UAlberta Medicine - Vol 1, Iss 2 by University of Alberta Faculty of Medicine & Dentistry

HELPING PATIENTS

TAKE FULLER BREATHS P. 28

CONNECTING AMPUTEES TO

PROSTHETIC TECHNOLOGY P. 19

INTRODUCING THE WHITE KNIGHTS:

THE ALUMS OF 1963 P. 32

UALBERTAMEDICINE VOL. 1 ISSUE 2

EDUCATING. DISCOVERING. IMPROVING LIVES.

ANSWERING ALBERTA'S CALL FOR HEALTH FAMILY MEDICINE TAKES THE LEAD P. 14

STOPPING THE 'CARE GAP' SELF–HEALTH EXPERT EXPLAINS PREVENTATIVE CARE P. 43

SMART-E-PANTS Hardwired to save lives P. 22

101 YEARS OF MEDICINE MOVING FORWARD INTO A NEW CENTURY

FACULTY MESSAGE

THIS FACULTY MUST TRAIN, RECRUIT AND RETAIN THE BEST YOUNG FACULTY MEMBERS POSSIBLE. IN ITS QUEST FOR REJUVENATION, WE WILL PURSUE EVERY OPPORTUNITY, PRESS EVERY ADVANTAGE AND ACCEPT NOTHING LESS THAN EXCELLENCE.

UALBERTAMEDICINE

HANK YOU for reading our first issue

of UAlberta Medicine. The publication’s goal is to share with you our stories of teaching, research and clinical care excellence. We are often asked to outline a big picture vision for the faculty. But for us and others, the trees often obscure the forest. The trees at our medical school have included accreditations, health authority reorganizations, national research schemes and provincial budget cuts, to name just a few. But leaders see only forests. Martin Luther King Jr. promised a mountaintop. Peter Lougheed saw a rawboned province coming of age. Wayne Gretzky won Stanley Cups skating where the puck wasn’t. This is called vision. This faculty’s forest is its youth—our tactic is purposeful rejuvenation. Forty-something faculty members are in the prime of their academic careers. They win 3M National

Teaching Fellowship awards. They successfully compete for CIHR operating grants. These people are our future, our greatest resource, our energy reserves. This faculty must train, recruit and retain the best young faculty members possible. In its quest for rejuvenation, we will pursue every opportunity, press every advantage and accept nothing less than excellence. When we are successful, this faculty will play a critical role in readying our resurgent city of Edmonton for the health problems associated with rapid growth, steeling this great province of Alberta for the aging of its diverse peoples, while defending the world from the global threats of viruses, overpopulation and obesity. Memories are created through a shared vision for success. With this vision, our faculty presents to you UAlberta Medicine, where our stories resonate. UAM

PHOTOGRAPH COURTESY STEPHEN WREAKES, ALBERTA HEALTH SERVICES

Contents

Vol. 1 Issue 2

Features 16 Cancer Researcher Lets Curiosity Lead Dr. Lynne-Marie Postovit challenges conventions as one of the world’s foremost cancer researchers. BY CAITLIN CRAWSHAW

19 The Bionic Woman Dr. Jacqueline Hebert is at the forefront of prosthetics technology. BY BEN FREELAND

28 Rural Alberta’s Breathing Advantage Living in a rural area no longer means having to suffer from chronic obstructive pulmonary disease, thanks to Dr. Michael Stickland. BY AMY HEWKO

32 The White Knights The MD Class of ’63 makes a powerful statement of support for MD students. BY JANET HARVEY

22 Cover Story Dr. Vivian Mushahwar has been working for years to develop a device that could alleviate the pain and suffering that comes along with pressure ulcers. She’s succeeded and millions of lives could be saved. BY JANET HARVEY

32 A Higher Purpose Dr. Sarah Forgie's commitment to excellence places her among Canada's top teachers. BY FACULTY STAFF

Dennis Ross, 36, relaxes at the cover photo shoot with two of his three children, Jaxyn, eight, (right) and Nate, four-and-a-half (front).

UALBERTAMEDICINE

CONTENTS

Editor-in-chief Dr. D. Douglas Miller Dean, Faculty of Medicine & Dentistry deanmiller@ualberta.ca

37 Life In the Fast Lane Pediatric research pair deftly manages work-life balance.

Managing editor Jo-anne Nugent Executive director, strategic support, Faculty of Medicine & Dentistry jo-anne.nugent@ualberta.ca

BY AMY HEWKO

43 Beyond the Prevention Paradox Patient-health management scholar Dr. Sumit Majumdar is making the idea of preventative medicine a reality for Canadians.

Senior writer/editor Cait Wills Faculty of Medicine & Dentistry cait@ualberta.ca Art director/designer Paige Weir paigeweir.com

BY FACULTY STAFF

45 University Cup Winner’s Heart in the Right Place Esteemed cardiologist, scientist and teacher exemplifies excellence. BY ROSS NEITZ

DEPARTMENTS First Words 5 Tracking the Secrets of Cancer Dr. John Lewis monitors cancer cells with an aim to pioneering visualization techniques. 6 Giving The Breath of Life to Infants Resuscitation techniques for newborns have been re-evaluated, thanks to work by two faculty scientists. 8 Leading Canada's Organ Transplant Program Faculty of Medicine & Denistry clinician scientist unites the country's top reasearchers to help Canadians waiting for live-saving organs. 10 Great Science = Better Health Three researchers have been recognized for their “demonstrable advancements in medicine” with Canada Research Chairs. 11 Targeting Obesity and Diabetes The Canadian Institutes of Health Research has recognized two faculty researchers with significant financial support. 12 Two for the Rhodes Two Rhodes Scholars convocate together for the first time in the faculty's 101-year history. 14 Answering Alberta’s Call for Health A record number of medical graduates are choosing family medicine, recent numbers show.

CONTRIBUTING WRITERS Michael Brown, Caitlin Crawshaw, Ben Freeland, Janet Harvey, Amy Hewko, Ross Neitz, Lawrence Richer, Susan Ruttan, Cait Wills CONTRIBUTING PHOTOGRAPHERS Curtis Comeau, Jessica Fern-Facette, Adam Goudreau, Timothy Greenfield-Sanders, Amy Hewko, Ian Jackson, Mico Livingston-Beale, Dwayne Martineau, Codie McLachlan, Bryce Meyer, Aaron Pedersen, Richard Siemens, Curtis Trent, Eugene Uhuad, John Ulan CONTRIBUTING GRAPHICS Patrick von Hauff PRINTER Capital Colour Edmonton, AB www.capitalcolour.com

ABOUT The Faculty of Medicine & Dentistry at the University of Alberta is a leader in educating and training exceptional practitioners and researchers of the highest international standards. The faculty’s mission is to advance health through excellence in teaching, research and patient care. It is home to one of the top 100 ranked medical schools in the world. For more information, please visit www.med.ualberta.ca. Faculty of Medicine & Dentistry 2J2.00 WC Mackenzie Health Sciences Centre Edmonton, Alberta, Canada T6G 2R7

The Last Word 47 The IT Factor in Health Care The marriage of technology and health care is a rocky one, says faculty IT expert. UALBERTAMEDICINE

No part of this publication may be reproduced without the explicit permission of the publisher, the Faculty of Medicine & Dentistry at the University of Alberta. Please direct all reproduction inquiries to meddent@ualberta.ca Copyright © 2014

Helping Parents Breathe Easy P. 6

FIRST WORDS

Grads Gravitate to Family Medicine P. 14

Top Faculty of Medicine & Dentistry Cardiologist Leads National Transplant Research Program P. 8

TRACKING CANCER’S SECRETS

Dr. John Lewis is monitoring cancer cell movement with the goal of obliterating tumour growth before metastasis. BY ROSS NEITZ

Dr. John Lewis points to a video on his com-

puter screen. In it, hundreds of small cells can be seen winding their way through a blood vessel, seeking a foothold on the surrounding tissue. While small and innocuous now, the cells are deadly. They are cancer. This movement of tumour cells is part of the process leading up to metastasis, or the spread of cancer from one organ to another. According to Lewis, an associate professor in the Department of Oncology and the Sojonky Chair in Prostate Cancer Research, it is vital researchers learn more about cancer cells. “We hear a lot about cancer and diagnosis, but really when we think about who succumbs to the disease, 90 per cent of patients who die of cancer have metastasis. So it is metastasis really that is the deadliest aspect of cancer.” The video capture of the spread of tumour cells is an innovation pioneered by Lewis’ research team, giving them a window into how the cells move around the body in real time. That technology has now also provided, for the first time, an in-depth look at how the cells attack the tissue from the bloodstream in order to form a new tumour—a process called “extravasation”. Lewis says his team wasn’t expecting what they found. “Tumour cells would get stuck in these organs in the blood vessels and they

IT’S A FACT IN THE FIELD OF CANCER, MEDICATIONS PROVIDED TO PATIENTS IN CLINICAL TRIALS AT THE FACULTY OF MEDICINE & DENTISTRY SAVE THE PROVINCE ALMOST $5 MILLION IN DRUG COSTS ANNUALLY. To learn more about cost savings through the faculty, go to www.uab.ca/ualbertamedicine.

PHOTO COURTESY DR. JOHN LEWIS

med.ualberta.ca

FIRST WORDS

DISCOVERY PAVES THE WAY FOR PERSONALIZED PROSTATE CANCER TREATMENT Dr. John Lewis is unlocking the secret to prostate cancer, having recently led research on the “key” to personalized cancer treatment through screening technology. These keys are biomarkers, he says, that may help identify unique strings of amino acids that recognize a patient’s cancer cells, which could then allow for specialized treatment through targeting just the cancer cells, instead of the surrounding healthy ones too. But each adapted drug needs to be evaluated with clinical trials, cautions Lewis. However, “cancer research and treatment is headed in the direction of personalized medicine, so the approval process may become more streamlined in the future.”

GIVING INFANTS THE BREATH OF LIFE Two Faculty of Medicine & Dentistry researchers are turning the ABCs of infant resuscitation on its head. BY ROSS NEITZ

would move around a little bit, and then they would stop and project these little fingers out of the tumour cell.” Those fingers are called invadopodia, and according to Lewis, it’s the first time they have been seen in cancer in a live model. The video evidence shows they are necessary for extravasation, as the entire tumour cell eventually follows the invadopodium out of the bloodstream and into the tissue. “It was one of those eureka moments that you don’t get very often,” says Lewis. “You cherish it as much as you can.” The findings may hold important implications for the future treatment of cancer. Lewis says his work shows the invadopodia can be inhibited pharmaceutically, stopping tumour cells from escaping the bloodstream and blocking the process of extravasation. According to Lewis though, the treatments may only have clinical use in very specific situations. Most often, by the time many cancers are diagnosed, metastasis has already occurred in the body and it’s too late to prevent extravasation. But the U of A scientist says the treatments could be extremely useful if applied during surgical procedures. “There is emerging evidence, and it’s scary evidence, that potentially these procedures can facilitate the spread of [cancer] cells,” explains Lewis. “After surgery some cells may be shed off the tumour and be circulated around the blood stream, and evidence suggests that there is an increased chance that these patients may develop metastatic disease somewhere down the road. So there might be a role for these kinds of treatments during surgery or after a biopsy to prevent metastasis.” Lewis says much more study is needed looking into the components of invadopodia, as well as work to develop targeted drugs that can inhibit it without causing broad side effects for the patient. He believes if there is a chance in the future to cure or block metastasis, fully understanding extravasation is a critical part. A part Lewis hopes his work plays a starring role in. “Hopefully in 20 years, looking back, we’ll appreciate how significant [this discovery] is.” UAM UALBERTAMEDICINE

or parents, the work being done

by researchers Dr. Po-Yin Cheung and Dr. Georg Schmölzer could not be more meaningful. Cheung and Schmölzer’s efforts are focused on the resuscitation of newborn babies—and their latest findings, being tested in a clinical trial in Edmonton, have already helped save the lives of eight infants. “The first time I saw it, I was excited,” says Schmölzer, an assistant professor in the Department of Pediatrics. “It was the greatest thing.” The life-saving work has re-imagined how to best resuscitate newborns just minutes after their birth. Every year, hundreds of thousands of babies around the world die after resuscitation efforts fail. Finding a way to save them has become a top-10 research priority in Newborn Health of the World Health Organization. According to Cheung, a professor in the departments of pediatrics, pharmacology and surgery, the new resuscitation method he and Schmölzer have pioneered may offer a solution. “In our highly translatable clinical model, the survival rate with this new method is close to 90 per cent, compared with a 35 per cent survival rate using the conventional model.” Resuscitation is needed for about one in

Drs. Georg Schmölzer (left) and Po-Yin Cheung work with an infant model to demonstrate their groundbreaking pediatric resuscitation research at the Faculty of Medicine & Dentistry at the University of Alberta in Edmonton.

HUNDREDS OF THOUSANDS OF BABIES AROUND THE WORLD DIE AFTER RESUSCITATION EFFORTS FAIL. FINDING A WAY TO SAVE THEM HAS BECOME A TOP-10 RESEARCH PRIORITY IN NEWBORN HEALTH OF THE WORLD HEALTH ORGANIZATION. every 1,000 babies who are delivered at term, and more often at preterm. The standard method involves providing the ABCs (airway, breathing, circulation) to infants in steps. Health workers give the newborn three chest compressions followed by a rescue breath, and repeat as needed. In the new method being tested, Cheung and Schmölzer have neonatal hospital staff combine all the steps into one. Rather than timed rescue breaths, oxygen flows constantly into the baby’s lungs while health workers give continuous chest compressions until the baby’s vital signs reach safe thresholds. “The slower that you get the heart rate

back, the more injury or damage occurs to the body—especially the brain—and the lower the chance that you get the baby resuscitated,” says Cheung. “In our test model, it shortened the resuscitation time by two thirds.” Schmölzer adds, “The feedback from the nurses afterwards was, ‘That was so much easier than what we normally do.’” The current clinical trial taking place in Edmonton is studying the results of the technique on 20 babies. Once it ends, the researchers plan to begin a larger clinical trial in centres across Canada and Europe. After that, if results continue to be positive, it would lead to a worldwide multicentre trial that

PHOTOGRAPHY BY CODIE MCLACHLAN/EDMONTON SUN/QMI AGENCY

could then lead to guidelines being changed around the world. Both researchers plan to continue their work refining the new technique. Schmölzer’s efforts have also been given a recent boost, after he was given the Heart and Stroke Foundation/University of Alberta Professorship in Neonatal Resuscitation, an appointment that comes with a three-year operating grant of $100,000 a year to help support research. “I’m really excited about it,” says Schmölzer. “The project we put forward is to investigate more about the new resuscitation technique. We continue to do lab research on it to identify the best methods.” With the chance to make a difference in millions of lives around the world, Cheung and Schmölzer say they are ready to continue the work—providing infants and their families the gift of life. UAM med.ualberta.ca

Dr. Lori West has been selected to head the Canadian National Transplant Research Program, the first program in the world to unite and integrate research communities.

FIRST WORDS

LEADING CANADA’S ORGAN TRANSPLANT PROGRAM Faculty of Medicine & Dentistry clinician scientist unites the country’s top researchers to help Canadians waiting for life-saving organs. BY JANET HARVEY

hen Adelaide Radbourne was waiting for a

heart transplant, her mother Chloe felt absolutely powerless. “It was honestly the most humbling experience of my life,” she remembers with emotion. “To wonder every day whether your child was going to live, and to know that the only solution was to wait for another child to die.” The national announcement that Dr. Lori West, a clinician scientist from the Faculty of Medicine & Dentistry, is leading Canada’s new organ transplant research program, came as good news to the Radbourne family. Adelaide received her heart transplant at the Stollery Children’s Hospital at the age of six months. Today, the four-year-old is a “busy, bossy, loving little girl”—a preschooler, budding ballerina and soccer player. The Radbournes must still travel from their Grande Prairie home to Edmonton every three months to meet with Adelaide’s organ transplant team, and Adelaide will need immunosuppressant drugs for the rest of her life. But according to Chloe, it is a small price to pay for the miracle of her daughter’s new heart, and she is optimistic that a new national transplant research program will help pave the way for more families across Canada to experience miracles like Adelaide’s. West, interim director of the faculty’s Alberta Transplant Institute and the cardiologist who first treated Adelaide and helped prepare her for transplant, will lead the Canadian National Transplant Research Program, which is designed to increase organ and tissue donation in Canada and enhance the survival and quality of life of Canadians who receive transplants. Several other faculty UALBERTAMEDICINE

IN 2010, NEARLY ONE QUARTER OF CANDIDATES FOR HEART AND LIVER TRANSPLANTS DIED WITHOUT RECEIVING TRANSPLANT SURGERIES. IN ADDITION, 40 PER CENT OF PATIENTS WITH LEUKEMIA OR OTHER BLOODRELATED DISEASES WERE WITHOUT BONE-MARROW DONORS.

researchers are also part of this national research network: Dr. James Shapiro will lead a project on “ex vivo organ transplant protection and repair,” while Tim Caulfield heads a project called “ethical, economic, legal and social (EELS) issues in transplantation.” The program brings together 105 investigators and 86 collaborators from across the country to carry out research and develop resources to help Canadian transplant patients and those waiting for tissue or organ transplants. ENORMOUS POTENTIAL TO IMPROVE LIVES

“This is a unique initiative,” said West. “We’ve never had a transplant-specific program with the potential to affect the lives of so many people suffering from malignancies and end-stage organ failure. The impact of transplantation as a field to Canadians with severe and chronic diseases is enormous.” That potential is borne out in the statistics: 4,500 Canadians are on waiting lists for organ transplants and many of these people will die before receiving one. In 2010, for example, nearly one-quarter of candidates for heart and liver transplants died without receiving transplant surgeries. In addition, 40 per cent of patients with

DID YOU KNOW?

Every kidney transplant performed saves the health system more than

$60,000

per year.

PHOTO COURTESY FOMD

IT’S A FACT

THE MULTI-ORGAN TRANSPLANT PROGRAM IS ONE OF THE MOST COMPREHENSIVE CLINICAL PROGRAMS IN CANADA. To learn more about how programs like these are making an impact, go to www.uab.ca/ualbertamedicine.

leukemia or other blood-related diseases were without bone-marrow donors. The economic impact of transplantation is also extraordinary. For example, every kidney transplant performed saves the health system more than $60,000 per year. A WORLD FIRST, DISTINCTLY CANADIAN

The new program will transform the field of transplantation by addressing barriers to donation, therefore increasing the number of available organs, improving the quality and viability of donated organs and grafts, and improving long-term survival and quality of life among transplant patients. It is the first program in the world to unite and integrate the research communities related to solid organ transplants, bone marrow transplants, and donation and critical care in a national research endeavour. West noted that the CIHR panel that provided peer review for the proposal called the program uniquely Canadian, an innovative approach to enhancing a national transplant system that would be difficult to achieve anywhere else. ‟One of the key strengths of this proposal is that every part of Canada—involving different researchers, sociologic fields, emerging researchers and

THE PROGRAM REPRESENTS AN INNOVATIVE APPROACH TO ENHANCING A NATIONAL TRANSPLANT SYSTEM [AND IS TRULY ORIGINAL].

established researchers—is a part of this consortium,” the review stated. “It would be difficult to gather such an accomplished and collegial group of people in any other country. The program represents an innovative approach to enhancing a national transplant system and is truly original.” The Canadian National Transplant Research Program will receive more than $23 million in funding. This includes $13.85 million from CIHR in partnership with Canadian Blood Services, Canadian Liver Foundation, Cystic Fibrosis Canada, Fonds de recherche du Québec Santé, Genome British Columbia and the Kidney Foundation of Canada. The program has raised an additional $10 million from other partners including industry, transplant centres, other universities and organ procurement organizations from across the country. UAM

A TIMELINE OF IMPACT: DIABETES AND THE CURE T

he evolution of what has been

called a “full cure” for Type 1 diabetes, the Edmonton Protocol, began as the brainchild of Dr. Ray Rajotte more than 40 years ago in what was then the University of Alberta’s Surgical Medical Research Institute. After years of research and the development of the purification and cryopreservation of islets, the Islet Transplantation Group was founded by Rajotte in 1982. It consisted of Drs. Rajotte, Garth Warnock, Norman Kneteman and Edmond Ryan. In 1987 Rajotte and his team received permission to begin islet transplantation in

human clinical trials in Edmonton, and in 1989 the first human islet transplantation procedure in Canada was completed by the Islet Transplantation Group. That same year, the first liver transplant at the University of Alberta was performed by Kneteman. Nine years later, Dr. James Shapiro traveled from England to do a transplant fellowship and PhD in experimental surgery and was recruited to the foundation as the director of the clinical islet transplant program. In 2000, Shapiro pioneered the Edmonton Protocol, which was announced in the New England Journal of Medicine as increasing islet transplant success rates from eight per cent to

100 per cent at the one-year mark. By 2006, more than 550 patients had been treated by the Edmonton Protocol in approximately 50 clinic centres around the world. Shapiro is the director of both the clinical islet transplant program and the living donor liver transplant program. The centre, located in the Alberta Diabetes Institute and headed by Dr. Norman Kneteman, celebrated its 1,000th liver transplant in 2014. The Alberta Diabetes Institute opened its doors in 2007 and is the outcome of the collaboration of University of Alberta faculty member Dr. James Collip who, with Drs. James Banting, Charles Best and John MacLeod, discovered insulin in 1921. A young Dr. Ray Rajotte was recognized in 1978 for his PhD thesis—which showed islets in animal models could be successfully cryopreserved—by Dr. George Molnar, who was recruited to the University of Alberta to spearhead diabetes research. UAM med.ualberta.ca

FIRST WORDS

GREAT SCIENCE = BETTER HEALTH Faculty of Medicine & Dentistry researchers are making a difference in life-saving treatments, thanks to important funding through the Canada Research Chairs program.

JAMES SHAPIRO

Transforming transplants through regenerative medicine Tier 1 Canada Research Chair in Transplant Surgery and Regenerative Medicine

BY FACULTY STAFF

The Canada Research Chairs (CRC) is a program of the Federal Government of Canada with the intention of recruiting and retaining the world’s best researchers. Each year the federal government invests approximately $265 million to help facilitate research excellence. The Faculty of Medicine & Dentistry houses 26 of those researchers, whose goal is to directly improve health outcomes through research excellence. In March 2014 three members of the faculty of were recognized for their “demonstrable advancement of medical research.”

Organ transplantation is life-saving and cost effective, but transplantable organs remain in short supply. Dr. James Shapiro aims to increase the quality and number of donor organs using ex vivo “life support,” and explore regenerative medicine stem-cell technologies for curative treatment of diabetes. Protecting and even repairing donated organs could decrease injuries related to organ recovery and transport, leading to a substantial increase in the supply of organs suitable for transplantation. Shapiro will also build on progress made in cellular transplantation of human beta cells, which could have a huge impact on the curative treatment of diabetes.

MARK GLOVER

GAVIN OUDIT

Defending DNA from damage Tier 1 Canada Research Chair in Structural Molecular Biology

New heart failure therapies are desperately needed, and Dr. Gavin Oudit is taking several novel approaches to drug discovery and its application to patients by using the human explanted heart program (HELP) at the Mazankowski Alberta Heart Institute as a bridge for cardiovascular medicine, focusing on patients rather than laboratory models. This approach is aimed at translating discoveries to help people live better and longer lives.

Human DNA is under constant attack from a bewildering array of environmental factors, from chemicals to radiation. To protect genetic information, all living things have evolved ways to find and repair DNA damage—the primary defence against DNA mutations that cause cancers. When these systems are compromised through inherited genetic mutations, it’s often linked to hereditary cancer risks—the best known of these is the protein BRCA1, associated with breast and ovarian cancers. Dr. Mark Glover uses protein imaging to reveal how BRCA1 and other proteins function as a DNA defender. He is now looking at finding new ways to inhibit tumour growth by selectively targeting DNA repair systems in cancer cells. UAM

Discovering ways to treat heart failure Tier 2 Canada Research Chair in Heart Failure

UALBERTAMEDICINE

IMAGES COURTESY OF RICHARD SIEMENS, UNIVERSITY OF ALBERTA

Drs. Sandra Davidge (left) and Dennis Vance (right) are two recipients in the Faculty of Medicine & Dentistry who received funding in 2014 from the Canadian Institutes of Health Research (CIHR).

TARGETING OBESITY AND DIABETES

Forty years of investigating ways to free society of an epidemic.

BY MICHAEL BROWN

r. Dennis Vance, a Distinguished

University Professor and researcher in the Department of Biochemistry, has received more than $1.2 million for five years from the Canadian Institutes of Health Research (CIHR) to look at a particular mechanism in the liver that has the potential to protect against obesity, Type 2 diabetes and cardiovascular disease. Vance says the funding is a renewal of a grant he has held continuously since 1974. “The research I initiated 40 years ago was trying to understand what regulates the manufacture of a molecule (a membrane lipid called PC) in all cells of our bodies. It was basic research on an important topic in biology. “Little did we realize that this fundamental research would lead us into developing a treatment for obesity and Type 2 diabetes,” he says. In recent years, Vance’s research group has discovered that an enzyme (PEMT) that makes PC is a very good target for drug therapy as a treatment for obesity and diabetes, two major health issues in Canada. And while Vance says the reliability of different research funding streams has become a concern recently, he says he is thankful for the ongoing support of the federal government. “The support, for which I am very grateful, allowed me to focus on fundamental research and attract talented graduate students and postdoctoral fellows,” he said. “This research will permit new discoveries and applications

that we cannot predict at the present time.” Another Faculty of Medicine & Dentistry scientist received CIHR funding in 2014: Dr. Sandra Davidge, a researcher in the departments of obstetrics and gynecology, and physiology, for a pair of projects relating to the long-term health of offspring. “When we look at health around birth, whether during pregnancy or at the time of birth, we’re not looking at that short nine months or what happens when the neonate is born, but what really has an impact on long-term health,” she says. One project looks at improving cardiovascular dysfunction in offspring who suffered from poor fetal growth in the uterus. The other looks at better understanding the mechanisms behind pregnancy complications at an advanced maternal age. “How you develop as a fetus and then as a post-natal infant will dictate your risk factors for chronic disease,” said Davidge, who is the director of the Women and Children’s Health Research Institute at the U of A. “If we can have better pregnancy outcomes, we can have healthier long-term benefits as they relate to chronic disease. It’s not just about women’s and children’s health; it’s about women’s and children’s health that leads into healthy populations.” Davidge says the critical mass of expertise of faculty and students who come through, as well as the infrastructure afforded her at the

IMAGE COURTESY OF RICHARD SIEMENS, UNIVERSITY OF ALBERTA

U of A, are second to none, and wouldn’t be possible without CIHR funding. “The impact of the CIHR is critical because we live on grants,” she said. “The only way I can do research is through grant funding; there is no other way to get it done. The success of these grants means the research can be done and would not have been possible without it.” Dr. David Evans, vice-dean, research, noted that CIHR funding like this is often used as a metric to compare Canada’s medical schools. “Drs. Davidge and Vance are just two of our researchers who, in 2014, will collectively generate $32 million per year in CIHR funding to support the faculty’s $201 million research enterprise,” he says. “This funding is very difficult to obtain (less than 15 per cent of operating grant applications are funded) and every CIHR grant awarded brings credit to the grantee, the faculty and the University of Alberta.” UAM

IT’S A FACT THE FACULTY OF MEDICINE & DENTISTRY GARNERED ABOUT 75 PER CENT OF TOTAL CANADIAN INSTITUTES OF HEALTH RESEARCH (CIHR) FUNDING TO THE UNIVERSITY OF ALBERTA IN 2011–2012. To learn more about faculty funding successes, go to www.uab.ca/ualbertamedicine. med.ualberta.ca

FIRST WORDS

Dr. Jeeshan Chowdhury (left) and Dr. Peter Gill (right) share the prestigious honour of being the only two Rhodes Scholars in the Faculty of Medicine & Dentistry to convocate together.

TWO FOR THE RHODES Two of the world’s most prestigious scholars graduate together, joining the ranks of the faculty Rhodes Scholars before them. BY CAIT WILLS

UALBERTAMEDICINE

hodes Scholar must, by defini-

tion, be well rounded. To meet the strict selection criteria of this “world’s most prestigious” scholarship based at Oxford University, applicants must personify the ideals of academic achievement and strength of character, laid out by Cecil John Rhodes, the benefactor of the scholarship’s establishment in 1902. For the first time in its history, the Faculty of Medicine & Dentistry had two of its Rhodes Scholars cross the stage as they graduated together in 2014, the final step in their medical school careers in a faculty both Dr. Peter Gill and Dr. Jeeshan Chowdhury credit with challenging them to reach and exceed their achievement goals.

“ WITHOUT A DOUBT, I WOULD NOT HAVE ACCOMPLISHED WHAT I HAVE TODAY WITHOUT THE UNWAVERING SUPPORT, ENCOURAGEMENT, MENTORSHIP AND GUIDANCE OF THE FACULTY.” Dr. Peter Gill “It was a long road, but I was very lucky to have been supported through it,” says Chowdhury, who received his MD and PhD in June. “I wouldn’t have been able to do this at any other institution,” he says. Gill echoes his colleague’s sentiments. “After meeting medical students from other universities, I have realized how fortunate

IMAGE COURTESY OF RICHARD SIEMENS, UNIVERSITY OF ALBERTA

IT’S A FACT ALONG WITH CREATING JOBS FOR RESEARCHERS AND NON-ACADEMIC SUPPORT STAFF, FACULTY OF MEDICINE & DENTISTRY SCIENTISTS ARE CONTRIBUTING TO NEW PRODUCT DEVELOPMENT AND TECHNOLOGY COMMERCIALIZATION. To learn more about how innovations like these are making an impact, go to www.uab.ca/ualbertamedicine.

“ WE ARE CONFIDENT THAT THESE TWO STUDENTS ARE IN THE FOREFRONT OF THE CANADIAN HEALTH CARE IN THE 21ST CENTURY.” Dr. Fraser Brenneis, vice-dean, education

we are at the U of A,” he says. Not all institutions are so supportive of medical students who pursue a Rhodes Scholarship, he believes. “Without a doubt, I would not have accomplished what I have today without the unwavering support, encouragement, mentorship and guidance of the faculty.” “We were as excited for Peter and Jeeshan when they were selected as Rhodes Scholars as we are proud of them now, as graduates,” said Dr. Fraser Brenneis, vice-dean, education, of the Faculty of Medicine & Dentistry. “These two men are shining examples of students who have challenged themselves, and those around them, to be physicians of compassion and dedication, which we strive to instil in our students.”

PETER GILL

FINDING A NEW FIELD As a teen, Peter Gill was a talented soccer player who dreamt of going pro in Europe— until an injury changed everything. “As a 16-year-old, to be told that you have a career-ending injury is devastating,” he says. But after coming to terms with the loss, Gill realized it left him free to pursue another childhood dream: becoming a pediatrician. After high school, he enrolled at the U of A and studied biological sciences and business before being accepted into the MD program. Having volunteered with children with disabilities—teaching him “the resilience of children and their inspirational capacity to transform disabilities into abilities”—Gill was sure pediatrics was where he belonged, and his pediatric rotations during medical school confirmed it: “Children are inspiring and always have such positive attitudes during times of illness.” Over the last few years, Gill’s career has

continued to unfold. In 2009, the MD/PhD student became the U of A’s 67th Rhodes Scholar. Since then, Gill’s research has focused on creating metrics to assess the quality of medical care children receive. “The establishment of indicators will enable clinicians, researchers, funding agencies and policy makers to identify care gaps where improvement is needed,” he says. In February 2013, this research was published in the Archives of Disease in Childhood, earning Gill a CIHR Rising Star Award. His many accolades also include the Queen Elizabeth II Diamond Jubilee Scholarship, recognizing not only his academic prowess, but also his work promoting children’s wellbeing. For years, Gill has volunteered with the Stollery Children’s Hospital, Kids with Cancer Society and a rural hospital in Uganda.

JEESHAN CHOWDHURY

IMPROVING TECHNOLOGY FOR DOCTORS Like Gill, fellow Rhodes Scholar Jeeshan Chowdhury is passionate about both medicine and research and the intersection between the two. Before travelling to Oxford in 2006, Chowdhury was part of an interdisciplinary research team at the U of A working on a hand-held “lab-on-a-chip” device for diagnosing health conditions more efficiently than a full-scale medical lab. At the University of Oxford, the MD/PhD student moved away from research and development to the evaluation and appraisal of commercial technology. “I’ve gone from one end of the pipeline to the other,” he says. But Chowdhury isn’t content to examine healthcare technology on a theoretical level. Since completing his thesis, he’s been actively working to improve technology for clinicians, co-launching an event in 2012 called

Hacking Health, which is meant to promote the creation of new medical applications by linking doctors with technology creators. “We want to bring clinicians into application development early, rather than late in the game, and have user-led or clinician-led development of technology,” he says. Since its inception, the event has been held all over the world, including Paris, Hong Kong, Berlin, Vancouver, Edmonton and Calgary.

MOVING INTO THE FUTURE OF MEDICINE Now that he has completed his Rhodes Scholarship, Gill is back in Canada, where he intends to stay. After graduating in June, Gill began a pediatric residency at Toronto’s Hospital for Sick Kids; after that, he plans to return to Alberta to work as both a researcher and clinician. Chowdhury will enter a family medicine residency at the University of Calgary. For both, their time at the faculty resonates not only as an opportunity to fulfil their academic desires, but also a challenge for them to achieve the depth of character as physicians outlined by Rhodes himself. “We are proud that Peter and Jeeshan chose to start their medical education in our faculty,” says Brenneis, “and that they represent the Faculty of Medicine & Dentistry as an example of education and research excellence. We are confident that these two students are in the forefront of the Canadian health care in the 21st century.” UAM

To learn more about the Faculty of Medicine & Dentistry's MD/PhD program, go to www.med.ualberta.ca/programs/md-phd. ualberta.ca

Dr. Bailey Adams will have the opportunity to focus her skills in a rural community as one of the 44 per cent of graduates in the Faculty of Medicine & Dentistry who selected a residency in family medicine in 2014.

FIRST WORDS

ANSWERING ALBERTA’S CALL FOR HEALTH A record number of MD graduates are selecting rural and regional family medicine. BY CAIT WILLS

r. Bailey Adams didn’t come to

her decision to be a family doctor in small-town Alberta lightly. “One of the reasons why I was interested in participating in the University of Alberta programs that focus on practice in rural communities was because I was hoping I would discover I didn’t like being in a small town,” laughs the native Edmontonian. The move by fledgling physicians to become family doctors is becoming increasingly evident, as a record number of medical graduates are listing family medicine as their first residency choice. Of the 170 medical students who graduated in spring 2014, some 44 per cent chose to become family physicians.

A RECORD NUMBER OF MEDICAL GRADUATES ARE LISTING FAMILY MEDICINE AS THEIR FIRST RESIDENCY CHOICE. That number has more than doubled in the last decade. And, more and more, the number of MD graduates practicing family medicine in rural communities as residents is on the rise, thanks to programs offered through the Faculty of Medicine & Dentistry. Adams’ journey from big-city student to rural doc started with the Preclinical Networked Medical Education (PNME) UALBERTAMEDICINE

program in her second year, when she spent a month in Peace River. The program began in 2011 as a pilot project that allows students to take a component of their studies in a rural clinical setting, which gave Adams exposure to daily clinical work for the first time. “I really like the variety of clinical exposure,” she says. In her third year, Adams participated in the Integrated Community Clerkship (ICC) program in another rural community under three primary preceptors. “Being in the ICC program helped me develop important mentor relationships with the preceptors, which in turn helped me build confidence in my decisions around treatment planning. It provided me with a good, well-rounded education,” she says. “The ICC program gave me access to learning a variety of care and exposed me to important patient interactions.” “The ICC program, which began in 2007, is an important element of the Family Medicine Residency Program,” says Dr. Fraser Brenneis, vice-dean of education in the Faculty of Medicine & Dentistry, explaining that it places third-year medical students in rural communities to work with family doctors for 41 weeks. “ICC program participants’ results show that about three of four choose a career as a family doctor, with almost half caring for patients in rural PHOTOGRAPHY BY AMY HEWKO

communities,” he says, and that “programs like these are undeniably impactful in exposing students to opportunities to see, live and train in a rural community and to imagine themselves being able to do the work.” The chance for trial runs at rural medical practice during med school is important to guiding the long-term decisions students make when entering residence, says Dr. Lee Green, chair of the Department of Family Medicine. “Students are having the opportunity to actually see what family medicine is like much earlier in their education, and realizing what it’s really like,” he says. “It’s endlessly challenging and interesting, and we family physicians develop strong and rewarding relationships with our patients. That’s appealing to students. “Rural family medicine also offers a sense of community, of belonging, that makes it a great place to live and to raise a family. Rural communities value their family physicians highly.” UAM

IT’S A FACT WHEN MEDICAL STUDENTS GO TO RURAL AND REGIONAL COMMUNITIES FOR PART OF THEIR MEDICAL TRAINING, THE COMMUNITIES OFTEN BENEFIT AS MUCH AS THE STUDENTS. To learn more about how rural medical programs are making an impact, go to www.uab.ca/ualbertamedicine.

U of A grads choose family medicine in record numbers 44% of 2014 graduates from the University of Alberta's MD program have selected family medicine as their chosen field. This number has more than doubled in a decade. 44% will study family medicine 39 graduates at the University of Alberta

2014

44%

will study family medicine 14 graduates at the University of Calgary

38%

2011

44%

21%

2007

of 2014 grads selected family medicine

2003

UNIVERSITY OF CALGARY

UNIVERSITY OF ALBERTA

39 graduates will study family medicine at the University of Alberta

33 students will focus on urban practice 6 students will focus on rural practice in the Rural Alberta North Program, based in Grande Prairie and Red Deer

17%

graduates will study family medicine at the University of Calgary

9 students will focus on urban practice. 5 students will focus on rural practice in the Rural Alberta South Program, based in Medicine Hat

ADVANCEMENT/IMPACT/ VALUE

CANCER RESEARCHER

DR. LYNNE-MARIE POSTOVIT CHALLENGES CONVENTIONS AS ONE OF THE WORLD’S FOREMOST CANCER RESEARCHERS. by Caitlin Crawshaw photography by Laughing Dog Photography

LETS CURIOSITY LEAD

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Dr. Lynne-Marie Postovit has been described

as one of the top scientists of her generation. Sitting in her gleaming fifth-floor laboratory in the Katz Group Centre for Pharmacy and Health Research, hearing her talk about cancer cells and her determination to understand them and stop them in their tracks, it’s easy to understand why. “With few exceptions, every cell in one’s body has the same DNA code, yet different cells express different genes and have very different functions,” she says. “The specification of which cells perform what functions begin in utereo. In diseases like cancer, this amazing process is undone, leading to cells that are no longer specified, which causes the cells to stop responding to their natural environment, and even send out signals that allow them to grow, spread and evade therapy.” Heady stuff, but the battle of identifying, marking and destroying cancer cells is one that this dynamic young scientist has been gearing up for most of her life. As a child, Postovit dreamed of making her mark in the world, although it was an overarching plan rather than a determined career ambition. It wasn’t until she was an adult completing research for her honours’ degree in life sciences that her career path became clear. “Stumbling into a lab that did cancer research was complete serendipity,” says Postovit. But her success has been no accident. Very early in her career, it was apparent that Postovit had an aptitude for research. As a doctoral student, she earned international recognition when she discovered that supplying nitric oxide to cancer cells could prevent them from metastasizing, work that ultimately led to a patent for a cancer treatment and the formation of a start-up company. After earning her PhD in cell biology, she pursued postdoctoral training at Western University. There, she helped discover a new kind of protein secreted by aggressive tumour cells, dubbed Nodal, leading to her second patent. This work also led to the identification of a molecule that inhibits Nodal and her third patent. UALBERTAMEDICINE

For her early success, Postovit was named Canada’s Premier Young Researcher by the Canadian Institutes for Health Research in 2009—Canada’s top prize for new scientists. The Scientist magazine also named her a “Scientist to Watch.” Looking beyond the beginning of Postovit’s career, one can see how the Faculty of Medicine & Dentistry is excited to leverage her talent. Postovit heads a team of eight, thanks to a $5 million multi-chair appointment supported by the University of Alberta, the Alberta Cancer Foundation, the Royal Alexandra Hospital Foundation and private donors. This collaboration across organizations is rare, says Postovit, but one of the many reasons why joining the faculty was an important and appropriate decision for her to continue developing her armaments in her battle against cancer cells. “It’s also what makes the position so special. There’s a translational element through the interaction with patients and a team of clinicians and scientists who are ready and in place to move forward,” says Postovit. “The commitment to excellence at the faculty attracted me here,” she says about her decision to uproot her young family and move across the country. “In particular, we have the finest scientists and world-class centres wherein we can discover new DID YOU KNOW? anti-cancer drugs with high-content OVARIAN CANCER screening, can detect ACCOUNTS FOR every mutation in a ABOUT cell with genomics and image everything from tumours to tiny proteins. We OF CANCERS need these types of AMONG WOMEN, resources to be able to BUT IT CAUSES discover and validate MORE DEATH new biomarkers and THAN ANY therapeutic targets, OTHER CANCER and all of them are OF THE FEMALE readily available at the REPRODUCTIVE Faculty of Medicine & SYSTEM. Dentistry.

“Another amazing asset is the clinical trials unit at the Cross Cancer Institute,” says Postovit. “This cancer-care hospital works with investigators and industry to move new discoveries from the laboratory to the patient. Hence, I am truly able to see our discoveries move from an idea in the lab, through pre-clinical models of cancer and then into patients.” Postovit’s work centres on how a cancer cell’s environment influences its growth and spread, particularly in terms of melanoma and breast cancer. Since arriving in 2013, she’s added ovarian cancer to the mix. “The big problem with ovarian cancer is that we catch it too late,” she says. According to the Canadian Cancer Society, ovarian cancer accounts for about three per cent of cancers among women, but it causes more death than any other cancer of the female reproductive system. The five-year survival rate for ovarian cancer is only 45 per cent. “It’s a cancer more people need to start studying and being engaged with,” Postovit says. To that end, she and her research team are trying to understand how cancer cells— especially ovarian cancer cells—resist therapy by adapting to their changing environment, much like stem cells. Postovit’s lab is also searching for specific biomarkers, molecules that indicate the appearance of cancer, to allow doctors to identify the disease before it spreads, ideally through a simple blood test. It’s a big project and Postovit is thankful to have a talented team of medical researchers behind her, including PhD candidate Scott Findlay. For years, Postovit has mentored Findlay and supervised his doctoral work, so following her to the faculty, “wasn’t too hard of a decision.” As a leader, she’s always open to the ideas of her team and good at juggling multiple projects. But, perhaps most importantly, she’s a researcher who can question the status quo. “Maybe this sounds intuitive, but for a lot of people it isn’t. Lots of people are afraid of new ideas or stuck in existing schools of thought,” says Findlay. “Lynne’s not afraid to challenge these things. I think that’s the mark of a good scientist.” UAM

The Bionic Woman Dr. Jacqueline Hebert puts the Faculty of Medicine & Dentistry at the forefront of prosthetics technology. by Ben Freeland photography by Curtis Trent

ADVANCEMENT/IMPACT/ VALUE

From

Darth Vader to Steve Austin in The Six Million Dollar Man, bionic limbs have been an integral part of science fiction for almost as long as the genre has existed. What fewer people know, however, is that science fact and science fiction have seen an astonishing convergence, thanks to medical researchers like Dr. Jacqueline Hebert. The Grande Prairie, Alberta, native has emerged as one of Canada’s leading pioneers in the rapidly progressing field of prosthetics and reinnervation technology at one of the UALBERTAMEDICINE

Larry Hayes-Richards (left) and Dr. Jacqueline Hebert determine the best use of prosthetics that will support the success of his reinnervation surgery, which Hayes-Richards says has improved his life “tremendously.”

most innovative facilities in the country. The term “targeted reinnervation” refers to the latest surgical techniques whereby amputees fitted with motorized prosthetic limbs are able to regain sensory feedback as well as motor control by reconnecting nerves. The term was introduced to the world by Dr. Todd Kuiken at Northwestern University in Chicago, the man heralded as the inventor of the world’s first “bionic arm.” This new technology, the process of targeted reinnervation, was introduced to Canada for the first time in 2008 at Edmonton’s Glenrose Rehabilitation Hospital, only two years after the first successful human trial in 2006. As a young researcher with a focus on

human mechanics and improving patient outcomes, Hebert leapt at the opportunity to work with this exciting new technology. Today she runs the BLINC (Bionic Limbs for Improved Natural Control) Lab, Canada’s leading prosthetics research laboratory, which partners researchers like Hebert and others in the Faculty of Medicine & Dentistry with the Glenrose Rehabilitation Hospital. Hebert is a member of the Division of Physical Medicine & Rehabilitation and was one of the participants in the prestigious Centennial Lecture Series in the faculty in 2013, when she spoke on how her translational research is an example of helping move scientific discoveries from “bench to bedside.”

“The partnership between the Glenrose and the faculty has been absolutely invaluable,” she explains. “The faculty has provided me with the support of other researchers and colleagues, and a well-established research infrastructure. Also, the reputation of the university as a centre of research excellence has opened doors to the international research community.” Targeted reinnervation aims to keep nerve connections “awake” so as to allow a person’s tactile senses to be restored. During surgery, Hebert’s team splits the muscles and rewires the nerves to link four or five muscle sites to the prosthetic control. The patient is then able to think about straightening and bending the arm, or opening and closing the hand, and the prosthetic movement comes naturally. The patient can also perform these movements at the same time rather than one after another. “This in itself is a major advancement in prosthetic control,” said Hebert. While Hebert’s work focuses primarily on upper limb prosthetics, upper and lower limbs both present different challenges visà-vis reinnervation, she says, and that upper limbs pose the biggest challenge. “The human hand is an unbelievably complex system,” she says. “From a reinnervation perspective, it’s fiendishly difficult.” The technological advances behind targeted reinnervation have largely stemmed from military needs, precipitated by recent wars in Iraq and Afghanistan. While Hebert’s Canadian patients have primarily been oilfield, industrial and farm injury-related, her groundbreaking work nonetheless won her the 2012 Sir Frederick Banting Award by the Canadian Military and Veteran Health Research Forum for her contributions to veterans’ health. “The groundbreaking reinnervation computer simulation research being carried out in Dr. Hebert’s laboratory represents the best type of interface between high technology and modern medicine,” says Dr. David Evans, vice-dean, research, of the Faculty of

Medicine & Dentistry. “Dr. Hebert’s work not only reflects her passionate support of those injured in service to our country, but also speaks to the power of great science to foster better health for all patients.” One Canadian veteran who has already benefited from Hebert’s handiwork is Edmontonian Larry Hayes-Richards. A former Canadian soldier who served in Cyprus in the late ’60s, Hayes-Richards lost his right arm as the result of a staph infection, which triggered lengthy discussions with Hebert about the new technologies that were starting to become available. “Dr. Hebert told me about the advances coming out of Chicago,” says Hayes-Richards. “And it turned out the people in Chicago were looking for patients in Canada. I discussed it with Veterans Affairs and they agreed to support me and pay for my first ‘bionic’ arm.” Following his reinnervation surgery, Hayes-Richards was fitted with an Austrianmade Ottobock arm, which proved unreliable and was ultimately replaced with a more advanced U.S.-made Boston Digital Arm, which he has been using for the past year. He continues to meet regularly with an occupational therapist in order to maximize his motor control and dexterity. “The key to living with a prosthetic limb is remembering that it’s never going to be quite as reliable as your original limb,” he explains. “If I’m holding something with my artificial hand I need to continually focus on it, otherwise I’ll drop it.” But while the rehabilitation process has been long and arduous, Hayes-Richards has nothing but praise for Hebert and her team. “I’m 69 years old; I thought I was way too old for this sort of procedure,” he says. “But it has improved my life tremendously. The research team has been absolutely fantastic, and Dr. Hebert has been wonderful to work with.” For Hebert, being at the forefront of one of medicine’s most exciting frontiers is its own reward. “I’ve always had a profound interest in human mechanics and rehabilitative medicine,” she says. “This field is brand new, less

TRUE PATRIOT LOVE MILITARY RECOGNITION OF MATERIAL INNOVATION

Dr. Jacqueline Hebert’s innovative work in prosthetic rehabilitation has won her accolades within and outside the world of medicine. Notable among her fans are the Canadian Forces, which in 2012 awarded her the Sir Frederick Banting Award for Military Health Research. Sponsored by True Patriot Love, a charity organization dedicated to supporting the physical, mental and social well-being of Canada’s veterans, the award is named after the Nobel Prize-winning Canadian physician and researcher who co-discovered insulin in partnership with University of Alberta faculty member Dr. James Collip, and honours medical contributions to Canada’s military. In recognizing Hebert’s contributions to the rehabilitation of Canadian veterans, Peter MacKay, the thenMinister of Defence, cited her work as “critical in order to meet the protection, promotion and health care needs of Canadian Forces personnel of today and into the future.”

than a decade old. I couldn’t ask to be in a more exciting domain of medicine. I’ve also benefitted tremendously from the Faculty of Medicine & Dentistry’s existing reputation for excellence in medical research, which has helped cement my reputation as a strong academic clinician scientist within a stellar research team. There could be no better place to do this work.” UAM ualberta.ca

Saving Superman by Janet Harvey photography by Aaron Pedersen

Christopher Reeve, aka Superman, died of complications related to pressure ulcers. Today, a team led by Faculty of Medicine & Dentistry researcher Dr. Vivian Mushahwar, is close to commercializing a product that could have saved his life, and will save the lives of potentially millions more. UALBERTAMEDICINE

Smart-e-Pants™ are custom designed to meet the needs of the study participants, and will be tailored for consumers starting in 2015 when the commercialization process is completed. (left) Dr. Vivian Mushahwar

N OCT. 10, 2004, Christopher Reeve died from

heart failure resulting from an infected pressure ulcer. In what now seems a strangely meaningful parallel, earlier that same year Dr. Vivian Mushahwar began to focus her research on the very condition that would ultimately lead to his death. It was not the biomedical engineering professor and neuroscientist’s first time wrestling with the problem of how to address pressure ulcers. In 1996 she had come up with an idea to prevent the dangerous condition while doing her PhD. For her candidacy exam, she had to write a grant proposal on something unrelated to her own research. Her work on the use of electrical stimulation to restore movement in people with spinal-cord injury had brought her into contact with many patients who suffered from pressure ulcers, and Mushahwar wondered what would happen if she could get the patients’ muscles to contract periodically using electrical stimulation. “Fidgeting is a natural response to discomfort that develops from sitting or lying down, but someone who does not have sensation or is unable to move, cannot fidget on their own,” explains Mushahwar, recalling the “aha” moment that sparked her idea. “So I wrote that as my candidacy exam. It all started there.” Fast forward several years to Mushahwar’s arrival at the University of Alberta. “‘The gods of neuroscience’ were here and all of the literature at the time referenced them,” she says of what brought her to Edmonton, referring to emeritus faculty members Drs. Tessa Gordon,

Keir Pearson and Richard Stein, and current faculty member Dr. Arthur Prochazka. She was also awarded a fast-track postdoctoral fellowship from the then-Alberta Heritage Foundation for Medical Research, which provided critical funding for her work. After completing her postdoc, she accepted the offer to join the Faculty of Medicine & Dentistry with an adjunct appointment in the Faculty of Rehabilitation Medicine, and took the opportunity because of the environment at the university and the available funding. “That continuum of basic, applied research and patient care was so visible here and I hadn’t seen it anywhere else in North America. It was breathtaking.”

WHAT ARE PRESSURE ULCERS? There are two types of pressure sores that develop in people with reduced mobility and sensation: those on the surface of the skin, which break through skin, fat or muscle all the way to the bone, and the other, which develops at the interfaces of bone and muscle and is only detected when extensive damage exhibits on the surface of the skin. This second level of pressure ulcer in particular can cause infection, sepsis, organ failure and death. In the United States pressure ulcers kill more than 60,000 people every year, making them one of the 10 leading causes of death.

med.ualberta.ca

Dennis Ross, 36

SUFFERED A T2-3 FRACTURE IN CAR ACCIDENT

I think the concept is an excellent idea. While I used the pants I noticed a significant decrease in spasticity, as well as less water retention in my lower legs. They were easy to put on and I couldn't even tell that there was a difference, and neither could anyone else. I felt a small amount of stimulation as I have some sensation, but I felt no pain. In the long run, Smart-e-Pants™ is great for reducing pressure ulcers and costly visits to the doctor, while building up those critical muscles in your behind and increasing blood flow. Once they are on the market, you can bet your behind I'll have a pair!

THE CLOSEFITTING SHORTS CONTAIN PADS THAT DELIVER A MINOR ELECTRICAL STIMULUS EVERY 10 MINUTES TO CAUSE MUSCLE CONTRACTION.

UALBERTAMEDICINE

That environment of excellence encouraged her to turn her attention to the issue of pressure ulcers again, where Mushahwar found that the thinking and the literature on the condition had not changed in the intervening eight years since her PhD candidacy exam, and the very serious problem had not been addressed in a clinical sense. Conventional wisdom was that pressure ulcers were a “care issue”, but even with best practices and the most diligent care, patients with reduced mobility were still developing pressure ulcers. Mushahwar and her team also found that turning a patient is not as effective for prevention as active contraction of that patient’s muscles, so they came up with a solution encompassing this new thinking on pressure

ulcers: Smart-e-Pants™. The close-fitting shorts contain pads that deliver a minor electrical stimulus every 10 minutes to cause muscle contraction. Phase 1 clinical trials, in which 70 patients used the device for anywhere from one month to 16 months in settings ranging from intensive care to home care, are already complete. Both patients and practitioners found the device very safe and feasible for everyday use, and none of the patients developed pressure ulcers. The Phase 2, multi-centre clinical trials will determine the innovation’s effectiveness and is on schedule. In the meantime, Mushahwar and her team are addressing the necessary regulatory approvals with Health Canada and the U.S. Food and Drug Administration to start selling the

Stewart Midwinter, 59 SUFFERED A QUADRIPLEGIC-LEVEL SPINALCORD INJURY IN PARAGLIDING MISHAP

As hard as it was to accept the loss of mobility associated with near total paralysis, worse still was the realization that I would now be likely to suffer a whole host of complications, including pressure sores, which could be fatal. I was delighted to learn that a clinical trial was commencing on new technology to help protect people against pressure sores, and, in participating in the study, used the Smart-e-Pantsâ&#x201E;˘ technology to help maintain and even increase muscle mass in my gluteus muscles, improving circulation and protecting me against the development of pressure sores. Three years later, I am still free of this lifethreatening complication.

PHOTO OF STEWART MIDWINTER BY BRYCE MEYER

Jordan Brandt, 26 SUFFERED A C5-6 INJURY AFTER A VEHICLE ROLLOVER I volunteered to take part in the study after a friend told me that a research project was looking for participants with spinalcord injuries. My participation in the study began in mid-2012 and I used the system until July 2014. I started by coming to the university so researchers could perform some tests on my buttock muscles using the same stimulator used in the pants. After that initial test, researchers involved with the study had a garment made in my size and began making home visits. They would come in the morning to place the electrodes in a location where they could get the strongest contraction, and would come back in the evening to take the system off and fill out a data collection sheet. They eventually left the data collection and the placement of the electrodes to me and my caregiver, once we were shown how to complete the information. When I started taking part in the study the contractions of my muscles could barely be seen. During the first year of the study those contractions had steadily grown stronger. By the end of the study the contractions were strong enough to move me in my seat. With the exception of some minor issues early on, the Smart-e-Pantsâ&#x201E;˘ system is a fantastic product. It was simple to operate and easy to put on. Luckily for me, using the system also had the unintentional benefit of helping with the constant pain I have in that region. Having friends in the same condition as myself who have had pressure ulcers, I know how much of an effect they can have on a personâ&#x20AC;&#x2122;s quality of life. I understand how important research like this is and am glad that I was able to contribute to this study. My hope is that the system becomes readily available to everyone at risk of developing pressure ulcers very soon. When it does become available, I'll be the first in line to get one.

UALBERTAMEDICINE

TREATING PRESSURE ULCERS COSTS THE CANADIAN HEALTHCARE SYSTEM $3.5 BILLION PER YEAR AND COSTS ABOUT $375 MILLION PER YEAR IN ALBERTA. A SINGLE PRESSURE ULCER CAN COST BETWEEN $20,000 AND $130,000 TO TREAT.

devices. Work is also expected to begin soon to demonstrate the cost-effectiveness of the pants for the health-care system through a partnership between Alberta Innovates – Health Solutions and Alberta Health Services. The upshot? Smart-e-Pants™ are expected to be available for sale in 2015, with the potential to improve, even save, the lives of millions of people around the world. They will also save billions of dollars in health spending, says Mushahwar, citing the expertise provided in collaboration as one of the reasons why the product commercialization has been possible. Dr. K. Ming Chan, a professor in the Division of Physical Medicine & Rehabilitation in the Faculty of Medicine & Dentistry, has been working as clinical lead on the co-ordination of the clinical testing in different health-care settings in Edmonton and Calgary for the last five years. “An important next step is to formally evaluate the efficacy of the Smart-e-Pants™ in preventing deep pressure ulcers and to establish the health-care savings that such a treatment would be able to achieve,” he says. As part of the collaboration encouraged through the Campus Alberta initiative of the Ministry of Innovation and Advanced Education, Mushahwar and her team have been working with Dr. Sean Dukelow, assistant professor in the Division of Physical Medicine & Rehabilitation at the Hotchkiss Brain Institute at the University of Calgary. Dukelow has been providing clinical advice to

Mushawhwar for the last six years and has a wealth of experience with the longstanding challenges of pressure ulcers for those with impaired mobility. “Once they develop, pressure ulcers are life altering for the patient and are typically difficult to treat,” he says. “Unfortunately, treatment of deeper pressure ulcers can take months or years. Even in our modern health-care system, we still see fatalities as a result of complications from pressure sores. In the time I have spent caring for individuals with pressure sores I have come to realize that the cure, in my opinion, is prevention. “It is paradoxical that we have cures for many common illnesses, yet still struggle with such a simple and preventable complication of immobility. Pressure ulcers can be frustrating and painful to treat for both the patient and the health-care provider. I look forward to a day when we can eradicate them completely.” So 10 years after Christopher Reeve’s passing, a device that could have prevented his death and that of many others—and could improve the quality of life for countless patients with reduced mobility—is almost ready for the market. What does that mean to Mushahwar? “It means everything,” she says simply. “I got into bioengineering to use my skills to help people. Making a difference in even one person’s life makes it all worthwhile.” And that is something that Superman himself would understand. UAM

CHRISTOPHER REEVE In 1995, Christopher Reeve became paralyzed from the neck down (quadriplegia) after being thrown from a horse during an equestrian competition. The accident altered the course of his life, forcing him to spend his days in a wheelchair, dependent on a respirator to help him draw breath. The man who made his mark playing Superman on the big screen went on to become a different kind of superhero as an advocate for spinal cord research. When he died in 2004, it was not the spinal cord injury itself that took his life but a harmless-sounding side effect: pressure ulcers. Reeve died from heart failure due to complications from an infection caused by a pressure ulcer, in spite of having received the very best care available at that time.

PHOTO OF CHRISTOPHER REEVE BY TIMOTHY GREENFIELD-SANDERS

med.ualberta.ca

ADVANCEMENT/ VALUE /IMPACT

Rural Albertaâ&#x20AC;&#x2122;s Breathing Advantage Pulmonary expert Dr. Michael Stickland is making it possible for rural and regional patients with chronic obstructive pulmonary disease to leverage technology in their quest for better health.

by Amy Hewko PHOTOGRAPHY BY CURTIS COMEAU

arb Gibson, a vivacious retiree, had a big problem. The former elementary-school teacher from Camrose was recently diagnosed with chronic obstructive pulmonary disease, or COPD. Like many seniors living in rural and regional areas in Alberta, she had neither the desire nor the means to drive for an hour each way, twice a week, to Edmonton to participate in any urban opportunities that would educate her on how to live with her disease.

ADVANCEMENT/ VALUE /IMPACT

ENTER THE PROGRAM.

CHRONIC OBSTRUCTIVE PULMONARY DISEASE EXACERBATIONS ARE ONE OF THE TOP REASONS FOR HOSPITALIZATION IN ALBERTA.

Taught by physicians like Faculty of Medicine & Dentistry Dr. Michael Stickland, rural and regional areas of the province are able to access the education needed by patients like Gibson who require respiratory therapy. “The provision of this kind of treatment in cities like Camrose is important because patients wouldn’t be able to otherwise easily access these services,” says Julie Gaalaas, Gibson’s respiratory therapist (RT) at the Smith Clinic in Camrose, where the program runs every eight weeks year round. Gaalaas has been an RT “forever” and has seen the program delivery benefit hundreds of patients, most of whom are seniors, she says. With the help of Alberta Health Services’ Telehealth delivery, Stickland, who is the director of the Breathe Easy program and one of its educators (he is also the director of the G.F. MacDonald Centre for Lung Health in Edmonton and the scientific director for the Respiratory Health Strategic Clinical Network), is able to deliver these pulmonary rehabilitation classes to rural Alberta, offering rural COPD patients easier access to the health care they need. In the past year, six new rural and regional sites have been added. Telehealth provides small-group consultations via television cameras and screens in a clinic setting. “To me, COPD is one of the ultimate challenges in physiology because it’s a condition that affects multiple components in the body—the lungs, the heart and the vasculature, as well as the amount of systemic inflammation,” Stickland says. “It’s a great challenge to understand what’s happening with these patients.” Chronic obstructive pulmonary disease exacerbations

are one of the top reasons for hospitalization in Alberta and, once admitted, patients stay for an average of 11 days. The impact on the health-care system is considerable: an estimated 5,000 COPD patients are hospitalized annually and economists estimate that the average cost of hospitalization for one COPD patient is $10,000. Rehabilitation and management of the disorder are key to keeping patients out of the hospital, and one of the most recognized aspects of his work is the rehabilitation program he directs, says Stickland. “The Canadian Physical Guidelines say you should take 10,000 steps each day,” he says. “Coming into rehabilitation, our patients get about 2,500 steps per day and some get less than that.” Stickland’s program aims to get patients into a program of mobility that will beat back a sedentary lifestyle, which affects more than lung function, says Stickland. “Rehabilitation makes you less out of breath and gives you better exercise tolerance and, under the right conditions, it will also make you more active, making your cardiovascular system better.” Stickland says that patients will often shy away from physical activity because of their reduced lung function, but taking a brisk walk twice a day can mean the difference between good and poor health. “If we can get these patients active and get them walking a couple times a week, that will really improve their cardiovascular condition and reduce their cardiovascular risk.” Pulmonary rehabilitation involves exercise as well as

“ I THINK THIS PROGRAM IS A REALLY GOOD MIX OF MEDICINE AND GIVING THE TOOLS THE PATIENTS NEED TO BE THEIR OWN HEALTH ADVOCATE.” Barb Gibson

chronic disease management education. Rehabilitation classes teach patients how to identify triggers, recognize lung flare ups, manipulate their medications to respond to triggers and relieve flare ups, and provide other management skills. The classes also offer other topics of interest to COPD patients, such as how to arrange for air travel with an oxygen tank. Patients who are able to participate in the Breathe Easy program are referred by their family doctor or a respirologist, and Gaalass says the tools provided by the program are critical to the health of these patients both during and after the program is completed. “The benefits of the Breathe Easy program are so important because, while it doesn’t improve the damage that already exists from COPD, it can improve the patients’ quality of life.” Access to the program has taken a giant leap forward, thanks to Stickland. “We have our main pulmonary rehabilitation program, which treats about 400 patients a year, and then we have the Telehealth program, which treats approximately 100 patients a year,” Stickland says. “We have a reach of about 500 patients a year, and that’s pretty impressive. PHOTOGRAPHY BY IAN JACKSON

“Our program is one of the largest in North America.” Not satisfied with those numbers, though, Stickland has developed an innovative rural health delivery method for his COPD patients: a podcast, which provides patients with the educational tools they need at their leisure, either while they’re participating in the program, or after they’ve completed it. This program is being expanded to six communities, with the expectation of being available incrementally over the next year. As Gibson winds up her eight-week stint of twice-weekly education classes and exercises, she has big plans for her next steps. “I like that this program is individualized,” she says from the recumbent bicycle she tackles weekly. “After the program is finished, as an alumna of Augustana (the University of Alberta’s campus in Camrose), I can and will be accessing the gym and aquatic centre.” Thanks to this program run by Stickland, Gibson believes she has been able to stay out of the hospital, in her home and is now on her way to good health. “I think this program is a really good mix of medicine and giving the tools the patients need to be their own health advocate,” she says. “It makes you invest in yourself in a positive way.” UAM

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The MD Class of ’63 makes powerful statement of support of The Dean’s White Coat Campaign. by Janet Harvey

HEN MEDICAL STUDENT Irfan Kherani received the

white coat marking his entry to the medical profession it was an emotional moment. “The white coat symbolizes a professional attitude moving forward, an appreciation of the work you’re going to do and the commitment that you are making to your patients,” he remembers. Now in his fourth year of medical school, the coat has lost none of its meaning for Kherani and has, in fact, taken on extra significance for the medical students who cannot afford the increasingly high cost of a medical education on their own. Enter the “white knights” of the Class of 1963. Led by Dr. Eliot Philipson (’63, MD), former president and CEO of the Canada Foundation for Innovation, they joined together to raise more than $30,000 for The Dean’s White Coat Campaign to mark the 50th WHITE COAT PHOTOGRAPHY BY 3 TEN PHOTO

The Dean’s White Coat Campaign: HOW TO GIVE Philanthropic support like that shown by the Class of 1963 is integral to the success of medical students in the Faculty of Medicine & Dentistry. To learn more about how to give to this campaign, as well as many other types of giving, go to www.med.ualberta.ca/giving.

(Top right) The class picture of the MD Class of 1963. (Top) Dr. D. Douglas Miller, dean of the Faculty of Medicine & Dentistry, congratulates Muhammad Raheem moments after he receives his white coat at the annual White Coat Ceremony in fall 2014. (Bottom) Each student in the MD Class of 2018 received a note from the MD Class of 1963 in the breast pocket of their white coat.

EVENT PHOTOGRAPHY BY JOHN ULAN

anniversary of their graduation and help offset the cost of a medical education. “We had the benefit of hindsight and sufficient perspective to realize that our successes in life, in large part, can be attributed to the education we received at the University of Alberta’s Faculty of Medicine & Dentistry,” says Phillipson. “My pitch was that a bursary named after our MD class would provide medical students today with the same opportunity for success that we were given 50 years ago.” Donations to The Dean’s White Coat Campaign contribute to a bursary to provide all University of Alberta medical students access to much-needed financial aid. Donors are recognized when first-year MD students receive their embroidered lab coat at the annual White Coat Ceremony. In recognition of gifts of $250, donors receive the opportunity to write a congratulatory note to their sponsored students for the pocket of the coat, and meet the students in person. In recognition of gifts of $1,250, donors will meet privately with four students and the dean to celebrate and learn of the students’ journey and plans. “You hear it over and over again, the commitment you make to serve your patients and the importance of your role in guiding them through some of the most challenging times of their lives. The coat reinforces that understanding and that dedication,” adds Kherani. “The white coat is a symbol of the promise we make to our patients and to our profession; that we have a responsibility to provide the highest level of care, to continuously learn and to prepare the profession’s future.” “Through this campaign, the dean is establishing a sense of the symbolism of the white coat and what it means, but also using the opportunity to raise money for student bursaries and scholarships. We’re all aware across North America of how the level of student debt is increasing as the cost of living and the cost of medical education goes up,” says Fraser Brenneis, vice-dean of education at the FoMD. “The white coat is a symbol of what we stand for in the medical profession and of medicine’s ties to science. Sometimes the importance of this symbolism can be lost over time so this campaign, along with the White Coat Ceremony, is an opportunity to re-establish that important connection.” UAM med.ualberta.ca

EXCELLENCE IN LEADERSHIP

The Faculty of Medicine & Dentistry has produced thousands of physicians and researchers who are also creative visionaries, community leaders and business pioneers. These outstanding alumni are only a small sample of the those who came before them, and those who are the next generation of distinguished health-care providers.

Pioneer in health-care collaboration BONNIE ABEL (MD, ‘82) Abel founded the first forensic nurse practitioner sexual assault program in Canada and led the formation of the Sexual Assault Response Team of Edmonton (SART), which has helped almost 4,500 sexual assault victims in the Capital Region in the last two decades.

Leader, influencer

Inner-City Health Advocate

Technological Visionary

FRASER BRENNEIS (MD, ‘82)

KATHRYN DONG (MSC,’07)

SHAWNA PANDYA (MD ’12)

As vice-dean, education, and as an integral part of the faculty's executive committee, Brenneis led the successful accreditation of the Faculty of Medicine & Dentistry, the School of Dentistry and the Medical Lab Sciences program, all successfully culminating in 2014.

As co-director of the Edmonton Inner City Health Research and Education Network, Dong launched the Inner City Health and Wellness program in 2013, which sees socially and economically vulnerable patients receive interdisciplinary primary and community-based care.

This neurology resident is also the chief medical officer and co-founder of Civiguard, a mass evacuation mobile app that is in the process of being commercialized and could save the lives of any of the 1.75 billion people who have smart phones.

Heart Health Triple Threat

Captains of Industry GREG ZESCHUK (MD, ’95), CO-FOUNDER, BIOWARE

Clean Water Heroes

JASON DYCK (’95, PHD) Dyck is the director of Cardiovascular Research Centre, the co-director of the Alberta Heart Failure Etiology and Analysis Research Team (Alberta HEART) and co-founder of Metabolic Modulators Research Ltd., a faculty spin-off company that develops new treatments for cardiovascular disease.

Founded in 1995 by FoMD graduates Ray Muzyka, Augustine Yip and Greg Zeschuk (pictured), Bioware is one of the world’s best video game developer agencies. Now part of the video-game giant Electronic Arts, Bioware has about 800 employees around the world.

These two share an important vision: to improve quality of life with the Kenya Ceramic Project, which develops ceramic-based water filters to help the 783 million people across the globe who do not have access to drinking water.

ABDULLAH SALEH (MD ’10), LEFT & ABRAAM ISSAC (MD ’10), RIGHT

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A HIGHER PURPOSE

DR. SARAH FORGIE’S COMMITMENT TO EXCELLENCE PLACES HER AMONG CANADA’S TOP TEACHERS.

BY ENGAGING HER STUDENTS THROUGH SONGS, ILLUSTRATIONS OR OTHER MEDIA, FORGIE AIMS TO CREATE “MEMORY HANGERS”—DEVICES THAT TRIGGER THE RECALL OF INFORMATION. UALBERTAMEDICINE

A FEW YEARS AGO, DR. SARAH FORGIE decided to take up the ukulele—

not as a new hobby, but as a teaching tool. The professor of pediatric infectious diseases dug around online for the chords to “Psycho Killer” by the Talking Heads, and paired them with lyrics she’d written about strep throat. After a few months of practice, she performed the memorable parody in class. The ukulele performance is an example of the type of creative risks Forgie regularly takes. It’s all part of the unique teaching style she has dubbed “Medutainment.” By engaging her students through songs, illustrations or other media, Forgie aims to create “memory hangers”—devices that trigger the recall of information. Because her students must learn and apply large volumes of information, mnemonic devices are important for helping the information stick. Medical resident Brittany Barber recalls with ease the information learned in Forgie’s classes. “At a junior level of our training, she allowed us to understand medicine in several domains,” she says. “Dr. Forgie’s modern and creative methods of teaching revolutionized our learning.” Forgie challenged students to not only create their own memory hangers, but also to share them and teach their peers using her innovative methods. Forgie’s teaching philosophy formed when she was a medical student. She was committed to “learning for a higher purpose,” and also vowed to help students engage with and apply course material in fun and meaningful ways. After finishing her formal education and stepping into the classroom, Forgie began an approach that aligns with the modern expectation that medical schools reduce the amount of traditional didactic teaching. Dr. Tom Marrie, dean of Dalhousie University’s medical school and an infectious disease specialist, was highly impressed with his young colleague when she joined the University of Alberta in 2003 when he was dean of its medical school. “We introduced problem-based learning to a curriculum in need of change,” says Marrie. “Dr. Forgie played a key role in this process, and worked with one other physician to train about 200 faculty members in problem-based learning.” Over the past decade, Forgie’s innovative methods have garnered both accolades and results. In 2012, she won Canada’s highest teaching recognition—the 3M National Teaching Fellowship. In 2013, she was featured as an international leader in medical education in a publication from the students’ union at Cambridge University. Her teaching excellence also contributed to two of the MD Program’s recent outstanding achievements—its highly successful accreditation and its placement in the top 100 of all international rankings, says the faculty’s leadership. “Sarah is one of the most creative and engaging professors I have ever encountered,” says U of A provost Dr. Olive Yonge, a renowned teaching and learning scholar in her own right. “She truly understands the philosophical basis of experiential learning. Her clever use of media adds another level of complexity and intrigue to her teaching.” UAM

IN THE

FAST LANE Pediatric research pair deftly manages work-life balance. by Amy Hewko photography by Jessica Fern Facette med.ualberta.ca

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FOR RESEARCHERS AMANDA NEWTON AND GEOFF BALL, THEIR BEST DISCOVERY WAS EACH OTHER. NEWTON, 38, SPECIALIZES in child and adolescent psychiatry and is

an associate professor of pediatrics with adjunct appointments to psychiatry and nursing. Ball, 43, is the director of the Pediatric Centre for Weight and Health at the Stollery Children’s Hospital and an associate professor of pediatrics with adjunct positions in public health and nutrition. The pair met in 2004, thanks to a mutual friend. Knowing that Newton was looking for a new collaboration, the friend gave her a list of pediatric researchers whose work aligned with Newton’s. “I wasn’t even a year into my faculty appointment and Mandi was still a postdoc,” Ball says, noting that Newton studied eating disorders during her PhD.

WHEN IT COMES TO FINDING A BALANCE BETWEEN DEMANDING CAREERS AND THE NEEDS OF THREE YOUNG CHILDREN, NEITHER BALL NOR NEWTON SEEM FAZED. “I was given a list of three names. One guy was maybe 20 years older than me and a senior scientist. Then there was Geoff, who was more junior, and a woman I had never met,” Newton recounts, chuckling. “Geoff was first alphabetically, so I contacted him.” They married in 2009, though the final stage of the work that brought them together is just coming to fruition. Soon they will share a 16-session family-lifestyle program with colleagues in Saskatchewan that addresses managing childhood obesity. “The whole motivation behind this work was to create a program that everybody can use because not everybody has the resources, the expertise or the time to develop something like this,” Ball explains. Their work keeps them busy, but the true juggling doesn’t start until UALBERTAMEDICINE

the office doors close and they return home to their three children: Lauren, 4; Alex, 2; and Nolan, 1. “What would we do without the kids?” Newton says of the demands of raising three young children. “Probably what we did before—work on papers in the evenings, maybe go see a movie or do other lovely adult-orientated things like travel. But this is a more colourful way to live, despite it being exhausting.”

A FAMILY

WHEN IT COMES TO finding a balance between demanding careers

and the needs of three young children, neither Ball nor Newton seem fazed. They say the trick is to leave work at the office and be just parents when they’re at home. “There would never be a time when I would be up at night worrying about a theoretical problem,” Newton laughs. “With three kids

med.ualberta.ca

UALBERTAMEDICINE

under the age of five, you don’t have time to think about work. They all need so many things.” Balance wouldn’t be possible without Rona, their nanny. Rona entered their lives when Lauren was six months old and Newton returned to work. Having a nanny works for their dynamic, Newton says, and that Rona has become part of the family, allowing Newton and Ball to dedicate their evenings and weekends to playgrounds, parks and children’s sports teams. With all of the activities, their children have a lot of opportunities to develop their own ideas of the future. “There really are these moments where something is said or done, and Mandi and I look at each other and think, ‘That was pretty neat,’” Ball says of their children’s active lifestyles. “More often than not, it’s the ‘Are you kidding me?’ look,” Newton adds, laughing.

PEDIATRICS

IT SEEMS ALEX TAKES after his father, who admits that, as a youth, he

only saw university as a way to play hockey. Ball was planning to embark on a teaching degree before a mentor encouraged him to consider a career in research. “At the time, I thought she was the most brilliant person I knew,” he says of the professor, with a grin aimed at Newton. “Until I met my wife, and then I was corrected.”

Newton, however, says she always knew she would attend postsecondary. After completing a nursing degree, she realized that she wanted to focus her career on improving delivery of care, rather than deliver the care itself. She immediately entered graduate studies and never looked back.

THEY’RE SCIENTISTS IN A VERY CLINICALLY CENTRED DEPARTMENT, AND THEY ARE EXPERTS IN VERY SPECIALIZED NICHES OF PEDIATRICS—OBESITY FOR BALL AND CHILDREN'S MENTAL HEALTH FOR NEWTON. Standing out is nothing new to either Newton or Ball. They were the first people in their respective immediate families to earn a university degree, let alone an advanced degree. They’re scientists in a very clinically centred department, and they are experts in very specialized niches of pediatrics—obesity for Ball and children’s mental health for Newton. The nature of their work also sets them apart: they integrate technology into the delivery of care. “That’s part our job: to be responsive to trends and provide the compelling argument that we’re the right people to do the work,” Ball says. In one of his latest projects, Ball is utilizing tablets in what’s known as a screening and brief intervention. Patients of a primary care clinic in downtown Edmonton have the opportunity to partake in a survey pertaining to their child’s eating habits and exercise routines. The parents will receive immediate feedback comparing their answers med.ualberta.ca

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with the Canadian recommendations. “It can be delivered quickly and broadly to lots of parents and families. It doesn’t matter if their kids are overweight or not,” Ball says of the study. “From a clinical care perspective, the clinic wants to have families accessing their dietitians, fitness professionals and mental health professionals because they have a lot of great health care professionals and resources. “From a scientific perspective, we want to know if and how this brief interaction with families can nudge them to access resources and health services to improve their health and well-being.” This approach is new to obesity, but similar strategies have been applied to other areas, such as problem drinking and smoking cessation. Ball says the brief interaction can cause a significant enough change in thinking to initiate a shift of behaviour. One of Newton’s latest projects is an app that will help adolescents treat an anxiety disorder outside of formal treatment with a therapist. Newton says that anxiety disorders is one of the most common mental health problems in adolescence and one of the leading causes for mental health visits to emergency departments in Alberta. “We call it an ecological momentary intervention; ecological, in that treatment is accessible during the teen’s everyday life such as home or school, and momentary in that treatment can be accessed at moments when it is most needed,” she explains, adding that the app will connect UALBERTAMEDICINE

to the youth’s calendar to initiate prompts to practice skills to reduce anxiety and into the youth’s social media accounts so they can share their progress with friends.

NEXT STAGE

AS NEWTON AND BALL continue to cruise through mid-career stages

of their lives with their young family, they say they couldn’t be happier with the choices they’ve made. They have their dream jobs; they redefine the standard of care for children across Canada and are raising three children who infuse excitement into their lives. A key to their success, they say, is the ability to be responsive. It keeps their research on trend, their children active and engaged, and helps them find balance between work and the rest of life. “Think about where you want your career to be and constantly redefine that. When you first start, what you think you want to do might be different five years down the road, and another five years after that,” Newton says. “I find research to always be a good adventure, but it’s also good to recalibrate and think about what you’re doing and redefine why you love what you do.” UAM

PATIENT ADVOCACY:

CARE TRANSFO MATION Health-management scholar makes preventive medicine a reality

The idea of a prevention paradox is not a new concept for Dr. Sumit Majumdar. He has been wrestling with the idea of how a physician can convince patients that, when they’re feeling fine, they still need more medical care if they want to live longer and better lives. The issue of how best to have a patient be their own health-care advocate in times of wellness, as well as in sickness, contributes to the “care gaps” Majumdar says is rampant across medicine— the gap between what everyone “knows” they should do and what the health-care system, physicians and patients actually do. In the case of emergency room patients who may be at risk for osteoporosis and not even know it, the care gap is particularly troubling, so it is the focus of his high-impact research, published in The American Journal of Medicine.

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“THIS IS MADE-IN-ALBERTA MEDICINE.” MAJUMDAR’S STUDY looked at patients over the age of 60 who visited

two Edmonton emergency departments for various complaints and needed a chest X-ray, which revealed moderate-to-severe spinal fractures. “Two-thirds of patients don’t even know they have such fractures,” says Majumdar about the incidental findings. One group was not contacted for an intervention, only physicians were contacted in another group and both physicians and their patients were contacted in a third group. This type of social marketing to physicians and patients is part of what Majumdar, a professor in the Department of Medicine in the Faculty of Medicine & Dentistry, calls T-2 translational science (more

Dr. Sumit Majumdar

commonly known as knowledge translation in Canada), which looks beyond the more typical T-1 translational science of moving medicine from the lab to the patient. Instead, this knowledge translation works on the premise that “we already know how to best care for patients; what we need to do is apply it to everyone who would benefit.” Majumdar’s discovery is simply spectacular: Of those patients who weren’t targeted with the intervention, only six per cent received follow-up treatment or testing for osteoporosis and this is “usual care,” says Majumdar. “Right now, in Alberta, this means the ‘care gap’ between what we know and what we do in this setting is more than 90 per cent,” he says, but when physicians were given educational material and a reminder, the treatment or testing rate improved to 49 per cent. And when both the physicians and patients were informed, the rate climbed to 65 per cent of patients being treated or tested. The research findings have a significant impact in a number of areas. The economic analysis, also published in the American Journal of Medicine, showed that if a timely intervention was done, as it was in the trial, including education and bone density tests, there would be a substantial reduction in fractures, improvements in quality of life and a cost savings of about $300 per patient for the health-care system. Osteoporosis, popularly known as the “silent thief” due to its asymptomatic nature, is a bone disease that affects one in three women and one in five men. In Canada, osteoporotic fractures outnumber heart attack, stroke and breast cancer combined, and are a leading cause of death and loss of independence among seniors. The disease also exacts an enormous financial cost. In 2010, the total cost of osteoporosis treatment to Canada’s health-care system exceeded $2.3 billion, rising to $3.9 billion when long-term care costs related to osteoporosis are added to the total. The results of Majumdar’s study are starting to be adopted across Canada and are now one of the “best practices” cited by Osteoporosis Canada, as well as by the National Osteoporosis Foundation of the United States and the International Osteoporosis Foundation, says Majumdar. He is hopeful that this protocol will soon be applied locally. “The Alberta Bone and Joint Health Institute is looking at the best way to implement this work,” says Majumdar, and that we should be ahead of the curve with this research. “This is made-in-Alberta medicine.” UAM Dr. Sumit Majumdar is utilizing knowledge translation in health care in order to teach his patients how to use preventative health-care practices.

UALBERTAMEDICINE

PHOTOGRAPHY BY BLUEFISH STUDIOS

by Ross Neitz photography by Aaron Pedersen

more than 35 years of advancing health

University Cup Winner’s Heart in the Right Place ESTEEMED CARDIOLOGIST, SCIENTIST AND TEACHER EXEMPLIFIES EXCELLENCE.

through teaching, research and patient care, Dr. Paul Armstrong never doubted his calling to serve others. But in his early years as a student in northern Ontario, the Distinguished University Professor in the Faculty of Medicine & Dentistry says the plan of how he would best accomplish his goal was an open question. “At that time I had the notion that I was going to win the battle for the mind and thought I’d be a psychologist,” he recalls. Armstrong was eventually convinced by a guidance counsellor to enter medical school and become a psychiatrist instead, setting him on the path to his life’s work. But while his desire to heal never swayed, his focus did. “During the last two years of medical school I lived in a psychiatric hospital to work off my room and board. At the end of that time I was convinced that psychiatry was not for me.” Instead, through a mentor, Armstrong developed an interest in cardiology. That initial spark of interest, decades ago, has since seen him earn global recognition and accolades for his work in the field, including Armstrong’s ualberta.ca

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OVER HIS 35-PLUS YEARS IN MEDICINE, ARMSTRONG’S WORK HAS HELPED LESSEN HEART ATTACK MORTALITY RATES FROM 30 PER CENT TO JUST FIVE PER CENT. latest achievement—being named the recipient of the 2014 University Cup, the U of A’s highest academic honour. The University Cup is awarded to a faculty member who has achieved outstanding distinction in scholarly research, teaching and service to the U of A and to the greater community. “Being the recipient of this award is very special,” says Armstrong. “The University of Alberta has been a great home for me and continues to be a great home for me.” For the past 21 years, Armstrong has improved tens of thousands of lives: He has served in several leadership capacities in the Faculty of Medicine & Dentistry as chair of the Department of Medicine, director of the Heart Function Clinic at the University of Alberta Hospital and director of the UAlberta Canadian VIGOUR Centre, a position he continues to hold. Outside of his duties at the university, Armstrong has also held positions as director of the Canadian Institutes UALBERTAMEDICINE

of Health Research Training Program and as founding president of the Canadian Academy of Health Sciences. Over his accomplished academic career, Armstrong has published—and continues to publish—more than 650 high-impact papers examining heart attacks and heart failure, and has won 18 major awards and distinctions for his research. And although his academic contributions to the field of cardiology have been tremendous, Armstrong says his passion to advance research has been driven by his dissatisfaction with the status quo in health care, a curiosity about why things happen to the heart the way they do and a desire to help patients. “I’ve probably failed more than most people you’ve ever met. What keeps you going over the failures is the people you care for, and their needs, and the satisfaction you get from helping them.” In that, his career has been remarkably

successful. Over his 35-plus years in medicine, Armstrong’s work has helped lessen heart attack mortality rates from 30 per cent to just five per cent. Part of that success stems from his leadership role with the Canadian VIGOUR Centre, where he helped shape and co-ordinate international clinical trials. That work has given new understanding to the diagnosis, treatment and prevention of cardiovascular disease. While Armstrong’s efforts have had a direct impact on countless patients, he has also had a lasting influence on colleagues and students. Throughout his academic career, Armstrong has focused on guiding and inspiring young researchers. He has supervised more than 50 trainees in research, several of whom now lead academic cardiology divisions or departments in Canada and around the world. Looking back, Armstrong says his time with them has been one of the most satisfying aspects of his career. “I well remember a young man who walked into my office when I was about seven or eight years into practice, whom I hadn’t seen for a year. And he said, ‘I just came back to thank you.’ I think at that point I realized that 99.9 per cent of us aren’t going to win Nobel Prizes, but one of the most important things we can do is pass the torch—to show people that if we did it, they can do it—and to find those people who are driven as we are to make a contribution.” While his own contributions to cardiology continue, Armstrong says he is beginning the transition to a slower lifestyle. Although he continues to teach, guide research and participate in the newly formed Cardiovascular Translational Science Institute, he now has a desire to spend more time reflecting and writing on matters of a philosophical nature. And though Armstrong’s contributions to cardiology have been valuable, he knows his career would not have been as rich an experience without the support of others. “The successes I’ve had have been because of a collaborative spirit and a generosity that I hope I’ve shown, and my colleagues have shown. If we work together, we’re clearly much better than the sum of our parts.” UAM

LAST WORD

THe IT Factor in Health Care Why the promise doesn’t quite meet the reality.

BY DR. LAWRENCE RICHER

E HAVE ALL WITNESSED how innovation in information

technology has transformed our lives. Most of us carry phones about as powerful as a room full of first-generation mainframe computers. We communicate in text, voice and video with exceptional ease. In medicine, the impact of information technology is growing. Many patients, particularly young ones or their parents, want to communicate with their physicians using current technology. Soon these phones and watches will provide real-time feedback on our health. Pictures and videos captured on mobile devices can be shared readily, making the diagnosis of a rash or seizure far easier. Patients want to see their test results and participate in decision-making. They want to use IT to facilitate their access and participation in the health system. The digitization of health care and its documentation promises to improve the care we provide. A comprehensive electronic health record across Alberta holds data that could be used to provide insight on what works and what doesn’t. It’s certainly not hard to imagine a plethora of opportunities in research. Data generated in the provision of health care can be linked to other sources to gain insights that would otherwise have gone unnoticed. For example, the discovery that the new form of the measles, mumps, rubella and varicella vaccine is associated with an almost three-fold increased risk of febrile seizures came through existing data sources. (Note, such seizures are common in children and generally have an uneventful outcome.) Why, then, is Canada so far behind the rest of the world in exploiting IT for medical care, communication and data analysis? Alberta leads the country in many ways (e.g. broad implementation of electronic medical records, NetCare and patient information portals like MyHealth), yet there is still little to celebrate. Compared to other countries and health institutions, Canada is at least 10 to 15 years behind in the use of IT, and that’s a conservative estimate. Other sectors—the airline industry, retail industry, and construction industry—all use data in highly effective ways: to increase safety, learn what their clients want and ensure that what is built will stand the test of time. Why then has the health-care system had so much difficulty realizing similar benefits? For one thing, health care cannot be readily compared to other industries. Providing health care is highly variable and plain old “messy.” Our systems are complex, having developed over generations and evolved to meet changing needs. Implementation is slow and expensive, and requires a change in the practice and culture of our institutions. Secondly, simply dropping a computer in place of paper won’t PHOTO COURTESY FOMD

IT’S MORALLY AND ETHICALLY UNACCEPTABLE THAT OUR SYSTEM IS NOT EQUIPPED TO USE DATA TO LEARN FROM ITS MISTAKES AND SUCCESSES.”

change a thing. We need to document the care being provided to the patient in front of us, but if that were all I needed to do—I’d prefer to use paper. The promise of IT in health care is, to a large extent, about the data. I need to learn from the data generated in providing care, and the only way to Dr. Lawrence Richer is the do that efficiently is to collect associate dean, clinical and it electronically. How have translational research, in other patients like mine faired? the Faculty of Medicine & Did I have the right diagnoDentistry. He has a keen sis last time or am I making interest in the application the same mistake again? Am I of information technology using the best evidence-based to medical research. care that I can? What are the things I can learn from a large group of practice that, through publication, will benefit others in making similar health-care decisions? It’s morally and ethically unacceptable that our system is not equipped to use data to learn from its mistakes and successes. A major barrier in the use of IT data is the issue of privacy. All too often the use of data is limited or completely blocked in the name of privacy. While an individual’s autonomy and right to privacy is paramount, I would expect that most would place an equal or greater emphasis on the accessibility, quality, and safety of their care. The least likely risk of privacy breach is often used as a reason to deny access. Patients are not protected by these decisions; they are and will continue to be harmed. While there absolutely need to be checks and balances with appropriate oversight, avoidance of risk cannot trump the appropriate use of health information for health-care improvement and research. We need to find ways, acceptable to everyone, that permit patients to make informed choices. We need technical solutions that allow patients to make specific choices about when and how their data can or cannot be used. Privacy can no longer be held as the primary objective when the safety and quality of care is threatened. I believe our patients would agree. The transformation of health care by information technology is already well underway. However, health care will only realize the greatest benefits if the data generated can be used: the walls need to come down! UAM med.ualberta.ca

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