UCalgary Medicine Magazine: Spring/Summer 2015 by Cumming School of Medicine

UCalgary

MEDICINE CUMMING SCHOOL OF MEDICINE

SPRING / SUMMER 2015

ESCAPE: New therapy is changing the standard of stroke treatment

Student Run Clinic

A rural medicine connection

Vol. 5 / Issue 5

U Calgary

MEDICINE CU M M I N G SCH OO L O F M E D ICI N E

S P R I N G / S U M M E R 2015

CONTENTS

SPRING / SUMMER 2015

ESCAPE: New therapy is changing the standard of stroke treatment

VOLUME 5 | ISSUE 5

Student Run Clinic:

A rural medicine connection

Vol. 5 / Issue 5

O N T H E COV E R

ESCAPE: New therapy is changing the standard of stroke treatment

UCalgary Medicine is published by the University of Calgary Cumming School of Medicine, providing news and information for and about our faculty, staff, alumni, students, friends and community. For more information contact: M A N AG I N G E D I TO R S

Amy Dowd T 403. 210.6577 E aedowd@ucalgary.ca

Kathryn Kazoleas T 403.220.5012 E kjslonio@ucalgary.ca

E D I TO R I A L T E A M

Jordanna Heller, Director, Communications and Media Relations Marta Cyperling, Manager, Media Relations Amanda Fisher, Communications Coordinator Aisling Gamble, Communications Advisor, Events and Recognition DEAN

Jon Meddings V I C E- D E A N

Glenda MacQueen S E N I O R A S S O C I AT E D E A N S

Ronald Bridges, Faculty Affairs Jocelyn Lockyer, Education Marcello Tonelli, Health Research Gerald Zamponi, Research A S S O C I AT E D E A N S

Tara Beattie, Graduate Science Education Sylvain Coderre, Undergraduate Medical Education Lara Cooke, Continuing Medical Education and Professional Development Janet de Groot, Equity and Professionalism Derek Exner, Clinical Trials Jennifer Hatfield, Strategic Partnerships and Community Engagement Ebba Kurz, Undergraduate Health and Science Education Doug L. Myhre, Distributed Learning and Rural Initiatives Kamala Patel, Faculty Development Paul Schnetkamp, Research Infrastructure Maureen Topps, Postgraduate Medical Education Ray Turner, Research Grants Samuel Wiebe, Clinical Research DESIGN

Combine Design & Communications P H OTO G R A P H Y A N D I L LU S T R AT I O N S

Riley Brandt, Rick Castiglione, Sean Davis, Amanda Fisher, Tomie Horton, Bruce Perrault, Adrian Shellard, Candice Ward

F E AT U R E S F R E E CO P Y / A L U M N I U P DAT E

To receive a free copy of UCalgary Medicine please call 403. 220. 2819 or email medcomm @ ucalgary.ca The Cumming School of Medicine is committed to staying in touch with our alumni. Please update your contact information at our website: alumni.ucalgary.ca (CLICK ON “ UPDATE YOUR INFO”) CUMMING SCHOOL OF MEDICINE ALUMNI F E AT U R E D I N T H I S I S S U E :

Miles Robert Aronson, Wenqian Chen, Lara Cooke, Cy Frank, Bill Ghali, Michael Hill, Borys Hoshowksy, Debra Isaac, Mange Manyama, Martin Spoor, Betsy Woolner

Student Run Clinic:

MESSAGE FROM THE DEAN

Helping some of Calgary's most marginalized people

A rural medicine connection ESCAPE:

MamaToto: Helping mothers and newborns in East Africa

Health policy expert returns to UCalgary this fall

All cancers have one thing in common—a mistake in the DNA

EDUCATION

Where in the world… 20

Treated like a local: Q and A with Dr. Debra Isaac

A birthday note from a clinical clerk

PM Agreement No. 41 0 9 5 52 8

cumming.ucalgary.ca/magazine

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Designed for education Driven by research Inspired by care Return Undeliverable Canadian Addresses to: University of Calgary Cumming School of Medicine Communications and Media Relations 7th Floor, TRW Building 3280 Hospital Drive NW Calgary, Alberta T2N 4Z6

RESEARCH

New therapy is changing the standard of stroke treatment

Spaces and places

D E PA R T M E N T S

WE'RE ONLINE

Expressions of Arthritis

ALUMNI

PHILANTHROPY

MESSAGE FROM THE DEAN

C U M M I N G . U C A LG A RY.C A / M AG A ZI N E

Message from the Dean

With the first half of another busy year behind us, I’d like to welcome you to the spring/summer 2015 edition of UCalgary Medicine magazine. We’ve spent the past few months focusing our efforts on several key initiatives connected to the Cumming School of Medicine’s (CSM) new strategic plan. In response to thoughtful input from faculty, staff and students, we launched new Graduate Student Scholarship and Postdoctoral Scholars Programs, and we created a unique scholarship opportunity for learners under-represented within our medical school to access a ‘pre-med’ program directly out of high school. These programs will allow us to recruit excellent students and trainees and to provide them with meaningful support throughout their academic careers with us.

We continue to strengthen our commitment to being an active part of the communities we serve, and have appointed Jennifer Hatfield, PhD, as our inaugural Associate Dean, Strategic Partnerships and Community Engagement. Her new position focuses on supporting and building partnerships that make us relevant, responsive and socially accountable to our broad and diverse communities. With support from one of our closest community partners, the Alberta Children’s Hospital Foundation, our Alberta Children’s Hospital Research Institute has built a genomicsbioinformatics platform that supports research programs across the university. To further develop core technology and academic expertise in this area and to advance our pan-institute initiatives in precision medicine strategic priority, the Cumming School recently directed $5-million in funding towards the creation of the Centre for Health Genomics and Informatics. In the pages that follow, I hope you’ll enjoy learning more about just a few of the CSM collaborations improving health and health care in southern Alberta and beyond.

I’m also pleased to have had several opportunities to welcome new and old friends into the CSM this year. In January, the university’s Foothills Campus hosted the launch of the IMAGINE Project—a grassroots, citizenled initiative aimed at inspiring a social movement to build a better, more patient-centred health-care system. The project was born of a shared interest between Calgary business leader Charlie Fischer and our own O’Brien Institute for Public Health. Over 400 health professionals, patients, policy makers and members of the public attended the launch, with hundreds more tuning in online. Join the conversation at imagineproject.net. In May, I hosted our school’s second Dean’s Public Talks—an event showcasing some of our most relevant and impactful research. Drs. Breanne Everett, Chad Ball and Gil Kaplan shared their work and innovations: from medical technologies, and novel techniques in trauma care, to air pollution and chronic diseases. If you missed it, I invite you to watch it online at cumming.ucalgary.ca. I look forward to seeing you in the fall for our next Public Talk—stay tuned for details—and thank you for partnering with us to create the future of health. I’d like to conclude this message by acknowledging the passing of a friend and colleague, Dr. Cy Frank, in March. A faculty member for more than 30 years, Cy was a highly respected, admired and valued mentor, scientist, teacher, surgeon, administrator and advocate. His warmth touched many, and his contributions to the CSM and to health care in Alberta were invaluable. He will be greatly missed. Jon Meddings, MD Dean, Cumming School of Medicine University of Calgary

Student Run Clinic: Helping some of Calgary's most marginalized people

Above: (L to R) Medical students Amelia Kellar, Kendra Houston and Gabrielle French, with Dr. Janette Hurley, and Joao Morgadinho, registered dietitian, at the Student Run Clinic at Inn from the Cold

By Doug Ferguson

pauses for a moment, then quietly laughs in disbelief. “As I’m telling you this, it all sounds so bad, doesn’t it?” she says as she waits for her checkup at the Student Run Clinic, a free health-care service run by students and physicians at the University of Calgary’s Cumming School of Medicine. Along with her husband and two THE MOTHER OF A HOMELESS FAMILY

small children, she was evicted from her family’s apartment after he lost his job. They arrived that evening at Inn from the Cold, an emergency shelter for families that is one of three sites hosting the student clinic for one evening each week. It’s now her fifth month at the shelter and due to her fears about the stigma of

being homeless, she asks that her identity not be made public; we’re calling her Jane. “We were scrimping every year to get the rent and fi nally, we just fell behind,” she says. “I’ve never been in a shelter before, so it’s humbling,” she says as her children play nearby. “You really see the other side.”

C U M M I N G . U C A LG A RY.C A / M AG A ZI N E

EDUCATION

elping some of Calgary’s most marginalized people is the goal of the Student Run Clinic. “It’s not just providing a service, it’s doing medicine from the heart,” says Dr. Janette Hurley, a clinical assistant professor at the University of Calgary. Under her guidance, the clinic was founded in 2009 by students from the Cumming School of Medicine. Because they are still undergoing training, the students are partly assisted by physicians who act as preceptors. The doctors volunteer their time to supervise and teach the students, write prescriptions and check diagnoses. They are also helped by a diverse group of health-care professionals from the community, including an osteopathic therapist, dietician and massage therapists. A similar clinic also takes place through The Alex Bus, a program sponsored by The Alex community health network that uses buses to reach out to the Calgary’s homeless populations in the inner city. Last year, the clinic was also extended to a third site at the Mosaic Refugee Health Clinic at Marlborough Mall, whose patients include people fleeing war and persecution in their home countries. With average rents for two-bedroom apartments in Calgary soaring to the

highest level of any metropolitan area in Canada as of October, staff at Inn from the Cold described 2014 as the most challenging year in the facility’s 17-year history. Along with three others in the city, the shelter had been at or over capacity for months. “For a little two-bedroom apartment, it’s no less than $1,400 per month,” says Jane. “If you don’t have a job, or you have a minimal paying job, you can’t afford that.” Hurley says an increasingly thin lifeline of only a paycheque or two is all that’s keeping a roof over the head of too many Calgarians, adding that a much stronger effort is needed to help Calgary’s marginalized people by creating more affordable housing, along with services that better match their circumstances. She compares her work at Inn from the Cold to some aspects of health care in the developing world. “You don’t need to leave Canada to practice global health,” she says. “You can stay here in Canada.” Inn from the Cold residents are treated each Tuesday at the clinic by fi rstand second-year medical students. “Everyone is very helpful and kind,” says Jane. “They discovered I was actually predisposed to being diabetic. I’m taking pills right now, but I can get off them if I lose enough weight.”

She also has high blood pressure, something she says isn’t helped by her situation. “It’s stressful here because we’re trying to find a place to live,” she says. While working at the Inn from the Cold site is helping University of Calgary medical student Amelia Kellar hone her skills on actual patients, her desire to help underserved people dates back to her teens. As a dance instructor, she worked with children from low-income families, ensuring they had the same chances as other pupils. “Everybody should get to try what they want to try, and figure out what their passion is,” says Kellar, who chaired the executive of the Student Run Clinic in the 2013-2014 academic year. “For me, I think I love working with people in general, but I think there is something to be said for making sure that whatever it is – whether it be dance, or whether it be medicine – that things should be accessible to everybody.” An information session is held each September for first-year students who want to take part in the clinic. After filling out applications detailing why they want to be involved, 23 students are chosen by lottery to be clinicians, with interviews held for positions on the eight-person executive. “This really needs to be your passion, because it’s a lot of work,” says Kellar. “It’s a lot of work in the kind of way that it’s a lot of work the night before you have a final exam, so it needs to be something you love doing.” Kellar’s first evening at Inn from the Cold helped her decide she wanted to be a pediatrician. “We spent over an hour with a young family with a baby,” she says. “The child was quite underweight, so we provided counselling on breast feeding and infant nutrition. “The parents just didn’t have the information, and if somebody hadn’t taken the time to give it to them, who knows how it would impact the child and how that would impact the family? That really appeals to me, because you feel like you get to make a difference.” In turn, a difference was made to Kellar. “I think it taught me a lot about learning to take the time and to slow down – how much value you can really bring to somebody and their experience if you just take the time to listen to them,” she says. “The people you work with

UCALGARY MEDICINE SPRING / SUMMER 2015

Dr. Annalee Coakley and Kimia Ghavami at the Mosaic Refugee Health Clinic

“ The people you work with teach you something about yourself and your career, and why you’re doing what you’re doing.” teach you something about yourself and your career, and why you’re doing what you’re doing.” Associate professor Chris Skinner of the University of Notre Dame’s School of Medicine in Australia was travelling through Calgary on sabbatical when he decided to visit the Inn from the Cold site. “I think this is very interesting,” he says, intrigued by everything from the clinic’s social justice aspect to the fact it’s run by students. “It gets students right in touch with the practicalities of medicine at an early stage.” Student participant Kimia Ghavami says she has grown to appreciate how unique the Student Run Clinic is. “I think when you get into a medical school, you’re itching for the opportunity to actually get to see what it’s like to be a

physician, to meet patients, and to learn in a real-life setting,” she says. “But I didn’t recognize how great an opportunity this really was until I talked to people at other medical schools across Canada.” Ghavami helps patients at the Mosaic Refugee Health Clinic site with everything from diagnosing illnesses to filling out forms to seeing specialists. “I like being around people,” she says. “I love hearing people’s stories—learning from them and learning about them.” Federal cuts to health-care funding for refugees have not been fully reinstated despite a Federal Court of Canada ruling, says Mosaic Refugee Health Clinic preceptor Dr. Annalee Coakley. “From my point of view, I am happy that children and pregnant women are now covered,” she says. “But we have lots of non-pregnant women and men that live below the poverty line and they have diseases that need treatment—and they are unable to pay for that treatment.” These patients can suffer from illnesses long predating their arrival in Canada, says Ghavami. “If you or I had blood in our urine, for example, we would probably race off to the doctor immediately,” she says. “But for them, it’s not the number one priority because they have so many other concerns.

Maybe in the countries where they’re from, they often couldn’t see a doctor right away, or having these symptoms is commonplace.” As someone who grew up around many refugees, Ghavami has deep sympathy for the people she serves. “I’ve seen first-hand what so many refugees face—the obstacle of arriving with very few resources or knowledge of their new home, but then going on to build new lives which contribute so meaningfully to our society. It’s a privilege to serve this community.” Back at Inn from the Cold, Jane says she tries to see the positive things about her life, despite her situation. “We have a roof over our heads, we have food and they try to help,” she says about the shelter and the Student Run Clinic. “They kind of give us a nudge, saying, ‘OK, you know we’re here to help with this stuff, so if you need help, we will give you help’.”

C U M M I N G . U C A LG A RY.C A / M AG A ZI N E

EDUCATION

Treated like a local: Q and A with Dr. Debra Isaac by Lauren Sharp

Director of the Southern Alberta Cardiac Transplant Program, Dr. Debra Isaac ﬁrst travelled to Georgetown, Guyana in January 2012 to assist with the donation of an echocardiography (heart ultrasound) machine. At Kaieteur Falls "It is the highest free fall waterfall in the world and we had to take a plane to get up there. It was a bit scary but the scenery was truly breathtaking." – Dr. Debra Isaac

What has been the most memorable part of your experience in Guyana? When I go to the hospital and I am treated like a local. It is so nice to know I am seen as someone who has something to offer. I love when I am walking somewhere and a patient or a patient’s parent says, “Dr. Isaac—you’re back!”

When you come back to Calgary, does it change your teaching perspective here in Canada?

What motivated you to pursue this kind of global health experience? For many years I have been focused on using innovative and high-tech equipment and protocols to develop and promote cardiac transplant and advanced heart failure support initiatives in Calgary and across Canada. Although this had been very rewarding, after a while I began to get interested in ways that I could use my skillset and some of the cardiac equipment available in Calgary to assist patients who have never had access to these resources in an entirely different part of the world.

Pediatric Cardiology Program, on-site and telemedicine consultations by my colleagues from the Alberta Children’s Hospital and myself, a partnership with Baby Heart International which has led to vastly improved diagnosis and management of children with heart disease and resulting in 13 free heart operations with another 36 on the list for this year, a heart failure clinic, a video teaching centre, and a soon-to-open heart care unit at the public hospital. All of these projects are built on the foundation of educating and supporting local health-care providers.

What kind of projects have you implemented in Guyana?

What changes have you seen between trips?

Since our first trip back in 2012, my team and I have, through donations from the Libin Institute, Alvin Libin Foundation, and other grant agencies, developed initiatives such as the Guyana Echocardiography Education Program, Guyana

A gradually developed expectation for a higher level of care. Instead of saying, “too bad, so sad, we don’t have those resources,” they say, “okay, now we have some options and we have the opportunity to use these to provide better care.”

I look at the privileges we have in Canada such as resources and quality of education and think about how lucky students are to be educated here. To have access to such a strong education before and during medical school really sets you up for success.

What is your favourite part about Guyana? I would have to say the people. They are so friendly, open and generous.

Dr. Debra Isaac is a Libin Cardiovascular Institute of Alberta cardiologist, clinical professor of medicine at the Cumming School of Medicine, echocardiography specialist, and director of the Southern Alberta Cardiac Transplant Program.

Expressions of Arthritis by Kathryn Kazoleas and Jaymi Taiani

It's a little-known fact that approximately 20,000 children in Canada are affected by juvenile arthritis.

“

My Flying Unicorn.

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Jocelyn, age 9

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C U M M I N G . U C A LG A RY.C A / M AG A ZI N E

“ Juvenile arthritis is a condition characterized by painful, swollen joints, impaired mobility and chronic fatigue. These physical detriments often leave children struggling to keep up with their peers and lead a ‘normal’ childhood.

The heavens are in turmoil, and the land is being shaped by the war above. Jack, age 13

“This condition affects children during such a crucial time of physical and social development,” says Dr. Paivi Miettunen, a pediatric rheumatologist at the Alberta Children’s Hospital. “They are faced with many challenges as they are often perceived by teachers and coaches as lazy or unmotivated, when in fact they’re suffering and the adults in their lives often don’t understand why.” Using the expressive nature of art, a unique partnership between the Alberta Children’s Hospital Research Institute (ACHRI), the McCaig Institute for Bone and Joint Health (MIBJH) and the University of Calgary’s Department of Art, created the “Expressions of Arthritis” program at the Alberta Children’s Hospital. The program is supported with sponsored space and personnel from the Alberta Children’s Hospital Foundation, and generous donations from the Mamdani Family Foundation and the

“

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Calgary Foundation. The goals of this program are to give these children a ‘voice’ and a medium of expression, and to focus on their abilities rather than their disabilities. Expressions of Arthritis found its roots in a creative workshop hosted by the team this past September at TELUS Spark. The workshop was led by Calgarybased artist Bev Kelly who herself suffers from chronic joint pain. Using a variety of materials and mediums, children aged 5–18 diagnosed with juvenile arthritis were guided through a creative process to express their physical and emotional experiences of living with the disability and chronic pain. Kelly also spoke to the students about her successes and experiences as an artist while enduring her own physical challenges. The overwhelmingly positive response from the participants and their families led Miettunen and Jaymi Taiani, PhD, knowledge translation specialist with

UCALGARY MEDICINE SPRING / SUMMER 2015

Arthritis is random. Sometimes it’s good, sometimes it’s bad, sometimes it’s all swirled. Kaysa, age 10

”

MIBJH, to carry the program forward. In January, Alicia Ponzio, a San Francisco based sculptor who also teaches at Pixar Studios, led a hands-on sculpting workshop. Three more national and internationally-based artists have committed to lead workshops using various mediums through the remainder of 2015. “Our vision is to establish an innovative, transferable program that gives a ‘voice’ and medium of expression through art to all children with arthritis and other chronic diseases,” says Taiani.

Find out more: mccaiginstitute.com/community Expressions of Arthritis was inspired by the Maud Lewis exhibit at the Art Gallery of Nova Scotia. Maud Lewis is a well-known east coast artist who suffered from juvenile arthritis.

Research innovations in arthritis: Early diagnostics and personalized medicine Dr. Marvin Fritzler, interim director of the McCaig Institute for Bone and Joint Health, is a rheumatologist studying biomarkers in blood. He has identified over 20 new proteins involved in the progression of several autoimmune diseases. Using a piece of equipment called the Bio-Flash, Fritzler develops patient-specific biomarker profiles that can be used to make an earlier and more accurate diagnosis of a variety of autoimmune and rheumatic diseases before irreversible tissue and organ damage has occurred. The Bio-Flash is one of only a handful in the world capable of developing new diagnostic tests.

Using this technology, Fritzler is currently collaborating with pediatric rheumatologists at the Alberta Children’s Hospital, including Dr. Heinrike Schmeling, to create new diagnostic tests for children with chronic arthritis, or juvenile idiopathic arthritis (JIA), and also for children with eye inflammation (uveitis). This technique not only allows for early diagnosis and intervention, which dramatically improves the long-term outcome for the patient, but also identifies the most appropriate and effective treatment for the patient. This “personalized medicine” approach will dramatically improve the lives of those who suffer from autoimmune and rheumatic diseases by alleviating the need for a trial-and-error approach to treatment.

04 RESEARCH

C U M M I N G . U C A LG A RY.C A / M AG A ZI N E

UCALGARY MEDICINE SPRING / SUMMER 2015

MamaToto: Helping mothers and newborns in East Africa by Kathryn Kazoleas

For over a decade, Dr. Jenn Brenner has been the Canadian Director of Healthy Child Uganda—a partnership responsible for saving the lives of countless mothers and their newborn babies.

his region has some of the highest mortality rates for women, newborns and children in the world. Most of these deaths are preventable, but in areas of extreme poverty, access to health services is limited. Through interventions developed and implemented by Healthy Child Uganda, Brenner and her team have seen marked reductions in mortality. Along with collaborating members at Mbarara University of Science and Technology in Uganda, and the Catholic University of Health and Allied Sciences in Tanzania, her team recently received a $1-million grant to introduce a pilot project in neighbouring Tanzania to replicate the successes of a process called MamaToto. A Kishwahili term meaning mother and child, MamaToto is an implementation process that has proven successful in reducing mother and newborn mortality due to delivery and post-delivery complications in Uganda. The process has been developed based on experiences and evidence from past projects and culminates in a best practices guide, which includes a package of interventions outlining how to best support care before, during and after childbirth. While MamaToto pays close attention to ensuring that health facilities are properly equipped and that the staff is trained, the process is structured largely around the concept of community health workers—volunteers who are trained to assess for ‘danger signs’ requiring referral, as well as to educate and promote health and wellness in the community—within the context of the local health system. Community health workers help to fill the health-care void in communities where formally trained health-care workers and services are limited. While several programs have demonstrated that community health workers are effective,

A Healthy Child Uganda facilitator shows participants in a Training the Trainer session how to counsel mothers in newborn care using baby dolls.

“ It’s an exciting opportunity for us to engage faculty and students here in Calgary and we have a track record of being able to do that through the work of Healthy Child Uganda.”

Brenner says there have always been questions surrounding effectiveness of volunteer community health workers on a large scale basis. “It’s harder to do,” she says. “Our challenge has been to demonstrate that if you follow a series of careful and strategic steps and make sure you don’t stumble into common pitfalls along the way, we can have success at the scale up level. And we’ve demonstrated that.” Brenner is quick to point out that the approach to implementing MamaToto is based on integration into the existing health system in the involved countries. “We don’t come in as outside partners and implement our own processes,” she says. “We support and facilitate implementation within the country’s existing system.” In what is seen as a real project strength, Ugandan co-investigators will be involved in the development and delivery of the program in Tanzania.

By taking this approach, the team hopes that a number of the challenges typically encountered in startups, like language barriers and geographical issues such as travel complexities, will be bypassed. “It’s also more cost effective to send teams from Tanzania to observe sites where activities are working well, and to meet with experienced health managers and field workers in Uganda if they’re faced with challenges as they’re implementing,” says Brenner. “Culturally there will be more of an understanding of how systems work as well, because health systems and communities are much more similar between Uganda and Tanzania than Canada and Tanzania.” From a research perspective, the team will be studying the concept of community health workers and health system strengthening in maternal, child and newborn health, thereby tracking what’s happening in both sets of communities. “It’s an exciting opportunity for us to

engage faculty and students here in Calgary and we have a track record of being able to do that through the work of Healthy Child Uganda,” says Brenner. “We’re hoping that students and faculty will be exposed to this type of setting and, perhaps, what we learn from this partnership and from doing this work are lessons we can bring back to Canada.” Dr. Mange Manyama of Catholic University of Health and Allied Sciences in Mwanza, Tanzania says partnering with the University of Calgary on this grant means strengthening their already existing relationship. “In rural Tanzania, almost 8,000 women die due to pregnancy and delivery complications and nearly 40,000 babies die during their first month of life,” he says. “This grant gives us an opportunity to demonstrate our intention of finding ways that will improve the health of our communities through research, education and service.”

Dr. Jenn Brenner is a clinical associate professor in the Department of Pediatrics and a member of the University of Calgary’s Alberta Children’s Hospital Research Institute and O’Brien Institute for Public Health.

C U M M I N G . U C A LG A RY.C A / M AG A ZI N E

EDUCATION

UCALGARY MEDICINE SPRING / SUMMER 2015

A birthday note from a clinical clerk

by Jason An, MD Class of 2015

RRRRI

RRR

RR RRI I

N NGG II

Lunch is over and it’s time to go back to class. Turns out this afternoon in eighth grade, our biology teacher has a unique activity planned. Our class assignment is to recognize and match each other with photos of ourselves that we were tasked to bring. This would have been easy, if only the photos weren’t taken when we were just newborns. As I hold the photo of myself when I was just a day old in my hand, a train of curiosities enters my mind. What was life like as an infant? Who was around me when I was born? And how exactly did I come into this world? That night, my mother tells me how she came into hospital after she broke her water, went into labour, and eventually had to have a caesarean section. “You were born on June 16 at around 5 a.m., an early morning boy,” she told me with a nostalgic smile. Nevertheless, these questions would occasionally find their way into my consciousness, sprinkling my high school and university years with curiosities of how I came into being.

R THE ALARM BELLS SOUND.

NGG IN

Twelve years fly by, and I’m in my fi nal year of medical school. It’s the year when students rotate through the different specialties in the city’s hospitals. So happens this month, June, I’m working my way through obstetrics and gynecology. Although the labour and delivery unit can be exhilarating, it’s also exhausting. Patient volumes, medical complications and emotional complexities can quickly overwhelm. Not to mention the regular 24-hour calls which take their steady toll on the body and spirit. As such, I could only respond with a sigh of defeat when I found out I was scheduled to work the 24-hour shift on my birthday. Disappointed and slightly bitter, I thought to myself, ‘being on call on my birthday? Just my luck.’

THE PAGER SOUNDS

and I glance at the screen. “G1P0 ROM in L+D to see. 06-15-2014 23:40.” I open my notes and start looking up ‘Rupture of Membranes’. After taking my history and reviewing with the resident, we decide to induce contractions. As we explain the plan to the patient, my pager goes off again, this time summoning me to the emergency department.

It’s three the next morning, and although I’m tired and drained, the emergency room bustles with energy and activity. My patient is a young girl with abdominal pain. Hours go by, and as I review her ultrasound results, my pager again directs me back to the labour and delivery unit. I arrive just as the doctors and nurses rush a patient with a stricken expression on a stretcher into the operating room. One of the residents trailing behind takes a second to explain that it was the woman from earlier that night, the one we induced. She had been pushing for hours and there were now ominous signs on the fetal strip that the baby was in danger. I was to leave the young girl with the abdominal pain in the emergency room until later; we were scrubbing in for a caesarean section now. Moments later we stand in our gowns and masks next to the patient on the operating table. The resident hovers the scalpel just above the skin and anxiously peers at the fetal monitor. Finally, the anesthetist’s voice from behind the sterile curtain

breaks the uneasy silence, “She’s under; we’re good to go.” The resident makes the incision into the abdomen with speed and confidence. Tissue layers separate, the glistening uterus appears. The myometrium is easily split by the sharp blade, and inside the womb we make out a full head of hair. As the baby is lifted up by the surgeon from its warm bloody home of the past nine months, into the cool sterile air of the operating theatre, I glance at the clock on the wall. It is 5:20 a.m., June 16, 2014. Five a.m.— an early morning boy. I come to the surreal realization that this is my birthday exactly 25 years ago, and

JUNE

16 this is how I was born. The baby takes his first breath of life, and his shrill cry pierces the calm intensity of the operating room as the surgeons briskly and skillfully repair the bleeding uterus. The baby is wrapped in blankets and brought next to the operating table for the mother to see. As tears of elation stream down the mother’s exhausted face, I wonder what this new life will become. He will learn to crawl, cry, walk, talk, laugh and love. Perhaps one day this infant will grow into an inquisitive

young boy and contemplate how he came into the world and who was there when he was born. Little would he know that a then medical student would have become a doctor, one who treasured the greatest privilege

As I journey home on my bike after this long night, I ponder on the larger journey that I have embarked on. I realize that the true value of our medical education lies not only in the knowledge gained but in the unique

As I journey home on my bike after this long night I ponder on the larger journey that I have embarked on. I realize that the true value of our medical education lies not only in the knowledge gained but in the unique opportunities we encounter in this profession. in seeing this new life enter the world. A magical moment that will never be known to the infant himself, but one remembered forever by all who witnessed it. It’s here in this cold OR with blinding lights and shining steel that I begin to truly comprehend where a mother’s love for her child comes from; nine months of carrying this weight, enduring enormous changes in the body, hours of excruciating pain and exhaustion, and the unspeakable joy when she holds a new life—an extension of her own— in her arms. It’s in these moments after birth that the bond between mother and child is deeply felt, and forged for a lifetime. And after a quarter of a century of my own existence, it’s this one hour on my birthday when it dawns on me that there is nothing I can ever do to thank and repay my mother for what she has done for me and given me: life.

opportunities we encounter in this profession. Opportunities to be involved in a family’s life in a brief yet powerful way, opportunities to marvel on the miracle of birth, reflect on the tragedy of death, and wonder on the delicate balance of life in between. Being on call on my birthday? Perhaps it was just my luck.

EDUCATION

UCALGARY MEDICINE SPRING / SUMMER 2015

Renee Deagle is a second-year student in the University of Calgaryâ&#x20AC;&#x2122;s MD program. Last year she organized a three-day trip to her home town of Consort, Alberta, to give 35 of her fellow students a taste of life and medical practice in a rural community.

TO DO LIST:

Talk to high school students at Consort School about medical school; tell them why and how they should apply, and teach them how to make short forearm casts

What is your rural medicine connection?

A rural medicine connection

Q and A with Renee Deagle Photography by Sean Davis

Iâ&#x20AC;&#x2122;m passionate about rural medicine and rural communities. I grew up in Consort, Alberta, and my parents continue to own and operate a ranch outside of the village. I have always been strongly connected to my home community and also to the rural way of life. After fi nishing my nursing degree at the University of Calgary, I practiced in several rural communities as a registered nurse (RN). My interest in continuing my career into medicine stemmed from those experiences.

Why did you organize this trip to Consort? My colleagues were curious about what it was like to live on a ranch and the unique challenges faced by people living in rural settings. I wanted to show them not only rural medicine but rural lifestyle as well. I also wanted them to experience the sense of community support that I felt while growing up in Consort. Planning an intensive trip like this required a great deal of help from the community, but I knew Consort would be up for the challenge.

Tour Veteran Hutterite Colony, Consort Hospital and the public health units, and Consort Senior Citizens Lodge

Skills day: suturing, low risk maternity, and speech and language pathology training

Practice with STARS: managing critically ill patients in a simulation environment

Watch a victim extrication demo put on by a crew of volunteer firefighters from all over Special Areas No.4 (a unique municipality located in east central Alberta; key communities include the hamlets of Monitor, Compeer, Altario and Kirriemuir, and the villages of Consort and Veteran)

Community hosted BBQs, fire pit and a potluck dinner complete with an auctioneer taking bids for supper

DISTRIBUTED LEARNING AND RURAL INITIATIVES (DLRI) QUICK FACTS Over 4,000 weeks of postgraduate (resident) and undergraduate (MD) medical education takes place outside of the city each year

25 specialty programs have rotations outside the city and they average 20 per cent growth annually in weeks of service in regional Alberta

Lethbridge is DLRI's largest training partner, delivering nearly 700 weeks of training annually

Rural Continuing Medical Education is delivered by the Cumming School to the entire province of Alberta

With a recent grant from the government, DLRI is now developing a curriculum for physician assistants

Longitudinal Integrated Clerkship students work in rural communities for their entire final year of training; the majority go on to choose careers in rural medicine

C U M M I N G . U C A LG A RY.C A / M AG A ZI N E

04 RESEARCH

Health policy expert returns to UCalgary this fall by Marta Cyperling

A University of Calgary health policy expert says she is bursting at the seams to share what she has learned over the past year, with students and colleagues.

What was the impact of the trip? My colleagues were completely overwhelmed by the generosity of the community. I have heard comments such as “best weekend of medical school so far.” People with no appreciation for the challenges and benefits of living in rural Alberta are now better informed and can gain insight into their future patients’ lives. The community of Consort and the Special Areas were able to showcase what an amazing place rural Alberta is to live and work, and several students have now expressed interest in practicing rural medicine.

Why is rural medicine important to you? One of the most crucial aspects of rural sustainability is preservation of a functional hospital. My hometown hospital had its acute care beds closed down several years ago when we couldn’t attract physicians to stay in the community. Now, even after recruiting two physicians to the community, we are still without our acute care beds. People in rural communities are often under serviced in terms of health care and health-care access. The shortage of physicians in rural Alberta is a very important issue facing our generation. I wanted to do my part to expose more of my medical school classmates to the benefits of working in rural Alberta in hopes that they would choose to work and live there in the future. I wanted them to see what a great place rural Alberta is to live and raise a family, as well as practice medicine.

“Even though we are a publicly funded health-care system, we still have a lot in common with the U.S. We have a lot of the same issues and want a lot of the same questions answered,” she says. “For example, we both want to know how to improve health-care access for vulnerable populations, what the best way to pay doctors is and what offers the best value for money.” Clement’s area of research focuses on how to achieve the greatest value for money with technology, meaning she wants to understand how other systems encourage the most efficient and cost-effective use of technology either through funding systems, health-care practitioners or public campaigns. “In the U.S. there is a clear overuse of technology in the health-care system

University of Calgary Rural Medicine Recognition Awards Pre·cep·tor: A teacher; an expert or specialist who gives practical experience and training to a student Last year, Distributed Learning and Rural Initiatives decided to ask the colleagues of participating physicians and the communities they serve to recognize outstanding preceptors. This inspired the creation of the University of Calgary Rural Medicine Recognition Awards. We are pleased to recognize the following inaugural recipients: Dr. Wally Tollestrup, Raymond, Alberta Dr. Ian Bennett Meritorious Service Award Recognizing a preceptor with a demonstrated education focus of over 10 years duration, or a single extraordinary demonstration of dedication to medical education. Dr. Garland Jonker, Lethbridge, Alberta Early Educator Award Recognizing a preceptor who has demonstrated a commitment to and enthusiasm for medical education, who is in the fi rst three years of teaching practice located in a community outside of Calgary. Dr. Ward Fanning, Strathmore, Alberta Dr. Hal Irvine Community Focus Award Recognizing a preceptor who has demonstrated dedication, through service and personal commitment, to improving the quality of life in his/her community.

Find out more: cumming.ucalgary.ca/ruralmedicine

esearcher Fiona Clement, PhD, is currently at the University of California-San Francisco (UCSF) as part of the Harkness Fellowship in Health Care Policy and Practice. Modelled after the Rhodes Scholarships, the program aims to produce the next generation of health policy leaders by inviting Fellows from nine countries to study health-care policy, delivery and reforms in the United States. “I’m going to hit the ground running when I return to the university. I’m particularly interested in sharing my new knowledge with students so am developing a new health policy course,” says Clement, an assistant professor in the Department of Community Health Sciences and member of the O’Brien Institute for Public Health. She returns to the University of Calgary in September 2015 after spending one year in the program.

“I have the chance to reﬂect on Canada’s health-care system and I am really proud of the universal access we have.” because the system is paid for each use. There is a financial incentive to overuse everything. It’s important to remember there are medical risks to all procedures and over exposing people can be harmful. We need to align the incentives to encourage evidence-based use of technology,” she says during a phone interview. While in the U.S., Clement has teamed up with a health policy expert in her research area and she is participating

in a series of high profile policy briefings and site visits throughout the year. The goal is to build leadership skills and network with some of the top health policy experts in the world. “Leaving Alberta for one year has given me a chance to objectively look at our system and see what we are missing. Being in the U.S., working with top health policy experts, seeing what works and doesn’t work, I am excited to bring that knowledge back to Canada,” she says. “I have the chance to reflect on Canada’s health-care system and I am really proud of the universal access we have. In the U.S., if you can pay for it, you can access incredible health care, but if you can’t, you are left out in the cold.” Researchers from nine countries— Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden and the United Kingdom— were chosen for this year’s fellowship. This is the third year Canada has been a full participant in the Harkness Fellowship, and this is the fi rst time a University of Calgary researcher has been selected. “Fiona is truly a rising star researcher, and this prestigious fellowship brings credit to her, her work, this university, and our new O'Brien Institute for Public Health,” says Dr. Bill Ghali, University of Calgary professor and director of the O’Brien Institute. “More importantly, her fellowship experience will bring new perspectives to her applied research here in Canada—perspectives that will potentially improve health care for Canadians.” The Harkness award is funded by the Canadian Foundation for Healthcare Improvement and the Commonwealth Fund.

RESEARCH

C U M M I N G . U C A LG A RY.C A / M AG A ZI N E

were randomized to standard medical care (which included the clot-busting drug tPA where appropriate) or standard medical care plus ET. The overall mortality rate was reduced from two in 10 patients for standard treatment of care to one in 10 patients—a 50 per cent reduction with ET. Overall, positive outcomes for patients increased from 30 per cent to 55 per cent. In many cases, instead of suffering major neurological disability, patients went home to resume their lives. The study included 22 sites worldwide and patients in the U.S., U.K., Ireland and South Korea. Canada had 11 participating hospitals and enrolled two-thirds of the patients. ESCAPE investigators reviewed and taught ET methods to all 22 sites in the trial and the therapy is changing the standard of ischemic stroke treatment.

WHAT IS ENDOVASCULAR TREATMENT?

ESCAPE:

New therapy is changing the standard of stroke treatment

UCALGARY MEDICINE SPRING / SUMMER 2015

Endovascular treatment is performed by inserting a thin tube into the artery in the groin, through the body, and into the brain vessels to the clot. This is done under image-guided care using an X-ray. The clot is then removed by a retrievable stent, restoring blood flow to the brain. Endovascular treatments were first developed in the 1990s, but ET has only recently been technically possible.

The Calgary Stroke Program Calgary Stroke Program (CSP) members contributed extensively to ESCAPE. A joint venture between the University of Calgary and Alberta Health Services, the CSP is recognized as one of the top programs in North America for stroke treatment and research. + The CSP is the largest training program for acute stroke in the country and has the highest number of academic stroke neurologists under 'one roof'. + The program is a leading academic training centre for stroke clinical fellows. Former trainees are spread throughout the world, and many current stroke neurologists in Canada have trained in Calgary. The program is an internationally recognized fellowship program (65 Fellows). + CSP team members are recognized leaders in stroke imaging and acute stroke trials. + The program is the only one to be fully accredited for comprehensive stroke care in Canada. Other programs are accredited for parts of stroke care only. + The CSP’s eight leading stroke clinician scientists have collectively published over 900 citations and have been cited 16,000 times worldwide.

Find out more: cumming.ucalgary.ca/escape-stroke by Marta Cyperling

“This is the most significant and fundamental change in acute ischemic stroke treatment in the last 20 years. These results will impact stroke care around the world.” - Dr. Michael Hill

anadian researchers have completed an international randomized controlled trial showing that a clot retrieval procedure, known as endovascular treatment (ET), can dramatically improve patient outcomes after an acute ischemic stroke. The study, led by researchers at the University of Calgary’s Hotchkiss Brain Institute (HBI), Cumming School of Medicine, shows a dramatic improvement in outcomes and a reduction in deaths from stroke. The results of the study were published earlier this year in the New England Journal of Medicine. The clinical trial, known as ESCAPE (Endovascular treatment for Small Core and Anterior circulation Proximal occlusion

with Emphasis on minimizing CT to recanalization times), shows there is a marked reduction in both disability and death among patients who receive ET for acute ischemic stroke. Ischemic stroke is caused by a sudden blockage of an artery to the brain that deprives the brain of critical nutrients, such as glucose and oxygen. Currently, the international standard of care based on Canadian, U.S. and European guidelines is to administer a drug called tPA when appropriate. Known as a ‘clot buster’, the drug dissolves the blood clot. In the ESCAPE trial, 316 patients who fit the criteria for ET and arrived for treatment within 12 hours of their stroke

ESCAPE Trial Team: Dr. Michael Hill is a professor in the departments of clinical neurosciences, community health sciences, medicine, and radiology at the University of Calgary. He is also director of the Stroke Unit for the Calgary Stroke Program, Alberta Health Services and a member of the HBI. Dr. Mayank Goyal is a professor of radiology and clinical neurosciences at the University of Calgary and a member of the HBI. He is also a neuroradiologist at Alberta Health Services and a member of the Calgary Stroke Program. Dr. Andrew Demchuk is a professor in the Department of Clinical Neurosciences at the University of Calgary and a member of the HBI. He is also a stroke neurologist and director of the Calgary Stroke Program, Alberta Health Services.

Warning Signs of Stroke In stroke, time equals brain. Each minute the brain is not receiving blood flow, about 1.9 million brain cells die. Many stroke treatments

Facial droop

Stroke Facts

work only if administered in a set period of time – patients need to recognize the signs of stroke and seek medical attention immediately.

Arm weakness

Think FAST; recognize and react to the warning signs of stroke:

Speech slurred or garbled

Stroke is a leading cause of death in Canada Stroke is the leading cause of serious long-term disability in adults

Time to call 9-1-1

Stroke can happen at any age

RESEARCH

C U M M I N G . U C A LG A RY.C A / M AG A ZI N E

UCALGARY MEDICINE SPRING / SUMMER 2015

All cancers have one thing in common—a mistake in the DNA D

NA damage is a common occurrence in human cells and is usually repaired quickly. But sometimes mistakes in DNA repair accumulate, altering the capacity of the cell to repair its DNA accurately and setting the stage for cancer. The aging process, along with repeated

exposure to toxins such as tobacco, asbestos, radon gas and UV light, are the usual causes of multiple errors in DNA. Occasionally, the DNA repair machinery itself is faulty, often because of an inherited weakness in repair capacity; DNA errors

accumulate for this reason. Inherited weaknesses in DNA repair are one of the major causes of cancers that run in families, such as those of the breast and colon. Established in December 2014, the Robson DNA Science Centre brings together a core

group of DNA scientists studying how cells detect and repair DNA damage. Ultimately, their research will be used to reduce cancer rates and improve treatment for cancer patients. Meet the research team at the Robson DNA Science Centre:

Corinne Doll, MD Finding reliable outcome “ predictors will transform anti-cancer therapy ”

Jennifer Cobb, PhD Inaccurate inheritance “ of DNA between cells drives cancer evolution ” Cobb and her lab investigate how cells prevent Genomic Instability and the propagation of DNA mutations. By understanding the cause of chromosomal rearrangements in our cells, which is an early event tumour formation, the hope is to develop cancer prevention therapies.

Tara Beattie, PhD Karl Riabowol, PhD Advanced age remains the “ strongest predictor of cancer we know ” Riabowol and his team are studying how cancer cells elude the molecular processes that normally enforce cellular aging. His research focuses on the tumour suppressor gene called ING1 (INhibitor of Growth) that we discovered as a gene inactivated in many cancer types. ING genes are involved in the onset of cell aging and in preventing the process of cellular immortalization that is necessary for cancers to develop and grow.

Susan Lees-Miller, PhD

“

Solving the molecular basis of cancer is key to new treatment strategies

”

The Lees-Miller laboratory is studying how cells detect and repair DNA double strand breaks—a major source of genome instability. Her research focuses on the role of two protein kinases, DNA-PK and ATM, in the cellular response to DNA damage and the maintenance of genome stability. Using this knowledge, her team is also determining how targeting these important proteins can improve outcomes for cancer patients.

Cancers need telomerase “ for uncontrolled growth— we can exploit that ” Beattie studies how misregulation of telomerase causes changes in DNA integrity, driving multiple human diseases. Her team’s research focuses on understanding the delicate balance between too much telomerase in cancer cells and too little in pre-cancerous disorders such as myelodysplastic syndrome, aplastic anemia, dyskeratosis congenita as well as idiopathic pulmonary fibrosis.

Ebba Kurz, PhD Deciphering how drugs “ alter cellular complexes will improve therapy ” The Kurz laboratory is studying the impact of common over-the-counter medications on the efficacy of anti-cancer chemotherapy. Her research focuses on a protein that untangles DNA strands (a topoisomerase). This protein is also the key target of several widely used anti-cancer chemotherapeutics. Her lab is studying how common drugs like aspirin interact with this protein and is uncovering novel mechanisms for DNA repair.

Aaron Goodarzi, PhD Cancer will be cured “ on the day we eliminate DNA instability ” The Goodarzi lab is working to understand how human cells repair and preserve DNA that has been severely damaged by ionizing radiation exposure. His research focuses on how cells resolve difficult to repair DNA breaks in regions of compact DNA packaging, such as heterochromatin (silent genes) and the repair of DNA breaks induced by high energy transfer (LET) radiation such as alpha-particle radiation from radon gas—the cause of over 3000 lung cancers in Canadians each year.

The centre was made possible by a $10-million gift from Dave Robson—through the Dave and Val Robson Fund at The Calgary Foundation—to the Southern Alberta Cancer Research Institute at the Cumming School of Medicine.

Dr. Doll is investigating clinical and molecular indicators of chemo-radiation responses in cervical and anal cancer patients. Over half of all cancer patients receive radiation therapy. However, there is not currently a means to reliably predict which patients will have a good vs. poor outcome with radiotherapy (± chemo) prior to treatment.

Nizar Bahlis, MD Genomic sequencing “ can reveal druggable alterations in cancer ” Dr. Bahlis and his team are aiming to improve the treatment of multiple myeloma by identifying genomic alterations and drug resistance mechanisms. They study signaling pathways in hematological malignancies and, in particular, multiple myeloma with the goal of discovering new molecular targets for therapeutic applications.

“The importance of research can’t be overstated,” says Dave Robson. “The scientists in the Robson DNA Science Centre are doing life-saving research that will help improve the lives of Canadians in years to come.” Contributors: Marta Cyperling and Aaron Goodarzi, PhD

UCALGARY MEDICINE SPRING / SUMMER 2015

EDUCATION

Advanced Technical Skills Simulation Laboratory

Designed for education Driven by research Inspired by care

Health Sciences Centre, Foothills Campus

What is the Advanced Technical Skills Simulation Laboratory (ATSSL)?

by Amy Dowd and Kathryn Kazoleas

Cumming School of Medicine students, faculty and staff train and work in some of the most advanced facilities in the country. Whether spaces like this exist because of research or to stimulate it, or to provide learners with hands on skills development in real-life health environments, they all contribute to improved patient care in southern Alberta and beyond. Take a look inside…

The ATSSL is a partnership between the University of Calgary’s Cumming School of Medicine and Alberta Health Services’ eSim South Provincial Program. It includes a surgical simulation lab, clinical simulation lab and classrooms to provide interprofessional education in a realistic and safe environment. Surgical simulation lab: • Twenty simulated operating room (OR) stations equipped with scrub sinks, OR tables, overhead OR lighting, dual LED monitors and ceiling supply units. • Four of the stations contain in-light cameras allowing for the display of real-time imaging throughout the lab and classroom. • Equipped with fully functional reprocessing area to clean and sterilize instruments. • Skills such as laparoscopy, arthroscopy, endoscopy and microsurgery are practiced by surgical residents. • Integrated cameras offer the opportunity to video record lab sessions. • Can be used to accommodate one large group or be configured to smaller spaces for simultaneous education sessions.

Opened: 2014

Clinical simulation lab: A facility where learners use a variety of simulation mannequins and task trainers capable of presenting a number of clinical situations and responding to the actions the health-care learners employ (e.g. heartbeat responding to proper chest compressions). These are used to enhance individual technical skills, clinical skills, and provide an opportunity to practice teamwork, leadership and communication skills with a focus always on patient safety and quality of care. Classrooms: • Two classrooms with capacity for 29 and 20 students. • Features wireless internet access, LCD projector, in-ceiling speakers, videoconference capabilities, remote viewing of wet lab sessions.

Why was it built? To allow medical trainees and healthcare professionals the opportunity to practice and develop their skills in a safe environment, allowing them to make mistakes and learn from them.

Who uses it? Medical students, residents, registered nurses, doctors and surgeons, as well as other health-care professionals such as respiratory therapists and paramedics; approximately 4,000 people per year from the Cumming School of Medicine, Alberta Health Services, SAIT, Mount Royal University, and professionals and students from across southern Alberta.

How is the ATSSL helping to create the future of health? Simulation provides the opportunity to practice clinical skills without the risk of harming a patient, while supporting knowledge transfer of best practices and research initiatives.

What is the coolest thing about the facility? Video recording surgical procedures gives instructors and students the opportunity to review procedures and discuss them, as well as to monitor procedures from a distance. They also allow faculty to develop research programs to evaluate new surgical techniques as well as new equipment and teaching methods. Trainees are also able to obtain videos of simulated surgical procedures thereby developing a portfolio.

QUICK FACTS • The facility has also used video conferencing capabilities to broadcast out to junior high and high schools to teach various sessions. • The facility has hosted a number of junior high and high school students for various events to promote health and health-related careers, such as Aboriginal Health Day and Discovery Days. Acknowledgment: George Mulvey, Manager, ATSSL

UCALGARY MEDICINE SPRING / SUMMER 2015

W21C Healthcare Human Factors and Simulation Laboratory Teaching, Research and Wellness Building, Foothills Campus

What is the W21C Healthcare Human Factors and Simulation Laboratory (HHFSL)? The HHFSL provides researchers with infrastructure to study various aspects of the interaction between people (such as physicians, nurses and patients) and clinical systems (such as medical devices, multi-disciplinary teams and clinical technologies). The technology allows users to create realistic clinical scenarios and then capture and analyze a breadth of data to better understand humansystem interaction.

Why was it built? To examine the safety of health care using human factors methods previously employed in high-risk industries such as aviation and nuclear energy.

Human factors: A body of knowledge regarding human capabilities/limitations and design; human factors engineering is the application of human factors knowledge to optimize the design of systems for human use. Through the leadership of Dr. Jeff Caird, W21C Human Factors Lead, professor in the Department of Psychology and adjunct professor in the Department of Community Health Sciences, a need was identified in western Canada for a centre focused on research excellence in health-care human factors and patient simulation, to bridge the gap between industry, academia, and government to facilitate health-care innovation and quality improvement.

Who uses it? Researchers, educators, physicians, graduate and postgraduate medical students; the eSIM patient simulation program; health service collaborators, including leaders from multiple branches of Alberta Health Services; and industry partners. It’s also used for external outreach; over 250 individuals toured the lab in 2014.

How is the HHFSL helping to create the future of health? Being embedded in the W21C Centre for Research and Innovation, the research being conducted by the simulation laboratory is vetted by experts from multiple disciplines. This technical expertise is further accentuated by the proximity of a collaborating medical unit in the Foothills Hospital. This unique mix enables users to answer research questions in an academically thorough and pragmatic manner.

What is the coolest thing about the HHFSL? The Eye Tracker. This device tracks a user’s pupil to estimate where the person is looking. It has been used in research studies to understand how clinicians direct their attention under varying circumstances.

Opened: 2009

QUICK FACTS • By providing a realistic yet controllable setting for testing novel technologies or processes, early stage innovations and proof of concept projects can be evaluated well before they could be used in actual clinical settings within Alberta Health Services or other clinical environments. • W21C leadership modelled the laboratory off of other usability labs at Vanderbilt and Harvard universities. Funding was provided through a Western Economic Partnership Agreement, which covered the capital costs for the space to be built. • The HHFSL human patient simulator, iStan, has clinically ‘died’ several times. Cats have nine lives; iStan has more.

Acknowledgment: Greg Hallihan, Human Factors Program Manager, W21C

C U M M I N G . U C A LG A RY.C A / M AG A ZI N E

3 2 Therapies and Operative Resuscitation with Angiography, Percutaneous Repair (RAPTOR) / Interventional Trauma Operating Room (ITOR)

McCaig Tower, Foothills Medical Centre, Alberta Health Services

What is the Resuscitation with Angiography, Percutaneous Therapies and Operative Repair (RAPTOR) / Interventional Trauma Operating Room (ITOR)? The RAPTOR is an intensive care unit, an operating room, an interventional radiology suite, and an emergency room trauma bay, all rolled into one. Because it’s a one-stop-shop, severely injured patients requiring bleeding control don’t have to be transported between different rooms/suites within the hospital to decide the best course of action. This saves critical time, ensures the best possible environment for the patient and allows for immediate response to a patient’s changing condition. The RAPTOR is also equipped to perform basic CT scans of the brain, allowing physicians to make emergency decisions quickly.

Why was it built? Foothills Medical Centre is the busiest trauma centre in Canada. Severely injured patients are at greater risk if they have to be moved around to get the therapies they need. Calgary’s RAPTOR suite was purposebuilt during construction of the McCaig Tower. It was the second of its kind in the world. The suite was funded by the Calgary Health Trust and the Government of Alberta’s McCaig Tower Capital Fund Project.

Opened: 2013

Who uses it? The RAPTOR is used for every trauma operation at Foothills Medical Centre; over 1,200 last year. Sometimes there are as many as 30 health-care professionals working in the suite, at least for the initial part of the trauma. Typically, a core team of about 10, which includes suregons, anesthesiologists and nurses, are present. That number can double depending on the equipment/expertise required to respond to the trauma.

How is the RAPTOR / ITOR helping to create the future of health? Through research: The suite was purpose-built based on research; years of collecting, reviewing and publishing data, plus simulating the end product. In another five years or so, the team will compare their original data with new data to demonstrate that the room is doing what it’s supposed to do—saving more lives. The answer anecdotally at least, is absolutely yes. Since the medical community learns by peer review publication and by professional word of mouth, the RAPTOR suite pushes medicine forward on a public health level. Through technology: The technology in the RAPTOR is highly advanced, so the reality is that not every trauma centre can afford it. But there are elements of it, concepts that come out of creating and using these super advanced rooms that can be reverse engineered to be simple, affordable and life-saving.

What is the coolest thing about the RAPTOR / ITOR? In five years, there may be hundreds of RAPTOR suites in North America, but it’s likely that very few, if any, will be built from the concrete up.

QUICK FACTS • The RAPTOR is about three times the size of a regular operating room. • The first RAPTOR was refitted in Liverpool Hospital in Sydney, Australia— and it’s run by a Canadian surgeon. • A lot of the technology for trauma intervention comes from ideas propagated in the aerospace world; the team behind the RAPTOR works closely with NASA and the Canadian Space Agency.

Acknowledgment: Dr. Chad Ball, Clinical Associate Professor, departments of surgery and oncology, Cumming School of Medicine; trauma and cancer surgeon, Foothills Medical Centre

ALUMNI

C U M M I N G . U C A LG A RY.C A / M AG A ZI N E

Alumni Update:

UCALGARY MEDICINE SPRING / SUMMER 2015

Alumnus Proﬁle: by Alison Myers

AS OF SEPTEMBER 1, 2014 the

Cumming School of Medicine Alumni Ofﬁce has a new director, Dr. Betsy Woolner. WOOLNER IS A GR ADUATE of the MD Class of 1988, (Poodles). She has been a community family physician in Calgary since 1996 and a member of the Department of Family Medicine since 2001. Her goal as director is to provide an easy point of contact for alumni to keep in touch, brag about their accomplishments, find ways to get involved with the Cumming School and with the University of Calgary as a whole and to connect with fellow alumni. “I’m new to my job, the Cumming School has a new Alumni Advisory Council and we have a whole new direction for alumni relations,” says Woolner.

Growing Our Alumni Footprint In the past, the alumni office tracked almost exclusively MD alumni. But the portfolio is expanding and we are now engaging graduates from our other educational programs, including Graduate Science Education and the Bachelor of Health Sciences.

Alumnus of Distinction Research Award This year, we want to recognize the time and energy many of our graduates dedicate to all types of research including clinical trials, health services research, social sciences or laboratory-based basic science research. Nominate a Cumming School of Medicine graduate for this prestigious award by July 17, 2015.

Alumni Advisory Council Dr. Jon Meddings, dean of medicine, is keen to broaden the alumni family even further to embrace residents and postdoctoral trainees. As a result, a new Alumni Advisory Council has been formed which includes members from these constituencies. “The new advisory council will be a great help to me as I learn about and try to engage alumni that perhaps haven’t felt included in the past,” says Woolner. MILES ROBERT ARONSON is the

Call to Brag MEDICINE ALUMNI

Share your news, interests, achievements, hobbies and activities with us! We want to hear about your accomplishments— professional and personal. The Cumming School of Medicine Alumni Ofﬁce wants to honour your successes. Let us know about new jobs, awards and achievements so we can celebrate with you and share your accolades with fellow graduates. We also realize that life is about more than just work. Keep us posted on your triumphs and talents outside the ofﬁce—we’d love to hear about them too! Have a shy colleague? Brag on their behalf!

CONTACT INFORMATION: Email: medalum@ucalgary.ca

RECENT SUCCESSES: Lucy Diep, BCR’13, received the inaugural Easter Seals Alberta Alumni Leadership Award for her work with Camp Horizon. Scott Forsyth, MD’99, was named the 2014–15 Alberta Professional Photographic Artist of the Year from the Professional Photographers of Canada.

Gurdeep Parhar, MD’92, received the 2015 AFMC – May Cohen Equity, Diversity, and Gender Award. Simon Hirota, Post Doctoral Fellow 2007-12, qualified to compete in the Canadian National Cyclocross Championships in Winnipeg. He has also just received a Canadian Institutes for Health Research (CIHR) Tier II CRC in HostMicrobe Interactions and Chronic Disease.

kind of person who sees problems for what they really are: challenges to overcome. He's been this way since he was a young boy growing up in Montreal, where he saw homelessness, hunger and worst of all, indifference in passersby.

“I’M A STRONG BELIEVER that all of us gravitate towards some things naturally in terms of a social issue,” he says. “Homelessness as the visible face of hunger was something that drew me in.” Aronson’s mind was preconditioned to see his potential to help as he was constantly watching his parents do simple things to change others’ lives. He remembers his mother gathering belongings for a family who arrived in Canada with little more than a suitcase. He remembers his father collecting clothing for a church to sell so they could raise money to feed the hungry. “My parents were consistently giving back,” he says, “and they were very quiet and humble about it. They showed me

and my brothers that it’s easy to help others in simple ways. There are no excuses. Just get up and do something.” With those lessons learned, it is no surprise that Aronson was not only able to envision a charity but actually make it happen. Spread the Love combined his desire to combat hunger with his passion for inspiring others to get involved. It’s all based on the simple concept of making sandwiches for organizations to distribute to the hungry. After 12 years, Spread The Love is a national non-profit organization with chapters across the country, including one at the University of Calgary, and has provided over 400,000 meals to hungry Canadians. It was through his engagement on campus that Pam Aranas first met Aronson when he was in his last year of the Bachelor of Health Sciences program. “I came to know him as someone who’s very driven, very community organized and strategic in his way of thinking about social entrepreneurship,” says the alumni programming officer. Those qualities made Aronson a perfect fit to co-chair the advisory

I think it’s critical “ to stay involved. You build so much real life at university. Whether you realize it or not, it shapes who you are. It opens up doors and provides opportunities.

”

When the opportunity came up, Aronson says he was eager to join in. “I think it’s critical to stay involved,” he says. “You build so much real life at university. Whether you realize it or not, it shapes who you are. It opens up doors and provides opportunities.” For Aronson, university shifted his journey from medicine to the prospect of helping people at an organizational level. “Majoring in Health and Society aligned perfectly with my passions,” he says. Now, with his involvement in the Community Impact Program, Aronson hopes to support alumni bridging the

My parents were consistently giving back, “ and they were very quiet and humble about it. They showed me and my brothers that it’s easy to help others in simple ways. There are no excuses. Just get up and do something.

”

council for the office’s new Community Impact Program. The program aims to find new ways to engage University of Calgary alumni with the school through community service projects. “He’s going to bring a great perspective to the program we’re trying to offer,” she says. “He’ll be a great leader and he’ll motivate people.”

gap between their own passions and their connection to the school that helped shape their lives.

ALUMNI

C U M M I N G . U C A LG A RY.C A / M AG A ZI N E

Alumna proﬁle:

u c at i on CaRMS * Ma d E l a c i tc h e 201 5 Med s U ndergraduate

by Leigh Hurst

THE MOUNTAINS WERE initially what drew Dr. Lara Cooke to apply to medical school at the University of Calgary. But it was Adele Meyers, coordinator of admissions and student affairs, who made her realize that Calgary was an ideal place to launch her medical education. “THE MINUTE I CAME IN for my interview I was struck by the beauty of the atrium and by Adele, who was so incredibly warm and welcoming; she immediately put us all at ease.”

Since first stepping through the doors of the Health Sciences Centre in 1996, Cooke has devoted a significant amount of time to medical education, both as a learner and a teacher. She completed her postgraduate medical education in neurology and a fellowship in headache medicine. Her formal education at the University of Calgary didn’t stop there. In 2007, Cooke completed a Master of Science in Medical Education that

focused on communications skills training for neurology residents. The mixture of these unique and diverse training experiences led Cooke to become a leader in educational programming at the Cumming School of Medicine. She founded the Office of Faculty Development and served as the assistant dean from 2006-10. “We were late to the table with faculty development and it became increasingly important to have an active faculty development office to ensure that we were training excellent teachers and that we would continue to meet accreditation standards,” she says. Currently, Cooke is the associate dean, Continuing Medical Education (CME) and Professional Development in the Cumming School of Medicine. “The strength of our program is not only our high educational standards but also our ability to showcase local expertise and present the content through a local lens. Our programs offer content that is evidence-based and provide access to local opinion leaders.” Programs offered through the CME office have a multidisciplinary focus and offer training for several professions including doctors, nurses, pharmacists and social workers. This, coupled with the quality of education, affords participants lots of opportunity for interaction and learning in an environment which is able to remain objective. Currently, the CME office is focused on broadening their audience and breaking down barriers to access. A large e-learning curriculum is gaining traction as educators work to bring content directly to learners anywhere and any time via webinars, podcasts and other digital media. Given her current position, Cooke has some parting words of wisdom for Class of 2015 MD graduates, the Cows: “When you embark on your residency, you need to develop a deliberate practice

for life-long learning and build this practice into your weekly schedule. It is a huge task to stay current in your field. Learning needs to be planned and incorporated into your daily routine.”

MEMORIAL UNIVERSITY

UNIVERSITY OF TORONTO

QUEENS UNIVERSITY

UNIVERSITY OF SASKATCHEWAN

November 16 – 19, 2015 University of Calgary This program provides an update focused on the information pearls pertinent for practice in primary care. It is intended for family physicians, nurse practitioners and nurses working in primary care in urban and rural settings. Can’t attend a course in Calgary? There are online options too!

UNIVERSITY OF ALBERTA

PEDIATRIC NEUROLOGY

UNIVERSITY OF OTTAWA

FAMILY MEDICINE

NEUROLOGY

4 GENERAL SURGERY

UNIVERSITY OF MANITOBA

UROLOGY INTERNAL MEDICINE

McGILL UNIVERSITY

CARDIAC SURGERY

ANESTHESIOLOGY PSYCHIATRY

ORTHOPEDIC SURGERY

UNIVERSITY OF BRITISH COLUMBIA

PHYSICAL MEDICINE & REHABILITATION

UNIVERSITY OF CALGARY

PLASTIC SURGERY

Primary Care REAL-WEB Webinar Series

An ongoing series of accredited CME webinars for primary care practitioners. This program focuses on best practice take-home messages in primary care. Each webinar features the latest advancements in diagnosis and treatment as well as addressing clinical cases.

EMERGENCY MEDICINE

VASCULAR SURGERY

WESTERN UNIVERSITY

Fall and Winter 2015/16 cumming.ucalgary.ca/cme

7 OBSTETRICS & GYNECOLOGY

PEDIATRICS

2015 Annual Family Practice Review and Update Course

DERMATOLOGY

McMASTER UNIVERSITY

Upcoming Continuing Medical Education Courses

DALHOUSIE UNIVERSITY

DIAGNOSTIC RADIOLOGY

PATHOLOGY

OTOLARYNGOLOGY

OPHTHALMOLOGY

*The Canadian Resident Matching Service (CaRMS) matches graduating MD students into postgraduate medical training (residencies) throughout Canada. 190 incoming residents will begin training at the University of Calgary in 2015.

UNIVERSITY OF CALGARY CUMMING SCHOOL OF MEDICINE

Philanthropy at work

Great cities are built on great universities, and great universities are built on great philanthropy. -Nuvyn Peters, vice-president (development), University of Calgary

The Healthy Brain Aging movement

Supporting the next generation

Connections strengthen bone and joint research

Cutting-edge technology leads to custom treatments

Page 2

Page 4

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Stories by Jaclyn Silbernagel

PHILANTHROPY

From left to right: Dr. Oury Monchi, Dr. Eric Smith and Dr. Bruce Pike

Community philanthropists advance the Healthy Brain Aging movement

he brain remains one of the least understood organs in the human body, yet one in three Canadians will be affected by a brain or nervous system disorder or injury in their lifetime. Susceptible to conditions such as vascular dementia, Alzheimer’s, stroke and Parkinson’s, the aging brain has been identified by the University of Calgary as an area of critical need on the research front. Led by the Hotchkiss Brain Institute (HBI), the brain and mental health strategic research theme is one of six guiding the university toward its Eyes High goals. Thanks to the generosity of Calgary’s community members, a unified fight for the improvement of brain health has begun through the HBI. An intricate web of high-level researchers who draw support from philanthropic partners now have the opportunity to work more closely together. A number of investigators are centralized in the Cumming School of Medicine at the Ron and Rene Ward Centre for Healthy Brain Aging Research—a collaborative space bringing scientists, clinical researchers, and trainees together to study how the

healthy brain ages and what goes wrong in some cases. Thanks to support provided by the Ronald and Irene Ward Foundation, the Centre will allow multidisciplinary

When you bring people “with the diversities of experiences, perspective and methodological knowledge together in this kind of milieu, you get collaborative outcomes that are much greater than the sum of their parts.

”

interactions. It will bring together diverse perspectives about research, prevention, clinical approaches, treatments and therapies and lead to innovative solutions for brain disorders. The space is named after Ron and Rene Ward. Ron lived an energetic, health-driven life. Even at 70 years old, he was an avid skier and golfer who ran three to four miles a day. Near the end of his life, Ron was diagnosed with Lewy

body dementia—a condition associated with Parkinson’s that causes rigid muscles and tremors and slows movement. It’s the second most common type of progressive dementia after Alzheimer’s, and it resulted in Ron’s passing in 2007. For the Ward family, the experience created a desire to help further research in the area of dementia. “It's difficult to watch someone deteriorate so quickly, and the surprising and sad part of it all is that it couldn't have happened to a healthier person,” says Paul Wanklyn, nephew of Ron and Rene, and trustee of the foundation. “Our family believes it’s important to leave this legacy. We believe that Ron and Rene made an impact, and seeing how excited the researchers are and how hard they’re all working to produce fantastic results for better health in our community is important to our family and would have fulfilled the Wards’ wishes. We’re thrilled for everyone.” Among the experts working together to better understand the aging brain are Oury Monchi, PhD, Tourmaline Oil Chair in Parkinson’s Disease; Bruce Pike, PhD, CAIP Chair in Healthy Brain Aging; and Dr. Eric Smith, Katthy Taylor Chair in Vascular Dementia, who will concentrate their efforts on dementia, with particular interest in Alzheimer’s disease, vascular disease, Parkinson’s disease, and Lewy body dementia. These researchers will work to understand the ‘why’ behind memory loss and cognitive impairment. They will explore healthy brains, comparing them to those that have been compromised. They will seek out answers to questions like: How can music and movement help heal the brain? What lifestyle choices will lead to longevity in the mind? Smith says the breadth and variety of expertise in the centre will open new avenues of looking at dementia diseases. "When you bring people with the diversities of experiences, perspective and methodological knowledge together in this kind of milieu, you get collaborative outcomes that are much greater than the sum of their parts,” says Smith. “Such collaborations will allow me to answer questions that I would never be able to answer on my own.” Collaboration is not a new concept, but physical proximity is a catalyst for more group efforts.

UCALGARY MEDICINE SPRING / SUMMER 2015

C U M M I N G . U C A LG A RY.C A / M AG A ZI N E

"A lot of things just happen in corridor discussions, and being together will further this,” says Monchi. “More than that, we will have what is called a collaborarium —where whoever is available can sit and have discussions. New collaborations will just happen, and existing ones will be carried out more efficiently." The Healthy Brain Aging program is magnifying the existing HBI network of expertise in recruiting both research leaders and the future generation of leaders. “I’m excited for trainees. With such cross-pollination, trainees are exposed to a broader range,” says Pike. “The Centre will be an incredibly rich environment for them.” Whether it’s working together locally or partnering with national and international colleagues, the HBI is leading the way in initiating and participating in meaningful collaborations that are advancing research approaches around the world. The centre will also be a technological hub using high levels of imaging and data analysis to seek answers. Another component will be a brain bank, allowing researchers to see the brain under a microscope and correlate that information with what they’re seeing in imaging scans. A comprehensive program that looks at potential risks for brain disease while using advanced neuroimaging techniques will help identify what leads to cognitive decline and impairments.

Paul Wanklyn

"Earlier detection means we have a better chance of intervening," says Pike. "We will use newer, more sensitive and quantitative methods to understand and track the disease at the earliest stage." Research focused on brain imaging techniques and applications are important in understanding the changes in a normal functioning brain compared to seeing how disease or age changes the brain. Studying those differences leads to new methods of treatment, which researchers at HBI will be able to test rapidly.

Smith explained how researchers are taking a holistic look at brain growth development and aging throughout one’s lifetime in order to get a full understanding of the brain and its function over time. Factors such as cognitive reserve— the mind’s resistance to damage of the brain—are influenced by things like childhood experiences, exposure to highly stimulating environments, social interactions, and physiological disruptions like small strokes. Smith says that information is helpful to determine how vulnerable an individual is to developing dementia, and how capable a brain is in defending itself from these diseases. While many questions have yet to be answered, what is clear is that life experiences help shape the brain and help determine how it reacts later in life. We are also living longer on average thanks to advances in other areas of medicine, which means an increased risk of health issues associated with aging. With its many components, the Healthy Brain Aging program will help investigators answer important questions, accelerate research, improve treatments and therapies, and hopefully develop prevention strategies for all types of debilitating dementias, ultimately improving health outcomes. "The community’s involvement is essential if we're going to make progress in studying aging and dementias,” says Pike. “There is no substitute for community participation.”

Connected by the cause – philanthropic support for the Healthy Brain Aging movement

2000

2007

Parkinson's Society of Southern Alberta

Brenda Strafford Foundation

Suter Professorship in Parkinson's Research (Bin Hu)

Created the Brenda Strafford Foundation Chair in Alzheimer’s Research (Marc Poulin)

2010

2011

The Ronald and Irene Ward Foundation

Mike Rose, Bob Yurkovich, Chris Potter and others

Gift to establish Ron and Rene Ward Centre for Healthy Brain Aging Research (multiple researchers)

Created the Tourmaline Oil Chair in Parkinson’s Disease (Oury Monchi)

Ed and Mimi Battle Contributed to the ESCAPE trial to improve stroke outcomes.

2012 Don and Ruth Taylor and family Started the Katthy Taylor Chair in Vascular Dementia (Eric Smith)

2013 Marian Lamb Supporting laboratories within the Ron and Rene Ward Centre for Healthy Brain Aging Research Alzheimer’s Society of Calgary Supporting the research of neuropsychiatrist Zaihnoor Ismail

2014 Louise Berlin and Donald Burns The Donald Burns and Louis Berlin Professorship in Dementia Research, a graduate award and postdoctoral fellowship The Campus Alberta Innovation Program Established the CAIP Chair in Healthy Brain Aging (Bruce Pike)

PHILANTHROPY

C U M M I N G . U C A LG A RY.C A / M AG A ZI N E

UCALGARY MEDICINE SPRING / SUMMER 2015

Supporting the next generation

A BLOOD CANCER THAT SPREADS OUT

Bursary supports those who serve for others way to pay tribute to a loved one while helping others. The Martin T. Spoor Memorial Bursary was established to honour the memory of Dr. Martin Spoor, who died in a plane crash while on an organ transplant mission. It provides support to future generations of doctors—future medical leaders like Meera Grover. Grover is a first-year medical student whose incredible history has led her to the study of medicine. At 28 she has completed a degree in development studies, worked overseas in the fight against child trafficking, completed the nursing program at the University of Calgary, worked as a street outreach nurse, and is now completing medical school. "My deep core belief is that everyone should have equal rights and opportunities and everyone should have equal access to health care. My feelings stem from a sense of justice," she says. Spoor lived his life to help people and Grover is structuring her life to be able to do the same. Calgary is home to her and her husband, and both are passionate about helping people. The Martin T. Spoor Memorial Bursary is allowing the couple to achieve their goals by alleviating some of the financial burden they face, while affording them the time to volunteer in their community. “Support like this helps me re-focus on what's important, which is people and medicine,” she says. "Physicians are uniquely positioned to influence societal change from a health perspective and that is something I want to do.”

Community backing paves way for personalized therapies

“

Our hope is that these bursaries will also help people in medical school and that finances won’t be a barrier for those continuing or starting medical school.

A BURSARY IS A THOUGHTFUL

”

Melanie, Borys, Hayla and Larissa Hoshowsky

Planning for future impacts future of others includes a number of considerations: Will I have enough money to retire? Will my children be able to afford an education? For Dr. Borys Hoshowsky and his wife Melanie it included, how can we give back to our community in a meaningful way? The Hoshowsky's concluded that one way to give back was through estate planning and a legacy gift—a planned future donation—to the Cumming School of Medicine. This generous intention will create the future Dr. Borys, Melanie, Larissa and Hayla Hoshowsky Medical Education Bursary to aid young people pursuing careers in medicine. Hoshowsky first became a pharmacist and went on to pursue medicine at the University of Calgary. He almost didn’t finish medical school, needing help with finances to carry him through his last year, but received generous support from a friend.

PLANNING FOR THE FUTURE

That generosity led Hoshowsky to go on and receive specialized training at the University of California, Los Angeles and to complete his residency in otolaryngology in Toronto. This culminated in a flourishing career in Calgary, working in a supportive and collegial environment at the Rockyview General Hospital for the past 26 years. “I was fortunate to get into medical school and receive help,” says Hoshowsky. “Our hope is that these bursaries will also help people in medical school and that finances won’t be a barrier for those continuing or starting medical school.” The Hoshowskys’ philanthropic nature will not only leave a legacy for their family, it will impact future medical students who can then improve the lives of others. “I’ve been very fortunate in a variety of different ways,” says Hoshowsky. “We're thankful we can give back in this way.”

Dr. Maureen Topps, Dr. Wenqian Chen, Dr. Sumathili Raja, Dr. Chirag Shah

One person can make a difference BECOMING A DOCTOR IS DIFFICULT for anyone, but international medical residents face additional challenges in their journey to pursue training and accreditation within the Canadian medical system. The concept of paying it forward isn't new, but Dr. Chirag Shah's personal experiences led him to want to help others in the same position by creating the Dr. Chirag Shah International Resident Award at the University of Calgary’s Cumming School of Medicine. Drs. Wenqian Chen and Sumathili Raja, both previous award recipients, understand the struggles of being an international medical graduate. This award has influenced their lives in different ways. Chen, an anatomical pathology resident, says the award has helped expand her social circle and she wants to help guide other immigrants through the long process of becoming a resident in the future. Raja practices family medicine, but getting to that point was no easy path. The award not only provided financial support, but also boosted her confidence.

I always want to do “more. I hope that other immigrants will have courage and hope; it’s a hard journey, but if you keep moving forward you'll be able to pursue your passions.

”

As a pupil of the life and teachings of Mahatma Gandhi, Shah says he wants to change the world in a positive way. He experienced many struggles over his lifetime but simple acts of kindness, including a woman giving him a bus ticket that allowed him to make it to a fellowship interview, made a difference in his life and he intends to make a difference in other people’s lives. “I always want to do more,” says Shah. “I hope that other immigrants will have courage and hope; it’s a hard journey, but if you keep moving forward you'll be able to pursue your passions.”

throughout the bone and bone marrow, multiple myeloma is a disease that typically has no familial connections— yet both Patrick Quinn and his mother, Myrna, have been diagnosed and treated for the condition. Dr. Nizar Bahlis is a clinician and researcher at the University of Calgary’s Cumming School of Medicine who is making advances in myeloma research and care, and has helped the Quinns reach a manageable stage in the treatment of the disease. "I feel well cared for. They said they could treat this and get this to a manageable place and they have," says Myrna. To help other patients with this condition and further future research, the Quinns have generously donated to support myeloma research. “We feel that we have benefitted from past research and that current research will help others in the future," says Patrick. “It is not a common cancer—and that makes it a challenge for researchers.” With the help of people like the Quinns, Bahlis and his team are undertaking research to understand myeloma cancer cells through genome sequencing, in which the DNA sequence of one’s genetic material is studied. “We hope in the future, because of genome sequencing, that we'll be able to offer what is called personalized therapies,” says Bahlis. “Not every patient is the same, and Myrna's myeloma is different from Patrick's myeloma. In the near future we hope every cancer patient will be offered personalized treatment based on their cancer cell mutation profile.” Personalized care is the way forward for individuals affected by myeloma and research is being bolstered thanks to community support. “It never ceases to amaze me how committed and selfless these patients are,” says Bahlis. “They not only want to help themselves but they also realize that if they help with research today it will help other people in the future.”

PHILANTHROPY

C U M M I N G . U C A LG A RY.C A / M AG A ZI N E

UCALGARY MEDICINE SPRING / SUMMER 2015

Connections strengthen bone and joint research

Cutting-edge technology leads to custom treatments

o you know somebody who has broken an arm, sprained an ankle or anyone with a hip or knee replacement? These are just a few of the many bone and joint-related issues that can compromise a person’s mobility. Nearly one in three Albertans are affected by bone and joint related issues —a statistic that will continue to increase with an aging population. Thanks to the support of community philanthropists Bob and Nola Rintoul, the Bob and Nola Rintoul Chair for Bone and Joint Health is advancing research in osteoarthritic care in southern Alberta. Steve Boyd, PhD, is the inaugural chair holder of the research program. Its legacy will have important outcomes in approaches to patient care, future therapies and hopefully, one day, a cure for diseases like osteoarthritis in children and adults. "The chair position provides flexibility —if you have a good idea you can implement it quickly," says Boyd. “It provides a cascade of other opportunities and has allowed me to make international connections. It also supports research using the latest in technological devices which may become the new norm in the future of bone and joint health.” The chair enables the hiring of trainees who work in the area of bone and joint research to use their skills and expertise to feed into the ecosystem of existing researchers. The man who initiated the chair was the late Dr. Cy Frank, a visionary leader and modest friend who worked closely with the Rintouls to connect them with the McCaig Institute for Bone and Joint Health at the University of Calgary. “Cy was the original catalyst that got this all going,” says Bob Rintoul. “He was humble and entirely committed to patient care, and his passing is an incredible loss.” Frank’s ability to connect donors with health-care needs has and will continue to improve health care in Alberta and around the globe.

Bob and Nola Rintoul

Generous donations are leading us to a world with “better mobility and better bone and joint health. ” Innovative investigations are taking place every day with the help of funds from the Rintoul Chair. Researchers are able to study things like embryonic cell therapies on fractures. Further research is required, but the idea is that physicians could inject embryonic cells into joints, which could potentially heal osteoarthritis. A study is underway partnering with the Canadian Space Agency to observe extreme environments and the effects of microgravity on bone. Such investigations could help inform future treatments and improve mobility. “People have higher expectations of their body and want to run and play tennis into old age,” says Boyd. “People want to stay active for the rest of their lives.” Bone and joint health is unique. Unlike other health issues, bone and joint problems are rarely acute. Maybe a sprained ankle isn't a big deal today,

but it puts you at high risk for developing joint diseases or experiencing joint degradation like osteoarthritis in the future. If you injure yourself early on you have to live with that for the rest of your life. “We explore. We gain a better understanding of the mechanics of bones and joints,” says Boyd. “Generous donations are leading us to a world with better mobility and better bone and joint health.” Thanks to the generosity of Bob and Nola Rintoul, which is being carried forward through their children Brent and Brenda, improved bone and joint health is possible.

ur genes provide cues to a great deal of information: predisposition for future diagnoses, incidence of rare disease and the possibility of inheritance for later generations. Researchers believe that understanding the human genome —the entire makeup of chromosomes that an individual possesses, and complete set of genes or genetic material present in a cell or organism—holds the key to learning more about health in ways that haven’t before been possible. In Calgary, the use of community funded Next Generation Sequencing (NGS) technology is radically changing the approach to medicine for researchers studying genetics. The technology is a catch-all term used to describe a number of modern genetic sequencing technologies, enabling researchers to determine the unique order of the elements of DNA and RNA more quickly and cheaply than previous methods. Thanks to support from the Alberta Children’s Hospital Foundation (ACHF), the Alberta Children's Hospital Research Institute (ACHRI) at the Cumming School of Medicine established Calgary’s first genomics facility three years ago. It houses NGS and supports research programs of investigators across campus. Since the introduction of NGS, there has been a major change in the way scientists extract genetic information, revealing countless insights into the human genetic material embedded in DNA. It has enabled rapid sequencing, creating a wealth of data for researchers to be able to understand an individual's DNA—data they hope can be used in the future to create personalized therapies tailored precisely to each individual. “We’re emerging into an era of personalized medicine," says Dr. Francois Bernier, head of the Department of Medical Genetics at the Cumming School of Medicine and director of clinical genetics at the Alberta Children’s Hospital. "You can use genomics to identify risk for disease, stratify patients into better risk

categories, and identify better treatment paths and better drug response. It’s an important transition to be able to look at an individual’s gene sequence and move to create personalized therapies that address their individual needs.” As this technology becomes more integrated into the health-care system, the immediate impact for patients will be answers for a large number of individuals and families who are dealing with complex disorders. NGS achieves results in minimal time and in a costeffective way.

We are incredibly “grateful to people in our community who invest in innovative research initiatives like this one. They act as catalysts in helping to move medicine forward.

“How we use that technology to support research in an ethical way is important for society. It becomes important for places like the University of Calgary to be emerging leaders not only in the implementation of the technology but also for developing recommendations for safe and effective use in health care,” says Bernier. As the technology grows and is applied in more areas of health, it’s not unreasonable to think that all physicians will order genetic tests at some point. And the ground-breaking technology wouldn’t be possible without philanthropy. “Community support is instrumental. It helps researchers and clinicians get access to cutting-edge technology," says Bernier. "It's community support that drives this type of innovation."

”

“We are incredibly grateful to people in our community who invest in innovative research initiatives like this one. They act as catalysts in helping to move medicine forward,” says Saifa Koonar, president and CEO of ACHF. Moving forward, ACHRI will spearhead a strong collaborative partnership amongst multiple institutes and faculties to enhance the use of the genomics technology housed at the Cumming School of Medicine. The newly created Centre for Health Genomics and Informatics supports both the research and the clinical applications of genomics. Genomics contributes to a number of key areas, including: new gene discovery, improved diagnosis, a better understanding of the biological basis of disease, new treatments, and transformative patient care. Dr. Francois Bernier

Cumming School of Medicine Alumni Call for nominations:

Alumnus of Distinction Award for Research “ In recognition of outstanding contributions to clinical, community-based or basic science research. ” DEADLINE: JULY 17, 2015

cumming.ucalgary.ca/alumni/awards

PM AG R EEM ENT N O. 41 0 9 5 528

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