University of Alberta Department of Pediatrics - Working Wonders 2017-2018

WORKING WONDERS Department of Pediatrics 2017-2018 Year in Review

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

Our Mission To 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

Cover photo: Pediatric resident Devin Chetan created the Little Heart Heroes Camp for children born with heart disease. Kids at the camp enjoy activities, such as this ball-scoop game, in a classic summer camp environment.

Contributors: Judith Chrystal, Caitlin Crawshaw, Alison Dotinga, Sasha Roeder Mah, Alexander Sorochan, University of Alberta, Tamara Vineberg Photos: Judith Chrystal, Rob Hislop, Manuela Stefan, John Ulan, University of Alberta, Tamara Vineberg Design: Animatters Animation & Design Studios Inc.

The Wonders Inside 8

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Little Heart Heroes

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Build Your Own Adventure

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Beyond Simple Cures

23

Up to the Challenge

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The Science of Improvement

30

Researchers Score Big in CIHR Competition

32 HeartsMap

The Courage to Change

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Specialized Care Requires Specialized Training

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When We All Work Together

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The Survivors

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To Do No Harm

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Research With Impact

What’s In the Air?

34 Guides to Wellness

ards - 38

4 Working Wonders -5 Our Amazing Staff

ort - 6 , Guidance and Supp

Leadership

Faculty Awards - 36

Graduate Student Aw A Good Match - 39

rs - 40

Department Membe Partners - 42

Working Wonders | Year in Review

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Working Wonders Social accountability is embedded in our vernacular and embodied in our actions Life’s most persistent and urgent question is, what are you doing for others?

Martin Luther King Jr. Professional transitions are an opportunity for reflection, to observe our exponential growth, development and maturity— appropriate concepts applied to a department of pediatrics.

Near the end of my final term as department chair, reflecting on these last 10 years, I have been able to observe how the culture and emphasis of our work with children and families has evolved to encompass social accountability. I am pleased to see these changes now embedded in our vernacular and embodied in our actions.

The World Health Organization defines socially accountable academic medicine as “the obligation to drive teaching, research and service activities towards addressing the priority health concerns of the community, region or nation they have a mandate to serve”.

The Department of Pediatrics at the University of Alberta, in partnership with Alberta Health Services, strives to represent the essence of the definition of true social accountability, focusing our academic domains on the priorities of our communities. For those who built the department, this was implicit, but today it is a celebrated and stated goal, ensuring that we put children and families at the centre of all that we do. This culture is now expressed much more explicitly under the term, “social pediatrics”.

Susan Gilmour has Chair served two terms as of of the Department Pediatrics.

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Department of Pediatrics, University of Alberta

We celebrate and acknowledge the successes, collaborations, and team approach throughout our department in Working Wonders. The examples of excellence featured in this edition highlight our strengths in social accountability. They are a testament to our sense of duty and obligation to meet the priorities of our patients in northern Alberta and also reach further to improve the lives of children in developing nations.

Communities, families and children look to us to focus our academic profession to ensure that we advocate for and meet their holistic health priorities.

Together, we are striving to meet these societal expectations through initiatives such as: coordinating an interdisciplinary approach to address chronic pain that impairs children’s ability to function in school, at home, in extracurricular activities and with friends providing healthcare to immigrant and refugee children, ensuring that Edmonton and Canada become a place of personal safety and opportunity—which cannot happen without good physical and mental health seeking evidence and support for vaccinepreventable illnesses to create healthier generations of children

acknowledging that health is influenced by many factors, including our environment understanding that health is not only the cure of a diagnosis, such as childhood cancer, but a lifelong commitment by patients, families and care teams contributing to a global community of children by working toward addressing the resource inequities that contribute to childhood mortality building on our scientific model and constructively analyzing what we do, how we do it and how our care can be improved, to ensure a safe environment for healthcare.

It has been a privilege to be the chair of this department. We have lived social accountability, long before it was a term in our lexicon, within the offices and labs of our buildings, the teaching units of our health partners and the clinics in our hospitals and communities. Here there are many examples of true wonders, enriching and improving the health and wellness of children and their families through research, education, service, and leadership. Thank you to all who dedicate their professional lives to this goal, are accountable in every way and can clearly answer “life’s most persistent and urgent question…what are you doing for others?”.

Susan M. Gilmour, MD, M.Sc., FRCP(C) Chair

F F A T S G N OUR AMAZI

We have amazing staff in the Department of Pediatrics. All of the accomplishments highlighted in Working Wonders are supported directly, and indirectly, by these individuals. They are dedicated to contributing to the research, education, clinical innovation and leadership that supports our vision and mission.

The first half of 2018 was a time of transition.

Our clinical administrative activities moved from the University of Alberta to our partner, Alberta Health Services. Throughout, our staff remained dedicated to ensuring that this important work for patients and families continued. I am proud that, as a larger team, we remain focused on the importance of our shared vision and continue to support our department.

Mary Ellen Davison Assistant Chair Administration

Members o f the suppo rt s group gath er in the atr taff ium of our administra tive home, the beautifu Edmonton l Clinic Healt h Academy.

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e c n a d i u G , p Leadershi t r o p p u S d n a

atives Chair’s Council initi forward t move the departmen

bers (left to right) Chair’s Council mem ar, Gary Lopaschuk, Manjula Gowrishank rina nnifer Walton and Ca Susan Gilmour, Je the department’s Majaesic celebrate ate annual Town Hall St e th at ts en em ev achi address. of the Department

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Department of Pediatrics, University of Alberta

cil. Members t and Divisional Coun en rtm pa de e th of visory to the chair air.

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rant G n io t a d n u o F R IH 1 new C s t n a r G t c je o r P R 6 new CIH rs e p a p d e r o h t u a r 454 senio

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Little Heart Heroes Pediatric resident develops a camp for kids Summer camp is a rite of passage for many kids. It’s a time for them to experience independence while participating in fun activities and also a great way to meet new friends. For children with complex chronic medical conditions, like those with heart disease, summer camp is not as accessible as it is for others.

That’s why Devin Chetan, a pediatric resident, created The Little Heart Heroes Fund and the Heart Heroes Camp.

The inspiration for the summer camp stemmed from Chetan’s interactions with families during his medical training. “If we can make things a little bit easier for the kids and their families and give them a chance they otherwise wouldn’t get, that’s what it’s all about for us,” says Chetan.

ted the Little Devin Chetan (left) crea r children born Heart Heroes Camp fo with heart disease.

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Department of Pediatrics, University of Alberta

The Little Heart Heroes programs were created to promote independence among campers and allow them to discover they aren’t alone–other kids have faced similar challenges. The main event every summer is Heart Heroes Camp, a medically-supervised summer camp for children born with heart disease. For one weekend, nurses and doctors from the Stollery Children’s Hospital become camp counsellors and take over the medical care for these children to ensure that all the kids and their families have to worry about is having fun.

“It was really interesting to see kids at camp comparing sternotomy scars and medical experiences. They were talking about all the things they could and couldn’t do. It was so nice to see them bond as they realized that there were other kids who were just like them,” Chetan says. “When one child wasn’t able to do something, the rest of the group banded together to support and encourage one another.”

The Little Heart Heroes Fund also offers a day camp for younger children. This program serves as a bridge for both the children and parents to reduce anxiety around sending their child away to attend the weekend-long program, develop more confidence and independence, and meet their peers and the Heart Heroes team.

Both of the Little Heart Heroes programs are free for all campers, so no child is excluded for financial reasons. Funds are raised through special events, community sponsorship, and donations to The Little Heart Heroes Fund, in association with the Stollery Children’s Hospital Foundation.

So far, The Little Heart Heroes Fund and Heart Heroes Camp have been a major success. Feedback from the parents and children has been amazing, and many of the children who attended the first year have returned. -AS

Jenny Laurie, whose da ughter Madison (seco nd from right) attended the camp, said the expe rience was incredible.

“It felt like they were family,” she says. “The with se same doctors and nu rses have looked after your children in their most vulnerable times .”

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Build Your Own

Funding partners allow a learner to create a fellowship in pediatric pain management

Adventure

Tara McGrath’s career path started to come into focus when she met several young patients with chronic pain at the Stollery Children’s Hospital during her University of Alberta pediatric medical residency.

The young people had regular, significant pain that impacted all aspects of their lives. They missed a lot of school, social activities, fitness and friendship that most kids take for granted. These patients, their families, and the care teams all were searching for causes and effective treatments that were not readily available.

Wanting to know more about pediatric chronic pain, and how she could help, McGrath began to search the literature and to look for more learning opportunities. She quickly discovered that this specialized field of study in pediatrics is relatively new and still developing. She was pleased to be able to create a unique learning experience at the U of A, the first of its kind in North America, with support from the Stollery Children’s Hospital Foundation.

It turns out that most chronic pain specialists in North America are anesthesiologists. Enter Mark Simmonds, anesthesiologist, adult and pediatric chronic pain physician and medical director of the Stollery Chronic Pain Clinic. McGrath approached Simmonds to supervise and help her build a yearlong curriculum for the new training fellowship.

He explained that helping young patients and their families manage chronic pain is time-consuming for practitioners and demands an ability to see and analyze medical problems in a different light, often in situations where many specialists have been unable to help. As such, helping children with

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Department of Pediatrics, University of Alberta

chronic pain is complex work, requiring patience, energy, enthusiasm and the ability to work with an interdisciplinary team on both medical and psychological strategies.

Simmonds was impressed with McGrath. “When I met up with Tara and she expressed her very sincere and grounded interest I realized that, for the first time in 10 years here, there was an individual who possessed the personal and professional qualities to become a leader in the field,” he says.

As a fellow, McGrath spent time with Simmonds, nurse practitioner Kathy Reid and psychologist Bruce Dick at the Stollery Pediatric Chronic Pain Clinic where they practice an interdisciplinary biopsychosocial approach. She expanded her experience by spending time with the Acute Pain Service, Aid for Symptoms and Serious Illness Support Team and Stollery’s child life specialists.

Because chronic pain can underlie many different conditions, Tara also spent time in five subspecialty clinics to learn from patients, allied health professionals and physicians there. “One of the big benefits of building my own fellowship was that I got to put these pieces together and create this mosaic of learning,” she explains.

had in improving their lives, even when such pain is unlikely to disappear entirely. “I see small gains everywhere,” she says. “I think the most significant thing is that these young people feel understood and they learn skills to communicate, to advocate, to eat healthy, to live healthy and to manage every day, every moment with pain.”

There are only a small number of pediatric chronic pain experts worldwide, so McGrath travelled to the United Kingdom and Australia to broaden her experience. There she discovered that it is not uncommon for pediatric pain physicians to also be rheumatologists, because of the overlap in both clinical practice and research in these areas.

Experiencing this international model for a rapidlychanging subspecialty helped solidify McGrath’s ultimate goal to pursue pediatric rheumatology after her fellowship.

Simmonds remains enthusiastic about McGrath’s choice of career path and hopes that she will be able to return to the Stollery as a staff member to share her experience, continue her research into discovering better ways of managing pain and help attract more physicians into the field.

McGrath has seen first-hand the positive impact that helping young people manage chronic pain has

“I have kind of carved my own path in an area I certainly think is needed,” she says. “I hope others will realize that you don’t have to be restricted by what existing fellowships offer and instead find a way to build their own adventure.” -JC

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Specialized Care Requires Specialized Training Fellowship programs benefit children locally and globally A physician brings expertise back to India Our training offers physicians from around the world the opportunity to learn from the experts at the University of Alberta, become leaders in clinical care or research, and even establish new services and training in their home countries.

Shine Kumar came from India to the U of A, and Stollery Children’s Hospital, for a one-year clinical research fellowship program in pediatric pulmonary hypertension. His interest in this very specialized field, and a lack of expertise in his home country, meant he had to look beyond his borders to learn more about helping children with the disease. “I chose to train at the U of A because it offered a comprehensive learning experience in this field, both clinical and research,” he says, and his faculty supervisor has a reputation as a world authority in this area.

Kumar returned home and, as a direct result of his training here, initiated a pediatric clinic dedicated to pulmonary hypertension, the first of its kind in South India. “I am able to treat and follow up around 150 patients per year and we now have a dedicated team for pregnant women with this disease and deliver good care,” he says. He is now a clinical associate professor leading the pulmonary hypertension clinic at Shine Kumar came from India to the U of A for a Amrita Institute of Medical one-year clinical research fellowship program in Sciences, Amrita Vishwa pediatric pulmonary hypertension.

Vidyapeetham University in Kochi, India.

In addition to helping other countries develop new services, hosting international learners benefits both regions by developing lasting relationships with specialists in other centres. Kumar co-hosted the Pediatric Pulmonary Hypertension Conference for the first time in India, and has published research with much success. “It is beyond words what I have learned and gained from coming to Alberta, both academically and personally,” he says.

Other international trainees have come from Ecuador, Japan, Australia, Spain, United Arab Emirates, the United States, Syria, and Thailand, among many other countries. -JC

owships Innovative Fs eofll e subspecialty in th

red in 13 area s such as: g is currently offe llowship program fe Fellowship trainin e tiv va no in es includ department and | Palliative Care ne | Pain Medicine Echocardiography Academic Medici tal and Neonatal Fe D 3| y og ol lmon litation Medicine Intensive Care Pu ysiology | Rehabi nt Hepatology Cardiac Electroph seases | Transpla Di us io ct fe In nt Transpla

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Department of Pediatrics, University of Alberta

The department is an educational leader The Stollery Children’s Hospital, Glenrose Rehabilitation Hospital, and Royal Alexandra Hospital Neonatal Intensive Care Unit offer complex services across a wide range of clinical areas. Providing specialized care requires specialized experts, and specialized experts require specialized training.

Hospitals are where much of this training takes place. “The Stollery is widely recognized as a clinical leader, and together we are educational leaders as well,” says Chloe Joynt, an associate professor and subspecialty postgraduate medical education program director. Joynt sees herself as a facilitator to help learners and medical education leads develop and navigate processes, share ideas or resources, and create new training opportunities in the department. “I was a residency program director for neonatology for several years and so I know the kinds of questions that I had at the time. I want to be the person who can help find the answers for others,” she explains.

Chloe Joynt oversees subspecialty fellowship training programs in the department.

The Department of Pediatrics is increasingly known for its innovative advanced training programs in a range of fields. These include fellowship programs focused on highly specialized areas, as well as training in clinical and basic science research to advance knowledge and further improve outcomes. Joynt notes that the Stollery has expanded many clinical niches (such as pulmonary hypertension and pediatric pain medicine), and that means we can now also teach within those areas. “We’re one of the few sites in Canada that can provide that specialized level of training,” she says. Physicians from across Canada, and around the world, come to Edmonton learn from members of our department.

One of the major funders of fellowship training is the Stollery Children’s Hospital Foundation. The department now receives $1.275 million each year to support physicians in these specialized programs. “Truly, without the foundation’s generous funding, we wouldn’t be able to run a lot of these innovative fellowships and we would not have been able to retain a lot of these people to then provide care and teach at the Stollery and partner sites. That funding has been critical,” explains Joynt. “The ultimate winners are children and families, because they’re getting these really well-trained people who have such great expertise. And we have a lot of children that need a lot of great expertise. So it’s fantastic.” -JC

Training fills a niche at the Stollery Our fellowship programs allow physicians to develop specialized skills based on local need and become experts themselves to care for children and eventually train other physicians here.

Jillian Popel completed Jillian Popel completed medical school, medical school at the U of residency training and a fellowship at the U of A. A in 2012 and an additional four years in the general pediatrics residency program in 2016. Thanks to generous funding from the Stollery Children’s Hospital Foundation, Popel took the opportunity to pursue a one-year fellowship in child maltreatment pediatrics here, in collaboration with the University of Toronto.

She now works half time at the Stollery Child and Adolescent Protection Centre, helping to fill a niche vacated by retiring physician Lionel Dibden. Popel provides medical and trauma screening for children when there is a concern about maltreatment, including cases of physical and sexual abuse. She works through the medical investigation, communicating with police or children’s services to make a safety plan if necessary. She also collaborates with the Zebra Child Protection Centre, a multidisciplinary centre in downtown Edmonton. Popel balances this often emotionally demanding role with work as a hospitalist seeing children with a wide variety of conditions. -JC

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When We All Work Together A multidisciplinary team helps kids with abdominal pain get back to the business of living When University of Alberta associate professor and pediatric gastroenterologist Rabin Persad was in training, he noticed a troubling pattern. Children with easily diagnosable diseases had access to treatment plans, medications and attention that those lacking a diagnosis simply weren’t getting. The pediatric gastroenterologist wondered, “How do we help these children and families who are having a really hard time getting optimal treatment?” He imagined pulling together a team of health professionals, pooling their combined strengths to address the complex needs of children with abdominal pain.

The resulting abdominal pain clinic at the Stollery Children’s Hospital was born about six years ago, says Persad, treating three or four patients one afternoon per month. Today, the five-person team— Persad, psychiatrist Heidi Wilkes, a nurse, dietitian, and psychiatric nurse—see up to eight patients per afternoon, twice a month. The group works closely with the Stollery Pediatric Chronic Pain Clinic, where nurse practitioner Kathy Reid, a specialist in chronic pain, co-follows many of the young patients.

“There’s nothing we could provide, individually, that’s anywhere near as good as what we can offer as a

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Department of Pediatrics, University of Alberta

team,” says Persad. “There’s so much more ability to provide family-centred, patient-centred care when we all work together,” echoes Reid.

“The nice part about the abdominal pain clinic is that neither the medical symptoms nor the psychiatric, mental health symptoms are disregarded,” elaborates Wilkes.

Diet, exercise and medication are key. Reid adds that it’s crucial for patients missing school or activities with friends to learn behavioural strategies that can bring them out of social isolation. “For kids with chronic pain,” Reid explains, “Depression is five times more common and anxiety is probably five to seven times more common.” For younger children, she and the main clinic’s psychologist, Bruce Dick, teach parents calming strategies to implement at home. For teens, they run group classes where patients learn relaxation strategies and mindfulness-based stress reduction while forming the kinds of healthy, supportive friendships they may have lost because of their illness.

Many families have reached the clinic as a last resort, says Wilkes. Even if children have been diagnosed with something like irritable bowel syndrome, says Persad, that diagnosis can be dismissive and patronizing. The relief is palpable when patients finally get the team’s help, says Reid, when they feel someone is listening and believes them.

While Persad and his team would love to send their patients home discomfort-free, they understand that’s not how it works with chronic pain. “Working in this clinic has helped me embrace ambiguity and to tolerate it a bit more,” says Wilkes, and she and her colleagues know to celebrate measured victories.

Says Persad, as more and more patients come in for follow-up appointments telling of decreased anxiety, higher grades and excited plans for the future, “That’s just phenomenal to me; these kids have taken an amazing turn.”

To help more children make that shift, Persad dreams of expanding the clinic with more staff, longer hours and new approaches such as neural stimulation for chronic pain treatment and other pharmacological and non-pharmacological methods.

Until then, he and his team will continue to embrace the challenges of working with chronic pain, helping to bring a little life back, one patient at a time. -SRM

Nurse practiti oner Kathy Reid, gastroe nterologist Rabin Persad and psychiatr ist Heidi Wilk es work togethe r to address medical, psyc hiatric and mental health symptoms of patients at the Stollery Children’s Ho spital pediatr ic abdominal pa in clinic.

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Beyond Simple Cures Community pediatric clinic takes a holistic approach to overcome barriers to wellness There is an ordinary red-brick building in northeast Edmonton where pediatricians are doing extraordinary things for their young patients. The pediatric clinic is a place where disadvantaged Northeast Community Health Centre’s children and youth are seen by physicians who take a 360-degree view of their health to consider the social and economic challenges facing their families.

Physicians take a holistic approach to care and help students and residents understand the social determinants of health.

“If you compare the demographics we see versus all of Edmonton, we have a higher number of new Canadians, families that don’t have English as their first language, a higher proportion of families living in postal codes with lower household incomes, and families with more children,” says Bonnieca Islam, a physician at the clinic and an associate teaching clinical professor. Many families coming to the clinic are refugees, as well.

Islam explains that factors like poverty, language barriers, and previous trauma can all play a role in the child’s overall health and, if not addressed, may hinder treatment. “It’s not like you’re just dealing with a child’s asthma,” she says. “You’re dealing with a child whose family doesn’t have money for medications or food.”

The clinic’s physicians—most of whom are also academic staff with the department—bring up-todate knowledge of the social determinants of health to the table. Because patient needs can be complex, they use every resource at their disposal to overcome barriers to wellness— from the Alberta Health Services’ language service to help translate

other Hopanda and Johanson (left), his m th nd an appointment wi brother Johannis atte Islam, an associate pediatrician Bonnieca sor in the Department teaching clinical profes of Pediatrics.

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Department of Pediatrics, University of Alberta

during patient encounters to the health centre’s emergency department to address urgent needs.

Staff also conduct outreach clinics in outlying areas so that families are seen in their home communities.

The clinic is the only general pediatrics clinic in Edmonton to use Telehealth services to arrange appointments with even more communities, negating the need for families to travel.

Recently, the clinic became a part of the Pediatrics Kids in Care (PKIC) program, which allows them to consider additional information about the many children in government care that they see.

PKIC gives physicians a more complete picture of children’s medical, past and family histories.

By liaising with caseworkers, foster parents, and biological parents (when possible), the clinic learns more about the child’s journey and how the past events in their life may be affecting their wellbeing now. “It’s a more complete approach because knowing more about a child’s past experiences allows us to provide trauma-informed care,” says Islam.

There is also the recent addition of a part-time social worker at the clinic to help families connect with supports like housing and food banks. Even so, Islam and her colleagues often feel the need to advocate for patient families in the community. She recently wrote a letter to a family’s property owner asking them to deal with a cockroach problem that was likely exacerbating their son’s asthma. “We’re not politicians, we’re pediatricians, but we try to do the best we can for families,” she says.

Many of the physicians are also becoming more involved in community-based research in the hope that outcomes can be shared with other stakeholders. On top of their advocacy work, the clinic is teaching the next generation of physicians how to be culturally aware and sensitive, which Islam feels is a crucial part of practicing medicine.

Fortunately, it seems to be an attitude residents share. “I definitely think there’s a new generation of physicians who are genuinely concerned with serving this population and the importance of being culturally sensitive,” she says. -CC

ING

LEARN D N A G N I H C RE FOR TEA

A CENT

Each day, the Northeast Community Health Centre’s pediatric clinic cares for infants and children with complicated health issues who may have even more complex life circumstances. Many are living in poverty, adjusting to life in a new country, coping with the long-term effects of trauma, or struggling in other ways that impact their health. With so many factors to consider in treating patients, the clinic is an ideal place to train the many medical students and physician residents who come through the clinic’s doors each year.

“Our clinic is different from a lot of other clinics because of the many socioeconomic factors that affect the families and kids,” says Bonnieca Islam, a physician at the clinic and an educator in the department. “We’re not seeing healthy babies, healthy checkups. Our students and residents see more complicated cases here,” she explains. This means unravelling the many factors contributing to a child’s health and taking a more holistic approach.

One of the more challenging and common issues physicians see at the clinic are children with

neurodevelopmental issues. These can include learning disabilities, ADHD, and FASD, as well as children who are struggling to learn simply because they are hungry or witnessing violence at home. The clinic also has a high number of patients with speech delays, which can be the result of caregivers being too busy or unaware of the importance of interacting with infants and toddlers through words and songs.

To make correct diagnoses and management plans, physicians need to get to know the patients and families, and sometimes even connect with teachers, social workers, and others in the community. “You have to tease out all of the factors involved,” she says.

And the clinic isn’t just a boon to students and physician residents. Islam points out that learners raise the standard of care for the entire clinic, which ultimately benefits its many young patients. “It’s well shown that clinicians who teach stay more current, just by virtue of learners asking good questions and keeping you on your toes,” says Islam. “And if you keep up-to-date with the latest medical evidence, that’s going to help patients.” -CC

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Up to the Challenge Researchers develop a new tool to help diagnose pneumonia in the developing world It looks as simple as a thermometer, but a new device developed by researchers in the department won $100,000 from Grand Challenges Canada for its potential to save the lives of children.

Worldwide, pediatric respiratory infections claim the lives of hundreds of thousands of children. Pneumonia alone is responsible for the deaths of 900,000 children under-five annually in the developing world where, without x-ray machines or laboratory testing, the only way to diagnose pneumonia is to count breaths—an imprecise method. A systematic review found that diagnosis using respiratory rate is poor and that any clinical

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Department of Pediatrics, University of Alberta

a awarded d a n a C s e g n Grand Challe 0 for the 0 ,0 0 0 1 $ s r e research ition that t e p m o c a in er Multimoment to help s a e id ld o b r s fo pment provides fund lo e v e d d n a h improve healt ter was e m o im lt u M e problems. Th m across o r f s a e id 0 2 one of only funded. e r e w t a h t a Canad

“decision tree” based on one clinical sign alone is unlikely to improve diagnosis or outcomes.

This challenge inspired Israel Amirav, an associate professor and Michael Hawkes, an assistant professor, to develop the Multimometer.

Building on the success of a forerunner, the Respimometer—a thermometer-shaped device that measured both respiratory rate and temperature— the researchers added two more diagnostic features to this simple tool. “Our idea was to develop a simple-to-use, point-of-care device that is used like an oral thermometer but simultaneously measures a child’s key vital signs: respiratory rate, temperature, oxygen saturation and heart rate,” says Amirav.

This diagnostic tool will transform the ability of the community health worker to accurately and efficiently identify pneumonia and other life-threatening conditions. For pneumonia, it will enable early treatment with antibiotics or oxygen as necessary to significantly reduce mortality.

Amirav, who leads the project, will use the grant money to improve the design of the Multimometer mouth interface and to integrate a reflexive pulse oximeter sensor into the device. He is hopeful that the tool will be an impactful tool in global health.

He says, “This is a huge step in advancing care and treatment in the developing world. With respiratory infections the number one killer of children under five years of age, we hope that the Multimometer will become a standard in care in the developing world, especially because it is a simple and cheap device that a community health worker can apply.”

As the research moves forward, Amirav believes that the Multimometer may also have other telehealth applications. “Children or even adults staying in remote areas without access to health care could potentially use it, relay the information to a nursing station that can then decide if their care needs to be escalated, ensuring their health-care needs are met,” he says. –UA

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ealth is ondary mana (like sec otional f these h s l o a p l ic e d e h m m ed care be both n) and e Stanleyects can rine dysfunctio r). In the e t ff Specializ t e e n te y a L L oc de s ago, kin’s and end ss Disor e called for ven year osed with Hodg cancers Traumatic Stre e in s ic y d t e n of M stncer Twe of both as diagn (like Po s, the Institute s hood ca d w d n il s u h k c o c r f o o e y 00 p en’s Madd early 20 rdized follow-u rica, the Childr fter man tion, she becam he A . ent a m e a o e, s adia stand th Am d, treatm r r e e im o t Lymph d iz th N d n e r a h in a t y h d n er at s. Wit e herap r caring loped sta survivor chemot e. Just a teenag e world and liv up deve ing guidelines fo lines for o r G y g h e t e n fr into Oncolo me ed scree ludes tim at high cancerget back e did. She beca o ure-bas -term. This inc t s e r o r e p e x w g e y a was e s, and was hich sh sues the nts long two son for patie for the health is xplains that this n l life—w h d a is a m it h r r , o d B n e g tio r in a rie screenin eloping. Spavo ince early detec for got mar ul Gulf Islands wards, I , r e y v s w e t e r a la om s risk of d nt developmen e beautif t 17 years afte h tter outc t e o b o g t ta to d r ld s o e s u ad mov an imp the fir ing co often le ia. “For e,” at anyth atment s h e r t tr u e c r d n a a a w Columb a nd y. , Stanle sfully un th a blessing a patients monton d o was blis E ic b n to li is c g e which er movin ing at th wrong— years aft routine screen ed w c u fe 8 d A 3 in s s. tion e wa had a ia h s d s k a n r c e n , o she say h a e d s g g Mad -sta me w e be gres ive

early st ag ble ca en, sh other t caught —one of the mo n of trou ds stopped. Th ause, a ig th s t after, an ven s r g r io p n e r o c lo e n n t p The fi e a o m r. N thy e ight and her breast c ung for toms m st cance d cardiomyopa p a e m r y b years old flashes. Too yo s f r o ha When forms some ot red if he that she ow symptoms. d le a having h ddocks wonde erience and did e v t h e tanleyto s test r Ma xp red tha clinic, S had yet e e th h Stanley- to her cancer e or, she discove s f o h k g ts efi ithout a thou d igh ris orr the ben rds: “W o to be relate thing. To her h homa were at h years w s e e uld be c m in o it c leu any n’t m me, I wo ymp s m L e r o o s ’s d e it in u n s online s s k o k g is Maddoc ram to m s of Hod g list of health idelines cts prog survivor dical gu self n e e lo ff m e a d g te n in u la p er fo he also of develo rs like h ctually tment. S ealth of survivo dead.” g a e in tr iv e linic is a d into r c c e e h r e aft e n th u f th g o oo be . “I itoring re e, the aim m childh uld have s before for mon Of cours atients right fro nic’s patients a she sho creenings year . d s e y z a li s a e li s p c h r s e n w e ” y o c r th and re t, a u an to foll many of eaked o rs-old. T he breast c hood, so g as three-yea at and fr regular lt ,s th u 1 d g 1 a h in w it d o n rea ent w s you nts. N a e tm ia n ti in e a o r started p p d e p il . a es ch Leukem made an a mammogram t one of th Acute Myeloid s is k It c e . o li d ld il d r u o a h o s B Ma k fo d out ab osed wit lf month Stanley- physician to as she foun Survivor as diagn t five-and-a-ha apy to destroy , w y e il n li m n fa o r r e her t jus ance thing cer-free chemoth (AML) a ore sleu rta Childhood C ospital, which ined can unds of a o r After m m H e e e r v lb ’s fi s A n a took into hildre thern ut she h the Nor t the Stollery C d cancers well ancer, b ht c ig r e e o a th o th h m d Progra ce. s of chil eeded access to y moved ever sin from the survivor mil en h fa s r e g ins that of the h follows in la z d p li n x a a e e s , R k e . c od do m, Dion s spoke adultho ley-Mad clinic.

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20

Department of Pediatrics, University of Alberta

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Working Wonders | Year in Review

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To Do No Harm Dawn Hartfield leads quality improvement to help patient safety While physicians have always pledged to do no harm, it has only been in the last three decades that patient safety has come to the forefront of medicine.

reluctance of healthcare providers to discuss errors by shifting from a culture of blame to one of a just (or learning) culture.

“In the past, it was only when a child died that a case would be reviewed to make sure nothing needed to improve,” says Dawn Hartfield, an associate professor and an expert in quality improvement (QI) and patient safety. Often, this review involved fingerpointing instead of problem-solving. Healthcare has come a long way since then, she says: “Now we learn from the event and interrogate the system, not people. We look at what it is about the system that’s setting people up to fail.”

When Hartfield isn’t leading QI efforts, she works as a clinician and supervises small teams of medical students and residents providing care to hospitalized children. Practicing medicine and teaching future physicians reminds her of the importance of QI, as well as the need to consider healthcare workers in the decision-making around it. “There’s a temptation for people in boardrooms to make decisions about how healthcare professionals should do their work,” she says. “What I like about being on call and speaking with patients is that I do both, and have a foot in both camps.” -CC

QI has become an integral part of the healthcare system, including pediatrics. Essentially, QI is about implementing changes in a system of care to solve problems that exist. If a patient were to have the wrong limb amputated, for instance, a hospital might decide to have patients write on the appropriate part of their body before surgery. “It’s a little bit like knowledge translation,” she says. “You find best practice and take it into the real world.”

Over the last 15 years, Hartfield has led QI and patient safety initiatives like Child Health Improvement and Patient Safety (CHIPS)—a multidisciplinary team at the Stollery Children’s Hospital. As the Associate Zone Medical Director, Integrated Quality Management for Alberta Health Services’ Edmonton Zone—a role she holds currently—Hartfield led the establishment of the QI system in the zone and continues to support development through training healthcare providers in QI and patient safety.

While QI has become better understood and more widely adopted in the healthcare system, this doesn’t always translate to better outcomes for patients.

Since the late 1990s, the rate of patients harmed while receiving care has remained the same (about 10 per cent). Experts believe that culture is a serious barrier to improvement. “When something goes wrong and people are afraid to talk about it, this perpetuates the same mistakes,” explains Hartfield.

She’s addressing current efforts to change the

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Department of Pediatrics, University of Alberta

Dawn Hartfield has taken on a leadership role in QI as Associate Zone Medical Director, Integrated Quality Management for Alberta Health Services’ Edmonton Zone.

The Science of Improvement A neonatologist is on the front lines of QI research at home and abroad With the health of patients on the line, healthcare providers are always striving for better patient outcomes—from reduced surgical complications to shorter hospital stays and everything in between.

But, as anyone who has ever made a New Year’s resolution knows, it takes more than good intentions to bring about any kind of change. When it comes to changing patient care, quality improvement (QI) provides tools to make lasting change. “It’s foundational,” says Khalid Aziz, a neonatologist and professor. He explains that QI—a concept that comes from industry—is a systematic approach to measuring and analyzing efforts taken to reach goals. “It’s not as important what you improve, it only matters that you’re trying to make that improvement,” he explains.

QI can seem rather mysterious to physicians since, historically, it hasn’t been part of a physician’s training—but Aziz is working to change this. Last year, he began teaching workshops to both resident physicians and faculty ain the department. “It demystifies it and gives them tools to use,” he explains. The program he teaches is called EPIQ (Evidence-based Practice for Improving Quality) and it applies QI principles to healthcare environments.

He leads the team that standardized the educational program during 15 years of multi-centre trials that showed the application of QI could improve outcomes in Canadian neonatal intensive care units.

EPIQ is translatable to any area of healthcare—and any health-are system, he says. Recently, Aziz finished a five-year University of Alberta project in Ethiopia that used EPIQ to enhance the capacity of the health-care system’s newborn and maternal care providers. The project involved teaching rural midwives, nurses, and allied health practitioners skills and knowledge—everything from infant resuscitation techniques to infection control—while training them in QI to ensure the skills would be practiced in the field and passed on to others.

However, QI is ineffective without buy-in from stakeholders and engagement is a big part of the approach. “If everyone believes washing your hands when you enter a baby unit is the most important thing, everyone would be doing it already,” he says.

And large-scale improvements—like reducing maternal and infant mortality rates—can require engaging with an entire healthcare culture.

Khalid Aziz is a champion of teaching and applying quality improvement methods in healthcare environments.

Aziz explains that in Ethiopia, the government has built a large number of healthcare centres to provide safer alternatives to giving birth in the villages. Getting more women out to these clinics has required engaging the entire community in the benefits of giving birth with a skilled birth attendant.

As a result, Aziz has been helping to create a public service announcement in the form of a catchy pop song and music video. “The goal is to start a dialogue in the community about these decisions,” he says. “I think the song has a very powerful message and will be widely played in Ethiopia.” –CC

Working Wonders | Year in Review

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Department Researchers

SCORE BIG

in CIHR Competition

A surprising discovery may lead to new treatments for lowering bad cholesterol Current cardiovascular disease treatments use statins to lower levels of LDL (bad) cholesterol in the blood and reduce strokes and heart attacks by 20 to 40 per cent. While this treatment is effective, Dawei Zhang explains how he and his team are working to find more effective, less expensive treatments.

What is your research project focused on?

We’re taking a new approach to reducing LDL cholesterol in the blood. We all have these proteins in our body, called LDL receptors, that are nature’s way of clearing out bad cholesterol. We recently discovered that another protein in the body (MMP14) interferes with the LDL receptors doing their job. If we can figure out how MMP14 interferes, that can lead to finding a way to block it and allow the body to clear the bad cholesterol more efficiently.

cholesterol that contributes to strokes and heart attacks in humans. I think we can find out within two to three years if this approach will help and then be able to move forward to the next step and start to develop treatment for people.

We think this approach is really promising. It is a novel finding and nobody reported it before, so it’s really exciting.

Dawei Zhang is an associate professor in the Division of Gastroenterology and Nutrition.

Did you suspect MMP14 was interfering, or was this a surprise discovery that led you to want to find out more?

A couple of years ago, we were working on PCSK9, a protein that is very “hot” in cardiovascular research right now. That is when we discovered that this one, MMP14, was interfering with the LDL receptors. We thought, ‘This is interesting, maybe this has potential to be a new therapeutic target to work on?’

Nobody had reported this function of MMP14 before and it’s a really lower function of the protein that we were not looking at specifically, so that’s why we found it by accident.

My lab works on finding ways to reduce bad cholesterol more efficiently, that’s all we do. We start from one point, but we always follow the experiment path when we find something new. And we go after that, if we can.

How will this research help individuals avoid strokes and heart attacks?

Eventually, we will try to validate our findings in different lab models. This will verify the therapeutic potential of MMP14 to help us reduce the bad

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Department of Pediatrics, University of Alberta

Basic science can often seem so far away from impacting individuals, but you are showing a direct path...

Yes, the impact is why discovery research is so important. For pure basic researchers, you have to demonstrate connections to how important your research is, that your discovery today has potential as long as we keep going. We just discovered this by accident and then, eventually, this is leading the way to a future therapeutic to treat human patient’s disease. -JC

Three Departme nt of Pediatrics m embers are shar $2.8 million in 2 ing 018 Canadian In stitutes of Healt (CIHR) project gra h Research nts. Our departm ent success rate competition was in this 17 per cent, high er than both the the University of national and Alberta rates.

Is winning the battle of the bulge—in your heart cells—the answer to tackling heart failure?

Jason Dyck is a professor in the Division of Pediatric Cardiology and director of the Faculty of Medicine & Dentistry’s Cardiovascular Research Centre.

Physicians are usually very good at keeping people alive after a heart attack, but those patients often go on to develop heart failure—when the heart can’t pump enough blood to meet the demands of the other organs. One of the factors that may impact the heart’s ability to keep up is the amount of fat that accumulates in the heart cells, especially if that fat is not burned for energy. This accumulation of fat is dangerous and has shown to lead to poor heart function and heart failure. CIHR funding will help Jason Dyck’s research team find out whether limiting the amount of fat that goes to the heart can decrease the onset of heart failure after a heart attack. –AD

A fascination with fat inspires department researcher’s quest for liver disease treatment Obesity is on the rise worldwide and can lead to a number of health issues including increased risk of heart disease, hypertension, diabetes, cancer, reproductive disorders, mood disorders and fatty liver disease. Fatty liver disease can progress to liver failure and the need for a liver transplant. Currently, there is no effective treatment for fatty liver disease. Richard Lehner’s CIHR funding will take his research on understanding fat metabolism in the body a step closer to his goal of developing a treatment for non-alcoholic fatty liver disease. -JC

Richard Lehner is a professor in the Division of Gastroenterology and Nutrition and associate dean of research facilities in the Faculty of Medicine & Dentistry.

Working Wonders | Year in Review

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Research With Impact Wendy Vaudry is broadening our understanding of how vaccinations affect children Larissa Hamilton was just nine years old when doctors diagnosed her with Acute Lymphoblastic Leukemia. For the next two years and three months, the little girl had round after round of oral, intravenous, and intrathecal chemotherapy to destroy the cancer cells.

The treatments left her with a weakened immune system and, because she couldn’t have immunizations during treatment, her family worried she might fall dangerously ill if she encountered sick kids in the community.

“It was extremely scary,” says her mother, April. If that ever happened—if Larissa was exposed to a child with chickenpox at a birthday party, for instance—she’d have to be whisked away to hospital for immediate assessment.

also unclear how well a child will tolerate a vaccine shortly after cancer treatment, so physicians worry about the risk of adverse effects (which can be anything from a rash or fever to anaphylaxis).

After the treatments ended, the family cheered as Larissa’s health—and her white blood cell counts— improved. “I was looking forward to getting her immunized again and caught up with her classmates so we didn’t have to worry so much anymore,” says April. But they were disappointed to learn that physicians typically waited a year after the end of treatment before vaccinating pediatric cancer survivors.

There are good reasons for this, says Wendy Vaudry, a professor and an infectious diseases specialist at the Stollery Children’s Hospital. For one thing, physicians don’t know how chemotherapy affects a patient’s previous immunity to diseases they’ve already been vaccinated for. “Do we start all over again or pick up where we left off?” she says. It’s

Pediatric infectious diseases specialist Wendy Vaudry (second from right) and nurses Barbara Neufeld (far left) and Christine Bon (far right), discuss research with participant Larissa Hamilton and her father Don. Larissa received early vaccination to study an immunization protocol for cancer survivors.

Impact 26

Department of Pediatrics, University of Alberta

To answer these questions, Vaudry is leading a clinical study supported by the Canadian Immunization Research Network (CIRN). Through the network, her research team recruited a number of child survivors of leukemia—including Larissa— willing to receive early vaccination and undergo blood tests to study the immune system impacts.

This study, which has yet to be published, is one of many vaccine-related research projects Vaudry is involved with. Much of her work is connected with the Immunization Monitoring Program Active (IMPACT)—a national surveillance initiative managed by the Canadian Paediatric Society and conducted by the IMPACT network of pediatric investigators on behalf of and funded by the Public Health Agency of Canada. Vaudry is one of two co-principal investigators leading national efforts to track

adverse events following vaccinations and study their effectiveness in preventing disease.

IMPACT gathers its data from 12 children’s hospitals across Canada (which constitute more than 90 per cent of the country’s specialty pediatric beds), including the Stollery Children’s Hospital. Much of the data on adverse events comes from the reports of physicians and nurses, but the IMPACT team also gathers the data actively. “We check every single admission to the hospital and screen it to find out if it could be related to immunization,” explains Vaudry.

Although very rare, adverse events can happen following vaccinations and the safety of vaccines should never be taken for granted, she argues.

This is especially important when new versions of vaccines are released to the market to protect people from ever-changing diseases like influenza.

IMPACT has been collecting this data for 27 years and it is used by other health researchers.

But Vaudry points out that government also benefits in a big way.

That’s why she now serves as vice-chair of the National Advisory Committee on Immunization (NACI), helping to shape the federal government’s policy decisions about vaccination.

“The exciting thing about immunization research is that it can affect the health of the entire Canadian population, not just individual children,” she says. “It’s nice to see it translated into policy before my very eyes and know that it will affect the health of thousands of children.” -CC

Impact Cont’d Working Wonders | Year in Review

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What’s In the Air? A unique clinic combines healthcare and research to help children with complex health issues related to the environment At the Children’s Environmental Health Clinic (ChEHC), patients come in with a wide variety of complaints— from lingering upper-respiratory infections and bowel problems, to developmental problems like ADHD and autism. “It seems to cover the whole of pediatric issues,” says Irena Buka, ChEHC’s clinical director and a clinical professor in the department.

What all of the cases have in common is a possible link to environmental causes, but no clear treatment plan. Buka explains that, much of the time, patients are experiencing a problem that even the clinic’s doctors have never seen before. “We go to the scientific literature to see if anyone has seen it and written about it.

Sometimes, it isn’t there and we realize this requires completely new research to answer our questions.”

A partnership between the Department of Pediatrics, Alberta Health Services, and Covenant Health, ChEHC isn’t just a clinic where patients come to see a physician: it is also a place of research and public education about the environment’s role in child health. But it is most often the clinic’s patients who drive the selection research projects.

nces owledge and experie kn r ei th e us ts en Graduate stud ith professor es to collaborate w lin ip sc di nt re ffe s and di from y industrial emission ud st to as rg Va oni Alvaro Osor right are Colin es. Pictured left to om tc ou h rt bi e rs Osnat Wine, adve Charlene Nielsen, o, an rr Se s su Je , Bellinger Vargas. and Alvaro Osornio-

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Department of Pediatrics, University of Alberta

The Data Mining and Adverse Birth Outcomes (DoMiNO) project, which began in 2013, is research that explores the connection between industrial emissions and adverse birth outcomes like prematurity and low birth weights. “There has been a lot of literature on traffic-related air pollution, but we’re looking at industrial emissions,” explains PhD candidate and research coordinator Osnat Wine. What makes this research challenging is that there are many thousands of chemicals being released into our air each day—and these chemicals can potentially create millions of dangerous combinations—making it hard to pinpoint which emissions are doing the most harm and to conduct proper studies about their effects. “It’s a very complex research question,” she says.

With so much relevant data to comb through, the DoMiNo team has been using data mining techniques to analyze information about where incidents of adverse birth outcomes are occurring in Canada, the sources of industrial emissions, how weather influences women’s exposures to emissions, and social factors. The project was a team effort involving 24 people from a long

list of disciplines, including computing science, geography, neonatology, obstetrics and gynecology, epidemiology, and knowledge translation.

The project has produced some interesting results, says Alvaro Osornio-Vargas, the project’s lead and a professor in pediatric environmental health.

The team managed to identify just five groups of chemicals likely to be creating most of the harm to babies.

Osornio-Vargas says Wine and the other graduate students were important members of the team and made significant contributions to the project’s success: “We have a very singular, very unique group of students.” He explains that most joined the team as mature professionals bringing significant work experience in their chosen disciplines. “The angle every one of them brought to the problem was fundamental. Without the team’s expertise, and the level of experience the students brought to the team, we wouldn’t have been as successful as we’ve been,” he says. -CC

*World He alth Organ n and Child ization Rep Health: Pre ort scribing Cle an Air

Air Pollutio

Clinic’s WHO designation allows international collaboration Because environmental health is a global concern, its solutions require international collaboration. In 2017, the Children’s Environmental Health Clinic (ChEHC) was designated a Collaborating Centre by the World Health Organization (WHO) following a lengthy application process. “This is a big award because you have to be invited to apply,” explains Irena Buka, who leads the clinical arm of ChEHC. She notes that the formal designation acknowledges ChEHC’s leadership in pediatric environmental health.

The four-year designation has also opened up new opportunities for collaboration with WHO, mostly around how pollution and climate change affect the health of children. Buka co-authored a 2018 WHO report for healthcare professionals and policy makers that takes an in-depth look at air pollution health impact. Says Buka, “There’s a lot of work for us to do, especially in awareness-raising and education—not just for healthcare professionals, but for the public.” -CC

Working Wonders | Year in Review

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HeartsMap A new app may shorten the time required for mental health crisis assessment When a child arrives at the Stollery Children’s Hospital in the midst of a mental-health crisis, the emergency department’s ability to quickly, yet accurately, assess the needs of the patient is key. “We’re confronting how to deal with an influx of patients and utilize our resources the best we can,” says Bruce Wright, associate professor and director of pediatric emergency medicine at the Stollery. Wright and his research team have embarked on a study to determine if an e-health tool called HeartsMap is the answer.

Developed by Quynh Doan—a health services researcher at the University of British Columbia— with input from University of Alberta associate professor Amanda Newton, HeartsMap is an electronic assessment tool that helps guide the care of pediatric patients with mental health symptoms.

Hospitals and clinics across B.C. have been using the app since 2015, and with the U of A’s reputation as a research site, says Wright, the Stollery was a natural choice as the first site outside of B.C. to test the tool.

The goal, says Wright, is to prove that the tool is both useful and easy to use for clinicians and patients alike.

Doan, Wright and Newton secured a Canadian Institutes of Health Research (CIHR) grant in the spring of 2017 and had their research team hired and trained by January 2018. Alongside Wright and Newton, a research co-ordinator, a pool of research assistants and research nurses round out the team.

The Stollery is testing both arms of the tool: HeartsMap, used by trained professionals who run through the survey with incoming patients, collect the data and compare the results to their own assessments; and MyHeartsMap, used by patients themselves. They’re also analyzing the usefulness of the app’s extensive list of local resources, says Newton, for cases where ongoing support in the community is more appropriate than emergency care.

For clinicians, Newton says “The HeartsMap survey can keep you focused and keep the family focused,” shortening the time required for assessment, an invaluable tool in the emergency department. For children entering the emergency department who agree to try MyHeartsMap, “It gives patients a way to

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Department of Pediatrics, University of Alberta

give a voice to some of the stuff that’s going on,” says Newton, providing a way to objectively untangle what can be complex issues.

How will the team know if their study is a success?

The research is still in its infancy, and Newton says that “So far, the success story for Bruce and the division would be the collaborative relationships that we’ve drawn upon to implement this and to make it work.” Wright agrees. “We wouldn’t be able to do this without the team,” he stresses, highlighting both the relationships he and Newton have built through Pediatric Emergency Research Canada (PERC) with colleagues like Doan, and the internal collaborative atmosphere at the U of A. For Wright, who plans to present their findings to PERC to build support for HeartsMap and MyHeartsMap among clinicians nationwide, if practitioners find it helpful enough to adopt in a variety of clinical settings—including as a screening tool during an annual checkup, for example—he’ll know it’s doing what it was meant to do.

Ultimately, says Newton, the biggest success story will be if children can say, “This helped me tell my story.” And if HeartsMap can streamline ER visits and help get families where they need to be faster, “That’s a win for everyone,” emphasizes Wright.

“The best patient care is always what we want,” he says, “and if we can use research to direct care that’s evidence-based, then even better.” –SRM

The Stoller y Children’s emergency Hospital departmen t receives 4 cases of pe ,600 diatric men tal health c risis per year.

Amanda N ewton is als investigato o co-princip r of anothe al r three-yea to address r project new menta l health as tools and a sessment pproaches to care in th e emergency departmen t.

Members of th e HeartsMap research team include (left to right) Mithra Sivakumar, P Candelaria, B atricia ruce Wright, Manasi Rajag opal and (not pictured) Amanda New ton.

Working Wonders | Year in Review

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The Courage to Change Rose Girgis finds inspiration and support in the department to take on medical education leadership roles In 2016, the late Faculty of Medicine & Dentistry (FoMD) Dean Richard Fedorak acted on his vision to develop a policy framework and guidelines that would improve the experience for clinical fellows at the University of Alberta. When the time to choose a leader came, Rose Girgis was ready.

Girgis first came to the U of A from Egypt in 1987, an MD credential in hand. She completed a master of sciences in biochemical genetics in the Department of Pediatrics. Then she went on to residency training in general pediatrics and endocrinology, as well as a research fellowship, eventually joining as academic staff and working her way through several pediatric leadership positions. She began improving fellowship program processes at the department level and made some impressive gains in just one year.

Encouragement from the department chair to expand her experiences, and cast her leadership net wider, made Girgis realize that she was wellsupported to take on a new administrative role and embrace the opportunity of the newly-created FoMD Director of Clinical Fellowships position.

Fellowships are specialized learning experiences outside of the established structure and policies of residency programs. While the freedom and flexibility to create unique learning experiences is attractive, a lack of formal policies and guidance for those involved in the programs can be challenging.

Such was the case, until very recently, with clinical fellowships at most universities across Canada.

“Every institution now is waking up to the fact that we need to have a framework,” she says. “The goal in all of this is to maximize the educational experiences of fellows in a fair environment where they are all well-treated and respected,” she explains. This includes examining everything from application processes, offer letters, funding, benefits and evaluations, to university wellness policies and guidelines for extensions, completions and certificates.

“It takes courage to change the culture,” she says, pointing to the inevitable push back during the first phases of implementation. Nearly three years on, as the new policies roll out, Girgis beams with pride.

“It’s beautiful to see the more organized process and it is important to mention that the department chairs are very pleased now,” she says. “They have guidance, a framework to work with and a person in leadership to go to; I have heard this so much.”

Girgis is quick to honour her mentors and those who offer encouragement or support as she navigates new roles and faces challenges. In addition to the vision of Fedorak and inspiration of department chair Susan Gilmour, Girgis cites FoMD associate dean Ramona Kearney for reminding her to stay focused on the objectives and process, and department Subspecialty Postgraduate Medical Education Program Director Chloe Joynt for contributing as an integral member of the task force that prepared the fellowship policies and guidelines.

Girgis also encourages others to get involved locally and beyond. “You cannot be stagnant, you have to move on to develop your career.” -JC

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Department of Pediatrics, University of Alberta

Rose Girgis, Direc tor of Clinical Fe llowships in the Medicine & Denti Faculty of stry, gains exper ience and experti up for leadership se by steppin roles.

g

Working Wonders | Year in Review

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Guides to Wellness A department committee provides resources to promote professionalism and wellness for faculty members Stress in the workplace is common. We’ve all had those days when the pile of work in front of us seems to get bigger rather than smaller, or we’ve butt heads with other members of the staff—and working in medicine has a whole other set of factors that can add to the stress. While a little bit of stress is natural, too much can easily lead to problems.

“If somebody is stressed all the time, then they may behave in a manner that is not felt as professional,” says Manjula Gowrishankar, associate chair of faculty development.

That’s where the Department of Pediatrics’ Advocacy Wellness Resource Committee comes in. The committee promotes professionalism and mediates issues within the workplace.

As the name implies, the three main goals of the committee are to provide advocacy for faculty members, to provide wellness opportunities, and to educate faculty on the resources available to them—all with the hopes of maintaining a professional and lowstress environment. The Department of Pediatrics is the first in the Faculty of Medicine & Dentistry to have a committee like this.

Gowrishankar formed the committee in February 2016 as part of her role as an associate chair, realizing that the department was large enough to coordinate our own support framework to help faculty members.

The Advocacy Wellness Resource Committee consists of Gowrishankar and four other individuals chosen for their varying expertise. It includes an external member and membership kept intentionally small to help maintain confidentiality of individuals and cases.

The committee uses guidelines and protocols from a number of institutions, including the University of Alberta, the Faculty of Medicine & Dentistry, and Alberta Health Services, to promote professionalism in the office, lab or clinical setting. If problems

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Department of Pediatrics, University of Alberta

occur, any faculty member or graduate student has the option to contact the committee for help.

A committee member is assigned to the case and, along with Gowrishankar, meets with the individual concerned to gather more information. From there, the committee puts a plan of action in place to resolve the conflict and follows up with later meetings to ensure that proper steps are taken.

The other major function of the Advocacy Wellness Resource Committee is to provide educational and wellness opportunities. The committee looks to educate faculty members about the wellness resources available to them, such as psychological or family counseling through the U of A. The committee has also brought in speakers from law firms and the Physician Family Support Program to speak about preventing stress in the work environment. As well, the committee is working on creating lunch and learn sessions for people to come in and talk about strategies to overcome stress and the resources available to them.

“Education, advocacy, wellness—they’re all coming together because we’re getting to the bottom of what’s stressing you,” Gowrishankar says.

Though the committee has only been around for a relatively short time, it has already made great strides in resolving workplace issues before they escalate and connecting faculty members with appropriate support. -AS

“Education, ad vocacy, welln ess—they’re together beca all coming use we’re gett ing to the bott om of what’s stress ing you.”

Manjula Gow rishankar Co mmittee Chai

r

Manjula Gowrishankar (top centre) leads the Advocacy Wellness Resource Committee, the first department in the Faculty of Medicine & Dentistry to formalize a framework to address issues of professionalism and wellness for faculty members. Other members of the committee include (left to right) Sujata Persad, Lorraine Breault, Helly Goez and (not pictured) Allan de Caen.

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Emergency department provides perfect setting for teaching moments A hospital emergency department can be a frenzied chaotic place at times and this may pose a challenging environment in which to teach pediatric residents, however for Aaron Moodley, it’s the perfect setting in which to pass along knowledge. Moodley, a clinical lecturer, realizes this environment might be intimidating for some new learners.

Aaron Moodley transfers his vast experience His insight into teaching garnered him a Top 10 Teachers as a emergency room Award in 2018. “It certainly has been an enjoyable privilege to physician to teaching be involved in medical instruction in some capacity over the learners in the past several years. Being tasked with the proverbial passing department. of the (knowledge) baton is a serious responsibility indeed,” he says. - TV

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.

Academic Faculty Research Paper Award David Eisenstat, Samina Ali Cooperation, Collaboration and Teamwork Recognition Award PICU/PCICU Extracoporeal Life (ECLS) Team Annual Teaching Award by Subspecialty Pediatric Residents Dawn Davies Pediatric Grand Rounds Award Daniel Garros Best Teaching Division Award in Undergraduate Medical Education Division of Gastroenterology and Nutrition Excellence in Undergraduate Teaching Division of Nephrology

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Department of Pediatrics, University of Alberta

Top Ten Teachers Award Mohammad Ansarian Elizabeth DeBruyne Karen Forbes Jessica Foulds Alicja Wladyslawa Janicka Mia Lang Jacqueline Lee Aaron Moodley Jillian Popel Hasu Rajani Excellence in Teaching Award in Community Pediatrics for Undergraduate Medical Education Breanne Frohlich, Isabelle Chapados Best Teacher Award in Community Pediatrics for Undergraduate Medical Education Eileen Estrabillo

Mentor still reaches out for advice for her own career For Janet Ellsworth, mentoring means helping learners understand who they want to be as a person and as a physician. “It’s about helping people identify their strengths and their weaknesses and giving them advice and tools on how to develop in terms of their career,” she says. Ellsworth, a professor in the Division of Pediatric Rheumatology, received the Annual Mentoring Award at the 2018 Department of Pediatrics Faculty Appreciation & Recognition Dinner.

Ellsworth’s career was impacted greatly by her own first mentor, Ross Petty, one of the founders of pediatric rheumatology in Canada. Their mentormentee relationship made her appreciate how important mentoring is as a part of teaching. “I realized that people don’t come in with a fully formed idea of who they are, who they want to be or how they want their careers to develop. A lot of decisions they make about what they want to do come from the experiences of working with people that they want to emulate,” says Ellsworth.

Although she is not part of a formal mentoring program, many learners and colleagues have turned to Ellsworth for advice on how to balance life with career. “One of the most important things I have learned over 31 years in the Department of

Pediatrics, and now try to share with others, is that you have know when to say ‘no’ and when to say ‘yes’ to opportunities that fit with your career and personal goals,” she says.

She also believes Janet Ellsworth, professor that, in order in the Division of Pediatric to be a good Rheumatology, has years mentor, it is of mentorship experience. important to have reflected on your own career first. “You have to have a little perspective. I don’t think everybody can mentor everybody else. To a certain extent, you find the mentor that you need at the time in your life when you need that particular skill set. What people need from a mentor is going to be different at different stages of their life,” she says.

Ellsworth is taking her own advice as she prepares for the next stage of her life—retirement in June 2020—by reaching out to mentors once again and taking their advice. Mentorship continues to have an impact on her career. - TV

Storytelling used as a tool for teaching Isabelle Chapados uses her skills as a storyteller to teach pediatric medical students and residents what they need to know to excel in their careers. In her downtime, when she’s not practicing as a pediatric endocrinologist, she’s writing and illustrating children’s books that focus on their health. Chapados, an associate clinical professor in the Division of General and Community Pediatrics, was recognized for her approach by receiving the Annual Excellence in Teaching Award in Community Pediatrics for Undergraduate Medical Isabelle Chapados, an associate clinical Education in 2018. It’s her third time professor in the Division of General and winning a teaching award. - TV Community Pediatrics, has won three teaching awards from the department.

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Graduate Student Awards AIHS Graduate Studentship LAUREN ALBRECHT PhD Candidate Supervisor - Lisa Hartling Myer Horowitz Graduate Students’ Association Graduate Scholarship 2017/18 NOUREEN ALI M.Sc. Candidate Supervisor - Sujata Persad WCHRI Graduate Studentship NADIA BROWNE PhD Candidate Supervisor - Geoff Ball Alberta Diabetes Institute (ADI) Graduate Studentship KIM HO PhD Candidate Supervisor - Gary Lopaschuk FoMD 2017 Motyl Graduate Studentship in Cardiac Sciences KIM HO PhD Candidate Supervisor - Gary Lopaschuk WCHRI Graduate Studentship MARYAM KEBBE PhD Candidate Supervisor - Geoff Ball 2017 DoP Recruitment Scholarship KHUSHMOL DHALIWAL M.Sc. Candidate Supervisor - Lonnie Zwaigenbaum

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2017 DoP Recruitment Scholarship KELSEA DRALL M.Sc. Candidate Supervisor - Anita Kozyrskyj Profiling Alberta’s Graduate Students Award 2017/18 ASHLEY RADOMSKI PhD Candidate Supervisor - Mandi Newton Government of Alberta Graduate Citizenship Award KHUSHMOL DHALIWAL M.Sc. Candidate Supervisor - Lonnie Zwaigenbaum 2018 Medical Sciences Graduate Program Scholarship NOUREEN ALI M.Sc. Candidate Supervisor - Sujata Persad Queen Elizabeth II Graduate Scholarship - Master’s level (Alternate) 2017/18 KHUSHMOL DHALIWAL M.Sc. Candidate Supervisor - Lonnie Zwaigenbaum FoMD 75th Anniversary Graduate Student Award ANNE HALPIN PhD Candidate Supervisor - Lori West

Department of Pediatrics, University of Alberta

Queen Elizabeth II Graduate Scholarship - Doctoral level 2017/18 MARYAM KEBBE PhD Candidate Supervisor - Geoff Ball 2018 Medical Sciences Graduate Program Scholarship SAMANEH KHANPOUR ARDESTANI PhD Candidate Supervisor - Sunita Vohra 2018 Medical Sciences Graduate Program Scholarship MARIHAN LANSING M.Sc. Candidate Supervisor - Justine Turner 2018 Medical Sciences Graduate Program Scholarship BRITTANY MATENCHUK M.Sc. Candidate Supervisor - Anita Kozyrskyj Queen Elizabeth II Graduate Scholarship - Master’s level 2017/18 BRITTANY MATENCHUK M.Sc. Candidate Supervisor - Anita Kozyrskyj FoMD/AHS Graduate Student Recruitment Scholarship SPARSH PATEL M.Sc. Candidate Supervisor - Georg Schmolzer

A Good Match Pediatric oncology research draws graduate student to University of Alberta Noureen Ali was shortlisted for a prestigious Rhodes Scholarship, while a Fullbright Scholarship tempted her to study in the United States. Instead, she chose a graduate program at the University of Alberta.

Ali completed her undergraduate degree in biological sciences at the Lahore University of Management Sciences in Pakistan. The search to further her studies in this area led her to the U of A Department of Pediatrics associate professor Sujata Persad’s research in colorectal cancer.

“My primary interest has always been the diagnostic aspects of oncology,” says Ali. Working with Persad, Ali’s focus is on osteosarcoma, which disproportionately affects the 13-to20 age group. “Osteosarcoma is quite aggressive,” says Ali, “and in the majority of cases, by the time it is diagnosed, it has already spread to other parts of the body, most commonly the lungs.”

Her project is looking at a potential biomarker that could show the severity of illness and help physicians predict what course of treatment they should recommend when facing osteosarcoma. The prevalence of cancer in society motivates her to contribute research in the areas of regular monitoring and screening for early detection.

Looking ahead, Ali is considering a future in clinical research or public health and experiences in the graduate program have been helpful to focus her career. “After being in the lab, I realize I would prefer an environment that is more patient-centred,” says Ali. “I really like to feel that connection with people.”

Sometimes, she says, on challenging days in the lab, one can become so wrapped up in experiments that it’s easy to forget what it’s all for. “I want to keep the bigger picture in mind, and that is to be able to make a change with the work we are doing.”

Ali’s studies are part of the Maternal and Child Health Scholarship Program (MatCH), a unique opportunity funded by a collaboration between the U of A Office of the Provost, Stollery Children’s Hospital Foundation, and Women and Children’s Health Research Institute.

The program encompasses basic science, clinical, epidemiology and health services research in the departments of medical genetics, pediatrics, obstetrics and gynecology as part of the Medical Sciences Graduate Program. -SRM

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CARDIOLOGY Joseph Atallah Konstantin Averin Angela Bates James Coe Timothy Colen Jennifer Conway Jason Dyck Luke Eckersley Carolina Escudero Lisa Hornberger Michal Kantoch Paul Kantor CRITICAL CARE Vijay Anand Natalie Anton Dominic Cave Alf Conradi Allan de Caen Jonathan Duff Gonzalo Garcia Guerra Daniel Garros Paula Holinski

Nee Khoo Gary Lopaschuk Andrew Mackie Mary Massicotte Angela McBrien Joseph Pagano Richard Schulz Cameron Seaman Edythe Tham Simon Urschel Lori West

Ari Joffe Charles Larson Laurance Lequier Lindsay Ryerson Venkatesan Sivarajan Liliane Zorzela

DEVELOPMENTAL PEDIATRICS Julia Ackland-Snow Carole Hapchyn John Andersen Lisa Lemieux Gail Andrew Matthew Prowse Debra Andrews Carmen Rasmussen Brenda Clark Lyn Sonnenberg Angela Currie Man-Joe Watt Cara Dosman Lonnie Zwaigenbaum Sheila Gallagher Keith Goulden DERMATOLOGY Loretta Fiorillo EMERGENCY MEDICINE Samina Ali Robin Arent Melissa Chan Eddie Chang William Craig Sarah Curtis Andrew Dixon Michele Dyson Mark Enarson Andrea Estey Lisa Evered Martin Gauthier Brent Hanasyk Lisa Hartling Robyn Hutchings Hsing Jou Janeva Kircher

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Manu Kundra Tricia Kutnikoff Shona MacLaughlin Matthew Montgomery Aaron Moodley Maria Oliva Amaly Rahman Andrea Robb William Sevcik Hareishun Shanmuganathan Brandy Stauffer Troy Turner Robert Wright

Department of Pediatrics, University of Alberta

Department Members* Divisional Director Academic Member Clinical Member New Member

ENDOCRINOLOGY Manpreet Doulla Rose Girgis Chelsey Grimbly Andrea Haqq

Mary Jetha Elizabeth Rosolowsky

GASTROENTEROLOGY AND NUTRITION Matthew Carroll Jason Silverman Susan Gilmour Justine Turner Hien Huynh Eytan Wine Patricia Kawada Dawei Zhang Richard Lehner Rabindranath Persad HOSPITAL MEDICINE Karen Forbes Jessica Foulds Dawn Hartfield Jillian Popel

Sunita Vohra Jennifer Walton

Community Heather Leonard IMMUNOLOGY AND ALLERGY, HEMATOLOGY, ONCOLOGY, PALLIATIVE CARE, ENVIRONMENTAL HEALTH (iHOPE) Shairaz Baksh Lesley Mitchell Mark Belletrutti Alvaro Osornio Vargas Aisha Bruce Sujata Persad Catherine CorriveauKumar Ramlall Bourque Mary Schlosser Dawn Davies Maria Spavor Sunil Desai Sneha Suresh Paul Grundy Beverly Wilson Cheryl Mack Yarden Yanishevsky Sarah McKillop Community Stuart Carr Per Lidman INFECTIOUS DISEASES Catherine Burton Sarah Forgie Michael Hawkes Bonita Lee Joan Robinson Rhonda Rosychuk

Timothy Vander Leek

Alena Tse-Chang Wendy Vaudry

GENERAL AND COMMUNITY PEDIATRICS Mohammad Ansarian Melanie Lewis Geoff Ball Kathleen Meier Lola Baydala Robert Moriartey Irena Buka Amanda Newton Bonnieca Islam Jayprakash Patidar Lynn Jacoby Hasu Rajani Wladyslawa Janicka Leigh Wincott Tehseen Ladha Mona Zhang Mia Lang Jacqueline Lee Community Faria Ajamian Olusegun Akinloye Ghassan Al-Naami Kelly Anderson Angela Antoniuk Georgeta Apostol Cecilia Baxter David Berry Charles Bester Michelle Bischoff Edwin Bolster Michael Bowman Jagdeep Brar Isabelle Chapados Rehana Chatur Thea Chibuk Mark Davidson Elizabeth DeBruyne Indra Dhunnoo Lionel Dibden Gordana Djordjevic Julia Drager Heather Dreise Georgina Driedger Abdelbaset Elsawiniya Eileen Estrabillo Christopher Ewing Elsa Fiedrich Breanne Frohlich Samy Galante Josias Grobler Evan Harris Michele HarveyBlankenship Carol Hodgson Abbeir Hussein Christine Kyriakides Scott Lappa Kan Lee Joan Lopatka Anna Malanowska Ben Malinowski Tami Masterson

*appointments at 2018-06-04

Lyle McGonigle Kyle Mckenzie Athar Mian Fateh Mohammed Sadia Nakhuda Fareeha Nasir Viktoria Pankiv Stephanie Pau Erika Persson Patrick Pierse Darlene Pon Edward Rabinovitch Djordje Radisic Munira Ramji David Roseman Neel Saini Darcy Scott Joel Semeniuk Raphael Sharon Lois Sim Carrie Slatter Kelly Stevens Geeta Sukhrani Waldemar Szymanski Reza Taghipour Kiran Talwar Johnny Teoh Kellie Waters Ken Wong Sam Wong Dawn-Ellen Young

NEONATAL-PERINATAL CARE Dalal Abdelgadir Marc-Antoine Landry Khalid Aziz Robert Lemke Paul Byrne Abraham Peliowski Po-Yin Cheung Ernest Phillipos Sylvie Cormier Mosarrat Qureshi Santiago Ensenat Amber Reichert Sandra Escoredo Georg Schmolzer Matthew Hicks Jonathan Stevens Abbas Hyderi Jennifer Toye Chloe Joynt Juzer Tyebkhan Ijab Khanafer-Larocque Michael van Manen Manoj Kumar Dianna Wang Vazhkudai Kumaran NEPHROLOGY Abdullah Alabbas Todd Alexander Manjula Gowrishankar NEUROLOGY Francois Bolduc Helly Rachel Goez Janani Kassiri Hanna Kolski Francois MorneauJacob John Neilson

Catherine Morgan Verna Yiu

Thilinie Rajapakse Lawrence Richer D. Barry Sinclair Richard Tang-Wai Jerome Yager

RESPIRATORY MEDICINE Israel Amirav Allison Carroll Maria Castro Codesal Elizabeth Hicks Tamizan Kherani Anita Kozyrskyj

Joanna MacLean Carina Majaesic Piushkumar Mandhane Manisha Witmans Peter Zuberbuhler

RHEUMATOLOGY Janet Ellsworth Lillian Lim

Dax Rumsey

Leadership Department Chair: Susan Gilmour Associate Chair Clinical Affairs: Carina Majaesic Faculty Development: Manjula Gowrishankar Associate Chair Medical Education: Jennifer Walton Associate Chair Research: Gary Lopaschuk

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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 (AHS) is Canada’s first and largest province-wide, full-integrated health system, responsible for delivering health services to residents of Alberta. Learners from Alberta’s universities and colleges, as well as those outside of Alberta, receive clinical education in AHS facilities such as the Stollery Children’s Hospital and various community locations.

The Stollery Children’s Hospital partners with the 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 Stollery Children’s Hospital Foundation raises money for specialized equipment, subspecialty 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 Foundation recognizes the tremendous impact education and research has on disease prevention, treatment and improved health outcomes, which is why it invests more than $1.25 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.

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Department of Pediatrics, University of Alberta

The Women and Children’s Health Research Institute is a partnership between the University of Alberta and Alberta Health Services, with core funding for pediatric research from the Stollery Children’s Hospital Foundation and women’s health research from supporters of the Lois Hole Hospital for Women.

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.

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

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

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Department at-a-glance 2017-2018

Second-largest department

at the University of Alberta

142

$80M

ANNUAL OPERATING & RESEARCH FUNDING

ACADEMIC FACULTY

16

150

CLINICAL COLLEAGUES

DIVISIONS

62

geographic catchment area for pediatrics

HELD BY DEPARTMENT PRINCIPAL INVESTIGATORS (PIs)

1263 PAPERS PUBLISHED THIS YEAR

SUPPORT STAFF

Largest

CIHR GRANTS

CIHR FOUNDATION GRANTS

234 in North America

60+

4 13

SPECIALIZED PEDIATRIC CARE PROGRAMS

Royal College of Physicians & Surgeons of Canada accredited programs

48

GRADUATE STUDENTS

105

28

POSTDOCTORAL FELLOWS

RESIDENTS AND FELLOWS

Quaternary clinical programming for cardiac science & transplant medicine