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  • 1. TABLE OF CONTENTS Page Department Head’s Report……………………………………………2 Allergy & Clinical Immunology………………………………………..4 Ambulatory Care…………………………………………………..….13 Blood Group Serology……………………………………………….15 Burntwood Region……………………………………………………17 Cardiology……………………………………………………………..19 Child Development Clinic…………………………………………….26 Child Protection Centre………………………………………………30 Community Pediatrics………………………………………………..32 Dermatology…………………………………………………………..34 Emergency Services………………………………………………….37 Endocrinology/Metabolism…………………………………………...39 Faculty Development ………………………………………………..46 Gastroenterology………………………………………………………48 Genetics & Metabolism……………………………………………….50 Hematology/Oncology………………………………………………...60 Infectious Disease……………………………………………………..60 Neonatology…………………………………………………….……..73 Nephrology…………………………………………………………….81 Neurology………………………………………………………………85 Pediatric Intensive Care………………………………………………87 Respirology…………………………………………………………….90 Rheumatology…………………………………………………………93 St. Boniface General Hospital……………………………………….96 Pediatric Undergraduate Medical Education………………………97
  • 2. Pediatric Postgraduate Medical Education……….……………..100 Quality Team………………………………………………………..106
  • 3. DEPARTMENT HEAD’S REPORT Department of Pediatrics and Child Health The academic years from July 2002 to June 2003 and from July 2003 to June 2004 represented a time of progress in all aspects of Departmental activities. Dr. Michael Moffat stepped down as Department Head and Dr. Cheryl Rockman-Greenberg stepped in as Acting Head in July, 2003 and was appointed Head in April, 2004. The past two years has seen consolidation of existing programs, growth in new areas, and development of new approaches to delivery of health care for the children of Manitoba. This report officially summarizes the Department’s activities until July 2003 and in a few sections includes 2004. The full 2004 report will follow next report. Our department has grown to a core group of 73 GFT’s and a complement of 35 community pediatricians. In the past year we have welcomed Dr. Janice Barkey, pediatric gastroenterologist and Dr. Kirsten Pederson, pediatric nephrologist. Dr Wade Watson, has taken the position of Director of Pediatric Faculty Development as well as the Assistant and Acting Postgraduate Associate Dean while Dr. Bryan Magwood has assumed the position as Undergraduate Associate Dean. Two new neonatologists, John Baier and Dr. Ganesh Srinivasan have joined us recently and we have recently recruited Dr. Aziz Mhanni, geneticist, Dr. Tanya Drews, pediatric Intensivist and Dr. Michael Salman, pediatric Neurologist, as well as Dr. Lonnie Ross, Craniofacial program, Dr. Darren Leitao, pediatric ENT specialist, and a new pediatric General Surgeon, Dr. Ioana Bratu. Dr. Jayson Stoffman has accepted a position in pediatric Hematology/Oncology and will officially join the Department in September, 2005. Recruitments continue in Allergy, Endocrinology, Neurology, Cardiology, Gastroenterology and Thompson as well as in Pediatric Ophthalmology and Pediatric Orthopedics. In addition, the Department, in collaboration with the Manitoba Institute of Child Health (“MICH”), is actively seeking a clinical epidemiologist to fill a newly established endowed chair in Clinical Epidemiology and evidence-based Child Health. In the past year, Dr. Anita Saxena, Pediatric Cardiology, unfortunately resigned to return to India and Dr. Chitra and Asuri Prasad, from Genetics and Pediatric Neurology respectively, left for the University of Western Ontario. Dr. Oscar Casiro, Neonatology and Director of our Neonatal Fellowship Program (to name a few of his duties), moved to Victoria, British Columbia to assume a new position at the University of Victoria. Dr. Henrique Rigatto, Neonatology, retired after 31 years of dedicated service to the University and the Children’s Hospital We have continued to provide excellence in teaching at the undergraduate and postgraduate levels of training. The PGME Program in Pediatrics, directed by Dr, Ming- ka Chan, was accredited by the RCPSC in 2002. We currently have 25 residents in the 3 year Core Pediatric Program plus approximately 15 fellows training in diverse specialties including, Allergy and Immunology, Emergency, Genetics and Metabolism, Hematology/Oncology, , Infectious Diseases, , Nephrology, Neonatology, Respirology, and Sports Medicine. The UGME Program, under the direction of Dr. Diane Moddemann, instituted a very successful Pediatric experience for medical students in their clerkship year in Brandon, Thompson and Portage la Prairie. In collaboration with the University of Manitoba and TeleHealth MB, our UGME program successfully piloted a new initiative of linking educational sessions (academic half-days) by TeleHealth to students in Thompson during their Pediatric rotation there. Dr. Jeff Hyman, one of our chief residents in Pediatrics for 2003 – 2004, was awarded the MMSA most outstanding
  • 4. Resident Award in 2003 and Dr. Patricia Birk in Pediatric Nephrology received an honorable mention for her demonstrated excellence in teaching. Some of our greatest successes in 2003 – 2004 have been in the research arena. Our links with the Children’s Hospital Foundation and MICH have been further consolidated. The Child Health Advisory Committee of the Children’s Hospital Foundation approved over $500,000 in grants in three major categories: Programs, Health Promotion, Disease Prevention and New Initiatives. These grants support research that demonstrates potential enhancement to health care services to children and youth. MICH, under the leadership of Dr. Malcolm Ogborn, Director of Research, has continued to expand its theme-based structure with the growth of the multidisciplinary “Biology of Breathing” theme led by Dr. Andrew Halayko and the research program in Pediatrics Neurosciences led by Dr. Marc del Bigio is emerging as a strength with increased collaboration with researchers in Genetics and Psychology. Themes currently under development include the areas of Nutrition and Genetics. Plans are being developed for an expansion of the research faculty to more than double its current size. The support that MICH offers is further reflected by the growth in external funding now secured by our Department members, who early in their careers received both mentorship and establishment or operating grants from MICH. For the first time in many years, all the Pediatric Sections with active research programs have received major national funding including Allergy, Endocrinology, Genetics, Hematology/Oncology, Neonatology and Nephrology. Researchers housed within the MICH facility now have external funding of over $4,000,000 per annum, a five-fold increase in 5 years. Finally, the mission of the Child Health Program is to provide the highest quality, comprehensive family-centered health care for children. We are extremely proud of our Child Health Quality and Decision Support Team, directed by Dr. Gerarda Cronin. This Team has developed and implemented care maps for the management of emergency asthma and tonsillectomy. The team continues to promote and help us achieve the highest standards of care by facilitating evidence-based decision-making. Leslie Galloway, Manager, Quality Team Child Health, received the Health Sciences Centre Award for outstanding achievement in pediatric care. This past year we have also seen the opening of our own Pediatric Hemodialysis Unit, a four-bed facility offering long-term hemodialysis in a pediatric-friendly and pediatric focused-environment. In conclusion, despite the challenges we face, the Department of Pediatrics and Child health takes enormous pride in its accomplishments and looks forward to further strengthening its programs. For more information please see related links at www.wch.ca and www.MICH.ca and myuminfo.umanitoba.ca. Cheryl Rockman-Greenberg, MD, CM, FRCPC, FCCMG Professor & Head Department of Pediatrics & Child Health University of Manitoba
  • 5. . SECTION OF ALLERGY & CLINICAL IMMUNOLOGY DEPARTMENT OF PEDIATRICS & CHILD HEALTH July 1st, 2002 to June 30th, 2004 MEDICAL STAFF Geographic Full-Time F. Estelle R. Simons B MD, FRCPC (Head) Allan B. Becker B MD, FRCPC Wade T.A. Watson B MD, FRCPC Research Kent T. HayGlass B Ph.D. Zhikang Peng B MD, M.Sc Keith J. Simons B Ph.D. Part-Time Mirla T. David B MD, FRCPC Thomas V. Gerstner B MD, FRCPC June M. James B MD, FRCPC Janet R. Roberts B MD, FRCPC Nestor Cisneros - MD, FRCPC (from November 2003) Fellows: Greg Appelt - MD, FRCPC Edmond Chan - MD, FRCPC Nestor Cisneros - MD, FRCPC (to November 2003) Per Lidman - MD, FRCPC Joel Liem - MD, FRCPC Members of the Section of Allergy & Clinical Immunology are dedicated to the advancement of Child Health, and to a comprehensive approach to the diagnosis and management of allergic diseases. They aim to provide exemplary care for infants, children, and adolescents with asthma, anaphylaxis, allergic rhinitis, urticaria, food allergy, drug allergy, stinging/biting insect allergy, and other allergic disorders. In addition, they provide leadership and excellence in allergy education and allergy research. Clinical Activities From July 1st, 2002 to June 30th, 2004, the Section of Allergy & Clinical Immunology members provided consultation services for thousands of patients with allergic disease in the Pediatric Allergy Clinic at Children=s Hospital and at the Meadowood Clinic and the Winnipeg Clinic. Allergy Clinics were also held in Selkirk, Ste. Rose, and in Morden/Winkler. In-patient services on the Children=s Hospital wards and in the Pediatric Intensive Care Unit were provided by Drs. Allan Becker, l:...reportsDept. of Pediatrics 2002-2004 Annual Report...
  • 6. -6- Tom Gerstner, Estelle Simons, and Wade Watson. The referral areas for allergy services at the Children=s Hospital includes not only Manitoba but also Alberta, Saskatchewan, northwest Ontario, and the Keewatin District, Nunavut. Teaching Activities Section members are involved in teaching undergraduate medical students about the scientific basis of the diagnosis and treatment of allergic disorders. In addition, they provide western Canada=s only Royal College of Physicians-approved Clinical Immunology and Allergy Training Program, currently directed by Dr. Allan Becker. They participate regularly in Academic Half-Day, Grand Rounds, and other educational activities in the Department of Pediatrics & Child Health. They contribute to the continuing medical education (CME) of physicians in the province of Manitoba through the Royal College of Physicians and Surgeons Maintenance of Competence (MOCOMP) presentations and other presentations, and they contribute to allergy CME nationally and internationally. They are also involved in teaching allied health personnel, including nurses and pharmacists, about allergic disorders. Some Section members are involved in the Canadian Institutes of Health Research National Training Program in Allergy and Asthma based at the University of Manitoba, which is chaired by Dr. Kent HayGlass. Several Section members supervise basic research being performed by postdoctoral students and by PhD and MSc students. Section members also serve as a community resource for professionals such as teachers, childcare workers and families who seek information and education about allergic disorders. Under the auspices of the Asthma Education Program directed by Dr. Wade Watson, more than 500 families of pre-schoolers, school-age children, and teens received one-on-one or small group teaching sessions about asthma, and public information sessions were held. The number of teaching hours per Section member varied with his/her job description; however, of note, a few Section members logged over 500 hours each, exclusive of preparation time. Research Activities The Section is internationally renowned for Allergy and Clinical Immunology research. In 2002-2004, research projects included studies of: mediators of the allergic response and their physiologic and pharmacologic antagonists, cytokines and chemokines, anaphylaxis, asthma, asthma prevention, mosquito allergy, and long-term down-regulation of the allergic response, including allergen immunotherapy. In addition to ongoing research collaborations with colleagues in the Faculty of Medicine (Department of Immunology, Department of Community Health Sciences, and Department of Internal Medicine) and in the Faculty of Pharmacy at the University of Manitoba, some Section members have active collaborations with colleagues at the University of British Columbia and the University of Toronto.
  • 7. -7- Research Funding Dr. A. Becker, A. Sandford (principal investigator), J. Manfreda, P. Pare, M. Yeung Canadian Institutes of Health Research Genetics of asthma 2002-2003: $67,000 Dr. A. Becker, M. Chan-Yeung (principal investigator), A. Ferguson, J. Manfreda, P. Pare, H. Ward Canadian Institutes of Health Research A follow-up study of a high risk birth cohort following a randomized controlled intervention study on the primary prevention of asthma 2002-2003: $95,581 Dr. A. Becker, Dr. A. Kozyrskyj (principal investigator), Dr. P. Ernst Canadian Institutes of Health Research Antibiotics and asthma 2002-2004: $70,000 per year Dr. A. Becker, P. Pare, J. Frohlich, J. Hill, A. Sandford, et al. Canadian Institutes of Health Research Inflammatory gene haplotypes and susceptibility to cardiac, vascular and pulmonary disease 2002-2007: $545,201 per year Dr. A. Becker, Dr. K. HayGlass, Dr. A. Kozyrskyj, Dr. M. Moffatt, Dr. P. Pare, Dr. A. Sandford Canadian Institutes of Health Research: New Emerging Team Program Origins of asthma in childhood: the role of gene:environment interactions (The SAGE project: Study of Asthma Genes and the Environment) 2002-2007: $246,600 per year Dr. A. Becker, Dr. K. HayGlass (principal investigator), A. Halayko, Dr. A. Kozyrskyj, A. Marshall, Dr. F.E.R. Simons, X. Yang Canadian Institutes of Health Research, National Training Program in Allergy & Asthma Allergy and Asthma: from molecular regulation to population health 2002-2008: $300,000 per year Dr. S. Mink, Dr. F.E.R. Simons, Dr. A.B. Becker, Dr. K.J. Simons Children=s Hospital Foundation of Manitoba, Inc. The pharmacodynamics and pharmacokinetics of epinephrine in the treatment of experimental anaphylactic shock 2002-2003: $43,735
  • 8. -8- Dr. F.E.R. Simons, Dr. K.T. HayGlass Dynavax Technologies Corporation Safety, tolerability, and immunogenicity of subcutaneously injected Amb a 1 immunostimulatory oligodeoxyribonucleotide conjugates in ragweed-allergic adults 2002-2003: $126,000 Dr. W.T.A. Watson, Dr. A.B. Becker, Dr. F.E.R. Simons Manitoba Health Children=s Asthma Education Project for Manitoba 2002-2003: $200,000 Dr. K. HayGlass, Dr. F.E.R. Simons Canadian Institutes of Health Research Chemokines in immune regulation of human allergic disease 2002-2003: $102,795 Dr. F.E.R. Simons Merck Frosst Canada, Inc. Clinical pharmacology of montelukast in adults with asthma 2002-2003: $50,000 Dr. A.B. Becker, Dr. F.E.R. Simons, Dr. W.T.A.. Watson AstraZeneca Pharma, Inc. The SMART trial: a multicentre study of Symbicort 2002-2003: $50,000 Dr. X. Gu, Dr. F.E.R. Simons, Dr. K.J. Simons Abrika Corporation Reformulation of the new H1-antihistamine acrivastine 2002-2003: $30,000 Dr. F.E.R. Simons UCB Pharma Clinical pharmacology of levocetirizine in children 2002-2003: $120,000 Dr. K.T. HayGlass, Dr. F.E.R. Simons Canadian Institutes of Health Research Chemokines in immune regulation of human allergic disease 2003-2004 - $133,000 Dr. K. HayGlass Canadian Institutes of Health Research Canada Research Chair in Immune Regulation 2002-2003: $200,000 Dr. K. HayGlass Canadian Institutes of Health Research Modulation of cytokine and IgE production in vivo (mouse) 2002-2003: $161,611 Dr. K. HayGlass Canadian Institutes of Health Research/Manitoba Health Research Council Cytokine mediated regulation of human immediate hypersensitivity
  • 9. -9- 2002-2003: $97,712 Dr. K. HayGlass Canadian Institutes of Health Research Characterization of immune mechanisms of resistance to HIV-1 infection 2002-2003: $115,875 Dr. Z. Peng, Dr. K. HayGlass Manitoba Institute for Child Health Development of novel IL-4 and IL-13 peptide based vaccines for the prevention and treatment of allergic diseases 2002-2003: $10,000 Dr. K. HayGlass Medical Research Council/Canadian Institutes of Health Research Multi-user equipment and maintenance grants (multiple co-authors) 2002-2003: $58,249 Dr. J. Gartner, Dr. K. HayGlass Manitoba Institute for Child Health Immunoregulation of graft-vs-host disease 2002-2003: $40,000 Dr. K. HayGlass Manitoba Institute for Child Health Equipment for measurement of pulmonary hypersensitivity in mice 2002-2003: $60,000 Dr. J. Rempel, Dr. K. HayGlass, Dr. J. Gartner An Opportunity for New Researchers in Aboriginal Health - Institute of Aboriginal People=s Health Contribution of natural killer cells in enhanced ability of Aboriginals to resolve Hepatitis C virus infection 2002-2003: $62,130 Dr. Z. Peng Sick Children=s Hospital Foundation (Toronto) IL-4 and IL-13 cytokine vaccines 2002-2003: $65,000 Dr. Z. Peng Children=s Hospital Foundation Equipment 2002-2003: $13,000
  • 10. PUBLICATIONS IN PEER-REVIEWED JOURNALS (excluding abstracts) Abramowicz M, Zuccotti G, Rizack MA, Goodstein D, Faucard A, Wong S, Hansten PD, Steigbigel NH, Beaver WT, Hirsch J, Kenney JD, Levy G, Mandell GL, Meinertz H, Roden DM, Simons FER. Drugs for asthma. Treatment Guidelines from The Medical Letter 2002;1:7-12. Abramowicz M, Zuccotti G, Rizack MA, Goodstein D, Faucard A, Wong S, Hansten PD, Hirsch J, Kenney JD, Mandell GL, Meinertz H, Roden DM, Simons FER, Steigbigel NH. Drugs for allergic disorders. Treatment Guidelines from The Medical Letter 2003;1:93-100. Ball TB, Plummer FA, HayGlass KT. Improved mRNA quantitation in LightCycler RT-PCR. Int Arch Allergy Immunol 2003;130:82-86. Becker AB, Watson WTA, Ferguson S, Dimich-Ward H, Chan-Yeung M. The Canadian Asthma Primary Prevention Study: Outcomes at 2 Years of Age. J Allergy Clin Immunol 2004;113:650-656 (Editor’s Choice). Birmingham N, Payankaulam S, Thanesvorakul S, Stefura B, HayGlass K, Gangur V. An ELISA- based method for measurement of food-specific IgE antibody in mouse serum: an alternative to the passive cutaneous anaphylaxis assay. J Immunol Methods 2003;275:89-98. Boulet LP, Phillips R, O’Byrne P, Becker A. Evaluation of asthma control by physicians and patients: Comparison with current guidelines. Can Respir J 2002;9:417-423. Bousquet J, Van Cauwenberge P, Bachert C, Canonica GW, Demoly P, Durham SR, Fokkens W, Lockey R, Meltzer EO, Mullol J, Naclerio RM, Price D, Simons FER, Vignola AM, Warner JO. Requirements for medications commonly used in the treatment of allergic rhinitis. Allergy 2003;58:192-197. Bousquet J, van Cauwenberge P, Khaltaev N, et al, including Simons FER (in collaboration with the World Health Organization). ARIA in the pharmacy: management of allergic rhinitis symptoms in the pharmacy. Allergy 2004;59:373-387. Campbell JD, Stinson MJ, Simons FER, HayGlass KT. Systemic chemokine and chemokine responses are divergent in allergic versus non-allergic humans. Int Immunol 2002;14:1255-1262. Campbell JD, Gangur V, Simons FER, HayGlass KT. Allergic humans are hypo-responsive to a CXCR3 ligand-mediated Th1 immunity-promoting loop. FASEB J 2004;18:329-331.
  • 11. Casale TB, Blaiss MS, Gelfand E, Gilmore T, Harvey PD, Hindmarch I, Simons FER, Spangler DL, Szefler SJ, Terndrup TE, Waldman SA, Weiler J, Wong DF (The Antihistamine Impairment Roundtable): First do no harm: managing antihistamine impairment in patients with allergic rhinitis. J Allergy Clin Immunol 2003;111:S835-S842. Diepgen TL, on behalf of the ETAC Study Group (including Simons FER). Long-term treatment with cetirizine of infants with atopic dermatitis: a multi-country, double-blind, randomised, placebo-controlled trial over 18 months. Pediatr Allergy Immunol 2002;13:278-86. Elzainy AAW, Gu X, Simons ER, Simons KJ. Hydroxyzine from topical phospholipid liposomal formulations: evaluation of peripheral antihistaminic activity and systemic absorption in a rabbit model. AAPS Pharm Sci 2003:5: Article 28. Emberley ED, Gietz RD, Campbell JD, HayGlass KT, Murphy LC, Watson PH. RanBPM interacts with psoriasin in vitro and their expression correlates with specific clinical features in vivo in breast cancer. BMC Cancer 2002;2:28. FitzGerald JM, Sears MR, Boulet LP, Becker AB, McIvor AR, Ernst P, Smiljanic-Georgijev NM, Lee JSM. Adjustable maintenance dosing with budesonide/formoterol reduces asthma exacerbations compared with traditional fixed dosing: a 5-month multicenter Canadian study. Can Resp J 2003;8:427-434. Gauvreau GM, Becker AB, Boulet LP, Chakir J, Fick RB, Greene WL, Killian KJ, Cockcroft DW. The effects of an anti-CD11a mAb, efalizumab, on allergen-induced airway responses and airway inflammation in subjects with atopic asthma. J Allergy Clin Immunol 2003;112:331-338. Gu X, Simons KJ, Simons FER. Is epinephrine administration by sublingual tablet feasible for the first-aid treatment of anaphylaxis? A proof-of-concept study. Biopharm Drug Dispos 2002;23:213-216. He JQ, Ruan J, Chan-Yeung M, Becker AB, Dimich-Ward H, Watson WT, Sandford AJ, Pare P. Polymorphisms of the GM-CSF genes and the development of atopic diseases in at-risk children. Chest 2003;123:438-444. He, JQ, Chan-Yeung, M, Becker A, Dimich-Ward, H, Ferguson AC, Manfreda J, Watson WTA, Sandford A. Genetic Variants of the IL13 and IL4 Genes and Atopic Disease in At-Rick Children. Genes Immunity 2003;4:385-389. Holgate ST, Canonica GW, Simons FER, Taglialatela M, Tharp M, Timmerman H, Yanai K. Consensus group on new-generation antihistamines (CONGA): present status and recommendations. Clin Exp Allergy 2003;33:1305-1324.
  • 12. Hsiao CC, Su WN, Forooghian F, Bader S, Rempel J, HayGlass KT, Gilman A, Schultz KR. Evaluation for synergistic suppression of T cell responses to minor histocompatibility antigens by chloroquine in combination with tacrolimus and a rapamycin derivative, SDZ-RAD. Bone Marrow Transplant 2002;30:905-913. Keahey L, Bulloch B, Becker AB, Pollack CV Jr, Clark S. Initial oxygen saturation as a predictor of admission in children presenting to the emergency department with acute asthma. Ann Emerg Med 2002;40:300-307 Kozyrskyj A, Mustard CA, Simons FER. Development of a drug treatment-based severity measure in childhood asthma. J Asthma 2002;39:421-428. Kozyrskyj AL, Mustard CA, Becker AB. Childhood wheezing syndromes and healthcare data. Pediatr Pulmonol. 2003;36:131-136. Kozyrskyj AL, Mustard CA, Becker AB. Identifying children with persistent asthma from health care administrative records. Can Respir J 2004;2:141-145. Kozyrskyj A, Mustard C, Simons FER. Inhaled corticosteroids in childhood asthma: Income differences in use. Pediatr Pulmonol 2003;36:241-7. Lemiere, C., Becker, A., Boulet, L., Bowie, D., Cartier, A., Cockroft, D., Cowie, R., Ernst P., Fitzgerald, M., Sears, M., Spier, S. Should combination therapy with inhaled corticosteroids and long-acting beta-2 agonists be prescribed as initial maintenance treatment for asthma. Can Med Assoc J 2002;167:1008-1009 Lewkowich IP, HayGlass KT. Endogenous IFN-γ and IL-18 directly limit the induction of type 2 immunity in vivo. Eur J Immunol 2002;32:3536-3545. Marshall AJ, Du Q, Draves KE, Shikishima Y, HayGlass KT. FDC-SP, a novel secreted protein expressed by follicular dendritic cells. J Immunol 2002;169:2381-2389. Peng Z, Rasic N, Liu Y, Simons FER. Mosquito saliva-specific IgE and IgG antibodies in 1059 blood donors. J Allergy Clin Immunol 2002;110:816-817. Peng Z, Simons FER. Mosquito allergy: immune mechanisms and recombinant salivary allergens. Int Arch Allergy Immunol 2004;133:198-209. Simons FER. Comparative pharmacology of H1-antihistamines: clinical relevance. Am J Med 2002;113 (Suppl. 8):38-46. Simons FER. What’s in a name? The allergic rhinitis-asthma connection. Clin Exp All Rev 2003;3:9-17. Simons FER, Peterson S, Black CD. Epinephrine dispensing patterns for an out-of-hospital population: a novel approach to studying the epidemiology of anaphylaxis. J Allergy Clin Immunol 2002;110:647-651 (Editor’s Choice).
  • 13. Simons FER, Prenner BM, Finn A, Jr, for the Desloratadine Study Group. Efficacy and safety of desloratadine in the treatment of perennial allergic rhinitis. J Allergy Clin Immunol 2003;111:617-622 (Editor’s Choice). Simons FER, Semus MJ, Goritz SS, Simons KJ. H1-antihistaminic activity of cetirizine and fexofenadine in allergic children. Pediatr Allergy Immunol 2003;14:207-211. Simons FER, Silas P, Portnoy JM, Catuogno J, Chapman D, Olufade AO. Safety of cetirizine in infants 6 to 11 months of age: a randomized, double-blind, placebo-controlled trial. J Allergy Clin Immunol 2003;111:1244-1248. Simons FER, Silver NA, Gu X, Simons KJ. Clinical pharmacology of H 1-antihistamines in the skin. J Allergy Clin Immunol 2002;110:777-783 (Editor’s Choice). Simons FER. Peanut allergy: recent advances. Ped Res 2003;54:291-292. Simons FER. First-aid treatment of anaphylaxis to food: focus on epinephrine. J Allergy Clin Immunol 2004:113: 837-844. Simons FER. H1-antihistamines: more relevant than ever in the treatment of allergic disorders. J Allergy Clin Immunol 2003;112:S42-52. Simons FER. Moving forward in pediatric allergy & immunology (editorial). Pediatr Allergy Immunology 2003:14:243-245. Simons FER, Chad ZH, Gold M. Anaphylaxis in children: real-time reporting from a national network. Allergy Clin Immunol Int: J World Allergy Org 2004;Suppl. 1:242-244. Simons FER, Kaliner MA. World Allergy Organization (editorial). Allergy Clin Immunol Int - J World Allergy Org 2003;15:193-194. Simons FER, Shikishima Y, van Nest G, Eiden J, HayGlass KT. Selective immune redirection in ragweed-allergic humans using Amb a 1 linked to immunostimulatory DNA. J Allergy Clin Immunol 2004;113:1144-1151 (Editor’s Choice). Skowronski DM, Lu H, Warrington R, Hegele RG, De Serres G, HayGlass K, Stark D, White R, Macnabb J, Li Y, Manson HE, Brunham RC. Does antigen-specific cytokine response correlate with the experience of oculorespiratory syndrome after influenza vaccine? J Infect Dis 2003;187:495-499. Stevenson J, on behalf of the ETAC Study Group (including Simons FER). Long-term evaluation of the impact of the H1-receptor antagonist cetirizine on the behaviour, cognitive and psychomotor development of very young children with atopic dermatitis. Pediatr Res 2002;52:251-257.
  • 14. Stevenson J, on behalf of the ETAC Study Group (including Simons FER). Relationship between behaviour and asthma in children with atopic dermatitis. Psychosom Med 2003;65:971-975. Sun D, Cheng L, Mao X, Wang H, Simons FER, Peng Z. Immune responses to long-term exposure to mosquito bites in a mouse model: IgE and IgG subclass responses, cytokine production, and skin reactivity. Can J Allergy Clin Immunol 2002;7:34-40. Wahn U, Meltzer EO, Finn AF Jr, Kowalski ML, Decosta P, Hedlin G, Scheinmann P, Bachert C, Rosado Pinto JE, Baena-Cagnani C, Potter P, Simons FER, Ruuth E. Fexofenadine is efficacious and safe in children aged 6-11 years with seasonal allergic rhinitis. J Allergy Clin Immunol 2003;111:763-769. BOOKS AND BOOK CHAPTERS Abramowicz M, Zuccotti G, Rizack MA, Goodstein D, Faucard A, Hansten PD, Steigbigel NH, Beaver WT, Hirsch J, Kenney JD, Levy G, Mandell GL, Meinertz H, Roden DM, Simons FER. The Medical Letter, The Medical Letter, Inc., New Rochelle, NY, 2003;44:1-110. Abramowicz M, Zuccotti G, Rizack MA, Goodstein D, Faucard A, Wong S, Hansten PD, Hirsch J, Kenney JD, Mandell GL, Meinertz H, Roden DM, Simons FER, Steigbigel NH (editors). The Medical Letter, The Medical Letter, Inc., New Rochelle, NY, 2004;45:1-104. Adkinson NF Jr, Yunginger JW, Busse WW, Bochner BS, Holgate ST, Simons FER (editors): Middleton’s Allergy: Principles and Practice, Sixth Edition (Volumes I and II), Mosby Inc. (an affiliate of Elsevier Science), St. Louis, MO, 2003:1-1761. Becker AB, Lacy P, Moqbel R. Eosinophilic leukocytes In: Wintrobe’s Clinical Hematology, 11th edition. In: Lee GR, Foerster J, Greer J, Lukens J, Rodgers G, Paraskevas F (editors), Williams and Wilkins, Baltimore, MD, 2003, chapter 11. Simons FER (editor). Histamine and H1-Antihistamines in Allergic Disease, 2nd edition, Marcel Dekker, Inc., New York, NY, 2002:i-xxiv,1-481. Simons FER. H1-antihistamines in children. In Simons FER (editor): Histamine and H1- Antihistamines in Allergic Disease, 2nd edition, Marcel Dekker, Inc., New York, NY; 2002:437-464. Simons FER, Simons KJ. Clinical pharmacology of H1-antihistamines. In Simons FER (editor): Histamine and H1-Antihistamines in Allergic Disease, 2nd edition, Marcel Dekker, Inc., New York, NY; 2002:141-178.
  • 15. Simons FER. Antihistamines. In: Adkinson NF Jr, Yunginger JW, Busse WW, Bochner BS, Holgate ST, Simons FER (editors): Middleton’s Allergy: Principles and Practice, Sixth Edition, Mosby Inc. (an affiliate of Elsevier Science), St. Louis, MO, 2003:834-869. Simons FER. Epinephrine (adrenaline) in the first-aid, out-of-hospital treatment of anaphylaxis. In Galli S (editor): Anaphylaxis, Wiley, Chichester, UK, 2004:228-243. Simons FER. Urticaria: principles of antihistamine treatment. In Greaves MW, Kaplan AP (editors): Urticaria and Angioedema. Marcel Dekker, Inc., New York, NY, 2004:369-392. Simons FER, Peng Z. Mosquito allergy. In Levine MI, Lockey RF (editors): Monograph on Insect Allergy. American Academy of Allergy, Asthma and Immunology, Milwaukee, Wisconsin, 2003: 175-203. Welch MJ, Meltzer EO, Simons FER. H1-antihistamines and the central nervous system. In Simons FER (editor): Histamine and H1-Antihistamines in Allergic Disease, 2nd edition, Marcel Dekker, Inc., New York, NY; 2002:337-388.
  • 16. HONOURS/AWARDS Dr. June James Commemorative Medal for the Queen’s Golden Jubilee Order of Manitoba Dr. Estelle Simons Commemorative Medal for the Queen’s Golden Jubilee American Academy of Allergy, Asthma, and Immunology Leadership Award Robyn Allen Achievement Award (Anaphylaxis Canada) Alexandra and Joshua Larman Medal, Department of Pediatrics, University of Indiana/James Whitcomb Riley Children’s Foundation Dr. Wade Watson Nominated for Outstanding Teacher Award, Med I, Faculty of Medicine, University of Manitoba
  • 17. AMBULATORY CARE MEDICAL STAFF L. Maureen Collison, M.D., FRCPC (Head) Leigh Fraser-Roberts, M.D., FRCPC (B.Sc.) Elske Hildes-Ripstein, M.D., FRCPC (M.Sc.) Susan Collison, M.D., FRCPC Sally Longstaffe, M.D., FRCPC (Head, Child Development Clinic) Margo Lane, M.D., FRCPC William DeGroot, M.D., FRCPC Michael Moffatt, M.D., FRCPC (M.Sc.) Brian Postl, M.D., FRCPC (Pediatrics), FRCP (Community Medicine), CEO, WRHA Merilee Zetaruk, M.D, FRCPC Debbie Lindsay, M.D., FRCPC Jim Strong, M.D., FRCPC Jeff Hyman, M.D., FRCPC The Section of Pediatric Ambulatory Care provides medical care to an outpatient and inpatient group of pediatric patients. The program provides general medical care particularly to the city’s core area through the general Medical Clinic, provides Northern Referral Clinics for complex northern medical patients, focused Neonatal Clinics, Encopresis and Enuresis Clinics, Urinary Tract Clinics, Adolescent Clinics, school-age behavioral and developmental clinics (Satellite), and eating disorders clinics. The Ambulatory Section also includes the Thompson group of general pediatricians (please see Burntwood Region Report) and the Sports/Medicine pediatric specialist. Members of the Section provide ongoing consultation services on an inpatient basis. Annually, the Clinic has approximately 12,250 outpatient visits and 1,500 admissions to hospital. Many of the general pediatricians also have identified northern pediatric consultation bases, i.e. Island Lake, Northwestern Ontario, Hodgson, Winkler, etc. Adolescent specialist, Dr. M. Lane, acts as the ongoing liaison with the Adolescent Psychiatry Team. In addition to general adolescent clinics, Dr. Lane is also the medical specialist for the Adolescent Eating Disorders Program. TEACHING ACTIVITIES The General Pediatric Ambulatory Care Section is actively involved in the education of residents and medical students, both on the inpatient and outpatient services. Dr. Bill DeGroot is the Director of General Pediatrics for the inpatient program. He is actively involved in the co-ordination of scheduling and teaching activities for the inpatient program. Pediatric residents rotate through both Sections of General Pediatric Medicine and Adolescent Medicine. Trainees also attend the more focused clinical programs, e.g. Enuresis and Encopresis Clinics and UTI clinics. Dr. Elske Hildes-Ripstein also participates in Critical Appraisal with the residents as a formalized part of their academic training. Dr. L. Fraser-Roberts is currently Associate Dean of Student Affairs and Assessment Director of Pediatric Undergraduate Education. All members of the Section provide ongoing clinical and didactic teaching to all levels of medical training from Med ! to Med IV, as well as participating in education sessions for in-training of Family Medical Residents. Dr. Maureen Collison, in addition to her clinical activities and Section Head 17
  • 18. activities, also co-ordinates the Continuing Medical Education for the members of the Department of Pediatrics & Child Health. Dr. Susan Collison, in addition to her general pediatric clinics, is developing a special interest in Attachment Disorders and older children with FAS in collaboration with the Child Development Clinic. Dr. S. Longstaffe, as Section Head of Child Development, liases with general pediatrics but has many specific areas of interest in Child Development. Dr. D. Lindsay, in addition to her Satellite Clinic, is a Child Protection expert. Dr. Jeff Hyman is currently enrolled in a Fellowship in Sports Medicine. Dr. J. Strong, in addition to his general pediatric clinic duties, is in a post-doctoral fellowship in Zoonotic Diseases and Pathogens. PROGRAM DEVELOPMENT December 2003 –“Baby Books” early literacy pilot ongoing in Neonatal Clinic. Evaluation in place and ongoing through next year. PUBLICATIONS Condello AS, Hancock BJ, Hoppensack M, Tenenbein M, Steward TC, Kirwin D, WilliamsonJ, Findlay C, Moffatt M, Wiseman N, Postuma R. Pediatric Trauma Registries: The Foundation of Quality Care. J Pediatrics Surg. 2001; 36:685-689 Ellen JM, Lane MA, McCright – Are adolescents being screened for sexually transmitted diseases? West J Med 2000 Aug:173(2):109-113 Kozyrskyj AL, Hildes-Ripstein GE, Longstaffe SE, Wincott JL, Sitar DS, Klassen TP, Moffatt MEM – Short Course Antibiotics for acute otitis media – Cochrane Database Syst. Rev.2000;2:CD001095 Nelson EA, Taylor BJ, Jenik A, Vance J, Walmsley K, Pollard K, Freemantle M, Ewing D, Einspieler C, Engele H, Ritter P, Hildes-Ripstein GE, Aracibia M, Ji X, Li H, Bedard C, Helweg-Larson K, Sidenius K, Karlqvist S, Poets C, Barko E, Kiberd B, McDonnell M, Donzelli G, Piumelli R, Landini L, Giustardi A, Nishida H, Fukui S, Sawaguchi T, Ino M, Horiuchi T, Oguchi K, Williams S, Perk Y, Tjappin D, Milerad J, Wennborg M, Aryayev N, Nepomyashchaya V. International Child Care Practices Study: Infant sleeping environment. Early Hum Dev. 2001 Apr:62(1):43-55 Psychosocial Pediatrics Committee, CPC (DRs. S. Longstaffe & D. Moddemann, Members). Role of the physician in smoking prevention. Pediatrics & Child Health 2001:6(1):89-95 Psychosocial Pediatrics Committee, CPS. The child with multiple impairments. Pediatrics & Child Health 2000: 5:297-402 Zetaruk MN. The young gymnast. Clin Sports Med 2000 Oct; 19(4):757-800. Review. 18
  • 19. BLOOD GROUP SEROLOGY Report of the Section of Blood Group Serology The ongoing research program of the Rh Laboratory focuses on the study of Human blood groups. Our investigations cover most aspects of the subject including serological definition and distinction, mode of inheritance, expression, chromosomal localization of the controlling genes and molecular characterization of specific antigens. Our research efforts have been enhanced by the unique resources at our disposal. As a local, national and international reference centre for the resolution of blood group incompatibility problems (fetal-maternal in cases of Hemolytic Disease of the newborn); donor-recipient in instances of potential transfusion reactions) we have accumulated an unparalleled collection of red cells and definitive antibodies that facilitate our research studies. During the past year The Canadian Blood Service (CBS) referred to us the serum of a multiply-transfused patient who had a high titre antibody to a low-incidence red cell antigen. We identified this as anti-Radin. Since the Radin antigen is of relatively low frequency in the general population, this particular antibody is unlikely to cause transfusion difficulties, i.e. it would be picked up on the cross-match, and a Radin negative donor would not be difficult to find. A second sample, again referred from CBS, was from a prenatal patient with a strong antibody to a high incidence antigen. We identified the antibody as anti-LWa. After phenotyping the patient’s family, a compatible donor (brother) was identified. Unfortunately, he was unable to donate blood, so we contacted Dr. Petri Sistonen at the Finnish Red Cross (where the incidence of LW a negative donors is the highest in the world) and arranged shipment of compatible blood. The blood was available for transfusion to either Mom or baby. Cases as described above and other unusual cases that have been referred to us lead to other investigations on the chromosomal localization of blood group genes and the molecular analysis of genes controlling blood group expression. Over the last year we have completed molecular/genetic investigations that place the low-incidence red cell antigen, LOCR, an antigen we discovered, in the Rh Blood Group System. Further we have also completed studies on the RAPH Blood Group system, confirming that the gene controlling RAPH blood group expression is located on chromosome 11p. Finally, we also have completed our investigations of a new low-incidence antigen called Reiter. We have also been involved in the mutational analysis of SLC4A1, the gene coding for the major red cell protein, band 3. We have established the molecular basis of 9 of 21 antigens carried on band 3. During the course of these investigations we have been able to define the immunological relationships between antigens from different regions of band 3 that result in the production of clinically significant (causing Hemolytic Disease of the Newborn or transfusion reactions) antibodies. Finally, we have been actively involved in The Centre for the Investigation of Genetic Disease. As experienced gene mapping specialists and linkage analysts we have been working to establish the chromosomal location of the gene causing Bowen Conradi Syndrome (a CIHR funded project), a lethal autosomal recessive disorder commonly found in the prairie Hutterite community. Although Bowen Conradi Syndrome is the Centre’s pilot project, we are also designing studies to locate the causative genes for other well-defined diseases (such as Severe Combined Immunodeficiency, Familial Dystonia, Larson’s Disease, Chudley-McCullough Syndrome and Robert’s Disease) that segregate in Manitoba families. The ultimate goal of the Centre is to integrate clinical 19
  • 20. and basic science research, in an attempt to reduce morbidity and mortality in children with genetic diseases. Publications Daniels GL, Cartron J-P, Fletcher A,Garratty G, Henry S, Jρrgensen J, Judd WJ, Levene C, Lin M, Lomas-Francis C, Moulds JJ, Moulds JM, Moulds M, Overbeeke M, Reid M, Rouger P, Scott M, Sistonen P, Smart E, Tani Y, Wendel S Zelinski, T. International Society of Blood Transfusion Committee on Terminology for Red Cell Surface Antigens - Vancouver Report. Vox Sang 2003;84:244-247 Coghlan G, Zelinski T. DNA microsatellite and linkage analysis supports the inclusion of LOCR in the Rh blood group system. Transfusion 2003;43:440-444 20
  • 21. Burntwood Region Program (Thompson) University of Manitoba Medical Staff Leigh Wincott BSc(H), MD, FRCPC (Head) Desmond Shulman MB, BC (Wits), FCP(Paed)S.A. Anne Nwebube MBBS, MhRCP Brenda Dawyduk RN MSc FNP-C The Burntwood Region Pediatric Program has progressively expanded. The program has provided a continuous 24-hour on call service for the regional hospital in Thompson and telephone consultation for the 27 other communities in the Region for almost ten years without a single gap in service. It works on a flexible consultation model. The Burntwood Region is the northern 52% of the landmass of Manitoba and contains many remote predominantly First Nation communities. Almost 50% of the 45,000 inhabitants are children. The outpatient clinic sees a wide variety of pediatric problems including acute and chronic illnesses, physical and developmental disabilities, behavioural and psychiatric issues. A specific clinic for Autism Spectrum Disorder has been developed and follows 30 children. The clinic in the Thompson high school reaches this often under serviced population. The Pediatricians provided 76 consultation clinics in the smaller communities of the Burntwood Region last year. Telehealth is also being used to provide care for children where this technology is available. Thirty-five percent of the 3500 clinic visits were first time consultations. Inpatient care excluding PICU care is also provided in Thompson. Neonatology services are provided for high-risk deliveries. A level 2 nursery provides care for premature and other newborns requiring additional monitoring or care. Children’s Hospital NICU provides support through video conferencing and nurse exchanges. Dr. Nwebube, a Neonatalogist runs the northern portion of the provincial High Risk Neonatal Follow-up. 79 children are currently followed in this program. The Fetal Alcohol Support Team (FAST) is a multi-displinary team that provides diagnostic and support services to in-utero alcohol and drug-exposed children and their families. They have also partnered with the Awasis Agency of Northern Manitoba (First Nation Child and Family Services) to use a community development approach in addition to the child and family based model. A third community with its own independent services is also working closely with FAST to provide services within the community. The program currently follows 475 children with the number growing weekly. 21
  • 22. The section participates in many community programs including the child abuse committee (Family Services), breastfeeding committee, healthy child initiative, and community school program. They also participate fully on Regional Health Authority committees including Child Health, Perinatal, Midwifery, Medical Advisory committees, and Regional Accreditation. Teaching Activities The Burntwood Region program is a regular rotation for pediatric residents and medical students in their clerkship pediatric rotation. International Medical Graduates chose to do a month of their Pediatric rotation in the Burntwood Program. The program also routinely has Family Practice residents, medical students and nurse practitioner students who come for an elective experience. Continuing Medical Education is also provided for the Family Physicians and other health care providers in the region through both formal and informal sessions. The Neonatal Resuscitation Program (NRP) and Pediatric Advanced Life Support (PALS) are provided on a regular basis. The Burntwood Program is funded for 3 full time positions. It is currently short one position because Dr. Wincott devotes one half his time to the Vice President Medical Position and Dr. Nwebube is working part time. The program is looking for a pediatrician comfortable with a large variety of pediatric problems including managing significantly ill children and newborns. There is a particularly need for a pediatrician with strong skills in developmental and behavioural pediatrics. 22
  • 23. CARDIOLOGY Medical Staff: Reeni Soni, MD FRCPC (Section Head, Director Variety Children’s Heart Centre) Abhay Divekar, MD FRCPC (Director Pediatric Cardiac Catheterization Laboratory) Anita Saxena, MDDM FACC (July 2003-June 2004) Summary of Activity: The Section of Pediatric Cardiology provides inpatient (Children’s and St. Boniface Hospitals) and outpatient clinical and diagnostic cardiac services to children from Manitoba, Northwestern Ontario, Nunavut and Eastern Saskatchewan. The section also has a Fetal Cardiology program operated out of VCHC and involvement in the Adult Congenital Program at the General Hospital. The years of 2002-2004 were a period of tremendous growth and expansion of pediatric cardiology services in Manitoba. Recommendations of the Sinclair and Thomas reports on the Cardiac Inquest were incorporated into these rebuilding efforts. Breakdown of Clinical Activity: 2002 2003 2004 Outpatient Visits 2453 3164 3494 Inpatient Consults 482 596 611 Holter Monitors 36 229 233 Echocardiograms 2621 3093 3171 Cardiac Catheterization 92 107 101 Outpatient services: Our clinic underwent a much needed “facelift” in 2004 through the generous support of numerous private donors and Variety Club in an effort to provide our patients with a more modern, inviting environment. Our outpatient services were expanded with the addition of increased technological and echocardiography resources resulting in a 30% increase in outpatient volumes and echocardiography volumes. As a result, our new patient referral waitlist was gradually reduced from 11 months to 6 weeks through aggressive waitlist reduction initiatives. We also added holter/cardiac event monitor capabilities to our clinic eliminating the need for travel to the Adult Cardiology department for these modalities. VCHC participated in a Child Health Quality Team led patient satisfaction survey for our outpatient clinic services with excellent feedback. 3500 3500 3000 3000 2500 2500 2000 2000 1500 1500 1000 1000 500 500 23 0 0 19 9 7 19 9 9 2001 2003 1992 1994 1996 1998 2000 2002 2004
  • 24. Outpatient Volumes Echocardiography Volumes Cardiac Catheterization Services: Huge strides have been made with regards to the provision of pediatric cardiac catheterization services in Winnipeg over the past three years. After demonstration of a consistent track record, approval was received from the WRHA to expand the list of interventional procedures offered locally reducing the need for families to travel out of province. Accordingly, procedures such as pulmonary/aortic valve dilations and aortic coarctation dilations are now performed in our laboratory. This has resulted in an increase in cath lab volume while keeping the waiting list from expanding. These advances have been possible due to close collaboration with Pediatric General Surgery and Adult Cardiovascular Surgery with respect to surgical back-up. The section has also performed a number of interventional catheterization procedures on adult patients with congenital heart disease. We have continued to have a partnership with Dr. Michal Kantoch (University of Alberta) which allows selected pediatric patients to undergo radiofrequency ablation procedures for arrythmias in Winnipeg. 2004 also saw the successful utilization of ECMO (extracorporeal membrane oxygenation) to support a pediatric cardiac patient for the first time since the cessation of the cardiac surgical program in 1995. This resulted in the first pediatric ECMO transport in Canadian history (to Edmonton). Catheterization Volumes 120 100 80 60 40 20 0 1997 1999 2001 2003 Fetal Cardiology: VCHC has been part of an aggressive initiative to increase the quality of fetal cardiac screening across the province. This has resulted in a significant increase in the number of referrals to our fetal program with an increased rate of antenatal cardiac abnormality detection. This has permitted better antenatal counseling, decision making and in utero intervention. We have developed a multidisciplinary approach to fetal care coordination. Out of Province Cardiac Surgical Program: The section continues to send approximately 150 children per year to other centers for cardiac surgery. The majority of these patients travel to Stollery Children’s Hospital Edmonton with selected patients going to Hospital for Sick Children in Toronto, Montreal Children’s Hospital, BC Children’s Hospital in Vancouver and Boston Children’s Hospital. Surgical mortality remains in a very acceptable range relative to North American statistics with much more consistency from year to year. Cardiac Surgical Mortality Rates 24
  • 25. - - - 2 2 2 2 2 < ` „ © Í ñ • • • • • • The out of province family support program has seen further refinement with production of a preparation video for families and further development of the multidisciplinary process. Western Canadian Children’s Heart Network (WCCHN): The last two years has also seen formal approval at Deputy Minister level of the Western Canadian Children’s Heart Network. This is the first Canadian interprovincial medical program that unites pediatric cardiology centers in Vancouver, Edmonton, Calgary, Saskatoon and Winnipeg. Weekly videoconferences are held with all of these centers to discuss surgical patients in addition to weekly teaching rounds. Plans are currently underway to create a common database between all five programs to facilitate exchange of information and research opportunitiesin. Family Centered Care / Family Support: The cardiology program has strived to incorporate the principles of family centered care into its services. Parents are now permitted to remain with their child during cardiac catheterizations which in many cases has lessened the need for deep sedation/anesthesia. The care coordination model has been applied to our fetal and surgical programs and is being used a template for other programs within the hospital. The program now has an official family support network, “Circle of Hearts”, which meets monthly in addition to hosting numerous major events over the last few years. The program also has an official bereavement support group, “Cherished Memories”, which also meets on a regular basis. Our website, www.vchc.ca, continues to expand and is now linked to by numerous children’s hospitals across the world. In 2002, we began to have biannual public forums with our patients to provide them with full access to our program performance, QA initiatives, and program development. Quality Assurance Initiatives: The section has worked in close collaboration with the Child Health Quality Team to ensure a high level of cardiac care. All cardiac catheterization results are forwarded to the multinational Pediatric Cardiac Care Consortium for annual benchmarking. Patient satisfaction surveys have been performed for our outpatient, cardiac catheterization and out or province surgical programs with positive feedback obtained. The section continues to generate a detailed annual surgical mortality report with the help of M. Jugenburg (Child Health Quality Team). 25
  • 26. Transition to Adult Care: Pediatric Cardiology now has formal transition clinics to help prepare adolescent patients for their move to Adult Cardiology. This process involves meeting with the nurse clinicians to review their cardiac course along with the preparation of an “all inclusive” patient binder with all of their relevant past documentation. Teaching: Both section members continued to be involved in didactic teaching of Med I, bedside clinical teaching of Med II/III, didactic teaching of Med IV, and clinical teaching of the Pediatric Residents. We also carried teaching responsibilities for the Adult Cardiology and Cardiac Surgical Fellowship Programs. Teaching commitments also included the departments of Nursing, Medical Rehabilitation, and Respiratory Therapy. Dr. Soni was nominated for Teacher of the Year award by the Med I classes of 2002 and 2003. Grants/Research: Influence of ductal decompression of the pulmonary circuit on vascular myogenic response in hypoxic pulmonary hypertension of the newborn. Dr. Paul H. T. Thorlakson Foundation - University of Manitoba Sonographic Fetal Heart Screening in Manitoba. HSC Innovations and Opportunities Fund – Health Sciences Center Carotid intima media thickness and cardiovascular risk factors in childhood type II Diabetes mellitus - funded by Canadian Diabetes Association Conferences Organized: “Building Bridges To Tomorrow – Growing up with Congenital Heart Disease”, May 14-16, 2004, Canad Inns Polo Park, Winnipeg This was the first family centered conference organized by VCHC and Circle of Hearts with sponsorship by the Children’s Hospital Foundation. It featured two full days of presentations from a multidisciplinary panel of speakers from across Canada and USA with over 250 registrants. There was also a parallel program particularly aimed towards our youth group with 50 participants from 12 to 18 years of age. “Defining Quality in Pediatric Cardiac Care”, October 23, 2004, Alberta Children’s Hospital, Calgary VCHC played a major role in the organization in this conference hosted by the WCCHN aimed at addressing quality assurance in the field of pediatric cardiology and cardiac surgery. Experts from Canada and USA presented various strategies for defining outcomes in addition to a look at valuable lessons learned from the Winnipeg Cardiac Inquest presented by Dr. P. Thomas from the University of Manitoba. 26
  • 27. Invited Lectures: Dr. Divekar: “Intravascular access for the pediatric cardiac catheterizer”– Grand Rounds for Pediatric Cardiology at the Children’s Hospital in Vancouver, British Columbia, Canada - 2003 Hypoplastic left heart syndrome: practical aspects of management – NICU Nursing Rounds Children’s Hospital and St. Boniface Hospital, 2003 “Coarctation of the Aorta”, Adult Cardiac City Wide Rounds, 2003 “Advances in Interventional Cardiology”, Building Bridges to Tomorrow Pediatric Cardiology Conference, Winnipeg, May, 2004 Dr. Soni: “Neonatal Arrythmias”, St. Boniface Neonatology Rounds and Children’s Hospital NICU Rounds, 2002 “Heterotaxy Syndromes”, Genetics Rounds, Children’s Hospital, 2003 “Fetal Supraventricular Tachycardia”, High Risk Obstetrical Rounds, Women’s Hospital, 2003 “Fetal Cardiomyopathy”, High Risk Obstetrical Rounds, Women’s Hospital, 2004 “Papillary Fibroelastoma – An Unusual Case of Childhood Stroke”, Neurosciences Rounds, Winnipeg, 2004 “Advances in Fetal Cardiac Assessment and Treatment Options and Their Implications for Family Support Services”, Keynote speaker, Sonographic Fetal Heart Screening Workshop sponsored by Philips Medical, Winnipeg, 2004 “Pediatric Cardiology in Manitoba – The Past, present, and future”, Building Bridges to Tomorrow Pediatric Cardiology Conference, Winnipeg, 2004 Published Articles: DeSomma M, Divekar A, Galloway AC, Colvin SB, Artman M, Auslender M. Impact of a 27
  • 28. clinical pathway on the postoperative care of children undergoing surgical closure of atrial septal defects. Appl Nurs Res 2002 Nov; 15(4): 243-8 Divekar A, Soni R, Ross D. Rapidly progressive idiopathic dilation of the right atrium in infancy associated with dynamic obstruction of the airways. Cardiol Young 2002; 12: 491-493 Legge LM, Kantoch, MJ, Seshia, SS, Soni R, A pacemaker for asystole in breath- holding spells, Pediatric Child Health 2002; 7:251-254 Li C, Chudley AE, Soni R, Divekar A. Pulmonary atresia with intact ventricular system and major aortopulmonary collaterals: association with deletion 22q11.2; Pediatric Cardiology, Nov- Dec, 2003: 24(6) 585-587 Saxena A and Soni NR, Pulmonary artery calcification in recipient twins of twin to twin transfusion syndrome: a report of three cases, Pediatr Cardiol. 2003 Jan-Feb;24(1):80-3. Divekar A, Coe JY, Saxena A. Tetrology of Fallot, total anomalous pulmonary venous return, and partial anomalous left pulmonary artery a rare association - Pediatric Cardiology (April, 2004) Divekar A, Rebeyka, IM, Soni R. Late onset Candida parapsilosis endocarditis after surviving nosocomial candidemia in an infant with structural heart disease. Pediatr Infect Dis J. 2004 May;23(5):472-5 Divekar A, Cases R, Soni R. Echocardiographic characteristics of venous air embolism presenting as "reversible pulmonary atresia" in a premature neonate. Cardiol Young 2004;14:102-105 Abstracts: Hawkins L, Legge L, Morrison C and Robinson G, Inter-provincial cardiac services – providing family focused care, Cardiology in the Young 11 Supp.1 2001, May 2001 Soni R, Coe JY, Dyck J, Legge L, Hutton S, Garcia T, Aminian S, McCort J, Saurette R, Amplatzer duct occluders effectively eliminate significant residual ductus arteriosus shunt after placement of umbrella devices, Can J Cardiol 17 Supplement 2001 (Canadian Cardiovascular Congress 2001, 54th Annual Meeting, October 2001 Peppelassis D, Divekar A, Dyck JD, Coe JY. Antegrade valvuloplasty of critical infant stenoses using a low profile high pressure balloon catheter. Can J Cardiol 18 Suppl B, 2002 (Canadian Cardiovascular Congress 2002, 55th Annual Meeting, October 2002) VanderPluym Taylor D, Dyck J, Harder J, Soni R, Divekar A, Coe JY. Sequential blood nickel analyses after inplantation of Amplatzer Septal Occluders in Children. Can J Cardiol 18, Suppl B 2002 (Canadian Cardiovascular Congress 2002, 55th Annual Meeting, October 2002) 28
  • 29. J. Rutledge, D. Taylor, D. Pepelassis, J. Dyck, J. Harder, R. Soni, A. Divekar, J. Y. Coe, “Aortic Insufficiency – not a complication of transcatheter ADS and PFO Closure”, Oral Session - Pediatric Cardiology: Arrhythmias and Catheter Intervention 27/10/2003; Canadian Cardiovascular Congress (CCC) 2003 AA Divekar, NR Soni, TL Lavery, JY Coe, Variety Children’s Heart Centre, Winnipeg and Stollery Children’s Hospital, Edmonton, CAN. Pacing lead induced tricuspid stenosis: Echocardiographic characteristics and implications for percutaneous valvuloplasty. Seventh Annual Pediatric Interventional Cardiac Symposium (PICS-VII) and the first-ever Emerging New Technologies In Congenital Heart Surgery (ENTICHS-I) Sep 2003; ORAL and POSTER presentations Brown R, Hawkins L, Hebden P, Knox P, Loeffler M, Legge L, Making the grade -Achieving success in delivering regionalized pediatric cardiac care, Can J Cardiol 19 Supplement 2003 (Canadian Cardiovascular Congress 2003, 56th Annual Meeting, October 2003) JY Coe, J Rutledge, J Dyck, A Divekar, R Soni, J Harder, Outcome of Balloon Valvuloplasty of Severe Stenosis in Neonates and Infants, Canadian Cardiovascular Congress 2004, 57th Annual Meeting, October 2004) JY Coe, J Rutledge, J Dyck, A Divekar, R Soni, G Sandor, Outcome of Pulmonary Atresia Treatment Facilitated by Radiofrequency Perforation, Canadian Cardiovascular Congress 2004, 57th Annual Meeting, October 2004) Future Directions: The section will continue with an active recruiting effort to bring the section up to a full complement of cardiologists with a wide range of areas of interest. The section would like to continue with expansion of cardiac catheterization, fetal and Adult Congenital services. We will strive to keep the waiting list from growing to allow timely access to diagnosis and intervention. We would like to continue with development of our current research interests and embark on new projects including exploration of epidemiology of CHD in Manitoba, hypertrophic cardiomyopathy in the Manitoba Mennonite population. The coming year will also see further development of the Western Canadian Children’s Heart Network with more opportunities for collaboration with other centers. 29
  • 30. CHILD DEVELOPMENT CLINIC Medical Staff Sally Longstaffe – MD, FRCPC (Head) Terry Benoit – MD, FRCPC Nancy Bowman – MD, FRCPC Diane Moddemann – MD, FRCPC Ana Hanlon-Dearman – MD, FRCPC, FAAP Oscar Casiro – MD, FRCPC (Newborn High Risk Follow Up Program) Gina Rempel – MD, FRCPC Clinical Activities The Child Development Section functions within the Department of Pediatrics to provide clinical diagnostic and some short term treatment services to children and families of children with developmental problems. Advocacy for children and collaboration with other services occur both at the Health Sciences Centre and elsewhere. Follow up for the children at high risk of developmental problems from perinatal difficulties occurs through the Newborn Follow-Up Program. The number of Child Development pediatric assessment visits in the last year is 1,136. Number of social work, psychology, outreach assessments etc. are tabulated elsewhere. The Section functions as a multidisciplinary clinic with medical representation as well as nursing, secretarial, social work, psychology, co-ordinator, early child development facilitators and community liaison. Multiple multidisciplinary clinics are conducted including Behavior Clinic, Early School Age Clinic, Autism Clinic, Child Protection Centre Developmental Clinic and Clinic for Alcohol and Drug Exposed Children. Psychiatry Consultation Clinics occur twice weekly with Dr. Jack Perlov or Dr. Leslie Jocelyn in attendance. Children may be seen by a single discipline or when appropriate after discussion in a multidisciplinary intake committee in a specialty clinic. Social Work parent counselling is provided as needed. Psychology consultation and some long term therapy are provided. The Clinic offers consultation to inpatient children. Outreach services are available for children with behavior problems at school or at home. This occurs in collaboration with the Manitoba Child Daycare Office. Regular two-week diagnostic nursery school sessions are held through the year to allow a period of observation for children whose problems are more complex. Regular rural physician outreach clinics are held several times per year in Dauphin, Swan River, The Pas, Flin Flon, Morden and Brandon. Early intervention for children with autism is provided in partnership with Department of Communication Disorders and Autism Outreach Program with “Let’s Get Started”, Let’s Get Talking”, “Let’s Get Playing” and Let’s Get Moving” programs. A close partnership with Children’s Special Services exists with onsite representatives coordinating support and developmental services to families. The Clinic for Drug and Alcohol Exposed Children (CADEC) has on site multidisciplinary clinics twice weekly. It also provides telemedicine diagnostic clinics to remote sites. The Clinic for Alcohol & Drug Exposed Children (CADEC) has been involved in team training 30
  • 31. for diagnostic teams from other geographic areas. Partnerships have occurred with other Manitoba services providing for children with FASD. Pediatric follow up of school age children with developmental problems is provided in the Pediatric Adolescent Satellite Clinic along with staff from the Pediatric Ambulatory Group and the Department of Child and Adolescent Psychiatry. There have been efforts to collaborate closely with the Rehabilitation Centre for Children in provision of services for children with cerebral palsy, spina bifida and feeding problems. Collaboration has been developed as well with Conciliation Services in assisting children who are experiences emotional decompensation during parental separation. Collaboration has also been strengthened with the Learning Disabilities Association of Manitoba. Collaboration with other disciplines in the centre and beyond occurs through the Developmental Disabilities Patient Care Team. Broader collaboration with other agencies and government departments has occurred through the SSCY initiative with a goal of better integration of services for children with developmental disabilities eventually involving a shared site. Teaching Activities The Section participates in Undergraduate Medical Education in the Preclerkship and Clerkship years and in Pediatric Resident training, with each Resident doing one or two rotations through the services during their residency. A pilot project has been started with psychiatry residents doing a rotation in Child Development. Members of the section are also involved in teaching in other programs such as Psychiatry, Clinical Placements in School of Rehabilitation and supervisors for graduate students. Total teaching hours for all Section members: • Undergraduate Medicine Teaching – 815 hrs. • Postgraduate Medicine Teaching – 1,438 hrs. • Graduate Teaching – 7 hrs. • Continuing Medical Education – 89 hrs. Research Activities Dr. S.E. Longstaffe, Dr. A. Chudley MMSF Functional MRI in Children with FAS $39,370 Dr. S.E. Longstaffe, Dr. A. Hanlon-Dearman Co-investigation, Evening Primrose Oil vs. Placebo in Treatment of ADHD (BscMed Project) 31
  • 32. $800.00 Dr. Ana Hanlon-Dearman (Supervisor) Dr. D. Moddemann, Dr. S. E. Longstaffe, Dr. N. Bowman, Dr. T. Benoit Development of an Autism Severity Score for Young CHRF Children Newly Diagnosed with Autism (BSc Med Project) $5,000.00 Dr. D. Moddemann CIHR Site Investigator- Choosing the right outcomes form the evaluation of therapies in preterm infants (TIPP follow up) $3,000.00 Capital Health Authority Site Investigator – Outcome of invasive pediatric therapies $12,000.00 Canadian Institute of Child Health Site Investigator – Caffeine for apnea of prematurity (CAP trial) $120,000.00 Canadian Institute of Child Health Site Investigator – Maternal antenatal corticosteroid study (MACS) $5,000.00 Dr. T. Benoit  Invited Attendee – National Advisory Committee Meeting for Department of National Guidelines for diagnosis of FAS Ottawa July 2003  Invited Speaker – St. Amant Conference re: Diagnosis of FAS Oct. 2003  Platform presentation (BSc Med) “Is there a specific neurodevelopmental profile associated with in utero exposure to solvent abuse? Seattle Washington Dr. A. Hanlon-Dearman – Member – Immigration Medical Advisory Committee (Ottawa) Dr. S. Longstaffe  Literacy Orientation and Language Development Project in partnership with Dr. E. Hildes-Ripstein.  Member, Canadian Fetal Alcohol Syndrome Research Consortium  Member – Autism Spectrum Disorders – Canadian-American Research Consortium – Manitoba Regional Group Publications Burrows K., Longstaffe SE., , Ford-Jones A., Shea, S., Nieman P., Prince T., Bernard- Bonnin A.: The Use of Stimulant Medication in the treatment of Attention Deficit 32
  • 33. Hyperactivity Disorder (Psychosocial Committee, CPS), Paed. Child Health; December 2002: vol 7(10), 693-95. Burrows K., Longstaffe SE., , Ford-Jones A., Shea, S., Nieman P., Prince T., Bernard- Bonnin A.: Alternative Therapies in treating children with attention deficit hyperactivity disorder (Psychosocial Paed. Committee CPS), Paed. Child Health December 2002; vol 7(10)710-718.. Burrows K., Longstaffe SE., , Ford-Jones A., Shea, S., Nieman P., Prince T., Bernard- Bonnin A.: Impact of Media Use on Children and Youth (Psychosocial Paediatrics Committee, Canadian Pediatric Society) Paed. Child Health May/June 2003 Vol 8(5) p. 301.306 Chui A., Debooy V., Granke N. Moddemann D.M., Casiro O. Evaluation of birth weight criteria for screening of retinopathy of prematurity. Canadian Pediatric Society 2003 Schmidt B., Asztalos E., Roberts R., Robertson, C. for the TIPP Investigators. .”Impact of bronchopulmonary dysplasia, brain injury and severe retinopathy of prematurity on the outcome of extremely low birth weight infants at 18 month.” JAMA 2003 Vol. 289: 1124-1129. Schmidt B., Davis P., Moddemann D.M. et al “Long term effects of indomethacin prophylaxis in extremely low birth weight infants”. Yearbook of Obstetrics and Gynecology 2003. Asztalos E., Vincer M., Thorpe K., Moddemann D.M. et al. Motor function in very pre term infants at a corrected age of 18 months: How big is the impact of cerebral palsy? Pediatric Research 2003A Rehan V.K., Moddemann D.M., Casiro O. “Outcome of very low birth weight ( 1500 g) infants born to mothers with diabetes”. Clinical Pediatrics 2002 Vol. 41: 481-491. Schmidt B., Roberts R., Fanasoff A. and the TIPP investigators: Why does indomethacin prophylaxis prevent patent ductus arteriosis (PDA) but not bronchopulmonary dysplasia (BPD) Pediatric Research 2002A Craig WR, Sinclair CJD, Hanlon-Dearman AC, Tayback SP, Moffatt MEK. Metoclopramide, thickened feedings, and positioning for gastroesophageal reflux in children under 2 years (Protocol for a Cochrane Review). In: The Cochrane Library, Issue 1, 2002 Oxford: Update. Hanlon-Dearman, AC. Sleep characteristics of young alcohol affected children; A quantitative and qualitative analysis. University of Manitoba 2003. Hanlon-Dearman A., Benoit T. Prasad C., Prasad A., Miyakawa V. Singal M.: Is there a specific neurodevelopmental profile associated with in utero exposure to solvent abuse? Pediatric Research Vol 53 No. 4 P 535A April 2003 33
  • 34. CHILDREN’S HOSPITAL CHILD PROTECTION CENTRE UNIVERSITY OF MANITOBA REPORT JULY 2002 – JUNE 2003 Medical Staff Charles Ferguson – MD, CM (Head) Debbie Lindsay – MD, FRCPC The Child Protection Centre (CPC) is a multidisciplinary unit, funded primarily by the Minister of Family Services and Housing, but housed within the Health Sciences Centre, as a program within the Department of Pediatrics and Child Health. The primary function of the CPC is to aid in the investigation of suspected child abuse/neglect. The CPC undertakes many programs and activities including clinics, parent-child assessments, ward consultation, education, research and psychological assessments. The CPC holds three weekly clinics. Children are referred where there have been allegations of abuse or where circumstances suggest the possibility of abuse (primarily sexual). Referrals are also seen for second medical opinions. Children are seen by the Child Life Specialist prior to the physician. Parents/guardians are seen by the CPC social workers. For July 2002 to June 2003, the CPC clinic saw 190 patients. Two clinics a week are also held in the Child Development Clinic where referrals are accepted either via the CPC clinic or in situations where a child’s abnormal behaviour/delay may be felt to be related to abuse. For July 2002 to June 2003, the CPC Development clinic saw 91 patients. The CPC also conducts consultations on inpatients at Children’s Hospital where there are concerns about physical, emotional or sexual abuse or the patient has experienced an unwitnessed or incompletely explained injury. For July 2002 to June 2003, 82 patients were seen in consultation. The CPC also accepts referrals for parent-child assessments from Child and Family Services agencies, where information about parents and children and their interrelationships will aid in case planning. Psychological assessments are done at the request of external sources, in addition to assessments done as part of parent-child assessments. Short-term, post disclosure play therapy is offered for children on an as needed basis. Participation in external committees is also part of the CPC’s mandate. These committees include the Provincial Advisory Committee on Child Abuse, Child and Family Services Abuse Committees and the Children’s Inquest Review Committee. The CPC also routinely fills requests from the community for public education materials such as brochures on the prevention of Shaken Baby Syndrome and parenting information on biting, as well as providing information to students (ranging from elementary to university level) on various 34
  • 35. topics as requested. Teaching Activities The CPC is actively involved in education within the hospital but primarily to external organizations. An Education/Research Committee meets bimonthly to screen and assign requests for lectures. Routine teaching sessions are given to RCMP, Winnipeg Police Service, U of M (Faculty of Law, Nursing, Human Ecology, Medicine). For July 2002 to June 2003, physician teaching hours totalled 142 hours. Psychology interns, pediatric residents, summer students, field placement social workers and child life interns all do rotations with the CPC. Submitted by Dr. Debbie Lindsay, Associate Director, Child Protection Centre 35
  • 36. COMMUNITY PEDIATRICS ANNUAL REPORT Child Health Program – Year 2004 Dr. Ruth Grimes- Section Head, Community Pediatricians It was a busy and challenging year for the Section of Community Pediatrics. Community pediatricians continued the long tradition of teaching trainees at all levels and accommodated wonderfully the increase of students this year as a result of the undergraduate curriculum change. Community pediatricians also accommodated pediatric residents in a now community pediatrics rotation. In contrast to the previously bland office experience only rotation, the pediatric residents immersed themselves in the lives of the community based pediatricians. This included rounding with the physicians where ever they had patients, “sticking it out” in the long days of office practice (regardless of finish time) and taking the opportunity to see the community pediatrician as a advocate within the hospital and community by attending committee meetings, agency meetings, and any patient systems meeting that came along the way. Informal feedback from the residents suggest that this was a more meaningful and enjoyable experience. As with all areas of medicine, this Section of Community Pediatrics struggled with the difficulties resulting from decreasing numbers of physicians in the field. In this calendar year, the Section of Community Pediatrics lost 3 well-established community pediatricians from practice. This has considerably increased the workload for those left behind, not to mention adding to an unfortunate growing population of pediatric patients with “no pediatrician”. Other struggles relate to increase wait time for many sub-specialty supports and the community pediatrician playing an increasing role in consultative care in an effort to support the subspecialties. How to reconcile increased demands for providing proper care and consultative care is a major issue. There is a lack of consensus amongst community pediatricians as to how to affect this change. The latter part of 2004 brought the opening of the pediatric Day Unit at Children’s Hospital. This is an excellent opportunity for community pediatricians to provide somewhat more intensive care in an out-patient setting. The ambulatory IV program was established to begin December 1, 2004. The section continues to meet regularly though the group meetings have been decreased from every month to every other month. Admittedly, it is a struggle to get a broad cross sections of pediatric representation at such meetings. This will continue to be an ongoing goal of mine as section head. These meetings continue to be an excellent opportunity for dissemination of information and exchange of ideas. Community pediatricians continue to support the hospital in many capacities beyond the teaching aspects. Community pediatricians are represented not just by the section head but by individuals on various committees that are all involved in improving the quality of care for Manitoba’s children. Such examples include the bronchiolitis working group, the asthma care plan working group, the emergency wait time working group. There has been a consorted effort by the Department of Pediatrics to insure adequate community representation in all aspects of the hospital’s running and as such community pediatricians have “come up to the plate” and provided input where needed. 36
  • 37. The year 2005 will prove to be equally challenging but I think will give exciting opportunities for continued academic challenges, opportunities to inspire residents to the filed of community pediatrics and opportunities for community pediatricians to advocate for their patients and themselves to better the health of Manitoba’s children 37
  • 38. Dermatology 2003-2005 Medical Staff H. Eileen Murray MD, FRCPC Professor and Head Philippa E. Kellen MBBCh, FF Derm (SA), FRCPC Jill Keddy-Grant MD FRCPC John W. P. Toole MD FRCPC Richard P. Haydey MD, FRCPC Clinical activities All members of the section of pediatric dermatology are part time. We provide a consultation service for children with chronic or severe acute skin problems. Patients are seen at the weekly Monday morning clinics, which are staffed by Drs. E. Murray, J. Keddy-Grant, and P. Kellen. Up until 2005 a wart clinic was held once every three months. To provide more timely service for these patients we will be seeing 10 patients referred to us with warts one Monday per month. Long term followup is maintained for patients with serious chronic skin disease. Educational materials are provided for parents of children with chronic diseases. For the past 2 years Drs. E Murray and J. Keddy-Grant have provided two pediatric clinics a month for the remote communities of Manitoba via the MB telehealth link. Dr. E. Murray also sees consultations for inpatients at the Children's centre and St. Boniface hospital. In 2005 a second dermatology clinic will be provided on Tuesday mornings, staffed by Dr. Eileen Murray. Year Consultations Return Telehealth Total Patient visits consults visits 2003 355 248 603 2004 254 280 63 534 Teaching activities 2003-2005 All members of the section are active in the teaching program. We all accommodate medical students, family practice or pediatric residents who wish 38
  • 39. to spend time in our offices. Medical students regularly attend the Monday morning clinics. They are given instruction in the examination of the skin and also given time to examine patients. Most of the students attend two clinics. They are provided with educational materials that have been prepared by the medical and nursing staff. Section members also conduct lectures and teaching seminars (52 hours total). Dr. Murray was the Education Content Coordinator for the CME Video Conferencing Program, a pilot project initiated by MB Telehealth - "Dermatology for Rural and Northern Family Physicians – 2002 - 2003. Five interactive teaching modules were produced. Drs. Murray and Keddy-Grant each presented 5 modules (30 hours total). In 2002- 2003, Dr. Murray was a member of the Mc Master University Continuing Education Health Sciences program planning committee, which developed 3 Evidence-Based Dermatology Mainpro C programs for Family Physicians. In conjunction with Biomedical communications, Dr. Murray has produced an educational and diagnostic program of pediatric dermatology for pediatric residents, pediatricians and primary care givers - a textbook on CD. 2005 Dr. Eileen Murray will be teaching residents and students during morning ward rounds on Tuesdays and holding teaching rounds Mondays at noon. Educational grants: 2001- 2002 - Manitoba Medical Service Foundation $35,000.00 – Diagnosing Skin Diseases: A diagnostic tool and educational resource for pediatricians and primary caregivers. 2001- 2002 - Children’s Hospital Foundation $23,000.00 – Diagnosing Skin Diseases: A diagnostic tool and educational resource for pediatricians and primary caregivers. Research Activities Dr. H.E. Murray GlaxoSmithKline Inc A randomized, double blind, placebo controlled, parallel group study to assess the safety and efficacy of three dose levels of rosiglitazone maleate in the treatment of chronic plaque psoriasis Current year - $69,000. Term - 2002- 2005 Dr. H. E. Murray Biogen Incorporated An open-label, multi-centre study to evaluate the safety and tolerability of intramuscular 39
  • 40. administration of alfacept (LFA-3/IgI fusion protein) in subjects with chronic plaque psoriasis who have completed studies C99-717 or C99-712. Current year - n/a Term - 2000 - 2003 Dr. H. E. Murray Serono A multicentre, randomised, double-blind, placebo controlled phase III study of subcutaneously administered onercept in the treatment and re-treatment of subjects with moderate to severe plaque psoriasis. Current year- $100,000. Term: 2004 - 2006 Dr. J. Toole Amgen A phase III, multicentre study to assess the efficacy and safety of etanercept 50mg twice weekly in psoriasis. Current year - $65,000. Term - 2003 -2004 Dr. J. Keddy-Grant Novartis A 26-week, randomized, multicentre, parallel-group, double-blinded, vehicle- controlled study to evaluate the incidence of atopic dermatitis flares when ASM981 (pimecrolimus) cream 1% is used at the first signs and/or symptoms of atopic dermatitis and it’s safety and tolerability in adults 18 years of age and older. Current year - $20,000. Term - 2003 -2004 Publications Tan JKL, Girard C, Krol A, Murray HE, Papp KA, Poulin Y, Chin DA, Jeandupeux D. Randomized placebo-controlled trial of metronidazole 1% cream with sunscreen SPF15 in treatment of rosacea. J Cutan Med Surg.2002; 6(6):529-534. Tashkin DP, Murray HE, Skeans M, Murray RP for the Lung Health Study Research Group. Skin manifestations of inhaled corticosteroids in COPD patients: Results from Lung Health Study II. Chest, 2004; 126:1123-33. 40
  • 41. EMERGENCY SERVICES ATTENDING PHYSICIANS Milton Tenenbein, M.D. FRCPC, FAAP, FAACT, FACMT (Director) Elisabete Doyle, M.D., FRCPC Fiona Fleming, M.D., FRCPC Amin Kabani, M.D., FRCPC Murray Kesselman, M.D., FRCPC Matthew Lazar, M.D., FRCPC Shelagh Mackenzie, M.D., FRCPC Bryan Magwood, M.D., FRCPC Marilyn Raizen, M.D., FRCPC, FAAP Tracy Ridley, M.D., FRCPC Samir Shah, MD, FRCPC Norm Silver, M.D., FRCPC Jennifer Teskey, MD, FRCPC Lynne Warda, M.D., FRCPC, FAAP Sue Webb, M.D., FRCPC (Assistant Director) Grant Yung, MD, FRCPC The Section of Emergency Medicine provides primary, secondary and tertiary medical care for children from Winnipeg, Manitoba, Northern Ontario and Nunavit. The annual census of the Emergency Department is approximately 40,000 visits and 10% of these children require admission to hospital. A Fast Track for less severely ill and injured children operates every evening to decrease the congestion in the Emergency Department and to shorten the waiting times for children with milder conditions. The Manitoba Poison Control Centre is located within the Emergency Department and staffed by the attending physicians. These individuals manage queries from the lay public and medical professionals regarding poisonings. Outreach Members of the staff regularly participate in Advanced Pediatric Life Support courses for physicians in Winnipeg and Manitoba to improve their skills in the management of critically ill and injured children. Both the city’s and the province’s ambulance medical advisory committees have representatives from our staff to ensure that medical needs of children in the pre-hospital arena are not overlooked. 41
  • 42. Teaching Considerable medical education is delivered in the Emergency Department. Students include senior Medical Students, Family Practice Residents, Pediatric Residents, Emergency Medicine Residents and residents from various other medical specialties. A two-year Fellowship in Pediatric Emergency Medicine is offered for those wishing to choose a career in this discipline. Each year we accept external students and residents from other Canadian and international centres for periods of study and clinical experience in our unit. Research Research activities include studies conducted primarily by the attending physicians, studies in cooperation with other Children’s Hospital Physicians and multi- centred studies in co-operation with children’s hospital emergency units in other cities in Canada and the USA. Particular areas of research expertise include Injury Prevention and Clinical Toxicology. 42
  • 43. ENDOCRINOLOGY/METABOLISM Medical Staff Heather J. Dean – MD, FRCPC (Section Head) Shayne P. Taback – MD, FRCPC Elizabeth A. Sellers – MD, FRCPC, Masters (Community Health Sciences) Janet Grabowski – MD, FRCPC, part-time Clinical Associate for type 1 diabetes Clinical Activities The Section of Pediatric Endocrinology & Metabolism provides inpatient and outpatient clinical services to pediatric patients with diabetes mellitus (type 1 and 2), endocrine disorders that affect growth, reproductive development, adrenal or thyroid gland functions, disorders of lipid metabolism, bone health and osteoporosis. The program provides clinical services for all of Manitoba as well as portions of eastern Saskatchewan, northwestern Ontario and Nunavut. An increase in the annual number of new children with type 1 diabetes from the previous level of 40-50 (from 1986- 2001) to ~70 has been documented. The number of new children each year with type 2 diabetes has increased from 0 before 1986 to 0-5 in 1986-1990, 5-15 in 1990-2000 and now 30-40 over the past four years. Members of the Section provide consultation services on an inpatient basis at Children’s Hospital and an outpatient basis from offices in the Community Services Building (CSB). All eight weekly ambulatory endocrine & diabetes clinics are held in the CSB. The Diabetes Education Resource for Children and Adolescents (DER-CA) is also located in the CSB. A detailed annual report of all activities related to prevention, care, education, support and research of children with diabetes is published annually and available from the DER-CA. The highlights of 2003-2004 were: 1) decreased overall hemoglobin A1C, the most important clinical outcome measure; 2) lowest incidence of DKA in children known to have type 1 diabetes ever recorded at Children’s Hospital; 3) development of the Maestro project for young adults with diabetes; 4) enhanced QA program; 5) incorporation of the 2003 Canadian Clinical Practice Guidelines into our service delivery except for not meeting recommended frequency of follow-up; and 6) increased health professional education. The faculty also participates in the provincial newborn screening program (Manitoba Health) for congenital hypothyroidism and congenital adrenal hyperplasia. A new initiative in endocrinology is a nurse-managed program for congenital hypothyroidism. Teaching Activities The faculty actively participates in teaching undergraduate medical education, postgraduate medical education, as well as undergraduate and postgraduate teaching in Nursing and Clinical Dietetic internships. These education activities include: formal lectures, tutorials, clinical electives for both local and visiting students from other universities, academic half day sessions and clinical rotations for both local Pediatric residents and visiting elective Pediatric residents from other universities; outpatient clinic teaching for Obstetric and Gynecology residents; and clinical rotations for the Internal 43
  • 44. Medicine Endocrinology Program fellows. Dr. Taback, along with Dr. Mike Moffatt, offers the University of Manitoba course on clinical trials in the Department of Community Health Sciences. Drs. Dean and Sellers provide seminars to health professionals on diabetes care in children throughout Manitoba and Canada. The teaching commitment of each of our faculty is approximately 400 hours annually. In addition to the general teaching activities of the Section, the full time members play additional roles in the academic and professional community at the local, provincial, national and international levels such as Manitoba Health, the Winnipeg Regional Health Authority, Canadian Diabetes Association, Children’s Hospital Foundation of Manitoba and Juvenile Diabetes Research Foundation. Research Activities Research activities include individual areas of specialization as well as participation in multicentre national and international endocrinology and diabetes clinical trials and registries. All of our faculty are members of the Manitoba Institute for Child Health and the Canadian Pediatric Endocrine Group. Dr. Dean and Dr. Sellers’ research interests are focused primarily on type 2 diabetes in children, particularly epidemiology, prenatal risk factors, community screening, treatment, quality of life and prognosis. They are also actively involved in research related to prevention, treatment and outcomes of type 1 diabetes in children. Dr. Taback’s principle interests at University of Manitoba were initially in the area of bone growth and bone health including the effects and ethics of growth hormone therapy, the effect of childhood chronic disease on young adult bone health and osteoporosis. In 2003, he initiated a new research program relating to the Vitamin D system and primary prevention of type 1 diabetes. Dr. Taback received a research scholarship from the Medical Research Council Regional Partnerships Program (transferred to Canadian Institutes of Health Research) in partnership with the Children’s Hospital Foundation of Manitoba in the field of bone health. In 2003 he was awarded a 3-year Manitoba Medical Service Foundation Research Professorship. PEER REVIEWED RESEARCH GRANTS 1. The Canadian Institute of Health Research. TRIGR Study – A Primary Prevention Study: Newborns at Risk for Type 1 Diabetes. 2002-2012 $80,000 per annum (local funds) (Local Principal investigator: S Taback, Co-investigator: H Dean). 2. MMSF. Pilot trial of Vitamin D in Prevention of Type 1 Diabetes. 2003-2005 $20,000 (Principal investigator: S Taback, Co-investigator: H Dean). 3. The Canadian Institute of Health Research. Impact of Diet and Exercise Activity on Outcomes of Maternal Obesity (Planning and Development Project). IDEA study group. 2004-2005 $100,580 (Principal investigator: G Shen, Co-investigators: H Dean, E Sellers and S Taback). 4. The Canadian Institute of Health Research/Interdisciplinary Health Research Teams. Diabetes in the Aboriginal Population: Defining, Understanding and Controlling an Emerging Epidemic. 01/01/01–31/12/05 $2,545,680.00 (Principal investigator: T Young, Co-investigators: H Dean and E Sellers). 44
  • 45. 5. The Canadian Institute for Health Research. Centre for Aboriginal Health Research – ACADRE Training Program.01/01/02 –31/12/06 $500,000 (Principal investigator: Dr. J O’Neil, Co-investigators: E Sellers, H Dean and S Taback). 6. Manitoba Institute of Child Health. The Prevalence of Diabetes and Diabetes Associated Risk Factors in a High-risk Pediatric First Nation Population. 01/07/02-01/07/04 $40,000 (Principal investigator: E Sellers, Co-investigator: H Dean). 7. Canadian Diabetes Association. Carotid Intima-media Thickness and Other Cardiovascular Risk Factors in Children and Adolescents with Type 2 Diabetes Mellitus. 01/07/03-01/07/04 $30,820.00 (Principal investigator: E Sellers, Co- investigator: H Dean). 8. The Arthritis Society. Bone Health of Young Adults with Juvenile Rheumatoid Arthritis. July 1/99-June 30/2003 $143,900 (Co-investigator: S Taback). 9. Health Sciences Centre Foundation. Grave’s Disease in Youth: From Genetics to Outcomes. March 2003-August 31, 2004 $17,900 (Principal investigator: S Taback). 10. National Institutes of Health (NIH) TRIALNET: A Consortium for the Prevention of Type 1 Diabetes. (Affiliate site co-ordinator: H Dean, Co-investigators: S. Taback and E. Sellers). 11. Manitoba Institute of Child Health Carotid Intima-media Thickness and Other Cardiovascular Risk Factors in Children and Adolescents with Type 2 Diabetes Mellitus: Inflammatory Mediator Substudy. 2004-2005 $24,200 (Principal investigator: E Sellers). 12. Canadian Diabetes Association Pilot Trial of Vitamin D Prevention in Type 1 Diabetes 2003-2005, $75,000 (Principal investigator: S Taback, Co-investigator: H Dean). 13. Canadian Diabetes Association The Next Generation Project 2004-2005 $26,140 (Principal investigator: H Dean, Co-investigator: E Sellers). 14. Canadian Diabetes Association Evaluation of the Maestro Project – Young Adults age 18-25 Years with Diabetes 2004-2005 $50,000 (Principal investigator: N Van Walleghem, Co-investigator: H Dean). 15. CIHR The GREAT ice Project: Gender Related Evolution in Asthma Team. Adolescent Females, Obesity and Asthma: An Inflammatory State 2004-2007 $1,331,652 (Principal investigator: A Becker, Co-investigators: H Dean and E Sellers). 16. Children’s Hospital Foundation of Manitoba Inc. The Maestro Project: Building Community Connections for Young Adults 18-25 Years of Age with Diabetes. 2004-2006 $74,000 (Principal investigator: N Van Walleghem, Co-investigator: H Dean). CORPORATE RESEARCH GRANTS (excludes estimate of free drug supplied for studies) 1. Roche NM 16189. Randomized Placebo-controlled Double Blind Multicenter Study of Orlistat in Adolescent Obesity. 2000-2002, $160,000 (Site investigator: H Dean). 2. Pfizer Co Inc. Extension of Safety Study of Inhaled Insulin in Adolescents with Type 1 Diabetes Mellitus. 2001-2002, $85,800 (Site investigator: H Dean). 3. Aventis Co. Inc. Glargine Versus BID NPH as Basal Insulin in Basal-Bolus Regimes for Adolescents with Type 1 Diabetes. 2003-2004. (Site investigator: H Dean, Co-investigator: E Sellers). 45
  • 46. INNOVATIVE PROGRAM GRANTS 2000-2002 University of Manitoba Outreach Program $ 5,500 Education, Care and Support of Children and Families Living with Type 1 and Type 2 Diabetes through Outreach: Implementation of a Strategy 2002-2003 Manitoba Medical Foundation $25,000 The Maestro Project: Building Community Connections for Young Adults Age 18-25 years with Diabetes 2002-2003 Health Sciences Innovation Fund $25,000 The Maestro Project: Building Community Connections for Young Adults Age 18-25 years with Diabetes 2003-2004 The University of Manitoba $25,000 The Maestro Project: Building Community Connections for Young Adults Age 18-25 years with Diabetes 2002-2004 The Lawson Foundation $75,000 The Maestro Project: Building Community Connections for Young Adults Age 18-25 years with Diabetes 2004-2005 Children’s Hospital Foundation of Manitoba, Inc. $74,000 The Maestro Project: Building Community Connections for Young Adults Age 18-25 years with Diabetes PUBLICATIONS - Peer Reviewed 1. Young TK, Martens PJ, Taback SP, Sellers EAC, Dean HJ, Cheang M, Flett B, Type 2 Diabetes Mellitus in Children. Prenatal and Early Infancy Risk Factors Among Native Canadians. Arch Pediatr Adolesc Med 156:651-655, 2002. 2. Dean HJ. Does Exogenous Growth Hormone Improve Athletic Performance? Clinical Journal of Sport Medicine, 12:250-253, 2002. 3. Sellers EA, Dean HJ, Greenberg C, Triggs-Raine B. The Prevalence of the HNF-1α (G319S) Mutation in First Nation Youth with Type 2 Diabetes. Diabetes Care 25:2202-2206, 2002. 4. Craig WR, Sinclair CJD, Hanlon-Dearman AC, Taback SP, Moffatt MEK. Metoclopramide, Thickened Feedings and Positioning for Gastro- oesophageal Reflux in Children under 2 years (Protocol for a Cochrane Review). In: The Cochrane Library, Issue 1, 2002. Oxford: Update Software. 5. Zacharias J, Noureldin A, Uhanova J, Schroth RJ, Hitchon C, Taback SP, Moffatt MEK. Hepatitis B Vaccination in Chronic Renal Failure (Protocol for a Cochrane Review). In: The Cochrane Library, Issue 3, 2002. Oxford: Update Software. 6. Dean HJ, Sellers EAC, Birk P, Blydt-Hanson T, Ogborn M. Children Are Not Small Adults: Albuminuria in Children with Diabetes (letter), Can Med Assoc J. 168:255-5, 2003. 46
  • 47. 7. Webster J, Taback SP, Sellers E., Dean HJ. Grave’s Disease in Children. (letter). Can Med Assoc J. 169:104-105, 2003. 8. Laurence S, Pacaud D, Dean H, Lawson M, Daneman D. Pediatric Diabetic Ketoacidosis. (letter) Can Med Assoc J. 169:278-279, 2003. 9. Dean HJ, Sellers EA. Type 2 Diabetes in Youth in Manitoba, Canada, 1986-2002. Can Journal of Diabetes, 2003; 27:449-454. 10. Kaila B, Dean HJ, Schroeder M, Taback SP. HLA, Day Care Attendance, and Socio-Economic Status in Young Patients with Type 1 Diabetes, Diabetic Medicine 2003;20:777-780. 11. Taback SP, Sellers EAC, Dean HJ. Is Luteininizing Hormone-releasing Hormone Agonist Justified in Short Adolescents? N Engl J. Med 2003;249:192-3. 12. Sellers EAC, Sharma A, Rodd C. Adaptation to Low Calcium Diet in Inuit Children. CMAJ 2003; 168:1141-3. 13. Barclay-Goddard R, Stevenson T, Poluha W, Moffatt MEK, Taback SP. Force Platform Visual and Auditory Feedback for Standing Balance Training After Stroke (Protocol for a Cochrane Review). In: The Cochrane Library, Issue 2, 2003. Oxford: Update Software. 14. Bernstein CN, Leslie WD, Taback SP. Bone Density in a Population-based Cohort of Premenopausal Adult Women with Early-onset Inflammatory Bowel Disease. American J of Gastroenterol, 2003;98(5):1094-100. 15. Taback SP. (letter) Pediatric Osteoporosis is Not Covered by the 2002 OSC Guidelines. CMAJ 2003; 168:675-676. 16. Sellers EAC, Dean HJ. Short Term Insulin Therapy in Adolescents with Type 2 Diabetes Mellitus. J of Ped Endo Metab 2004; 17(11):1561-4. 47
  • 48. PUBLICATIONS – Invited 1. Dean HJ, Dancing with Different Ghosts: Treatment of Type 2 diabetes in Youth. (Guest Editorial) Diabetes Care, 25:237-238, 2002. 2. Dean HJ, Sellers EAC. Type 2 Diabetes, Polycystic Ovary Disease and Insulin Resistance Syndrome in Children. Pediatrics and Child Health, 7:333-336, 2002. 3. Taback SP, Dean H., Elliott E. Management of Short Stature. West J. Med 176:169-2, 2002. 4. Dean H., A Snow Storm in May. Guest editorial. Diabetes Quarterly, summer 2002. 5. Teskey J, Dean HJ, Sellers EAC. Polycystic Ovary Syndrome in Teens: The Need for Early Detection. Can J of Diagnosis, 19:61-62, 2002. 6. Dean HJ. Treatment of Polycystic Ovary Syndrome with Metformin in Adolescents: A Pediatric Endocrinology Perspective (Guest Editorial). J. Pediatr Adoles. Gynecol, 16:109-111, 2003. 7. Dean HJ (editorial) Experts Predict a Healthy Future for Peer-Reviewed Journals. Can J Diab 27:119, 2003. 8. Van Walleghem N, MacDonald C, Dean HJ. The Maestro Project: Building Connections for Young Adults with Type 1 Diabetes in Manitoba. Diabetes Quarterly, Spring 2004. 9. Dean HJ (editorial). Report Care Time for Canadian Journal of Diabetes. Can J Diab 28:111, 2004. 10. Dean HJ. Insulin for Youth with Diabetes. Canadian Journal of Continuing Medical Education. 16:101, 2004. 11. Dean HJ (editorial). The Zero Tolerance Approach to Roman Numerals in Diabetes. Can J Diab 28:355, 2004. 12. Taback SP, Dean H. Management of Short Stature. In Moyer VA (ed.). Evidence- based Pediatrics and Child Health. 2nd ed. BMJ Books, 2004: pp 334-340. 13. Dean HJ. Type 2 Diabetes in Children and Adolescents. The Family Physician and Diabetes in Children and Adolescents. Canadian Diabetes, Autumn (17):2004. PUBLICATIONS – Peer Reviewed (as part of a National or International Research Group) 1. Holcombe JH, Zalami S, Arora V., Mast CJ. for the Lispro in Adolescents Study Group. Comparison of Insulin Lispro with Regular Human Insulin for the Treatment of Type 1 Diabetes in Adolescents. Clinical Therapeutics 24:629-638, 2002. 2. Muirhead S, Sellers EAC, Guyda H. Indicators of Adult Height Outcome in 21- hydroxylase Deficiency Congenital Adrenal Hyperplasia. J. Pediatr 2002; 141:247-252. 3. McCrindle BW, Ose L, Marais D. Efficacy and Safety of Atorvastatin in Children and Adolescents with Familial Hypercholesterolemia or Severe Hyperlipidemia: A Multicenter, Randomised, Placebo-controlled Trial. J Pediatr 143:74-79, 2003. 48
  • 49. AWARDS Dr. H. Dean: Manitoba Medical Students Association Teaching Award (nominated by Med II for teaching excellence in Pre-Clerkship) 2002 Women of Distinction for Science, Technology, & Innovation 2003 YM-YWCA, Winnipeg, Manitoba Outstanding Achievement Award to members of Canadian 2003 Diabetes Association National Camp Medical Task Force Dr. E. Sellers: Manitoba Medical Student Association Teaching Award 2002 (nomination for teaching excellence in Pre-Clerkship) Dr. S. Taback: Manitoba Medical Service Foundation 2003-2006 Clinical Research Professor in Population Medicine 49
  • 50. FACULTY DEVELOPMENT DEPARTMENT OF PEDIATRICS AND CHILD HEALTH 2002-2004 Medical Staff Wade Watson, MD, FRCPC - Head Ming-Ka Chan, BSc, MD, FRCPC Diane Moddemann, MD, FRCPC Faculty Development is available for assisting the Office of Undergraduate and Postgraduate Medical Education in the development of educational strategies to improve the teaching and learning environment for medical students and residents. A needs assessment survey was sent to full and part-time faculty members to help define the educational needs for department members and to promote the evolution of ideas and skills so that department members may become better educators. Collaboration with University Faculty Development Programs is ongoing. Teaching Philosophy as it relates to Pediatrics and Child Health 1. To provide the best education for different levels of the learner 2. To foster the development of future physicians in the CANMEDS model and have caring, compassionate, competent and ethical professionals who are excited about learning and patient care. 3. To promote life-long learning 4. To promote self assessment and reflection 5. To create a cooperative learning environment and promote inter and intra professional teamwork 6. To create and maintain a dynamic needs based, learner-centered curriculum whose outcome is a physician who delivers patient-centered care. 7. To promote the scholarship of teaching 8. To promote ongoing faculty development and create dedicated educators 9. To meet the goals and objectives of the Undergraduate, Postgraduate and Faculty Education Programs 10. To meet the goals and objectives of the Mission and Vision of the Child Health Program: CHILD HEALTH PROGRAM MISSION WORKING TOGETHER FOR HEALTHIER CHILDREN: 50
  • 51. Providing high-quality, comprehensive, family-centered health care CHILD HEALTH PROGRAM VISION All children will reach their full potential. We will strive for this by: • Continually improving the services we provide; • Advocating for children; • Being leaders in research and learning; • Providing care that is high quality, evidence-based and accountable; • Valuing our staff and fostering an environment of teamwork, professional growth, and mutual respect. 11. To meet the responsibilities we have to our patients and society. Academic/Scholarly Aspects of the Program • Pediatric Medical Education Interest Group (monthly) o Resident and faculty attendees (35 total members since Fall 2004) o Accredited group learning activity as defined by the Maintenance of Certification Program of The Royal College of Physicians of Canada • Teaching Improvement Programs (TIPS) • Workshops and Seminars in collaboration with the Office of Educational Development Committee Involvement • Postgraduate Medical Education (PGME) • Undergraduate Medical Education (UGME) • Education Coordinating Committee (ECC) 51
  • 52. GASTROENTEROLOGY Medical Staff Stan P. Moroz, MD, FRCPC, (Head) Janice L. Barkey, MD, FRCPC Nursing Wendy Mandziuk, RN, Nurse Clinician Cathy MacLean, RN, Clinic Nurse Secretary Natalie Meyer Dr. Barkey joined the Section in January 2003 after completing her Pediatric Gastroenterology Fellowship at the University of Calgary. Her Pediatrics residency training was at the Winnipeg Children’s Hospital. In her final year, she was Chief Pediatric Resident. She is currently completing requirements towards a Masters degree in Medical Education. Her Master’s thesis focuses on the acquisition of colonoscopy skills. Recruitment of a third physician is actively in progress. Clinical Activity Children and adolescents with a wide variety of gastrointestinal, liver and nutritional problems referred from Manitoba, Saskatchewan, Nunavut and Northwest Ontario are assessed and treated by the Section. Diagnostic procedures such as endoscopy, liver biopsy, esophageal pH and intestinal motility studies are performed. Some therapeutic interventions such as polypectomies and variceal banding are also done. During the past year 590 new patients were seen and there were 920 followup assessments. Sixty patients were admitted under the care of the Section and 200 procedures were performed. Teaching Undergraduate The members of the Section actively participate in clinical and didactic teaching in General Pediatrics and Pediatric Gastroenterology. Medical students participate in an elective rotation in Pediatric Gastroenterology. Postgraduate The members participate in didactic programs for Postgraduate trainees. Clinical teaching is conducted in relation to patient care and Residents rotate through the service on an elective basis. The members contribute to the Adult Gastroenterology training program. The members also participate in the MOCOMP program for Pediatricians. Research Dr. S. Moroz A review of 25 years of experience with children and adolescents with inflammatory bowel disease (IBD) seen at the Children’s Hospital has been completed and is being 52
  • 53. prepared for submission for publication. A study to assess the long term impact of IBD diagnosed in childhood on education, employment and family life is in progress. Dr. J. Barkey An evaluation tool for Gastroenetrology trainees performing gastroscopy and colonoscopy was developed and recently trialled in Cleveland Clinic Children’s Hospital. Our site is participating in a Canadian multicentered study on children with biliary atresia. Organizations Both physicians are members of the Canadian Association of Gastroenterology (CAG) and North American Society for Pediatric Gastroenterology Hepatology and Nutrition (NASPGHAN). Dr. Barkey is co-chair of the CAG National Basic Sciences Rounds and CAG Education Committee. She is also a member of NASPGHAN Endoscopy Committee. 53
  • 54. GENETICS & METABOLISM The Section of Genetics and Metabolism is currently incorporated into the Child Health Program for clinical service provision. The historical rationale and background for establishing Genetics and Metabolism as a service within the Child Health Program relates to the fact that the preponderance of clinical services were traditionally directed towards children and their families. The Genetics and Metabolism Service investigates children displaying a variety of birth defects and developmental disorders and a determination is made of the possibility of the disorder being genetic in origin. In 1992, the Section of Metabolism that managed children and adults with inborn errors of metabolism merged with the Section of Genetics to form the Section of Genetics and Metabolism. Prior to 1991, clinical geneticists were primarily trained in pediatrics in addition to clinical genetics training. There is now a 5-year Royal College approved training program in Medical Genetics. The Section has been responsible for the province-wide prenatal genetic diagnostic services and maternal serum screening program that involves the assessment and counselling of adult patients and couples. Recent developments have led to the scope of clinical services being expanded increasingly into several areas of adult medicine. This includes the increased utility of molecular testing to determine carrier status of individuals in high-risk populations or in families at risk for genetic and genetic metabolic disorders. Currently there are approximately 5000 patients who are seen through the service annually. Of these, over 60% are adults. The establishment of this service as a separate Program will ensure all Winnipeg Regional Health Programs of equitable access to service and permit Genetics and Metabolism to establish priorities and objectives consistent with the need for service provision in all areas. Genetics and Metabolism views as its mandate the provision of exemplary clinical service to all patients and Programs of the Winnipeg Regional Health Authority. In the discharge of this mandate the new Program will endeavor to establish a responsive system of service delivery. It will respond to requests for service and identify to other Program leaders and clinicians opportunities for the provision of enhanced services through the involvement of Genetics and Metabolism. Following a recent retreat of the section we have developed a Mission, Vision and Values document (Appendix). Service Provision In addition to its role and responsibilities in areas of medical education and research the established Program will focus in the immediate future on the provision of service in Winnipeg, in Manitoba, and in the traditional catchment areas outside the province in the following key service areas: • The assessment, diagnosis, management and counselling of children and adults and their families with birth defects, developmental disabilities, and inherited metabolic diseases • The assessment, diagnosis and counselling of children and adults with known or suspected genetic or inherited disorders • The provision of prenatal maternal screening and genetic diagnostic services 54
  • 55. • The provision of genetic assessment, counselling, testing and diagnosis to individuals and families with suspected inherited cancer • Provide medical genetics consultation to multidisciplinary teams including CADEC (Clinic for Alcohol and Drug exposed Children), Neuromuscular clinic, Craniofacial clinic, and others that may be developed. Key Strategies and Goals We will strive to improve access to the Genetics and Metabolism consultation and referral service. We will provide a high quality, comprehensive Medical Genetics Service that will meet the needs and expectations of all Winnipeg Regional Health Authority Programs and service providers. We will implement a plan for the extension of genetic services into currently emerging fields in which the expertise and knowledge of Genetics professionals can assist in the diagnosis, treatment and management of diseases. We will continue to foster an atmosphere of high quality service provision, education and research through collaboration and expertise with other Programs. A. General Medical Genetics (Adult and Children) Services This will be achieved by expanding the number of our clinics within the HSC site, collaborating with multidisciplinary teams such as the CADEC and developing new links with other multidisciplinary teams such as the Craniofacial clinic, the cleft palate program, Hereditary Lipid clinic, and a Neuromuscular clinic. We also plan to extend the use of clinical assessments with the use of TeleHealth to enhance our responsiveness to service provision to rural areas. Close ties with Child Health, Women’s Health and Internal Medicine will be maintained. In Child Health, the Medical Director of the Medical Genetics Program will sit on the Section Heads committee of the Child Health Program. This service works closely with the DNA Diagnostic, Metabolic Diseases and Cytogenetics Laboratories of the HSC. B. Prenatal Genetic Screening and Diagnosis Service We will continue to coordinate the prenatal genetics diagnostic and maternal screening program for the province. This service is provided in collaboration with the Women’s and Children’s service at HSC and St. Boniface General Hospital and the Cadham Provincial Laboratory. We will continue to improve the efficiency and delivery of service by introducing new reliable methods of prenatal screening that will increase the reliability and utility of prenatal screening and diagnosis. Patient assessments and counselling will continue to be offered in person and the use of the TeleHealth link to rural areas will be expanded beyond its current use. This service works closely with the DNA Diagnostic and Cytogenetics laboratories of the HSC. C. Metabolic Service The recruitment of a second medical geneticist to share assist in the delivery of general genetics and metabolic service provision is anticipated for the summer of 2004. This service will continue to provide ongoing diagnosis and management and follow-up of children and adults with metabolic-genetic disorders. The recently established adult 55
  • 56. metabolic clinic will allow a continuing seamless transition of care from childhood to adulthood. We will continue to work in collaboration with the Program in Internal Medicine to further expand the assessment diagnosis and management of adults with metabolic-genetic diseases. The metabolic service also works closely with the HSC Metabolic Diseases Laboratory in Clinical Chemistry and the Perinatal Screening Committee of the Cadham Provincial Laboratory. The service will remain responsible for the follow-up and confirmation of diagnosis in children with positive newborn screens for a variety of disorders. D. Cancer Genetics Service We will continue and expand the numbers of families and individuals who are seen because they are affected with cancer themselves or they are at increased risk of cancer due to an inherited predisposition. We will work with the Programs in Laboratory Medicine, Oncology and Cancer Care Manitoba to lobby for necessary laboratory equipment for the development of genetic testing for men and women at risk for hereditary cancer, and particularly for breast and ovarian cancer and hereditary colon cancer. We will also work with colleagues in these programs to develop a multidisciplinary approach to patient information sharing, health and preventative medical care, risk assessment and counselling. This service works closely with the DNA Diagnostic Laboratory of the HSC. Human Resources The Genetics and Metabolism service is currently provided by medical staff, genetic counsellors and administrative and secretarial support staff, who are primarily located at the HSC site. Members of the Section include: Medical Staff/Faculty: Bernie N. Chodirker, MD Albert E. Chudley, MD Cheryl R. Greenberg, MD Sandra Marles, MD Cross-Appointed Members: Angie Dawson, PhD Jane Evans, PhD Dan Gietz, PhD John Hamerton, PhD Vid Persaud, MD Lorne Seargeant, PhD Beth Spriggs, PhD Barbara Triggs-Raine, PhD Gaynor Williams, MD Klaus Wrogemann, PhD Emeritus Member: James C. Haworth, MD 56
  • 57. Genetic Counsellors: Claudia Carrilles (on leave) / Caroline Powell (Assistant) Linda Carter Monique LaPointe Karen MacDonald Shannon Sanders Judy Saltel-Olson Kim Serfas Residents/Fellows: Ahmed Almaqrhi, MB Yousef Housawi, MD Chumei Li, MD Barbara Morash, PhD Reena Ray, PhD Julie Richer, MD Alison Rusnak, MD Plan for Next Three Years 1. We hope to achieve Program status with the WRHA before the end of 2004. 2. We will increase the number of adults counselled and tested for hereditary cancer. This objective will be achieved by supporting the Lab Medicine and Oncology Programs in obtaining laboratory equipment that would allow this expansion of service. This will impact substantially on the number of patients being seen for breast and ovarian cancer and hereditary non-polyposis colorectal cancer. The results are more families seen and counselled and a substantial reduction in waiting times. 3. Increase the number of genetic counsellors by 2.0 FTE. With the growing number of genetic tests being offered, which results in more patients to support in educating about health options and reproductive issues, there is a need to have appropriately qualified consellors to support and complement the genetics team. These individuals are qualified health practitioners with a Masters Degree level of training who function in a similar way as clinical nurse specialists in other medical disciplines. The additional genetic counsellors will allow the medical staff to continue program development, and facilitate the expansion of education and research programs. 4. Increase the representation and participation of genetics team members in multidisciplinary clinics. Since the arrival of Dr. Lonny Ross, the craniofacial clinic and cleft lip and palate program have been greatly enhanced. Genetics and Metabolism has never been established as a core member of these teams. There is strong evidence from other tertiary care centres that the assessment of patients in these clinics enhances diagnosis and clinical care. With the presence of an additional geneticist and hiring of the necessary complement of genetic counsellors, we will be in a strong position to offer a more collaborative participation in multidisciplinary teams. 57
  • 58. We will encourage and expand our multidisciplinary approach for cancer genetic patients and their family members who are at risk. This will be achieved by developing a closer collaboration and planning of expanded services with the WRHA Oncology Team and Cancer Care Manitoba. We will expand our activities in the area of adult FAS diagnosis that is currently limited by availability of staff to coordinate this important health assessment. 5. Expand the metabolic service providing diagnostic and management capabilities for adult patients in conjunction with the Program in Internal Medicine. In addition to the geneticist’s involvement in the Adult Metabolic Clinic, the recruitment of an internist to the Adult Metabolic Clinic is a priority, which is supported by the current Program Medical Director in Medicine. Fragmentation of genetics into different programs would be detrimental to the growth of a centrally coordinated Medical Genetics Program, and would go against the Mission Statement. With the establishment and recognition of a Medical Genetics Program within the WRHA, there would be enhanced ability to develop, coordinate and expand genetics teams’ integration with other Programs at various sites. 6. Identify new clinic and office space for the program. A. Currently many general and cancer adult patients are seen in the Children’s Hospital Clinics. An ideal place for these individuals would be in other sites such as Cancer Care Manitoba outpatient facility for the cancer patients, and a more mature space in the WRHA region for adult general genetics clinics. With the opening of the CSRP at the HSC, Genetics will be well positioned as a Program to successfully argue for these patient care issues. B. Genetics office space is inadequate for the number of employees in the program. Some of the staff are off site and this has led to poor staff morale, team alienation, inefficiency, and reduced productivity for the program. With the opening of the CSRP at the HSC, Genetics will be well positioned as a Program to more successfully argue for these employee care issues. Descriptions of Faculty Activities: Dr. Bernie Chodirker's primary clinical focus continues to be prenatal diagnosis but he is active in other areas including cancer genetics. As post-graduate education director for medical genetics, he is very involved in the teaching of genetics residents and fellows. His current research activities are related to two multicenter trials i.e. 1) enhanced maternal serum screening and 2) prenatal diagnosis of Smith-Lemli-Opitz syndrome. Dr. Ab Chudley’s research interests remain in the delineation of genetic syndromes particularly those associated with developmental disabilities. He is involved in the Canadian-American Autism Research Consortium that has a major goal in “Unravelling the Mystery of Autism Spectrum Disorders”. He is a co-leader of the Manitoba Autism Research Team. He is Section Head and with the section has spear headed the move to develop a Program in Genetics within the WRHA. He remains active in all areas of education of clinical genetics and in particular the issue of FASD. He is a member of Health Canada’s Advisory committee on FASD. 58
  • 59. Dr. Cheryl R. Greenberg primary clinical activities remain the provision of metabolic services within the Section. Her research interests remain in the investigation of the contribution of metabolic diseases to infant morbidity and mortality in Manitoba’s and surrounding unique populations particularly CPT1 deificeny and glutaric academia type 1. She is an active member of the the Centre for Investigation of Genetic Disease, a collaborative research initiative between clinicians and basic scientists located in MICH. Administratively she has been kept quite busy being Acting Head and Medical Director, Dept of Pediatrics and Child. Dr. Sandra Marles has clinical and research interests in FAS, hereditary forms of cancer and dysmorphology. She teaches clinical genetics to medical and dental students, pediatric and genetics residents. Publications: Abidi, F.E., Chudley, A.E., Schwartz, C.E., Stevenson, R.E. XLMR syndromes associated with mutations in the XNP gene. Proc. Greenwood Genet Center 22: 38-43, 2003 Almqvist, E.W., Brinkman, R.R., Wiggins, S., Hayden, M and the Canadian Collaborative study of predictive testing for Huntington disease including Greenberg, C.R.: Psychological consequences and predictors of adverse events five years after predictive testing for Huntington disease. Clinical Genetics 64: 300-309 Andrew, S.E., Whiteside, D., Buzin., Greenberg, C.R., and Spriggs, E.L.: An intronic polymorphism of the MLH1 gene contributes towards incomplete genetic testing for HPCCC. Genet Test. 2002 6:319-22. Björklund, N., Evans, J., Seargeant, L., Chodirker, B., Greenberg, C.R.: C677T MTHFR frequencies in different Canadian provinces. J. Med Genet, In Press. Boland, F.J., Chudley,A.E., Grant, B.A. The challenge of fetal alcohol syndrome in adult offender populations. Forum on Corrections Research 14:61-64, 2003 Brooks-Wilson, A.R., Kaurah, P., Suriano, G., Leach, S., Senz, J., et al, including Greenberg, C.R.: Germline E-caderin mutations in hereditary diffuse gastric cancer: Assessment of 43 new families and review of genetic screening criteria. J Med Genet, In Press Chalmers, K.., Marles, S., Tataryn D., Scott-Findlay, S. and Serfas, K. Reports of information and support needs of daughters and sisters of women with breast cancer. Eur J Cancer Care (Engl) Mar: 12(1):81-90, March, 2003. Chudley, A.E. Landmarks in genetics through philately: The tools used by dysmorphologists. Clin Genet. 63:105-108, 2003. Chudley, A.E. and Chodirker, B.N. Landmarks in genetics through philately: Down syndrome. Clin Genet 63: 268-272, 2003. Chudley, A,E. Genetic landmarks through philately: Georges Marinesco (1863-1938).Clin Genet. 64:297-299. 2003. 59
  • 60. Creighton, S., Almqvist, E.W., MacGregor, D., Fernandez, B., Beis, J., Welch, J.P., Riddell, C., Lokkesmoe, R., Khalifa, M., MacKenzie, J., Sajoo, A., Farrell, S., Robert, F., Shugar, A., Summers, A., Meschino, W., Allingham-Hawkins, D., Chiu, T., Hunter, A., Allanson, J., Hare, H., Schween, J., Collins, L., Sanders, S., Greenberg, C.R., Cardwell, S., Lemire, E., McLeod, P., and Hayden, M.R.: Predictive, prenatal and diagnostic genetic testing for Huntington’s Disease: The experience in Canada from 1987 - 2000. Clin Genet. 63(6):462-75, 2003. Dawson, A.J., Wickstrom, D.E., Riordan, D., Cardwell, S., Casey, R., Baldry, S. and Brown, C. A unique patient with an Ulrich-Turner syndrome variant and mosaicism for a tiny r(X) and a partial proximal duplication 1q. Am. J. Med. Genet. 124A:303-306, 2004. Elliott, A.M., Evans, J.A., Reed, M.H. and Chudley, A,E. Celani-Lenz syndactyly with features of Kabuki syndrome. Clin Dysmorphology (In Press). Koren, G., Nulman, I., Chudley, A.E., Loocke, C.: Fetal Alcohol Spectrum Disorder. CMAJ 169; 1181-1185, 2003. Lehotay, D.C., Lepage, J., Thompson, J.R., Greenberg, C.R.: Acylcarnitine levels in normals and heterozygotes for MCAD deficiency: A relationship between genotype and phenotype. J Inherited Metabolic Diseases , In Press. Li, C., Divekar, A., Chudley, A.E., Soni, R.: Pulmonary atresia with intact ventricular system and major aortopulmonary collaterals: association with deletion 22q11.2. Pediatr Cardiology 24(6):585-7, 2003. Lowry, R.B., Innes, A.M., Bernier, F.P., McLeod, D.R., Greenberg C.R., Chudley, A.E., Chodirker, B., Marles, S.L.., Crumley, M.J., Loredo-Osti, J.C., Morgan, K. and Fujiwara, T.M.: Bowen-Conradi Syndrome: A clinical and genetic study. Am J Med Genet. 30;120A(3):423-8, 2003. Marles, S., Reed, M. and Evans, J.: Humeroradial synostosis, ulnar aplasia and oligodactyly, with contralateral Amelia, in a child with prenatal cocaine exposure. Am J Med Genet 116(1):85-89, 2003. Sanders, S.R., Dawson, A.J., Vust, A., Hryshko, M., Tomiuk, M., Riordan, D. and Prasad, C.: 2003. Intertitial deletion of chromosome 2p16.2p21. Clin. Dysmorph. 12:183-185. Weiler, T., Frosk, P., Wrogemann, K. and Greenberg, C.R.: Limb girdle muscular dystrophy, type 2H. Encyclopedic Reference of Molecular Mechanisms of Disease. On Line 2003 . Weiler, T., Frosk, P., Wrogemann, K., and Greenberg, C.R.: Limb girdle muscular dystrophy, type 2B and Miyoshi myopathy. Encyclopedic Reference of Molecular Mechanisms of Disease. On Line 2003. Research Funding: Canadian Foundation for the Study of Infant Deaths ($39,702- April 2004 - June 2005) “CPT 1 Deficiency and the High Rate of Sudden Death in an Inuit population” Investigators: CR Greenberg, B. Martin, A. Macaulay, S. Phillips, R. Thompson. 60
  • 61. Canadian Institute of Health Research (CIHR). Institute of Health Research Technology (IHRT)— ($4.17 million operating and $100,000 equipment; 2001-2006). “Unravelling the Mystery of Autism: From Genotyping and phenotyping to early identification and prevention.” Investigators: J.J. Holden, et al (Including A.E. Chudley, D. Yu, and W. Richter – Winnipeg Reginal Team). CIHR ($180,611/yr X [Average Annual Operating Amount] + $114,000 for equipment] 2003- 05) “The SAFER study: Second and first trimester evaluation of risk of fetal trisomies. A prospective demonstration study of the use of maternal serum pregnancy- associated plasma protein-A (PAPP-A) and dimeric inhibin-A in combination with existing biochemical markers and maternal age to improve the assessment of risk of fetal trisomy 21 and to reduce the need for amniocentesis“. Investigators: A.R. MacRae, D.Chitayat, B.N. Chodirker, G.A. Davies, P.H. Holowaty, G.J. Knight, C.A. Lockern, J.J. MacKenzie, G. Palmaki, A. Toi, P.G.Van Caeseele. CIHR ($125,757-(July 2003- June 2006) “Mapping the Gene Locus for Bowen-Conradi Syndrome”. Investigators: C.R.Greenberg, B. Triggs-Raine, T. Zelinski, K. Wrogemann. CIHR Strategic Training Program Grant ($1,440,000; $240,000/year for 6 years, April 2003-March 2009). “Transdisciplinary Inter-Institute Training Program in Autism Spectrum Disorders”. Investigators: J.J. Holden, J.M. Bebko, A.E. Chudley, M. Feldman, S. Lewis, P.M. Minnes, K.G., Munhall, A.M.D. Perry, R. Woodhouse and D.C.T. Yu. Garrod Association of Canada ($25,000- Sept 2002-Sept 2003) "Clinical, Biochemical and Molecular Characterization of an Inuit kindred with both CPT1 and CPT2 deficiencies" Investigators: CR Greenberg, L Seargeant, P MacLeod, F Bamforth, A Chan and C Prasad. Genzyme Corporation ($18,500 pa) Personnel Support Enzyme Replacement Therapy in Lysosomal Storage Diseases Manitoba Institute of Child Health ($15,788 - August 2001 - June 2004) “Effectiveness of Aggressive Medical Intervention with Neuroprotection in the Management of Presymptomatic Patients with Glutaric Acidemia Type 1 in Manitoba”. Investigators: A. Prasad, C. Prasad, F. Booth, L. Seargeant, B. Seifert and C.R. Greenberg. Manitoba Institute of Child Health ($37,486- July 2003 - June 2004) “CPT 1 Deficiency in the Inuit” Investigator: CR Greenberg. Manitoba Medical Service Foundation ($35,000 Jan 2003-Dec 2003). “Functional MRI in Fetal Alcohol Syndrome”. Investigators: K.Malisza, S. Longstaffe and A.E. Chudley. National Institute of Health. ($840 US. per patient enrolled in study - 2002-3) “Feasibility of Screening for Smith-Lemli-Opitz syndrome” Investigators: B. Chodirker , P. Van Caeseele, J.E. Haddow, G. Cunningham, A. MacRae , S. Puck , R. Williamson, G. Knight, P .Benn, J. Canick , L. Bradley, L. Kellner. The Dr. Paul H.T. Thorlakson Foundation Fund ($24,000/annum 2002/2003). “Application of comparative genomic hybridization (CGH) to genetic analysis of paediatric acute lymphoblastic leukaemia (ALL)” Investigators: PI S. Mai (Co- investigators AJ Dawson, G Williams) 61
  • 62. Appendix MISSION STATEMENT The Genetics and Metabolism programme provides leadership in delivering comprehensive high-quality, accessible genetic, metabolic, and related care for Manitoba and other catchment areas in a timely patient and family focussed fashion. The programme strives for excellence in teaching and research and actively participates in policy development at provincial, national and international levels. VISION STATEMENT To become a recognized program operating in a centrally located environment that is appropriate and friendly for patients and staff. This program should be recognized at the local, national and international level for quality genetics service, education and research. The care will be multidisciplinary in scope and be widely available through outreach clinics and teleMedicine. We envision working in an environment that has sufficient staffing to provide for sick leave, education and vacation coverage and which encourages and promotes ongoing education of staff. We will partner with other members of the health care team to improve the health of the population. We will continue to reevaluate our program to ensure the highest quality of care. VALUES • We value providing high quality, current, evidence based and timely medical care. • We value non-directive genetic counselling which includes providing appropriate balanced information in a unbiased manner with support for decisions made by patients about their care. • We are committed to maintaining national and international standards of care. • We support the training and education of future genetic professionals. • We believe in providing genetic education for other health care professionals and the public. • We support research that will benefit patient care and the discovery of new knowledge. • We believe in a system where all staff members are challenged appropriately and strive for continued growth. • We value continuing quality improvement. • We believe in equal access to genetic services. • We respect the social, cultural and spiritual needs of patients. • We value the contribution of all members of staff and encourage continuing education and the pursuit of excellence. • We encourage and support the innovations and creativity of all members of the genetics program. • We believe in maintaining the dignity, privacy and confidentiality of our patients. 62
  • 63. • We believe in an ethical approach to patient care, education and research. • We will strive to be fiscally responsible and cost-effective. • We value teamwork. We recognize the importance of a balanced lifestyle. 63
  • 64. HEMATOLOGY/ONCOLOGY Paediatric Haematology/Oncology/Bone Marrow Transplant Medical Staff Sara J. Israels, MD FRCPC, (Head) Bonnie P. Cham, MD FRCPC David D. Eisenstat, MD MA FRCPC Patricia J. McCusker, MD FRCPC ML (Marlis) Schroeder, MD FRCPC Rochelle A. Yanofsky, MD FRCPC The Section of Pediatric Haematology provides broad-based inpatient and outpatient clinical service to pediatric patients with both benign hematologic and malignant disease. The program provides clinical services for all of Manitoba as well as portions of eastern Saskatchewan, Northwestern Ontario and Nunavut. Approximately, 50 new childhood cancer cases are seen by the program each year. In addition, the program cares for children with bone marrow failure syndromes, immunodeficiency, hemoglobinopathies, and haemostasis abnormalities. Members of the section provide consultation services on an inpatient basis at Children’s Hospital and an outpatient basis at CancerCare Manitoba. This year there were 3622 outpatient visits, 824 admissions to Children’s Hospital, and 765 patients seen in consultation. A provincially designated Pediatric Bone Marrow Transplant Program shared an inpatient facility with the Adult Transplant Program on the sixth floor of the General Centre until October, 2002 after which the Pediatric Program moved to CK5 at the Children’s Hospital. This year eight transplants were done for indications ranging from leukemia to inherited metabolic diseases. A comprehensive Bleeding Disorders Program provides multidisciplinary care for children with haemophilia and other inherited bleeding disorders. The clinical service is supported by a multidisciplinary team of nurses, social workers, teachers, childlife specialists, occupational and physiotherapists, home care coordinators, protocol managers and clinical research associates. Three members of the faculty are also directors of clinical laboratory services: The Haemostasis Laboratory (Dr. Israels), the HLA Laboratory (Dr. Schroeder), and the laboratory services of the Manitoba Rh Program (Dr. Cham). The section has a Royal College accredited training programme in Pediatric Hematology/Oncology (Program Director, Dr. Patricia J. McCusker), and is actively involved in the education of residents in the Pediatrics, Pathology and Radiation Oncology training programs, and of medical students from the University of Manitoba and abroad. Members of the section provide both clinical and didactic teaching to all levels of medical trainees as well as providing undergraduate and postgraduate research training. Teaching contributions are also made to continuing medical education in areas that include ethics and evidence-based medicine, and to the education of allied health personnel and the public. 64
  • 65. Research activities include participation in multicentre national and international hematology and oncology clinical trials and registries. Local research interests presently focus on the development of quality-of-life instruments, cancer epidemiology, platelet biology and neuro-development. The year 2002-2003 has been marked by the following changes: • An increased workload per physician as we continue to pursue recruitment of another physician. • Dr. David Eisenstat is anticipating for the following changes: Two graduate student committees, two undergraduate student committees, one additional graduate student to supervise, journal reviewer of Cancer Research, external reviewer of Canadian Diabetes Association, and also expecting 3-6 visiting professorships from Canadian/ US academic centers. Teaching activities: Dr. Patricia J. McCusker is the Program Director of the Royal College-accredited training program in Pediatric Hematology/Oncology. The section is actively involved in the education of residents in the Pediatrics, Pathology and Radiation Oncology training programs, and of medical students from the University of Manitoba and abroad. Members of section provide both clinical and didactic teaching to all levels of medical trainees as well as providing undergraduate and postgraduate research training. Teaching contributions are also made to continuing medical education in areas that include ethics and evidence-based medicine, and to the education of allied health personnel and the public. In July 2002, the section accepted a fellowship trainee from abroad and another fellowship trainee was welcomed in October 2003. The section is actively seeking fellowship candidates for the coming years. The total teaching hours for all Section members: • Undergraduate Medicine teaching - 530 hours • Postgraduate Medicine Clinical teaching - 1,709 • Other postgraduate teaching - 453 hours • BSc Med Student supervision # of students - 2 students • Graduate student supervision - 5 students • Post Doctoral Fellow supervision – 3 students Publications: Al-Matar MJ, Petty RE, Tucker LB, Malleson PN, Schroeder ML, Cabral DA. The early pattern of joint involvement predicts disease progression in children with oligoarticular (pauciarticular) juvenile rheumatoid arthritis. Arthritis Rheumatol 2002;45:2708-15. Cham B, Israels L. In Mechanism in Hematology. Editor Lyonel Israels, Esther Israels. Core Health Services Inc., Gnosis Inc., 3rd edition, 2002 (book chapter). Cham B, Bonilla MA, Winkelstein J. Neutropenia associated with Primary Immunodeficiency Syndromes. Sem Hematol 2002;96(2):107-112. 65
  • 66. Dale DC, Cottle TE, Fier CJ, Bolyard AA, Bonilla MA, Boxer LA, Cham B, et al. Severe Chronic Neutropenia: Treatment and Follow-Up of Patients in the Severe Chronic Neutropenia International Registry. Am J Hematol 2003;72:82-93. De Melo J, Qiu X, Du G, Cristante L, Eisenstat DD. Dlx1, Dlx2, Pax6, Bm3b and Chx10 homeobox gene expression define the retinal ganglion and inner nuclear layers of the developing and adult mouse retina. J Comp Neurol 2003;461:187-204. Doda W, Freedman M, Yanofsky R, Silva M, Wu J, Woodman R, Dower N, Kaiser A, Halton J, Odame I, Jardine L, Bernstein M, Brossard J, Fernandez C, Hand JP, Vohra S, Stephens D, Dror Y. The Canadian Inherited Marrow Failure Registry (CIMFR), the first comprehensive study of inherited marrow failure syndromes. First Annual Report. Blood 100(11):874a,2002. Eisenstat DD, Costa R, Mason W. Management of Low Grade Glioma in Children and Adults. (Submitted) Israels SJ. Neonatal platelet function. In: Platelets (Michelson AD, ed). Academic Press, pp. 367-75,2002. Israels SJ. Factor VII deficiency. eMedicine Journal[serial online]. Available at: http://www.emedicine.com/ped/topic #3041.htm, 2002. Israels SJ. Factor XIII deficiency. eMedicine Journal[serial online]. Available at: http://www.emedicine.com/ped/topic #3040.htm, 2002. Israels SJ. Inherited abnormalities of fibrinogen. eMedicine Journal[serial online]. Available at: http://www.emedicine.com/ped/topic #3042.htm, 2002. Israels SJ, Israels ED. Platelets Structure and Function in Mechanism in Hematology, 3rd Ed (Israels LG and Israels ED, eds). Core Medical Information, pp. 369-392, 2002. Israels SJ, Poon M-C, Rand ML. Platelet Function Disorders: An Information Booklet for Patients, Families and Health Care Providers (2nd. Ed), 2002. (Patient/Physician Guidelines) Israels SJ, Rand ML and Michelson D. Neonatal platelet function. Seminars in Thrombosis and Hemostasis 2003;29:363-71. Kaila B, Dean HJ, Schroeder ML, Taback SP, HLA Day Care attendance and socio- economic status in young patient with Type I Diabetes. Diabet Med 2003;20:777-80. Kothari S, Cizeau J, McMillan-Ward E, Israels SJ, Bailes M, Ens K, Kirshenbaum LA and Gibson SB. BNIP3 plays a role in hypoxic cell death in human epithelial cells that is inhibited by growth factors EGF and IGF. Oncogene 2003;22:4734-44. Lindemulder S, Sather H, Gaynon PS, La M, Yanofsky R, Stork LC. Isolated Central Nervous System (ICNS) relapse in children with Standard Risk (SR) ALL: Results of CCG-1952. Blood 2002;100(11),156a. Luo M, Ramdahin S, Iqbal S, Pan Y, Jacobson K, Narayansingh MJ, Schroeder ML, Brunham RC, Embree J, Plummer FA. High resolution sequence-based DPB1 typing 66
  • 67. identified two novel DPB1 alleles, DPB1* AND DPB1*9501, from a Kenyan population. Tissue Antigens 2003;62:182-4. Male C, Andrew M, McCusker PJ, et al. Comparison of venography and ultrasound for the diagnosis of asymptomatic deep vein thrombosis in the upper body in children: results of the PARKAA study. Prophylactic Antithrombin Replacement in Kids with ALL treated with Asparaginase. Thromb Haemost 2002;87(4):593-8. McNicol A, Israels SJ. Platelets and anti-platelet therapy. J Pharmacol Sci 2003;93:381-96. Michaud J, Feng W, Osato M, Cottler G, Israels S, et al. In vitro analyses of known and novel RUNX1/AML1 mutations in dominant familial platelet disorder with predisposition to acute myelogenous leukemia: implications for mechanisms of pathogenesis. Blood 2002;99(4):1364-72. Mitchell L, Andrew M, McCusker PJ, et al. Trend to efficacy and safety using antithrombin concentrate in prevention of thrombosis in children receiving l- asparaginase for the treatment of acute lymphoblastic leukemia. Results of the PAARKA study. Thromb Hemost 2003;90(2):235-44. Mitchell LG, Andrew M, McCusker PJ, et al. A prospective cohort study determining the prevalence of thrombotic events in children with acute lymphoblastic leukemia and a central venous line who are treated with L-asparaginase: results of the Prophylactic Antithrombin Replacement in Kids with Acute Lymphoblastic Leukemia Treated with Asparaginase (PARKAA) Study. Cancer 2003;97(2):508-16. Oen K, Malleson PN, Cabral DA, Rosenberg AM, Petty RE, Reed M, Schroeder ML, Cheang M. Early predictors of long-term outcome in patients with juvenile rheumatoid arthritis: subset-specific correlations. J Rheumatol 2003;30:585-93. Schroeder ML. Red cell antigens. In LG Israels, ED Israels, editors. Mechanisms in Hematology Third Edition. Core Health Services Inc. Concord, Ontario, pp.107-21,2002. Schroeder ML. Transfusion-associated graft-versus-host disease. Br J Hematol 2002;117:275-87. Woodgate RL, Degner LF, Yanofsky R. A Different Perspective to Approaching Cancer Symptoms in Children. J Pain and Symptom Management 2003;26(3):800-17. Yang KL, Schroeder ML, Cherng JM, Lin PY. Serological identification of a non-HLA antigen in Oriental Population. European J Immunogenet 2003;30,283-87. Yanofsky RA. Hemophilia. In Emergency Pediatrics, 6th edition, Roger M. Barkin, Editor; Peter Rosen, Assistant Editor. C.V. Mosby Company, Philadelphia, pages 696-708, 2003. Research activities: Research activities include participation in multicentre national and international hematology and oncology clinical trials and registries. Local research interests presently focus on the development of quality-of-life instruments, cancer epidemiology, platelet epidemiology, platelet biology and neuro-development. 67
  • 68. Grants received: Sara J. Israels CancerCare Manitoba Foundation The role of CD63 in Platelet Integrin Signaling Current - $48,094 Term – 2002-2003 Sara J. Israels Manitoba Medical Service Foundation (MMSF) CD63 in Platelet Integrin Signaling Current - $27,000 Term – 2002-2003 Bonnie P. Cham Annual Honorarium from Severe Chronic Neutropenia International Registry Foundation (University of Washington) Term = 2000-2002 David D. Eisenstat CancerCare Manitoba The role of BNIP-3 in hypoxia-induced cell death in brain tumors Current - $50,000 Term – 2002-2004 David D. Eisenstat March of Dimes Birth Defects Foundation (US) Basil O’Connor Starter Scholar Research Award Role of Dlx Homeobox Genes in Retinal Development and Retinoblastoma Current $117,000 Term – 2001-2003 David D. Eisenstat CancerCare Manitoba Foundation Identifying targets of Distal-less (Dlx) homeobox genes in the developing vertebrate utilizing chromatin immunoaffinity precipitation Current = 50,000 Term – 2000-2003 David D. Eisenstat Canadian Institutes of Health Research (CIHR) Characterization of 3-phosphoglycerate dehydrogenase in health and disease Current - $94,667.00 Term – 2002-2005 David D. Eisenstat Cancer Research Society (Montreal, Quebec) Role of glia maturation factor (GMF∃) in neuronal differentiation and neuroblastoma Current - $94,665 Term – 2001-2003 68
  • 69. David D. Eisenstat Manitoba Health Research Council Neuronal differentiation during development and in pediatric malignancies Current - $50,000.00 Term – 2000-2003 Patricia J. McCusker Canadian Hemophilia Society HRQL (Hemophilia) Current - $83,000 Term – Continuing Patricia J. McCusker Society Cangene HRQOL (ITP) Current - $4,000 Term – Continuing ML Schroeder (Oen KG, Nickerson P and Schroeder ML) Manitoba Institute of Child Health (Children’s Hospital Foundation) Immunogenetics and cytokine genes in rheumatoid arthritis in an aboriginal population Current - $21,750 Term - July 2001 to September 2004 ML Schroeder (El-Gabalawy H, Schroeder ML.) National Institutes of Health HLA Microsatellite Association in Aboriginal Canadian Patients with Rheumatoid Arthritis Current - $250,839 Term – April 2002 to June 2004 ML Schroeder (El-Gabalawy H, Lee N, Co-investigators: Schroeder ML, Oen K) National Institutes of Health A study to determine the association of cytokine and major histocompatibility genes in patients with juvenile and adult rheumatoid arthritis in the Cree and Ojibway population. HLA microsatellite associations in aboriginal Canadian patients with rheumatoid arthritis. Current - $164,050 USD Term – April 2002 to June 2004 Rochelle A. Yanofsky Clinical trials Children’s Oncology Group Current: $22,000 Term – November 2002 – June 22, 2002 Rochelle A. Yanofsky Clinical trials Children’s Oncology Group Current - $39,460.64 Term - July 2002 – June 2003 69
  • 70. Rochelle A. Yanofsky Dr. Paul H.T. Thorlakson Foundation Application of Comparative Genomic Hybridization (CGH) to Genetic Analysis of Pediatric Acute Lymphoblastic Leukemia Current: - $24,000 Tern - July 2002 to June 30, 2003 External Services: Sara J. Israels Association of Hemophilia Clinic Directors of Canada: Subcommittee of Hemophilia Clinic Directors of Canada on Prophylaxis Association of Hemophilia Clinic Directors of Canada: Women with Bleeding Disorder Committee Canadian Council of Pediatric Hematology/Oncology Directors Canadian Hemophilia Society (Manitoba Chapter) Medical Advisory Committee Canadian Hemophilia Society: Standards of Care Subcommittee Canadian Hemophilia Society: von Willebrand Disease Subcommittee Canadian Pediatric Platelet Study Group Children’s Cancer Foundation – Candlelighter’s Research Advisory Committee Expert Advisory Committee on Blood Regulation, Health Canada External review: Site visit to Division of Paediatric Oncology Department of Pediatrics, Children’s Hospital of Western Ontario Manitoba Blood Advisory Committee MMA Insurance Committee Royal College of Physicians and Surgeons Task Force Speciality in Pediatric Hematology/Oncology Directors Bonnie P. Cham Canadian Medical Association Committee on Ethics MMA Ethics Committee Royal College of Physicians and Surgeons of Canada – Bioethics Committee David D. Eisenstat Alberta Cancer Board External Grant Reviewer Canadian Brain Tumour Consortium (CBTC) Credentials Committee CBTC Review Panel, Head, Neopharm, Inc. PRECISE Trial Children’s Oncology Group, Brain Tumor DSG Biology Committee Councilor, Winnipeg Chapter, Society for Neuroscience Neurobiological Technologies Inc, NTI-0301, Human CRF for Malignant Glioma Advisory Board member Winnipeg High School Science Fair Supervisor Patricia J. McCusker Member, Board of Directors, Association of Hemophilia Clinic Directors of Canada Member, CHARMS Committee, Association of Hemophilia Clinic Directors of Canada Member, MS User Group Committee, Association of Hemophilia Clinic Directors of Canada Chair, Quality of Life Committee, Association of Hemophilia Clinic Directors of Canada Director, Canadian Hemophilia Society (Winnipeg) 70
  • 71. Member, Research Committee, Canadian Hemophilia Society (Winnipeg) Board member, Sunshine Foundation of Canada Physician Advisor, Sunshine Foundation of Canada Member, Sunshine Foundation of Canada, Dream Activities Committee Member, WRHA Child Health Morbidity and Mortality Committee Member, WRHA Oncology Pharmacy and Therapeutics Committee Member, WRHA Pharmacy and Therapeutics Committee for Paediatrics WRHA Working Group on Palliative Care Needs Assessment Rochelle A. Yanofsky Local Principal Investigator for COG (Administrative) Member, COG Task Force developing a treatment protocol for children with recurrent A.L.L. Member, National Grants Review Committee (The Toronto Hospital for Sick Children Foundation) WRHA/CCMB Oncology Standards Committee Member, Winnipeg Regional Health Authority Staff Council 71
  • 72. INFECTIOUS DISEASE 72
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  • 75. 75
  • 76. 76
  • 77. NEONATOLOGY Medical Staff Mary M.K. Seshia – MB, ChB, MRCP(UK), FRCP (Ed), FRCPCH (UK) (Head) Ruben Alvaro – MD, FAAP Rebecca F. Caces – MD, FRCPC, FAAP (Director, Neonatal Transport Program) Aaron Chiu – MD, FRCPC, FAAP (Director, Neonatal-Perinatal Fellowship Program) Oscar Casiro – MD, FRCPC (Director, High Risk Follow-Up) Catherine M.G. Cronin – MD,MBA, FRCPC, FRCPI, FAAP, DCH Shyamala Dakshinamurti – MD, FRCPC, Henrique Rigatto – MD, (Director, Neonatal Research) Fellows (Neonatal-Perinatal) Abdulrahman Al-Matary Mohammad Khalil Ibrahim Kutbi (until Dec. 2002) Ylva Andersson Fellows (Clinical Teaching) Aamir Hussain Nnana Idiong Medical Officers M.Kofi A.Gyampoh Kathy Darvill Saiyed Nazar 77
  • 78. The Section of Neonatology continues to strive to provide excellence in patient care, teaching and research. The clinical service is a busy one, together with St. Boniface providing tertiary care for all sick neonates in Manitoba, North Western Ontario and Nunavut. There is marked clinical diversity in the population served which gives strength to our academic program. In keeping with the concept of an integrated perinatal/neonatal program, we have a strong liaison with the Section of Maternal-Fetal Medicine and the Newborn Follow-up Program. In addition to the in house clinical service, the Section, through the Neonatal Transport Program, is responsible for ensuring safe transport of sick newborns from the referring hospitals and nursing stations, as well as transporting neonates requiring cardiac surgery. The Section encourages a multidisciplinary family-centred approach to patient care, and the sustained and dedicated support of all health professionals involved in the Section must be not only acknowledged but praised. RESEARCH ACTIVITIES: Drs. Ruben Alvaro & A. Chiu (Multicentre Collaborative Study) Medical Research Council of Canada (CIHR) Caffeine for apnea of prematurity (CAP) trial April 1999 – March 2004 - $2,091,920 Drs. Ruben Alvaro & Oscar Casiro (Multicentre Collaborative Study) NHMRC Australia Postnatal dexamethasone in tiny babies: does it do more good than harm? A randomised controlled clinical trial (The DART study) July 2000/ June 2004 – $688,902 Dr. Ruben Alvaro INO Therapeutics Inc, AGA Linde Health Care Co. Early INO for near term infants – follow-up 2003 - $6,000 78
  • 79. Dr. C.M. Cronin CIHR Evidence-based Practice Identification and Change 2002 – 2005 - $188,750. Dr. S. Dakshinamurti Thorlakson Foundation - principal investigator (2002 - Dec 2004) “Influence of Ductal Decompression of Pulmonary Vascular Circuit on Vascular Myogenic Response in Hypoxic Pulmonary Hypertension” 2002- 2004 - Operating Grant: $35,375 Dr. S. Dakshinamurti Winnipeg Rh Foundation Institute - principal investigator “Effect of Concurrent Hypoxia and Mechanical Strain on Proliferative Activation of Pulmonary Vascular Smooth Muscle Cells” April 2003-2005 Operating Grant - $45,000 Salary Support - $55,000 Dr. S. Dakshinamurti HSC Allied Health Disciplines - collaborator “The Effect of Exogenous Surfactant on Lung Inflammatory Response in Preterm Infants Weighing Less Than 1300 Grams at 28 Weeks Gestation” Nov 2002 - Nov 2004 - $10,000 Dr. S. Dakshinamurti Manitoba Institute of Child Health Establishment Grant 2002 - 2004 - $50,000 RESEARCH ACTIVITIES: (continued…) Drs. Henrique Rigatto (Principal), R. Alvaro, O. Casiro & A. Chiu Medical Research Council of Canada (CIHR) CO2 inhalation as a new treatment modality for apnea of prematurity July 2000-June 2004 - $112,465 Dr. M. Seshia Health Sciences Centre Foundation Strengthening the Continuum of Care. TeleNeonatology: Linking Community Hospitals, Tertiary Centres and Home 2002 - $24,989 Dr. M. Seshia CIHR 79
  • 80. Canadian Neonatal Network (CNN) and Evidence-based Practice Identification and Change (EPIC) 2002-2005 - $188,750 Dr. M. Seshia Children’s Hospital Foundation of Manitoba Evidence Practice Implementation and Change 2003 - $44,250 Teaching Activities The Neonatal/Perinatal Medicine Fellowship Program of the University of Manitoba is fully accredited by the Royal College of Physicians and Surgeons of Canada. Education of future academic neonatologists is a very important goal of the Section. Undergraduate teaching is provided both to the Faculty of Medicine with some responsibilities to other faculties eg Law. Provincially, members of the Section participate in teaching the Neonatal Resuscitation Program and continuing education to rural communities. Total teaching hours for all Section members: • Undergraduate Medicine Teaching – 254 hours • Postgraduate Medicine Teaching – 13124 hours • Graduate Teaching – 1440 hours • Continuing Medical Education – 105 hours • BSc Med Student Supervision – 1 student • Graduate Student Supervision – 1 students, 20 hours 80
  • 81. PUBLICATIONS: Al-Matary A, Kutbi I, Alvaro R.E, Kwiatkowski, K, Cates D, Rigatto H: The mechanistic rationale for some preterm infants to breathe primarily periodically with apneas: The major role of peripheral chemoreceptor drive. Pediatr. Res.437A, 2003. Alvaro R, Hasan S, Chemtob S, Qurashi M, Al-Saif S, Rigatto H: The inhibition of breathing observed with placental extract in fetal sheep is due to prostaglandin. Pediatr Res 51:333A, 2002. Chien LY, Ohlsson A, Seshia MM, Boulton J, Sankaran K, Lee SK: Variations in antenatal corticosteroid therapy: A persistent problem despite 30 years of Evidence, Obstet Gynecol. 2002, (99)3:4018 Chiu A, Al-Saif S, Alvaro R: Pulmonary Colonization with Ureaplasma urealyticum in the very low birth weight infants and bronchopulmonary dysplasia: a meta-analysis. Ped Res. 2003;53:312A Citano S, Dakshinamurti S, Stephens NL & Murphy TM: Myosin Light Chain Phosphorylation at 3s During Electrical Field Stimulation in Guinea Pig Tracheal. Am. Thorac Soc. 2003A Del Negro CA, Wilson CG, Butera RJ, Rigatto H, Smith JC: Periodicity, mixed-mode oscillations and quasi periodicity in a rhythm-generating neural network. Biophysical J 82:206-214, 2002. Innes AM, Seshia MM, Prasad C, al-Saif S, Friesen F, Chudley AE, Reed M, Fillinjg LA, Haworth JC, Greenberg CR: Congenital rickets caused by maternal vitamin D deficiency Ped Ch Health 2002;7:7:455. Jenson HB, Gauntt CJ, Easley KA, Pitt J, Lipshultz SE, McIntosh K, Shearer WT, the Pediatric Pulmonary and Cardiovascular Complications of HIV-1 Infection Study Group (Rigatto H, Chairman). Evaluation of Coxsackievirus Infection in Children with Human Immunodeficiency Virus Type 1-Associated Cardiomyopathy. J Infectious Diseases 185:1798-1802, 2002. Kutbi I, Al-Matary A, Kwiatkowski K, Cates D, Rigatto H. Increased peripheral chemoreceptor contribution to respiration early in life: A major destablizing factor in the control of breathing. Pediatr Res 53:436A, 2003. Kutbi I, Qurashi M, Khan A, Kwiatkowski K, Cates D, Rigatto H. Do small preterm infants require alarm settings with shorter duration for apnea than larger infants? Pediatr Res 51:383A, 2002. Lipshulta SE, Easley KA, Orav EJ, Kaplan S, Starc TJ, Bricker JT, Lai WW, Moodie DS, Sopko G, Schluchter MD, Colan SD, the Pediatric Pulmonary and Cardiovascular Complications of Vertically Transmitted HIV Infection (P2C2 HIV) Study Group (Rigatto H, Chairman). Cardiovascular status of infants and children of women infected with HIV-1 (P2C2 HIV): a cohort study. The Lancet 1-6, 2002. 81
  • 82. MacKay TL, Jakobson LS, Ellemberg D, Lewis TL, Maurer D, Casiro O: Deficits in the processing of local and global motion in very low birthweight children. Journal of Vision 3(9), 289a, , doi:10.1167/3.9.289. McIntyre I, Cates D, Rigatto H: Effects of key neuromediators on respiratory neurons cultured from the pre-Bötzinger region. Pediatr Res 51:395A, 2002. Meyers A, Gong Y, Zhang M, Casiro O, Pettigrew N, and Minuk G: Liver development in a rat model o Fetal Alcohol Syndrome. Digestive Disease and Sciences 2002:47(4): 767-772. Qurashi M, Kutbi I, Alvaro R, Kwiatkowski K, Cates D, Rigatto H. Increased peripheral chemoreceptor activity is critical in destabilizing breathing in term infants with excessive periodic breathing and hypoxemia. Pediatr Res 51:326A, 2002. Qurashi M, Kutbi I, Alvaro RE, Kwiatkowski K, Cates D, Rigatto H: Increased peripheral chemoreceptor activity is critical in destabilizing breathing in term infants with excessive periodic breathing and hypoxemia. Pediatr. Res. 326A, 2002. Rehan VK, Moddemann D, Casiro OG. Outcome of very-low-birth-weight (<1,500 grams) infants born to mothers with diabetes. Clin Pediatr (Phila) 2002, Sept: 41(7):481-91. Sankaran K, Chien LY, Walker R, Seshia M, Ohlsson.Variations in mortality rates among Canadian neonatal intensive care units. CMAJ, 2002, 22;166(2) 173-8. Starc TJ, Lipshultz SE, Easley KA, Kaplan S, Bricker JT, Colan SD, Lai WW, Gersony WM, Sopko G, Moodie DS, Schluchter MD, the Pediatric Pulmonary and Cardiovascular Complications of Vertically Transmitted HIV Infection (P2C2 HIV) Study Group (Rigatto H, Chairman). Incidence of cardiac abnormalities in children with human immunodeficiency virus infection: The Prospective P2C2 HIV Study. J Pediatrics 141:327-335, 2002. Walker RC, Ohlsson A, Sankaran K, Seshia M, Stewart SD, Lee SK Infants born in hospitals where the delivery room is located distant from NICU have poorer outcomes. Ped Res. 2002, 51,4 Weiler HA, Yuen CK, Seshia MM: Growth and bone mineralization of young adults weighing less than 150 g at birth: Early Human Develop. 2002, 67,101-112 BOOK CHAPTERS: Rigatto H. Periodic Breathing. In: Lung Biology in Health and Disease. Mathew O, Lenfant C (eds), Marcel Dekker, Inc., p. 237-272, 2003. Rigatto H. Control of Breathing in Fetal Life and Onset and Control of Breathing in the Neonate. In: Fetal and Neonatal Physiology. Polin R, Fox WW, Abman SH (eds), 3rd Edition W.B. Saunders Company and Elsevier Science Company, 2003. 82
  • 83. PRESENTATIONS: Caces R.: Outreach to rural communities, topic: Group B. Strep. Casiro O: Newburn-Cook C, Heaman M, Schopflocher D, Forget E, Jacobs P, Casiro O, Roos L, Blanchard J: Direct Medical Costs of Preterm Birth to Age Seven. SOGC meeting, Charlottetwown, PEI., June 2003. Round table on International Medical Students Exchange Programs. 30th Anniversary Celebrations. Saitama Medical School, Saitama, Japan. Nov. 2002. Martin B, Casiro O. "Electives in Developing Nations and Other Challenging Settings: A Strategy to Address Health Risks" . *10th Ottawa International Conference on Medical Education, Ottawa, July 2002. *ACMC Annual Meeting, Quebec City, April 2003 Chiu A: Chiu A, DeBooy V, Granke N, Moddemann D, Casiro O: Evaluation of birth weight criteria for screening of ROP. Oral presentation at Canadian Pediatric Society Annual Meeting, Calgary, Chiu A, Debooy V, Granke N, Moddemann D, Casiro O: Evaluation of birth weight criteria for screening of retinopathy of prematurity. Oral presentation at CPS 2003, Calgary. Ped & Child Health 2003;8(suppB):15B Cronin CM: Keynote Speaker at Annual Child Health Research Symposium, U. of Calgary, April 2, 2003 Pediatric Grand Rounds, McMaster U., Nov. 21,2002 Dakshinamurti S: S. Dakshinamurti, L. Mellow. Downregulation of Myosin Light Chain Phosphatase Activity: A Mechanism of Failed Relaxation in Early Hypoxic Pulmonary Hypertension. Abstract (Poster Presentation), Society For Pediatric Research, 2003 Chitano, S. Dakshinamurti, N.L. Stephens and T.M. Murphy. Myosin Light Chain Phosphorylation at 3s During Electrical Field Stimulation in Guinea Pig Tracheal Strips Transiently Increases at 3 Weeks Of Age. Poster Presentation. Am Thorac Soc. 2003A Novel Approaches to Pulmonary Hypertension, Department of Pediatrics, U. of Manitoba Grand Rounds, March 2002 83
  • 84. Rigatto, H: Grand Rounds Guest Speaker, First Annual Neonatal Lecture, Department of Pediatrics, University of Saskatoon, Saskatoon, Saskatchewan, March 6, 2003. Topic: Neonatal Apnea and Control of Breathing: A Personal Perspective Seshia M.: Poster Presentation, Society for Pediatric Research, May 2003: Can the S.T.A.B.L.E.® Program Be Effectively Delivered by Telehealth? Invited Speaker, Canadian Pediatric Society June 2002 - Teleneonatology Canadian Society for Telehealth, October 2002: The S.T.A.B.L.E® Program: Comparing in-person to videoconferenced Delivery” Teleneonatology: Towards a Virtual NICU AWARDS: Seshia M: Canadian Society for Telehealth: Aventis Award for Research and Innovation in the use of e-Technologies in Health Education, October 2002. 84
  • 85. NEPHROLOGY Pediatric Nephrology 2003 – 2004 Annual Report Staff (includes part time and staff who have moved out of the section during the last year) Section Head Dr Malcolm Ogborn Nephrologists Dr Patricia Birk Dr Tom Blydt-Hansen Dr Kristen Pederson Researcher Dr Harold Aukema, Ph.D. Nursing Sandy Neustedter Shirley Penner Julie Strong Rhonda Thorainson Dialysis Nurses Phyllis Malowski Dot Mochan Heather Murison Yvonne Rhoden Bev Trudel Dietitian Lisa Fiebelkorn Social Work Meagan Beamish Sonya Busca Jennifer Sveinson Administrative asst. Shannon McAteer Clerical support Gail Martin Brent Oliver Research Staff Dr Neda Bankovic-Calic Waylon Hunt Rose Jacobson Helen Konrad Heather Kovacs Elizabeth Lylyk Evan Nitschmann Carol Nuttall Elizabeth Saftiuk 85
  • 86. Clinical activities The section remains responsible for the care of children with kidney disease from Manitoba, Northwestern Ontario and most of Saskatchewan, offering diagnostic renal biopsy, acute and chronic dialysis, and renal transplantation. The section also provides support to the intensive care and other tertiary care programs requiring assistance in the areas of critical fluid and electrolyte balance and the monitoring of potentially nephrotoxic protocols. The section was joined in October by Dr Kristen Pederson, from the Hospital for Sick Children in Toronto, who is developing a special focus in the dialysis programs. The section has seen significant changes in programs in the last year: • In cooperation with Pediatric Intensive Care, a successful continuous renal replacement therapy (CRRT) program has been established, allowing very precise volume and electrolyte control of critically ill children. • A pediatric hemodialysis unit with dedicated pediatric and adolescent nursing and educational support has finally opened and is now operating successfully. Not only is the unit providing age appropriate care for our own patients, but has created the opportunity for pediatric patients from other jurisdictions to receive therapy during travel. • The section is receiving a steadily increasing number of referrals for hypertension and has expanded our 24 hour ambulatory blood pressure assessment program to 3 units. • The section has commenced outreach clinics in Thompson, Manitoba. Discussions have begun to explore a role for the section in the Renal Health Program being developed in the Island Lake Area, with a first visit to the community planned for May, 2004. Overtures have been made to establish an outreach clinic in Saskatoon but no clinic is yet planned there. • The section continues to receive national and international attention for the pioneering program of protocol renal biopsies in transplant recipients to detect and guide early intervention in renal allograft rejection. • Section staff have produced a book on the experience of kidney disease as described by children and families in their own words called “Little Heroes”, which should be in publication by the fall of 2004. The Section continues to face challenges imposed by the rapid growth in all its programs and the arguably uniquely large geographic and administratively diverse referral area. Areas of particular concern remain the provision of administrative secretarial and clerical support, and the provision of social work services, which, although increased from 0.2 EFT to 0.4 EFT, remains well below recognized case work standards. The issue of provision of appropriate emotional support continues to be developed in collaboration with Child And Adolescent Psychiatry. The challenge of developing a transition program for adolescent patients remains only partially met, being complicated by issues around age of transfer and the huge workloads of the adult renal programs to whom the patients will eventually be referred. Although the section remains an active participant in the North American Pediatric Renal Transplant Cooperative Study, which runs continent wide bench marking programs in chronic renal failure, dialysis and transplantation, demands on nursng and support staff have left data entry usually in arrears in this important quality assurance exercise. 86
  • 87. Education The section is in the second year of a reinstated fellowship program, with one fellow, Dr Aviva Goldberg, who will leave the program at the end of this academic year to undertake further advanced training in both nephrology and bioethics at the University of Chicago. We remain a popular rotation at both the resident and under graduate elective level. We accepted one external resident elective from Memorial University in the last year. Dr Patricia Birk was again cited for excellence in undergraduate nephrology teaching. Research Our section remains the most active pediatric nephrology program in Western Canada and one of the most productive in Canada. The section has maintained continuous national and industry funding for clinical and basic science research programs for several years in the areas of chronic renal allograft nephropathy and nutritional modification of renal injury. Research of the section has been presented at all major North American Nephrology and Transplantation meetings held during the last academic year, as well as at specialist meetings in the areas of nutrition and aboriginal health. Dr Patricia Birk is an active member of a Canadian Nephrology Young Investigator’s group, which has led to the recent development of new multicentre collaborations in the area of study of chronic allograft nephropathy. Research grants and contracts. Mechanism of soy protein amelioration of progression of chronic renal injury (Canadian Institutes of Health Research, Dr M. Ogborn PI) $153,249 Impact of long-term consumption of high protein diets on renal and bone health implications for dietary reference intakes. (Canadian Institutes of Health Research Dr H. Aukema PI) $327,607 Structure function relationships of renin-binding proteins (Advanced Foods and Materials Network Dr R Aluko PI, Dr M. Ogborn co-investigator) $288,000 Mechanism of soy protein amelioration of renal injury (Children’s Hospital Foundation of Manitoba, Inc, Dr M. Ogborn, PI) $45,000 Effects of dietary CLA on eicosanoid synthesis & progression of renal disease (NSERC/Dairy Farmers of Canada- Dr H. Aukema PI) $136,158 A Single Center, Prospective, Randomized, Controlled Study Of Two Chronic Immunosuppressive Protocols Using Sirolimus Or Mycophenolate Mofetil To Prevent Or Reverse Disease Progression In Pediatric Renal Transplants With Chronic Allograft Nephropathy", (Wyeth Canada, Dr T Blydt-Hansen PI) $198,000 Protocol TMA-CL-002. A Multicenter, Randomized, Double-Blind, Placebo-controlled, Parallel-group Study In Pediatric Patients of the Safety and the Pharmacokinetic Profile of Two Different Intravenous Doses of TMA-15 (Teijin America, Dr T. Blydt-Hansen) $56,000 Fibrogenic and fibromodulating effects of immunosuppressants in a rat model of ischemia- reperfusion injury (Wyeth-Ayerst, Canada, Dr P. Birk PI) $80,000 Validation of new image analysis technology for the quantification of chronic allograft nephropathy in pediatric allograft recipients. 87
  • 88. (Fujisawa Canada Inc, Dr P. Birk PI) $11,000 Dr. John Gill (UBC) and Dr. Patricia Birk (U of M) (St. Paul's Hospital PILOT Project Awards) "The use of the kidney implant biopsy to predict adverse outcomes after live kidney donation" $ 8,842 Total research funds held $1,303,856 Publications (not including abstracts) 1. Lu J, Bankovic-Calic N, Ogborn MR, Saboorian H, Aukema HM. Detrimental effects of a high fat diet in early renal injury are ameliorated by a diet containing fish oil in Han:SPRD-cy rats. J Nutr 133 133:180-186, 2003 2. Dean H, Sellers E, Birk P, Blydt-Hansen T, Ogborn MR. Children are not small adults. CMAJ 168:255-256, 2003. 3. Ogborn MR, Nitschmann E, Bankovic-Calic N, Weiler H, Fitzpatrick-Wong S, Aukema H. Dietary conjugated linoleic acid reduces PGE2 release and interstitial injury in rat polycystic kidney disease. Kidney Int 64:1214-21, 2003 4. Weiler H, Austin S, Fitzpatrick-Wong S, Nitschmann E, Bankovic-Calic N, Mollaard R, Aukema H, Ogborn MR. Hyperparathyroidism in rat polycystic kidney disease is reduced by dietary conjugated linoleic acid. Am J Clin Nutr (in press 2004) 5. Aukema H, House JD, Bankovic-Calic N, Ogborn MR. Increased renal fibrosis and expression of renal phosphatidylinositol 5-kinaseβ and phospholipase Cγ1 proteins in piglets exposed to Ochratoxin A. Nephron 96:19-25,2004 6. Birk PE, Stannard KM, Konrad HB, Blydt-Hansen TD, Ogborn MR, Cheang MS, Gartner JG, Gibson IW. Surveillance biopsies are superior to functional studies for the diagnosis of acute and chronic renal allograft pathology in children. Pediatric Transplantation (in press 2004). 7. Sankaran D, Lu J, Bankovic-Calic N, Ogborn MR, Aukema HM. Modulation of renal injury in pcy mice by dietary fat containing (n-3) fatty acids depends on level and type of fat. Lipids (in press, 2004) 8. Fair DE, Ogborn MR, Weiler HA, Bankovic-Calic N, Nitschmann E, Fitzpatrick-Wong SC, Aukema HM. Dietary soy protein attenuates renal disease progression after 1 and 3 weeks in Han:SPRD-cy weanling rats. J Nutr, ( In press 2004) 9. Clark W.F and Ogborn M.R., Flaxseed and flaxseed lignans: Effect on the progression and severity of renal failure. In “Flax –the genus Linum” Taylor and Francis, London, U.K., 2003. 10. Ogborn M.R., Flaxseed and flaxseed products in kidney disease. In “Flaxseed in Human Nutrition” Cunnane S.C. and Thompson L.M (eds), AOCS, Champaign, Ill., 2003 11. Blydt-Hansen TD, Katori M, Lassman C, Ke B, Coito AJ, Iyer S, Buelow R, Ettenger R, Busuttil RW, Kupiec-Weglinski JW. Gene transfer-induced local heme oxygenase-1 overexpression protects rat kidney transplants from ischemia/reperfusion injury. J Am Soc Nephrol. 2003 Mar; 14(3): 745-54. 88
  • 89. NEUROLOGY Medical Staff Frances Booth – MD, FRCP (Head) Asuri Prasad – MB, BS, MD, MRCP (UK), FRCPC, FAAP, FAAN Winifred Chan-Lui – MD, FRCPC, FRCP (UK) Charuta Joshi – MD, FRCPC Namrata Shah – MBBS, MD, DCH, FAAP, MD, FRCPC The major role of the Section remains provision of excellent clinical care at Children’s Hospital on an inpatient and outpatient basis and in the St. Boniface Hospital nurseries. Pediatric Neurologists continue to serve children with a wide variety of illnesses including epilepsy, headaches, neurodevelopmental and behavioural dysfunction, learning disabilities, neuromuscular disease, cerebral palsy, metabolic and degenerative diseases and brain and spinal cord tumors. Since the last report, we have been joined by Dr. Namrata Shah with special interest and expertise in neuromuscular disease. Teaching The Section members remain active in both undergraduate and post-graduate teaching in the form of bedside teaching, formal lectures and tutorials and joint conferences with the neuroscience community and with clinical genetics. Clinical Activities • Outpatient clinics continue three times a week. • In-patient Services at Children’s Hospital and at the St. Boniface Hospital nurseries continue mainly on a consultant basis with a small number of patients being admitted under the Pediatric Neurology Service. • EEG interpretation continues predominantly at Children’s Hospital with this laboratory providing the majority of neurophysiological services for children in the province. • Prolonged inpatient and outpatient video-EEG monitoring is also available. • EMG and Nerve Conduction Services are provided by both Dr. Chan-Lui and Dr. Namrata Shah. • Clinics are held at St. Amant Centre on request (Dr. F. Booth). 89
  • 90. Research activities Research activities continue, both on a multicentre basis (Ischemic Stroke Registry) and an individual basis. We continue to be involved with studies involving photic stimulation in children. Publications Greenberg C, Prasad A, Dilling L, Thompson J, Haworth J, Martin N, Wood-Steiman P, Seargeant L, Seifert B, Booth F and Prasad C. Outcome of the First 3-Years of a DNA- Based Neonatal Screening Program for Glutaric Acidemia Type I in Manitoba and Northwestern Ontario, Canada. Molecular Genetics and Metabolism 2002; 75:70-78. Shah N, Mitchell W, and Boles, R. Mitochondrial disorders: an under-recognized etiology of Infantile spasms. Journal of Child Neurology 2002; 17(5): 369-72 Mitchell W, Shah N. Vigabatrin for Infantile spasms. Pediatric Neurology 2002; 27(3):161-4 90
  • 91. PEDIATRIC INTENSIVE CARE UNIT Medical Staff 1. 1. Dr. Murray S. Kesselman, MD, FRCPC, Diplomate American Board of Pediatrics and Sub-Board of Pediatric Critical Care Medicine. Section Head - Section of Pediatric Critical Care Attending Physician - Children’s PICU Children’s Emergency Department Associate Professor, Department of Pediatrics & Child Health 2. 2. Dr. B.J. Hancock, MD, FRCSC, FACS Attending Physician - Children’s PICU Pediatric Surgeon - Children’s Hospital Associate Professor - Department of Surgery and Department of Pediatrics and Child Health 3. 3. Dr. Bryan Magwood, BSc, MD, FRCPC Attending Physician - Children’s PICU Children’s Emergency Department Director, Clinical Ethics Services, Health Sciences Centre Assistant Professor, Department of Pediatrics and Child Health 4. 4. Dr. Samir Shah, MD, FRCPC Attending Physician - Children’s PICU Children’s Emergency Department Assistant Professor, Department of Pediatrics and Child Health 5. 5. Dr. Tanya Drews, MD, FRCPC Attending Physician - Children’s PICU Assistant Professor, Department of Pediatrics and Child Health As the Attending Intensivist, section members direct a team providing intensive support or monitoring to children age 6 weeks to 16 years who require admission to the Pediatric Intensive Care Unit (PICU). The range of clinical conditions, ages and sizes of children requires a broad knowledge of pediatrics as well as specialized skills in pediatric critical care. Services provided include: • Trauma care • Post-operative care • Support for the spectrum of critical illness where complex problems involving the heart, lungs, kidney or brain require advanced technologic support. • Specialized monitoring that cannot be provided on the regular ward. • Long-term ventilation and airway support for children with chronic respiratory or neuromuscular disorders. • Consultation services to the hospital wards, emergency department and other hospitals in Manitoba, Northwestern Ontario and Nunavut who refer children to our institution. 91
  • 92. • Resuscitation and stabilization for pediatric patients throughout the Health Sciences Centre. Teaching Activities An important function of the section is to teach resuscitation, critical assessment and organ support to the pediatric, anesthesia and emergency residents who rotate through the service. Much of this teaching is accomplished at the bedside and importantly, includes the nursing staff and allied health care providers who make up the care team. The section participates in the Academic Halfday program for pediatric residents and provides lectures and seminars at the School of Respiratory Therapy, and participates in Undergraduate Medical Education. Dr. Magwood is extensively involved in teaching the Clinical Ethics Course and the Medical Humanities Programme and the University of Manitoba. He is the current Associate Dean for Undergraduate Medical Education. Dr. Hancock teaches at all undergraduate levels as well as postgraduate surgical education. She is very involved in providing Advanced Trauma Life Support Courses and in teaching Pediatric Advanced Life Support. Dr. Kesselman teaches at the postgraduate and undergraduate medical level as well as lectures at the School of Respiratory Therapy and for the Pediatric Emergency Medicine Fellows. Dr. Shah teaches at the undergraduate and postgraduate medical level as well as lectures at the School of Respiratory Therapy and for the Pediatric Emergency Medicine Fellows. Dr. Tanya Drews teaches at the undergraduate and postgraduate medical level. Research Activities Dr. Murray S. Kesselman 1. Hypothermia Pediatric Head Injury Trial 2. Severe Sepsis In Children Research Study 3. PICU Database Project 4. Canadian PICU Collaborative to Improve Patient Care and Safety in the ICU Dr. Hancock is currently involved in research in the field of renal transplantation in collaboration with Dr. P. Birk (Pediatric Nephrology). Dr. Shah is currently involved in research in the following studies: 1. Magnesium Administration in Severe Pediatric Status Asthmaticus May Reduce the Need for Intubation, Promote Early Extubation and Decrease Intensive Care Stay. 2. Comparison of Variables Affecting Outcome In Refractory Pediatric Status Epilecticus (SE) Presenting to a Canadian Prairie Pediatric Intensive Care Unit (PICU). 92
  • 93. Publications Condello, A.S., Hancock, B.J., Hoppensack, M., Tenenbein, M., Charyk Stewart T, Kirwin D, Williamson J, Findley C, Moffatt, M, Wiseman N., Postuma R, Pediatric Trauma Registries: The Foundation of Quality Care. J.Ped Surg 36(5):685-89,2001. 93
  • 94. RESPIROLOGY 94
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  • 96. 96
  • 97. RHEUMATOLOGY Annual Report for Department of Pediatrics. July 2002-June 2003 Section of Pediatric Rheumatology and Immunology Medical staff: Kiem G. Oen, BA, MD, FRCPC, (Head) Marliss Schroeder MD, FRCPC. (Associate member) Clinical activities The Section of Pediatric Rheumatology and Immunology provides clinical care for children and adolescents with rheumatic and connective tissue diseases and those with primary immunodeficiency diseases. Rheumatology Most of the patients we see have chronic arthritis, while others have other chronic autoimmune illnesses, which may present with acute exacerbations. In addition to Dr. Oen, our patient care team consists of a Clinic Nurse Coordinator, physio- and occupational therapists and social workers. Concurrent care from other specialists at the Children’s Hospital is often necessary. Our team provides medical treatment, physio- and occupational therapy, and patient education. This is achieved mostly through outpatient clinics and day-care treatments with few in-patient treatments. In 2002-2003 we had 1,021 outpatient visits (895 follow-up and 131 new consultations), 23 intraarticular joint injections, 54 in-patient consultations, 18 day admissions and 6 in-patient admissions for rheumatology. Immunology Clinical care and consultations for patients with immunodeficiencies are provided through Out-patient Clinics and in-patient consultations. Patients with antibody deficiencies receive intravenous replacement treatments in the Outpatient clinic and receive concurrent care especially from the Section of Respirology. The Immunology Clinic Nurse Coordinator administers treatments and coordinates care for our patients. Dr. Schroeder provides bone marrow transplantation and attendant care for patients with severe combined immunodeficiencies. For Immunology we had 83 outpatient visits (70 follow-up and 13 new consults), and 12 in-patient consults. Two children with severe combined immunodefiency received bone marrow transplants. Teaching Dr. Oen teaches Pediatric Rheumatology and immunodeficiency immunology to all levels of trainees and Continuing Medical Education for practicing physicians. The total formal teaching contact hours for undergraduate and postgraduate trainees in 2002-2003 were 98, in addition to clinical teaching in out-patient and in-patient settings (8 postgraduate resident rotations and 16 students in 2002-2003). Research Research in the Section focuses on juvenile rheumatoid arthritis. In 2002-2003 we published our studies on the outcome of children with juvenile rheumatoid arthritis, in collaboration with other Western Canadian pediatric rheumatology centres. We also 97
  • 98. continued family and immunogenetic studies of juvenile and adult rheumatoid arthritis in our aboriginal population. Grant support Immunogenetic and cytokine genes in rheumatoid arthritis in an aboriginal population. $21,750 July 2001 –Sept 2004, Manitoba Institute of Child Health, the Children’s Hospital Foundation Investigators: K. Oen (principal), C. Peschken, P. Nickerson, J. Evans, M. Schroeder, J. Canvin, H. El-Gabalawy, D. Robinson A study to determine the association of cytokine and major histocompatibility genes in patients with juvenile and adult rheumatoid arthritis in the Cree and Ojibway population. HLA microsatellite associations in aboriginal Canadian patients with rheumatoid arthritis. $164,050 USD. April 1, 2002 - June 2004. Investigators: Dr. H. El-Gabalawy and Dr. J. Lee Nelson (Principals). Co-investigators: Dr. M. Schroeder, Dr. K. Oen Publications: 1. Oen K, Malleson PN, Cabral DA, Rosenberg AM, Petty RE, Cheang M. Disease course and outcome of juvenile rheumatoid arthritis in a multicentre cohort. Journal of Rheumatology 2002;29:1989-99. 2. Oen K, Reed M, Malleson PN, Cabral D, Petty R, Rosenberg A, Cheang M. Radiologic outcome and its relationship to functional disability in juvenile rheumatoid arthritis. Journal of Rheumatology 2003;30:832-840. 3. Oen K, Malleson PN, Cabral DA, Rosenberg AM, Petty RE, Reed M, Schroeder ML, Cheang M. Early predictors of long-term outcome in patients with juvenile rheumatoid arthritis: Subset specific correlations. Journal of Rheumatology 2003;30:585-593. 4. Oen K: Long-term outcomes and predictors of outcomes for patients with juvenile idiopathic arthritis. Best Practice and Research Clinical Rheumatology 2002:16:347-360. 5. Malleson P, Oen K, Cabral D, Petty RE, Rosenberg AM, Cheang M. Predictors of pain in children with juvenile rheumatoid arthritis. Proceedings Park City and Beyond, March 2003. (Abstract) 98
  • 99. ST. BONIFACE GENERAL HOSPITAL ANNUAL REPORT 2003 – 2004 Women and Child Program St. Boniface General Hospital 1. Staff. Program Director: Ms. Noelie Lavergne Clinical Director (Acting): Dr. Mark Heywood Associate Head: Dr. Nigel MacDonald Section Head, Neonatology: Dr. M. Davi Section Head, Ambulatory Paediatrics: Dr. S. Kovnats Clinicians: Drs. A. Cameron, D. Grewar Neonatologists: Drs. R. Alvaro, R. Caces, A. Chiu, G. Cronin, S. Dakshinamurti, S. Moisiuk Neonatal Nurse Practitioner: Ms. D. Askin Consultants: Drs. G. Altman, M. Barker, G.B. Black, W. Chan-Lui, D. Moddemann, G. Shady, A.M. Shojania and N. Wiseman 2. Clinical Activities. A. Ambulatory Paediatrics The Ambulatory Paediatric staff continue to provide services to a large number of children from urban, rural and Nunavut communities, providing both primary and consultation clinics as well as outreach and northern visits. Subspecialty clinics that are offered include Child Psychiatry, ENT, Hematology, High Risk Newborn Follow up/Child Development, Orthopedics, Paediatric Surgery and Psychology. Ancillary services are Audiology, Dietetics, Occupational Therapy, Physiotherapy, Social Services, Speech and Language Pathology. Additional consultation clinics and ancillary services are limited by a lack of space which is hoped to be addressed in the new planned facility. B. Neonatology. Levels I, II, III Neonatology continue to be provided at St. Boniface General Hospital under the leadership of Drs. M. Davi (Section Head) and R. Alvaro (Assistant Section Head), inborn and outborn transports are accepted. The number of deliveries continue to rise, being 4,509 in 2003. The overall perinatal mortality was 13.1 per 1,000 births showing not much change with …/2 ANNUAL REPORT 2003 – 2004 Women and Child Program 99
  • 100. St. Boniface General Hospital Submitted by Dr. Nigel MacDonald, Associate Head, Dept. of Paediatrics June/04 the majority of deaths from extreme prematurity (< 750 grams) and lethal anomalies. Morbidity appears to be improving although IVH and ROP continue to elude meaningful reductions. 3. RESEARCH ACTIVITIES 1. CAP Study (Caffeine for Apnea for Prematurity Trial). This study looks at the efficacy and safety of Methylxanthines in very low birth weight infants. Involved physicians are Drs. R. Alvaro, A. Chiu, D. Moddemann. 2. DART Study This is looking at postnatal Dexamethasone in very low birth weight infants and is a randomized controlled clinical trial run by Drs. Alvaro and Chiu. 3. RSV lower respiratory infection Drs. S. Moisiuk and B. Law are looking at the risk of hospitalization for RSV infections in preterm infants between 33 and 35 weeks gestation. 4. TEACHING ACTIVITIES. There is a fairly active teaching program in both Neonatology and Ambulatory Paediatrics providing teaching to postgraduate, undergraduate and nursing students. Unfortunately there are space constraints that limits that amount of teaching available in the ambulatory facility. 5. PUBLICATIONS - Submissions are awaited. In summary, the St. Boniface General Hospital Child Health Program is active and participates in hospital, university and community activities. The ambulatory program is in need to recruit and expand its facility and the Neonatology Program must prepare for the probable discontinuance of obstetrical care at the Victoria Hospital. The program looks forward to the anticipated appointment of a new head of Paediatrics and Child Health. Respectfully Submitted, Yours sincerely, Nigel T. MacDonald, M.B., Ch. B., D.C.H., F.R.C.P. (C). Associate Head, Department of Pediatrics June 02/02 100
  • 101. PEDIATRIC UNDERGRADUATE MEDICAL EDUCATION July 2003 – June 2004 MEDICAL STAFF Director: Diane Moddemann, MD, FRCPC UGME Committee Members: Sylvia Kovnats, MD, FRCP (ITC Coordinator) Leigh Fraser-Roberts, MD, FRCP (Pre-Clerkship Coordinator) Bill deGroot, MD, FRCP (Head of General Pediatrics) Ruth Grimes, MD, FRCP (Section Head – Community Pediatrics) Ruben Alvaro, MD, FRCP (Neonatology) Linda Remple, BN, MScA (Nurse Coordinator) Resident Representatives: Jeff Hyman – Chief Pediatric Resident Orlee Guttmann Tannis Wiebe Student Representatives: Paul Moorehead Marni Hanna OVERVIEW OF THE SECTION’S FUNCTION AND FOCUS The Pediatric Undergraduate Medical Education Program functions within the context of the Undergraduate Medical Education Program, Faculty of Medicine, University of Manitoba. The Pediatric Undergraduate Medical Education Program strives to provide a learning environment that will encourage the student to appreciate and understand the unique feature of infant, child and adolescent medicine. This will help prepare the student to incorporate and build upon their knowledge of Pediatrics throughout their medical education and upon graduation as a competent physician. The fundamental purpose of the Pediatric program is to provide the student with the ability to acquire basic knowledge, skills and attitudes appropriate for pediatric medicine, which will serve as a foundation for providing competent childcare in whatever field of medicine the student enters. Undergraduate Pediatric Medical Education is divided into two main components, the first two Pre-Clerkship years and the Clerkship years. Pediatric concepts are taught throughout the Pre-Clerkship curriculum as integrated components of the various teaching blocks including the “various systems”. The accumulation of these concepts provides a framework for the intensive six-week Pediatric rotation in the Clerkship years. During the first two years the goals and objectives are met through a series of lectures, tutorials, problem-based learning sessions, independent learning, bedside teaching and clinical sessions with actual patients and standardized “patients”. 101
  • 102. The Pediatric Clerkship rotation involves an intensive six-week block of ambulatory and inpatient components to provide the students with a broad experience in pediatric health. Clerks work under close supervision of GFT and community pediatricians as well as pediatric residents. The three-week inpatient component allows the Clerk to work as a team member of one of the pediatric general medical services. The ambulatory component provides the student with the opportunity to work closely with a pediatrician in an outpatient setting and at Children’s Clinic or St. Boniface Hospital, in addition to various other learning environments such as Emergency, Fast Track Clinic, various subspecialty and community clinics. We have instituted a successful rural rotation with interested students having the opportunity to complete part of the rotation in Thompson, Brandon, Portage La Prairie and Selkirk. Problem solving sessions, self-study, computer aided learning tutorials, seminars and/or discussions with pediatricians and sub- specialists round out the learning opportunities. There are 360 students enrolled in The Faculty of Medicine all of whom receive identical pediatric learning experiences. In order to provide the necessary teaching, we rely extensively on the expertise and teaching commitments of geographical full-time, community pediatricians, pediatric residents and fellows. Approximately 135 individuals provide greater than 5000 hours of undergraduate medical education yearly in addition to ward supervision and supervision in various clinical settings. Committee members, along with other faculty members, are involved in providing Faculty Development to the pediatricians through the TIPs programs and other venues. COMMITTEE INVOLVEMENT Members of the Pediatric Undergraduate Medical Education Committee participate in numerous Department of Pediatrics and Child Health as well as Faculty of Medicine education committees. These include: Department of Pediatrics and Child Health Committees - Education Coordinating Committee - Pediatric Continuing Medical Education Committee - Department Undergraduate Medical Education Committee - Pediatrics Medical Education Interest Group Faculty of Medicine - Clerkship Committee - Clinical Comprehensive Exam Management Committee - Committee on Evaluation, Clinical - In-training Evaluation Review Committee - Introduction to Clerkship Committee - Pre-Clerkship Curriculum Committee - Clinical Skills Committee - OSCE Committee - Systems Blocks Coordinating Committees Continuing Medical Education 102
  • 103. - TIPs Faculty Committee The Director is a member of the Pediatric Undergraduate Program Directors of Canada Committee (PUPDOCC), as well as a member of the Council of Medical Students Evaluation in Pediatrics (COMSEP). Yearly national and international program directors’ meetings are attended. Through these organizations, information is shared between programs, common educational goals and strategies implemented and research information disseminated. TEACHING AWARDS PRESENTED At the Department level we present yearly teaching awards to a resident, geographic full-time pediatrician and a community pediatrician identified by the medical students as providing exemplary teaching in the Pediatrics programs. This year the awards were given to: Resident: Dr. Shezan Amed GFT: Dr. Ruben Alvaro Community: Dr. Kelleigh Klym Special Award for Continued Commitment and Excellence in Education: Dr. Jeff Hyman The Faculty of Medicine also presents awards for excellence in Undergraduate Medical Education at its annual Teaching Awards Ceremony. The following members of the Department were nominated for their teaching excellence: Medicine I: Dr. Brian Magwood Dr. Charuta Prasad Dr. Wade Watson Dr. Ana Hanlon-Dearman Dr. Reeni Soni Medicine II: Dr. Patricia Birk Dr. Oscar Casiro Dr. Ana Hanlon-Dearman Most Outstanding Clinician – Clerkship Dr. Bill deGroot Most Outstanding Resident: Dr. Gerald Brennan Dr. Jeff Hyman Dr. Jeff Hyman was awarded the “Most Outstanding Resident” award 103
  • 104. PEDIATRIC POSTGRADUATE MEDICAL EDUCATION (PGME) Section Description The Section of Postgraduate Medical Education oversees the training of physicians pursuing a career in pediatrics. There are currently 26 residents (PGY 1-4) and 8 fellows (PGY5 and higher) within the program at various stages of their training. The University of Manitoba offers a fully approved four-year training program in Pediatrics leading to certification by the Royal College of Physicians and Surgeons of Canada. The program is organized to meet the Royal College CanMEDS competencies (Medical Expert, Communicator, Collaborator, Manager, Health Advocate, Scholar and Professional) and provides the trainee with opportunities to develop broadly based competencies in all aspects of the health care of children including general/consultant and subspecialty care. The program in an integrated one, taking place mainly at the Children’s Hospital, Health Sciences Center, with some rotations at St. Boniface General Hospital, Thompson General Hospital as well as at community preceptor sites within Manitoba. Our educational activities are coordinated with the Undergraduate and Faculty Development Educational Programs. Medical students apply to the University of Manitoba through the Canadian Resident Matching Service (CaRMS). Each year we receive approximately eighty applications for 4-5 positions. Students are “ranked” after a review of their application and a personal standardized interview. In the past five years, students who have joined our program have had training from across Canada. Medical Staff for 2002-03 Ming-Ka Chan, MD, FRCPC - Head PGME COMMITTEE MEMBERS REPRESENTATION TERM Michael Moffatt, MD, FRCPC Department Head Ongoing Allan Cameron, MD, FRCPC St. Boniface Rep. Ended June/03 Aaron Chiu, MD, FRCPC Fellowship Directors Rep. Sept. 2001 Stan Moroz, MD, FRCPC Section Head Rep 1995 Shayne Taback, MD, FRCPC Resident Research 1999 Janet Grabowski, BSc (Med), MD, FRCPC PT 1995 Frank Friesen. MD, FRCPC PT 1999 Milton Tenenbein, MD, FRCPC GFT Nov.1996 William DeGroot, MD, FRCPC Inpatient Ward Rep Dec.2001 Ruth Grimes, MD, FRCPC Section Head – Comm. Peds. Dec.2001 Liz Sellers, MD, FRCPC GFT Dec. 2002 Kelleigh Klym, MD, FRCPC PT Dec. 2002 RESIDENT COMMITTEE MEMBERS Grant Yung Chief Resident 2002-03 Simone Vaz Chief Resident 2002-03 Jennifer Teskey Third Year Resident 2002-03 Billy Quan Third Year Resident 2002-03 Karen Stannard Second Year Resident 2002-03 Shazhan Amed Second Year Resident 2002-03 Tannis Wiebe First Year Resident 2002-03 Melissa Gross First Year Resident 2002-03 104
  • 105. Pediatric Residents 2002-2003 First Year Second Year Michael Cooke Shazhan Amed Melissa Gross Mohammed Barzanji Orlee Guttman Gerald Brennan (until Dec. 18/02) Abdullatif Haresha Deepa Francis Tanya Kemp Scott Sawyer Alison Rusnak (Genetics) Karen Stannard Stasa Veroukis Tannis Wiebe Amal Zubani Third Year Fourth Year Gerald Brennan (as of Dec 19/03) Abdulkader Alrezqi (Saudi) Hani Hadi Sukeshini Amarasekera (MATH – Extra) Jeff Hyman Edmond Chan (MATH – Allergy) Jaret Mcleod (until Sept 25/02) Aviva Goldberg (MATH - Nephrology) William Quan Jaret Mcleod (as of Sept 26/02) Jennifer Teskey Simone Vaz Grant Yung Subspecialty Residents & Fellows Khalid Aljamaan (Saudi – Hematology and Oncology) Abdul Al-Matary (Neonatology) Nestor Cisneros (MATH- Allergy and Immunology) Aamir Hussain (Neonatology) Nnanake Idiong (Neonatology) Mohammed Khalil (Neonatology) Ibrahim Kutbi, (Neonatology) Per Lidman (MATH - Allergy and Immunology) Medical Staff for 2003 - 2004 Ming-Ka Chan, BSc, MD, FRCPC - Head PGME COMMITTEE MEMBERS REPRESENTATION TERM Cheryl Greenberg, MD, FRCPC Department Head Ongoing Aaron Chiu, MD, FRCPC Fellowship Directors Rep. Sept. 2001 St. Boniface Rep. Sept. 2003 Stan Moroz, MD, FRCPC Section Head Rep 1995 Shayne Taback, MD, FRCPC Resident Research 1999 Janet Grabowski, BSc (Med), MD, FRCPC PT 1995 Frank Friesen. MD, FRCPC PT 1999 Milton Tenenbein, MD, FRCPC GFT Nov.1996 William DeGroot, MD, FRCPC Inpatient Ward Rep Dec.2001 Ruth Grimes, MD, FRCPC Section Head – Comm. Peds. Dec.2001 Liz Sellers, MD, FRCPC GFT Dec. 2002 Kelleigh Klym, MD, FRCPC PT Dec. 2002 Wade Watson, M.D., FRCPC Dir – Faculty Development July 2003 RESIDENT COMMITTEE MEMBERS Hani Hadi Chief Resident 2003-04 Jeff Hyman Chief Resident 2003-04 Karen Stannard Third Year Resident 2003-04 105
  • 106. Shazhan Amed Third Year Resident 2003-04 Tannis Wiebe Second Year Resident 2003-04 Melissa Gross Second Year Resident 2003-04 Anita Lau First Year Resident 2003-04 Brandy Wicklow First Year Resident 2003-04 Pediatric Residents 2003-2004 First Year Second Year Andrew Dixon Michael Cooke Sergio Fanella Melissa Gross Anita Lau Orlee Guttman Eddsel Martinez Abdullatif Haresha Brandy Wicklow Tanya Kemp Julie Richer (Genetics) Stasa Veroukis Tannis Wiebe Amal Zubani Third Year Fourth Year Shazhan Amed Hani Hadi Mohammed Barzanji Jeff Hyman Gerald Brennan (until Dec 12/03) Jaret Mcleod (until Sept 17/03) Scott Sawyer William Quan Karen Stannard Jennifer Teskey PEDIATRIC FELLOWSHIP SUBCOMMITTEE Dr. Ming-Ka Chan, Chair COMMITTEE MEMBERS REPRESENTATION TERM Allan Becker, MD, FRCPC Pediatric Allergy & Clinical ongoing Immunology Tom D. Blydt-Hansen, MD, FRCPC Pediatric Nephrology ongoing Aaron Chiu, MD, FRCPC Neonatal-Perinatal Medicine ongoing Bernie Chodirker, MD, FRCPC Genetics and Metabolism ongoing Louise Giles, MD, FRCPC Pediatric Respirology ongoing Barbara Law, MD, FRCPC Pediatric Infectious Diseases ongoing Sally Longstaffe, MD, FRCPC Developmental Pediatrics ongoing Patricia McCusker, MD, FRCPC Pediatric Hematology and Oncology ongoing Lynne Warda, MD, FRCPC Pediatric Emergency Medicine ongoing Merrilee Zetaruk, MD, FRCPC Pediatric Sports Medicine ongoing Subspecialty Residents & Fellows 2003-04 Saleh Al-Harbi (Saudi – Respirology as of Sept/04) Khalid Aljamaan (Saudi – Hematology and Oncology) Mohammed Almutairi (Saudi – Emergency) Abdul Almatary (Neonatology) Greg Appelt (MATH - Allergy and Immunology) Karen Backway (Nancy Fund - Hematology and Oncology) Gerald Brennan (MATH – Emergency as of Dec 13/03) Haider Arishi (Saudi – Infectious Diseases) Edmond Chan (MATH- Allergy and Immunology) Cecilia de Cabo (Neonatology as of April 2004) Aviva Goldberg (MATH - Nephrology) Aamir Hussain (Neonatology) 106
  • 107. Mohammed Khalil (Neonatology) Per Lidman (MATH - Allergy and Immunology) Joel Liem (NTPAA - Allergy and Immunology) Mosarrat Qureshi (Neonatology) Academic/Scholarly Aspects of the Program Formal Rounds • Intake Rounds (twice weekly) • Service/Potpourri/Subspecialty/Trauma Rounds (weekly) • Academic Half-Day (weekly) • Pediatric Grand Rounds (weekly) • Research/Epidemiology Rounds (weekly) • Journal Club (monthly) Workshops • Transition to Senior Resident Workshop (Annual) • Canadian Pediatric Chief Residents’ Skills Workshop (Annual) Educational Awards • 2002-03 Pediatrician of the Year: Dr. Charlie Ferguson • 2003-04 Pediatrician of the Year: Dr. Bill DeGroot • 2003-04 Faculty awards for outstanding contributions to resident education: o Dr. Fran Booth o Dr. Charuta Joshi o Dr. Martin Reed Resident Research Awards 2002-03 • Winner of the University of Manitoba Pediatric Resident and Fellow Research Competition (Resident category): Dr. Grant Yung • Winner of the University of Manitoba Pediatric Resident and Fellow Research Competition (Fellow category): Dr. Abdul Al-Matary • Winner of the National Pediatric Resident and Fellow Competition (Resident category): Dr. Ra Han – University of Toronto • Winner of the Pediatric Resident and Fellow Competition (Fellow category): (Tie) Dr. Constadina Panagiotopoulos – University of British Columbia and Dr. Michel Roy – University of Montreal 2003-04 • Winner of the University of Manitoba Pediatric Resident and Fellow Research Competition (resident category): Dr. Shazhan Amed • Winner of the National Pediatric Resident and Fellow Competition (resident category): Dr. Shazhan Amed • Winner of the Pediatric Resident and Fellow Competition (fellow category): Dr. Jayson Stoffman • University of Manitoba recipient for the Program for Excellence in Resident Research (co- sponsored by the Canadian Society for Clinical Investigation and the Canadian Institutes of Health Research) (resident category): Dr. Shazhan Amed Annual Events • Welcome Party • Fall Retreat 107
  • 108. • Holiday Party • Spring Retreat Educational Research Activities 2003 – 2004 “A Comparison of the Handheld Computer with Paper as a Means of Enhanced Data Collection for the Clinical Assessment of Medical Students.” Grant received from Medical Council of Canada $20000 (1 year) and Health Sciences Centre Innovations and Opportunities Fund $5000 (1 year) PI: Dr. Ming-Ka Chan Royal College Exams Pediatrics 2002-03 Abdulkader Alrezqi Sukeshini Amarasekera Aviva Goldberg (MATH - Nephrology) Simone Vaz Grant Yung Pediatrics 2003-04 Subspecialty Pediatrics Gerald Brennan Edmond Chan (Pediatric Allergy and Immunology) Edmond Chan Per Lidman (Pediatric Allergy and Immunology) Hani Hadi Jayson Stoffman (Pediatric Hematology and Oncology) Jeff Hyman Jaret Mcleod William Quan Jennifer Teskey Director Committee Involvement (2002 onwards) • Department of Pediatrics & Child Health Committees o Departmental Postgraduate Medical Education Committee o Executive and Planning Committee o Education Co-ordinating Committee o Pediatric Continuing Medical Education Committee o Pediatric Fellowship Subcommittee o ER Waiting Time Working Group o Pediatrics Medical Education Interest Group • Faculty of Medicine o Faculty Postgraduate Medical Education Committee • National o Royal College Pediatrics Subcommittee-Nucleus Member (Area 2 Representative) o Royal College Pediatrics OSCE Exam Committee Member and Examiner o Canadian Pediatric Training Program Directors Committee Contact information Program Administrative Assistant: Lisa Ferens Address: AE104-840 Sherbrook St. Winnipeg, Manitoba, R3A 1S1 Phone: (204) 787 2439 Fax: (204) 787 1938 Email: pgme_peds@exchange.hsc.mb.ca 108
  • 109. Website Links • Link to PARIM (Professional Association of Residents and Interns of Manitoba): www.parim.org • Link to CARMS website: www.carms.ca (Canadian Resident Matching Service) • Link to fellowship training programs: www.sections@cps.ca (Canadian Pediatric Society) Pediatric Fellowships Programs • Dr. Allan Becker, Pediatric Allergy & Clinical Immunology Office: 204-787-2455 FAX: 204-787-5040 Email – becker@cc.umanitoba.ca • Dr. Sally Longstaffe, Developmental Pediatrics Office: 204-787-4378 FAX: 204-787-1138 Email – slongstaffe@hsc.mb.ca • Dr. Lynne Warda, Pediatric Emergency Medicine Office: 204-787-1873 Fax: 204-787-2070 Email – lwarda@mts.net • Dr. Bernie Chodirker, Genetics Office: 204-787-4803 Fax: 204-787-1419 Email – BChodirker@exchange.hsc.mb.ca • Dr. Patricia McCusker, Pediatric Hematology and Oncology Office: 204-787-4135 Fax: 786-0195 Email: patricia.mccusker@cancercare.mb.ca • Dr. Barbara Law, Pediatric Infectious Diseases Office: 204-789-3629 Fax: 204-789-3926 Email – blaw@ms.umanitoba.ca • Dr. Aaron Chiu, Neonatal-Perinatal Medicine Office: 204-787-1829 Email – achiu@exchange.hsc.mb.ca • Dr. Tom D. Blydt-Hansen, Pediatric Nephrology Office: 204-787-4947 Fax: 204-787-1666 Email – tblydthansen@exchange.hsc.mb.ca • Dr. Louise Giles, Pediatric Respirology Office: 204-787-4753 Email – gilesbl@cc.umanitoba.ca • Dr. Merrilee Zetaruk, Pediatric Sports Medicine Office: 204-787-2583 Email – mzetaruk@shaw.ca 109
  • 110. CHILD HEALTH QUALITY TEAM Table of Contents MEDICAL STAFF.............................................................................................5 PUBLICATIONS IN PEER-REVIEWED JOURNALS (excluding abstracts).............10 TEACHING ACTIVITIES.................................................................................17 PROGRAM DEVELOPMENT............................................................................18 PUBLICATIONS............................................................................................18 Publications.................................................................................................20 University of Manitoba................................................................................21 Medical Staff................................................................................................21 Teaching Activities........................................................................................22 Quality Assurance Initiatives:......................................................................25 Invited Lectures:..........................................................................................27 Clinical Activities...........................................................................................30 Teaching Activities........................................................................................31 Research Activities.......................................................................................31 MMSF........................................................................................................31 CHRF........................................................................................................32 CIHR.........................................................................................................32 Capital Health Authority..............................................................................32 Canadian Institute of Child Health...............................................................32 Canadian Institute of Child Health...............................................................32 ANNUAL REPORT.........................................................................................36 Dermatology................................................................................................38 2003-2005..................................................................................................38 Medical Staff..............................................................................................38 Clinical activities.........................................................................................38 Year .........................................................................................................38 Consultations.............................................................................................38 Return visits..............................................................................................38 Telehealth consults....................................................................................38 Total Patient visits......................................................................................38 Teaching activities ....................................................................................38 2003-2005.............................................................................................38 2005......................................................................................................39 Educational grants:....................................................................................39 Research Activities.....................................................................................39 ATTENDING PHYSICIANS.............................................................................41 Outreach.....................................................................................................41 Medical Staff..............................................................................................43 Clinical Activities........................................................................................43 Teaching Activities.....................................................................................43 Research Activities ....................................................................................44 AWARDS ..................................................................................................49 110
  • 111. Dr. H. Dean:..............................................................................................49 Dr. E. Sellers:............................................................................................49 Medical Staff................................................................................................50 Faculty Development is available for assisting the Office of Undergraduate and Postgraduate Medical Education in the development of educational strategies to improve the teaching and learning environment for medical students and residents. A needs assessment survey was sent to full and part-time faculty members to help define the educational needs for department members and to promote the evolution of ideas and skills so that department members may become better educators. Collaboration with University Faculty Development Programs is ongoing......................................................................................50 Academic/Scholarly Aspects of the Program...................................................51 Committee Involvement................................................................................51 ..................................................................................................................54 Service Provision..........................................................................................54 Key Strategies and Goals..............................................................................55 Human Resources .......................................................................................56 Plan for Next Three Years.............................................................................57 ............................................................................................................58 A. Currently many general and cancer adult patients are seen in the Children’s Hospital Clinics. An ideal place for these individuals would be in other sites such as Cancer Care Manitoba outpatient facility for the cancer patients, and a more mature space in the WRHA region for adult general genetics clinics. With the opening of the CSRP at the HSC, Genetics will be well positioned as a Program to successfully argue for these patient care issues....................................................................................................58 B. Genetics office space is inadequate for the number of employees in the program. Some of the staff are off site and this has led to poor staff morale, team alienation, inefficiency, and reduced productivity for the program. With the opening of the CSRP at the HSC, Genetics will be well positioned as a Program to more successfully argue for these employee care issues..........58 Appendix.....................................................................................................62 Paediatric Haematology/Oncology/Bone Marrow Transplant............................64 Medical Staff..........................................................................................64 Fellows (Neonatal-Perinatal).........................................................................77 Medical Staff..............................................................................................89 Teaching......................................................................................................89 Clinical Activities...........................................................................................89 Teaching Activities........................................................................................92 Research Activities.....................................................................................92 Publications...............................................................................................93 Clinical activities...........................................................................................97 Teaching......................................................................................................97 Research.....................................................................................................97 Grant support .............................................................................................98 MEDICAL STAFF.........................................................................................101 111
  • 112. OVERVIEW OF THE SECTION’S FUNCTION AND FOCUS................................101 COMMITTEE INVOLVEMENT........................................................................102 TEACHING AWARDS PRESENTED................................................................103 Medical students apply to the University of Manitoba through the Canadian Resident Matching Service (CaRMS). Each year we receive approximately eighty applications for 4-5 positions. Students are “ranked” after a review of their application and a personal standardized interview. In the past five years, students who have joined our program have had training from across Canada. ..................................................................................................................104 Medical Staff for 2002-03............................................................................104 Pediatric Residents 2002-2003....................................................................105 First Year Second Year ........................................................................105 Third Year Fourth Year.........................................................................105 Subspecialty Residents & Fellows................................................................105 Medical Staff for 2003 - 2004......................................................................105 Pediatric Residents 2003-2004....................................................................106 First Year Second Year .......................................................................106 Third Year Fourth Year........................................................................106 Subspecialty Residents & Fellows 2003-04...................................................106 Academic/Scholarly Aspects of the Program ................................................107 Formal Rounds.........................................................................................107 Workshops...............................................................................................107 Annual Events..........................................................................................107 Educational Research Activities.................................................................108 Royal College Exams................................................................................108 Department of Pediatrics & Child Health Committees..............................108 Faculty of Medicine...............................................................................108 National...............................................................................................108 Contact information..................................................................................108 Website Links .........................................................................................109 Pediatric Fellowships Programs.................................................................109 INTRODUCTION.........................................................................................114 PERSONNEL...............................................................................................114 FUNDING...................................................................................................114 ACCOUNTABILITY AND REPORTING............................................................114 Child Health Quality Council...................................................................115 STRATEGIC PLANNING, QUALITY TEAM......................................................115 Mission.................................................................................................115 Vision...................................................................................................115 Values .................................................................................................116 STRATEGIC PLANNING, CHILD HEALTH PROGRAM.......................................116 QUALITY IMPROVEMENT............................................................................117 ABC PROJECT 3.5: Clinical Resource Management..................................117 Process Mapping and Improvement ......................................................117 Bronchiolitis..........................................................................................117 Emergency Wait Time...........................................................................118 112
  • 113. Orthopedic Short Stay Working Group....................................................118 Transitional Care Home.........................................................................118 EPIC Study...........................................................................................118 ISO 9001:2000 in Diagnostic Imaging....................................................119 Family Centred Care .............................................................................119 RISK MANAGEMENT...................................................................................119 UTILIZATION.............................................................................................119 ACCREDITATION........................................................................................120 STANDARDS...............................................................................................120 ORGANIZATIONAL DEVELOPMENT..............................................................121 DECISION SUPPORT...................................................................................122 Benchmarking .........................................................................................122 Canadian Pediatric Decision Support Network (CPDSN):..........................122 Canadian Neonatal Network (CNN):.......................................................122 Balanced Scorecard..................................................................................122 FUTURE DIRECTIONS.................................................................................122 ACKNOWLEDGEMENTS...............................................................................123 APPENDIX 1: Progress towards Vision..........................................................124 113
  • 114. INTRODUCTION 2003 was the second year of operation and was a hectic year for the Child Health Quality Team. Highlights are summarized below. PERSONNEL Child Health Quality Team Director: Dr. Gerarda Cronin Quality Manager: Leslie Galloway Quality Analyst: Maggie Jugenburg Administrative Assistant: Karla Hoare Family Centred Care Advisor Joanne Van Dyck (effective September 2003) Associates Management Intern: Dr. Ryan Bates (till June 2003) Chair, Child Health Standards: Dr. Patricia Birk We bid farewell to Dr. Ryan Bates, who completed his Aboriginal Management Internship project on Strategic Planning for the Program in June 2003, and is currently Chief of Pediatrics in Saipan. Following an external review of the Family Centred Care Advisor position in Summer 2003, it was decided that the FCCA should become a member of the Quality Team, and Joanne joined the Team in September. FUNDING The Child Health Quality Team is funded by the Child Health Program, except for the salary of the Family Centred Care Advisor. We are grateful to the Children’s Hospital Foundation for funding this position for 2003-2004. The Team ended the year with a positive variance. The organizational development function of the Team is a profit centre. ACCOUNTABILITY AND REPORTING The Child Health Quality Team reports to the Child Health Program Management Team and meets with the team on a monthly basis. Balanced Scorecards are reported every six months to the WRHA Vice-President in charge of the Child Health Program, and to the senior executive whose portfolio includes Quality at each of the teaching hospitals. The Child Health Quality Council, which includes parents, acts as a steering committee for Quality in the Child Health Program; the Child Health Standards Committee reports to WRHA Standards and to the College of Physicians and Surgeons of Manitoba. Reports are also furnished to the Family Advisory Committee, CHMAC, Nursing Management, Allied Health Management, and the Department of Pediatrics, as well as to the Health Sciences Centre Quality Council. All reports are posted on the Shared Drive and are available on request from the Team. In addition, a newsletter, Quality for Kids, is published quarterly in electronic and paper form. 114
  • 115. Child Health Quality Council The Child Health Quality Council meets monthly. During 2003, representation was broadened to include additional parents and representatives from the Rehabilitation Centre for Children. In the Fall, representatives from each patient care team were added in preparation for Accreditation. Council receives regular reports on all current Quality projects. Additional issues discussed at the Council included  Review of antibiotic therapy in cellulitis  Focus on patient satisfaction  Standards audits  Evidence based care  Emergency waiting time  Short stay orthopedic working group  FISH Philosophy  Family centred care  Assessing the responsiveness of healthcare organizations to culturally diverse groups  Introduction to Accreditation Standards  Educational opportunities, including the IHI Annual Forum, FISH workshops, Balanced Scorecard workshops, and Certificate in Quality Management. The Child Health Quality Council will be the Accreditation Team for the 2005 survey by CCHSA and the Program’s self-assessment began in early 2004. STRATEGIC PLANNING, QUALITY TEAM The Quality Team is currently executing the strategic plan for Quality in Child Health that was completed in January 2002. Mission The mission of the Quality Team is to facilitate achievement of the vision by providing leadership and support for the following activities: • Quality Improvement • Utilization • Standards • Risk Management • Accreditation In addition, we were asked to provide Decision Support for the Program Management Team. Vision Our vision is that within 5 years the Child Health Program will be a learning organization. It will set benchmarks across Canada for several key quality indicators, will be given an outstanding Accreditation report by CCHSA, and will be capable of winning a National Quality Institute or similar award. Progress 115
  • 116. towards achieving the vision of the Child Health Quality Team is outlined in Appendix 1. Values • Leadership • Empowerment • Respect • Systems thinking • Quality • Integrity • Creativity • Open and effective Communication • Balance between work and personal life • Environmental responsibility STRATEGIC PLANNING, CHILD HEALTH PROGRAM As part of our Decision Support mandate, and in order to fulfill the recommendations of the 2001 CCHSA Accreditation Survey, the team worked with PMT, with clients, and with staff across the entire Program to develop Vision, Mission and Values statements for the Child Health Program. Final approval was given by the PMT in February 2003. Between Fall 2002 and Summer 2003, Dr. Ryan Bates (mentored by Dr. G. Cronin) facilitated the PMT’s work on development of a strategic plan for the Child Health Program. Input was sought from internal and external stakeholders. This plan, completed in July 2003, was developed in alignment with the WRHA Strategic Directions and the HSC Goals and is available as a separate document. The plan has five themes:  Patient safety  Clinical Resource Management  Client Relationship Management  Integration of Services  Human Resource Development The Strategic Plan is available on each patient unit and has been used in the Program’s Business Planning process. 116
  • 117. QUALITY IMPROVEMENT ABC PROJECT 3.5: Clinical Resource Management Pursuant to an external review by Deloitte and Touche in 2001, this project was designed to facilitate optimization of resource use in the Child Health Program through the use of evidence based clinical tools and case management. Internal and benchmarking data gathered during the course of the project suggest that significant improvement in the delivery of evidence-based care can be achieved through effective knowledge translation. This project commenced in April 2003 and is ongoing. The Project Co-Leads are Leslie Galloway and Dr. Gerarda Cronin. Using Pareto analysis, we determined that the top three reasons for hospital admission were Tonsillectomy, Pneumonia and Asthma. It was decided to develop a Care Map for asthma because the requisite critical success factors were in place, and a Care Map for tonsillectomy because it was by far the commonest reason for surgical admission and because guidelines had proven unsuccessful in changing clinical practice in the past. ALC days were found to be largely associated with children with complex needs, often external to the Program. It was decided to develop Standards for Case Management that could serve as a template for interdisciplinary and interdepartmental collaboration. The project has been very labour intensive but is proceeding on schedule. We have learnt many valuable lessons that can be applied in the future. Critical success factors include our excellent project manager, the support provided by WRHA PMO and Quality and Decision Support Team, and the provision of some backfill for key participants. Critical to future success will be the expertise gained during the project and the tools developed to support implementation. We anticipate that this project will be an enabler of efficiencies and of future organizational learning in the Child Health Program. Members of the Quality Team are liaising with other ABC project teams on issues of relevance to Child Health. Process Mapping and Improvement This year we have used this technique extensively to map and redesign processes, using Microsoft Visio. See HSC’s Annual Report 2002-2003 for more details. Bronchiolitis Under the leadership of Leslie Galloway and Dr. Elske Hildes-Ripstein, the Bronchiolitis working group completed a third PDSA cycle of this evidence-based guideline and is currently auditing implementation. The clinical scoring sheet has been revised and a research study is currently under way to validate the tool. The principal author is Jannell Plouffe. 117
  • 118. Emergency Wait Time Under the leadership of Lisa Lloyd Scott and the support of the Quality Team, this group is implementing process improvements that will streamline admission to the ward and reduce the waiting time for children in the ER. Orthopedic Short Stay Working Group For the second year in a row, significant reductions in wait time for closed reduction procedures were obtained by allocating specific OR time to orthopedics during the high-volume summer months. Transitional Care Home Arising from the vision of Barbara Wesley, one of our parent representatives on the Child Health Quality Council, and with the support of WRHA, work is ongoing on a business plan to examine the feasibility of establishing a “Home away from home” for Aboriginal and other Northern children and their families who must spend time in Winnipeg for investigation or treatment, and who do not need to be hospitalized. EPIC Study The Neonatal services at both Winnipeg teaching hospitals are now members of the Canadian Neonatal Network and are actively participating in a groundbreaking study of evidence-based quality improvement. The centres are participating in a benchmarking collaborative that is working to reduce the incidence of bronchopulmonary dysplasia (BPD) in preterm infants. While data from the late 1990s suggested that our performance in this area was already good, we have set the ambitious goal of reducing the incidence of BPD by 50%. In 2003, the teams across Canada completed systematic reviews of the literature, sharing them at a workshop in May. Based on strong evidence, we have made several major process improvements in the early care of preterm infants. We have identified major inconsistencies in the care of newborn infants between Canadian neonatologists, and our research will be presented in June 2004 at the AGM of the Canadian Pediatric Society. Dr. Shoo Lee, the leader of the Canadian Neonatal Network, was a visiting speaker in October. Dr. Cronin is a member of the Steering Committee of the Canadian Neonatal Network and leads the EPIC team at St. Boniface General Hospital. Dr. Molly Seshia leads the EPIC team at Health Sciences Centre. Leslie Galloway also provides support. 118
  • 119. ISO 9001:2000 in Diagnostic Imaging Dr. Martin Reed, long a Quality Champion, obtained funding in 2003 to embark upon ISO registration for the Children’s Hospital Diagnostic Imaging Department. The Exchange Group (www.exg.ca) was chosen to guide the Department in the project, which is ongoing. The Child Health Quality Team is providing support to this very valuable project. Family Centred Care Family centred care is an integral component of Quality. With the leadership of Joanne Van Dyck, the Program Management Team has approved the principles of FCC and policies and procedures are in development. Every patient care team now has a parent representative. The team worked with several patient care teams to encourage the inclusion of parents on rounds. Joanne is working on educational initiatives for the orientation programs for nursing staff and residents. Joanne represented the Child Health Program at a workshop to customize the Picker satisfaction tool for children’s hospitals, and helped organize the implementation of a pilot study in the Fall. The results are being analyzed. Other family centred care initiatives in 2003 include the development of a comment card prototype, which has been used sequentially in several patient care areas. The results have generally been excellent and there have been very helpful suggestions for staff. The comment card is available in both official languages and is also now being used at St. Boniface General Hospital. A Family Orientation Video was completed and is available for families and for new staff orientation programs and an Annual Memorial Service was held to honour deceased children. In order to facilitate transparency, a Guideline on Processing Access Requests on the Patient Care Unit (Appendix A to HSC Policy # 30.30.70 - Access to Personal Health Information) was developed and implemented. RISK MANAGEMENT In 2003, the Child Health Program completed the ISMP survey of safe medication practices. Interestingly, the Program self-assessment was more favourable than adult areas for questions related to education about medication. Numerous occurrence investigations have now been conducted using the ALARM© protocol. Arising from one such occurrence investigation, an FMEA (Failure Modes Effects Analysis) of the medication dispensing process is underway at St. Boniface General Hospital under the leadership of Yvonne Morier. Methods of improving implementation of recommendations are now being investigated. Under the leadership of Heather Falk, safety huddles have become a daily event on CH/CK3. Several safety alerts have been forwarded to Health Canada and to ISMP and have been featured on their bulletins. UTILIZATION We believe that optimizing resource utilization (like all Quality activities) requires not only leadership, but also structure and process. Because there are currently no real-time measures of utilization available, our current approach to utilization 119
  • 120. management has been to begin to develop clinical tools for evidence based practice (see above). The validity of this approach is suggested by recent data showing a decrease of 0.5 days in the ALOS since introduction of the Complicated Appendectomy Care Map. We have also been working with other ABC project leaders who are selecting a utilization tool for the Region, and have been collecting information from colleagues in other centres on methods of using the information to improve utilization. ACCREDITATION In the Fall of 2003 it was determined that the Child Health Program and the Rehabilitation Centre for Children would collaborate for the next CCHSA Accreditation survey. The Child Health Quality Council, which includes two CCHSA surveyors (Cheryl Susinski and Dr. Cronin), will be the Program’s accreditation team. Education began in November 2003 and each patient care team is reviewing the AIM standards and performing a self-assessment, which is being collated by the Quality Team. We have already identified the need to focus on outcomes and on population health. STANDARDS Dr. Patricia Birk chairs the Child Health Standards Committee, which is one of the most active Program Standards Committees at WRHA. Karla Hoare provides administrative support. Dr. Joanne Embree chairs the Child Health Mortality and Morbidity Subcommittee. Both committees are multidisciplinary. During 2003, the Child Health Mortality and Morbidity Subcommittee met 7 times and reviewed over 40 cases (all deaths at Children’s Hospital). The Child Health Standards Committee met 9 times and led a number of audits of both low- volume, high risk, and common problems. Quality initiatives, conducted with support of the Quality Team, included, but are not limited to:  Audit of practice, and development of a guideline for management of V-P shunts  Audit of practice, and improvement of the Evidence based guideline for Bronchiolitis  Audit of practice in children presenting to Emergency with febrile neutropenia  Audit of practice in immunization of chronically ill hospitalized children  Development of audit tool for pediatric resuscitation  Development of audit tool for management of UTI  Review of Asthma audit and recommendations  Development of guidelines and educational package on prevention of sickle cell crises in susceptible children presenting for surgery; collaboration with CPSM on dissemination throughout the Province  Review of system changes in cardiac catheterization lab  Review of pediatric drug dosage handbooks  Medication order writing guidelines and compliance audits  Development of Do Not Resuscitate guidelines  Review of guidelines from other programs 120
  • 121. ORGANIZATIONAL DEVELOPMENT Quality is everyone’s business. Organizational development is a major focus of the Quality Team. Activities in 2003 included, but are not limited to: • Sponsorship of three individuals to pursue the Certificate in Quality Management at the University of Manitoba (in collaboration with the Rehab Centre for Children) o Heather Falk, Manager of Patient Care, CH/CK3 o Brent Oliver, Administrative Assistant, Children’s Clinic o Colette Wilson, Quality Manager, RCC o In addition, Nora Schwetz, Nurse Clinician, Hemophilia, is independently pursuing the CQM. • FISH workshops (3) in collaboration with HSC Quality and Decision Support (KH, MJ, LG). This initiative was wildly successful and FISH workshops have become a regular Work Life feature at HSC. • Two workshops on Quality and the Balanced Scorecard (all) • Quality for Kids Newsletter, published quarterly (Editor: KH) • Grand Rounds presentation on Patient Safety (GC) • Presentation at the launch of Quality Performance at St. Boniface General Hospital (GC) • Presentation at Bug Day, Health Sciences Centre (GC) • Presentation at Allies for Health Research Conference (GC) • Participation in the first WRHA Physician Orientation (GC) • Seminar at the Residents’ Core Curriculum, University of Manitoba (GC) • Presentations to WRHA MAC (GC) • Multiple informal presentations and meetings with patient care teams and working groups (all) • Presentations at Staff Forums (GC) The resource library of the Team was heavily used throughout the year. External activities have included, but are not limited to: • Poster presentation at AGM of CAPHC, Calgary, June 2003 (LG) • Presentation to the ninth annual Child Health Research Symposium, University of Alberta, Calgary, April 2003 (GC) • Presentation to Manitoba Quality Network Implementing the Balanced Scorecard in Health Care, March 2003 (GC) • Two presentations to the AGM of the Medical Women’s International Association, Alaksa, August 2003 (GC) • Personal Development activities of team members o Certificate in Quality Management (KH) o Seminars on Project Management and MS Project (MJ, LG, GC) o Satellite Broadcast of Annual Forum of Institute of Healthcare Improvement (all) 121
  • 122. DECISION SUPPORT Benchmarking Canadian Pediatric Decision Support Network (CPDSN): The Team is currently working with colleagues in CAPHC to develop a strategic plan for governance of the Canadian Pediatric Decision Support Network. Canadian Neonatal Network (CNN): See EPIC STUDY above. Balanced Scorecard Maggie Jugenburg has developed a strategy map for the Program’s Balanced Scorecard that is based on the AIM dimensions, as well as an educational module that is understandable to almost anyone. Maggie is currently in great demand and the model is being used outside the Child Health Program. FUTURE DIRECTIONS As we begin our third year of operation, it is gratifying to note continued progress towards our long term vision (Appendix 1). The Future Directions envisioned in this section of the 2002 Annual Report have all been realized. Our Quality Plan for FY 2004-05 is in development. We envision • Implementation of the Tonsillectomy Care Map in May and of the ER Asthma Care Map in June. We will be working with the Emergency Program to roll out the Asthma Care Map to other city ERs later in the year. We will also develop an inpatient Asthma Care Map. Given the emphasis on prevention, a significant increase in the workload of the Children’s Asthma Education Centre is expected! • Tools developed in the course of ABC project 3.5, including risk logs, databases for literature search, templates for care maps, process maps, will be invaluable aids to further development of evidence based clinical tools. We need to improve the involvement of Pediatric Residents in this activity. • We believe that implementation of real-time data systems is key to savings in resource utilization, and we look forward to the incorporation of such data in performance measurements. • We will pilot the newly developed Case Management Standards with two groups of patients: Children with Complex Heart Disease and Children with Complex Medical Needs. We will also work with the WRHA PMO to design databases to support Case Management. 122
  • 123. • We are working with the HSC Executive to develop stronger mechanisms for “closing the loop” on implementation of recommendations arising from Occurrence investigations. • We hope to work with the Website Committee to develop the Children’s Hospital website as a vital resource for staff and families. • We will continue our focus on organizational development in pursuit of the Learning Organization. ACKNOWLEDGEMENTS We wish to acknowledge the leadership and support of the Program Management Team (Dr. Cheryl Greenberg, Dr. Mike Moffatt, Ann Reichert, Ron VanDenakker, Cheryl Susinski, Helga Bryant and Dr. Nathan Wiseman). We have had wonderful support from colleagues in Health Records and Quality Support Services; particular thanks are due to Gail Grimsen. This year, we want to particularly thank the WRHA Quality and Decision Support Team, who have provided outstanding support for Quality and Standards audits in Child Health. We also thank the Project Management Office at WRHA and especially our Lady with the Laptop, Project Manager Eleanor Suderman, without whose efforts our Clinical Resource Management project would be floundering. Most importantly, we thank all the staff, physicians and parents who enthusiastically contribute their ideas and enthusiasm. Quality is truly a team sport! Respectfully submitted Gerarda Cronin Director, Quality and Decision Support Child Health Program 123
  • 124. - 124 - APPENDIX 1: Progress towards Vision Within 5 years the Child Health Program Progress towards goal • will be a learning organization Several staff members have now taken training in Quality methods; some teams have mission statements and Balanced Scorecards, and all teams have indicators. Many processes have been examined and improved. • will become a benchmark across Canada Accreditation Focused Visit November 2002 for several key quality indicators suggests that [WRHA] is “moving towards becoming a benchmark for Quality Improvement”. However, the process has just begun. • will be capable of winning a National Quality Institute or similar award Intermediate Goals: Within 3 months: • a Quality Analyst will be hired and Achieved May 2002 oriented • a detailed project plan will be drawn up Achieved January 2002 • a communication strategy will be Achieved Spring 2002 developed Within 1 year: • a vision statement for Child Health will be Completed February 2003 developed with the involvement of staff and family representatives • health care providers across the system will 321 people have now attended workshops on understand basic concepts of quality Quality and the Balanced Scorecard; 81% of improvement, utilization and risk participants have been from the Child Health management Program; two members of the Quality Team are Certified Quality Managers; three additional staff have been sponsored to take CQM. Clinical teams are now speaking the language of Quality. • each Patient Care team will begin reporting Reporting system is in place and regular reporting regularly on indicators that relate to the occurs. Lack of automated reporting is a challenge. organizational vision, in each of the 4 domains of quality • a basic data support system will be in place Currently, this consists of data in multiple media. Much data reentry is necessary due to the basic nature of our information systems. • there will be regular feedback to staff This is ongoing and includes Staff Forums, Department Meetings, and Newsletters. • management will listen to staff and parents Ongoing. and will incorporate their input • a systems approach to occurrence reporting In place. Toolbox now includes systems analysis will be introduced (ALARM©) and FMEA. • areas for process improvement will have Many processes, both clinical and administrative, been identified have been redesigned. • targets for improvement will be set In place for all indicators. 124
  • 125. - 125 - Within 2 years: • quality teams in each area will use the Most patient care teams are now functioning in this PDSA model to improve processes way. • management will endeavour to remove Much remains to be done in the HR, IS and finance existing barriers to improvement areas. The strategic plan has helped. • data will be benchmarked with comparable Already in place, specifically, the Canadian institutions across Canada Neonatal Network (CNN) and the Canadian Pediatric Decision Support Network (CPDSN). • networking will be encouraged The Team now has strong networks of quality professionals in Child Health and in other fields from across Canada and abroad. • leaders will be identified and supported Physician Management Institute courses were provided for managers in 2002-2003 (initiative of the Child Health Program Management Team). Funding from WRHA allowed participation of the Aboriginal Management Intern in strategic planning. • tangible improvements in utilization will be To date, any improvements have been in terms of realized hours (waiting time) rather than in “macro” measures such as LOS. Within 3 years: • quality will be the “way we do things” Staff are beginning to incorporate a focus on quality into everyday decision making. • front-line employees will understand their Many staff have indicated that the Strategy Map of importance to the strategic plan the Balanced Scorecard helps them to “see the big picture” • there will be team learning at all levels Patient care teams are learning in teams about Accreditation and related concepts • a learning organization will be developing • staff morale will be high Completion of the WRHA Staff Satisfaction Survey has been low; a team member is participating in a working group to address this. • patient satisfaction will be high Some improvements have been made based on Initial patient satisfaction surveys. Comment cards indicate a high level of patient satisfaction in most clinical areas tested to date. • cost savings will be reinvested in evidence based programs 125