UCalgary Medicine Magazine Fall 2011

FALL 2011

SUMMER 2010

A UNIVERSITY OF CALGARY Faculty of Medicine Publication

Optimizing a treatment

A unique treatment for specific cancers of the abdomen

A royal occasion A look at the Royal Couple’s exclusive tour of the Faculty’s own W21C – page 10

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Straight to the heart

How a small electronic device could potentially save lives

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uCalgary

Medicine Vol 3 Issue 3 | FALL 2011

UCalgary Medicine is published three times a year by the University of Calgary Faculty of Medicine, providing news and information for and about our faculty, staff, alumni, students, friends and community.

For more information contact:

Managing Editor Kathryn Sloniowski T 403.220.2232 E kjslonio@ucalgary.ca

Dean Dr. Thomas E. Feasby

Vice Dean Dr. Jon Meddings

Senior Associate Deans Dr. Richard Hawkes, Research Dr. Benedikt Hallgrímsson, Education Dr. Ronald Bridges, Clinical Affairs

Associate Deans Dr. Anthony Schryvers, Undergraduate Science Education Dr. Bruce Wright, Undergraduate Medical Education Dr. Jennifer Hatfield, Global Health & International Partnerships Dr. Doug L. Myhre, Distributed Learning & Rural Initiatives Dr. Joanne M. Todesco, Postgraduate Medical Education Dr. Frans A. van der Hoorn, Graduate Science Education Dr. Jocelyn Lockyer, Continuing Medical Education Dr. John Reynolds, Basic Research Dr. Michael Hill, Clinical Research Dr. Janet de Groot, Equity & Teacher-Learner Relations Dr. Kamala Patel, Faculty Development

Design and Production Kelly Budd, Radius Creative

Photography Carlos Amat, Rebecca Davidson, Government of Alberta, Trudie Lee, Bruce Perrault, Kathryn Sloniowski

Free Copy/Alumni Update

To receive a free copy of UCalgary Medicine please call 403.220.2819 or e-mail medcomm@ucalgary.ca The Faculty of Medicine is committed to staying in touch with our alumni. Please update your contact information at our website www.alumni.ucalgary.ca (click on “update your info”)

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PM AGREEMENT NO. 41095528 RETURN UNDELIVERABLE CANADIAN ADRESSES TO: University of Calgary Faculty of Medicine Communications & Fund Development Health Sciences Centre 3330 Hospital Drive NW Calgary, Alberta T2N 4N1

Fall 2011

Volume 3 Issue 3 | FALL 2011

pg4 Showcasing our Faculty | Message from the Dean Sharing our accomplishments as a Faculty.

pg5 New realms of possibility | Philanthropy

In honour of Ronald Ward, a successful entrepreneur who passed away from dementia, his estate is funding a foundation set up to discover breakthroughs in brain disease.

pg6 Optimizing a treatment | Service to Society

A unique treatment redefines chemo as we know it, and is showing promising results for patients with specific cancers of the abdomen.

pg10 A royal occasion | Research

Cover Story

After their first international tour as a married couple, The Duke and Duchess of Cambridge are no strangers to the Faculty of Medicine.

pg14 All eyes on alumni | Education

Dr. Eric Wasylenko sits down with Kathryn Sloniowski to discuss his career as a doctor since graduating with UCalgary’s medical class of 1982.

pg16 Straight to the heart | research

In attempts to reduce sudden death caused by sudden cardiac arrest, a new study has been launched to discover if a small implantable device can help.

pg18 A unique APPROACH | research

A unique registry is contributing to advancing cardiac care as we know it.

FALL 2011

SUMMER 2010

A UNIVERSITY OF CALGARY FACULTY OF MEdICINE PUbLICATION

pg19 In the news | NEWS

Top stories from the Faculty of Medicine.

Optimizing a treatment

A unique treatment for specific cancers of the abdomen

A Royal Occasion A look at The Royal Couple’s exclusive tour of the Faculty’s own W21C – page 10

medicine.ucalgary.ca

page 06

Straight to the heart

How a small electronic device could potentially save lives

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On the cover A Royal Visit exclusive

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FALL 2011

contents

message from the dean

Showcasing our faculty I have said many times how proud we are of our staff and students at the Faculty of Medicine. It is because of their hard work and dedication that we have become a highly respectable institution, known for our firstclass education, state-of-the-art research and integrity.

This summer has been an exciting time for the Faculty. It was with great enthusiasm that we welcomed the medical class of 2014, and at 178 students, we are happy to know they will help fill the ongoing need for medical professionals in the years to come.

The summer also marked a very exciting historical moment for the Faculty. Their Royal Highnesses, The Duke and Duchess of Cambridge chose our institution as the only Canadian university to visit on their first international tour as a married couple.

In an exclusive tour, they visited our Ward of the 21st Century (W21C) Research and Innovation Centre—highlighting the Faculty’s commitment to technological innovations and research in health care. Hosting them was a true honour, and as a Faculty, we were given a rare opportunity to highlight our achievements on an international front.

On pages 10, 11, 12 and 13, we share the momentous occasion with you.

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Throughout this issue we illustrate many times just how our Faculty and staff have come together to change the lives of those around us. On pages 14 and 15 we catch up with alumnus Dr. Eric Wasylenko, who

has, since graduating in 1982, made an incredible impact in our community. From his contributions to palliative care, to his continuing interest in ethics, we are very proud of his contributions to society and that we can call him one of our own.

We are also very happy to be able to offer a rare glimpse into a unique treatment called ‘hot chemo’—a procedure used to treat specific cancers of the abdomen that may have no other treatment options. Calgary was the first Canadian site to offer the procedure, with our Faculty’s own Dr. Walley Temple. Brent Pearce, a 32-year-old husband and father of two was kind enough to let cameras document his experience with the procedure—giving us all insight into this unique treatment. On pages six, 7, 8 and 9, as Brent and his wife Ruth share their story with us, and as we take an in depth look at the procedure on, I’m sure you’ll agree that some very incredible things happen at the Faculty of Medicine.

While these are only a few of the stories in this issue, one thing is clear−great things happen here every day. I trust you’ll enjoy reading about just a few of these great things, and I welcome any feedback you may have.

Tom Feasby, MD Dean, Faculty of Medicine University of Calgary

Fall 2011

Philanthropy

New realms of possibility The brain is a mysterious part of the body and its diseases are often just as perplexing. In honour of Ronald Ward, a successful entrepreneur who passed away from dementia, his estate is funding a foundation set up to discover breakthroughs in brain disease.

By Colleen Biondi Dr. Eric Smith.

When he began medical school, there was no doubt what area of study Dr. Eric Smith would pursue. “The brain seemed to be the most mysterious part of the body,” says the esteemed Calgary neurologist, who is an assistant professor in the Department of Clinical Neurosciences and a member of the Hotchkiss Brain Institute (HBI). Since arriving in Calgary from Harvard’s Medical School in 2008, he has worked on a complex aspect of brain impairment that has stymied researchers to date—dementia.

“Dementia is a medical term for problems of memory and thinking serious enough to cause disability and to keep people from living full lives,” says Smith. There are multiple causes, the primary one being Alzheimer’s disease.

But within the last decade, vascular problems have been found to damage the brain due to compromised blood flow or brain bleeding, and are estimated to be the second biggest contributor to dementia.

Smith is working with fellow HBI member Dr. David Hogan, a gerontologist and the director of the newly-opened Brenda Strafford Centre on Aging, to better diagnose vascular dementia using magnetic resonance imaging (MRI) scans at local dementia clinics. They will track how often patients have risk factors for getting little strokes (escalated blood pressure, cholesterol and sugar levels), how adequately they are treated and medically managed and whether patients who have risk factors−under control−develop cognitive problems at a reduced rate over time. “We can provide clinical care and research to better understand the quality of care and risk factors. We couldn’t have this combined approach without the generous gift from the Ronald and Irene Ward Foundation,” says Smith.

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The private foundation, funded by the estate of the late Ronald Ward, successful oil and gas entrepreneur and geologist, and his wife Irene, was created two years ago to support research into neurological disorders including dementia, explains trustee and close relative of the Wards, Paul Wanklyn. Ronald died of Lewy Body Dementia in 2007 and it is important to the family that the trust provides the financial support ($750,000 over five years) to contribute to breakthroughs in brain disease, he adds. “I am very pleased the fund is accomplishing its goals by helping top researchers accomplish theirs.”

Dementia is rarely due to a single failure; there are many factors at play. When pathologists examine the brains of people who have suffered from dementia, they often see Alzheimer’s disease, evidence of little strokes (up to 40 per cent of older people suffer from these without realizing it) and a pathology called Lewy bodies (these are aggregates of protein that build up in brain cells). There needs to be a better understanding of Alzheimer’s and Lewy bodies, but existing success with vascular disease prevention and management could reduce risk for dementia today.

The good news is there are treatments that already work for vascular disease such as medicines to lower blood pressure and cholesterol and to manage diabetes. “It is possible that we might be able to target these medicines to certain sub-groups to reduce the risk of getting dementia. That is quite exciting,” says Smith. D

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Service to society

Optimizing a treatment

Chemotherapy is typically thought of as being given through an IV, or taken by swallowing a pill. A new treatment however, redefines chemo as we know it, and is showing promising results for patients with specific cancers of the abdomen.

“You’ve got cancer” are the dreaded words nobody should have to hear, but unfortunately, too many do. For some, treatment options are vast−offering hope for remission and eventually a cure. For others, treatment options may be lacking, initiating a bleak outlook as to what lies ahead. A new treatment however, is bringing hope to some patients—providing an option when, in many cases, there would be no other. It’s called ‘hot chemo’ and it’s being performed by the Faculty of Medicine’s own, Dr. Walley Temple.

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Fall 2011

Service to society

Inside the hot chemo procedure.

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Service to society

By adding heat, the activity level of the already concentrated chemotherapy (approximately 25 times more active than conventional, intravenous chemotherapy), increases another 50 to 100 times . This is an effect Temple says is, “the principle of the procedure.” While most side effects are a consequence of the surgery and the chemo side effects remain minimal, the procedure is quite intense−taking between eight and 10 hours from start to finish, including tumor removal, hot chemo and reconstruction.

The HIPEC procedure is currently used to treat mesotheliomas (cancer induced from asbestos exposure) and cancers of the colon, rectum and appendix, and may be used for stomach cancer in the future. Treatment is usually reserved for cases involving disease recurrence or cases that initially present with metastatic disease (disease that has spread from the original tumor site). To qualify for the procedure, recurrences or metastasis must be limited to the abdominal cavity and patients must have been previously responsive to traditional, systemic chemotherapy. The treatment is however bringing considerable hope to patients and families, as most recipients of the treatment will initially face a zero per cent chance of a cure. Prognosis following hot chemo increases significantly−appendiceal cancer patients will face a 50 to 75 per cent five year survival rate, while colon and rectal cancer patients will see their five year survival rate increase to 30 per cent.

To ensure the best possible prognosis, Temple also suggests the possibility of patients undergoing additional chemotherapy treatments post op, in a combined approach to beat the disease.

Inside the hot chemo procedure.

“Some cancers that recur, recur in unusual ways in that they coat the surface of the bowel and lining of the abdomen,” says Temple, a member of the Southern Alberta Cancer Research Institute and a professor in the Departments of Surgery and Oncology. “If you can remove the tumor surgically, we administer a hot chemo bath that can kill the remaining cells in the abdomen—on the surface of the bowel in particular.”

The combined procedure Temple is referring to is called heated intraperitoneal chemotherapy (HIPEC), but is more commonly referred to as ‘hot chemo’. Used to treat specific cancers of the abdomen such as colon and rectal cancer, it is most often used in treating patients who have had a recurrence of the disease, and in many cases, have no other viable treatment options. Calgary is proud to have been the first Canadian site to perform the procedure, first offering it in 2000.

The unique procedure begins with the surgical removal of the tumor in a process referred to as ‘stripping’. Once the tumor is removed, a hot chemo bath is applied to the abdomen with full intent on destroying any remaining cancer cells. So, what exactly is a hot chemo bath? The chemotherapy used is heated to approximately 42 C, and as opposed to conventional intravenous chemotherapies, the hot chemo is pumped directly into the abdominal cavity for approximately 60 minutes—creating a sort of ‘bath like’ setting. By doing this, the chemo has the ability to penetrate two to three mm into the surrounding tissue, destroying all cancer cells that may have escaped the stripping process.

“Often patients have the treatment we give them and they’ll go on to other treatments afterwards as an adjuvant to finish the job,” he says. “The drugs are getting better so the results of our surgery get better because it’s a team—a multidisciplinary treatment.”

To date, approximately 200 patients have received the treatment in Calgary.

Centres have, since the opening of Calgary’s centre, been opening up nationwide. Qualified surgical oncologists are now performing the procedure in Montreal, Halifax, Edmonton and Toronto. With only two qualified doctors to perform the procedure in Calgary, Temple and his colleague Dr. Lloyd Mack, Calgary remains the busiest Canadian site. Temple says while they have accepted patients from all provinces, with the new centres now open, they try to refer patients to their nearest centre. As it stands, Calgary, and now Edmonton, mainly serves western Canada. International cases are referred to the United States.

In addition to pioneering hot chemo’s Canadian presence, Calgary has also had a training program for several years. Each year one or two surgical oncologists are trained to perform the procedure.

“We’ve trained doctors who have or will go to the Bahamas and to Slovenia, Australia and the United States.”

Watch the hot chemo procedure by scanning the QR code with your smartphone.

Don’t have a smartphone yet? No problem!

You can check out the video online at: www.youtube.com/ucalgarymedicine Dr. Walley Temple.

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Fall 2011

Brent Pearce was living the life any 32-year-old would dream of. He and his wife Ruth had been living in the Cayman Islands for nearly seven years, and together they were raising their two young sons: Aiden, 3, and Elias, 1. It was a life of bliss until things took an unexpected turn.

“There was fluid in my stomach making me look pregnant,” Brent says. “I was bloated and had a herniated belly button.”

After several tests came back inconclusive, doctors drained the fluid from his stomach and sent it away for further testing. The young couple received the devastating results just two days before Brent’s work contract ended and they were to return home to Salmon Arm B.C.—the fluid contained cancerous cells.

“As soon as the doctor came back with the results and said it was cancerous, we bumped our flights ahead and came back to Canada as fast as we could,” he says.

The diagnoses was pseudomyxoma secondary to appendix cancer—a rare condition that only affects approximately 1,000 people worldwide, each year. Characterized by mucin-producing tumors and mucin in the abdomen, the disease usually arises from a primary cancerous source, which in Brent’s case, was difficult to locate.

“They didn’t know where the primary source was,” says Ruth. “Usually end stage cancer presents like that.”

As they waited for answers, Ruth sent her husband’s medical records to a doctor in Germany, who suggested the HIPEC procedure.

“He’s the one who said ‘you should really get this new procedure done’ and that’s when I contacted Dr. Temple’s assistant,” she says. “She said to just get the referral sent in, and we met with Dr. Temple within two weeks.”

It was the end of June when Brent underwent the hot chemo procedure. The recovery process was anything but easy but he kept himself occupied in his hospital room with books, a Lego set, and visits from his family and friends.

“I want to say going through this has been an eye-opener,” he says. “You really realize how short life can be.”

Ruth, who was living in a rented condo with the couple’s children during Brent’s recovery, says the procedure has given her hope.

“Basically they said he had months to live and I knew all along from my research that this was our only hope,” she says. “Our lives were turned upside down and when that happens, you don’t know how to plan for the future. Now I feel like there’s a chance for a future.” D

Brent with his wife Ruth and sons Aiden (left) and Elias (right).

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Brent with son Aiden.

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Service to society

Brent’s story

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Fall 2011

Research

A royal occasion They’re no strangers in the home. The world watched eagerly when they got married and their faces continue to grace the covers of magazines and newspapers worldwide. And now, after their first international tour as a married couple, The Duke and Duchess of Cambridge are no

By Marta Cyperling strangers to the Faculty of Medicine.

It was a secret only a few people were privy to, but they had to keep quiet for months. They could only call it “Operation Bluebird” and although they were bursting to talk about it they couldn’t even tell this secret to family members or closest friends.

In June when it was finally revealed that Prince William and his wife Kate, The Duke and Duchess of Cambridge, were going to visit the University of Calgary’s Faculty of Medicine, researchers and staff behind the scenes breathed a sigh of relief. There was a lot of hard work ahead but at least now they could openly talk about the covert operation.

On July 7th Their Royal Highnesses visited the Faculty’s Ward of the 21st Century (W21C) Research and Innovation Centre—a ‘living laboratory’ and test site for cutting edge hospital design, new approaches to health-care delivery and innovative medical technologies. The University of Calgary was the only Canadian university on the couple’s first official international tour.

the W21C and had the opportunity to demonstrate one of the interactive research projects for the Duke and Duchess. Pearson was one of three people in a control room operating iStan, a wireless patient-simulator. Programmed to mimic cardiac arrest during a simulation exercise, it was Prince William’s job to use the automated external defibrillator (AED) and give chest compressions to save iStan’s life. When he finished the compressions, iStan replied with, “thank you for saving me, Your Royal Highness,” a comment made by Dr. Ward Flemons, a physician in the control room.

Pearson was impressed with the Royal Couple’s interest after the demonstration.

“When the scenario finished, Will and Kate came into the control room and shook our hands. I was very surprised.

Kate asked about the AEDs, where they were placed in communities and how they were used,” says Pearson. “Prince William also had a little fun with the simulator.

We asked if he wanted to make him talk and he said ‘yes’. He made Stan say “my belly hurts”. People in the simulation room heard Stan but didn’t know it was Will controlling it.”

The Royal Couple was greeted at the W21C by Premier Ed Stelmach, University of Calgary president and vice-chancellor Elise Teteris, a research associate in W21C, Elizabeth Cannon, PhD, and other Will and Kate with flower girls Makayla Willick and Ryenne Katterhagen. demonstrated an eye tracking system used dignitaries. A crowd of hundreds waited outside the building in 28 C to monitor and improve tasks by health-care providers. “It’s a light-weight summer heat hoping to catch a glimpse of the couple as they arrived. device that I can wear while I walk around. Will and Kate could see my eye Aimee Pearson, a MSc psychology student, was one of the few people inside movements and where I was looking.”

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Research Researchers watch as Will performs CPR on iStan.

For the purpose of the Royal Visit, W21C teamed up with Alberta Shock Trauma Teteris’ demo only lasted a few minutes and she still can’t believe the Royal Air Rescue Society (STARS) air ambulance to create a video demonstrating Visit went by so quickly. “We did dozens of practise runs and two months of how the eye tracking device could be used for training purposes during prep work. The excitement that day was unbelievable−the day is a blur to me.” helicopter rescues. Will, a helicopter pilot himself, and Kate were shown the video and The Duke and Duchess were shown three “When the scenario finished, other health-care technologies including a saw the versatility of the technology and its Will and Kate came into potential application in aviation health care. wireless band aid that continuously monitors a patient’s core body temperature−a useful the control room and Currently, eye tracking technology is often tool for select patients who have infections shook our hands.” used in non-clinical settings such as driving, and require continuous observation. A athletics and aviation research. While it’s pressure sensing mattress cover used to new to the health-care setting, it can be used to track the eye movements of prevent bed sores and a computer keyboard designed for easy cleaning to health-care professionals in cases such as performing surgical procedures prevent infectious diseases from spreading was also shown to the couple. and preparing medication.

UCalgary president and vice-chancellor Elizabeth Cannon, PhD, with Will and Kate.

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Fall 2011

Research

While the W21C research team helps develop technologies to enhance patient safety and quality of care, another unique attribute of the ward is its link to patients at the Foothills Medical Centre. “This allows for the new technologies to be tested, and allows researchers to refine the product and then go to market,” says Dr. Bill Ghali co-director of W21C and an internal medicine specialist and professor in the Departments of Medicine and Community Health Sciences at the Faculty of Medicine. “We have a good mix of academia and industry, we have some exciting partnerships with different Canadian companies, and some products such as the pressure sensing mattress covers are already on the market and have the potential to be a valuable new technology for the health sector.”

The royal visit lasted 45 minutes and created many long term opportunities for the university and for the faculty. “The Royals put the spotlight on us,” says Dr. Tom Feasby, dean of the Faculty of Medicine.

The national and international media coverage has raised the profile and awareness of the research performed at UCalgary and the Faculty of Medicine.

“There were a number of calls from the public, the website hits were in the thousands, and people were talking about it on social media,” says Susan Mide Kiss, who is the communications lead for W21C and has tracked the impact of the visit. “People continued to visit our website after the tour to learn more about our research and how we are changing health-care systems. Other research and health-care centres have called us to ask about research opportunities.”

In addition to the new partnerships that were formed, Mide Kiss says the Royal Visit also had an impact on young students. “It’s exciting for a young generation of researchers and health-care professionals. It was a chance for them to see really exciting work being done right here in Calgary at the W21C and at the university.” D

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Education

All eyes on alumni They walk in our doors as ambitious students and walk out as educated health professionals, determined to make a difference in the world. In this issue, Dr. Eric Wasylenko sits down with Kathryn Sloniowski to discuss his career as a doctor since graduating with UCalgary’s medical class of 1982—the locusts.

What was your first job as a doctor?

I was a rural family doctor for the first nine years of my career. I practiced in Okotoks with privileges at the High River Hospital.

people who have lived their whole lives in this kind of a community, say a farmer or a rancher, get to see, depending on time of year, cows grazing, maybe a friend or a neighbor harvesting their fields in the fall, and they get to have a great vista of the mountains.

What has been your proudest moment as a doctor thus far?

That sounds like a great project. How did you get the funding to build it?

I still feel that helping individual people, making a difference in their lives, is one of the best things we all do. But I also love building things as part of a team−facilities, new clinical programs, innovative care processes−that will make a difference both for colleagues and for a large number of patients in the population.

What types of things have you built?

One of them was the Foothills Country Hospice. This was one of the first freestanding, purpose-built, non-profit, private residential hospices built in rural Canada. It was built on an acreage outside of Okotoks and is primarily meant to serve rural communities. It has provided the opportunity for people to not have to leave their own communities, and to stay with or near their loved ones as they approach death. One of the neat things for us is that

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The land was donated by a physician colleague, Jim Hansen, and his family, and we were able to build the hospice completely with private funding. A small group of volunteers got together and developed a mission, advocated and raised about $5 million from the community to build it. Very few of the people had health-care or management experience, and we were able to build this facility that’s been open now for two-and-a-half years. I happened to help lead it but it was truly a community inspired project.

How is it currently funded?

Once we opened, the Calgary Health Region began supporting us with twothirds of yearly operating funding. We raise the money each year for the other third of operating costs. The budget is around $2 million or so. Two-thirds of the funding now comes from Alberta Health Services—the same funding arrangement they have with every other hospice in Calgary.

Fall 2011

Education

The Foothills Country Hospice located outside of Okotoks.

Can you describe the environment of the Foothills Country Hospice?

There are eight patient rooms and two family bedrooms—we wanted it to be very small and very home-like. It’s a place where people can get expert attention given to their symptom management. That way they’re relieved of the suffering that interferes with their ability to live each day as happily as the illness allows, and to address the spiritual, psychological and relationship things that are important to them before they die. There’s nice programming and tremendous attention to people and their families—all hospices are like that. There’s lots of laughter that goes on, there’s lots of events that go on, and we like to incorporate the notion that people are living until the moment they die−they’re not waiting to die.

What sparked your interest in palliative care?

When I was in practice I had a number of patients who were facing lifelimiting illness and I was struck by the fact that there seemed to be a really deep need to have conversations about the bigger aspects of their life. It wasn’t just the physical things that I could help them with as a physician, but their relationship issues and their psychological and spiritual needs as they faced end-of-life. To have the ability to relieve somebody’s suffering in the months before they die, and to have their family members feel like they participated in relieving suffering for their loved ones, carrying on through the normal grief to actually recognize that we, together, made a difference to that loved person. Helping them carry on with the rest of their lives thinking that although it was sad that this person who they loved had died, the whole journey wasn’t so awful. So part of my motivation to get into palliative care was to help change the perception that a terminal diagnosis means a painful, awful death and sadness.

How do you feel about working with people facing end-of-life circumstances?

People will often ask me that and say ‘it must be really sad’. I find that many times because of the tremendous courage and relationship healing that goes on it can actually be very life affirming and it’s a real privilege to be that deeply into somebody’s life that we can make that much of a difference.

What kind of involvement do you currently have with the hospice?

Right now, very minimal. I’ll be back there providing some on-call coverage and help as the need arises, but I’m taking a two to three year hiatus to work in other areas.

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Inside the Foothills Country Hospice.

What area are you working in now?

Right now I have two main jobs: Medical Director of Clinical Ethics for Alberta Health Services, and Medical Director of Project & Strategy for the new South Health Campus. I’m half way through a master’s degree in health ethics at the University of Toronto, and I do a lot of teaching and ethics consults throughout our system.

Can you elaborate on your interest in clinical ethics?

Clinical ethics could mean a lot of things. We help people navigate the minefields of really conflicted, ethical dilemmas, whether it’s patients, providers, physicians, family members or health systems. There are both technology and resource constraints, and conflicting values make the decisions in our health care world very difficult, fraught with lots of moral distress. We help people to answer the question ‘what’s the right thing to do in this very difficult circumstance?’ We have worked hard to provide those services not only in hospitals, which is the traditional approach, but to create ethics programs in home care, public health, and mental health. I’m hoping to spend a number of years, closer to the end of my career, working on resource allocation−the ethics of resource allocation for big health systems like in Alberta.

You mentioned how you enjoy building things. Are you building anything currently?

Right now I’m very focused on helping to open the South Health campus in Calgary. This is one of the first, what is called ‘green field’ hospitals built in Canada, in a number of decades. It’s going to have a very innovative focus on technology, on partnerships with community providers and the population, and will incorporate newer models of care delivery. The early visionaries for this campus have done a tremendous job, and I’m keen to help actualize their vision.

Do you have any words of advice for aspiring doctors?

Family medicine does afford the opportunity to do some very different and neat things throughout an entire career. I’ve had a very varied career, as have many of my colleagues. I feel very privileged to be involved in so many different aspects of care and system work. Also, we’ve all got to do a lot of work in educating and training and supporting aspiring doctors and new practitioners to focus on the wider aspects of the healing arts—the communication arts.

We need to make sure that in our education and in our early experiences, we’re focusing as much on that human connection as we are on the technical expertise that we develop. D

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RESEARCH

Straight Sudden cardiac arrest is the cause of far too many deaths in Canada each year. In attempts to help curb those numbers, a new study, lead by one of the Faculty of Medicine’s own, has been launched to discover whether a

by Kathryn Sloniowski small, implantable device can help.

While it may only be the size of a stop-watch, Medtronic’s implantable cardioverter defribrillator, also known as an ICD, has a lot riding on it. In a new international study, the REFINE ICD trial, lead by Faculty of Medicine’s Dr. Derek Exner, it is hoped to determine if ICDs can prevent death caused by heart rhythm problems in patients who have survived a heart attack. The study is based on Exner’s past research in the REFINE study, where a new method was developed that identified patients at high risk for serious heart rhythm problems following a heart attack.

“Sudden death is a major cause of death in Canada and around the world,” says Exner, who is a member of the Libin Cardiovascular Institute. “This study may change how we manage patients after a heart attack and has the potential to save thousands of lives each and every year.”

With approximately $16.8 million supporting the pilot phase of the program, the Libin Cardiovascular Institute is serving as the Clinical Coordinating Centre and will be collecting patient data from 16 sites in Canada, the United States, and Europe.

The pilot phase has an anticipated duration of 18 months. If it’s shown to be feasible in terms of study enrollment and site activation, the study will expand to include up to 75 sites, with investments potentially reaching over $40 million. Approximately

10,000 patients could be screened—1,400 of whom will be enrolled in the study. Of those enrolled, patients will be equally assigned or randomized to receive either conventional care including medication and lifestyle modification, or conventional care plus an ICD. ICDs have been proven to be highly effective in treating rapid ventricular arrhythmias, and are presently used to prevent death in patients with very poor heart function or who have survived a life-threatening heart rhythm problem. This new study will however focus on a different cohort of patients—patients with at least a minor reduction in heart function after a heart attack, plus additional criteria identified in the REFINE study. This cohort represents a large percentage of those who die suddenly each year, although ICD therapy is not currently available to them as a treatment option.

“Research to identify those at risk and methods to prevent death from heart rhythm problems are vital,” says Exner. “It is an honour to be leading such an important study.”

In addition to the Faculty of Medicine and the Libin Cardiovascular Institute, The Government of Alberta, Advanced Education and Technology, Western Economic Diversification Canada, Medtronic, GE Healthcare, and Western Economic Partnership Agreement have all been involved as partners in this project. D

How the ICD works:

The ICD is a small, battery powered computer that is implanted directly under the skin. Small wires go through the blood stream and connect to the heart, measuring electrical signals and is thus constantly monitoring the heart for irregularities. If a heartbeat isn’t measured, it will kick in as a pacemaker. If it detects too many heartbeats it may continue to monitor the heart, or deliver a short series of rapid beats or a shock, to reset the heart’s rhythm.

The measurements are transferred via a small, built in antenna in the ICD, to a bedside monitor. The data is then uploaded to a computer where it can be reviewed.

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Fall 2011

In addition to his membership with the Libin Cardiovascular Institute, Dr. Exner is also an assistant professor in the Departments of Cardiac Sciences and Community Health Sciences.

Fast Facts: • Heart disease is the leading cause of death in Canada, and the fastest growing disease worldwide • Sudden cardiac arrest is a sudden lost of heart function and is not a heart attack medicine.ucalgary.ca

• Cardiac arrest is often caused by rapid and/or chaotic activity of the heart−referred to as ventricular tachycardia or ventricular fibrillation • Cardiac arrest is reversible in most patients if treatment is administered within minutes−the only effective treatment being an electrical shock

• Sudden cardiac arrest accounts for up to 50,000 deaths in Canada each year • A heart attack is caused by a blocked vessel resulting in a loss of blood supply to part of the heart ucalgary medicine | Page 17

RESEARCH

to the heart

RESEARCH

A novel APPROACH Cardiac procedures can be daunting. However, thanks to a unique registry, patients can take solace in knowing they’re contributing to the advancement of cardiac care as we know it.

By Kyle Glennie Dr. William Ghali.

If you’ve had a cardiac bypass surgery in Alberta in the past 15 years, you’re in it. Had an angioplasty or a catheterization done in the province over the last decade? You’re in it too. In fact, if you’ve had any cardiac service in Alberta over the last 10 years, you are in it as well.

Welcome to the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH), one of the largest, most comprehensive cardiac registries in the world.

“APPROACH is a cardiovascular database that goes back to 1995, and it’s unique because there has been a complete capture of every person having invasive cardiac procedures in the province since 1995 with complete follow of their outcomes after having the procedure.” Dr. William Ghali, APPROACH’s director of research, has been with the team shortly after the project began and knows just how powerful a tool the database is.

“Having this data gives us an ability to study cardiac care, study what works and what doesn’t, look at trends in quality of care, look at new technologies as they get taken up in cardiac care, and we then see the outcomes from that.” The data also captures the health care experience for cardiac patients by keeping track of which patients underwent invasive procedures and which did not.

“Studying those who did not have an invasive procedure is really just as helpful as studying those who did as we can then figure out why this happened; perhaps there were social factors involved or limited access,” explains Ghali.

Alberta isn’t the only province benefitting from this detailed registry; other provinces across Canada are on board as well. British Columbia was the first to adopt the APPROACH-style database in 1999 and they have recently begun expanding the project. Saskatchewan is also running a similar registry launched with the help of the APPROACH team, and hospitals in Ontario and Newfoundland are doing the same. Manitoba, New Brunswick and Quebec are now considering the database for their provincial health-care systems.

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Expanding the project throughout Canada didn’t happen overnight, but it didn’t happen by accident either. When Dr. Merril Knudtson, a professor in the Departments of Medicine and Cardiac Sciences, started APPROACH in 1995, his ambitions were for a database that could be utilized by health-care professionals across the country.

Mission accomplished.

Aside from helping improve cardiac care in Canada, data from the APPROACH registry has been used by researchers who have penned over 150 research papers that have been published in a wide range of medical and scientific journals.

All of the success achieved by the APPROACH team—an amalgamation of professionals that includes Diane Galbraith, whom Ghali calls the ‘glue’ of the team and someone who eats and sleeps APPROACH—has not gone unnoticed. The project, under the leadership of Knudtson, was named one the top achievements in Canadian health research by the Canadian Institutes of Health Research and Canadian Medical Association Journal.

“You don’t get up and go to work anticipating an award like this, and it’s nice for the whole team to earn these accolades,” says Ghali.

“But I think when you look back at what has been achieved, it does makes sense for the project to be honoured.”

No arguments here. D

Dr. Merril Knudtson with colleagues Dr. Russell Hull and Dr. Cy Frank. All were recognized for top achievements in Canadian health research.

Fall 2011

NEWS

In the News

Pediatric study to compare seizure drugs Dr. David Johnson, an emergency department doctor at Alberta Children’s Hospital is leading a study looking at which drug is most effective in treating children suffering from seizures.

The Pediatric Seizure Study will compare the medications diazepam and lorazepan−both drugs are effective in treating seizures however it is not currently known which one is most effective.

“Children are often therapeutic drug orphans,” says Johnson who is a member of the Alberta Children’s Hospital Research Institute for Child and Maternal Health. “As doctors we cannot be reliant on studies done on adults rather than children. This study seeks to provide the most definitive information possible on which drug is the most effective.”

Children admitted to the emergency department while having a seizure, and who meet the criteria for the study, will be automatically enrolled

without parental consent and will be randomly assigned to be treated with one of the two drugs.

Once the seizure has stopped, parents will be informed of their child’s enrollment in the study, at which point they may choose to withdraw their child or to continue to participate.

The Alberta Children’s Hospital is the lead Canadian research site for the comprehensive study. Eleven hospitals in North America are participating−two of which are in Canada. The study is funded by the National Institutes of Health (NIH) in the United States and is being led by investigators at Children’s National Medical Center in Washington, DC. For more information on how to exclude your child from the study, contact Janie Williamson at 403-955-3186, pert@ucalgary.ca or visit http://www.childrensnational.org/seizurestudy/ Further information is available by calling the international hotline at 1-866-377-8557.

Paulette Hillier looks on as Dr. David Johnson examines her twin daughters Chloe (l) and Lainey (r). Both girls suffer from epilepsy.

Stressed? Hungry?

Researchers might know why Researchers in the Hotchkiss Brain Institute (HBI) have uncovered a mechanism by which stress increases food drive in rats, providing possible insight into why stress is thought to be one of the underlying contributors to obesity.

Normally, the brain produces neurotransmitters (chemicals responsible for how cells communicate in the brain) called endocannabinoids that send signals to control appetite. In the study researchers found when food is not present, a stress response occurs, temporarily causing a functional re-wiring in the brain. This rewiring may impair the endocannabinoids’ ability to regulate food intake and could contribute to enhanced food drive.

The researchers also discovered when they blocked the effects of stress hormones in the brain, the absence of food caused no change in the neural circuitry. If similar changes occur in the human brain, these

medicine.ucalgary.ca

findings could have several implications for human health.

“The fact that the lack of food causes activation of the stress response might help explain the relationship between stress and obesity,” explains one of the researchers, Quentin Pittman, PhD. These results lay the foundation for future studies to investigate the use of therapies that affect these systems in order to manipulate food intake. They also open the door to studies looking at whether or not the stress brought about by lack of food affects other systems where endocannabinoids are known to play a role.

The work for this study was conducted jointly in the labs of Jaideep Bains, PhD, and Pittman. Experiments were carried out

by Karen Crosby and Wataru Inoue, PhD. The research is supported by operating grants from the Canadian Institutes of Health Research (CIHR) and Alberta InnovatesHealth Solutions (AIHS).

Survey to investigate CCSVI The Faculty of Medicine’s, Dr. Luanne Metz is the lead researcher of a new web-based survey, documenting and tracking experiences of Albertans with MS—particularly those who have undergone the Zamboni procedure, or similar procedures.

“This study will complement other ongoing CCSVI studies to address questions that must be answered in order to design clinical trials,” said Dr. Luanne Metz, a member of the Hotchkiss Brain Institute.

The Alberta Multiple Sclerosis Initiative (TAMSI) study will include an online survey that is self administered. Patients with MS or related conditions, once registered, will fill it out at six, 12, 18 and 24 month intervals. Anecdotal information will be matched up with files from patients’ electronic health records from visits with a physician or medical tests. The survey is available at www.tamsi.ca.

The study is being funded with an investment of up to $1 million by Alberta Health and Wellness.

Researchers from the University of Calgary, University of Alberta and experts from the multiple sclerosis community have been involved with putting this study together.

ucalgary medicine | Page 19

You ARe inviteD The University of Calgary Faculty of Medicine Alumni Affairs invites you and a guest to our

Annual Alumni Reception and Alumnus of Distinction Award Presentation 6:00 pm Saturday, October 22, 2011 HRIC Atrium, UofC Faculty of Medicine Tickets $35 per person RSVP by October 14 to 403-210-8935 or medalum@ucalgary.ca Honouring Dr. Gurdeep Parhar (MD’92) for his outstanding contributions to education.

medicine.ucalgary.ca/alumni

PM AGREEMENT NO. 41095528 RETURN UNDELIVERABLE CANADIAN ADRESSES TO: University of Calgary Faculty of Medicine Communications & Fund Development Health Sciences Centre 3330 Hospital Drive NW Calgary, Alberta T2N 4N1