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MEDICAL STAFF.doc.doc

  1. 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. 2. Pediatric Postgraduate Medical Education……….……………..100 Quality Team………………………………………………………..106
  3. 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. 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. 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. -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. -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. -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. -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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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

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