University of Alberta Department of Pediatrics by University of Alberta, Department of Pediatrics

WORKING WONDERS Department of Pediatrics 2016-2017 Year in Review

Our Vision To be leaders internationally by improving the health of children, their families and communities.

Our Mission To delivery 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

Cover photo: Dr. Catherine Morgan engages with Levi Noble at the Stollery Children's Hospital Contributors: Caitlin Crawshaw, Judith Chrystal, Ali Dotinga, Jennifer Lavallee, Ross Neitz, Dave Von Bieker Photos: Erin Boschee, Richard Siemens, Sam Wong Design: Plumbheavy Design Co.

Features

Amazing Race for Health Advocacy

Peer to Peer

A Path Through Pediatrics

Northern Exposure

Big Data Helps Small Patients

Good to Go

Life Lessons

Specialized Supporter

Crucial Conversations

Legacy of Hope

An Apple a Day

The Long Game

Inside 4

Message from the Chair

Department-at-a-Glance

Faculty Awards

Appetite for Answers

Outside In

External Awards

Significant Grants

Department Members

Partners 3

If I have seen further than others, it is by standing on the shoulders of giants. Isaac Newton

Message from the Chair

Department of Pediatrics, University of Alberta

We are realizing the vision of those who came before us The 2016-2017 academic year was the 60th anniversary of the Department of Pediatrics, our diamond year celebration. Diamonds are a symbol of endurance and strength. Sixty years as a growing and thriving department is a testament to our collaborative strength, perseverance and vision. Milestones and moments, such as a diamond year, also provide us an opportunity to reflect on where we have come from and what our vision for the future is. During this past year we have celebrated many accomplishments in research, teaching and clinical care. But what we have achieved is based on the strong pediatric foundation built by the early pioneers of the department. Our regional and national leadership in simulation education, social pediatrics and PedsCases podcasts could not have occurred without the work of faculty members who came before us. This includes people such as the very first pediatrician and pediatric divisional director, Dr. Douglas Leitch, who personally wrote the undergraduate curriculum, taught the lectures, ran the clinics and did the ward teaching! Dr. William Taylor, also a “giant,” was one of the first national leaders and early adopters of problem-based learning. Department members receive over $25 million in peer-reviewed research funding annually. Our scope spans discovery science to translational and clinical research. Advances in understanding influences of the cognitive outcomes of neonates and children, or research to ensure that our pediatric patients are successful adult patients, is made possible because of previous department members like Dr. Ernie McCoy (department chair 1971-1984). Dr. McCoy was the Markle Scholar in Medical Science who brought research awards to the university and department from the US Public Health Services. Under Dr. McCoy’s leadership, the department’s research flourished throughout the 1970s. Reviewing the history of the department, it is humbling to read about the phenomenal dedication, commitment and hard work of our early members. We’ve grown from a department of two faculty members in 1956, to a department of 250 academics and clinical colleagues—a place of diversity in teams and dedication to excellence in teaching, research and clinical care. Working together, we have realized the vision of those who came before to improve the lives of children and youth. Our department was built, and continues to grow, supported by important partnerships with the University of Alberta, Alberta Health Services, and the Stollery Children’s Hospital Foundation and the Women and Children’s Health Research Institute. After 60 years, the Department of Pediatrics at the University of Alberta is a leader in higher education and research. Our departmental faculty of 1956-1957 would be proud to read this review. We dedicate this to all who, over the last 60 years, have contributed in every way to achieve the founding vision.

Dr. Susan M. Gilmour Chair, Department of Pediatrics University of Alberta Stollery Children’s Hospital

Clinical Affairs Dr. Carina Majaesic

Associate Chair, Clinical Affairs Purpose Advocate for all pediatric physicians in their clinical practices at the Stollery Childrenâ&#x20AC;&#x2122;s Hospital and all affiliated sites Promote all clinical activities that support the research and education mandates of the department Support department members who take on roles in clinical administration Liaise with hospital administration to ensure physician input in all matters related to the delivery of pediatric patient care Support the integration of and communication with community based physicians into the department Current Initiatives Clinical Support Services Steering Committee established to enhance clinical support services Transformational change project to improve the relationship between our clinical partners and medical colleagues for the benefit of patients Quality improvement project to reduce the number of unused clinic spots

Medical Education Dr. Jennifer Walton

Associate Chair, Medical Education Purpose Provide leadership and guidance to pediatric faculty members Set priorities for medical education activities within the department Foster and promote medical education both within the department and with stakeholders and partners within the Faculty of Medicine & Dentistry, University, public and health authorities Work to integrate and promote medical education with clinical practice, research and advancement of knowledge translation to support improvement in health care Current initiatives Clinical teaching unit restructure to implement external review recommendations Supporting core educational activities in the department Developing a community of practice of educators to support and foster scholarship in education Implementing the Royal College of Physicians & Surgeonsâ&#x20AC;&#x2122; competency by design framework into residency programs Preparing for residency program accreditation in 2017

Department of Pediatrics, University of Alberta

Research Dr. Gary Lopaschuk

Associate Chair, Research Purpose To foster and promote research excellence in the department To facilitate research initiatives that affect researchers at various levels To support the development of researchers within the department To support the implementation of research within the department Current initiatives Recruitment for research intensive faculty members Develop a system in which all pediatric patients have the opportunity to participate in research Fully operationalize our Pediatric Clinical Investigation Unit and integrate these operations with the Northern Alberta Clinical Trials + Research Centre Provide support to facilitate departmental members leading major national and international research projects Increase graduate student program to 60+ students

Faculty Development Dr. Manjula Gowrishankar

Associate Chair, Faculty Development Purpose Provide leadership and guidance to pediatric faculty members to attain their career goals in a timely manner Develop & implement programs to enhance the ability of faculty members to succeed at all stages of their academic careers Current initiatives Advocacy Wellness Resource Committee Lunch and learn workshops for divisional leadership Junior faculty development workshop series Mentorship program

Real world experiences help new doctors understand the complex social determinants of health for families

ears ago, Dr. Mia Lang referred a young patient to a specialist and was frustrated when the sick child’s family missed the appointment. She called them afterward and was shocked by the explanation: “The appointment was on the only day they could get to the food bank.” Lang, a clinician and UAlberta associate professor of pediatrics, realized she’d let herself judge the family before taking time to understand their circumstances. “To me, that was a powerful lesson,” she says. As a committed health advocate — a physician who takes the time to understand and dismantle their patients’ barriers to health — Lang was reminded that even well-intentioned doctors can lapse into judgmental thinking. Lang subsequently became the director of the pediatric residency program, and her role involved educating new doctors about the social determinants of health (such as family income, support networks, education, and culture). “I was very much aware that both residents and my own colleagues lacked an understanding about the vulnerabilities many of our patients experience,” she says. But the PowerPoint presentations and lectures offered to residents were not likely to help much. One day, while watching the The Amazing Race — a reality television show based on a worldwide scavenger hunt — Lang had an idea. Instead of classroom-based learning, she’d break groups of new residents into teams and send them out to tackle challenges in the community. ‘The Amazing Race for Health Advocacy’ takes place every second July and divides residents into five or six teams, each with a different challenge. Recently, a group was asked to take the bus to and from the foodbank and transport the food back with old suitcases and a stroller. Another team was asked to buy everything on a lengthy grocery list — including expensive vitamin D drops for children — with just $20. “Until you experience that unique embarrassment of having to take an item out of your cart, you don’t understand what it’s like to live within a modest budget,” she says. Just like the television show, two groups each session encounter unexpected roadblocks, such as parking tickets that must be dealt with at the campus parking office, or a confusing child tax benefit form to fill out. At the end of the activity, residents debrief and share what they’ve learned with one another. “By the end of it, the residents haven’t walked a mile in anyone’s shoes by any means, but maybe they’ve taken a small step,” says Lang. Feedback from both participants and community partners — like the Edmonton Food Bank, Boyle Street Community Services, and Youth Empowerment and Support Services — has been overwhelmingly positive, year over year. Lang’s peers have also lauded her efforts and, in 2016, she earned the Patil Teaching Innovation Award from the Association for Medical Education (an international H E organization). Lang says physicians around the world are starting to understand the importance of social determinants to patient outcomes: “Until we understand our patients’ circumstances, there’s a limit to how effective our treatments will be.” -CC

Department of Pediatrics, University of Alberta

T H A L

Y C A C DVO

mazing Race for Health Advocacy

Dr. Nick Giffin, Dr. Sarah Johnson and Dr. Chris Novak (l-r) have all participated in Dr. Mia Langâ&#x20AC;&#x2122;s residency program learning challenge. Lang is now associate dean of faculty development for the Faculty of Medicine & Dentistry.

Peer to Peer Student podcast helps learners around the globe

hat started as a student project in the Department of Pediatrics has proven to be an invaluable educational tool around the world. In 2008, UAlberta medical students Peter Gill and Lauren Kitney approached faculty members about the idea of developing easy-to-access learning materials to help supplement core pediatric content in the undergraduate curriculum. The project evolved into PedsCases, an educational website comprised of a variety of tools including podcasts, complimentary videos, quizzes and case studies for learners and educators alike. There are now over 100 podcast episodes, available for free on iTunes, that reached one million downloads in September 2016 and have been viewed in nearly every country in the world. Student projects rarely reach these kinds of milestones, and when Gill and Kitney first brought the idea to Dr. Melanie Lewis – then the pediatric clerkship director - she admits she was concerned about its longevity. “The issue with these endeavours that start as a student’s vision is that they’re often difficult to maintain momentum once those students are gone,” explains Lewis. “We were lucky to have Peter at the helm because he is a man who is committed, who had an incredible vision for PedsCases.” Faculty members Lewis and Dr. Karen Forbes, the current pediatric clerkship director, provide sustainability for the project. They coordinate and orchestrate day-to-day moving pieces and ensure the content aligns with the Canadian Undergraduate

Department of Pediatrics, University of Alberta

Curriculum in Paediatrics, but the students run everything else from recording to sound editing and publishing. They also recruit two new members each year, the key to ensuring the project endures as students graduate. “It’s been incredible, because this system made us able to build a team that spans from first-year students all the way through to residents, and members that have moved on both here and elsewhere,” says Forbes. PedsCases alumni also continue to advocate for the project in other cities, resulting in new interest from students far away. “There are also a number of students from other universities who not only view the podcasts but now contribute to them, which is unexpected and very exciting,” says Forbes. “I’ve had several students from the United States contact me, asking me if they can participate. So from its little grassroots beginning, Pedscases has become much larger than we had imagined.” Drs. Gill and Kitney, now MDs, have since gone on to residencies at the Hospital for Sick Children at the University of Toronto and elsewhere, and Gill continues to be a very active team member - a fact that reflects PedsCases core values. “I think the way the team has grown ensures that there is background leadership, but also there’s a whole group of other students who are contributing integrally,” says Lewis. “We’ve maintained the initial vision that PedsCases has always had – it’s about peers helping peers.” -AD

View PedsCases episodes on YouTube. For more information about PedsCases, or to get involved, visit their website at www.pedscases.com.

219,172 Canada

83,131

25,404

United Kingdom

Ireland

15,087

United Arab Emirates

653,517

United States

133,442

13,689

Saudi Arabia

10,798

11,870

Australia

India

Other Regions

12,963

New Zealand

PODCAST DOWNLOADS PER COUNTRY

Approx 2/3 of podcast viewers are between 18-34, suggesting the site is primarily used by medical students and residents.

1.3 MILLION

PedsCases downloads as of April 11, 2017

100th podcast posted on April 7, 2017

Bonjour First French language podcast posted March 13, 2017

The current team involved with PedsCases podcasts includes Ms. Amarjot Padda, Ms. Larissa Shapka, Dr. Melanie Lewis, Dr. Karen Forbes, and Ms. Nikita-Kiran Singh (l-r) 11

A Path through Pediatrics D

r. Jill (Avis) Byrne completed her PhD in the Department of Pediatrics in 2016. “Most people interpret that as, ‘So, you’re a pediatrician?’” says Byrne, who is a clinical researcher with expertise in childhood obesity prevention and not a medical doctor. “I’ve always been interested in children and health, that’s why the researchers at UAlberta really stood out to me,” notes Byrne, who credits the department for encouraging students with diverse backgrounds to enter the graduate program. “It’s quite wonderful because you get this multi-disciplinary lens to research and not just one that is a purely medical approach,” explains Byrne, who is now the director of clinical research for the Faculty of Medicine & Dentistry. Byrne has a background in psychology and began a master’s degree in the Department of Pediatrics in 2012, researching childhood obesity under the supervision of Dr. Geoff Ball. Before she completed her degree, Byrne transferred into the PhD program. “The thing I love most about the department, and what I will always appreciate, is the warm learning environment. There was no question that I felt couldn’t be asked,” she says. Byrne says she learned invaluable skills that allowed her to gain a newfound sense of confidence. “It was in this department that I developed and finessed my communication abilities so that I was able to clearly and concisely connect with researchers, stakeholders, patients – and even the public.” The once-shy student says she used to be intimidated to participate in seminars and meetings; however, with the support of those in the department, she was encouraged to become an active participant in her learning career. “I attribute a lot of this to my supervisor, Dr. Ball, who encouraged me to leverage every opportunity to present and talk about my research - even when it made me feel uncomfortable,” she remarks. Byrne learned how to speak with ease in front of people and began to reach her stride in the art of conducting research. It was here she gained a deep understanding of the nuts and bolts of how the process works. Through the course of her research, Byrne recruited nearly 300 participants. “Recruitment isn’t easy,” she stresses, “and the last thing I wanted to do was come across as a cold, scientific robot.” The Department of Pediatrics helped Byrne discover how to show empathy for her participants while demonstrating herself as a credible researcher. After Byrne graduated, she says she felt well-prepared to tackle the leadership position she is working in now. Today, her goal is to provide navigational support to researchers so they can get their own studies up and running. Though she is no longer working directly in the Department of Pediatrics, Byrne believes this is where her career truly began and where a solid foundation of experience prepared her for new challenges. “I learned so many skills there, I wouldn’t trade my journey for anything.” -JL

Department of Pediatrics, University of Alberta

Dr. Jillian Byrne is embarking on a career after completing her PhD with supervisor Dr. Geoff Ball

A student with a non-medical background navigates through graduate studies to a career

Northern Exposure D

r. Sam Wong finds the challenges of pediatric practice in Yellowknife rewarding. “I’m the neonatologist, I’m the intensivist, I’m the endocrinologist, I’m the cardiologist until they actually arrive and do clinics,” says Wong, about the unique variety of rural pediatrics. “In one day you’ll have a GI patient, you’ll have a cardiology consult, and you’ll have behavioural issues that you have to deal with.” Dr. Erin Boschee began her Yellowknife third-year residency rotation with Wong in March of 2017. She agrees it has been valuable to have the chance to experience and understand the triaging and managerial skills that are necessary in a northern rural pediatric practice. Wong began his own Yellowknife rotation during his 1999 UAlberta general pediatrics residency. He remains drawn to rural communities, and Indigenous communities in particular. “The practice I have is part based in Edmonton, part based in Yellowknife. I work with three different distinct First Nations and Inuit populations of the Denè and the Cree in Northern Alberta and the Inuit in Nunavut … and I see patients on occasion from the Metis population in Northern Alberta.” Rural populations bring Wong face-to-face with social issues like poverty, obesity and access to care, especially for mental health. “Access to care is really hard,” says Wong. “If you live in a community that has no drive-in access, like the majority of the communities in Nunavut, you’re not going to have access to mental

health.” It is hard to face such issues and not take on an advocacy role at some level, Wong explains. “When you work up North,” says Wong, “every patient has some issue that you’re dealing with. It’s not well-baby checkups and well-child checkups. There are a lot of social determinants of health that are problematic up there including overcrowding of houses and poor access to food.” Rural patients inspire Boschee. “Seeing the patient journey to access medical care firsthand has given me a great appreciation for the strength and resiliency of many northern families,” she says. That journey requires frequent travel across long distances, isolation from their homes and cultural communities, and limited access to allied health resources. While there are unique challenges, Wong does not see his work in rural practice as involving personal sacrifice when compared to an urban setting. Far from isolating, he finds Yellowknife socially and culturally vibrant. Wong has formed strong connections with those he serves, having discovered “the sense that you’re with these people and you take care of them, that you’re part of the community.” Wong and his team now facilitate six residency rotations per year in Yellowknife. Each resident brings challenges and a teaching workload, but Wong insists, “We like having residents there because I think we really enjoy what we do, and if we can convince more people that this is a great career choice, then that’s good for all of us.” -DVB

Our residency program provides a unique experience in rural medicine

View from Old Town, Yellowknife, Northwest Territories

Department of Pediatrics, University of Alberta

Northern and Rural Residency Rotations Taloyoak, Nunavut

Yellowknife, NWT

Dr. Sam Wong introduces residents, like Dr. Erin Boschee, to a medical career in the North

High Level, AB Slave Lake, AB Saddle Lake, AB Red Deer, AB

Cold Lake, AB Mascwacis,AB AB Mascwacis,

Big Data helps Small Patients C

anada has one of the world’s highest incidences of inflammatory bowel disease (IBD), an umbrella term for a cluster of diseases that damage the digestive tract (including ulcerative colitis and Crohn’s disease). About one-quarter of patients are diagnosed as children, and are at risk of long-term serious complications because of their age. “Chronic inflammation can have a major impact on growth and development, as well as pubertal status,” explains pediatric gastroenterologist Dr. Matthew Carroll, a lead physician in the Edmonton Pediatric IBD Clinic (EPIC), where many of the province’s patients are treated. Before the disease was recognized by doctors, children would suffer from stunted growth and delayed puberty. “People have a window of opportunity for growth and development,” he explains. “Once you reach a certain age, that window starts to close.” Early intervention is needed for children to maintain normal development and avoid medical complications down the road. However, the drug therapies needed to get a patient’s inflammation under control also carry risks of long-term side effects. “Decisions we make for an 11-year-old patient now can have massive impacts when they’re 30 or 50 or 80,” says Carroll. It’s crucial that doctors make medical decisions with as much information as possible. Since joining EPIC five years ago, Carroll has been on a mission to improve patient treatment using data — both upto-date medical research and detailed information about patients. Carroll has led efforts to incorporate the newest IBD research into the clinic’s treatment protocols and closely monitor the health of clinic patients using eCLINICIAN (an electronic medical record) and a comprehensive patient registry with quality assurance-based key outcome indicators. Collecting detailed patient data helps physicians keep tabs on how individuals are responding to treatments, allowing for earlier intervention in the event of a problem. Detailed record keeping also helps the team spot trends across the clinic’s nearly 400 patients (who hail from across Western Canada and the North) and conduct research in-house.

Department of Pediatrics, University of Alberta

Recently, Carroll developed a new, faster protocol for administering infliximab, a medication given intravenously to about one-quarter of the clinic’s patients. The new method shortened the infusion time from four hours to just one hour for eligible patients. Detailed records allowed the clinic to monitor how patients responded to the new protocol and the clinic used surveys to gauge the satisfaction of families, who were overwhelmingly pleased by the change. “Of more than 100 patients, only one didn’t switch over in the long run,” he says. The new protocol has saved the health service precious resources, too. It was once the case that patients would line up in the clinic for their IVs, spend four hours hooked up to machines, and then another hour being monitored for potential reactions - all of which required ongoing care from nursing staff. Now that the process is quicker, staff have more time to deal with other activities at the clinic. Carroll and his team also use eCLINICIAN’s real-time quality metrics to alert them to signs that a patient’s health might be declining. Regular quality care outcome reports and linkage with other health-care informatics systems allow monitoring of the medical care patients receive inside and outside of the clinic. As a result, the clinic can intervene at the earliest sign of a medical complication or departure from planned care goals. Good data collection and analysis is fundamental for the clinic’s internal quality control. “The only way you know if you’re meeting your goals and outcomes is if you measure them,” says Carroll. Over time, this amounts to big gains for the clinic’s small patients: “We want these kids to get the best possible treatment they can and to live long, happy, normal lives.”-CC

The IBD clinic uses information to adjust treatment, save time and improve long-term outcomes Dr. Matthew Carroll talks to young patient Cael Lambert about medical mattersâ&#x20AC;Ś and hockey

Children born in Canada face higher risks of developing an inflammatory bowel disease (IBD) than anywhere else in the world, according to a massive 10year study that revealed rising rates among children under 16 years old. The Department of Pediatricsâ&#x20AC;&#x2122; Dr. Matthew Carroll, at the Edmonton Pediatric IBD Clinic (EPIC), is the Alberta lead on the national study, published in 2017. (Trends in Epidemiology of Pediatric Inflammatory Bowel Disease in Canada: Distributed Network Analysis of Multiple Population-Based Provincial Health Administrative Databases, American Journal of Gastroenterology.)

On-site, multidisciplinary simulation helps rural hospitals prepare for critically ill kids

Dr. Melissa Chan (centre), assistant program director for the general pediatrics residency program, is joined by multidisciplinary team members Mr. Domhnall Oâ&#x20AC;&#x2122;Dochartaigh, Dr. Lorissa Mews, Dr. Warren Ma, Mr. Stephen Miazga and Ms. Kristin Simard

Department of Pediatrics, University of Alberta

FORT SASKACHEWAN COMMUNITY HOSPITAL

STURGEON COMMUNITY HOSPITAL

NORTH EAST HEALTH CENTRE

WESTVIEW HEALTH CENTRE

MISERICORDIA HOSPITAL

DEVON GENERAL HOSPITAL

LEDUC COMMUNITY HOSPITAL

STRATHCONA COMMUNITY HOSPITAL

GREY NUNS HOSPITAL

On-site simulation training was piloted at these locations and is offered annually to pediatricians and family physicians at our Pediatric Update outreach conference.

Good to Go

t the Leduc Community Hospital emergency department, it’s rare for staff to encounter acute medical emergencies involving children.

“In a month, we might see one critically-ill kid,” says Karen Muncaster, a nurse and clinical educator at the rural hospital southwest of Edmonton. As a result, staff rarely encounter “pediatric codes” — medical emergencies in which staff must resuscitate a child in cardiac or respiratory arrest. On these occasions, staff are under intense pressure to recall protocols and locate equipment or drugs they seldom use. This is a common story, says pediatric emergency physician Dr. Melissa Chan: “Adults experience medical emergencies — like heart attacks or car accidents, for example — far more often than children do.” In addition, many physicians and nurses may feel heightened anxiety treating young patients. Knowing that more education would likely ease the pressure on emergency department staff, Chan and Dr. Warren Ma, Alberta Health Services deputy zone clinical department head, worked together with a team to create an educational simulation to help ER staff who rarely treat kids. “We wanted to make a safe learning environment in a multidisciplinary setting,” says Chan. Launched in 2016, and piloted in nine of 12 hospitals in the Edmonton zone, the simulation involves a fictional medical scenario and a pretend patient (a high-tech mannequin). Staff must work together to provide life-saving care, as they would in a real-life emergency. While some team members are initially apprehensive — “It puts people on the spot more than they’re used to,” says Chan — feedback has been overwhelmingly positive and the site-based simulation is now a permanent offering. In addition to allowing staff to practice skills, and learn new ones, the simulation experience helps emergency departments ensure they have the resources they need to treat kids — and within easy reach. This was one of the takeaways for Muncaster after the simulation was conducted at her hospital this spring. Her team discovered that the hospital lacked some supplies — like blood pressure equipment adapted specifically for pediatrics — or couldn’t immediately find them. “You don’t always know what you have or don’t have until you look for it,” she says. Staff also learned that they lacked certain resource materials, like a copy of pediatric algorithms for life support and drug dose references. Debriefing after the simulation exercise allows staff to learn about new tools and strategies from UAlberta experts, says Muncaster: “The staff have really embraced the knowledge they’ve learned and found the experience to be a very positive thing.” -CC

Life Lessons A

dolescence is a time of transition to adulthood. For kids with a chronic health condition, this includes moving from a child and family-focused health care system to being more independent in an individualfocused adult system. Pediatric cardiologist Dr. Andrew Mackie was surprised by the number of adolescents and young adults with congenital heart disease (CHD) “lost to follow up”, not attending a cardiology clinic for five or even 10 years, after spending much of their childhood engaged with specialized health care teams in the pediatric world. Even more disturbing was his experience with older teens that ended up in emergency rooms with very serious complications that may have been avoided if they had proper follow up care. “We work so hard as cardiologists, cardiac surgeons, nurses and other allied health providers looking after these kids in early childhood,” explains Mackie. “So to then lose contact with them at 18-19 years of age is unfortunate. After all we’ve invested in them, we can’t simply drop the ball 18 years later.” Inspired to make a difference, Mackie embarked on a path to improve the way the CHD clinic teams prepare teens to successfully transition to adult care. The key for success in the adult world, it seemed, was for teens to have enough knowledge about their health condition and the skills to self-manage, including being able to communicate confidently with physicians and nurses.

Teens gain knowledge, confidence and communication skills to navigate in the adult health care system

Mackie knew that any change they implemented in the clinic needed to be evidence-based. “There were no peer-reviewed publications in the literature in 2008, when I first began to look, on transition to adult care for those with CHD,” says Mackie. “There were programs, and publications that described what the programs do, but there was no data, no results to demonstrate efficacy.” Advances in care since the 1980s have meant increasing numbers of survivors of childhood disease are now reaching adulthood and, in the last five years, the body of research is expanding exponentially to address the new challenges this presents. Research coordinator Ms. Kathryn Rankin, Dr. Andrew Mackie and nurse practitioner Ms. Jody Gingrich meet up in the Mazankowski Alberta Heart Institute 20

Department of Pediatrics, University of Alberta

Mackie and his team have added to research in adolescent transition. His sequential series of research studies that began in 2009 are entitled CHAPTER (Congenital Heart Adolescents Participating in Transition Evaluation Research) along with a “prologue” study that began by focusing on the risk factors of youth in Quebec lost to clinical follow up. CHAPTER studies I, II, III and IV are in various stages of publication, enrollment and funding requests with each building on the results of the previous study. The results provided the evidence needed for Mackie to develop a formal transition program and hire a nurse educator for the CHD clinic at the Stollery Children’s Hospital. Jody Gingrich now meets one-on-one with 16-17 year olds to provide the information and tools these teens need to begin to manage their own health. The one-hour, one-on-one session covers the new expectations for managing their health care as an adult, as well as information about their condition, interventions the teen received as a child, their specific heart anatomy, what their “normal” test results should be, and late complications they should watch for as they get older. Next up is a “sex, drugs and rock & roll” conversation that covers risk factors specific to those with CHD. Mackie has learned a lot through his research and transition program implementation in the CHD clinic. It turns out that most of his findings are directly translatable to other conditions. He was surprised when asked to give a lecture on adolescent transition to pediatric oncologists at Memorial Sloan Kettering Cancer Institute in New York. When he reviewed the literature for oncology, he found amazing similarities. “You could literally take the same papers and just change the name of the chronic condition,” he says. “It was a learning experience for me.”-JC

Tech and Teens care Not surprisingly, health ts cen les interventions for ado ns are Tee gy. olo hn involve using tec ices, dev bile mo ir the t hou rarely wit ts por and Mackie’s research sup video the use of texting, email, se young the et me to and websites Videos ”. are y the e her “w patients II study, R TE developed for the CHAP for rs rte sta used as conversation od -go -so not and d discussing goo en we bet ns ctio era int of examples will , ers vid teens and healthcare pro et ern Int the on be freely available . once the study is published

Dr. Sarah McKillop, centre, embraces young cancer survivors Heidi Peters (l) and Rickie-Lee Hildebrand (r) at the Cross Cancer Institute

Specialized Supporter D

r. Sarah McKillop is a pediatric, adolescent and young adult oncologist who works on both sides of the street in child and adult care models. She was recruited to the department in 2013, and provides pediatric hematology/oncology care at the Stollery Children’s Hospital and adolescent and young adult (AYA) oncology care at the Cross Cancer Institute. As one of only a handful of such specialists in Canada, McKillop’s position is unique and her roles are varied. Unlike children with chronic diseases, where adolescents transition over time to adult care, patients who survive childhood cancer more abruptly enter the adult health care system if their cancer relapses after the age of 17. These young adults attend McKillop’s AYA clinic to help them transition and to understand what the adult system looks like so they don’t “get lost” in the new world. Oncology care at the Stollery is broad-based, and child and family-focused, with many integrated supports. The Cross model assumes a higher independence level for adult patients and divides them into tumour-specific groupings with a dedicated care team for each.

Department of Pediatrics, University of Alberta

McKillop is the AYA oncologist for the sarcoma tumour group at the Cross, taking responsibility for clinical care of AYA’s with a new diagnosis of sarcoma. She also provides AYA consults to patients with other diagnoses to assist with aspects of their cancer journey, such as fertility or challenges with adherence to therapy that are often approached differently for younger age groups. “I’m trying to create supports for the young adult’s normal development so that the cancer experience is not as challenging as perhaps it can be,” McKillop says, as she talks about her work, and the work of others in the growing field of AYA medicine.

A physician with a unique role helps adolescents and young adults with cancer

Department member Paul Grundy is chair of the Adolescent and Young Adult National Network and Expert Lead of Pediatric, AYA Oncology at the Canadian Partnership Against Cancer. Sarah McKillop contributes to leadership with the organization’s working groups. The partnership recently released Adolescents & Young Adults with Cancer: A System Performance Report, available at www.partnershipagainstcancer.ca. McKillop has also contributed to guidelines published in Adolescent and young adult cancer: principles of care in Current Oncology, A Canadian Cancer Research Journal.

Dr. Farooz Iqbal from family medicine (with stethoscope) joins pediatric colleagues Dr. Abobo Moses, Dr. Janet Ellsworth, Dr. Mercedes Chan, and Dr. Dax Rumsey (l-r) for rounds in the atrium in Edmonton Clinic Health Academy

New rheumatology transition rounds open dialogue

The psychosocial aspects of care are especially important for the approximately three per cent of young adults with cancer in Canada, who are in the midst of important developmental milestones in their lives. “If you put an 18 or 20 year old in a cancer clinic where everybody else is 50, 60 or 70 years old, how do they get support for school, or all of the life changes that are happening in their world at that age?” she asks. “Young adults tell us it is very isolating.” McKillop has advocated to establish an AYA patient navigator position at the Cross and received a grant in 2016 to pilot this resource for young adults who may feel overwhelmed or need help communicating with physicians and other care providers. The navigator will help guide patients, be a liaison with health care providers, and create an informal community where possible. McKillop’s advocacy work extends nationally as she teams up with colleagues across Canada in the Canadian Partnership Against Cancer, Adolescent and Young Adult National Network. -JC

When the Department of Pediatrics’ rheumatology team started to meet regularly with their adult clinic colleagues to discuss cases of adolescents and young adults, a few things became apparent. For example, the adult care providers were often surprised that the pediatric patients are not in more pain when they have multiple swollen joints. The rheumatologists were also not prepared for how little many of these patients know about their life-long disease, expecting them to have a complete understanding. The Division of Pediatric Rheumatology members initiated quarterly transition rounds with physicians in adult rheumatology from across Edmonton, as a precursor to developing an adolescent transition clinic. “We felt that both groups would benefit from one another to learn about challenges we face in transferring and receiving patients from pediatric rheumatology and talk about how we could provide insight into each other’s practices to inform and improve patient care,” explains Dr. Mercedes Chan. A big topic discussed in the meetings is adolescent development, including the physical, psychological and social competencies that often are not fully mature when young people move to adult care. “There are infinitely more challenges, and expecting a teen to all of a sudden act like a 35 year old who has their act together is a tall order,” says Chan. Transition clinics can serve as a ‘practice clinic’ for adolescent and young adult patients, where they can make mistakes but still have guidance. The learning goes both ways when the pediatric team is able to discuss more difficult patient cases with the adult team. They can gain from their adult colleagues’ experience that offers insight into management or learn about specialists who have more specific interests and expertise. Chan notes that, “Most of all, these new transition rounds have opened a dialogue that benefits our patients.”-JC

Crucial Conversations New policies guide ethical considerations to facilitate newborn organ donation

Caregivers will be better prepared to help families who wish to explore organ donation in the NICU, thanks to the work of Dr. Michael van Manen

onversations around organ donation can be ethically complex and intensely personal, especially when the donor and recipient are newborn babies. Dr. Michael van Manen is a neonatologist with the Northern Alberta Neonatal Program. He conducted qualitative research with a team of front-line staff, parents, and stakeholders to formulate policies and guidelines around ethics and Donation After Circulatory Determination of Death, or DCD, in the NICU. DCD presents several challenges. Conversations and decision making for DCD occur in the context of endof-life care, as families are coming to terms with a shift towards comfort care for their children. Approaching these discussions can be difficult, says van Manen. “How do you broach it in such a way that you are still supporting parents to say ‘no, this isn’t for me’?” NICU staff are generally used to infants passing away in private, held by their loved ones, but pragmatics of care delivery for DCD are different. In addition, potential conflicts of interest need to be mitigated. “The moment organ donation comes into play, there’s a concern that practitioners are now going to alter endof-life palliative care practices in order to get organs for another child,” van Manen explains.

van Manen and his team navigated these difficult ethical issues. After a year of focus groups, multiple surveys of frontline staff, and circulating drafts to stakeholders, the policy was drafted. This level of stakeholder involvement and use of qualitative methods is innovative. Though DCD cases are rare, having policies and guidelines in place puts the Stollery Children’s Hospital ahead of the curve. “In many facilities, the first cases of DCD are usually done without any policies or procedures in place,” says van Manen, increasing concerns that care for the potential donor and family will be compromised. Alberta Health Services, and other governing bodies, recently approved the DCD guidelines. van Manen hopes that, “If a family does want to pursue tissue or organ donation, if they’re interested in DCD, we would now be more prepared to respond to that family and make sure that we still deliver end-of-life and palliative care for that patient and family in an ethically appropriate fashion.” -DVB

FOR MORE INFO http://nsuworks.nova.edu/tqr/vol22/iss1/4/ 24

Department of Pediatrics, University of Alberta

Dr. Dawn Da vi

Dr. Cheryl M ac k

Everyday Ethics Dr. Dawn Davies and Dr. Cheryl Mack have a special interest in bioethics and patient advocacy. Some of that shared interest is a byproduct of the palliative care each of them specializes in at the Stollery Children’s Hospital. “A lot of the situations that we might get called about when a child has a really long, complex illness, involve palliative care and ethics consults around the same time,” explains Davies. In addition to her clinical work at the Stollery and academic work at UAlberta, Davies is the chair of the Canadian Pediatric Society Bioethics Committee. She completed a master’s of health care ethics and law in 2011, finding it useful for providing additional ways to think about situations and language to describe them. Davies has testified before our country’s Senate on the issue of medical assistance in dying (MAiD) to represent the unique perspective of pediatrics and is now be part of the working group to advise on the specific issue of mature minors. The society plans to release MAiD guidelines for practitioners later in 2017. Mack has a varied clinical background in adult and pediatric anesthesia, more recently focusing on pediatric palliative care. After experiencing a difficult ethical case, where she felt she did not have the tools to advocate properly for her patient, Mack pursued a master’s degree in health ethics and law and is now a PhD candidate with majors in moral philosophy, philosophy of science, and philosophy of mind. She is the chair of the University of Alberta, Mazankowski Alberta Heart Institute and Stollery Children’s Hospital Ethics Committee. “Every day, with clinical ethics, we get consults on either conflict at the bedside around decision-making, or uncertainty around decision-making for particular patients,” says Mack. The ethics committee gets involved to help support teams and families in making tough decisions and is a 24-7 resource to help debrief teams when they have gone through difficult cases.

Patient advocates value the role of bioethics in both complex and routine decisions

Although ethical considerations can come to the forefront in palliative cases, Davies would like to see ethics be more integrated into frontline care and approached more systematically at the institutional level. “Right now, it seems to be this separate thing that we only call in to consult the committee when many months have gone by and the situation is already playing out,” she notes. “People may think every ethical decision is a one-off, but if we look at things more systemically, they probably aren’t.”

CAUTION: ETHICAL DECISION-MAKING AHEAD

Davies also would like to see more conversations “beyond survival” when decisions are made to pursue innovative aggressive treatments, where there is a lot of uncertainty about long-term outcomes. Mack finds that, “ethics is getting more and more relevant for that type of care, because it grounds the whole decision-making around making sure patients and families are as informed as they can be, and understand the limits of what we can offer.” Both Davies and Mack would also like to see ethics embedded in the medical school and residency training curriculum. Mack is involved in providing a foundation for medical students in their first two years at UAlberta, but sees more of a challenge once learners are on the wards and in residency programs. “Trying to bring ethics into day-to-day conversations is our challenge, when they are very busy with the clinical work.” says Mack. “So the ethics committee members try to do a lot of resident teaching, separate from the medical school curriculum.” -JC

Legacy of Hope

espite a growing body of work that shows hope for those with fetal alcohol spectrum disorder (FASD), researchers are still fighting intense social stigma in their work, says long-time FASD advocate Dr. Gail Andrew of the Glenrose Rehabilitation Hospital: “There’s a public misconception that they’re throwaway kids and will all end up in jail, so why bother?”

At the time, there was very little research about FASD and even less public awareness. Andrew became passionate about creating better treatments for children and families touched by FASD. She returned to Edmonton in the late ‘90s and helped the province develop guidelines for the diagnosis of the disorders, before travelling across the province educating physicians. “I called it my road show,” she laughs.

Andrew’s interest in FASD began in the 1980s, as a pediatrician and behavioural consultant in Camrose. She noticed that some of her young patients didn’t respond to treatment and wondered if prenatal alcohol exposure could be the culprit. “Many of my patients were in foster care and had come through a lot of adversity,” she says. “It just began making sense with my own self-directed learning.”

Not long afterward, Andrew helped create a universityaffiliated FASD clinic at the Glenrose Rehabilitation Hospital. “We could see that this was an essential health service for a very disadvantaged population,” she says. It also enabled more research on the nature of FASD and treatment options for those affected.

Department of Pediatrics, University of Alberta

Dr. C arm e

Glenrose team finds new ways to help those affected by prenatal alcohol exposure through advocacy and research

Dr. Gail Andrew has spent nearly 30 years devoted to advocacy and research for those with FASD

Andrew’s award-winning advocacy has extended beyond clinical work and research to the broader community, including the justice system. Once, she helped a Yukon prison find better ways to transition inmates with FASD (one-quarter of the prison population) back into the community. On another occasion, she testified at the House of Commons on the role of FASD in the criminal justice system. Andrew has also lobbied extensively for better social supports for children and adults with the disorder, and helped educate diverse professionals and the general public about it — focusing on prevention. “In an ideal world, we’d prevent FASD,” she says. –CC

ussen sm a nR

Research study will measure success of self-regulation strategies for teens Fetal Alcohol Spectrum Disorders (FASD) affect each children uniquely, but problems with self-regulation are a hallmark symptom. That’s because alcohol consumption during pregnancy damages parts of the brain responsible for decision-making, inhibition, planning, working memory, and other kinds of “executive function.” “People with FASD tend to have a lot of adverse behavioural outcomes,” says Dr. Carmen Rasmussen, a UAlberta associate professor of pediatrics. “They are more likely to get into trouble with the law, drop out of school, have mental health problems, and have problems adapting to society.” At the same time, researchers are discovering more reasons for hope. Thanks to the adaptability of the human brain, it’s possible that teaching kids strategies for managing their emotions may improve their behaviour and rewire damaged parts of the brain over time. One well-known teaching strategy, known as the ALERT program, has been shown to help children with FASD (and other developmental difficulties, too). The 12week program pairs trained interventionists with participants for one-on-one sessions to teach skills to cope with the feelings that contribute to anti-social behaviour. Since many of the anti-social behaviours associated with FASD begin in adolescence, Rasmussen wondered if an intervention would also work in older children. In 2016, she began co-leading a study that adapted ALERT for adolescents and will soon offer it to participants in both Edmonton and Vancouver. She and her colleagues want to know if participating in the program improves self-regulation and behaviour, and if it changes levels of cortisol (a stress hormone linked to self-regulation). Rasmussen is hopeful that at least some of the participants will benefit. -CC

Dr. Francois Bolduc (centre) and Dr. Piush Mandhane (r) collaborated on research for pregnant women like Ms. Tara Daubert, who gave birth to a healthy girl in May

Department of Pediatrics, University of Alberta

The research study shows infants do better on developmental tests when their mothers consume more fruit during pregnancy. An increase of six or seven points on an IQ test could mean the difference between a child living independently as an adult or requiring community supports.

An Apple

a Day

Combining epidemiological analysis and pre-clinical research with fruit flies is a novel approach “An apple a day keeps the doctor away.” It’s an old truth that encompasses more than just apples—eating fruit, in general, is well known to reduce risk for a wide variety of health conditions such as heart disease and stroke. But now a new study is showing the benefits of fruit can begin as early as in the womb. The study showed that mothers who consumed more fruit during pregnancy gave birth to children who performed better on developmental testing at one year of age. Dr. Piush Mandhane, senior author of the paper, made the discovery using data from the Canadian Healthy Infant Longitudinal Development (CHILD) Study — a nationwide birth cohort study involving over 3,500 Canadian infants and their families. Mandhane leads the Edmonton site for the research. “We wanted to know if we could identify what factors affect cognitive development,” Mandhane explains. “We found that one of the biggest predictors of cognitive development was how much fruit moms consumed during pregnancy. The more fruit moms had, the higher their child’s cognitive development.” Using a traditional IQ scale as a model, the average IQ is 100; two-thirds of the population will fall between 85 and 115. Mandhane’s study showed that if pregnant mothers ate six or seven servings of fruit or fruit juice a day, on average their infants placed six or seven points higher on the scale at one year of age.

Public interest in the fruit consumption study has been strong.

193

tracked media mentions

33 million potential audience reach

Published in the Wall Street Journal, Daily Mail (UK), Chatelaine, MSN, Telegraph (UK), Postmedia newspapers and many others

Fruit flies that consume fruit juice show similar results To further build on the research, Mandhane teamed up with Dr. Francois Bolduc, an associate professor in pediatric neurology, who researches the genetic basis of cognition in humans and fruit flies. Both researchers believe that combining pre-clinical models and epidemiological analysis is a novel approach that may provide useful new insights into future medical research. “Flies are very different from humans but, surprisingly, they have 85 per cent of the genes involved in human brain function, making them a great model to study the genetics of memory,” says Bolduc. “To be able to improve memory in individuals without genetic mutation is exceptional, so we were extremely interested in understanding the correlation seen between increased prenatal fruit intake and higher cognition.” According to Bolduc, fruit flies have a long track record in the field of learning and memory. Several genes known to be necessary in fly memory have found to be involved in intellectual disability and autism by Bolduc and others. In a subsequent series of experiments, he showed that flies born after being fed increased prenatal fruit juice had significantly better memory ability, similar to the results shown by Mandhane with one-year-old infants. Though the findings are encouraging, Mandhane cautions against going overboard on fruit consumption, because potential complications such as gestational diabetes and high birth weight—conditions associated with increased intake of natural sugars—have not been fully researched. Instead, he suggests that expectant mothers meet the daily intake recommended in Canada’s Food Guide and consult with their doctors. –AD & RN

The Long Game T

he stress of surgery can take its toll on the kidneys, regardless of a patient’s age or the reason for their surgery.

“Acute Kidney Injury (AKI) happens in many populations, across different types of care, in all countries,” says pediatric nephrologist Dr. Catherine Morgan. “But children having cardiac surgery are especially at risk.” Somewhere between 30 and 60 per cent of children who undergo heart surgery experience AKI, a sudden decline in kidney function. As a result, patients tend to spend more time in hospital, require ventilation for longer, and have a higher mortality rate. Morgan explains that the condition also makes it harder for clinicians to dose medication or manage a patient’s fluids and nutrition after surgery. At the moment, AKI is usually discovered through blood tests or if there is difficulty managing a patient’s fluids after surgery, says Morgan: “Right now, we don’t have a good way of picking it up early — only when large changes have already happened.” While doctors can manage AKI, there may be long-term consequences. “The big question that remains is if this injury is entirely recoverable or if it creates long-term change that affects them as adults,” Morgan says. One possibility is that children who suffer kidney injury after surgery may be prone to developing chronic kidney disease later on, which can have many negative health consequences. Morgan wants to find ways to identify children at high risk of AKI in order to intervene sooner. “If we could predict AKI even a couple of hours earlier, we might be able to change the outcomes for some of the kids,” she says. In 2016, she conducted a study with colleagues in the Division of Pediatric Cardiac Surgery, and at the Stollery Children’s Hospital intensive care unit, that used near infrared spectroscopy (NIRS) to measure levels of oxygen and blood flow in a patient’s kidneys during surgery. Preliminary research findings suggest that moderately lower levels of blood flow in the kidneys might protect against AKI. If this is the case, it may be possible to lower a patient’s risk with medical management before or during surgery. Morgan explains that further research can be done to explore treatments that recreate a similar environment in the kidney. Results also suggest that this kind of monitoring may be useful as an additional tool to help predict kidney injury. Morgan is also exploring the long-term health impacts of AKI and is co-leading a study of critically ill children — including those who’ve had cardiac surgery — in Edmonton and Montreal. Like her other work, this project isn’t just focused on answering immediate research questions, but building research collaborations that will endure. “If you want to address intervention questions and long-term outcomes, you really need collaboration across multiple departments and hospitals. I think it’s important for us to build networks not just for ourselves, but for others researching in the same areas,” she says. Ultimately, sick kids benefit from a critical mass of research: “There’s real opportunity to change the outcomes for these kids.” -CC

Department of Pediatrics, University of Alberta

Protecting young cardiac patients from suffering kidney damage during heart surgery may prevent long-term effects

CHILDREN WHO UNDERGO HEART SURGERY

30% TO 60%

EXPERIENCE AKI (sudden decline in kidney function)

Dr. Catherine Morgan engages with Levi Noble at the Stollery Childrenâ&#x20AC;&#x2122;s Hospital

APPETITE for Answers

Research collaboration improves care for kids with stomach bugs while reducing costs to the health system

Public Health was able to identify a gastroenteritis outbreak in Edmonton with the help of the APPETITE study and patients like Charlie, pictured here with Dr. Bonita Lee (centre) and Dr. Samina Ali (r)

Department of Pediatrics, University of Alberta

30,000 CHILDREN

YEAR

VOMITING AND DIARRHEA

$400 MILLION E

ach year in Alberta, more than 30,000 children are admitted to hospital emergency departments because of vomiting and diarrhea, costing taxpayers $400 million. “Even the garden variety ‘stomach bug’ has an incredible burden on the health-care system,” explains Dr. Samina Ali, a pediatric emergency physician and professor in the Department of Pediatrics. Children can be susceptible to dangerous complications related to infectious gastroenteritis (like severe dehydration, electrolyte imbalance, kidney damage or severe anemia). However, effective medical treatment often requires pinpointing the cause of their illness, which can be tricky. There are hundreds of different micro-organisms that can cause gastroenteritis, including: viruses (like Norovirus and Rotavirus), bacteria (like E.coli and Salmonella) and, more rarely, parasites (like Giardia lamblia, found in lakes and rivers). “We want to find better ways of identifying causes of gastroenteritis in children,” says associate professor Dr. Bonita Lee. That’s why she’s helping lead a province-wide research project called the Alberta Provincial EnTeric Infection TEam (APPETITE). The initiative began in 2014 and includes nearly 50 collaborators from UAlberta, the University of Calgary, and Alberta Health, as well as 3,000 patients recruited through Alberta pediatric emergency departments, calls to Health Link (the province’s nursing healthadvice hotline), and public health clinics. Researchers hope to improve care for patients while reducing costs to the system.

“We’re now finishing year three of five, but we’ve already produced close to a dozen publications informing clinicians and scientists about how to test for and treat children with gastroenteritis,” says Ali. In 2016, the team published research that shed light on clinical management to prevent Hemolytic Uremic Syndrome (HUS), a dangerous form of complication from E. coli infection commonly referred to as “hamburger disease.” Findings included identifying which blood tests can facilitate early diagnosis and which early interventions can help prevent complications like kidney damage. “This information has changed the way I practice as a pediatric emergency physician,” says Ali. Another highlight of the 2016 research findings was the demonstration of the usefulness of a rectal swab test to diagnosis infectious gastroenteritis in situations in which a child doesn’t have diarrhea, or when a stool sample wasn’t collected. “Before this, if a patient was only vomiting, we couldn’t do any test to look for the cause of gastroenteritis,” says Lee. By the time the study winds down in the next year or so, the team will likely publish 50-60 different research studies. This will include work by Ali, who is currently studying the pain experience of children with gastroenteritis, and Lee’s work on viral and C. difficle gastroenteritis with other APPETITE members. Ali says the project is novel in that it involves collaboration between clinicians, researchers, and the public healthcare system. “APPETITE brings us all together, so we can learn from one another,” says Ali. “The results of these studies are already influencing both how we diagnose and manage patients.”-CC

hat does innovation look like in the Department of Pediatrics? It’s a question Dr. Lawrence Richer is well acquainted with, because he spends a significant amount of time looking for the answer. When asked what he does for a living, Richer describes himself as “someone who attends a lot of meetings,” as a way to quickly explain the many roles he plays. In addition to being a pediatric neurologist and associate professor, he is interim director for the Division of Neurology in the department. As if that would not keep him busy enough, he holds several external leadership positions, including associate dean of clinical research in the Faculty of Medicine & Dentistry, director of the Northern Alberta Clinical Trials + Research Centre, and associate director of the Women and Children’s Health Research Institute, among others. Despite all of his responsibilities and the demands that exist for his time and attention, Richer insists he is keen to keep his eye on the prize — it always comes back to the Department of Pediatrics. “I may be taking care of something in the Faculty, for example, but I never stop wearing my pediatric hat,” he says. Richer has spent a decade and a half at the university and is constantly searching for ways to inject innovation into his roles. All of these, he says, come back full circle to the department. UAlberta is currently positioning itself as an international leader in clinical trials, with Richer acting as a primary driver. Improving the lives of children is his motivator. “Being in this line of work has a lot to do with our ability to push for new and better ideas in research because there are fewer studies out there for children than there are for adults,” he reflects. “Kids deserve the same level of evidence and safety in medicine, so we are always asking ourselves ‘How can our department do more with the research we have, and where can we find efficiencies?’” One measure of his success in this is an upcoming award from the International Society of Clinical Trials that validates his work. Richer says it has not been a difficult choice to spend his entire career in the department. “The people here are so supportive. I could not be in so many roles without their help and they keep me focused,” he says. In return, the department continues to provide Richer with challenges, by giving him opportunities to look for new and innovative ways to advance his goals. Last fall, for example, Richer was part of a team that organized a campaign called, Be the Cure. After much preparation (and several million social media impressions), Albertans learned how they can make a difference as participants in critical research. “It was a successful project and, I’m proud to say, the pediatric element received the highest degree of attention.” According to Richer, fostering leadership, advancing unique opportunities and partnerships, and working with colleagues who are always willing to be collaborative and champion important initiatives, are some of the elements that make working here a remarkable place to build a career. Giving people the room to innovate — to prompt real-life, impactful change — makes coming to work, and all those meetings, well worth it, he laughs. -JL

Department of Pediatrics, University of Alberta

Dr. Sarah Forgi

A pediatrician in the Office of the Provost Dr. Sarah Forgie is a pediatric infectious diseases physician who has been leading a double life as vice-provost learning initiatives at UAlberta for almost two years. It’s a half-time position that is quite different from her clinical work in the Department of Pediatrics, and offers insight into the higher levels of academia that not everyone is aware of. “A lot of people ask me, ‘Who is the Provost and why are you in their office?’” she laughs.

Outside In Support for external leadership roles brings innovation back to pediatrics

The Provost and Vice-President (Academic) leads the academic mission of the university with a team of vice-provosts. Forgie’s vice-provost role is a relatively new one, providing leadership to education initiatives at the university, including oversight to the Centre for Teaching and Learning (CTL), and chair of the General Faculties Council Committee on the Learning Environment. How did she end up there? Forgie was already involved in many activities external to the department and passionate about education. She is a 3M Teaching Fellow and completed her M.Ed. three years ago, widening her exposure on campus. She co-chaired the Provost’s Digital Learning Committee and, in 2015, she served as a Provostial Fellow, conducting a qualitative analysis of faculty development through centres for teaching and learning at research-intensive universities. With all this behind her, she was thrilled to be approached for the VP role. As someone who thrives on learning new things, the position intrigued her, but the thought of potentially giving up her clinical work could have been a deal breaker. “I really wanted to maintain my clinical practice so, with the department chair’s support, we came up with a way that I could do both,” she explains. Working at a new level that encompasses the entire university has opened her world. “I sit in meetings with philosophers, anthropologists, and scientists and it’s really neat - it’s a whole new perspective. I bring a view from medicine, as well, which is helpful because many people are not sure what happens over here,” she says. She also meets or hears about people with similar areas of interest, previously unaware of each other, and takes great pride in bringing them together.

Dr. Lawrence Richer takes a breather between meetings at the Li Ka Shing Centre for Health Research Innovation

Forgie’s term at the Office of the Provost is a welcome step on the path of her self-described “unconstructed life”. She is enthusiastic about encouraging others to consider diverse leadership roles on campus that benefit the university and bring new connections and perspectives back to the department. “Take the opportunity to learn something new, it can only be a good thing.” -JC

Department-at-a-Glance The Department of Pediatrics at the University of Alberta is one of Canadaâ&#x20AC;&#x2122;s leading academic health centres for pediatric specialty and subspecialty education and research. We also work in conjunction with the Stollery Childrenâ&#x20AC;&#x2122;s Hospital, and other facilities, to provide leading edge clinical care. www.pediatrics.ualberta.ca

About Us

$80 MILLLION

Annual operating/research funding

Second-largest department at the University of Alberta

16 DIVISIONS

124

academic faculty

122

clinical academic faculty

Department of Pediatrics, University of Alberta

200

support staff

Education

105

Royal College of Physicians & Surgeons of Canada accredited programs

graduate students

residents and fellows

3M Teaching Fellow

Supported by the Stollery Childrenâ&#x20AC;&#x2122;s Hospital Foundation

Research

600 over

CIHR grants held by department principal investigators (PIs)

papers published per year

Supported by the Women and Childrenâ&#x20AC;&#x2122;s Health Research Institute

CIHR grants with department as co-PI

Clinical Care

Largest geographic catchment area for pediatrics in North America

60+

specialized pediatric care programs

Quaternary clinical programming for cardiac science and transplant medicine

Faculty Awards Each year, 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 in June provides faculty members an opportunity to network as well as celebrate their successes.

Dr. Kumar Kumaran and his team were awarded with the Cooperation Collaboration and Teamwork Recognition Award for their work on The Babyâ&#x20AC;&#x2122;s Journey, a collaborative project with the Royal Alexandra NICU, womenâ&#x20AC;&#x2122;s health, pediatrics and NICU families.

Academic Faculty Research Paper Award Dr. Todd Alexander and Dr. Anita Kozyrskj Clinical Faculty Research Paper Award Dr. Allan de Caen Cooperation Collaboration and Teamwork Recognition Award Royal Alexandra Hospital NICU Innovation Award Dr. Justine Turner Annual Teaching Award by Subspecialty Residents Dr. Loretta Fiorillo Pediatric Grand Rounds Award Dr. Maria Spavor

Best Teaching Division Award in Undergraduate Medical Education Division of Gastroenterology and Nutrition Excellence in Undergraduate Teaching Division of Nephrology Top Ten Teachers Award Dr. Georgeta Apostol Dr. Robin Arent Dr. Mark Enarson Dr. Sandra Escoredo Dr. Karen Forbes Dr. Jessica Foulds Dr. Jacqueline Lee Dr. Hasu Rajani Dr. William Sevcik Dr. Jennifer Walton Best Teacher Award in Community Pediatrics Dr. Isabelle Chapados Excellence in Community Pediatrics Dr. Indra Dhunnoo and Dr. Heather Leonard

Department of Pediatrics, University of Alberta

External Awards Dr. Samina Ali, Top Pediatric Research Award Canadian Association of Emergency Physicians

Dr. Mia Lang, Patil Teaching Innovation Award Association for Medical Education in Europe (AMEE)

Dr. Jason Dyck, Fellow Canadian Academy of Health Sciences

Dr. Hasu Rajani, Award of Excellence in Community Premier’s Council Award

Dr. Loretta Fiorillo, Resident Wellbeing Award Professional Association of Resident Physicians of Alberta (PARA)

Significant Grants Dr. Todd Alexander Canada Foundation for Innovation’s John R. Evans Leaders Fund ‘Renal tubular microperfusion, resurrection of classic physiological approaches to study modern genetic models’ Canada Research Chair (2016) Renal Epithelial Transport Physiology (Tier 2) Drs. Todd Alexander, Geoff Ball, Lisa Hartling, Michael Hawkes, Andrew Mackie Women and Children’s Health Research Institute Innovation Grants Dr. Khalid Aziz World Health Organization (2016), supported by the Bill and Melinda Gates Foundation Co-investigator of project aiming to reduce neonatal mortality in Ethiopia Partnership for Research and Innovation in the Health System (PRHIS) from Alberta Innovates – Health Solutions (2016) Edmonton co-lead of Family Integrated Care (FICare) plan aiming to integrate the family into the care of their preterm baby Dr. Geoff Ball Faculty of Medicine & Dentistry Tier II Basic Science Award for Excellence in Mentoring Graduate Students and Postdoctoral Fellows Drs. Geoff Ball and Michele Dyson AHS MNCY Strategic Clinical Network Funding from Health Outcomes Improvement Fund Dr. Jason Dyck Canadian Research Chair Molecular Medicine Dr. David Eisenstat 2015-2016 Hair Massacure funding Endowed Muriel and Ada Hole Kids with Cancer Society Chair in Paediatric Oncology (2016-2021) Renewed for another term

Dr. Lisa Hartling Canadian Institutes of Health Research (2016) ‘Integrated knowledge translation with parent stakeholders to optimize children’s emergency care’ Dr. Nee Khoo Women and Children’s Health Research Institute (2016) Clinical Research Seed Grant – physical activity promotion in children and adolescents with hypoplastic left heart syndrome (HLHS) Dr. Richard Lehner Canadian Institutes of Health Research (2016) Metabolic role of arylacetamide deacetylase (AADAC) 2017 Natural Sciences and Engineering Research Council of Canada (NSERC) Discovery Grant Competition Dr. Gary Lopaschuk Canadian Institutes of Health Research (2016) The metabolic basis of heart failure in diabetes and obesity Dr. Rhonda Rosychuk NSERC Discovery Grant “Statistical methods for Repeated Events” Dr. Jason Silverman Women and Children’s Health Research Institute (2016) Clinical Research Seed Grant – small intestine microbiome in infants with short bowel syndrome Dr. Georg Smolzer Heart and Stroke Foundation (2016) National New Investigator winner and Alberta Investigator winner Dr. Lonnie Zwaigenbaum Brain Canada-Azrieli Foundation grant. Early autism diagnosis and treatment research

Department Members

LEGEND:

|Academic Member

CARDIOLOGY | Dr. Joseph Atallah || Dr. Konstantin Averin | Dr. James Coe | Dr. Timothy Colen | Dr. Jennifer Conway | Dr. Jason Dyck || Dr. Luke Eckersley || Dr. Carolina Escudero | Dr. Lisa Hornberger | Dr. Michael Kantoch | Dr. Paul Kantor | Dr. Nee Khoo | Dr. Gary Lopaschuk | Dr. Andrew Mackie | Dr. Patti Massicotte || Dr. Angela McBrien | Dr. Richard Schulz || Dr. Cameron Seaman | Dr. Edythe Tham | Dr. Simon Urschel | Dr. Lori West CRITICAL CARE | Dr. Vijay Anand | Dr. Natalie Anton | Dr. Dominic Cave | Dr. Alf Conradi | Dr. Allan de Caen | Dr. Jonathan Duff | Dr. Daniel Garros | Dr. Gonzalo Guerra | Dr. Paula Holinski | Dr. Ari Joffe || Dr. Laurance Lequier | Dr. Lindsay Ryerson || Dr. Ben Sivarajan | Dr. Liliane Zorzela DERMATOLOGY || Dr. Loretta Fiorillo DEVELOPMENTAL PEDIATRICS | Dr. Julia Ackland Snow | Dr. John Andersen | Dr. Gail Andrew | Dr. Debra Andrews | Dr. Brenda Clark | Dr. Angela Currie | Dr. Cara Dosman | Dr. Keith Goulden || Dr. Lisa Lemieux | Dr. Matthew Prowse | Dr. Carmen Rasmussen

|Clinical Member

| Dr. Lyn Sonnenberg | Dr. Man-Joe Watt || Dr. Lonnie

Zwaigenbaum

EMERGENCY MEDICINE | Dr. Samina Ali | Dr. Robin Jo Arent | Dr. Melissa Chan | Dr. Eddie Chang | Dr. William Craig | Dr. Sarah Curtis | Dr. Andrew Dixon | Dr. Michele Dyson | Dr. Mark Enarson | Dr. Andrea Estey | Dr. Lisa Evered | Dr. Lisa Hartling | Dr. Robyn Hutchings | Dr. Hsing Jou | Dr. Manu Kundra | Dr. Tricia Kutnikoff | Dr. Shona MacLachlan | Dr. Matthew Montgomery | Dr. Maria Oliva | Dr. Amaly Rahman | Dr. William Sevcik | Dr. Hareishun Shanmuganathan | Dr. Troy Turner | Dr. Bruce Wright ENDOCRINOLOGY || Dr. Manpreet Doulla || Dr. Rose Girgis | Dr. Andrea Haqq | Dr. Mary Jetha | Dr. Elizabeth Rosolowsky GASTROENTEROLOGY AND NUTRITION | Dr. Matthew Carroll | Dr. Susan Gilmour || Dr. Hien Huynh | Dr. Richard Lehner | Dr. Rabin Persad | Dr. Jason Silverman | Dr. Justine Turner | Dr. Eytan Wine | Dr. Jason Yap | Dr. Dawei Zhang

Department of Pediatrics, University of Alberta

|Divisional

Director

GENERAL AND COMMUNITY PEDIATRICS || Dr. Tamer Adham | Dr. Faria Ajamian | Dr. Ghassan Al Naami | Dr. Kelly Anderson | Dr. Mohammad Ansarian | Dr. Angela Antoniuk | Dr. Georgeta Apostol | Dr. Geoff Ball | Dr. Cecilia Baxter | Dr. Lola Baydala | Dr. David Berry | Dr. Charles Bester | 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. Elizabeth DeBruyne | Dr. Indra Dhunnoo | Dr. Lionel Dibden | Dr. Julia Drager | Dr. Heather Dreise | Dr. Abdelbaset Elsawiniya | Dr. Eileen Estrabillo | Dr. Elsa Fiedrich | Dr. Breanna Frohlich | Dr. Samy Galante | Dr. Evan Harris | Dr. Carol Hogson | Dr. Bonnieca Islam || Dr. Lynn Jacoby | Dr. Wladyslawa Janicka | Dr. Christine Kyriakides | Dr. Tehseen Ladha | Dr. Mia Lang | Dr. Scott Lappa | Dr. Jacqueline Lee | Dr. Kan Lee | Dr. Melanie Lewis | Dr. Joan Lopatka | Dr. Anna Malanowska | Dr. Ben Malinowski | Dr. Tami Masterson | Dr. Lyle McGonigle

|New Member | Dr. Kathleen Meier | Dr. Athar Mian | Dr. Fateh Mohammed || Dr. Robert Moriarity | Dr. Sadia Nakhuda | Dr. Amanda Newton | Dr. Viktoria Pankiv | Dr. Jayprakash

HOSPITAL MEDICINE || Dr. Karen Forbes | Dr. Jessica Foulds | Dr. Dawn Hartfield | Dr. Heather Leonard | Dr. Sunita Vohra | Dr. Jennifer Walton IMMUNOLOGY, HEMATOLOGY, ONCOLOGY, PALLIATIVE CARE, ENVIRONMENTAL HEALTH (iHOPE) | Dr. Shairaz Baksh | Dr. Mark Belletrutti | Dr. Aisha Bruce | Dr. Stuart Carr | Dr. Catherine Corriveau-Bourque | Dr. Dawn Davies | Dr. Sunil Desai || Dr. David Eisenstat

| Dr. Paul Grundy | Dr. Per Lidman || Dr. Cheryl Mack | Dr. Sarah McKillop | Ms. Lesley Mitchell | Dr. Alvaro Osornio-

Vargas | Dr. Sujata Persad | Dr. Kumar Ramlall | Dr. Maria Spavor | Dr. Timothy Vander Leek | Dr. Beverly Wilson || Dr. Jean Jacques De Bruycker | Dr. Yarden Yanishevsky INFECTIOUS DISEASES | Dr. Sarah Forgie | Dr. Michael Hawkes | Dr. Bonita Lee || Dr. Joan Robinson | Dr. Rhonda Rosychuk || Dr. Alena Tse-Chang | Dr. Wendy Vaudry NEONATAL-PERINATAL CARE || Dr. Dalal Abdelgadir | Dr. Marcia Antunes | Dr. Khalid Aziz | Dr. Paul Byrne || Dr. Po-Yin Cheung | Dr. Santiago Ensenat | Dr. Matthew Hicks | Dr. Chloe Joynt | Dr. Manoj Kumar | Dr. Vazhkudai Kumaran | Dr. Marc-Antoine Landry | Dr. Robert Lemke | Dr. Abraham Peliowski | Dr. Ernest Phillipos | Dr. Mosarrat Qureshi | Dr. Amber Reichert | Dr. Georg Schmolzer | Dr. Jonathan Stevens | Dr. Jennifer Toye | Dr. Juzer Tyebkhan | Dr. Johny Van Aerde | Dr. Michael van Manen || Dr. Dianna Wang

NEUROLOGY | Dr. Francois Bolduc | Dr. Helly Goez | Dr. Janani Kassiri | Dr. Hanna Kolski | Dr. Francois Morneau-Jacob | Dr. John Neilson || Dr. Lawrence Richer | Dr. Barry Sinclair | Dr. Richard Tang-Wai | Dr. Jerome Yager

New External Leadership Appointments Dr. Khalid Aziz, Associate Director UAlberta Ethiopia-Canada Maternal, Newborn and Child Health Project (MNCH Project) Dr. Jason Dyck, Member Canadian Institutes of Health Research Advisory Board IAB on Chronic Conditions Dr. Michele Dyson, Associate Director University of Alberta Evidence Synthesis Centre Dr. Helly Goez, Assistant Dean Diversity, Faculty of Medicine & Dentistry, University of Alberta

RESPIRATORY MEDICINE | Dr. Israel Amirav | Dr. Allison Carroll | Dr. Maria Castro Codesal | Dr. Elizabeth Anne Hicks | Dr. Tamizan Kherani | Dr. Anita Kozyrskyj | Dr. Joanna MacLean | Dr. Carina Majaesic || Dr. Piush Mandhane | Dr. Manisha Witmans | Dr. Peter Zuberbuhler

Dr. Dawn Hartfield, AHS Associate Zone Medical Director Integrated Quality Management

RHEUMATOLOGY | Dr. Mercedes Chan || Dr. Janet Ellsworth | Dr. Dax Rumsey

Dr. Michael Hawkes, Director Research and Global Health, Medcan Clinic

*appointments at 2017-05-01

RETIREMENTS

Dr. Paul Grundy, Chair AYA National Network and Expert Lead of Pediatric, AYA Oncology at the Canadian Partnership Against Cancer

Dr. Michele Harvey-Blankenship, Medical Lead Pediatric Child Weight and Health clinical team Dr. Lisa Hartling, Director University of Alberta Evidence Synthesis Centre

Dr. Chloe Joynt, Facility Section Head David Schiff NICU

Dr. Bob Couch Endocrinology

Dr. Manoj Kumar, Associate Medical Director eCritical Alberta

Dr. John Dyck Cardiology

Dr. Yarden Yanishevsky, President Alberta Society of Allergy & Clinical Immunology

Dr. Jeffrey Smallhorn Cardiology Dr. Peter Zuberbuhler Respiratory Medicine

Dr. Verna Yiu, President and CEO Alberta Health Services Pediatric Environmental Health Unit Officially recognized by the World Health Organization (WHO) as a collaborative center Dr. Ruth Collins-Nakai Inducted into the Order of Canada (30 years as pediatrics professor and Associate Dean of FoMD at the University of Alberta)

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.

Alberta Health Services Alberta Health Services (AHS) is Canada’s first and largest province-wide, fully-integrated health system, responsible for delivering health services to residents of Alberta. Students from Alberta’s universities and colleges, as well as from universities and colleges outside of Alberta, receive clinical education in AHS facilities and community locations.

Stollery Children’s Hospital Foundation The Stollery Children’s Hospital Foundation raises money for specialized equipment, sub-specialty medical education to train the best of the best, research to discover new treatments and cures for child health issues, and specialized programs that improve patient and family outcomes at the Stollery Children’s Hospital.

The Stollery Children’s Hospital is home to more than 640 physicians and more than 670 multidisciplinary staff in allied health disciplines, all dedicated to providing children with the best health care in Canada. With 133 beds, the Stollery Children’s Hospital partners with Glenrose Rehabilitation Hospital, Covenant Health and North Zone AHS to cover one of the largest catchment areas of any pediatric facility in Canada. With a referral base of more than 1.7 million, the Stollery cares for children from northern and central Alberta, as well as parts of Manitoba, Saskatchewan, British Columbia, the Northwest Territories, Yukon and Nunavut.

The Foundation recognizes the tremendous impact education and research has on disease prevention, treatment and improved health outcomes, which is why it invests more than $1 million each year to support trainees in the Department of Pediatrics and is a core funding partner for the Women and Children’s Health Research Institute at the University of Alberta.

Department of Pediatrics, University of Alberta

Women and Children’s Health Research Institute The Women and Children’s Health Research Institute (WCHRI) supports research excellence dedicated to improving the health and lives of women and children. WCHRI is the only research institute in Canada to focus on both women and children’s health, including perinatal health.

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

WCHRI is a partnership between the University of Alberta and Alberta Health Services, with core funding from the Stollery Children’s Hospital Foundation and the Royal Alexandra Hospital Foundation. Support is offered through grant competitions, start-up costs, ongoing research funding and expert research services. WCHRI also invests in the next generation of researchers through graduate and summer studentships, and research and travel grants.

Pediatric Medical Genetics

Child & Adolescent Psychiatry Pediatric Anesthesiology Pediatric Pathology Pediatric Radiology Pediatric Surgery

Department of Pediatrics, University of Alberta Edmonton Clinic Health Academy (ECHA) 11405-87 Avenue Edmonton, AB T6G 1C9 pediatrics@ualberta.ca www.pediatrics.ualberta.ca