CUMMING SCHOOL OF MEDICINE
Brain surgery without breaking the skin Focused ultrasound offers promising alternative to invasive surgery
SPRING 2018 Indigenous learners AIM-HI 1 Health in the field
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Keeping up the momentum
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Brain surgery without breaking the skin
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Inventor of the poop pill
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Adventures in entrepreneurship 12
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Indigenous learners AIM-HI By Kelly Johnston and Michael Wood
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niversity of Calgary PhD student, Pearl Yellow Old Woman, says going to university can be intimidating. “My struggle as an Indigenous learner is finding a safe place to be who I am and to be supported in my cultural values and knowledge.” For help, Yellow Old Woman signed up for a new mentorship program offered at UCalgary. The Alberta Indigenous Mentorship in Health Innovation (AIM-HI) Network is creating a community of support around students with connections to their peers, elders or other knowledge keepers. The AIM-HI Network involves post-secondary education institutions throughout the province, enhancing support for current students, like Yellow Old Woman, and attracting new students to health research. “AIM-HI is about being connected to other Indigenous scholars who are also working through the balance of being in a western-trained institution, yet still being from an Indigenous community, and to help them reconcile the clashes that sometimes occur between those two paradigms,” says Dr. Cheryl Barnabe (MSc’11), one of the program’s principal investigators and co-chair of the Group for Research with Indigenous Peoples (GRIP) in the O’Brien Institute for Public Health. The program is uniquely structured as an intergenerational, cascading mentorship (a member is both a mentor and mentee), designed to both recruit and retain Indigenous learners in all health-focused research disciplines, including health, laboratory and social sciences. “Most classic mentorship programs have a hierarchical program, as in there’s somebody who made it through, and they supervise people who are trying to make it,” says Barnabe. Yellow Old Woman is excited about being matched to a mentor and a little nervous about becoming a mentor herself. “Our elders say that you don’t speak of issues that you don’t know of. The only place where I come with expertise and authority is my own life experience. If my struggles
and achievements could help mentor Indigenous students coming into the program in a positive, healthy way then I want to contribute,” says Yellow Old Woman. First Nations, Inuit and Métis scholars are underrepresented in the health research field. The AIM-HI Network is part of a nationwide effort to change that by providing new and expanded opportunities for mentees to succeed in health research careers. “When I think of Indigenous health research, I draw upon my own experience of being an Indigenous teen mother, living in a First Nations community and not being able to access the same health care supports for my disabled daughter as a parent living in the city. That experience has led me on a journey to create change,” says Yellow Old Woman. “My vision would be to work with the Indigenous community and perhaps conceptualize a health model that’s informed by traditional knowledge and ways of knowing, and an Indigenous parents’ perspective.” The Canadian Institutes of Health Research has committed $8 million to the nationwide program. The commitment comes on the heels of the Truth and Reconciliation Commission of Canada report, which calls on all levels of government to increase the number of Indigenous people working in health care.
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Simulation allows you to get comfortable with managing complex or acute patients, working as a team.”
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Health in the field Helping mothers and infants in Uganda By Genevieve Juillet and Melanie Tibbetts
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mproving maternal and infant health in Uganda has long been important work for the Cumming School of Medicine (CSM). Since 2003, a partnership with Mbarara University of Science and Technology in Mbarara, Uganda, has resulted in a variety of projects, including the SIM for Life initiative. Focused on using simulation-based education as a teaching method, the CSM, the KidSIM program at the Alberta Children’s Hospital, and Mbarara University are working together to create a program that improves maternal, newborn and child health outcomes in Uganda. “There’s so much strength in simulation education,” says Heather MacIntosh, SIM for Life manager at the CSM. “Part of our work with Mbarara University is sharing our expertise in designing, executing and evaluating simulation exercises that give trainees a chance to practice essential skills in a safe, supportive environment.” Program simulations have been designed for low-resource settings and target the skills necessary to handle post-partum and postoperative bleeding, neonatal and adult sepsis, and the resuscitation of newborns who aren’t breathing. “Here in Calgary, we’re used to using technology, such as machines during resuscitation, to treat infants,” explains MacIntosh. “But in communities in East Africa, health-care workers need to be able to perform these techniques manually, which is a completely different skill set.” In addition to clinical skills, simulations also focus on inter-professional teamwork — how doctors, nurses, technicians and other health-care practitioners can work together to help patients. “Participating in SIM for Life has shown me the benefits of simulation in residency training, especially when it has not previously been a part of the curriculum,” says Dr. Jessica Monteiro, a second-year pediatric resident with the CSM who spent three weeks in Mbarara in the fall of 2017.
“Simulation allows you to get comfortable with managing complex or acute patients, working as a team and, when necessary, leading that team. You’re then able to debrief following the exercise for a maximized learning experience.” To date, more than 150 medical and nursing students at Mbarara University have participated in SIM for Life education sessions. The next steps include incorporating four different simulation opportunities into medical and nursing studies, rolling the program out to health centres across the southwest region of Uganda, and creating a medical simulation centre of excellence in East Africa. “Global, maternal and child health is important for the CSM, as is forming valuable partnerships with institutions around the world,” says MacIntosh. “We have a long-term vision of capacity building with our partners who we learn so much from, lessons that we’re able to bring back to our students at the CSM. This type of collaborative education has the potential to model a new care approach for all levels of health providers.”
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KEEPING UP THE MOMENTUM Grant funding and support programs ensure success of Cumming School researchers By Melanie Tibbetts Research drives knowledge and innovation. It leads to the development of life-changing technology, and the discovery of more effective treatments and less invasive surgery methods.
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very day, researchers at the Cumming School of Medicine (CSM) are working to improve the lives of those in southern Alberta and around the world. And every day, those same clinical professionals, scientists, trainees and students are faced with funding pressures that put the momentum of their research at risk. On Jan. 24, the federal government announced an investment of $372 million across Canada, including $27.5 million coming directly to the CSM. The funding will help researchers continue their work on 34 health-related projects and is part of the Canadian Institutes of Health Research (CIHR) Project Grant funding for the fall 2017 competition. “In the world of science, funding is everything,” says Dr. Jon Meddings, dean of the CSM. “It’s what paves the way to advancement. It’s imperative that our researchers have the flexibility to follow their findings wherever they may lead. That’s when the magic happens, when some of the most profound discoveries occur.”
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The awarded funding will allow for this type of curiosity-driven, exploratory research that’s used to improve patient care and outcomes. “I’m so proud of our researchers,” adds Meddings. “The incredible work they’re doing today is impacting the future of health care. And that future is very bright.” Since the grant-writing process is often daunting and complicated, the CSM has implemented four support programs to help ensure the success of our researchers.
Cumming School of Medicine research programs The Research Enhancement Program provides up to $5,000 in funding for principle investigators to obtain training in new techniques and methodologies that will enhance their research and consequently, increase their competitive edge when submitting future grant applications.
A Bridge Funding Program exists for the Natural Sciences and Engineering Research Council of Canada (NSERC) Discovery Grant, CIHR Project and Foundation grant competitions. It helps researchers who’ve scored close to the cutoff defined by CIHR and NSERC, but are ultimately unsuccessful in securing the grant, by providing financial support until they can apply again.
The Internal Peer Review Program makes it easy for researchers to connect with one another. Each of the CSM’s seven research institutes has a peer review lead who helps organize review panels that give researchers critical feedback on their grant applications.
In partnership with Alberta Health Services, a Clinical Research Fund has been established to support high impact clinical studies that influence clinical practice and improve the delivery of care.
In addition to these programs, the CSM’s Office of the Associate Dean Research (OADR) offers research facilitation and grant development support. The OADR provides researchers with all grant-related information, hosts information sessions, reviews grants and works with applicants to develop their applications. This allows researchers to focus on what they do best — drive discoveries. “We’ve created a supportive environment that has resulted in more grant submissions, greater success rates and an increase in the total dollars awarded per competition,” says Meddings. “These supports in addition to investments by our federal government is the key to new treatments, breakthroughs and advances in health science.”
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BRAIN SURGERY
without breaking the skin By Kelly Johnston, Holly Kerr and Tanya Morton
Bruce Pike, PhD
Focused ultrasound offers promising alternative to invasive surgery
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lias Pharaon is 85 years old and can sign his name for the first time in five years thanks to a new way of doing brain surgery. Performed by a team of surgeons, physicians and researchers at the Hotchkiss Brain Institute (HBI) at the Cumming School of Medicine (CSM), magnetic resonance guided focused ultrasound (MRgFUS) is a new technology that allows surgeons to access the brain without cutting the skin or drilling into the skull.
The patient is awake the whole time and the results are immediate.”
Innovative technology paves the way to non-invasive treatment “We’re able to see the brain with real-time temperature imaging and focus multiple beams of high intensity ultrasound to the brain region responsible for tremor,” says Dr. Zelma Kiss, neurosurgeon, HBI member and professor in the departments of Clinical Neurosciences and Psychiatry. “The patient is awake the whole time and the results are immediate.” Pharaon came from B.C. for the treatment at Calgary’s Foothills Medical Centre. He volunteered to undergo the procedure and participate in the research project conducted by Dr. Kiss; Bruce Pike, PhD, a professor in the departments of Radiology and Clinical Neurosciences; and Dr. Davide Martino, movement disorder specialist and associate professor in the Department of Clinical Neurosciences. The MRgFUS system is the only one in Western Canada.
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“I couldn’t believe the tremor in my right hand was gone. I didn’t feel anything during the procedure,” says Pharaon. “I was so happy. It has changed my life — I feel like I can go out in public again.” Essential tremor is the most common type of movement disorder, and is usually treated with medication. For some, like Pharaon, the medication doesn’t work and the tremors become so severe people can no longer dress or feed themselves. “The condition occurs because different parts of the brain aren’t talking to each other properly and the abnormal network function causes the tremor to appear,” says Martino, who’s also a member of the HBI. Martino identifies patients who qualify for treatment and conducts all the follow-up work, which includes brain scans, clinical evaluations, cognitive and functional testing, and motor and sensory abilities. At this point, only patients with severe medication resistant essential tremor are being treated with MRgFUS.
Direct benefits for Canadians In Canada, one in three people will experience a brain or nervous system illness or injury within their lifetime. The economic burden is staggering: the federal government estimates direct illness costs of neuro-psychiatric conditions alone exceed $12 billion annually — a total that doesn’t include lost productivity or other indirect losses. This cost is surpassing that of all other diseases in Canada. The MRgFUS technology is providing new hope for effective treatments that drastically reduce recovery times and risks associated with traditional neurosurgery.
“This is the beginning of a much larger research platform,” says Pike, an HBI member and MRgFUS research team lead. “The idea of neurosurgery in an awake patient without breaking the skin is revolutionary. With the use of this technology, we’re looking at different treatment options for a number of devastating brain diseases such as Parkinson’s disease, dementia, epilepsy and brain tumours.”
Collaboration facilitates critical funding to support excellence in research Using this technology has been supported in part through community donations to the Rob McAlpine Legacy Initiative, formed by a group of individuals who’ve collectively contributed $1.5 million towards the development of the MRgFUS Research Platform. The community initiative is named in honour of Rob McAlpine, who was the vice-president of finance and chief financial officer with Spartan Controls in Calgary. McAlpine was diagnosed with Multiple Systems Atrophy (MSA) in 2006 and passed away from the condition in November 2015. MSA is a type of movement disorder that’s associated with the degeneration of brain cells and is also referred to as a Parkinson’s plus disorder. McAlpine’s friends and family describe Rob as an extraordinarily intelligent and passionate individual who gave everything he had to those close to him. After his diagnosis, McAlpine’s colleagues were moved to create a fund to support research for those affected by similar disorders.
Bruce Pike, PhD, Carolyn McAlpine, Mike Begin and Dr. Zelma Kiss
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It has changed my life — I feel like I can go out in public again.” Elias Pharaon and Dr. Zelma Kiss
Making a difference “When someone who makes such a difference for others becomes ill, you want to do something; educate yourself and find a way to help others who’re suffering from something similar to what Rob was dealing with,” says Mike Begin, former CEO of Spartan Controls. “When we decided to move forward with this initiative, it didn’t take long for people to come together and create something to honour his legacy.” Colleagues, longtime friends and those who related to the cause established the Rob McAlpine Legacy Initiative before Rob passed away. Though he never had an opportunity to see the MRgFUS treatment in person, his family believes he would be thrilled to know how far the initiative has come. “We feel so grateful to see this initiative helping people with conditions similar to that which affected Rob,” says McAlpine’s wife, Carolyn. “Celebrating Rob’s spirit in this way has created
new memories my children and I will cherish of their father and my best friend.” MRgFUS research is being supported through collaboration with Alberta Health Services with additional funding from the Canada Foundation for Innovation and private donors, including a significant contribution from the Cumming Medical Research Fund. These major investments are paving the way for a larger research platform that’s attracting world leaders in imaging, neurology, neurosurgery and neuroscience to Calgary. Led by the Hotchkiss Brain Institute, Brain and Mental Health is one of six research strategies guiding the University of Calgary toward its Eyes High goals. The strategy provides a unifying direction for brain and mental health research at the university and positions researchers to unlock new discoveries and treatments for brain health in our community.
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Dr. Thomas Louie
Uncapping the story:
The UCalgary scientist who invented the poop pill By Kelly Johnston
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he pioneer of the “poop pill” believes that to practice medicine you need to optimize science and art. “Often times in health care, it’s fixing people up. They’re your work of art,” says Dr. Thomas Louie, a clinical professor at the Cumming School of Medicine. “Being a good physician is being a good scientist and a good artist. Every patient you work on is a painting and is to be appreciated.” Trying hard comes naturally to Louie. At 72, he works at least 60 hours a week, tending to patients and doing research in the lab where he developed a non-invasive method to treat C. difficile, a serious gut infection that can cause symptoms ranging from severe diarrhea to life-threatening inflammation of the colon. “The idea came from animals and work in veterinary medicine. Animals sick with unidentified intestinal ailments get better when they’re given fecal matter,” says Louie. “When I think of it, animals have been eating dung for years; maybe instinctively they know it can help them when they’re sick.” Louie adds understanding the role of gut microbes in maintaining health is very much in vogue these days. Louie began doing fecal transplants more than 20 years ago in patients’ homes. Patients were
referred from all parts of Canada and, in the early days, some from the United States. The procedure, delivered via enema, was close to 100 per cent effective in stopping recurrences of C. difficile infection. In 2010, concerned for two patients who weren’t cured by using an enema, he had the idea to try delivering the treatment in pill form. The pills have now been proven to be as effective as the colonoscopy method. In addition to improving health care for individuals, Louie has also helped create ways to improve health care systems. “I’ve spent much of my career as an infectious diseases and infection control physician. In the early ’90s, I was part of a team that developed an infection control training program at the University of Calgary to provide advanced skills and degrees in hospital epidemiology. That program has played a pivotal role in creating a provincewide infection control program. Alberta now has one of the best systems in the country thanks to the work and commitment of a lot of great people.” Pursuing a career in medicine was not on Louie’s radar as a child. He didn’t grow up dreaming of becoming a doctor. While he always had an interest in science, he says he just drifted toward medicine, following the path of his four older brothers to the
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Having a Fecal Microbiota Transplant (FMT) may sound highly technical and invasive but if that transplant is in the form of a pill, it couldn’t be simpler. In Dr. Louie’s lab, all the poop pills are made individually, by hand. The poop comes from donors — three volunteers who donate their stools full of healthy organisms to reset the microbiome in the gut of a sick person.
Please don’t try this at home
Here is the life-changing recipe that cures most patients suffering from C. difficile.
Dr. Thomas Louie’s
“Poop pill” Recipe to treat C. difficile Ingredients:
Process: 1. Suspend the poop in the saline. 2. Filter the poop to catch all food particles. Use a fine filter, everything larger than a poppy seed should be discarded.
• One donated poop from medically screened donor
3. Spin remaining poop at 400 times the centre of gravity for about a half-hour (use centrifuge). You’ll see a muddy substance at the bottom of the tube and cloudy “water” on top. 4. Pour off the “water” on top — it’s holding all the good bugs. 5. Spin “water” at 10,000 times the centre of gravity for about a half-hour (use ultracentrifuge). 6. Pour off the “water” (which should be clear now).
• Saline (phosphate buffered with extra additives to make sure the oxygen doesn’t attack the bugs)
7. The good bugs will be held on the rim of the container. The bugs will have a strong unpleasant smell. 8. Transfer bugs into smallest gel pill capsule, then put that pill into a second larger pill capsule.
1 donated poop = 2½ tsp. of good bugs • Empty gel pill capsules (two sizes)
(enough for 20 pills which will treat one patient)
University of Alberta’s medical school, prior to UCalgary creating its own medical program. In 1970, Louie was in the first group of internal medicine residents at the UCalgay’s medical school. “Developing a career was somewhat accidental for me. I think I would have been involved in science in some way, perhaps a civil engineer,” says Louie. “I like not having a desk job, and I like talking to people. You follow what gives you
satisfaction and hopefully the work you do is felt to be mostly play. If your work gives you artistic satisfaction, it will stand the test of time.” Dr. Thomas Louie is a clinical professor in the departments of Medicine and Microbiology, Immunology and Infectious Diseases. He’s also a professor emeritus and member of the Snyder Institute for Chronic Diseases.
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Adventures in entrepreneurship: Learning to master business and innovation in health care By Amy Dowd Being an entrepreneur is just business as usual for Virginia Goetz. “I’ve always had an entrepreneurial spirit,” says Virginia Goetz (MBT’18), a graduate of the Cumming School of Medicine’s Master of Biomedical Technology (MBT) program. “Both of my parents have their own business. At a young age I knew you could work for yourself and build what you wanted.” As an undergrad, Goetz started a windowwashing business with her sister. It gave her a taste of calling the shots, and planted a seed.
As a master’s student, the MBT program provided the building blocks to expand her entrepreneurial foundation. It also helped her better understand herself. “You need to know your strengths and weaknesses to build the right team, which is essential to being an entrepreneur.” With an existing interest in pediatrics, Goetz spent her year-long capstone project working on a prototype for a mouth splint to help kids with juvenile arthritis in their jaw joints. She found the ideal mentor in Dr. Marinka Twilt, a pediatric rheumatologist at the Alberta Children’s Hospital (ACH). Dr. Twilt suggested the project and Goetz ran with it. “She was a fabulous mentor; her network of colleagues helped bring together the interdisciplinary team of experts we needed.” For Goetz, there’s a natural connection between health care and entrepreneurial thinking. “From the patient perspective, when you’re innovating new medical devices or drugs, I think that gives people optimism, hope, about whatever they’re going through.” Currently a first-year medical student at the University of Alberta, Goetz is planning to continue her research this summer and explore where that takes her. The opening of a new jaw clinic at the ACH means there could be an opportunity to see how her prototype fits into the clinical care pathway. “My two biggest passions are entrepreneurship and medicine,” she says. “I hope I can continue to combine them in the future.”
Virginia Goetz
Jacob George
What a difference a month can make. Just ask Jacob George.
Entrepreneur essentials
When biomedical engineering masters student Jacob George signed up for a volunteer make-athon in August 2016, he set in motion what he calls the defining experience of his graduate program. Armed with a mechanical engineering background, plenty of design competition knowhow, and the support of his supervisor Steven Boyd, PhD, director of the McCaig Institute for Bone and Joint Health, George worked with his teammates to create a device to assist people with their at-home stroke rehabilitation. “We were paired up with Zhao, the father-in-law of one of my teammates,” says George. “He had a stroke and, living in rural China, he didn’t have consistent access to rehab facilities or clinicians.” The team built a robot that moved Zhao’s arm back and forth around the elbow joint. The following year, they took their design to the TENET i2c (innovation to commercialization) business pitch competition. After connecting with Dr. Sean Dukelow, lead of the Calgary Stroke Program, they realized there was a similar need for at-home rehab in places like Alberta.
“We wanted to step up, to fill this gap; that’s where our company came from.” Now George is building on his experience and hopes to facilitate affordable, accessible stroke rehabilitation at home through Re-able, the company he co-founded with former teammate and University of Calgary alumnus Riley Booth (BSc’14, MSc’18). “I always thought it would be cool to run my own thing,” he says. “I got involved in design projects because I thought I could make impactful changes.” Re-able is developing a smartphone app and wearable activity tracker designed to integrate stroke recovery movement into daily life. Both Goetz and George credit great advice from mentors and support from the Hunter Centre for Entrepreneurship and Innovation, the Hunter Hub for Entrepreneurial Thinking, and Innovate Calgary as a vital part of their experience. “The entrepreneurial community here is extremely supportive,” says George.
People tend to be naturally better at one thing; the entrepreneurial journey is really about filling in the gaps for everything else. Make sure you connect with your market really, really well.
Tips from Jacob George
Mentorship is really important. Don’t just be open to the support and input of others, go out and seek it.
Tips from Virginia Goetz
Be honest and ask for what you want, graciously and confidently. The worst people can say is no.
Cumming School of Medicine
Alumni of Distinction Research Award
Nominations will be accepted until May 11, 2018. The winner will be chosen by the members of the Medicine Alumni Advisory Council and announced in June. Nominees are encouraged from all CSM programs. Preference will be given to nominees who haven’t previously been recognized with an Alumni of Distinction Award or a University of Calgary Arch Award.
cumming.ucalgary.ca/alumni/awards
For more information, please contact us medalum@ucalgary.ca cumming.ucalgary.ca/alumni Cumming School of Medicine University of Calgary 3280 Hospital Drive NW Calgary, AB T2N 4Z6 Join the conversation | | @UCalgaryMed Managing editor Melanie Tibbetts 403.210.6577 melanie.tibbetts@ucalgary.ca Editorial team Jordanna Heller Pauline Zulueta Contributors Amy Dowd Kelly Johnston Genevieve Juillet Holly Kerr Tanya Morton Melanie Tibbetts Michael Wood Photo and illustration contributions Paul Barber Riley Brandt Marnie Burkhart Quentin Collier Amanda Fisher Adrian Shellard Amanda Starlight Pauline Zulueta
18-ALU-001
Know a Cumming School of Medicine (CSM) alum who deserves to be recognized for their outstanding contributions to clinical, community-based or basic science research? Nominate them for the 2018 Alumni of Distinction Research Award.