and

Surgeons accredited programs*


In Maskwacis Four Nations, less than an hour from Edmonton, community members expressed a need for greater access to pediatric health care. That voice was heard and has grown to become the Maskwacis Pediatric Resident Outreach Clinic, seeing up to 25 children each busy Thursday.

In 2011, a community member invited Dr. Lola Baydala to work as a pediatrician in the Maskwacis Health Clinic. At the time, she was collaborating with the community as part of the Maskwacis Life Skills Training Program (MLST).

In the spring of 2013, Department of Pediatrics residents Drs. Megan Fowler and Jessica Nicoll heard about the need for pediatric health care in Maskwacis. They recognized it as an opportunity to advocate for a high-risk population close to home, and felt it should be part of the resident curriculum.

Fowler and Nicoll brought the idea to Baydala. With the support of the department residency program and Randy Littlechild, the medical director of Maskwacis Health Services, the clinic was formally approved in October 2013. They began recruiting preceptors and scheduling residents to attend the clinic on a weekly basis. Drs. Daniela Migliarese Isaac, Hayley Turnbull and Richelle Wright have joined the group and been instrumental to the project.

The team applied for and successfully received the 2014 Canadian Pediatric Society (CPS) Residency Advocacy Grant. The grant is being used towards conducting community-based focus groups, translation of medical and advocacy documents into Cree, and supporting Maskwacis community members in sharing their culture with residents via seminars.

Focus groups with Elders, caregivers and community health care workers identified community-driven child health priorities now being used to further guide public health strategies to improve child health outcomes. Feedback revealed the greatest pediatric care needs centered on the social determinants of health and access to stigma-free, culturally congruent medical care for all children. Baydala and community pediatrician Dr. Heather Dreise are each committed to attending the clinic two Thursdays a month, with back up from other community pediatricians.

The clinic is a way for pediatric residents to broaden their understanding of the impact of colonialism and residential school experiences on the health of First Nations children, youth and their families, and it provides a context for Maskwacis children admitted to the Stollery Children’s Hospital.

“When residents look after patients from the Maskwacis communities, they understand how social determinants affect health,” says Baydala.

Teaming Up With the CommunityA new outreach clinic provides learners with a better understanding of Aboriginal culture


Nicoll agrees, adding that, “This experience allows us to have a different exposure to pediatrics and hopefully a better understanding of Aboriginal culture. Now when we see these patients in the Stollery, we have some understanding of the social injustices and barriers to accessing health care that the Maskwacis community faces.”

Fowler is happy with the growth of the clinic. “I’m proud to be part of a project that is addressing the health disparities of a neighbouring community. Working with the Maskwacis community has been extremely rewarding.”

Isaac also notes that, “The most rewarding part is collaborating with the community, and seeing and hearing the positive impact reported by caregivers and patients who feel a true difference is being made.” ~ SK

Dr. Lola Baydala (large photo - r) is an associate professor in the Division of General and Community Pediatrics and a University of Alberta Community Scholar award recipient.

Dr. Mohamed El-Kalla (large photo - l) is a general pediatrics residency program trainee.

Global health researcher also benefits those close to home

At the Maskwacis Pediatric Outreach Clinic, Dr. Lola Baydala notices many children with methicillin-resistant Staphylococcus aureus (MRSA) skin infections. With approval from Randy Littlechild, medical director of Maskwacis Health Services, she connected with Dr. Michael Hawkes, pediatric infectious diseases, to address the high prevalence of the infections.

“There is a slightly different strain that has been recognized for decades in Northern Aboriginal communities in the prairies of Canada. We’re particularly interested in this one. Our lab has sophisticated typing technologies that enable us to distinguish the USA 300 strain from other strains that have some affinity for Aboriginal communities,” says Hawkes.

“Once we have some preliminary data, we may be able to describe colonization rates in the community and can think about doing prospective surveillance studies at a community level to figure out exactly what’s going on. Where is the MRSA and how is it getting transmitted?” questions Hawkes.

Hawkes’ interest is tropical disease in global health where he sees socioeconomic disparities play a major role in why children get infections like malaria. He draws a parallel with the MRSA cases.

“Within Canada we also have socioeconomic disparities and our First Nations populations do represent a vulnerable population. There are similarities between global health and Aboriginal health. That’s where my interest comes in,” says Hawkes.

Dr. Michael Hawkes is an assistant professor in the Division of Infectious Diseases.

Picubu Roan (small photo) from the Maskwacis community, attends the clinic with her baby.

When entering the pediatric emergency subspecialty residency program, learners bring a wealth of general knowledge with them but many find that they have less knowledge of emergency-specific areas like trauma, toxicology and injury.

Dr. Andrew Dixon, program director, distributed a needs assessment to all current and recently graduated trainees across Canada to determine what the needs were for fracture management in emergency medicine training. Respondents felt that x-ray interpretation and treatment strategies were the highest priority for learning.

Dixon and his colleagues in the Division of Emergency Medicine then developed new orthopedic interactive sessions to provide additional training specifically on fracture management. Dixon facilitated a series of five case-based, interactive sessions to cover both common fractures and those known to be more complicated.

He is now working on transforming these interactive sessions into online self-study modules.

“We are working to release these modules on Google Sites, along with an x-ray repository for further self-study.”

Dr. Dixon says the format of these new sessions is unique.

“All I could locate through my own research were traditional textbook sessions. I was unable to find anything specific to orthopedics and fractures in this format, especially in children.”

In the future, Dr. Dixon hopes to see these sessions open up to a larger audience. An agreement already exists to release the Google Sites version to the survey respondent groups.

The division is also pleased to have created a new observational program: the Direct Observed Clinical Shift, or DOCS. This new program allows the trainee to be “shadowed” by a staff member for several hours to provide feedback on areas of the trainee’s professional manner not usually critiqued.

The Division of Emergency Medicine educates five sub-specialty trainees, 156-169 residents and 168 medical students a year. ~ KB

Dr. Andrew Dixon is a pediatric emergency medicine physician and an assistant professor in the Division of Emergency Medicine.


Priorities for LearningSharing a new web-based model of learning about fracture management

Dr. Shine Kumar travelled halfway across the world to work with Department of Pediatrics professor Dr. Ian Adatia. Kumar was looking for further training in an area that would be of benefit in his native India. When his mentor drew his attention to the work of Adatia, an authority in pediatric pulmonary hypertension, Kumar realized he had found a perfect fit.

Adatia is a recognized expert in his field and developed the first pulmonary hypertension clinic for children in North America. On the research side, he is working to develop a handheld device that would use speech and voice recognition technology to diagnose pulmonary hypertension.

“Anyone who aspires to work in this field would want to work with him,” says Kumar, now a clinical research fellow in pediatric pulmonary hypertension and critical care at the Stollery Children’s Hospital. “In the past 10 months, I have learned so much. He has taught me never to give up on a patient and that nothing is impossible.”

The words speak volumes of Adatia’s care for his patients and his reputation as a teacher and mentor. He has mentored more than 30 trainees and currently supervises three fellows in his pulmonary hypertension service, three elective trainees from other disciplines and two computer science PhD students. Three of his former trainees have gone on to start their own pulmonary hypertension clinics in Geneva, Switzerland; Hanover, Germany; and ,Toronto.

Teaching Better DoctorsA wide-ranging philosophy of teaching and mentoring inspires learners

Part of Adatia’s philosophy is to insist that his trainees write up a case or series of observations and submit a paper for publication. “I think this aspect of my approach to teaching is very important and the resolve, integrity and courage to submit one’s work to peer review is a very valuable lesson,” he explains.

Adatia has a very broad view of teaching that includes more than just his work with students, residents and fellows. At the annual international conference he co-organizes, he incorporates education sessions for the families of his young patients. He trained the first nurse practitioner to work in pediatric pulmonary hypertension in Canada and is now training a nurse practitioner to join his own clinic.

Adatia says he learns a great deal about mentoring from the trainees themselves. “Often they’ve come from other international programs and have insights that I don’t. This two-way connection makes relationships much more fruitful,” he explains. “It’s always a balance between teaching an academic and clinical approach that is rigorous and demanding, yet making sure trainees have a rewarding experience. But if they can come out of the program knowing something about a compassionate yet rigorous approach to patients and families that’s not in the textbooks, and with a publication or two, that will make them better doctors.” ~ JH

Dr. Ian Adatia (l) is a pediatric cardiologist and professor in the Division of Critical Care (PICU).

Dr. Shine Kumar (r) is a clinical research fellow in pediatric pulmonary hypertension.


Pediatric residents and fellows come to the Department of Pediatrics from nearly every continent on the planet (all except Antarctica!). Future pediatricians can train in one of 13 Royal College-accredited programs, including general pediatrics and subspecialties, as well as many fellowship programs. All of our programs recently completed an internal review and we are well-prepared to meet the Royal College of Physicians & Surgeons of Canada external review requirements in 2017.

The Stollery Children’s Hospital Foundation provides generous support of over $1 million each year to help fund pediatric education.

Learners Come From Every Corner of the Globe

55

7

2

3

513

7

5

2

2

14 2014 DEPARTMENT OF PEDIATRICS ANNUAL REPORT

55

7

2

3

513

7

5

2

2

101 Pediatric residents and fellows in 2013/2014

15

2.7number of

active extramural grants per principal

investigator with greater than 40% protected

research time*

Dr. Hanna Kolski’s motivation in both clinical care and research in muscle diseases is to help children. “The motivation comes from the families; I think that is one of the things that gets lost sometimes,” she says. Duchenne muscular dystrophy is a devastating degenerative genetic disease that affects one in 3,500 boys.

Despite some success with new treatments, the future can seem bleak when physicians look at the existing documented natural history of children with the disease: children are in a wheelchair by age 10, have severe scoliosis and surgery by early adulthood, and heart failure and death in the second decade of life. But the real picture of this future is improving.

Families look to Kolski and her colleagues at the Stollery Children’s Hospital and Glenrose Rehabilitation Hospital to help them understand what their children’s lives will be like with Duchenne. “They want to know what to expect in 10 years. But nobody had systematically looked at the change in this natural history with new treatments in hundreds of patients. Up until now, nobody has known what to tell them,” she explains.

Kolski’s decade-long involvement with the Cooperative International Neuromuscular Research Group (CINRG) has produced a large databank of clinical and genetic

information, and documented improvement through clinical trials. With partner sites in Canada, the United States, Europe, Australia, India and South America, the consortium of medical and scientific investigators share the common goal of contributing to the research and treatment of neuromuscular diseases to improve quality of life.

An ongoing observational study is defining a new natural history for Duchenne, a “new normal” to share with families. With treatments, this new normal extends walking by three years, reducing scoliosis and eliminating the need for surgery in the vast majority of kids. Kolski’s current interest is heart treatment and ACE inhibitors/steroids show promise in stabilizing the heart in pediatric populations.

The strengths of CINRG are the international network to collect data from a large number of patients, with the rigorous standardization of that collection and assessment, and the strong integration of clinical and research interests. Kolski sums up her dedication by saying, “There is a direct link to the research and it stems from the clinical interaction with patients. We realize how hard it must be for them and we want to help even more.” ~ JC


Dr. Hanna Kolski is a pediatric neurologist and an associate professor in the Division of Neurology.

The New NormalImproving quality of life for kids with Duchenne muscular dystrophy

Research in the Department of Pediatrics puts an emphasis on collaborative projects ranging from treatments for children with cancer to assessing environmental factors that affect the health of children. We have researchers working everywhere, from basic science to clinical trials to policy development. Each area is critically important to the success of translating research knowledge into practice, and transferring this knowledge to the bedside.

$1,929,229value of salary

awards per principal investigator with greater

than 40% protected research time*

$16,398,988value of research operating

grants (30 faculty members)*

214total number of peer

reviewed publications for faculty members with

greater than 40% protected research

time*

48number of

M.Sc. and PhD students*

*2013 Chair’s Charter data

The Stollery Children’s Hospital and the Mazankowski Alberta Heart Institute together perform one of the highest numbers of pediatric cardiac surgeries in Canada. More than 30 per cent of children who undergo cardiac surgery will develop acute kidney injury (AKI).

Children who develop AKI often have a more difficult recovery after surgery, with some requiring dialysis. They may also be more likely to develop further kidney problems later in life.

As a pediatric nephrologist with the Department of Pediatrics, AKI researcher Dr. Catherine Morgan wants to know what causes this injury after cardiac surgery and how we can detect or predict it earlier than what doctors are currently able to do.

“When in surgery, the child is placed on a heart/lung bypass machine to manage blood and oxygen flow in the body while the heart is being repaired. The heart surgery, and being on bypass, can alter the child’s normal blood flow to the kidney and vary oxygenation. We want to know how these complex changes affect the kidney.”

Predict to PreventA non-invasive method to measure oxygen in the kidney during congenital heart surgery could prevent injury

Near Infrared Spectroscopy (NIRS) is commonly used to measure brain oxygenation during heart surgery in children. A sensor is applied to the skin and emits specific wavelengths of light. It gets information back about how the tissue underlying it absorbs this light. Morgan looked to NIRS to monitor the kidneys as well. NIRS sensors are being applied to the region on the back overlying the kidney of the children during surgery.

Morgan hopes the results of this research will help physicians predict those most likely to develop AKI early. This would allow for a more proactive approach in preventing injury and provide enhanced patient support to those at higher risk by, for example, helping to decide which children need a dialysis catheter to be placed preemptively during surgery.

This project, funded by the Women & Children’s Health Research Institute, is in collaboration with Drs. Dominic Cave, anesthesiologist and intensivist, Lindsay Ryerson, intensivist, and Mohammed Al-Aklabi, cardiac surgeon.

“The department has a very strong collaborative environment between clinicians and investigators,” says Morgan. “This project wouldn’t have been possible without this collaboration.” ~ KB

Dr. Catherine Morgan is a pediatric nephrologist and assistant professor in the Division of Nephrology.



Photo: Laughing Dog

It is globally recognized that pain is undertreated in children who break their bones. The Oral Analgesic Utilization for Childhood Musculoskeletal Injuries study (OUCH) is a cross-Canada Canadian Institutes of Health Research (CIHR) funded study looking to find the perfect combination of drugs for children who require more than Tylenol® or Advil® when they leave the emergency department.

This randomized control trial is taking place in the emergency departments of the Stollery Children’s Hospital in Edmonton, Centre Hospitalier Universitaire Sainte-Justine in Montreal and Children’s Hospital of Eastern Ontario in Ottawa. Dr. Samina Ali, at the University of Alberta, leads the study with Sylvie Le May, PhD, at Universite de Montreal.

Started in August 2013, the study is looking to find what combination of drugs will give minimal side effects with maximum pain treatment. “You don’t want to give a pain medication that takes away their pain but leaves them so sleepy that they are non-functional for two days. How is that useful for a child, or their family, in their daily life? ” questions Ali.

The team is recruiting 500 children that have broken limbs, and moderate to severe pain, across the three sites. They are confident that combining data, rather than conducting three smaller studies, will provide the definitive answers they are looking for.

The children, ages six to 18 years, are treated in the emergency department with one or both of two painkillers. They are then closely monitored for a minimum of two hours, during which time their pain scores, vital signs, level of sedation, and side effects are measured.

Children receive either oral morphine alone, ibuprofen alone or both drugs, randomly assigned by computer. Participants and research personnel also don’t know what combination they use, as packaging and formulations are identical.

To discover which combination is best, the children rate their pain immediately before and 30 minutes after taking each dose using multiple pain scales, including the Visual Analog Scale, the Colour Analog Scale, and the Faces Pain Scale-Revised. While the Visual Analog Scale will be the primary measure for the study, an embedded second study will compare the utility of the other two scales to this reference scale.

The project has recruited more than two-thirds of participants needed and should finish recruitment by August 2015.

“We’re also completing some systematic reviews to look at both the effectiveness and side effects of commonly-used medications for musculoskeletal injury. Ultimately, we are looking for a definitive answer to say that a specific drug or combination of drugs is the one that is the best at treating pain, with the least side effects,” says Ali.

Ali enjoys working in this collaborative team environment, solving clinical problems together.

“I really feel like our team cares. They want children’s pain to be better treated. They believe in what they are recruiting for. Everyone works better when you believe in what you are working for,” she says. ~ SK

Dr. Samina Ali is a pediatric emergency medicine physician and an associate professor in the Division of Emergency Medicine.


Taking the OUCH Out of PainA cross-Canada study looks to find what drugs are best for children with broken limbs


In the world of research collaboration, the Adiponectin Gene Therapy: A Promising New Therapy to Improve Outcomes in Heart Transplantation project is a perfect storm of the best kind. Storm-master Jason Dyck, PhD, has assembled a team of colleagues at the University of Alberta to develop therapeutic strategy aimed at improving organs for transplant. In 2014, the team gained the generous support of a $1 million grant for gene therapy research from the University Hospital Foundation’s Gerald Averback Award in Cardiovascular Gene Therapy/Genomics and Vascular Biology to make it happen.

Dyck’s research team includes fellow Department of Pediatrics member Dr. Lori West, director of the Alberta Transplant Institute, and surgeons Dr. Darren Freed and Dr. Jayan Nagendran. The combination of Dyck’s work on gene therapy, West’s transplants in lab models and Freed and Nagendran’s ex vivo heart and lung perfusions creates a true collaboration where all of the participants’ main areas of interest combine.

Transplant is not Dyck’s area of expertise, but he is energized by the possibility of improving a stunning statistic. “There are approximately 175 heart transplants performed in Canada each year, 30-40 of them pediatric. Not only is there a donor shortage, but we are only able to use about 15-30 per cent of adult hearts and 50 per cent of pediatric hearts that are donated. I was shocked to learn that,” he asserts.

Improving the function of donated hearts that may otherwise be deemed unusable for transplant and preserving function of those that need to be transported long distances are the two main aims of the research. The

Perfect StormResearchers combine their interests to improve transplants

key may be a protective hormone naturally secreted by a healthy-weight body but lacking in transplant recipients, many of whom are obese. The hormone helps improve organ function and reduces rejection. Standard cardiac gene therapy hasn’t worked as well as hoped, partly because of the need to target the therapy to the heart without affecting the rest of the body. However, this team’s approach will be to deliver the gene therapy in hearts outside of the body prior to transplant. This will obviously allow the therapy to be delivered directly and specifically to the heart.

“I’m doing work in gene therapy,” says Dyck. “Over at the Li Ka Shing building, Lori is doing transplants in lab models. And Darren and Jayan are doing work where they take out an organ and perfuse it to improve function and protect function during transport over long distances and long periods of time. I thought, this a great opportunity to perform gene therapy on an isolated organ. Just the heart is genetically modified to produce the protective hormone and it doesn’t affect the rest of the body.”

Dyck has the ideas, the funding, and the passion to bring this research together. And, he also has the opportunity to work with a great team. “What I love about the University of Alberta is that it’s a very collaborative environment. It’s the culture here. That’s the great thing.” ~ JC

Jason Dyck, PhD, is a professor in the Divison of Cardiology.

Dr. Lori West is a pediatric cardiologist and also a professor in the divison.


Dr. Elizabeth Rosolowsky is a pediatric endocrinologist with a busy clinical and teaching load. She’s also an academic and interested in studying clinically relevant questions. Faced with limited resources of time and funds, Rosolowsky was elated to be awarded a Clinical Research Seed Grant funded by the Women and Children’s Health Research Institute (WCHRI) with the generous support of the Stollery Children’s Hospital Foundation.

Type 1 diabetes is one of the most common chronic illnesses of children; the Pediatric Diabetes Education Centre at the Stollery sees up to 1,000 unique patients a year. “Patients are diagnosed when they are young. We offer education about caring for diabetes in order to optimize glycemic control. Without proper care, children and adolescents can have devastating complications when they are older,” explains Rosolowsky. The focus of her seed grant research project is to find out how youth and their caregivers perceive measures of long-term glycemic control, in particular the hemoglobin A1c measurement, and how these perceptions relate to their day-to-day diabetes care practices.

Based on her clinical experience and the handful of publications on this topic, Rosolowsky suspects that the majority of children and their caregivers here do not know or understand what a hemoglobin A1c is or its

relationship to long-term health. “The hemoglobin A1c measurement is one of the most important concepts in diabetes care,” says Rosolowsky. “Yet for children with diabetes and their caregivers, the day-to-day diabetes care tasks may be more immediately relevant. It’s important for our centre to learn whether patients, caregivers, and providers share similar glycemic goals and whether these shared glycemic goals are associated with adherence to day-to-day diabetes care behaviours.”

Rosolowsky seeks to build a body of research with the $15,000 WCHRI grant that will allow her to get to the next step in improving the health of children with diabetes. In the competitive world of funding, it can be difficult for clinicians to go up against those with weightier research portfolios. “This is exactly the kind of grant that somebody like me needs, because most of my time is allotted for clinical work and teaching, but I still want to conduct research that will inform clinical practice. It’s the perfect starter funding that will allow me to become more competitive for subsequent grants,” she explains. ~ JC

If You Plant a SeedA starter grant helps build a body of research

Dr. Elizabeth Rosolowsky is a pediatric endocrinologist and assistant professor in the Division of Endocrinology/Metabolism.

The WCHRI Clinical Research Seed Grant competition is intended to foster clinical and educational research in the Stollery Children’s Hospital and Lois Hole Hospital for Women that would be immediately relevant, or rapidly translatable, towards improved health outcomes for children and women. It is designed to encourage a research integrated hospital environment by engaging a variety of care providers in clinical research. The award offers up to $15,000 for a one-year term.

Immigrants come to Edmonton from continental Africa for a variety of reasons, but most make the journey filled with hope and ready for change in their lives. Families with sickle cell anemia, a serious inherited blood disorder that affects multiple organs and systems, can be overwhelmed when they face a journey of another kind – that of learning about and adjusting to the approach of western medicine.

Dr. Aisha Bruce and the multidisciplinary team at the Pediatric Sickle Cell Program at the Stollery Children’s Hospital work with a rapidly expanding patient population. Sickle cell is common in certain ethnic groups, especially those of continental Africa. As the number of immigrants from African countries such as Nigeria increases, so has Bruce’s patient base, tripling in just three years.

Despite the families’ interest in helping their children, it can take up to six phone calls to get a patient family to come for an important test, medications are not always taken, and the mandatory myriad of forms not filled out. Team members suspect that cultural differences contribute to patient families’ ability to fully embrace western medicine and our different approach to sickle cell anemia. “In western medicine, we’re able to intervene early and extend the life expectancy of children with sickle cell to almost normal,” explains Bruce. “But in their home countries, life expectancy may be limited to two years or even two months. Treatments are just not as available or affordable. And, for them, an inherited disease can bring stigma.”

Bruce has learned a lot about African cultures in her work, but questions remain. “I have tried explaining in every way possible, and I don’t know what approach is most

A Journey of Another KindQualitative research will help immigrant families relate to western medicine

effective and I don’t know whether it is simply that family or the culture as a whole that responds well to different approaches,” she says. A $15,000 Clinical Research Seed Grant funded by the Women and Children’s Health Research Institute (WCHRI) with the generous support of the Stollery Children’s Hospital Foundation, could change that. “There are lots of recommendations from medical associations to be culturally sensitive, but what does that really mean to these particular patient families? I want to know what their perspective is.”

Bruce proposed a qualitative study, looking at 12 to 15 families. Most funders would not consider an application for a study with such small numbers, even though this type of study could translate across disease spectrums and apply to other populations of children. While the grant will go a long way to getting this research off the ground, Bruce is just as thankful for the expertise of WCHRI’s qualitative research support team. “It may be a very simple process piece that we can institute to help families navigate the system,” she says. “We’re expecting to be able to implement health care change, which is phenomenal and basically what the seed grant is about.” ~ JC

Dr. Aisha Bruce is a pediatric hematologist and an assistant professor in the Division of Immunology, Hematology, Oncology, Palliative Care and Environmental Health (iHOPE).



WCHRI funding enhances our research in the Stollery

In 2014, to help enhance research in the Stollery Children’s Hospital, WCHRI created a new program called “Clinical Research Capacity Building.” The program provides stable funding for a study coordinator so teams can more easily bring research into the hospital and translate the knowledge to better care.

WCHRI believes that this program has excellent potential to achieve transformative changes in the hospital and community.

The following teams from the Department of Pediatrics were awarded funding from this new program:

• Critical Care Research Team (CCResT) – Led by Dr. Ari Joffe

• Pediatric Emergency Department Team – Led by Dr. William Craig

• Stollery Single Ventricle Outcomes Team – Led by Dr. Andrew Mackie

• Edmonton Pediatric Inflammatory Bowel Disease Center (EPIC) – Led by Dr. Hien Huynh

The first Pediatrics Research Day, held in May 2014, was a great success. Over 200 people came to learn about research that our faculty, graduate students, and trainees are involved in.

Oral presentations ranged from topics such as delivering neonatal palliative care to examining the diagnosis of Fetal Alcohol Spectrum Disorders (FASD). There were close to 100 poster presentations on research ranging from night call experiences in pediatric clerkships at Canadian medical schools to building a multi-stakeholder children’s environmental health research agenda in Alberta.

Keynote speaker Dr. Jonathon Maguire of University of Toronto gave an engaging presentation on TARget Kids! This longitudinal research is aimed at linking early life exposures to health problems.

The afternoon featured a forum on adolescent mental health, with Amanda Newton, PhD; Carmen Rasmussen, PhD; and Dr. Lonnie Zwaigenbaum presenting their research, followed by a panel talk.

The day featured remarks from Dr. Susan Gilmour, chair of the Department of Pediatrics and special guests Tracy Macdonald, senior operating officer of the Stollery Children’s Hospital, Karen Faulkner, vice-president of the the Stollery Hospital Foundation and Dr. Sandy Davidge, director of the Women and Children’s Health Research Institute (WCHRI). ~ SK

Pediatrics Research Day 2014


Graduate Students Claim National Awards

Student Pursuing Degree Award(s)

Jillian Avis PhD CIHR Master’s Award, AIHS Incentive Award & AIHS Graduate Studentship

Nikole Byrne M.Sc. Queen Elizabeth II Graduate Scholarship, Faculty of Graduate Studies and Research (FGSR), University of Alberta

Shijun Deng PhD Doctoral Recruitment Scholarship, FGSR, University of Alberta

Michelle Foisy PhD Knowledge Translation Canada Graduate Student Fellowship

Tamara Germani PhD AIHS Clinical Fellowship, WCHRI Incentive Award & Canadian Child Health Clinician Scientist Career Enhancement Award

Ty Kim M.Sc. Alberta Diabetes Foundation Scholarship & Queen Elizabeth II Graduate Scholarship, FGSR, University of Alberta

Antoinette Nguyen PhD 75th Anniversary Graduate Student Award, FoMD, University of Alberta

Arnaldo Perez Garcia PhD WCHRI Graduate Studentship

Katherine Pohlman PhD Medical Sciences Graduate Program Committee Award, FoMD, University of Alberta

Ann-Marie Przyslupski M.Sc. Branch Out Neurological Foundation Master’s Grant

Ashley Radomski PhD Queen Elizabeth II Graduate Scholarship, FGSR, University of Alberta

Marghalara Rashid PhD Medical Sciences Graduate Program Committee Award, FoMD, University of Alberta (two awards)

Florencia Ricci PhD Swallow Fellowship, local family donation

Patricia Sibernagel M.Sc. Supervisor Funding

Mordechai Slae M.Sc. AIHS Clinical Fellowship

Geetha Venkateswaran M.Sc. Medical Sciences Graduate Program Committee Award, FoMD, University of Alberta & WCHRI Graduate Studentship

Deenaz Zaidi PhD Medical Sciences Graduate Program Committee Award, FoMD, University of Alberta & WCHRI Studentship


Our exceptional graduate students held just over $335,000 in student awards for the 2014-15 academic year. Students are supported by a diverse range of organizations from the Alberta Diabetes Foundation to the Canadian Institutes

of Health Research (CIHR). The Department of Pediatrics attracts graduate students from a variety of disciplines and has about 45 students throughout the year.

Dr. Florencia Ricci’s admiration for Dr. Charlene Robertson is clear. “You can’t not learn something from Dr. Robertson,” she emphasizes. Ricci is the recipient of a new two-year Swallow Fellowship in Outcomes Research within the Division of Developmental Pediatrics under the supervision of Robertson and a team of professionals involved in the Western Canadian Complex Pediatric Therapies Follow-up Program (CPTFP). This program assesses children who have undergone new life-saving therapies at the Stollery Children’s Hospital.

Children come from across Western Canada for life-saving therapies such as early complex cardiac surgery, solid organ transplantation, and extracorporeal membrane oxygenation (ECMO). Developmental follow-up takes place at six months after their procedures, at 18 to 24 months of age, and again at four to five years of age. The program provides assessment and intervention as needed for the surviving children. It also improves care for future children by analyzing information from acute care to improve outcomes, and by conducting research where there is something new to be learned.

The work of Robertson, together with colleagues across the Department of Pediatrics and referral sites, can have a powerful impact on the lives of children and their families. One example involves children who developed late-onset, progressive bilateral permanent hearing loss in a proportion much higher than expected for intensive care graduates.

Fellowship of CareFollowing children after life-saving therapies

“This hearing loss, combined with the children’s many other problems was not right – I thought that we just can’t accept this,” she says. Through an extensive investigation, Robertson and colleagues determined a diuretic was the likely cause.

Knowing that furosemide must be delivered in a specific way, a multidisciplinary team was formed to change the formulary for how this drug was given at the Stollery. The change made a dramatic difference, as there has been a marked reduction in this disability. And now new residents even don’t know that it was ever a problem; the learners are all taught the new formulary. “And that information goes around the world,” says Ricci. “That is the impact.”

The program has been a labour of love for Robertson and nearly 20 years in, after creating it and seeing it develop with growing support from the entire department, she is ready to pass it on to the next generation. It is her intent that Ricci take the reins and continue this work. ~ JC

Dr. Charlene Robertson (l) is professor emeritus in the Division of Developmental Pediatrics and co-chair of the Western Canadian Complex Pediatric Therapies Follow-up Program.

Dr. Florencia Ricci (r) is the Swallow Fellow in Outcomes Research.


Clinical Care

The Department of Pediatrics at the University of Alberta, in partnership with Alberta Health Services (AHS), provides clinical care for children and their families in the Edmonton and surrounding areas in private pediatric practices, regional clinics, community hospitals, the Glenrose Rehabilitation Hospital and the Stollery Children’s Hospital.

Thanks to the strong relationship with AHS and the child health care community, our department is able to offer an array of specialty medical services, sophisticated diagnostic techniques and specialized surgical procedures not readily available elsewhere.

The Department of Pediatrics’ Division of Pediatric Gastroenterology and Nutrition (GI) is first in line to participate in a new provincial program to provide a consistent and efficient referral experience for patients of pediatric gastrointestinal services.

Dr. Hien Huynh, director of the Division of Gastroenterology and Nutrition, says the division wanted to be one of the leaders of this initiative provincially and he worked with colleagues and others to collaborate when developing a new standard referral pathway.

In partnership with Alberta Health Services (AHS) and Dr. Steve Martin, a gastroenterologist with the Alberta Children’s Hospital, Alberta Referral Pathways for Pediatric GI Services builds connections between primary care physicians, pediatricians, allied health and subspecialists to improve Alberta’s gastroenterology referral process.

Huynh says, “We were excited to be part of testing this new program. It is very important that we work to streamline how referrals from physicians to specialists occur. Part of streamlining the referral process is ensuring patients are referred correctly and the correct information is being transferred with them.” The referral guidelines that Huynh was instrumental in developing also aim to give approximate wait times for the process.

Together with the adult division, Pediatric GI is one of the first twenty pathways to be a part of the Alberta Referral Pathways program. Jodi Glassford and Annabelle Wong, both with AHS, are the co-pathways advisors to support the Pediatric GI referral pathway development.

“It is great to facilitate the connection between physicians like Dr. Huynh and Dr. Martin,” says Glassford. “It is the fusion of the expertise and passion of the physicians that will make this project successful.”

The goal of establishing clear and consistent referral processes and requirements is to lay a foundation for referral automation in the future. Referring users will select from

Clearing a PathGastroenterology is the first to streamline the referral process in a provincial program

a list of specialists appropriate for the patient’s specific condition, recommendations of most appropriate program and current approximate wait times. On the other end, if the chosen specialist is having trouble triaging the patient, they can request more information from the referring physician. eReferral is in a limited production rollout with future funding to be secured once the evaluation is completed. ~ KB

Scoping national wait-times

The Division of Gastroenterology and Nutrition is spearheading the assessment of referral wait times on a national level. Dr. Jason Yap, pediatric gastroenterologist and member of the Canadian Association of Gastroenterology, is studying endoscopy wait times both in Alberta and across the country.

The Pediatric Survey of Access to Gastroenterology (PSAGE) is a national survey sent to members to collect information about respondents’ patients and the wait times these patients experience. Though this survey is specifically looking at wait time for endoscopy, Yap would like to determine if the referral wait time information also provided is demonstrative of an appropriate waiting period and, if not, what the recommendation would be.

Yap is in the unique position to be able to review the provincial and national data simultaneously. “This information will help us determine what our current benchmarks are and if the provincial and national indications are similar,” he says. ~ KB

Dr. Hien Huynh (l) is an associate professor and director in the Division of Gastroenterology and Nutrition.

Dr. Jason Yap (r) is also an associate professor in the division.


When thinking of heart surgery, many immediately think of traditional open-heart surgery that often involves an incision into the chest and the patient being put on a heart/lung bypass machine during the procedure, with the heart essentially “stopped”. Nowadays, there are also less invasive catheter procedures that require much smaller incisions, not in the chest, and do not require stopping the heart. Though these new procedures are lower risk, there are places in the heart you just cannot go without the full surgery.

What if you could combine the expertise and benefits of each of these procedures?

Last spring, the Mazankowski Heart Institute unveiled its new cardiology hybrid suite to do just that. This facility fuses a surgical operating room and surgical catheter lab, opening up many more options for treating patients. Dr. Andrea Wan is a catheter specialist utilizing this new facility.

When Two Become OneThe Mazankowski Alberta Heart Institute’s new cardiology hybrid suite

“This suite allows the team [surgeon and catheter specialist] to work simultaneously on one patient,” says Wan. “We are able to be much more creative in how we treat children with complex congenital heart diseases and conditions. We are trying to optimize how we work together to make some of these procedures less invasive.”

Wan says the Department of Pediatrics was very supportive in getting the suite up and running. “Not only are all the physicians great to work with, but the department also provided financial assistance to allow me to invite my mentor to travel from Toronto to observe one of the first procedures in the space.”

Dr. Wan says the suite was a huge plus in her choice to come to Edmonton. “I was very excited at the chance to work at the Mazankowski Heart Institute, integrated with the Stollery Children’s Hospital, as it is one of the few hospitals in Canada doing the full range of pediatric catheter procedures.” ~ KB


Dr. Andrea Wan is a pediatric cardiologist and assistant professor in the Divsion of Cardiology.


Tiny Isaac Tymchuk, held by parents Matt and Shandra, was the first baby in Western Canada to benefit from the work of the teams in the hybrid suite.

~ Photo: Edmonton Journal Topher Seguin

The birth of a baby is truly a miracle. But about one in every 100 of these wondrous events becomes a terrifying ordeal for the parents when the newborn needs resuscitation. Now, Dr. Po-Yin Cheung and Dr. Georg Schmolzer are working on restoring the miracle for these parents and their babies with a new method of neonatal resuscitation that doubles the infant’s chances of survival.

The new technique combines two components of CPR—rescue breaths and chest compressions—so that they occur at the same time instead of one after the other. The method is currently being tested in a clinical trial and results to date have been tremendous—not only greatly increasing the likelihood of survival but also cutting the recovery time in half. Faster recovery is crucial for the health of the child because every second without oxygen increases the chances for damage to the brain and other serious long-term health complications.

Breaths of LifeNeonatal resuscitation method helps cement NICU’s reputation as a national leader

The two faculty members first came up with the innovative method when Schmolzer was Cheung’s post-doctoral fellow. “I had the expertise on the cardiovascular system and his was on the respiratory system so it was a fruitful collaboration,” says Cheung. “We had the theoretical backup, we talked about it and said, ‘why not try it’.” Cheung and Schmolzer, recent recipient of the Heart and Stroke Foundation/University of Alberta Professorship in Neonatal Resuscitation, hope to extend the trial soon to other centres in Canada.

For Cheung, this kind of clinical breakthrough is a natural result of the tremendous growth in excellence he has seen in the Neonatal Intensive Care Unit (NICU) since his arrival in 1992 as a neonatal fellow. “Our division is positioned to be a leader in research on neonatal resuscitation in the country because of the state-of-the-art research equipment and the personnel and infrastructure we have,” he says. “In five years we can be one of the leading centres in the world.” ~ JH


Dr. Po-Yin Cheung (r) is a neonatologist and a professor in the Division of Neonatal-Perinatal Care (NICU).

Dr. Georg Schmolzer (l) is a neonatologist and an assistant professor also in the divsion.

Dr. Israel Amirav knew there was a problem with the inhalation masks his patients were using. These standard masks were scaled down versions of adult masks and did not seal properly. Because of this, the medicine administered through the mask would dissipate in the air instead of being delivered to the child.

He heard frustration from his patients’ parents in using the mask. “You know doctor, you prescribed this ventilator, but my son does not like it, he’s fighting it,” they’d say.

Amirav set off to investigate how these masks were created. He found the current models used were based on adult measurements and the only mask that used children’s measurements was an airplane oxygen mask developed over 60 years ago. This mask was based on measurements of 30 to 40 children.

Amirav decided the time was right to create a new mask. At the time, he was a pediatric pulmonologist in Northern Israel. He joined the Department of Pediatrics in June 2013.

“I decided to measure infants’ faces and heard about the 3-D camera technology the computer science department created at Technion Israel Institute of Technology in Haifa, Israel,” said Amirav.

He made a connection and borrowed their camera, going into the local community to take pictures of about 300 children’s faces. Using the 3-D technology is a simple

Into Thin AirUsing a 3-D camera to design a better-fitting inhalation mask

process. The camera is portable and each photo takes less than a minute to complete. Using the accompanying software, the photos are easily archived and analyzed.

The software measures each child’s face by clicking on points of the face on the 3-D photo. The children measured were between the ages of zero to four years. Technion did a cluster analysis and divided the data into three different sizes: small, medium and large.

Using a mathematical process, each child’s photo of each cluster size was averaged, producing the three average sizes. These sizes were transferred to the design of the mask. With the patient in mind, Amirav punched a hole in the mask so a pacifier could fit in. This creates an insulation effect in the mask and helps soothe the child in between taking the medicine.

The masks have FDA and Health Canada approval and are being distributed here.

Amirav is happy to see his idea come to life. “We can now give the mask to the mother to use on the child. They come back to us and say, ‘My child takes the medication and sleeps well now, doesn’t cough, and is developing well,’” said Amirav. ~ SK

Dr. Israel Amirav is a pediatric respirologist and associate professor in the Division of Respiratory Medicine.


Administration

The Department of Pediatrics could not fulfill our education, research and clinical care mandates without the people we nurture and the processes we continually seek to improve. Our people include 267 faculty members and 216 support staff.

The Department of Pediatrics offers solid learning opportunities, great support for learners and world-class facilities. With all this going for it, medical education directors have no problem filling spaces in our programs. Over 100 applicants vie for just ten spots in the general pediatrics program, for example. So why would medical education administrators Cheryl Good and Erin Blazey challenge the education and communications teams to make any changes to something that already works?

“The program directors want to get the best candidates,” explains Good. “And Erin and I both have personalities where we’re always trying to improve things.” Part of the most recent improvement involved making the Canadian Resident Matching Service (CaRMS) process a memorable one for general pediatrics program applicants. The applicants travel from one university to another across Canada for sets of interviews where both applicants and program directors rank their top choices. It is an important opportunity for applicants to find out as much as possible about each program and have a positive experience to inform their choices.

The improvement to provide good information and a great experience began with a series of posters developed by the general pediatric education and communications teams to

Program PromotersKeeping pace with tech-savvy learners

showcase the outstanding program at education events, including the CaRMS interviews in 2014. The unique aspects and advantages of the program were identified and “branded” to present a consistent and professional message.

Inspired by the Department of Surgery, Good and Blazey took things to the next level by creating a website specifically for CaRMS applicants, incorporating the posters as part of the brand. “These are people raised in the digital age, so they are very tech-savvy,” says Blazey. Everything from information about the interview process and itinerary, program details, resident testimonials, teaching locations and hotels is included on the site to allow applicants to peruse at their own pace from wherever they are. The University of Alberta was the only pediatric program across Canada to have a website specifically for CaRMS applicants.

“The website has all of the information, and more, that we used to give them as an old-school emailed document,” says Good. “The response was overwhelming that they loved the site – and that they loved the whole interview day in Edmonton. They said it was the best, well-organized CaRMS interview that they had across Canada. So I think that we’re doing things right.” ~ JC


Sandra Kinash is communications assistant, Cheryl Good is medical education senior administrator, Judith Crystal is communications coordinator, Erin Blazey is a medical education program coordinator and Dr. Katie Doherty is an incoming general pediatrics resident.


Dr. Manjula Gowrishankar is a pediatric nephrologist and professor in the Division of Nephrology.

Education, research and patient care—these elements are at the very core of the Department of Pediatrics. And it is no accident that education always comes first; training new physicians is a primary focus. Now the department is leading the way with a new approach to faculty development: the Peer Consultation for Teaching Program.

“Teaching is central to everything faculty members do,” explains Dr. Manjula Gowrishankar, faculty development program director for both the department and the Faculty of Medicine & Dentistry (FoMD). “But how do we know if we’re doing a good job? How do we recognize a great teacher but also provide feedback to help our colleagues improve their teaching?”

Those are the questions that led Gowrishankar and Dr. Bruce Fisher, the FoMD associate dean of faculty development, to create the program. The goal is to provide faculty members with feedback on their bedside teaching through interaction with trained peer observers who have learned how to provide appropriate comments.

This type of program exists in some Canadian medical schools and is slightly more common in the U.S. To Gowrishankar’s knowledge, however, the Department of Pediatrics’ program is the first to attempt to eliminate bias

Developing TeachersPediatrics leads the way with a peer consultation for teaching program

by bringing in trained observers from other departments. It also incorporates face-to-face feedback rather than just workshops and online training. The program was developed and piloted within the Departments of Pediatrics, Internal Medicine and Family Medicine and is now available faculty-wide.

The program committee has secured research funding from the Royal College of Physicians and Surgeons of Canada to formally evaluate the program before extending it to apply to classroom teaching and resident training as well. In the meantime, feedback from participants has been very positive. “The peer review training was a comfortable, safe place to share our concerns about our teaching and feedback skills,” says Dr. Mia Lang, associate professor.

“I was able to receive some honest, thoughtful and constructive feedback on my teaching in the clinical setting,” adds Dr. Karen Forbes, another associate professor. “I was paired with a colleague from another department whose clinical context was quite similar to mine. This allowed us to share ideas that were meaningful and impactful to our respective learners. Not only did I learn by being observed, but also through being an observer.” ~ JH

The Big BangAn EMR transition improves processes for patients

Dr. Mark Belletrutti started early to prepare his colleagues for the Big Bang, when an electronic medical record (EMR) management system would go live, replacing multiple paper patient charts and processes. Implementation of eCLINICIAN would mean a change in how physicians and staff in the Department of Pediatrics practice and deliver care to patients at the Stollery Children’s Hospital outpatient clinics. It would also challenge the status quo.

In 2011, Alberta Health Services (AHS) was rolling out eCLINICIAN in various departments within the “adult world” and Belletrutti wanted the department to be next in line. The Big Bang would come after a pilot and full year of collaboration with AHS and support staff within the department to redefine workflows and re-examine roles and responsibilities.

“I got involved because I saw the potential for the EMR to really improve how we deliver care, how we manage our patients, how we interact with other specialties,” says Belletrutti. “It’s another way to improve communication and really consolidate information for the patient in one chart.”

Belletrutti worked with the department’s centralized support staff teams, led by Susan Sorochan and Melina Webber, to address the change by acknowledging the challenges and by sharing information in a timely manner to keep everyone involved abreast of the progress made and what was to come.

Both Sorochan and Webber point to the personal commitment from their teams in helping those in the department, and those at AHS, to work through the change process and maximize the potential of the EMR. “A couple

of our key people would drop what they were doing and go to where they were needed – sometimes that was going right into the clinic to see the EMR from another user’s perspective,” says Webber.

When the Big Bang finally came, the department was as prepared as possible. “We received very positive feedback from the AHS implementation team. They advised us that, of all the roll-outs they have done, we were way ahead of the game,” says Sorochan. “This was wonderful to hear as we worked very hard to ensure everyone was up to speed.”

Patients and their families have already benefited from implementation of eCLINICIAN. The transition of pediatric patients to adult care, formerly a cumbersome process that amalgamated paper charts, is now virtually seamless; information sharing has helped clarify and expedite delivery of test results and notes from other caregivers to physicians; and, patient wait times are managed more effectively. The change process continues, as physicians and staff optimize the EMR, see opportunities to standardize procedures and create new workflows, and look forward to helping each other improve processes for our patients. ~ JC

Dr. Mark Belletrutti is a pediatric hematologist and assistant professor in the Division of Immunology, Hematology, Oncology, Palliative Care and Environmental Health (iHOPE); Bobbi-Jo Squires is a divisional administrator; Raisa Ahmadi is the coordinator of central booking; Melina Webber is the clinical services supervisor;Susan Sorochan is the divisional administration supervisor; and Judy Cromar is a senior transcriptionist.


Dr. Dax Rumsey, from the Atlantic shores of Torbay, Newfoundland and Dr. Mercedes Chan, from the Pacific Coast of Vancouver, B.C. are meeting in the middle as the newest faculty members of the Division of Rheumatology. Their arrival has seen their division grow from one member to three. They are among the 16 faculty members hired in the Department of Pediatrics since July 2013.

The supportive environment drew Rumsey to our department. “We have a dedicated rheumatology nurse, work with physiotherapists and occupational therapists and have access to a first-rate musculoskeletal system radiologist,” he said.

Rumsey is also completing a master of science in clinical epidemiology at the University of Alberta’s School of Public Health. His thesis focuses on enthesitis-related arthritis, using data from a Canadian national database of patients with juvenile idiopathic arthritis (JIA). “Not a lot is known about what medications work best to treat enthesitis. Hopefully, the research will uncover that and how enthesitis affects the quality of life of these patients.”

With a master of health professions education, Chan will use her medical education training in teaching and developing educational programs, bringing her international experience with her. She has hiked mountains to provide care to children in remote areas of Thailand and Myanmar, has seen patients in rural

East Meets WestNew faculty members bring experience from opposite regions of Canada and beyond

Rwanda and instructed pediatric rheumatology education in the United Kingdom, Thailand and China. Through the Office of Global Health here, Chan has offered her perspective to medical students travelling overseas through pre-departure seminars. She has learned to be resourceful and open-minded to other cultures and different processes.

“In China, we did corrective surgeries for burn patients who had huge adhesions and needed rehabilitation. I remember the occupational therapists using bottles or cardboard for splints. We wouldn’t consider that mainstream, but it worked,” she said.

Rumsey and Chan are settling in Edmonton.

“My family is into our Catholic faith. We’ve already met people in this community,” Rumsey says. His family hopes to explore the Rocky Mountains, check out some Edmonton Eskimos football games, and see the Edmonton Oilers play hockey again. Chan has enjoyed discovering little coffee shops and bistros while walking. She plans to cross-country ski and explore the waters through kayaking or dragon boating.

Both miss the salt air of the ocean but Chan adds, “It helps that people here are welcoming and engaging.” ~ SK

Between July 2013 and the end of 2014, 16 faculty members have joined the Department of Pediatrics.

Dr. Melissa Chan, Division of Emergency Medicine

Dr. Mercedes Chan, Division of Rheumatology

Dr. Timothy Colen, Division of Cardiology

Dr. Jennifer Conway, Division of Cardiology

Dr. Andrea Estey, Division of Emergency Medicine

Dr. Jessica Foulds, Division of Hospital Medicine

Dr. Michael Hawkes, Division of Infectious Diseases

Carol Hodgson, PhD, J. Allan Gilbert Chair for Medical Education Research

Dr. Sarah McKillop, Division of Immunology, Hematology, Oncology, Palliative Care and Environmental Health (iHOPE)

Dr. Dax Rumsey, Division of Rhuematology

Dr. Hareishun Shanmuganathan, Division of Emergency Medicine

Dr. Jason Silverman, Division of Gastroenterology

Dr. Michael van Manen, Division of Neonatal-Perinatal Care

Dr. Andrea Wan, Division of Cardiology

Dr. Yarden Yanishevsky, Division of Immunology, Hematology, Oncology, Palliative Care and Environmental Health (iHOPE)

Dr. Liliane Zorzela, Division of Pediatric Critical Care

Drs. Mercedes Chan and Dax Rumsey are pediatric rheumatologists and assistant professors in the Division of Rheumatology.


Process improvement initiatives are taking place in many areas of the Department of Pediatrics. To point to just two examples, our finance unit is helping to put processes in place to document clinical contributions through Academic Alternative Relationship Plan (AARP) billings and the Division of Cardiology is striving to improve complex systems through transformative change initiative.

Improving for Excellence

Physicians in the Department of Pediatrics deliver clinical services, but are compensated differently than physicians in the community. AARP billings data is increasingly viewed as the key to providing our funder with information about clinical contributions and “value for money” in this area of service. The billings are also crucial to providing physicians with data to help improve delivery of care to patients and families.

In response to this increased focus on AARP billings data, the department’s finance team has stepped in to improve processes for everyone and deliver information that more accurately reflects the scope and volume of clinical service provided by faculty members. Finance Manager Cheryl Moneta explains the service-focused business model and improvements to the data collected. “We’ve got subject-matter expertise, leadership and project management to keep the infrastructure and the processes of billing moving forward,” she says, pointing to a strong team in the department. “The goal is to give the physicians a picture of their clinical activities.”

The change hasn’t been easy, as physicians adjust to the increased level of accountability and administration. Adding to the scenario are multiple external stakeholders and systems involved in the billings process. Medical Billings Supervisor Paola Altobelli is on the ground as the liaison in the department, increasing communication and helping to navigate through the complexity with colleagues. Now the department is starting to see results from more rigorous data collection efforts. “It empowers the physicians,” says Altobelli. “It allows them to look at their clinical activity and resource appropriately. The data will tell them if they need to adjust, increase resources, or change the way they do things.” ~ JC

Numbers Paint a Picture

Academic Alternative Relationship Plan

The provincial government funds many faculty members in the Department of Pediatrics through an Academic Alternative Relationship Plan (AARP).

Participation in the plan guarantees payment for physicians to devote time to teach and conduct research, in addition to being compensated for clinical services. A position with this unique funding arrangement is an attractive option for those who wish to pursue academic careers in the Department of Pediatrics at the University of Alberta.



PedsCREW

More than 120 professionals involved in the Congenital Heart Program (CHP) at the Stollery Children’s Hospital showed support for a 2014 retreat to kick off transformative change. Dr. Paul Kantor, director of the Division of Cardiology, leads the initiative with the help of University of Alberta’s Organizational Health and Effectiveness facilitator Alan Day and his team.

Despite an already excellent reputation for delivery of care, including a survival rate of 99 per cent, Kantor and his colleagues feel they can improve on this excellence. “The retreat was part of a strategic initiative for the congenital heart program,” he says. “Globally, the trend is for patient

care to be organized as team-based, rather than separate specialties. We want to function as a seamless program, not a group of silos.”

While still early in the process, the multi-department, multi-disciplinary effort has already seen results of a strong sense of readiness for transformational change, a shared understanding of five areas of focus, and the creation of more than seven action scenarios to assess for implementation. Kantor sums up the initiative by pointing out that, “With transformational change being a process, we are at a positive new beginning in reaching the goal of the Congenital Heart Program.” ~ JC

Raising the Bar with Transformative Change

such as “Applause Cards” for colleagues to recognize each other’s good work, social events like potlucks and holiday gatherings, and wellness workshops that are enjoyed by everyone in the department.

Our PedsCREW committee promotes recognition, engagement and wellness within the Department of Pediatrics. Membership on the committee is voluntary and the group has developed a number of initiatives


DEPARTMENT OF PEDIATRICSDr. Susan Gilmour, ChairMary Ellen Davison, Assistant Chair Administration Divisions

CARDIOLOGYDr. Joseph AtallahDr. James CoeDr. Timothy ColenDr. Jennifer ConwayDr. John DyckJason Dyck, PhDDr. Lisa HornbergerDr. Michal KantochDr. Paul KantorDr. Nee Khoo

Gary Lopaschuk, PhDDr. Andrew MackieDr. Mary Patricia MassicotteDr. Jennifer RutledgeRichard Schulz, PhDDr. Jeffery SmallhornDr. Edythe ThamDr. Simon UrschelDr. Andrea WanDr. Lori Jeanne West

CRITICAL CAREDr. Ian AdatiaDr. Vijay AnandDr. Natalie AntonDr. Dominic Cave Dr. Alf ConradiDr. Allan de CaenDr. Jonathan Duff

Dr. Gonzalo Garcia GuerraDr. Daniel GarrosDr. Paula HolinskiDr. Robin Ari JoffeDr. Laurance LequierDr. Lindsay RyersonDr. Liliane Zorzela

EMERGENCY MEDICINEDr. Robin Jo ArentDr. Melissa ChanDr. Eddie ChangDr. William CraigDr. Sarah CurtisDr. Andrew DixonDr. Mark EnarsonDr. Andrea EsteyDr. Lisa EveredLisa Hartling, PhDDr. Robyn HutchingsDr. Hsing JouDr. Manu Kundra

Dr. Tricia KutnikoffDr. Shona MacLachlanDr. Matthew MontgomeryDr. Maria OlivaDr. Amaly RahmanRhonda Rosychuk, PhDDr. William SevcikDr. Hareishun ShanmuganathanDr. Carrie SlatterDr. Daina ThomasDr. Troy TurnerDr. Bruce Wright

ENDOCRINOLOGY METABOLISMDr. Robert CouchDr. Rose GirgisDr. Andrea Haqq

Dr. Mary Jetha Dr. Elizabeth Rosolowsky

GASTROENTEROLOGY AND NUTRITIONDr. Matthew CarrollDr. Susan GilmourDr. Hien HuynhRichard Lehner, PhDDr. Rabin Persad

Dr. Jason SilvermanDr. Justine TurnerDr. Eytan WineDr. Jason YapDawei Zhang, PhD

GENERAL AND COMMUNITYDr. Faria Ajamian Dr. Kelly AndersonDr. Mohammad Bagher Ansarian Dr. Angela Antoniuk Dr. Georgeta ApostolGeoff Ball, PhD Dr. Cecilia Irene Baxter Dr. Lola Therese BaydalaDr. David Berry Dr. Charles Bester Dr. Mahesh Bhembari Dr. Edwin Bolster Dr. Michael Bowman Dr. Jagdeep Brar Dr. Irena Buka Dr. Isabelle Chapados Dr. Rehana Chatur Dr. Thea Chibuk Dr. Mark Davidson Dr. Indra Dhunnoo Dr. Lionel James Dibden Dr. Wai Doyle-Chan Dr. Julia Drager Dr. Heather Dreise Dr. Abdelbaset Elsawiniya Dr. Eileen Estrabillo Dr. Elsa Fiedrich Dr. Samy Galante

Dr. Evan Harris Dr. Michele Harvey-Blankenship Dr. Bonnieca Islam Dr. Alicja Janicka Dr. Christine Kyriakides Dr. Tehseen Ladha Dr. Mia LangDr. Scot Victor Lappa Dr. Kan Lee Dr. Jacqueline Ann Lee Dr. Heather Leonard Dr. Melanie Lewis Dr. Joan Lopatka Dr. Anna Malanowska Dr. Tami Lynn Masterson Dr. Donald William McConnell Dr. Breanne McCook Dr. Lyle McGonigle Dr. Kathleen Meier Dr. Athar Mian Dr. Fateh Mohammed Dr. Robert Moriartey Dr. Sadia NakhudaAmanda Newton, PhD Dr. Gus Ortega Dr. Viktoria Pankiv Dr. Jayprakash Patidar Dr. Patrick Pierse

Divisional DirectorAcademic MemberClinical Member

DERMATOLOGYDr. Loretta Fiorillo

DEVELOPMENTAL PEDIATRICSDr. Julia Ackland-SnowDr. Gail AndrewDr. John AndersenDr. Debra AndrewsDr. Diana AndriashekDr. Brenda ClarkDr. Angela CurrieDr. Cara Dosman

Dr. Keith GouldenDr. Matthew ProwseCarmen Rasmussen, PhDDr. Charlene RobertsonDr. Lyn SonnenbergDr. Man-Joe WattDr. Lonnie Zwaigenbaum

Divisional Members*

Partners

The Department of Pediatrics works closely with many local and national organizations to foster the very best environment for learning, research and clinical care.

Women and Children’s Health Research Institute (WCHRI)Stollery Children’s Hospital FoundationAlberta Health Services (AHS)

The department also supports and partners with several other departments within the University of Alberta.

Child & Adolescent PsychiatryPediatric AnesthesiologyPediatric Medical GeneticsPediatric PathologyPediatric RadiologyPediatric Surgery

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HOSPITAL MEDICINEDr. Karen ForbesDr. Jessica FouldsDr. Dawn Hartfield

Dr. Jennifer WaltonDr. Sunita Vohra

Dr. Darlene Pon Dr. Edward Rabinovitch Dr. Djordie Radisic Dr. Hasmukhlal Rugnath Rajani Dr. Munira Ramji Dr. David Roseman Dr. Neel Saini Dr. Raphael Sharon Dr. Lois Sim

Dr. Kelly Ann Stevens Dr. Geeta Sukhrani Dr. Waldemar Szymanski Dr. Johnny Teoh Dr. Alena Tse-Chang Dr. Kellie Waters Dr. James Leigh Wincott Dr. Sam Wong Dr. Mona Zhang

IMMUNOLOGY, HEMATOLOGY, ONCOLOGY, PALLIATIVE CARE, ENVIRONMENTAL HEALTH (iHOPE)Shairaz Baksh, PhD Dr. Mark BelletruttiDr. Aisha BruceDr. Stuart CarrDr. Dawn DaviesDr. Sunil DesaiDr. David EisenstatDr. Paul GrundyDr. Per Lidman

Dr. Sarah McKillopLesley Mitchell, M.Sc.Dr. Alvaro Osornio-VargasSujata Persad, PhDDr. Maria SpavorDr. Kent StobartDr. Timothy Vander LeekDr. Beverly WilsonDr. Yarden Yanishevsky

NEPHROLOGYDr. Abdul AlabbasTodd Alexander, PhDDr. Manjula Gowrishankar

Dr. Catherine MorganDr. Maury Pinsk

INFECTIOUS DISEASESDr. Sarah ForgieDr. Michael HawkesDr. Bonita Lee

Dr. Joan RobinsonDr. Wendy Vaudry

NEUROLOGYDr. Francois BolducDr. Helly GoezDr. Janani KassiriDr. Hanna KolskiDr. Francois Morneau-Jacob

Dr. John NeilsonDr. Lawrence RicherDr. David SinclairDr. Richard Tang-WaiDr. Jerome Yager

NEONATAL – PERINATAL CAREDr. Marcia AntunesDr. Khalid AzizDr. Paul ByrneDr. Po-Yin CheungDr. Santiago EnsenatDr. Sandra EscoredoDr. Chloe JoyntDr. Manoj KumarDr. Vazhkudai KumaranDr. Marc-Antoine LandryDr. Robert Lemke

Dr. Abraham PeliowskiDr. Ernest PhilliposDr. Mosarrat QureshiDr. Amber ReichertDr. Georg SchmolzerDr. Mehaboob ShaikDr. Jonathan StevensDr. Jennifer ToyeDr. Juzer TyebkhanDr. Michael van Manen

RESPIRATORY MEDICINEDr. Israel AmiravDr. Alison CarolDr. Maria Castro CodesalDr. Tamizan KheraniAnita Kozyrskyj, PhD

Joanna MacLean, PhDDr. Carina MajaesicDr. Piush MandhaneDr. Peter Zuberbuhler

RHEUMATOLOGY Dr. Mercedes ChanDr. Janet Ellsworth

Dr. Dax Rumsey

* as of 05-14-2015

ADJUNCTDr. Darryl AdamkoDr. Stephen BamforthMary BaumanRobyn BlackadarDr. Cecilia BukutuOana CaluseriuDr. Alicia ChanDr. Bruce DickDr. Hamdy El-HakimDr. Larry FliegelDr. Dawna GilchristDr. Gary HnatkoDr. Shailly Jain-GhaiDr. Terry Klassen

Bodil LarsenDr. Norma LeonardDiana MagerDr. Marek MichalakDr. David NicholasVincent RasoGwendolyn RempelDr. Consolato SergiDr. Martin SomervilleDr. Oksana SuchowerskyDr. Bernard ThebaudDr. Kathryn ToddDr. Paul Wales

Department of Pediatrics, University of AlbertaEdmonton Clinic Health Academy (ECHA)11405-87 Avenue Edmonton, AB T6G 1C9

www.pediatrics.ualberta.ca [email protected]

department of pediatrics annual report - 2014

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